The relation between hypoxia-inducible factor (HIF)-1alpha expression with p53 expression and outcome in surgically treated supraglottic laryngeal cancer.

OBJECTIVE: The purpose of this study was to examine whether a relationship exists between HIF-1alpha expression and the pro-apoptotic protein p53 in supraglottic laryngeal squamous cell carcinomas (SCCs), which could provide information concerning patient prognosis. METHODS: The study population was composed of 106 previously untreated men with SCC of the supraglottic larynx. All the patients underwent surgical resection of the tumor and bilateral neck dissection. Immunohistochemical analysis of HIF-1alpha and p53 protein expression was performed in relation with clinicopathological parameters and prognosis. RESULTS: HIF-1alpha nuclear expression was detected in 71% of primary carcinomas and 55% of the paired lymph node metastases. There was a significant positive correlation between HIF-1alpha and T-classification but no associations were observed with other clinicopathological variables and with prognosis. There was no correlation between the expression of HIF-1alpha and p53. HIF-1alpha overexpression in combination with p53 immunostaining was not associated with disease recurrence or survival. CONCLUSION: The data suggest that HIF-1alpha expression does not have a prognostic value in surgically treated supraglottic laryngeal SCC, and that immunohistochemical determination of p53 does not allow improving the clinical significance of HIF-1alpha.

[Functional and oncologic results of the surgical salvage in the management of recurrent nasopharyngeal carcinomas]. / Resultados oncológicos y funcionales de la cirugía de rescate en las recidivas locales de los carcinomas nasofaríngeos.

PURPOSE: To evaluate the indications and results of the surgical salvage in the treatment of recurrent nasopharyngeal carcinoma at the primary site. MATERIAL AND METHOD: Twelve patients with biopsy-proven recurrent nasopharyngeal cancer were managed with the subtemporal-preauricular and facial translocation approaches. One patient was staged as having recurrent T stage (rT1) 1 disease; 3 patients, rT2; 2 patients, rT3; and 6 patients rT4. RESULTS: With a mean follow-up of 3 years, the 3-year actuarial survival rate was 42%. Survival for recurrent T stage was as follows: rT1, 100%; rT2, 67%; rT3, 50%; rT4, 17%. Survival rates for patiens with rT3 and rT4 disease without intracranial disease are 40%. CONCLUSIONS: Facial translocation and subtemporal-preauricular approaches are versatile surgical techniques for radical resection of nasopharyngeal recurrences with an acceptable morbidity. The long term survival results are encouraging for rT1-rT3 tumors and also for rT4 without intracranial extension of the disease.

Resultados oncológicos y funcionales de la cirugía de rescate en las recidivas locales de los carcinomas nasofaríngeos / Functional and oncologic results of the surgical salvage in the management of recurrent nasopharyngeal carcinomas

Objetivo: Evaluar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos. Material y Método: Doce pacientes con recidivas locales de carcinomas nasofaríngeos se intervinieron mediante una vía subtemporal-preauricular6 o una translocación facial6. El estadio de la recidiva se clasificó en un paciente como rT1; 3 como rT2; 2, como rT3; y 6 comorT4. Resultados: La supervivencia global a los 3 años fue del42%; subdividida por estadios: rT1, 100%; rT2, 67%; rT3,50%; rT4, 17%. La supervivencia de los pacientes con enfermedad localmente avanzada sin progresión intracraneal fue del 40%. Conclusiones: La translocación facial y el abordaje subtemporal-preauricular posibilitan una resección completa de las recidivas nasofaríngeas, incurriendo en una morbilidad aceptable. La supervivencia a largo plazo de los pacientes con recidivas clasificadas como rT1-rT3 resulta esperanzadora, incluso la de los clasificados como rT4 sin afectación intracraneal (AU)

Purpose: To evaluate the indications and results of the surgical salvage in the treatment of recurrent nasopharyngeal carcinoma at the primary site. Material and Method: Twelve patients with biopsy-proven recurrent nasopharyngeal cancer were managed with the subtemporal-preauricular 6 and facial translocation 6 approaches. One patient was staged as having recurrent T stage (rT1) 1 disease; 3 patients, rT2; 2 patients, rT3; and 6 patients rT4. Results: With a mean follow-up of 3 years, the 3-year actuarial survival rate was 42%. Survival for recurrent T stage was as follows: rT1, 100%; rT2, 67%; rT3, 50%; rT4,17%. Survival rates for patiens with rT3 and rT4 disease without intracranial disease are 40%. Conclusions: Facial translocation and subtemporal-preauricular approaches are versatile surgical techniques for radical resection of nasopharyngeal recurrences with an acceptable morbidity. The long term survival results are encouraging for rT1-rT3tumors and also for rT4 without intracranial extension of the disease (AU)

[Functional outcomes of transoral laser surgery of supraglottic carcinoma]. / Resultados funcionales de la laringectomía supraglótica láser.

OBJECTIVES: To analyse the functional outcome of patients with supraglottic carcinomas treated by transoral laser surgery. METHODS: The clinical records of 55 patients who underwent transoral laser surgery were reviewed. Swallowing capacity, surgical complications, requirements for tracheotomies, percentage of decannulations, laryngeal paralysis, stenosis, aspiration associated pneumonia, time to remove the nasogastric tube and postsurgical stay in hospital were the studied variables. RESULTS: 52% of the patients had a normal or within functional limits swallowing performance. 18% suffered aspiration pneumonia. 13% developed a laryngeal stenosis. 7% suffered of laryngeal palsy. 18 tracheostomies were performed, of them 10 could be reverted. The mean time to remove the nasogastric tube was 9 days. The mean hospital stay was 23 days. CONCLUSIONS: The main functional advantages of transoral laser surgery for supraglottic carcinoma, when compared with the conventional approach, are a lower incidence of temporary tracheotomies, a faster removal of the nasogastric feeding tube, and a lower incidence of pharyngocutaneous fistulas (0%).

[Orthotopic murine model of head and neck squamous cell carcinoma]. / Modelo murino ortotópico de carcinoma epidermoide de cabeza y cuello.

PURPOSE: To develop a reliable animal model able to reproduce the behavior of head and neck squamous cell carcinomas (HNSCC). This model should facilitate our understanding of the molecular mechanisms of tumorigenicity and progression of these tumors, as well as the evaluation of novel therapies. MATERIAL AND METHODS: 20 nude mice nu/nu were injected intraorally and submucosally with a cell line derived from a human squamous cell carcinoma of the glottis. RESULTS: 90% of the mice developed locally agressive squamous cell carcinomas, invading the surrounding muscle fibers and into loose connective tissue structures. All the tumors showed perineural growth. Four (22%) of the 18 mice showed bone destruction, and 22% vascular invasion. Tumor cells invaded lymphatic vessels in all the specimens, and 100% of the mice developed regional lymph node metastases. None of the animals developed haematogenous metastases. CONCLUSIONS: We present a metastasing model of HNSCC that resembles its human counterpart in many aspects.

Resultados funcionales de la laringectomía supraglótica láser / Functional outcomes of transoral laser surgery of supraglottic carcinoma

Objetivo: Analizar los resultados funcionales de aquellos pacientes tratados mediante una laringectomía supraglótica láser. Material y métodos: Cincuenta y cinco pacientes se incluyeron en el estudio. Se analizó la capacidad deglutoria, complicaciones quirúrgicas, necesidad de traqueotomía, porcentaje de decanulaciones, parálisis laríngea, estenosis, neumonía por aspiración, tiempo hasta la retirada de la sonda nasogástrica y estancia postquirúrgica. Resultados: El 52% de los pacientes presentó degluciones normales o dentro de los límites funcionales, un 18% sufrió neumonías por aspiración, el 13% estenosis, y el 7% parálisis laríngea. Se realizaron 18 traqueotomías (10 pacientes se pudieron decanular). El tiempo medio de permanencia con sonda nasogástrica fue de 9 días y el de estancia hospitalaria de 23 días. Conclusiones: Un menor número de traqueotomías temporales, un tiempo de permanencia con la sonda nasogástrica más corto y una menor incidencia de fístulas faringo-cutáneas (0%) son las principales ventajas de la laringectomía supraglótica láser cuando se comparan sus resultados con los de la técnica convencional

Objectives: To analyse the functional outcome of patients with supraglottic carcinomas treated by transoral laser surgery. Methods: The clinical records of 55 patients who underwent transoral laser surgery were reviewed. Swallowing capacity, surgical complications, requirements for tracheotomies, percentage of decannulations, laryngeal paralysis, stenosis, aspiration associated pneumonia, time to remove the nasogastric tube and postsurgical stay in hospital were the studied variables. Results: 52% of the patients had a normal or within functional limits swallowing performance. 18% suffered aspiration pneumonia. 13% developed a laryngeal stenosis. 7% suffered of laryngeal palsy. 18 tracheostomies were performed, of them 10 could be reverted. The mean time to remove the nasogastric tube was 9 days. The mean hospital stay was 23 days. Conclusions: The main functional advantages of transoral laser surgery for supraglottic carcinoma, when compared with the conventional approach, are a lower incidence of temporary tracheotomies, a faster removal of the nasogastric feeding tube, and a lower incidence of pharyngocutaneous fistulas (0%)

[Surgical repair of an anastomotic stenosis in pharyngeal reconstructions using antebrachial free flaps]. / Reparación quirúrgica de una estenosis anastomótica en reconstrucciones faríngeas con colgajos libres antebraquiales.

To obtain suitable deglutoria function and less morbidity after hypopharyngeal surgery, antebrachial free flaps is a very useful option. A posible complication is oral feeding impossibility due to neopharyngeal stenosis. Tumor recurrence must be excluded. We described two cases of hypopharyngeal stenosis after antebrachial free flap reconstruction, proposing surgical reanastomosis with fibrous ring resection and salivary by-pass stent.

Modelo murino ortotópico de carcinoma epidermoide de cabeza y cuello / Orthotopic murine model of head and neck squamous cell carcinoma

Objetivo: Desarrollar un modelo animal capaz de reproducir de un modo fidedigno el comportamiento de los carcinomas epidermoides de cabeza y cuello (CECC). Este modelo es necesario para la comprensión de los mecanismos moleculares responsables de la génesis y progresión de estos tumores, así como para la evaluación de nuevos tratamientos. Material y métodos: Veinte ratones atímicos nu/nu se sometieron a la inoculación intraoral y submucosa de una línea celular derivada de un carcinoma epidermoide glótico. Resultados: Dieciocho ratones (90%) desarrollaron carcinomas epidermoides localmente agresivos, con invasión del músculo y del tejido conjuntivo adyacentes. En todos ellos se encontró crecimiento perineural. Cuatro tumores (22%) presentaron destrucción ósea y el 22% invasión vascular. Todos los animales que desarrollaron tumores presentaron invasión de los vasos linfáticos y metástasis ganglionares regionales. Ningún animal desarrolló metástasis hematógenas. Conclusiones: Presentamos un modelo murino de CECC con capacidad para generar metástasis y que reproduce en múltiples aspectos el comportamiento de estos tumores en humanos

Purpose: To develop a reliable animal model able to reproduce the behavior of head and neck squamous cell carcinomas (HNSCC). This model should facilitate our understanding of the molecular mechanisms of tumorigenicity and progression of these tumors, as well as the evaluation of novel therapies. Material and methods: 20 nude mice nu/nu were injected intraorally and submucosally with a cell line derived from a human squamous cell carcinoma of the glottis. Results: 90% of the mice developed locally agressive squamous cell carcinomas, invading the surrounding muscle fibers and into loose connective tissue structures. All the tumors showed perineural growth. Four (22%) of the 18 mice showed bone destruction, and 22% vascular invasion. Tumor cells invaded lymphatic vessels in all the specimens, and 100% of the mice developed regional lymph node metastases. None of the animals developed haematogenous metastases. Conclusions: We present a metastasing model of HNSCC that resembles its human counterpart in many aspects

Reparación quirúrgica de una estenosis anastomótica en reconstrucciones faríngeas con colgajos libres antebraquiales / Surgical repair of an anastomotic stenosis in pharyngeal reconstruction wing antebrachial free flaps

El colgajo libre antebraquial es una alternativa cada vez más utilizada en la reconstrucción hipofaríngea. Una posible complicación es la estenosis de la neofaringe, lo que produce una alteración o imposibilidad en la alimentación oral. Siempre debe descartarse la posibilidad de una recidiva tumoral. Presentamos dos casos de estenosis hipofaríngea tras una reconstrucción con un colgajo libre antebraquial, proponiendo realizar una reanastomosis extirpando el tejido fibroso y colocando un by-pass salival

To obtain suitable deglutoria function and less morbidity after hipopharyngeal surgery, antebrachial free flaps is a very useful option. A posible complication is oral fedding impossibility due to neopharyngeal stenosis. Tumor recurrence must be excluded. We described two cases of hipopharyngeal stenosis after antebrachial free flap reconstruccion, proposing surgical reanastomosis with fibrous ring resection and salivary by-pass stent

[Anterior craniofacial resection: oncologic outcome and complications in a series of 111 cases]. / Resección craneofacial anterior: resultados oncológicos y complicaciones en una serie de 111 casos.

INTRODUCTION: Anterior craniofacial resection is a standardized procedure for the treatment of ethmoid and frontal orbital tumors with intracranial invasion. METHODS: A retrospective review of 111 patients with sinonasal tumors involving the anterior skull base who underwent combined craniofacial surgery. RESULTS: The most frequent pathological entity was adenocarcinoma (54 cases) and other epithelial tumors (29 cases). Five year actuarial survival according to the Kaplan-Meier method was 40%. Survival was affected by the histology of the tumor, brain involvement, and deep soft tissue involvement of the orbit. The UICC staging system did not show statistical prognostic significance. Complications occurred in 39 (35.1%) patients, resulting in 4 (3.6%) postoperative deaths. Major complications included cerebrospinal fluid leak in 18 patients, meningitis in 10, infection in 9, stroke in 4, and pneumocephalus in 4. The extent of the craniofacial resection was the most important factor associated with major complications. CONCLUSIONS: Despite the advanced stage of most of the patients, anterior craniofacial resection succeeded in terms of an acceptable survival rate. Nevertheless, significant complications were observed although in most patients were not life-threatening and had no negative impact on the quality of life.

Resección craneofacial anterior: resultados oncológicos y complicaciones en una serie de 111 casos / Anterior craniofacial resection: oncologic outcome and complications in a series of 111 cases

Introducción: La resección craneofacial anterior es un procedimiento bien establecido para el tratamiento de los tumores etmoidales y fronto-orbitarios con invasión intracraneal. Material y métodos: Se realizó una revisión retrospectiva de 111 pacientes con tumores nasosinusales con invasión intracraneal sometidos a una resección craneofacial. Resultados: El tipo histológico más común fue el adenocarcinoma (54 casos) y otros tumores epiteliales (29 casos). La supervivencia actuarial a los 5 años fue del 40 por ciento. La supervivencia se afectó negativamente por la histología del tumor, invasión del cerebro y la invasión profunda de la órbita. El estadio tumoral no influyó de forma significativa en las expectativas de supervivencia. Se presentaron complicaciones en 39 (35,1 por ciento) pacientes, resultando en 4 (3,6 por ciento) muertes postoperatorias. Las complicaciones más importantes incluyeron fístula cerebroespinal en 18 pacientes, meningitis en 10, infección en 9, infarto cerebral en 4 y neumocéfalo en 4. La extensión de la resección fue el factor más importante asociado a complicaciones. Conclusiones: A pesar del estadio avanzado de la mayor parte de los pacientes, la resección craneofacial anterior consiguió unas aceptables tasas de supervivencia. Sin embargo, se observaron complicaciones importantes, aunque en la mayoría de los casos no pusieron en peligro la vida de los pacientes ni tuvieron un impacto negativo en la calidad de vida (AU)

INTRODUCTION: Anterior craniofacial resection is a standardized procedure for the treatment of ethmoid and frontal orbital tumors with intracranial invasion. METHODS: A retrospective review of 111 patients with sinonasal tumors involving the anterior skull base who underwent combined craniofacial surgery. RESULTS: The most frequent pathological entity was adenocarcinoma (54 cases) and other epithelial tumors (29 cases). Five year actuarial survival according to the Kaplan-Meier method was 40%. Survival was affected by the histology of the tumor, brain involvement, and deep soft tissue involvement of the orbit. The UICC staging system did not show statistical prognostic significance. Complications occurred in 39 (35.1%) patients, resulting in 4 (3.6%) postoperative deaths. Major complications included cerebrospinal fluid leak in 18 patients, meningitis in 10, infection in 9, stroke in 4, and pneumocephalus in 4. The extent of the craniofacial resection was the most important factor associated with major complications. CONCLUSIONS: Despite the advanced stage of most of the patients, anterior craniofacial resection succeeded in terms of an acceptable survival rate. Nevertheless, significant complications were observed although in most patients were not life-threatening and had no negative impact on the quality of life (AU)