Survival Analysis in Patients with Laryngeal Cancer: A Retrospective Cohort Study.

INTRODUCTION: The worldwide incidence rate of laryngeal cancer is declining. However, the 5-year survival for these patients has decreased in recent years from 66% to 63%. This may be due to changes in the treatment of the disease. The present study aimed to evaluate the survival rate of patients with LC according to the stage of the disease and the treatment applied. For this purpose, surgical versus organ preservation protocols (OPP) based on chemoradiotherapy were evaluated. METHODS: A retrospective cohort study was conducted in a tertiary hospital. The study included adult patients with a clinical diagnosis of primary LC. Patients with LC and systemic metastases and those with synchronous tumors at diagnosis were excluded. Univariate and multivariate analyses were performed to determine the association between exposure to LC treatment and the time to event (death). Overall survival (OS), cause-specific survival (CSS), and disease-free survival (DFS) were calculated. RESULTS: Patients with advanced tumors (stages III and IV) had almost three times the risk of LC death than those in the initial tumor stages (I and II) [HR CCS = 2.89 (95%CI 1.30-6.39)]; [HR OS = 2.01 (95%CI 1.35-2.98)]. Patients who underwent surgical treatment had a higher chance of survival than those who were treated according to OPP [HR = 0.62; 95%CI (0.38-1.02)] in CSS, 0.74 [95%CI (0.50-1.90)] in OS, and 0.61 [95%CI (0.40-0.91)] in DFS. DISCUSSION: OPP changed the management of patients with advanced stages of LC, establishing CRT as an alternative to surgery. Our data did not reveal clinically relevant differences in OS between patients treated with OPP and those who underwent surgery; however, we reported differences in the DFS rate after five years of follow-up in favor of the surgery-treated group of patients. CONCLUSION: Surgical treatment improves CSS and DFS at five years in patients with initial LC with respect to radiation therapy alone. Furthermore, surgical treatment associated with complementary radiation therapy offers better CSS and DFS in patients with advanced LC.

Hamartoma condroide laríngeo: un caso excepcional / Chondroid hamartoma of the larynx: an exceptional case

No disponible

Clasificación pronóstica de los tumores malignos de glándula parótida / Forecast clasification for malignant tumors of the parotid

Objetivo. La clasificación histológica de la Organización Mundial de la Salud (OMS) junto con mejores estudios de imagen aportan información relevante para el manejo de los cánceres de parótida. Sin embargo, su pronóstico depende de otros factores diferentes de la histología y la extensión tumoral. El presente trabajo valora la utilidad de la clasificación pronóstica de Vander Poorten creada en 1999 de los cánceres parotídeos que incluye todos estos factores en los pacientes de nuestro medio. Métodos. Seguimiento de 19 pacientes con carcinomas de parótida distintos de tumores linfoideos o metástasis intraparotídeas entre los años 1998 y 2012. Se obtuvo su índice pronóstico a partir de las fórmulas propuestas por Vander Poorten, que incluyen los factores de edad, tamaño tumoral, afectación ganglionar, invasión cutánea, afectación del nervio facial, crecimiento perineural y márgenes de resección, antes de la cirugía (PS1) y después (PS2). Se relacionó la supervivencia global a los 5 años de cada paciente a partir de su inclusión en alguno de los 4 grupos de riesgo definidos. Resultados. La estratificación de riesgo de Vander Poorten según los resultados PS2 se distribuyó en grupos de riesgo (GR) 1 (3 pacientes, 15,7%), 2 (5 pacientes, 26,3%), 3 (un paciente, 5,8%) y 4 (10 pacientes, 52,2%). Los 6 pacientes que fallecieron durante el seguimiento pertenecían al GR4. De los 4 supervivientes del GR4 solo uno ha superado el seguimiento de 5 años. La comparación de las medias que relacionan las variables de resultado pretratamiento (PS1) y postratamiento (PS2) mostró una mejor supervivencia global en los pacientes con valores de PS1 < 4,5 y PS2 < 4,9, mientras que la mortalidad fue mayor a partir de los índices de PS1 > 6,5 y PS2 > 7,7. Conclusiones. El índice de Vander Poorten es aplicable en áreas hospitalarias con escaso número de carcinomas de parótida. Permite establecer un pronóstico de supervivencia más certero sobre pacientes individuales (AU)

Objective. The histological classification of the World Health Organization (WHO), along with improved imaging studies, provide relevant information for the management of parotid carcinomas. However, the prognosis depends on factors other than histology and tumor extension. This article evaluates the usefulness of a prognostic classification of parotid cancers, including these factors in patients in a hospital area. Methods. A follow-up was conducted on 19 patients with parotid carcinomas, excluding lymphoid tumors or intra-parotid metastases, between 1998 and 2012. The prognostic index was obtained from the formulas proposed by Vander Poorten, with factors including age, tumor size, lymph node involvement, skin invasion, facial nerve involvement, perineural growth and margins of resection, before surgery (PS1) and after (PS2). Overall survival was related to 5 years for each patient based on their inclusion in any of the 4 risk groups defined. Results. Risk stratification based on the results Vander Poorten PS2 was distributed into Risk Groups (GR) 1 (3 patients, 15.7%), 2 (5 patients, 26.3%), 3 (1 patient, 5.8%) and 4 (10 patients, 52.2%). The 6 patients who died during follow-up belonged to GR4. Only one of the 4 patients belonging to GR4 has exceeded the 5-year survival up to the current time. The comparison of the values that relate the pretreatment (PS1) and after treatment (PS2) results showed overall survival in patients with PS1 < 4.5 and PS2 < 4.9, whereas mortality was greater with indices of PS1 > 6.5 and PS2 > 7.7. Conclusions. Vander Poorten index can be applied in hospital areas with small numbers of parotid carcinomas. It enables a more accurate prognosis for individual patients (AU)

Mejora de la planificación de las cirugías endoscópicas nasosinusales a partir de imágenes en 3 dimensiones con Osirix (R) y estereolitografía / Improved planning of endoscopic sinonasal surgery from 3-dimensional images with Osirix(R) and stereolithography

Introducción y objetivos: La elevada variabilidad anatómica de los senos paranasales requiere disponer del mejor conocimiento de su conformación tridimensional para afrontar la cirugía con mayor seguridad y eficiencia. El objetivo del estudio fue validar la utilidad de Osirix® y la estereolitografía en la mejora de la planificación de las cirugías endoscópicas nasosinusales. Métodos: Se utilizó Osirix® como visor y gestor de imágenes DICOM en 3 dimensiones (3D) en la planificación de 114 cirugías endoscópicas nasosinusales por poliposis (86) y rinosinusitis crónica (28) junto con prototipos rápidos estereolitográficos en 7 mucoceles frontoetmoidales. Resultados: Se identificaron mayor número de estructuras anatómicas, más rápidamente y con una correlación clínico-radiológica estadísticamente significativa (p < 0,01) a favor de Osirix y estereolitografía, que con placas en 2D de la TAC. Con una participación de los residentes superior al 75% de la cirugía, se redujo el tiempo quirúrgico en 38 ± 12,3 min en sinusitis crónicas y en 42 ± 27,9 en poliposis nasosinusales, alcanzando los residentes de cuarto año una competencia quirúrgica del 100% en los hitos quirúrgicos cruciales con 16 cirugías (IC: 12-19). Conclusiones: La utilización sistemática de Osirix® para visualización y tratamiento autónomo de imágenes nasosinusales en 3D desde archivos DICOM permite a los cirujanos efectuar las cirugías endoscópicas nasosinusales con mayor confianza y seguridad y en menos tiempo que utilizando imágenes en 2D. Los residentes también alcanzan la competencia quirúrgica más rápidamente, con mayor seguridad y con menos complicaciones. La mejora en la planificación se incrementa cuando el equipo quirúrgico dispone de prototipos rápidos estereolitográficos en los casos de mayor complejidad (AU)

Introduction and objectives: The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning. Methods: Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles. Results: Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P<.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38 ± 12.3 min in CRS and 42 ± 27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19). Conclusions: The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases (AU)

Alteraciones emocionales y psicopatológicas en pacientes oncológicos laringectomizados / Emotional and psychopathological disorders in laryngectomized oncological patients

Introducción y objetivos: Se desconoce si afrontar un cáncer de laringe y someterse a laringectomía total son experiencias tan impactantes emocionalmente para el paciente como los cánceres de otras localizaciones. El objetivo del estudio fue identificar la incidencia de sufrimiento emocional y psicológico en pacientes laringectomizados y describir sus matices sintomatológicos. Métodos: Estudio transversal descriptivo de la respuesta emocional y psicopatológica de 100 pacientes oncológicos sometidos a laringectomía total, evaluados inmediatamente tras la cirugía (N = 35), al iniciar la rehabilitación comunicativa (N = 23) y a los 5 años del diagnóstico (N = 42) frente a un grupo control de 55 sujetos sanos. La batería de evaluación psicopatológica para ansiedad, depresión, trastorno por estrés postraumático, intrusión, evitación y excitación constó de una entrevista específica, la Escala Hospitalaria de Ansiedad y Depresión (HADS) y el Inventario de Estrés Postraumático (IES-R). Resultados: Los pacientes laringectomizados presentaron baja incidencia de alteraciones emocionales y psicológicas como ansiedad (6,9%), depresión (5,9%) y/o trastorno por estrés postraumático (28,4%) con intensidad suficiente para constituir un diagnóstico psicopatológico. Un 57,4% de los pacientes presentaba malestar emocional difuso de carácter postraumático (el 52,6% de ellos), más prevalente e intenso en el grupo en rehabilitación. Conclusiones. Los síntomas de ansiedad, depresión y trastorno por estrés postraumático tras una laringectomía total no son de suficiente intensidad y cualidad para constituir entidades clínicas diagnosticables, sino cuadros de trastorno adaptativo. Son menores que los de pacientes afectados por cáncer de otras localizaciones y se presentan fundamentalmente en la fase de rehabilitación, donde deberían centrarse las actuaciones psicológicas preventivas y de apoyo (AU)

Introduction and objectives: It is unknown if patients who suffer from laryngeal cancer and undergo total laryngectomy experience as much emotional shock and psychological distress as patients with cancers in other locations do. The aim of the study was to identify the incidence of emotional and psychological disorders in laryngectomized patients and describe their symptomatological nuances. Methods: A descriptive cross-sectional study of emotional and psychopathological response of 100 cancer patients undergoing total laryngectomy was performed. The patients were evaluated immediately after surgery (n = 35), when initiating communicative rehabilitation (n = 23) and 5 years after diagnosis (n = 42), versus a control of 55 healthy subjects. Psychopathological assessment battery for anxiety, depression, intrusion, avoidance, arousal and posttraumatic stress disorder consisted of a specific interview, the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R). Results: Laryngectomized patients had low incidence of emotional and psychological disorders such as anxiety (6.9%), depression (5.9%) and/or posttraumatic stress disorder (28.4%), but with sufficient intensity to constitute a psychopathological diagnosis. A significant level of distress was found in 57.4% of patients, with clear diffuse traumatic nature in 52.6% of them, which was more prevalent and intense in the rehabilitation group. Conclusions: Symptoms of anxiety, depression and posttraumatic stress disorder during different stages after total laryngectomy are not of sufficient intensity and quality to be diagnosable clinical entities; they can be considered an adaptive disorder. The symptoms are less than those of patients with cancer in other locations and appear mostly in the rehabilitation stage, where preventive performances and psychological support should be focused (AU)

Improved planning of endoscopic sinonasal surgery from 3-dimensional images with Osirix® and stereolithography.

INTRODUCTION AND OBJECTIVES: The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning. METHODS: Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles. RESULTS: Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P<.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38±12.3min in CRS and 42±27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19). CONCLUSIONS: The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases.

Emotional and psychopathological disorders in laryngectomized oncological patients.

INTRODUCTION AND OBJECTIVES: It is unknown if patients who suffer from laryngeal cancer and undergo total laryngectomy experience as much emotional shock and psychological distress as patients with cancers in other locations do. The aim of the study was to identify the incidence of emotional and psychological disorders in laryngectomized patients and describe their symptomatological nuances. METHODS: A descriptive cross-sectional study of emotional and psychopathological response of 100 cancer patients undergoing total laryngectomy was performed. The patients were evaluated immediately after surgery (n=35), when initiating communicative rehabilitation (n=23) and 5 years after diagnosis (n=42), versus a control of 55 healthy subjects. Psychopathological assessment battery for anxiety, depression, intrusion, avoidance, arousal and posttraumatic stress disorder consisted of a specific interview, the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R). RESULTS: Laryngectomized patients had low incidence of emotional and psychological disorders such as anxiety (6.9%), depression (5.9%) and/or posttraumatic stress disorder (28.4%), but with sufficient intensity to constitute a psychopathological diagnosis. A significant level of distress was found in 57.4% of patients, with clear diffuse traumatic nature in 52.6% of them, which was more prevalent and intense in the rehabilitation group. CONCLUSIONS: Symptoms of anxiety, depression and posttraumatic stress disorder during different stages after total laryngectomy are not of sufficient intensity and quality to be diagnosable clinical entities; they can be considered an adaptive disorder. The symptoms are less than those of patients with cancer in other locations and appear mostly in the rehabilitation stage, where preventive performances and psychological support should be focused.

El melanoma nasofaríngeo: una entidad infrecuente / Nasopharyngeal melanoma: A rare disorder

No disponible

Osteosarcoma radioinducido. Un excepcional caso infantil en senos paranasales / Radioinduced osteosarcoma. An exceptional infantile case in paranasal sinuses

Introducción: los sarcomas de senos paranasales representan menos del 1 por ciento de los tumores sinusales8. Los osteosarcomas se localizan básicamente en el seno maxilar. Material y métodos: Presentamos aquí el excepcional caso de un osteosarcoma radioinducido de senos paranasales, presentándose además a la temprana edad de 15 años. Resultados: Hacemos un análisis del tratamiento seguido con un rabdomioscroma de ala nasal; de sus metástasis óseas; así como de un osteosarcoma radioinducido de senos paranasales; permaneciendo la paciente viva y con buena calidad de vida 14 años después del primario. Discusión: Analizamos la toma de decisiones; la influencia de la paciente en alguna de ellas; peculiaridades del tratamiento; errores (AU)