ABSTRACT
Objectives: Induction chemotherapy (ICT) followed by definitive treatment is an accepted non-surgical approach for locoregionally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, ICT remains a challenge for cisplatin-unfit patients. We evaluated paclitaxel and cetuximab (P-C) as ICT in a cohort of LA-HNSCC patients unfit for cisplatin. Materials and Methods: This is a retrospective analysis of patients with newly diagnosed LA-HNSCC considered unfit for cisplatin-based chemotherapy (age >70 and/or ECOG≥2 and/or comorbidities) treated with weekly P-C followed by definitive radiotherapy and cetuximab (RT-C) between 2010 and 2017. Toxicity and objective response rate (ORR) to ICT and RT-C were collected. Median overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox regression analysis was performed to determine baseline predictors of OS and PFS. Results: A total of 57 patients were included. Grade 3-4 toxicity rate to ICT was 54.4%, and there was a death deemed treatment-related (G5). P-C achieved an ORR of 66.7%, including 12.3% of complete responses (CR). After P-C, 45 patients (78.9%) continued with concomitant RT-C. Twenty-six patients (45.6%) achieved a CR after definitive treatment. With a median follow-up of 21.7 months (range 1.2-94.6), median OS and PFS were 22.9 months and 10.7 months, respectively. The estimated 2-year OS and PFS rates were 48.9% and 33.7%, respectively. Disease stage had a negative impact on OS (stage IVb vs. III-IVa: HR = 2.55 [1.08-6.04], p = 0.03), with a trend towards worse PFS (HR = 1.92 [0.91-4.05], p = 0.09). Primary tumor in the larynx was associated with improved PFS but not OS (HR = 0.45 [0.22-0.92], p = 0.03, and HR = 0.69 [0.32-1.54], p = 0.37, respectively). Conclusion: P-C was a well-tolerated and active ICT regimen in this cohort of LA-HNSCC patients unfit for cisplatin-based chemotherapy. P-C might represent a valid ICT option for unfit patients and may aid patient selection for definitive treatment.
ABSTRACT
La estenosis congénita del orificio piriforme es una anomalía descrita recientemente en la literatura, provocada por un crecimiento excesivo de la apófisis ascendente del hueso maxilar, pudiendo ocasionar problemas respiratorios y alimenticios desde el periodo neonatal. Presentamos el caso de una recién nacida diagnosticada de esta patología asociada a un megaincisivo central único. La actitud elegida fue la observación, junto con la aplicación de medidas conservadoras. Un año después del diagnóstico, la paciente tiene un adecuado desarrollo ponderoestatural (AU)
Congenital nasal pyriform aperture stenosis has recently been described in the literature. It is caused by an upward overgrowth of the maxillary bone apophysis and may cause breathing and feeding problems from the neonatal period on. We present the case of a newborn girl diagnosed with this pathology associated with a solitary maxillary central incisor. Observation with conservative measures was the attitude chosen. One year after diagnosis the patient shows adequate height and weight development (AU)
Subject(s)
Humans , Female , Infant, Newborn , Constriction, Pathologic/diagnosis , Nasal Bone/abnormalities , Incisor/abnormalities , Nasal Cavity/abnormalities , Jaw Abnormalities/surgery , Natal Teeth/abnormalitiesABSTRACT
Congenital nasal pyriform aperture stenosis has recently been described in the literature. It is caused by an upward overgrowth of the maxillary bone apophysis and may cause breathing and feeding problems from the neonatal period on. We present the case of a newborn girl diagnosed with this pathology associated with a solitary maxillary central incisor. Observation with conservative measures was the attitude chosen. One year after diagnosis the patient shows adequate height and weight development.
