Salvage Endoscopic Nasopharyngectomy for Locally Recurrent T1 and T2 Nasopharyngeal Carcinoma.

Assessment of salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma (rNPC). This is a retrospective study of ten rNPC who underwent salvage endoscopic nasopharyngectomy. Recurrent status for each recurrence was determined before surgery and only recurrent T1 (rT1) and recurrent T2 (rT2) were taken up for surgery after review with radiation oncology colleagues. There were seven rT2 and three rT1 patients. Two patients have undergone simultaneous radical neck dissection (RND) together with endoscopic nasopharyngectomy for associated neck nodes. Outcome of the study was done in turn of disease free, disease residual and disease recurrence. Locally disease free and overall survival rates were 40% (4/10) and 50% (5/10) respectively. Locally disease free till the last follow up was achieved in 4 patients while one patient is on palliative chemotherapy post-surgery for locally positive disease for the last three years. Of the four patients that are locally disease free, two patients received chemoradiation (CTRT) post-surgery while two patients only underwent endoscopic nasopharyngectomy for rT1. There were no any major operative complications except nasal crusting. Recurrent T1 and T2 can be manage with endoscopic nasopharyngectomy and post-surgery ctrt should be given in feasible patients. To detect early recurrent and improve the survival, regular endoscopic follow up is needed.

Analysis of Epstein Barr Virus Encoded RNA Expression in Nasopharyngeal Carcinoma in North-Eastern India: A Chromogenic in Situ Hybridization Based Study.

INTRODUCTION: Nasopharyngeal carcinoma (NPC) is a common cancer in the North-East region of India. Though the role of environmental contributors of NPC in the North-Eastern part of India is firmly established, EBV as an etiological agent in the region remains unexplored. MATERIAL AND METHODS: Fifty-one patients, who presented at the department of ENT, NEIGRIHMS and were confirmed as NPC upon histopathological examination, were included in the study. Chromogenic in-situ hybridization (CISH) was used for the evaluation of EBER (Epstein Barr Virus Encoded RNA). Presence of nuclear signals was taken as positive for EBER expression. EBER status was correlated with various clinicopathological parameters like age, sex, dietary habits, histological types of NPC, and ethnicity of the patients. RESULTS: The age range of the study group was 25 to 70 years with a mean age of 44.64 years and a male:female ratio of 3:2. Non-keratinizing undifferentiated type of NPC was the most common histological type. EBV was positive in 59% (30/51) of our cases. It showed a statistically significant correlation with the Naga community (P=0.01), with consumption of smoked food (P=0.02), and cigarette smoking (P=0.02). There was no correlation of EBV with age, sex, lymph node metastasis, stage, and histology. CONCLUSION: Our result indicates that EBV may be an additional risk factor in the pathogenesis of NPC in this region of India. So apart from lifestyle modification, a future study for a screening test for EBV viral load even in asymptomatic patients may be considered, for determination of disease susceptibility, early diagnosis, and proper management.

Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique.

PURPOSE: To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. MATERIALS AND METHODS: We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. RESULTS: We achieved technical success in all the three patients with immediate relief of dyspnea. CONCLUSION: Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort.

Analysis of Human Papilloma Virus 16/18 DNA and its Correlation with p16 Expression in Oral Cavity Squamous Cell Carcinoma in North-Eastern India: A Chromogenic in-situ Hybridization Based Study.

BACKGROUND: The incidence of head and neck squamous cell carcinoma (HNSCC) is quite high in North Eastern India. Apart from the traditional risk factors like tobacco and alcohol consumption, human papilloma virus (HPV) is now considered an established causative agent. These HPV related tumour have a clinico-pathological profile that is quite divergent from conventional non-HPV related tumours. Association of HPV in oral cancers has not been explored in north-east India. MATERIALS AND METHODS: Thirty-one patients with oral cavity squamous cell carcinoma (OSCC) on treatment from October 2010 to January 2013 were included in the study. Patients who received neo-adjuvant chemotherapy were excluded. HPV 16/18 DNA was evaluated using Chromogenic in-situ Hybridization (CISH). Presence of nuclear signals was taken as positive HPV expression. p16 was evaluated using immunohistochemistry and was considered positive if ≥ 80% of the tumour cells showed strong and diffuse nuclear/cytoplasmic immunostaining. The results were analysed using Fisher exact test and confidence interval was calculated where required. RESULTS: The study group age ranged from 30 to 80 years (median age- 54.2 years). The most common site was gum, with well differentiated squamous cell carcinoma being the most common histology. HPV 16/18 DNA was positive in 29% (95% CI: 13.03% - 44.97%) cases and had a clear tendency towards statistical significance with non-smoker cases (p=0.05), lymph node metastasis (p=0.05) and a significant correlation with p16 overexpression (p=0.04). There was no significant correlation with other clinico-pathological parameters. CONCLUSION: HPV 16/18 is associated with OSCC, commonly seen among non-smokers and may be related to nodal metastasis. So, HPV may be used as a prognostic factor in OSCC and p16 may be considered as a surrogate marker for HPV.

5th Rib Osteo-pectoralis Major Myocutaneous Flap-Still a Viable Option for Mandibular Defect Reconstruction.

Reconstruction of mandible is of paramount importance following ablative surgery for oral cancer. Though osteocutaneous micro-vascular free flap is generally accepted to be the mainstay of mandibular reconstruction, other reconstructive options are also done for mandibular reconstruction with good results. Seventeen patients of oral cavity cancer involving the alveolus who had underwent hemi-mandibulectomy were reconstructed using 5th rib osteo-pectoralis major myocutaneous flap. Procedure related pleural tear occurred in 3 patients during harvesting of the rib which were repaired intra-operatively with no post-operative complications. There were 2 failures in our series, in the rest 15 patients the flap had taken up; have good oral continence taking semi-solid diet and have satisfactory cosmetic appearance. This study shows that 5th rib osteo-pectoralis major myocutaneous flap is a quick, easy to learn, one stage reconstructive procedure with a good predictable cosmetic and functional outcomes.