ABSTRACT
INTRODUCTION: Adenoid cystic carcinoma (ACC) of the head and neck is a rare malignancy of the salivary glands that accounts for approximately 10% of salivary gland carcinoma. Despite aggressive local therapy, local recurrence and distant metastases occur frequently. Response rates (RR) to potential curative and palliative chemotherapy are limited, so new strategies are needed. CASE REPORTS: We describe five case reports of patients with unresectable locally advanced or metastatic ACC of the head and neck who have been treated with sorafenib, a multi-tyrosine kinase inhibitor (mTKI). RESULTS: In this case series, we found that three out of five patients treated with sorafenib survived, respectively, 16, 35 and 35 months. Two patients showed a partial response (PR) and one patient had a prolonged stable disease (SD) for almost three years. Grade 3 adverse events (AE) occur under sorafenib so adequate toxicity management is essential. This retrospective case series hints towards the possibility of clinical benefit for treating ACC patients with sorafenib. Efficacy of sorafenib should be studied in a prospective-randomized clinical trial which is a challenging task due to the rarity of the disease.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Adenoid Cystic/drug therapy , Lung Neoplasms/drug therapy , Salivary Gland Neoplasms/drug therapy , Sorafenib/therapeutic use , Adult , Aged , Bone Neoplasms/drug therapy , Bone Neoplasms/secondary , Carcinoma, Adenoid Cystic/pathology , Carcinoma, Adenoid Cystic/secondary , Fatigue/chemically induced , Female , Hand-Foot Syndrome/etiology , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Lung Neoplasms/secondary , Lymph Nodes , Lymphatic Metastasis , Male , Middle Aged , Mucositis/chemically induced , Neoplasm Recurrence, Local , Pericardium , Pleural Neoplasms/drug therapy , Pleural Neoplasms/secondary , Progression-Free Survival , Retrospective Studies , Salivary Gland Neoplasms/pathologyABSTRACT
Complete fistulas of the second branchial cleft have a complicated course between the internal and external carotid arteries, crossing the hypoglossal and glossopharyngeal nerve. Therefore, surgical excision implies a tedious dissection of the fistula between the neck vessels and nerves and the multiple or large incisions have major cosmetic consequences. In cases of complete fistulas, we report a more simple method by stripping. Using a guide wire fixed to the first 2cm of the fistula, the fistulous tract is stripped completely inside out to its pharyngeal opening by pulling the oral end of the guide wire. This technique uses a limited skin incision with an excellent cosmetic result and very low morbidity; and furthermore, it shortens the procedure and hospitalisation time.
