ABSTRACT
A retrospective study of 142 patients that had previous surgery for carcinoma of the tongue or floor of mouth looking into the factors that affect significantly the evolution of our patients and in which circumstances we could benefit from new therapeutic techniques. Cause specific survival at 3 and 5 years was 63.4% and 56.9% respectively. Recurrences were found locally in 32 patients (22.5%), regional in 32 (22.5%) and metastasis in 11 (7.4%). T staging had no did impact on local recurrence, but the presence of positive margins (p = 0.0323). Regional control for N0/N1 was 85% (90/106) versus 55.5% (20/36) for N2/N3 (p = 0.001). Regional control by N staging was 84.5% (73/86) for N0, 85% (17/20) for N1, 57% (30/35) for N2 and 0% for N3 (0/1). Both, N staging and number of positive nodes had a significant impact in specific survival. Positive margins and the presence of positive nodes have the greatest impact on survival and regional control. Adjuvant postoperative radiotherapy did not increase survival, but not prospective random selection was performed. To evaluate this.
Subject(s)
Carcinoma, Squamous Cell/mortality , Mouth Floor , Tongue Neoplasms/mortality , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Humans , Middle Aged , Mouth Floor/radiation effects , Mouth Floor/surgery , Neoplasm Staging , Retrospective Studies , Survival Rate , Tongue Neoplasms/pathology , Tongue Neoplasms/therapyABSTRACT
Hemos realizado un estudio retrospectivo de 142 pacientes intervenidos de carcinoma de lengua móvil o suelo de boca buscando qué factores afectan de forma significativa la evolución de nuestros pacientes y en qué circunstancias podríamos beneficiarnos de nuevas modalidades terapéuticas. La supervivencia causa específica a 3 y 5 años fue de 63,4 por ciento y 56,9 por ciento respectivamente. Se detectó una recidiva local en 32 pacientes (22,5 por ciento), regional en 32 (22,5 por ciento) y a distancia en 11 (7,4 por ciento). No se ha encontrado influencia del T en la incidencia de recidiva local pero sí lo tiene la presencia de márgenes positivos (p=0,0323). El control regional en N0/N1 fue de un 85 por ciento (90/106) frente a un 55,5 por ciento (20/36) en los N2/N3 (p=0,001). El control regional, especificado por estadio N fue de 84,5 por ciento (73/86) en los N0, 85 por ciento (17/20) en los N1, 57 por ciento (30/35) para los N2 y 0 por ciento para los N3 (0/1). Tanto el estadio N como el número de ganglios mostró una significativa repercusión en la supervivencia específica. En nuestra experiencia los factores que mayor impacto tienen en el control del cáncer de cavidad oral y suelo de boca son la presencia de bordes quirúrgicos infiltrados y el estado del cuello. El empleo de radioterapia adyuvante no implicó un incremento en la supervivencia, si bien no se hicieron grupos aleatorios para su valoración (AU)
A retrospective study of 142 patients that had previous surgery for carcinoma of the tongue or floor of mouth looking into the factors that affect significantly the evolution of our patients and in which circumstances we could benefit from new therapeutic techniques. Cause specific survival at 3 and 5 years was 63.4% and 56.9% respectively. Recurrences were found locally in 32 patients (22.5%), regional in 32 (22.5%) and metastasis in 11 (7.4%). T staging had no did impact on local recurrence, but the presence of positive margins (p = 0.0323). Regional control for N0/N1 was 85% (90/106) versus 55.5% (20/36) for N2/N3 (p = 0.001). Regional control by N staging was 84.5% (73/86) for N0, 85% (17/20) for N1, 57% (30/35) for N2 and 0% for N3 (0/1). Both, N staging and number of positive nodes had a significant impact in specific survival. Positive margins and the presence of positive nodes have the greatest impact on survival and regional control. Adjuvant postoperative radiotherapy did not increase survival, but not prospective random selection was performed. To evaluate this (AU)
Subject(s)
Middle Aged , Adult , Aged, 80 and over , Aged , Humans , Mouth Floor , Carcinoma, Squamous Cell/mortality , Tongue Neoplasms/mortality , Survival Rate , Retrospective Studies , Neoplasm StagingABSTRACT
Between January 1980 and April 1995, 57 treatment-naive patients diagnosed as glottic epidermoid T1 carcinoma were treated in the ear, nose and throat department of Juan Canalejo Hospital of La Coruña, Spain. Seventy-nine percent (79%) (45/57) had T1a lesions and 21% (12/57) had T1b. All patients were treated by the radiotherapy department of the Regional Oncological Center with Co60 at doses ranging from 50 Gy to 70 Gy. Local control was achieved in 74.5% (43/57). Cause-specific survival was 96% at 3, 5, and 10 years. The larynx was preserved in 96.5% (55/57). The local recurrence rate was significantly lower for T1a (16.8%) than for T1b (57.8%) (p < 0.05). No significant differences were found in local control or survival with different dosing regimens.
Subject(s)
Carcinoma, Squamous Cell , Glottis/pathology , Glottis/radiation effects , Laryngeal Neoplasms , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/radiotherapy , Follow-Up Studies , Humans , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/radiotherapy , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Retrospective Studies , Survival RateABSTRACT
With improved loco-regional control of cancer of the head and neck, second primary tumors (SPT) have an increasingly negative impact on survival. The appearance of SPT depends on the location and extension of the primary and is associated with lower survival. SPT were studied in a series of 1493 previously untreated patients with carcinoma of the head and neck and a minimum follow-up of 2 years. SPT occurred in 6.3% (96/1493). SPT were associated with the following primary tumor sites: 10.8% (57/727) larynx, 4% (6/153) hypopharynx, 4% (16/404) oral cavity, and 4% (6/153) oropharynx. Forty-three percent (42.7%) of SPT were carcinomas of the head and neck, 27% bronchogenic carcinomas, and 17.7% esophageal carcinomas. Survival at 6 months, 1 year, 3 years, and 5 years of patients diagnosed as SPT was 62%, 43%, 21%, and 16%, respectively.
Subject(s)
Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/therapy , Neoplasms, Second Primary/epidemiology , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Incidence , Male , Middle Aged , Survival AnalysisABSTRACT
Con la mejora en el control loco-regional del cáncer de cabeza y cuello la aparición de los segundos tumores primarios (STP) es un factor que condiciona el incremento de la supervivencia. Presentamos los STP que aparecieron en una serie de 1.493 pacientes con carcinomas de cabeza y cuello, con un seguimiento mínimo de 3 años. El índice de STP fue del 6,3 por ciento (9611.493). La localización del tumor primario que más se asoció con la aparición de un STP fue la laringe con un 10,8 por ciento (571727), seguido de la hipofaringe 4 por ciento (61153), cavidad oral 4 por ciento (161404) y orofaringe 4 por ciento (61153). El 42,7 por ciento de los STP *correspondieron a carcinomas de cabeza y cuello, un 27 por ciento a carcinomas bronquiogénicos y un 17,7 por ciento a carcinomas de esófago. La tasa de supervivencia a los 6 meses, 1 año, 3 años y 5 años de diagnosticado el STP fue de 62 por ciento, 43 por ciento, 21 por ciento y 16 por ciento, respectivamente (AU)
With improved loco-regional control of cancer of the head and neck, second primary tumors (SPT) have an increasingly negative impact on survival. The appearance of SPT depends on the location and extension of the primary and is associated with lower survival. SPT were studied in a series of 1493 previously untreated patients with carcinoma of the head and neck and a minimum follow-up of 2 years. SPT occurred in 6.3% (96/1493). SPT were associated with the following primary tumor sites: 10.8% (57/727) larynx, 4% (6/153) hypopharynx, 4% (16/404) oral cavity, and 4% (6/153) oropharynx. Forty-three percent (42.7%) of SPT were carcinomas of the head and neck, 27% bronchogenic carcinomas, and 17.7% esophageal carcinomas. Survival at 6 months, 1 year, 3 years, and 5 years of patients diagnosed as SPT was 62%, 43%, 21%, and 16%, respectively (AU)
Subject(s)
Middle Aged , Adult , Aged, 80 and over , Aged , Male , Female , Humans , Carcinoma, Squamous Cell , Neoplasms, Second Primary/epidemiology , Head and Neck Neoplasms/therapy , Survival Analysis , Incidence , Combined Modality TherapyABSTRACT
The evolution of 39 patients undergoing cordectomy by laryngofissure between 1980 and 1995 was analyzed. All patients were male. There were 33 (84.6%) T1a and 6 T1b (15.4%). Cause specific survival at 3, 5 and 10 years was 92.3, 89.7 and 89.7%, with an overall survival of 89.7, 84.3 and 65.8% at 3, 5 and 10 years respectively. Positive margins were found in two patients. Local recurrences were present in 4 patients (10.2%), loco-regional in 1 patient (2.5%), and paratracheal in 1 patient (2.5%). Salvage therapy included total laryngectomy in four patients (10.2%) and partial surgery in one patient. Correct evaluation of tumor extension and adequate free margin analysis are the essentials to avoid local recurrence after cordectomy, a well establish option for treatment of early glottic carcinoma.
Subject(s)
Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Vocal Cords/surgery , Adult , Aged , Carcinoma, Squamous Cell/mortality , Humans , Laryngeal Neoplasms/mortality , Laryngectomy/methods , Male , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Survival RateABSTRACT
The relationship between emergency tracheotomy (ET) and stomal recurrence (SR) was evaluated in 369 patients who underwent surgery for laryngeal cancer. Emergency tracheostomy was performed in 31 patients. Age, sex, primary location, T stage, pN stage, histological grading, and time from emergency tracheotomy to definitive treatment were examined. Stomal recurrence occurred in 2.1% overall; in 1.2% of the tracheotomy-free group, and in 13% (4/31) of the emergency tracheotomy group (p < 0.0001). Recurrences were significantly more frequent in subglottic (p = 0.00007) and T3 lesions (p < 0.0001). Emergency tracheostomy often is needed in patients who have primary subglottic tumors or tumors than invade the subglottis. The relationship between ET and SR appears to be more circumstantial than causal. Aggressive local treatment is recommended in patients with subglottic lesions or subglottic tumor extension to prevent SR.
Subject(s)
Tracheostomy , Tracheotomy , Adult , Aged , Carcinoma, Squamous Cell/surgery , Emergencies , Female , Humans , Laryngeal Neoplasms/surgery , Larynx/surgery , Male , Middle Aged , Recurrence , Retrospective StudiesABSTRACT
We have studied the post-surgical results of 48 perforations of the nasal septum, regarding their etiology, location and size, which must be taken into account when deciding which closure technique to use.
Subject(s)
Nasal Septum/surgery , Adult , Female , Humans , Male , Middle Aged , Surgical Procedures, Operative/methods , Treatment OutcomeABSTRACT
The main point in managing suspected impaction of esophageal foreign bodies is to decide whether the patient needs an esophageal endoscopy. Decision-making is based on clinical history, physical examination, and radiographic studies. We review 100 cases of adults having esophagoscopy for removal of esophageal foreign bodies. Fish bones were the most frequently responsible foreign body and the cervical esophagus was the most frequent level of impaction. Decision-making based on clinical history and patient-referred symptoms revealed a positive esophagoscopy in 72% of the suspected cases. Radiographic studies gave falsely positive and falsely negative information in 30% of the cases. Rigid esophagoscopy was used successfully for foreign body removal in 99% of the cases. Average hospital stay was 3.2 days. No complications associated with the use of a rigid esophagoscope were found.
Subject(s)
Esophagus , Foreign Bodies , Adolescent , Adult , Aged , Aged, 80 and over , Esophagoscopy , Female , Food , Foreign Bodies/diagnosis , Foreign Bodies/therapy , Humans , Male , Middle AgedABSTRACT
Nutritional management of patients with head and neck cancer have received little attention in the literature, but its role in the management of patients undergoing surgical, chemotherapeutic, or radiotherapeutic treatment is gaining more importance. We present the nutritional results obtained in 69 patients who underwent oncological surgery for head and neck malignant tumours. Nutritional requirements were administered by enteral via, through a nasogastric tube. The results show no deterioration of the nutritional status during the postoperative period, with a positive nitrogenun balance from the beginning of the nutritional program. Results were measured using two anthropological measures (PCT and CMB) and two laboratory datas (Albuminum and transferrin).
