ABSTRACT
Malignant fibrous histiocytoma is one of the commonest soft tissue sarcomas in adults, affecting, in order of frequency, the extremities, trunk and head and neck. We treated 131 patients with malignant fibrous histiocytoma by radical, wide, or marginal resection. Their mean age was 43 years, and there were 54 in the head and neck and 77 in the trunk and extremities. The extent of clearance of the tumour, local recurrence, and 5-year survival were studied in these two groups. In the head and neck group, local recurrences developed in 86% after marginal resection, 66% after wide resection and 27% after radical resection. The comparative figures in the trunk and extremities group were 75, 71 and 18%, respectively. The overall 5-year survival was 48% in the head and neck group and 77% in the trunk and extremities group (p=0.03). Repeat operations for recurrences of tumour offered a 'cure rate' of 23% in the head and neck group and 61% in the trunk and extremities group. Inadequate resection of the sarcoma in the head and neck was associated with a high incidence of local recurrence and a poor prognosis. Therefore, we suggest that the initial operation for sarcoma in the head and neck should be as radical as possible to reduce the chance of local recurrence and to improve the outcome.
Subject(s)
Head and Neck Neoplasms/surgery , Histiocytoma, Malignant Fibrous/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/mortality , Histiocytoma, Malignant Fibrous/diagnosis , Histiocytoma, Malignant Fibrous/mortality , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/surgery , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To discuss treatment options for tonsillar squamous cell carcinoma.</p><p><b>METHODS</b>A total of 108 patients with biopsy-proven tonsillar squamous cell carcinoma, treated between 1984 and 2000, were reviewed, including 82 men and 26 women, with ages ranging from 19 to 70 years. Treatments consisted of either radiotherapy and surgery reserved as salvage treatment (Salvage Surgery, 83 patients), or planned surgery with preoperative radiation (Planned Surgery, 25 patients). Radiotherapy was delivered primarily in a dosage of 60 - 70 Gy for Salvage Surgery patients and 40 - 50 Gy for Planned Surgery patients. Both salvage and planned surgeries were radical, with resection of the lateral oropharyngeal wall, segmental resection of the mandible and neck dissection. The pectoralis major myocutaneous flaps were used to repair surgical defects.</p><p><b>RESULTS</b>The percentages of radical surgery used in the Salvage Surgery and Planned Surgery groups were 24.1% (20/83) and 88.0% (22/25), respectively (P = 0.000). The local recurrence rates were 28.9% (24/83) and 20.0% (5/25) in the Salvage Surgery and Planned Surgery groups, respectively (P = 0.378). The neck recurrence rates were 9.6% (8/83) and 8.0% (2/25) in the Salvage Surgery and Planned Surgery groups respectively (P = 0.804). The 5-year survival rates were 59.3% and 55.3% in the Salvage Surgery and Planned Surgery groups, respectively (P = 0.7056).</p><p><b>CONCLUSIONS</b>Although the two treatments had a similar survival rate, Salvage Surgery avoided 60% commando operations compared with the Planned Surgery group, which benefits to recovery of oral functions. Primary radiotherapy is recommended as the treatment of choice for tonsillar squamous cell carcinoma. After radical radiotherapy, salvage surgery should be undertaken in the case of tumor remnants or recurrences.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Therapeutics , Combined Modality Therapy , Salvage Therapy , Tonsillar Neoplasms , Therapeutics , Treatment OutcomeABSTRACT
Purpose:To investigate the local factors that influenced cervical lymphatic metastasis and prognosis of the floor of mouth carcinoma.Methods:A retrospective study was undertaken of 65 patients with squamous cell carcinoma of floor of mouth, who were treated between 1983 and 1998. Local factors including the tumor location, the tumor size, local invasion and pathological differentiation were investigated for the correlation with cervical lymphatic metastasis and prognosis of the disease.Results:Cervical lymphatic metastasis was 46.2% (30/65) for these 65 patients, and 96.6% of the involved lymph nodes were located in level Ⅰ(submandibular region) of the neck. Of these 65 patients, cervical lymphatic metastasis was 62.2% and 40.0% for 45 anterior and 20 posterior floor of mouth carcinoma, respectively ( P = 0 .096).Cervical metastasis was 59.5% and 21.7% for tumor size greater than or less than 3 cm, respectively ( P = 0.003).Cervical metastasis was 46.8% and 44.4% for tumors invading the tongue or not, respectively.Cervical metastasis was 60 0% and 42 0% for tumors invading the gum or not, respectively.Cervical metastasis was 76.5% for the poorly differentiated and was 42.1% for the moderately and well differentiated squamous cell carcinoma ( P = 0.018). The overall 5 years survival was 46.4% for the 65 patients. The 5 years survival was 61.4% for these without cervical metastasis and 28.9% for these with cervical metastasis ( P = 0.0013).Conclusions:The local factors such as the tumor size greater than 3 cm, tumor invasion to the tongue and the gum, and the poorly differentiated squamous cell carcinoma of floor of mouth increased the incidence of cervical metastasis, and therefore adversely influenced the prognosis.
