Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma.

BACKGROUND: The increasing incidence of radiation-induced osteosarcoma of the maxilla and mandible (RIOSM) has become a significant problem that can limit long-term survival. The purpose of this study was to analyze the association of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma (NPC). METHODS: We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat-sen University Cancer Center during the period August 1964 to August 2012. Of these patients, 47 who developed RISOM and met inclusion criteria were included in this study. Two of these 47 patients refused treatment and were then excluded. RESULTS: For all patients treated for NPC at Sun Yat-sen University Cancer Center during the study period, the total incidence of RIOSM after radiotherapy was 0.084% (47/53,760). Two patients (4.4%) had metastases at the diagnosis of RIOSM. Thirty-nine of the 45 (86.7%) patients underwent surgery for RIOSM; most patients (24/39; 61.5%) who underwent resection had gross clear margins, with 15 patients (38.5%) having either a gross or microscopic positive margin. All patients died. The 1-, 2-, and 3-year overall survival (OS) rates for the entire cohort of 45 patients were 53.3%, 35.6% and 13.5%, respectively. The independent prognostic factors associated with high OS rate were tumor size and treatment type. CONCLUSIONS: RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely intervention. Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.

Sentinel lymph node biopsy versus elective neck dissection in patients with cT1-2N0 oral tongue squamous cell carcinoma.

OBJECTIVE: This study aimed to compare the value of sentinel lymph node biopsy (SLNB) with that of elective neck dissection (END) for the prediction of cervical lymph node metastasis in patients with clinically diagnosed T1-2N0 (cT1-2N0) oral tongue squamous cell carcinoma (OTSCC), and it aimed to examine the prognostic value of individualized treatment in sentinel lymph node (SLN)-negative patients. STUDY DESIGN: The study entailed a retrospective review of 82 patients with cT1-2N0 OTSCC. Thirty patients underwent SLNB, and 52 patients underwent END. RESULTS: There was a significant difference between the SLNB and END groups in the incidence of occult cervical lymph node metastasis in initial specimens (30% vs 11.5%; P = .037). However, there were no significant differences between the groups for 10-year overall and cervical recurrence-free survival rates and 10-year overall survival rate. CONCLUSIONS: SLNB is superior to END for the prediction of cervical lymph node metastasis in patients with cT1-2N0 OTSCC. Neck dissection may be reduced for SLN-negative patients, owing to the comparable prognosis of SLNB.

Reconstruction of through-and-through cheek defects with folded free anterolateral thigh flaps.

PURPOSE: The purpose of this study was to assess the clinical application and therapeutic efficacy of through-and-through cheek defects reconstructed with folded anterolateral thigh (ALT) flaps. PATIENTS AND METHODS: From January 2009 to May 2012, 10 patients with through-and-through cheek defects resulting from resection of cheek tumor underwent reconstruction with the folded ALT flap at Sun Yat-Sen University Cancer Center, Guangzhou, China. Surgical procedures in harvesting the ALT flap, as well as the surgical anatomy, are described, and the success rate is reported. RESULTS: All ALT flaps were fasciocutaneous flaps. One patient with a thrombotic event required operative exploration in the perioperative period. All 10 flaps were based on a single perforator for reconstruction of defects. In all 10 cases, the donor site was closed primarily for the ALT flap, leaving only a linear scar that was inconspicuous with normal clothing, and the thigh had no functional deficit. CONCLUSIONS: The free ALT flap has good pliability and can be folded for the reconstruction of both the inner and outer lining of through-and-through cheek defects. This flap presents good functional results at the recipient site with the additional advantages of minimal donor-site morbidity, a very acceptable esthetic result, and a high level of patient satisfaction.

Influence of pathologic complete response to neoadjuvant chemotherapy on long-term survival of patients with advanced head and neck squamous cell carcinoma.

OBJECTIVE: The aim of this study was to analyze whether pathologic complete response (PCR) to neoadjuvant chemotherapy (NAC) affected long-term survival in advanced head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS: All patients with advanced HNSCC were previously untreated and underwent NAC followed by surgery. The 5-year overall survival, disease-free survival, local control rate, and reasons for treatment failure were analyzed. RESULTS: A total of 101 cases were included, and the response rate to NAC was 67.3%, including 17 patients (16.8%) who achieved PCR. The 5-year overall survival (OS) of the PCR group (82.4%; histologically complete response group [HCG]) was higher than that of the pathologic incomplete responder group (45.4%; histologically incomplete response group [HICG]) (P = 0.045). No statistically significant difference was noted between the two groups in terms of local recurrence and nodal recurrence, but the local control rate in HCG (88.2%) was higher than that in HICG (62.7%) (P = 0.034). CONCLUSIONS: Achieving PCR could improve locoregional control and long-term survival in patients with advanced HNSCC.

[Use of a linear stapler device in total laryngectomy].

OBJECTIVE: To evaluate the value of using a linear stapler device for the closure of the pharynx during total laryngectomy. METHODS: Sixteen total laryngectomies were performed between August 2010 and December 2011, during the operation, the TA 60 linear stapler was used for pharyngeal closure. Among these patients, two patients had the history of pre-operative radiotherapy, four patients recurred after radiotherapy, ten patients were treated for the first time. 100 ml methylene blue was injected into the newly closed laryngopharyngeal cavity through the nasopharyngeal breather pipe for checking up whether it was watertight or not. RESULTS: Among the sixteen patients, methylene blue leakage from the mucosal joint of the gular cavity closed by the stapler were not found in fifteen patients, it was only found in one patient. The transudatory places were sutured with absorbable Vicryl sutures. This patient healed well without pharyngocutaneous fistula. Negative surgical margins were achieved in all patients. No patient needed to be transferred to open surgery. Using a linear stapler device in total laryngectomy, 45 minutes could be saved as compaired to manual suture. One patient developed a light pharyngocutaneous fistula. The incidence of pharyngocutaneous fistula was 6.25% (1/16). CONCLUSIONS: This stapled closed technique for pharyngoplasty is efficient, eliminates the risk of wound contamination, saves operation time and decreases the incidence of pharyngocutaneous fistula. This technique can be recommended as alternative for repairing the pharynx in patients undergoing total laryngectomy.

Planned neck dissection before combined chemoradiation in organ preservation protocol for N2-N3 of supraglottic or hypopharyngeal carcinoma.

OBJECTIVE: To investigate the clinical therapeutic outcomes and neck node control of a pretreatment neck dissection in the chemoradiation protocol of organ preservation for N2-N3 of supraglottic and hypopharyngeal carcinoma. METHODS: Forty-six patients (group A) with untreated N2 or N3 squamous cell carcinoma of the supraglottis or hypopharynx underwent pretreatment neck dissection in a chemoradiation protocol, while 39 patients (group B) did not undergo pretreatment neck dissection in a chemoradiation protocol. Salvage surgeries were used for local or cervical node residual tumor or recurrence after chemoradiotherapy. RESULTS: In group A, the mean time between neck dissection and chemoradiation was 21 days (range 15-29). Only 3 patients (6.5%) experienced wound complications. A 'boost' of radiation of 12 Gy was delivered after 33 neck dissections (64.8%) in patients with extracapsular spread. The Kaplan-Meier 5-year overall survival rate was 42.5%. The 5-year overall survival rate and disease-specific survival rate in group A was 42.5 and 46.4%. The rate of neck node control in group A was better than that in group B (86.3 vs. 65.9%, p = 0.02). CONCLUSIONS: Pretreatment neck dissection in a chemoradiation protocol for supraglottic or hypopharyngeal carcinoma showed low complication rates, no delay for radiation, optimal radiation doses, and a high nodal disease control.

Submandibular salivary gland transfer for the prevention of radiation-induced xerostomia in patients with nasopharyngeal carcinoma: 5-Year outcomes.

BACKGROUND: Our aim in this study was to investigate the value of the submandibular salivary gland transfer procedure in prevention of radiation-induced xerostomia in patients with nasopharyngeal carcinoma (NPC). METHODS: In all, there were 70 patients, consisting of a test group (36 patients) and a control group (34 patients) in a nonrandomized fashion. In the test group, the submandibular salivary gland was transferred to submental space before radiotherapy (XRT) and shielded. Salivary gland functions were evaluated by the amount of saliva and a quality of life questionnaire before and after XRT and 3 and 60 months after XRT. RESULTS: At 5 years, the trapping and excretion functions of salivary gland were significantly better in the test group (p = .000 and p = .000). The mean weight of saliva after XRT was heavier (1.65 g vs 0.73 g, p = .000), and the incidence of xerostomia was lower in the test group, with no difference in 5-year survival and neck nodal recurrence between the 2 groups. CONCLUSIONS: Salivary gland transfer procedure prevents XRT-induced xerostomia and improves quality of life of patients with NPC.

Laryngeal framework reconstruction using titanium mesh in glottic cancer after frontolateral vertical partial laryngectomy.

OBJECTIVES: To investigate the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy. STUDY DESIGN: Prospective study. METHODS: Defect of laryngeal framework, caused by frontolateral vertical partial laryngectomy in nine patients with T2 or T3 squamous cell carcinoma of glottic, were reconstructed with titanium mesh from 2007 to 2009. Computed tomography (CT) and fiberscopic examinations were performed at two weeks and three months postoperatively. RESULTS: No aspiration and laryngeal stenosis was observed in the nine patients. CT scanning showed that titanium mesh was fastened well without displacement and deformity and that there was no laryngeal stenosis. Fiberscopic inspection showed that the larynx lumen was maintained well without stricture, shrinkage, and necrosis. No titanium mesh was exposed to the larynx lumen. CONCLUSIONS: Titanium mesh was a good alternative for reconstruction of the laryngeal framework. It provided adequate structural support to maintain airway patency.

[Application of SELDI-TOF-MS in establishing a model for predicting radiotherapy response of hypopharyngeal cancers].

OBJECTIVE: To detect the serum proteomic fingerprints in patients with hypopharyngeal squamous cell carcinoma (HPSCC) by surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS) protein chip array technique. METHODS: The serum samples were obtained from 58 HPSCC patients for protein expression analysis using SELDI-TOF Protein Chip technique and cation-exchange (CM10) protein array. All the spectra were compared and the qualified mass peaks with mass-to-charge ratios (m/z) between 1 and 70 kD were autotimatically detected. The tree analysis pattern was generated using Biomarker Patterns Software. RESULTS: The protein profiles of HPSCC serum were analyzed according to the clinical and pathological features of the patients and their treatment response. No significant difference was noted in the serum proteins between HPSCC patients with different statuses of cervical lympha node metastasis (P>0.05), and the difference between well differentiated and poorly differentiated HPSCC was only minor. No significant difference was found in the serum proteins between chemotherapy-sensitive patients and the insensitive patients (P>0.05), but 5 proteins were identified to be overexpressed in the sensitive patients (P < / = 0.05). Radiotherapy-sensitive HPSCC patients were segregated from the insensitive group with a sensitivity of 86.67% and specificity of 100%. CONCLUSION: The serum protein at the m/z value of 6115.74 is overexpressed in radiotherapy-sensitive HPSCC patients. Serum protein profiling allows the prediction of radiotherapy response in HPSCC patients, and the identified proteins may serve as candidate biomarkers for predicting the radiotherapy sensitivity of HPSCC.

[Survival and prognostic analysis of 221 patients with advanced laryngeal squamous cell carcinoma treated by surgery].

BACKGROUND AND OBJECTIVE: The prognosis of advanced squamous cell carcinoma of the larynx is poor Prognostic factors of this disease vary in different studies. This study was to analyze the most important factors affecting the prognosis of the patients with advanced (stage III and IV) squamous cell carcinoma (SCC) of the larynx. METHODS: Clinical data of 221 patients with advanced SCC of the larynx were retrospectively analyzed. Survival analysis was performed by the life table method; comparison among/between groups was performed using the log-rank test; and multivariate analysis was carried out using the Cox proportional hazard model. RESULTS: The two- and five-year overall survival rates of the 221 patients were 76.9% and 51.1%; while the 2-and 5-year disease free survival rates were 60.0% and 43.0%. Patients in stage III had better prognosis than those in stage IV. Post-operative radiotherapy improved the survival rate in patients with positive surgical margins. There was no difference in the survival rate between patients underwent partial laryngectomy and those underwent total laryngectomy. Multivariate analyses indicated that age, anatomic type, post-surgical stage, surgical margin and radiotherapy influenced the disease free survival (p<0.05), whereas, age, post-surgical stage and surgical margin affected the overall survival (p<0.05). CONCLUSIONS: The prognosis of patients with advanced SCC of the larynx receiving surgery is poor. Age, post-surgical stage and surgical margin are the most important factors affecting the overall survival.

[Detection and clinical significance of lymphatic microvessel density in supraglottic laryngeal carcinoma].

BACKGROUND AND OBJECTIVE: Lymphatic microvessels may play an important role in tumor metastasis. This study detected lymphatic microvessel density (LVD) in supraglottic laryngeal carcinoma to find its correlation to clinicopathologic characteristics, and to assess its prognostic significance in supraglottic laryngeal carcinoma. METHODS: Clinical data of 51 supraglottic laryngeal carcinoma patients who underwent primary lesion resection were reviewed. Immunohistochemical staining was performed with podoplanin monoclonal antibody to recognize lymphatic microvessels. The correlations of LVD to clinicopathologic characteristics and prognosis were analyzed. RESULTS: The mean LVD was 3.25+/-2.37, with a median of 3, in the 51 specimens of supraglottic laryngeal carcinoma. LVD was significantly higher in the patients with cervical lymph node metastasis than in those without (P=0.009). The overall 5-year survival rate was 54.9%. The 5-year survival rate was significantly lower in the patients with poorly differentiated tumor, stages T3-4 disease, lymph node metastasis, stages III-IV disease and high LVD than in their counterparts. Cox regression analysis revealed that LVD, T classification, and differentiation were independent factors for survival. CONCLUSION: LVD is related to lymph nodes status, and is an independent factor for prognosis of supraglottic laryngeal carcinoma.

[Re-operation extent of primary lesion of thyroid cancer].

BACKGROUND AND OBJECTIVE: Many thyroid cancer patients need to receive second operation because of tumor residue. This study was to explore the resection extent of primary lesion in re-operation of thyroid carcinoma. METHODS: Clinical data of 55 thyroid carcinoma patients who received re-operation were reviewed. The patients, including seven men and 48 women, were aged of 18-56. All patients received ipsilateral residual lobectomy, isthmectomy, ipsilateral anterior cervical muscle and level VI lymph node dissection. The optimal extent for radical re-resection of primary lesion was explored. RESULTS: Tumor residue was proved by pathology in 29 patients, with a rate of 52.73%. Of the 29 patients, eight had primary lesion residue, seven had level VI lymph node residue, and 14 had both. Tumor cells were connected with muscle in four patients. Forty-five metastatic lymph nodes were found. CONCLUSION: Ipsilateral residual lobectomy, isthmectomy, ipsilateral anterior cervical muscle and level VI lymph node dissection is the basic re-resection extent of primary lesion for thyroid carcinoma patients.

[Use of en bloc principle in re-operation of thyroid carcinoma].

OBJECTIVE: The study is to explore the extent, main-point and use of en bloc principle in re-operation of thyroid carcinoma. METHODS: Clinical data of 75 patients received re-operation from 2002 to 2006 because of nonstandard operation were reviewed, including 10 men, 65 women, age ranging from 21-56. Ipsilateral completing lobectomy, isthmectomy, ipsilateral anterior cervical muscle, and level VI dissection were done in all the patients by en bloc principle. RESULTS: Residual tumor was found in 39 cases. There were, 10 in primary site, 8 in VI level, and 21 in both. Therefore tumor residual rate was 52.0%. The total metastatic lymph nodes in VI level were 63. Among the eight patients with recurrent laryngeal nerves paralyses which were hurt in the first operation, 4 were found been cut completely, 4 were ligated. The ligated locations were all near the place which the nerve enter the larynx. The ligated nerves were released, and the patients voice was improved greatly. CONCLUSIONS: Ipsilateral completing lobectomy, isthmectomy, ipsilateral anterior cervical muscle and VI level dissection is adequate for thyroid carcinoma patients who received nonstandard operation. The principle of en bloc resection can be used in the reoperation of thyroid carcinoma.

[Clinicopathological features and prognosis of nasopharyngeal adenocarcinoma].

OBJECTIVE: To investigate the clinical manifestations, EB virus serology and treatment outcome of nasopharyngeal adenocarcinoma (NPAC). METHODS: Clinical records of NPAC patients between 1964 and 2000 in Cancer Center of Sun Yat-sen University were retrospectively reviewed. RESULTS: Among 48 patients with NPAC, 45.2% (7 cases of N1, 8 cases of N2 and 4 cases of N3) of them presented with cervical metastasis. Pathologically, common type and salivary gland type of NPAC accounted for 58.3% (28 cases) and 41.7% (20 cases) respectively. The positive rate of the EB virus antibody VCA-IgA was 56.7% in the whole group and only 23.7% in the salivary gland type of NPAC. The overall local control rate and the 5-year disease free survival rate by Kaplan-Meier method were 87.0% (40/46) and 65.2% respectively. Baseline data analysis showed that age, gender, N stage and M stage were not the significant factors, never the less the T stage was not balanced between the two groups (surgery plus radiotherapy vs radiotherapy alone, chi2 = 4.801, P = 0.045). The patients treated by surgery plus radiotherapy had significantly higher 5-year disease free survival rate than by radiotherapy alone (88.9% vs 74.7%, Log Rank test: chi2 = 4.272, P = 0.039). Cox's multivariate analysis showed treatment modality and N stage were the significant factors influencing survival (RR were 15.276 and 6.529, P < 0.05). CONCLUSIONS: NPAC is a distinct entity in all types of nasopharyngeal carcinoma. EB virus serology has limited value in its diagnosis. Surgery plus radiotherapy could be another choice of treatment for early lesions of NPAC.

[Survival analysis of 229 patients with advanced squamous cell carcinoma of the oral tongue].

BACKGROUND & OBJECTIVE: Patients with advanced squamous cell carcinoma (SCC) of the oral tongue have poor prognosis. This study was to analyze the most important factors affecting the prognosis of the patients with advanced (stage III and IV) SCC of the oral tongue. METHODS: Complete clinical and follow-up data of 229 patients with pathologically confirmed advanced SCC of the oral tongue, initially treated at Sun Yat-sen University Cancer Center were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier analysis, comparison among groups was analyzed using log-rank test, and multivariate analysis was conducted using the Cox proportional hazard model. Independent risk factors were deducted. The risk function was established and evaluated. RESULTS: The mean survival time of the 229 patients was 80.33 months, with the two-and five-year survival rates of 50.66% and 37.99%, respectively. Univariate analysis showed that age, tongue base invasion, cervical lymphatic metastasis, stage, surgical treatment, recurrence and residual tumor were risk factors affecting prognosis (P<0.05). Multivariate analysis indicated that tumour invasion across the midline, cervical lymphatic metastases, surgical treatment, recurrence and residual tumor were independent factors for prognosis. Moreover, the risk function effectively predicted the prognosis. CONCLUSIONS: The prognosis of patients with advanced SCC of the oral tongue is poor. Tumour invasion across the midline, cervical lymphatic metastasis, surgical treatment, recurrence, and residual tumor are independent factors affecting the prognosis.

[Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis].

OBJECTIVE: To determine the value of concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma from the mainland of China. METHODS: Data were extracted from randomized trials comparing chemotherapy plus radiotherapy with radiotherapy alone in locally advanced nasopharyngeal carcinoma. Actuarial rates of survival and distant metastases were calculated. The followed electronic databases were searched the Chinese Biomedicine database, Pubmed, Medline, Embase and Cochrane library; Data were extracted by tow reviewers and Review manager 4.1 software was applied for statistical analysis. RESULTS: Eighteen trials with 1993 patients were include according to the including criterion. The 3-year overall survival rate of the chemoradiotherapy group and the radiotherapy group were 68.47% and 56.38% respectively, and the 5-year overall survival rate of the two groups above were 51.91% and 41.09% respectively, while the distant metastases rate of the chemoradiotherapy group and the radiotherapy group were 26.19% and 38.71% respectively. The result demonstrated that chemoradiotherapy increased overall survival by 12% at 3 years, and 11% at 5 years after treatment. After chemoradiotherapy, the rate of distant metastasis was reduce by 12%. CONCLUSIONS: In patients with locoregionally advanced nasopharyngeal carcinoma, chemoradiotherapy significantly improves overall survival at 3 years, and 5 years compared with radiotherapy alone.

[Clinical features and diagnosis of head and neck rhabdomyosarcoma: a report of 24 cases].

BACKGROUND & OBJECTIVE: Rhabdomyosarcoma is a rare malignant tumor. This study aimed to summarize the clinical features of head and neck rhabdomyosarcoma. METHODS: Clinical data of 24 patients with head and neck rhabdomyosarcom, treated in Cancer Center of Sun Yat-sun University from 1989 to 2005, were analyzed. RESULTS: Of the 24 patients, 15 (62.5%) were younger than 25; 12 (50.0%) with tumors originated from nasosinus. All patients presented with localized mass: 14 (58.3%) had large masses (>/=4 cm) at their first visit; 13 (54.2%) had clinical lymph node metastasis (cN+), and 12 (50.0%) of them were confirmed by pathology (pN+); 2 (8.3%) had distant metastasis. Of the 24 patients, 3 were at stage I, 3 at stage II, 16 at stage III and 2 at stage IV. Bone erosion was indicated by CT in 16 (66.7%) patients. Fourteen patients received immunohistochemical examination: 10 (71.4%) were HHF-35-positive, 6 (42.8%) were Desmin-positive, 9 (64.3%) were Myolobin-positive, 9 (64.3%) were Vemintin-positive. Thirteen patients were treated with multi-disciplinary treatment. The 3-year survival rate was 42.8% for those having chemotherapy as part of the treatment. CONCLUSIONS: Head and neck rhabdomyosarcoma is usually seen in adolescents and mostly developed in the nasosinus. It usually manifests as a localized mass and has a high frequency of lymphatic metastasis and distant metastasis. Chemotherapy-dominant multidisciplinary treatment is recommended for this disease.

[Treatment of advanced maxillary sinus squamous carcinoma: an analysis of 92 cases].

BACKGROUND & OBJECTIVE: There is no satisfactory treatment for advanced maxillary sinus squamous carcinoma. The treatment strategy is controversial. This study aimed to explore a rational treatment for advanced maxillary sinus squamous carcinoma. METHODS: Clinical data of 92 patients with stage T3-T4 maxillary sinus squamous cell carcinoma, treated in Cancer Center of Sun Yat-sen University from Jan.1978 to Dec.2001, were reviewed. Of the 92 patients, 21 received radiotherapy alone, 8 received surgery alone, 63 received multimodality therapy (51 received surgery combined with radiotherapy, and 12 received chemoradiotherapy). RESULTS: The 3-and 5-year survival rates were significantly lower in radiotherapy group and surgery group than in multimodality therapy group (19.0% and 25.0% vs. 46.0%, P<0.05; 9.5% and 12.5% vs. 33.3%, P<0.05). In multimodality therapy group, the 3-and 5-year survival rates were 33.3% and 23.8% for the patients who received radiotherapy followed by surgery, 52.9% and 47.1% for the patients who received surgery follow by radiotherapy, 53.8% and 30.8% for the patients who received pre-and postoperative radiotherapy, and 50.0% and 33.3% for the patients who received chemoradiotherapy. There were no significant differences in survival rate between these four subgroups (P>0.05). CONCLUSIONS: The efficacy of multimodality therapy is better than that of single therapy strategy for advanced maxillary sinus squamous carcinoma. The best treatment pattern for advanced maxillary sinus squamous carcinoma needs further research.

[Clinical study of 36 cases with adenoid cystic carcinoma of the maxillary sinus].

OBJECTIVE: To study the clinical characters, management and the prognosis of patients with adenoid cystic carcinoma of the maxillary sinus. METHODS: The clinical data were analyzed retrospectively for 36 patients with adenoid cystic carcinoma of the maxillary sinus to evaluate the treatment results of different modalities. The contribution of every factors influencing on survival were also analyzed. Survival analysis was performed by life table method, comparison among/between groups was performed using log-rank test, and multivariate analysis was carried out using Cox proportional hazard model. RESULTS: The 5-year survival rate was 58.33% in all patients, while they were only 75.0% and 42.9% in stage III and stage IV lesions respectively. The 5-year survival rate of 66.7% was obtained in patients who received surgery combined with radiotherapy,71.4% and 12.5% respectively in those treated by surgery and by radiotherapy alone. Multivariate analysis indicated that stage, treatment modality, and the tumour residues in the primary treatment were the predict factors for the prognosis. CONCLUSIONS: Advanced adenoid cystic carcinoma should be treated by combined surgery and radiotherapy. Stage, treatment approach and short-term therapeutic response are the most important factors affecting the prognosis of the patients with adenoid cystic carcinoma of the maxillary sinus.

[Surgical treatment and long-term efficacy on stage T1-3N0 differentiated thyroid carcinoma].

BACKGROUND & OBJECTIVE: Whether to choose total thyroidectomy or lobectomy for the primary lesion of differentiated thyroid carcinoma (DTC) limited in one lobe is controversial. This study was to investigate the patterns of surgical treatment for stage T1-3N0 DTC, and observe the long-term efficacy. METHODS: Clinical data of 153 DTC patients, first treated at Cancer Center of Sun Yat-sen University from 1985 to 2000, were reviewed. The postoperative pathologic stage of these patients was T1-3N0. The multiple centricity of primary lesions, patterns of surgical treatment, and prognosis were analyzed. RESULTS: Of the 153 DTC patients, 21 had cancer multifocality: 12 had multiple cancer foci in one lobe and 9 had cancer multifocality in both lobes. Ninety-two patients received unilateral lobectomy plus isthmectomy; 44 patients received ipsilateral subtotal lobectomy plus isthmectomy. Among the 9 patients who had cancer multifocality in both lobes, 7 received unilateral lobectomy plus isthmectomy with contralateral subtotal lobectmoy and 2 received bilateral subtotal lobectomy. Eight patients, whose primary lesions were at isthmus, underwent isthmectomy plus bilateral partial lobectomy. Regional lymph node metastasis appeared in 7 patients after initial operation: 6 in the neck and 1 in the upper mediastinum. Five patients had distant metastasis after operation. The 5-, 10-and 15-year survival rates of these 153 patients were 98.7%, 96.1% and 86.9%, respectively. Age, pathologic type, tumor size and distant metastasis affected the survival (P<0.05). The patients whose age was less than 45 years, tumor size was less than 4 cm, pathologic type was papillary or mixed carcinoma, and who had no distant metastasis had relatively good prognosis. Age and distant metastasis were independent prognostic factors. CONCLUSIONS: It is feasible to perform unilateral lobectomy or subtotal lobectomy plus isthmectomy for patients with stage T1-3N0 DTC. The long-term outcomes of stage T1-3N0 DTC patients are relatively well. Age, pathologic type, tumor size and distant metastasis affect prognosis.