ABSTRACT
OBJECTIVES: Intractable aspiration pneumonia in patients with post-radiotherapeutic nasopharyngeal carcinoma (PNC) is a formidable complication, but has not attracted enough attention in clinical practice. Modified laryngotracheal separation (MLTS) was applied for these patients in our hospital, the surgical effects of which were assessed. PATIENTS AND METHODS: Retrospective analysis of 9 PNC cases complicated by intractable aspiration pneumonia in our hospital was carried out. All cases were diagnosed as lower cranial nerve palsy. Their aspiration pneumonia was not effectively prevented or controlled after a series of previous treatments, including active anti-infectives, neurotrophy, acupuncture, nutrition support, nasogastric feeding and tracheotomy. Ultimately all of them received modified laryngotracheal separation (MLTS) surgery. Efficacy of the operation was assessed. RESULTS: In all patients, aspiration pneumonia was effectively controlled after the operation, body weights increased more than 6kg six months later, and nutrition status, swallowing function and quality of life were all improved. CONCLUSIONS: Intractable post-radiotherapeutic aspiration pneumonia in patients with nasopharyngeal carcinoma was possibly caused by lower cranial nerve palsy, which might be related to radiation fields overlapped. Modified laryngotracheal separation is effective in eliminating intractable aspiration in PNC. Suitable patients should be carefully selected although the procedure is potentially reversible.
Subject(s)
Larynx/surgery , Otorhinolaryngologic Surgical Procedures/methods , Pneumonia, Aspiration/surgery , Radiotherapy/adverse effects , Trachea/surgery , Aged , Carcinoma/radiotherapy , Cranial Nerve Diseases/complications , Cranial Nerve Diseases/etiology , Deglutition Disorders/etiology , Deglutition Disorders/surgery , Humans , Male , Middle Aged , Nasopharyngeal Neoplasms/radiotherapy , Neck Muscles/transplantation , Nutritional Status , Pneumonia, Aspiration/etiology , Quality of Life , Respiratory Mucosa/surgery , Retrospective StudiesABSTRACT
BACKGROUND: Some investigations have suggested that induction chemotherapy with a combination of taxanes, cisplatin and fluorouracil (TPF) is effective in locally advanced head and neck cancer. However, other trials have indicated that TPF does not improve outcomes. The objective of this study was to compare the efficacy and safety of TPF with a cisplatin and fluorouracil (PF) regimen through a meta-analysis. METHODS: Four randomized clinical trials were identified, which included 1,552 patients with locally advanced head and neck cancer who underwent induction chemotherapy with either a TPF or PF protocol. The outcomes included the 3-year survival rate, overall response rate and different types of adverse events. Risk ratios (RRs) and their 95% confidence intervals (CIs) were pooled using RevMan 5.1 software. RESULTS: The 3-year survival rate (51.0% vs. 42.4%; p = 0.002), 3-year progression-free survival rate (35.9% vs. 27.2%; p = 0.007) and overall response to chemotherapy (72.9% vs. 62.1%; p<0.00001) of the patients in the TPF group was statistically superior to those in the PF group. In terms of toxicities, the incidence of febrile neutropenia (7.0% vs. 3.2%; p = 0.001) and alopecia (10.8% vs. 1.1%; p<0.00001) was higher in the TPF group. CONCLUSION: The TPF induction chemotherapy regimen leads to a significant survival advantage with acceptable toxicity rates for patients with locally advanced head and neck cancer compared with the PF regimen.
