[Epidemiological and clinical characteristics of 705 salivary glands neoplasms]. / Charakterystyka epidemiologiczno-kliniczna 705 nowotworów gruczolów slinowych.

UNLABELLED: The epidemiological data concerning the rare group of tumors derived from salivary glands recorded in the National Cancer Registry is insufficient because it records only malignant salivary glands tumors. AIMS OF THE STUDY: The epidemiological and clinical characteristics of 699 patients with salivary glands tumors (n=705). MATERIAL: The data were retrieved from ENT Department District Hospital in Kielce (01.09.1989-28.02.2001) and from Department of Otolaryngology Head and Neck Surgery Holy Cross Cancer Centre in Kielce (01.03.2001-31.12.2008). RESULTS AND CONCLUSIONS: In the analyzed group of 699 patients with 705 salivary glands tumors women predominated, consisting 54,2% of all group. The average age in group of malignant tumors was higher than in nonmalignant group. The risk of malignant neoplasms development increased with patient age. In the analyzed group of 705 salivary glands tumors the nonmalignant neoplasms dominated-78,3%. Out of all cases, 547 (77,6%) were localized in the parotid gland, 80 (11,3%) in submandibular gland and 78 (11,1%) in minor salivary glands. Nonmalignant tumors were more frequent in the parotid gland (82,8%) and submandibular gland (71,3%), whereas in minor salivary glands nonmalignant and malignant neoplasms the occurrence was nearly the same. In general-the smaller the salivary gland, the risk of development malignant tumors was higher. In group of nonmalignant salivary gland tumors two histopathological types dominated - pleomorphic adenoma and Warthin's tumor, which comprised 91,8% of the whole group. In the group of 153 malignant salivary gland tumors the most common histopathology were - adenoid cystic carcinoma, mucoepidermoid carcinoma and adenocarcinoma. In the analyzed period of 20 years' time, the incidence of salivary glands tumors increased with high siginificance, both for nonmalignant, as well malignant tumors.

[Recurrence of cancer of the paranasal sinuses after primary treatment--analysis of conditions and results of salvage treatment]. / Wznowy po leczeniu raka masywu szczekowo-sitowego--ocena uwarunkowan i wyników leczenia ratunkowego.

THE AIM OF THIS STUDY: is to demonstrate epidemiological and clinical parameters of the group of patients with sinonasal malignancies and to analyze its impact on development of recurrences after primary surgical treatment conducted in Head and Neck Surgery Department of Holly Cross Cancer Center Kielce during 7-years period 2001-2007. The retrospective analysis of the group of 42 patients with sinonasal malignancies was made, based on medical record and outpatient follow-up, considering: age, sex, primary focus, histological outcome, local and clinical stage and methods of the therapy. In the group of patients with at least 3-years period of follow-up (n=42) the dependence the rate of oncological failures such as local recurrence, nodal metastases, distant metastases or the second primary focus on clinical and epidemiological factors was analyzed. The probability of survival rate was also estimated. The studied group consists of 42 patients (27M, 15K, M:K = 1.8:1). Age ranged from 28 to 87. The most common localization was maxillary sinus--59.5%. Patients with high local (T3, T4) and clinical (III, IV) stage constitute 77.5% of the studied group. In 66.7% cases the radiation therapy had to follow the surgery. In the group of 42 patients with at least 3-years period of follow-up the oncological failure appeared in 17 cases (40.5%): local recurrence (8), nodal metastases (7), distant metastases (1) and all of them in 1 case. The treatment was performed through: local recurrence (surgery in 2 cases, CHTH--3, symptomatic treatment--3), nodal metastases (RND--3, SND--4, supplementary radiotherapy--7), distant metastases--CHTH--2 cases. Thanks to these procedures the 5-year survival rate is 23.1% and the 3-year survival rate is 29.4%. CONCLUSIONS: (1) The oncological failure after primary surgical treatment in the group of patients with sinonasal malignancies developed in 40.5% cases, mainly as local recurrence or nodal metastases. (2) Primary localization and sex have no impact on the rate of the recurrence. (3) The oncological failures significantly more often relate to young patients with high local, clinical stage and low grade of malignancies. (4) The recurrence after primary surgical treatment in the group of patients with sinonasal malignancies substantially reduces 3- and 5-year survival rate (29.4%; 23.1%) compared with the entire studied group--54.8%; 40.0%.

[Metastases to the parotid gland and parotid region]. / Przerzuty nowotworów zlosliwych do slinianki przyusznej i regionu przyusznicy.

INTRODUCTION: Among the malignant tumors found within the parotid gland, the primary tumors, as well as a metastatic tumors may be found. AIM: Epidemiological and clinical characteristic, and preliminary assessment of treatment results of metastatic tumors to the parotid gland and the parotid region. MATERIAL AND METHODS: The retrospective analysis of 60 cases with metastatic tumors to the parotid gland and parotid region, selected from the material of Dept. ORL H&N Surg. Holy Cross Cancer Center in Kielce - Poland (2001-2008), with the analysis of age, sex, localization and histopathology of primary tumor, stage according to O'Brien classification, diagnostic methods and treatment modalities, and analysis of 3 and 5 years survival. RESULTS: In the analyzed group of 60 patients (35M + 25F), in the age ranging from 31 to 92 years (mean age 73,5), the most common primary localization of metastatic tumor was skin of the head and neck (Squamous Cell Ca - 41,6%; Malignant Melanoma 25,0%). The therapy with radical intention was applied in 75,0% of patients treated, mostly combined surgery and radiotherapy. 25,0% of patients received symptomatic and palliative treatment only. In the group with 3 (17 cases) and 5 years (6 cases) of observation accordingly, 53,1% and 33,3% total survival was achieved. CONCLUSIONS: The most common primary localization of metastases to the parotid region are Squamous Cell Carcinoma and Malignant Melanoma of the head and neck skin. Metastases to the parotid gland and region are usually diagnosed in the advanced local stage of the disease. The treatment of choice in mentioned above metastases are surgery followed by radiotherapy. The unfavorable prognosis of metastatic tumors to the parotid gland and parotid region may be improved, with systematic follow up of the patients with the skin cancer.

[Epidemiology and clinical characteristics of the sinonasal malignancies]. / Nowotwory zlosliwe jam nosa i zatok przynosowych w materiale wlasnym--charakterystyka epidemiologiczna i kliniczna.

INTRODUCTION: Sinonasal malignances (SNM) usually present as a difficult diagnostic and therapeutic problem. In the paper presented, the epidemiological and clinical characteristics of SNM, diagnosed in Holy Cross Cancer Center in Kielce (Dept. of Otolaryngology, Head and Neck Surgery), from 2001 to 2007, as well as a calculated survival rates are discussed. MATERIAL AND METHODS: From the hospital data and current clinical observations of 87 patients with SNM the age, sex, localization, stage of the disease, pathology and treatment applied, was taken for analysis. In cases with at least 3 year observation, the Kaplan-Meier survival curves were calculated. Results. In the analyzed group of 87 cases, ranging from 8 to 82 years of age (average 62.3 years), there was 48 male, and 39 female patients (M:F = 1.2:1). 59.8% of all group was in the age above 60 years, with the most common age group 71-80 years (33.3%). The most common defined localization was a maxillary sinus (33.3%), but due to very advanced stage at time of diagnosis in 37.9% of cases, the precise localization within the region was not possible to define. The primary epithelial tumors were diagnosed in 52.9% (n=46), of all SNM, the non epithelial malignant tumors in 42.5% (n=37), and metastatic tumors to the nose and paranasal sinuses in 4.6% (n=4). In the group of epithelial SNM the Squamous cell carcinoma dominated (26/46-56.5%), and in the non epithelial SNM the most common group was a malignant lymphoma (10/37-27.0%). At time of diagnosis the majority of patients with epithelial SNM (80.4%) presented with advanced local stage of the disease (T3+T4a+T4b). The combined modality treatment was applied in the most of patients in the analyzed group (79.3%). The probability of 3 years disease free survival, calculated with Kaplan-Meier method was 64.0%, and 5-years survival--45.0%. CONCLUSIONS: (1) The SNM present as a very heterogeneous group of tumors. (2) The most common SNM are a Squamous cell carcinoma, and malignant lymphoma. (3) The majority of SNM are diagnosed at then advanced stage of local disease. (4) The calculated probability of 3-years survival was 64.0%, and 5-years survival 45.0%. (5) The diagnostic, as well as therapeutic approach to SNM requires a multidisciplinary cooperation.

[The epidemiology and clinical characteristics of malignant melanoma localized in nasal cavity and paranasal sinuses--analysis of 6 cases]. / Obraz epidemiologiczny i kliniczny czerniaka zlosliwego jam nosa i zatok przynosowych--analiza 6 przypadków.

INTRODUCTION: The mucosal malignant melanoma (MM), represent a rare group of tumors (0.2%--8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival. MATERIALS AND METHODS: 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL H&N Surgery, Holy Cross Cancer Center in Kielce. RESULTS: In group of mucosal MM which was taken to analysis there was 5 female and 1 male patient, with range of age from 55 to 80 (mean--69.4) with following localization: nasal septum--2 cases; lateral wall of nasal cavity--2; and paranasal sinuses--2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4-96 months) 3 patients died, all due to the fatal progression of the MM. CONCLUSIONS: (1) Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. (2) The surgery, followed by Rtg-therapy is still the treatment method of choice. (3) The prognosis of mucosal MM in the nose and paranasal sinuses is bad.

Evolution of the epidemiology and clinical characteristics of larynx and hypopharynx carcinoma in Poland from 1991 to 2001.

A retrospective analysis was performed of 12,888 cases of larynx and hypopharynx carcinoma diagnosed in 19 ENT Departments in Poland during an 11-year period from 1991 to 2001. An assessment of basic epidemiological data, including also tumor site and disease stage at the time of diagnosis, was conducted. Epidemiological trends over the 11-year period of the analysis were examined. The average M:F proportion was 8:1, with a significant increase in the number of female patients during the analyzed period. The predominant localization of carcinoma was in the glottis (47.2%), followed by the supraglottis (40.3%) and pyriform sinus (7.8%). A significant increase in pyriform sinus tumors was observed in the analyzed period. Majority of cases (57.4%) presented with local advanced stage (T3+T4) carcinoma of the larynx and hypopharynx, with the highest rate (81.0%) for the pyriform sinus carcinomas, and with the lowest rate for glottic tumors (41.8%). Regional lymph node metastases were diagnosed in 47.7% of the analyzed cases, with the highest rate (82.2%) in cases of pyriform sinus carcinomas, and the lowest (31.7%) in glottic carcinomas. In the 11-year period, a significant drop in N0 cases and a tendency toward increased rates of N2 and N3 lymph nodes metastases cases of supraglottic carcinoma were observed. Distant metastases at the time of diagnosis were registered in 2.2% of the analyzed cases, with the highest percentage in the posterior pharyngeal wall (7.6%) and pyriform sinus (7.4%) carcinomas.

[The evolution of epidemiology and clinical characteristics of laryngeal and hypopharyngeal carcinoma in Poland from 1991 to 2001]. / Ewolucja obrazu epidemiologicznego i klinicznego raka krtani i krtaniowej czesci gardla w Polsce w latach 1991-2001.

On the base of retrospective analysis of 12,888 cases of carcinoma of larynx and hypopharynx, diagnosed in 19 ENT Departments in Poland from 1991 to 2001, the assessment of basic epidemiological data, including the localization of tumor and stage of local and clinical advancement of the disease at the time of diagnosis has been conducted. In analyzed period of 11 years the trends to change of the mentioned above parameters has been examined. The significant increase of female patients in this period was observed, with average proportion M:F = 8:1. The glottis localization of carcinoma dominated (47.6%), followed by supraglottis (40.8%) and pyriform fossa (7.8%), with significant increase of pyriform fossa tumors in the analyzed period of 11 years. In the majority of cases the carcinoma of larynx and hypopharynx was diagnosed in the advanced stage (T3 + T4) of local disease, with the highest percentage in localization within the pyriform fossa (81.0%), and the lowest percentage in glottis tumors (45.6%). The regional lymph nodes metastases has been diagnosed in 46.7% of the analyzed group, with the highest percentage in tumors localized in pyriform fossa (82.9%), and the lowest percentage in tumors of glottis localization (33.1%). In the 11 years time the significant drop down of N0 cases and tendency to increase of N2 and N3 in the supraglottis localization of tumor. The distant metastases in the analyzed group at the time of diagnosis has been registered in 2.0%, with the highest percentage in posterior pharyngeal wall (7.6%) and pyriform fossa (7.4%). The authors postulate the renewal of prospective study on epidemiology, clinical characteristics and treatment results of larynx and hypopharynx carcinoma in Poland.

[Treatment failures of surgical and combined (surgery and radiotherapy) treatment in carcinoma of the larynx and hypopharynx--20 years experience of ENT Department, District Hospital in Kielce]. / Niepowodzenia leczenia chirurgicznego i skojarzonego (chirurgia + telegammaterapia) u chorych na raka krtani i krtaniowej czesci gardla leczonych na Oddziale Otolaryngologii Wojewódzkiego Szpitala Zespolonego w Kielcach w Latach 1978-1997.

The 280 cases (29.8%) of treatment failures after surgical and combined (surgery + rtg-therapy) treatment in 940 cases of carcinoma of larynx and hypopharynx has been taken into analysis. The recurrence within regional lymph nodes (11.9%), followed by local recurrences (11.5%) has dominated in this group. The distant metastases had been registered only in 2.6% of the whole treated group and the second primary tumours (included to the analysis of treatment failures) has been registered in 3.8%. The failures distribution has not been related to the sex and age of the patients, but significant dependence of failures rate to the general condition of the patient, the local and nodal advancement of the disease, and histological grade of tumour has been found. The highest rate of treatment failures was in hypopharynx localisation of primary tumour and the lowest in glottic region of the larynx. The results obtained in salvage treatment after failure of primary treatment has been unfavourable. In general, only 22.1% of patient with primary treatment failure has achieved 3-years survival, and 13.6% 5-years survival rate. In should be pointed out, that salvage treatment has been applied only to 40.8% of this group. The remaining patients received only symptomatic and palliative treatment.

[Results of surgical and combined (surgery and radiotherapy) treatment in carcinoma of the larynx and hypopharynx--20 years experience of the ENT Department, District Hospital in Kielce]. / Wyniki leczenia chirurgicznego i skojarzonego (chirurgia + telegammaterapia) chorych z rakiem krtani i czesci krtaniowej gardla leczonych na Oddziale Otolaryngologii Wojewódzkiego Szpitala Zespolonego w Kielcach w latach 1978-1997.

The epidemiological characteristic of 940 patients with carcinoma of larynx and hypopharynx, treated from 1978 to 1997 was presented, as well as the results obtained in this group with surgical and combined (surgery + rtg-therapy) treatment. There was a prevalence--75.2% of highly advanced cases (III degrees + IV degrees). The 65.6% of patients had been treated by surgery alone, and the remaining had received additional rtg-therapy after surgery. The 3-years survival rate had been achieved in 77.8%, and 5-years survival in 61.7% of the whole group. The analysis of the survival rates had proved the significant differences depending mainly to localisation of primary tumour, and clinical advancement stage of the disease.

A comparative study of cefaclor vs amoxicillin/clavulanate in pediatric pharyngotonsillitis.

BACKGROUND: Pharyngotonsillitis (PT) caused by group A beta hemolytic streptococci (GABHS) is one of the most common infections of childhood. Two antibiotic suspensions, cefaclor (CEF) and amoxicillin/clavulanate (AMC), are commonly used in Poland for the treatment of PT caused by GABHS in children. MATERIAL/METHODS: This multi-center, randomized, single-blinded study was undertaken in order to compare the efficacy and safety of CEF (20 mg/kg/d) and AMC (25 mg/kg/d) in 10 days treatment of GABHS-related PT. 100 children (mean age 6 years) were enrolled into the study. Clinical and bacteriological assessments were done on the 14-18 th, and 38-45 th days after randomization. RESULTS: No GABHS strain isolated from throat smears was resistant in vitro to both antibiotics. Both antibiotics had almost 98% effectiveness at the post therapy visit. On follow-up, significantly more relapses and recurrences were observed in the AMC-treated group than in the CEF-treated group (relapse rate 21.28% vs 15.56%, p<0.02, recurrence 10.64% vs 6.66%, p<0.002). The relapse odds ratio in the AMC group was 1.7 times greater than in the CEF group, and recurrence was 1.5 times higher. There were significantly higher rates of gastrointestinal adverse events in children treated by AMC (p<0.02). CONCLUSIONS: CEF provides a clinically and bacteriologically effective treatment for children with PT caused by GABHS, comparable to AMC but significantly safer in terms of gastrointestinal side effects. AMC shows a greater risk of relapse and recurrence than CEF.