Prognostic indicators for malignant tumours of the parotid gland.

The best treatment of malignant parotid tumours still remains to be defined, and a better knowledge about the tumour features that predict the treatment result is needed. The histological classification of parotid tumours may present difficulties on account of their great morphological diversity. In a series of 152 patients with a malignant tumour of the parotid gland, the prognostic factors and treatment results were investigated over a 25-year period. Treatment consisted of surgery, radiation therapy or a combination (49%, 13% and 38% respectively). Crude 5-year survival was 50% with significant differences related to stage (stage I, 65%; stage II, 50%; stage III, 21%; and stage IV, 9%). With respect to histopathology, the adenoid cystic carcinomas and the acinic cell carcinomas had the best prognosis (76% and 67% 5-year crude survival and 53% and 67% 10-year crude survival respectively). There was a significant difference in crude survival between well/intermediate and poorly differentiated tumours (P = 0.007). In a Cox hazard regression analysis including 136 patients and using death from cancer as the end-point, the following parameters were independent prognostic predictors: T-classification (P = 0.002), M-classification (P < 0.0001), N-classification (N+versus N0) (P = 0.005), local invasion (P = 0.003) and histological differentiation of the tumour (P = 0.03). The TNM system is a good predictor of treatment outcome for malignant parotid tumours. The use of a combination of clinical and histological factors will assist the design of treatment strategies for parotid gland tumours.

Comparison of two T-classification systems for sino-nasal carcinoma.

It is often difficult to determine the actual site of origin of tumours originating in the sino-nasal region, and a uniform classification system that covers all tumours in this area is warranted. A retrospective series of 165 consecutive patients with sino-nasal carcinoma, treated and followed at the Aarhus University Hospital between 1963 and 1991, was evaluated and T-staged according to the Lederman classification. The 80 maxillary antrum carcinomas were also staged according to the UICC 1997 system. In univariate analysis, the UICC T-classification was prognostic for locoregional tumour control and disease-specific survival. However, when adjusted for covariates (gender and nodal involvement) in a multivariate analysis, the UICC classification was not a significant independent prognostic parameter. In contrast, the Lederman T-classification was prognostic both in univariate and multivariate analysis. The Lederman T-classification was more prognostic for locoregional control and disease-specific survival than the UICC TNM classification. In addition, the Lederman classification is easy to use and has a broader applicability as it covers all sites in the sino-nasal area.

Sino-nasal cancer in Denmark 1982-1991--a nationwide survey.

Cancer of the nasal cavity and paranasal sinuses is a rare disease. The many different histologies and sites make the management of this disease a challenge. The current report from the Danish Society for Head and Neck Oncology comprises a joint analysis of five retrospective series covering the entire country, with 315 patients seen in the 10-year period from 1 January 1982 to 31 December 1991. Tumour sites were nasal cavity (n = 156), maxillary sinus (n = 139), ethmoid sinus (n = 14), sphenoid sinus (n = 5) and frontal sinus (one case). The most common histologies included squamous cell carcinoma (126 cases), adenocarcinoma (41 cases), malignant melanoma (38 cases) and malignant lymphoma (34 cases). A total of 284 patients (90%) received treatment with curative intent; most of these patients were treated with radiotherapy, either alone (120 patients) or in combination with surgery (111 patients). There was no significant difference between the five centres in disease specific survival and overall survival. The results showed that histology, localization and nodal involvement were significant prognostic factors for locoregional control and survival. Patients with squamous cell carcinoma had a significantly poorer prognosis compared with patients with adenocarcinoma. However, a Cox multivariate analysis revealed that this was likely the result of tumour localization, as most adenocarcinomas were in the nasal cavity. The experience from this data collection has inspired the Danish Society for Head and Neck Oncology to arrange common data registration of several other clinical head and neck series. In the future, the Society plans to expand this activity further.

Adult rhabdomyoma located near the thyroid gland. A case description.

A case of adult rhabdomyoma, a rare muscle-derived tumor, is described in a 40-year-old man. The tumor was located in close proximity to the thyroid gland and was initially misinterpreted as an adenoma of the gland. The most important differential diagnoses are discussed including methods available for differentiating those from rhabdomyoma.

Cancer of the nasal cavity and paranasal sinuses. A clinico-pathological study of 277 patients.

In the period 1963-1991, a total of 277 consecutive patients with malignant tumours of the nasal cavity and paranasal sinuses were treated at Aarhus University Hospital. The major histological types included squamous cell carcinoma (46%), lymphoma (14%), adenocarcinoma (13%), and malignant melanoma (9%). Kaplan-Meier estimates of 5-year corrected survival (death from cancer) showed the best prognosis for adenoid cystic carcinoma (87%), adenocarcinoma (65%) and lymphoma (56%), and the poorest prognosis for undifferentiated carcinoma (17%) and malignant melanoma (24%). The 5-year corrected survival for squamous cell carcinoma was 35%. Of the 180 patients with treatment failure, the vast majority occurred locally (n = 166); a minor proportion was regional (n = 23) or distant (n = 30). For the 195 patients with carcinoma, the following parameters were of statistical prognostic significance (5-year corrected survival): histological differentiation (moderate-well 65% vs. poor 22%), primary T-site (nasal cavity 56% vs. maxillary antrum 39% vs. other sinuses 24%), tumour stage (T2 68% vs. T3 37% vs. T4 29%), nodal stage (N0 48% vs. N1-3 21%), treatment (radiotherapy + surgery 56% vs. radiation alone 35%).

Preincisional infiltration with bupivacaine in tonsillectomy.

OBJECTIVE: To investigate the value of preincisional peritonsillar infiltration of bupivacaine hydrochloride before tonsillectomy under general anesthesia. DESIGN: Double-blind trial with two groups comparing 0.25% bupivacaine with placebo (normal saline). The patients were followed up for 10 days after surgery. SETTING: Department of Otolaryngology, University Hospital of Aarhus (Denmark). PATIENTS: Men and women 18 to 40 years of age referred to our department for bilateral tonsillectomy, but with no sign of acute infection or suspected malignant neoplasm. Twenty-six patients entered the study; five were excluded for failure to complete the postoperative data; and two, one from each group, had postoperative bleeding. Data from 19 patients were analyzed, nine in the bupivacaine group and 10 in the placebo group. INTERVENTION: One group had 5 mL of 0.25% bupivacaine hydrochloride (Marcaine) infiltrated around each tonsil, the other an identical placebo (normal saline) infiltration. OUTCOME MEASURES: A visual analogue scale was used as the primary efficacy measure. The daily intake of analgesics and a possible weight loss were registered. RESULTS: A notably lower score on the visual analogue scale was found in the bupivacaine group. CONCLUSIONS: Preoperative blocking of nociceptive impulses reduces prolonged postoperative pain, but no reduction in the intake of analgesics was found. Medication was insufficient for the first postoperative days.