Case report: De novo pathogenic variant in WFS1 causes Wolfram-like syndrome debuting with congenital bilateral deafness.

Background: Congenital deafness could be the first manifestation of a syndrome such as in Usher, Pendred, and Wolfram syndromes. Therefore, a genetic study is crucial in this deficiency to significantly improve its diagnostic efficiency, to predict the prognosis, to select the most adequate treatment required, and to anticipate the development of other associated clinical manifestations. Case presentation: We describe a young girl with bilateral congenital profound deafness, who initially received a single cochlear implant. The genetic study of her DNA using a custom-designed next-generation sequencing (NGS) panel detected a de novo pathogenic heterozygous variant in the WFS1 gene related to Wolfram-like syndrome, which is characterized by the presence of other symptoms such as optic atrophy. Due to this diagnosis, a second implant was placed after the optic atrophy onset. The speech audiometric results obtained with both implants indicate that this work successfully allows the patient to develop normal speech. Deterioration of the auditory nerves has not been observed. Conclusion: The next-generation sequencing technique allows a precise molecular diagnosis of diseases with high genetic heterogeneity, such as hereditary deafness, while this was the only symptom presented by the patient at the time of analysis. The NGS panel, in which genes responsible for both syndromic and non-syndromic hereditary deafness were included, was essential to reach the diagnosis in such a young patient. Early detection of the pathogenic variant in the WFS1 gene allowed us to anticipate the natural evolution of the disease and offer the most appropriate management to the patient.

Trends in disease-specific survival of head and neck squamous cell carcinoma patients treated in a single institution over a 30-year period.

OBJECTIVE: Over the last few decades, there have been changes in the diagnostic capabilities and treatment of head and neck squamous cell carcinoma (HNSCC) patients. However, the impact of these changes on the ultimate survival of patients remains unclear. The objective of this study was to analyze the changes in disease-specific survival of patients with HNSCC treated consecutively over a period of 30 years in a tertiary center. MATERIAL AND METHODS: We carried out a retrospective analysis of 5,206 carcinomas located in the oral cavity, nasopharynx, oropharynx, hypopharynx, larynx or with metastatic squamous cell carcinoma without a known primary tumor treated in our center during the period 1985-2016. The overall and disease-specific survival was analyzed according to the year of diagnosis of the tumor. RESULTS: There was a significant trend towards an increase in disease-specific survival over the study period, with an average survival gain of 0.28% per year, which means an increase in 5-year disease-specific survival values from about 63.5% during the initial years of the study to 72% during the final years. Patients who had a greater increase in survival were those with primary tumors located in the rhino-oro-hypopharynx, with advanced tumors (stages III-IV) and treated with radiotherapy or chemoradiotherapy. This increase in disease-specific survival did not translate into overall survival. CONCLUSION: Over the last 30 years we have observed a significant increase in the disease-specific survival of the patients with HNSCC, with an average increase of 0.28% per year in the 5-year specific-disease survival.

Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal.

PURPOSE: The aim of the study is to determine the predisposing factors for pharyngocutaneous fistula (PCF) in patients undergoing total laryngectomy (TL) or extended TL and, secondarily, to propose a new severity-based classification system. METHODS: This is a retrospective study of 400 patients who underwent TL or extended TL. Major fistula was defined as a fistula (1) persisting for ≥ 4 weeks, (2) requiring surgical treatment, or (3) associated with perioperative mortality. RESULTS: PCF formation occurred in 93 patients (23.3%) and major fistula in 72 (18.0%). Extended surgery with partial or total pharyngectomy, previous treatment with radiotherapy, and postoperative hemoglobin levels < 99 g/L were associated with a significantly higher risk of developing major fistula. CONCLUSIONS: We propose a new PCF classification system according to clinical severity. Predictors of major fistula were the type of surgery, previous radiotherapy, and low (< 99 g/L) postoperative hemoglobin levels. We consider the use of onlay flaps in irradiated patients who require partial pharyngectomy.

Neumolaberinto: una complicación atípica en un implante coclear / Pneumolabyrinth: an atypical complication in a cochlear implant

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Inclusion of extracapsular spread in the pTNM classification system: a proposal for patients with head and neck carcinoma.

IMPORTANCE: The inclusion of data about the presence of metastatic neck nodes with extracapsular spread (ECS) in the neck dissection improves the prognostic classification of patients with head and neck squamous cell carcinoma (HNSCC). OBJECTIVE: To evaluate the prognostic capacity of ECS in patients with HNSCC, and to analyze the usefulness of including this information in the pathological classification of patients treated with a neck dissection. DESIGN: Retrospective unicenter study performed from 1985 through 2007. SETTING: Tertiary referral center. PARTICIPANTS: A total of 1190 patients with HNSCC treated with a neck dissection. INTERVENTION: Unilateral or bilateral neck dissection . MAIN OUTCOMES AND MEASURES: Adjusted survival and local, regional, and distant metastases-free survival. Patients were classified according to a recursive partitioning analysis (RPA) method, considering pN category and number of neck nodes with ECS as the independent variables. RESULTS: Five-year adjusted survival for patients without metastatic nodes in the neck dissection (pN0) was 85.5%, for patients with neck node metastases without ECS (pN+/ECS-) it was 62.5%, and for patients with neck node metastases with ECS (pN+/ECS+) it was 29.9%. There were significant differences in survival between patients with pN0 lesions and pN+/ECS- (P < .001), and between patients with pN+/ECS- and those with pN+/ECS+ (P < .001). According to the RPA method, we propose classifying patients according to 4 categories: category I, pN0 lesions; category II, pN1/ECS+ or pN+/ECS-; category III, pN2-3/1 node and ECS+; and category IV, pN2-3/2 or more nodes and ECS+. The RPA-derived classification achieved a better prognostic discrimination than the pTNM classification. CONCLUSIONS AND RELEVANCE: The inclusion of information about ECS in the neck dissection improved the prognostic classification of patients with HNSCC in relation to the pTNM classification.

Parotidectomías en tumores benignos: clasificación "Sant Pau" de la extensión de la resección / Parotidectomies in benign parotid tumours: "Sant Pau" surgical extension classification

Introducción y objetivos: En la actualidad coexisten diferentes opciones para tratar un tumor benigno de la glándula parótida, lo que ha llevado a una cierta confusión sobre la extensión de la resección que se realiza en cada caso. Para intentar mejorar dicha información, se creó en nuestro servicio un sistema de clasificación por áreas para definir la parte extirpada. Se empezó a utilizar en julio de 2006 y en este artículo se revisa su aplicabilidad y utilidad. Métodos: Se analizan 44 pacientes operados en nuestro servicio de tumores clínicamente benignos de la glándula parótida, en el periodo comprendido entre julio de 2006 y diciembre de 2008. A todas las resecciones se les aplicó el sistema de clasificación de nuestro centro, que divide la parótida en 5 áreas: I (lateral craneal), II (lateral caudal), III (profunda craneal), IV (profunda caudal), V (accesoria). Resultados: La clasificación ha sido de fácil aplicación y no ha presentado ningún problema práctico en los 44 pacientes operados. Al analizar las áreas resecadas en la cirugía, destaca el alto porcentaje (47%) de parotidectomías laterales parciales caudales (resección del área II). La parotidectomía lateral (resección áreas I–II) ha sido la segunda en número con 14 casos (33%). El 20% restante se ha repartido entre las demás opciones. Conclusiones: El sistema de clasificación por áreas ha permitido definir con claridad la cirugía realizada en cada caso y ha permitido explicar de forma fácil la resección realizada, incluso en aquellos casos de resecciones poco habituales (AU)

Introduction and goals: At present different options co-exist for treating a benign tumour of the parotid gland, which has led to some confusion about the extent of resection performed in each case. In an effort to improve this situation, we created a classification system to define the areas removed. We started using this classification in July, 2006, and this article reviews its applicability and usefulness. Methods: We analyzed 44 patients who underwent surgery for clinically benign tumours of the parotid gland in our department between July, 2006, and December, 2008. In all resections, our classification was applied, dividing the parotid gland into five areas: I (lateral superior), II (lateral inferior), III (deep superior), IV (deep inferior), V (accessory). Results: The classification was easily applied and has presented no practical problem in the 44 patients operated. When analyzing the areas excised in surgery, the most common surgery was lateral inferior partial parotidectomy (removal of area II) in 47% of the cases. Lateral parotidectomy (removal of areas I and II) was the next most frequent, with 14 cases (33%). The remaining 20% was distributed among the other options. Conclusions: Our classification system appears to be a simple and easy way to define the surgery performed in each case, which simplifies the description of the resection performed, even in unusual resections (AU)

Parotidectomies in benign parotid tumours: "Sant Pau" surgical extension classification.

INTRODUCTION AND GOALS: At present different options co-exist for treating a benign tumour of the parotid gland, which has led to some confusion about the extent of resection performed in each case. In an effort to improve this situation, we created a classification system to define the areas removed. We started using this classification in July, 2006, and this article reviews its applicability and usefulness. METHODS: We analyzed 44 patients who underwent surgery for clinically benign tumours of the parotid gland in our department between July, 2006, and December, 2008. In all resections, our classification was applied, dividing the parotid gland into five areas: I (lateral superior), II (lateral inferior), III (deep superior), IV (deep inferior), V (accessory). RESULTS: The classification was easily applied and has presented no practical problem in the 44 patients operated. When analyzing the areas excised in surgery, the most common surgery was lateral inferior partial parotidectomy (removal of area II) in 47% of the cases. Lateral parotidectomy (removal of areas I and II) was the next most frequent, with 14 cases (33%). The remaining 20% was distributed among the other options. CONCLUSIONS: Our classification system appears to be a simple and easy way to define the surgery performed in each case, which simplifies the description of the resection performed, even in unusual resections.

Influence of the persistence of tobacco and alcohol use in the appearance of second neoplasm in patients with a head and neck cancer. A case-control study.

OBJECTIVE: To evaluate the influence of persistent tobacco and alcohol use on the risk of a second metachronous neoplasm in the aerodigestive tract in head and neck squamous cell carcinoma (HNSCC) patients. METHODS: A matched case-control study was carried out in 514 patients with HNSCC. Case patients developed a second metachronous neoplasm in the aerodigestive tract after treatment of an index HNSCC. A patient free of second neoplasm was individually matched to every case patient by location of the index tumor, tumor stage, sex, previous tobacco and alcohol consumption, age, general health status, and treatment. Data about persistence in tobacco and alcohol consumption after treatment of the index tumor was collected retrospectively. A validation study was carried out to confirm the adequacy of this retrospective information. RESULTS: Persistent tobacco smoking and alcohol drinking after treatment of a HNSCC contributed to the risk of appearance of second neoplasm. The odds ratio of a second neoplasm for patients who continued to smoke was 2.9 (95% CI OR 1.8-4.1), and for patients who continued to use alcohol it was 5.2 (95% CI OR 3.3-7.9). There was a strong association between persistence of tobacco and alcohol use after treatment of the HNSCC index tumor. According to the attributable risk estimation, persistent tobacco and alcohol consumption would be responsible for one-third of the second neoplasms in the patients with a HNSCC index tumor. CONCLUSIONS: Persistence of tobacco and alcohol use after treatment of a HNSCC had a significant influence on the appearance of a second neoplasm in the aerodigestive tract. Cessation of tobacco and alcohol use should be a major goal after treatment of a HNSCC.

Supracricoid laryngectomy as salvage surgery after failure of radiation therapy.

Supracricoid laryngectomy can be an alternative in selected patients with a local recurrence after radiotherapy when endoscopic treatment or more conservative external approaches are not indicated. In this study, we reviewed our experience in patients who underwent salvage supracricoid laryngectomies for local recurrence following radiotherapy. Between 1997 and 2005, salvage supracricoid laryngectomy was performed in nine consecutive patients. The primary tumour was located in the glottis in eight cases and in the supraglottis in one case. The reconstruction method consisted of a cricohyoidoepiglottopexy in six cases and a cricohyoidopexy in three. One patient died of a complication associated to salvage treatment and another died as a consequence of a new recurrence of the laryngeal tumour. All patients were decannulated and recovered the ability to swallow. The mean cannulation and nasogastric feeding tube times were 11 and 27 days, respectively. The mean hospitalisation time was 34 days. Six patients had wound healing complications, all of which were solved without further surgery. Laryngeal function was preserved in 78% of the patients treated. In conclusion, supracricoid laryngectomy is an effective technique as salvage treatment in selected cases of local recurrence after radiotherapy and it can be an alternative to total laryngectomy when other methods of salvage conservation laryngeal surgery are not indicated.

Metachronous second primary tumours in the aerodigestive tract in patients with early stage head and neck squamous cell carcinomas.

Early-stage head and neck carcinomas can usually be controlled with the appropriate treatment. In these patients, the long-term prognosis mainly depends on second metachronous malignancies, frequently in the aerodigestive tract. Our study aims to identify risk factors for the appearance of second tumours in this group of patients with early head and neck cancer. Of 949 patients included in the study, 189 (20%) developed a metachronous second primary malignancy, most frequently in the aerodigestive tract. Independent risk factors associated with second tumours were heavy alcohol use and the location of the index tumour in the oropharynx. Compared to non-drinkers, heavy drinkers (>80 g/day) presented a 1.8-times higher risk of a second tumour (CI 95%: 1.01-3.50). Patients with oropharyngeal tumours had a 2.15-higher risk than patients with oral cavity tumours (CI 95%: 1.03-4.47). Recursive partitioning analysis was used to characterise two risk groups for second tumours. The low-risk group included patients over 75 years and patients with low levels of carcinogen use. It comprised 171 patients (18%) with a 5.3% frequency of second tumours. The high-risk group accounted for 80% of the patients (n = 778), and the rate of second neoplasms was 16.3%. Classification of the patients according to the mentioned variables allows us to focus follow-up and prevention efforts on high-risk patients.

Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients.

OBJECTIVES/HYPOTHESIS: The objectives were to quantify the incidence of clinically unsuspected thyroid tissue in cervical lymph nodes encountered during neck dissection in patients with head and neck carcinoma, to describe the location and histological aspect of these inclusions, and to assess their clinical significance. STUDY DESIGN: Retrospective study. METHODS: The histological records of 1123 neck dissections in 752 patients with head and neck carcinoma were reviewed. In cases with thyroid inclusions, the pathological diagnosis was reviewed and an immunohistochemical study against thyroglobulin and calcitonin was carried out. RESULTS: Clinically unsuspected thyroid tissue was found in lymph nodes in 11 of the 752 patients with head and neck carcinoma treated with neck dissection. In five cases, the thyroid inclusion was compatible with a metastases of an occult papillary thyroid carcinoma. In the other six cases, a collection of thyroid follicles without malignant characteristics was found beneath the lymph node capsule. These latter cases were considered benign thyroid inclusions. A thyroidectomy was performed in three of the patients with lymph node metastases of the papillary carcinoma. An occult papillary carcinoma was found in only one case. The other two patients had been treated previously with radiotherapy for an early-stage glottic carcinoma. Immunohistochemical study did not find calcitonin-positive cells within the benign thyroid inclusions. After a follow-up period ranging from 1.2 to 8.2 years, no patient had any kind of local, regional, or distant relapse related to the thyroid disease. CONCLUSION: The incidence of unsuspected thyroid tissue in lymph nodes of patients with head and neck carcinoma treated with neck dissection was 1.5%. Both lymph node metastases of a papillary carcinoma and benign thyroid inclusions were found. The study results suggest that the incidental finding of thyroid tissue in the lymph nodes during a neck dissection in patients with head and neck carcinoma does not necessarily indicate the need for aggressive therapy.

Variability in nerve patterns of the adductor muscle group supplied by the recurrent laryngeal nerve.

INTRODUCTION: Accurate knowledge of the nerve supply of each individual muscle is needed to achieve a successful selective reinnervation of the larynx. The aim of the present work was to study the nerve supply of the adductor laryngeal muscles supplied by the recurrent laryngeal nerve. STUDY DESIGN: Morphologic study of human larynges. METHODS: The muscular nerve supply was studied in a total sample of 75 human larynges obtained from necropsies (47 males and 28 females, age range from 41-95 years) and examined by careful dissection using a surgical microscope. RESULTS: The arytenoid muscle received one branch from each recurrent nerve. In 88% of cases, this branch arose in a common trunk with the upper branch of the posterior cricoarytenoid muscle. In 8% of cases, the nerve for the arytenoid muscle also had a branch going to the lateral cricoarytenoid muscle. The arytenoid muscle also received from one to three pairs of branches from the posterior division of the internal laryngeal nerve; these were interconnected ipsi- and contralaterally and were also connected to the two branches coming from the recurrent laryngeal nerve. The lateral cricoarytenoid muscle received from one to six branches from the recurrent nerve, but in 5.8% of cases, it also received a twig from a connecting branch between the recurrent nerve and the external (5.6%) or the internal laryngeal nerves (0.2%). The thyroarytenoid muscle received from one to four branches from the recurrent nerve, but in 5.6% of cases, it also received a twig from a connecting branch between the recurrent nerve with the external (4.6%) or the internal (1%) laryngeal nerves. CONCLUSION: No abductor or adductor division of the recurrent laryngeal nerve was found in the present study. In 88% of cases, the nerve supply to the arytenoid muscle (adductor) and the posterior cricoarytenoid muscle (abductor) arose from a common trunk, which in 8% of cases, also had a branch to the lateral cricoarytenoid muscle. Furthermore, the high incidence of branches innervating the adductor muscles from connections between the recurrent laryngeal nerve and the internal and external laryngeal nerves led us to reconsider the contribution of these nerves in the supply to this muscle group.

Comparison of the Radiation Therapy Oncology Group recursive partitioning classification and Union Internationale Contre le Cancer TNM classification for patients with head and neck carcinoma.

BACKGROUND: Prognostic models need to be tested in external validation studies to assess generalizability. Recursive partitioning analysis (RPA), a prognostic system based on the creation of a classification tree, has been proposed as a classification method in patients with head and neck carcinoma. The aim of this study was to compare the RPA and Union Internationale Contre le Cancer (UICC) TNM classification systems in patients with head and neck carcinoma treated consecutively in a single center. METHODS: A total of 2166 patients with carcinomas of the oral cavity, oropharynx, hypopharynx, and larynx was classified according to both the RPA and the TNM classification systems, and the results were compared. The endpoints considered were observed survival and survival free of locoregional tumor. The two methods of classification were evaluated objectively by use of measures of intrastage homogeneity (hazard consistency), interstage heterogeneity (hazard discrimination), predictive power (outcome prediction), and patient distribution between stages (balance). RESULTS: When the endpoint considered was observed survival, there were no clinically relevant differences between the two classifications. However, when the endpoint was locoregional control, the RPA system was sensitive to the type of treatment used, and it was not generalizable. CONCLUSIONS: To evaluate generalizability, new classification proposals need external validation studies that objectively measure the quality of the model. The performance of the RPA system was not reproducible in our cohort of patients when the endpoint evaluated was locoregional control.

Results of an organ preservation protocol with induction chemotherapy and radiotherapy in patients with locally advanced laryngeal carcinoma.

An alternative treatment in patients with advanced laryngeal carcinoma who are candidates for total laryngectomy is induction chemotherapy and radical radiotherapy in an organ preservation approach. We conducted a study to evaluate results of this treatment in patients with locally advanced laryngeal carcinoma, candidates for total laryngectomy, who were treated at a single institution between 1985 and 1997. During the study period, 224 began treatment with induction chemotherapy. Induction chemotherapy consisted of three cycles of cisplatin and 5-fluoruracil in the majority of cases. Four patients died as a consequence of complications associated with chemotherapy treatment. Subsequent treatment consisted of total laryngectomy in 79 patients and radical radiotherapy in 141. After radical radiotherapy, local control for patients who achieved a complete response after induction chemotherapy was 74%, significantly better than 57% in patients with a non-complete response (P=0.04). Considering the initial group of 224 patients, the frequency of organ preservation was 39%. Considering only the patients treated with induction chemotherapy and radiotherapy, the organ preservation frequency was 62%. In a multivariate study, only the response after induction chemotherapy was significantly related to organ preservation.

The effect of waiting time on local control and survival in head and neck carcinoma patients treated with radiotherapy.

PURPOSE: To determine the influence of waiting time for radiotherapy on local control and survival in a cohort of patients with head and neck carcinoma of different locations and stages treated with radiotherapy. MATERIAL AND METHODS: Retrospective study of 797 patients with squamous cell carcinoma located in the oral cavity, pharynx or larynx, treated with radiotherapy, and with a minimum follow-up of 3 years. Local recurrence and survival were analyzed in function of the waiting time, defined as the interval between date of histologic diagnosis and date of radiotherapy. A univariate and multivariate analysis was carried out. RESULTS: Median waiting time to radiotherapy was 44 days (25 and 75% quartiles: 33 and 60 days). There were significant differences in the waiting time period in relation to the primary location and the local extension of the tumor. Both univariate and multivariate analysis showed that waiting time had no significant impact either on local control or survival. CONCLUSION: Within the range of the waiting time observed in our study, delay in the initiation of radiotherapy did not affect local control or survival in patients with head and neck carcinoma.

Variability of the nerve supply patterns of the human posterior cricoarytenoid muscle.

OBJECTIVES/HYPOTHESIS: To achieve a successful selective reinnervation of the larynx, an accurate knowledge of the nerve supply of each individual muscle is required. The posterior cricoarytenoid muscle, the only abductor or respiratory muscle of the larynx, plays a vital role in cases of recurrent palsy and orthotopic transplantation. Descriptions of the posterior cricoarytenoid muscle nerve supply pattern vary considerably. The goal of the present study was to establish an accurate morphological description of the posterior cricoarytenoid muscle nerve supply in a large sample of human larynges. STUDY DESIGN: Morphologic study of human larynges. METHODS: The posterior cricoarytenoid muscle nerve supply was studied in a total sample of 75 human larynges obtained from necropsies (47 male and 28 female samples; age range, 41-95 y) and examined by careful dissection using a surgical microscope. RESULTS: The posterior cricoarytenoid muscle nerve supply in all cases (100%) came from the anterior division of the recurrent nerve. However, in six cases (4%) a small branch also arose from the ramus anastomoticus. The number of branches coming from the anterior division varied, ranging from one to six. The two-branch pattern was the most frequent (42.7%), followed by the three-branch pattern (34%) and the one-branch pattern (7.3%). The remaining 16% of cases showed patterns of four, five, or six branches. When two or more branches were present, a connection between them was observed in 64% of cases. Five different types of origin of the various branches were observed along the course of the recurrent nerve in relation to the cricothyroid joint: type a, vertical segment below the cricothyroid joint (7.5%); type b) vertical segment behind the cricothyroid joint (40.5%); type c) vertical segment just above the cricothyroid joint (16%); type ) from the genu, in common with the arytenoid branch, above the cricothyroid joint and just below the cricoarytenoid joint (34%); and type e) oblique segment (2%). CONCLUSION: Despite the variability of the innervation of the posterior cricoarytenoid muscle and its strong connection with the interarytenoid nerve, this should not preclude successful reinnervation.

Is the external laryngeal nerve an exclusively motor nerve? The cricothyroid connection branch.

OBJECTIVES: To obtain an accurate morphological description of the nerve that provides communication between the external laryngeal nerve and the recurrent laryngeal nerve in a large sample of human larynges. STUDY DESIGN: Morphological study of human larynges. METHODS: Microdissection of 103 human larynges obtained from necropsies was performed. Both the external laryngeal nerve and the recurrent laryngeal nerve were identified and dissected. The existence of a communication between the two nerves was evaluated. RESULTS: A neural communication between the external laryngeal nerve and the recurrent laryngeal nerve was found in 85% of the larynges studied (bilaterally in 44% and unilaterally in 41%). Two patterns of communication (with single or double branches) were found. The communication between the nerves can appear at different levels, giving off collateral branches to the cricothyroid muscle (23%), the cricothyroid joint capsule (49%), and the subglottic mucosa (50%). CONCLUSIONS: The nerve supply of the human larynx is more complex than classically considered. Our study does not support the classic neuroanatomical belief that the external laryngeal nerve is purely a motor nerve to the cricothyroid muscle. Our results reveal that it carries sensory and motor fibers on to other muscles (thyroarytenoid) or regions (subglottis mucosa and cricothyroid joint), as has been demonstrated in experimental studies in cats and dogs.

Hypothyroidism in patients treated with total laryngectomy. A multivariate study.

One of the complications of the treatment of head and neck carcinoma patients is hypothyroidism. The objective of our study was to quantify the prevalence of hypothyroidism in patients with laryngeal or hypopharyngeal cancer treated with a total laryngectomy and to evaluate the importance of different variables in the appearance of hypothyroidism in this group of patients. A transversal study in 182 patients treated with total laryngectomy between 1986 and 1998 was carried out. TSH and FT4 were determined in all patients. Hypothyroidism was classified as subclinical (increased TSH and normal T4 levels) and clinical (increased TSH and decreased T4 levels). Univariate and multivariate analysis was carried out to examine the relationship between hypothyroidism and different variables. Our results showed that the prevalence of hypothyroidism in our group of patients was 52% (27% subclinical and 25% clinical). Sex, initial extension of the tumour, hemithyroidectomy, use of chemotherapy and radiotherapy were variables associated with the appearance of hypothyroidism in the univariate analysis (P < 0.05). When all these variables were included in a multivariate study, only hemithyroidectomy (RR 3,6; CI 95% 1,7-7,2) and combined treatment with radiotherapy (RR 3,4; CI 95% 1,2-9,6) appeared as prognostic factors. In conclusion, hypothyroidism is a frequent complication in patients treated with a total laryngectomy (52%), especially when this treatment includes hemithyroidectomy and/or radiotherapy. We consider that it is important to check the thyroid function periodically in these patients to obtain early diagnosis and appropriate treatment.

Results of an organ preservation protocol with induction chemotherapy and radiotherapy in patients with locally advanced pyriform sinus carcinoma.

An alternative to the classical treatment for locally advanced (T3-T4 stage) pyriform sinus carcinoma with surgery and postoperative radiotherapy is to begin treatment with induction chemotherapy in an organ preservation approach. In patients with complete clinical response, this treatment is followed by radiotherapy; in noncomplete responders, it is followed by surgery and postoperative radiotherapy. We conducted a retrospective study to evaluate such treatment in a cohort of 78 patients with locally advanced pyriform sinus carcinoma treated at a single institution between 1985 and 1997. In all patients, induction chemotherapy with cisplatin and 5-fluoruracil was carried out. Two patients died as a consequence of complications associated with chemotherapy treatment. Of the 76 patients who completed treatment, 23 (30%) achieved a complete response at the primary site, 38 (50%) attained a partial response, and 15 patients (20%) had a stabilization-progression. The 5-year adjusted survival of patients treated with radiotherapy alone was 57% and, in patients treated with surgery, 51%. There were no significant differences in survival related to the subsequent treatment used (P > 0.05). The larynx was preserved in 14 of the 23 patients (61%) who completed treatment with induction chemotherapy and radiotherapy. The frequency of organ preservation for the group of 78 patients who began treatment with induction chemotherapy was 18%.