Long-term follow-up and a detailed prognostic analysis of patients with oropharyngeal cancer treated with radiotherapy.

PURPOSE: To find a prognostic factor for patients with oropharyngeal cancer (OPC) who were followed for long term after definitive radiotherapy. METHODS: OPC patients that had been treated with radiotherapy at our institution were reviewed. Sex, age, performance status (PS), subsite, disease stage, T-stage, N-stage, RT dose, concurrent chemotherapy, the duration of RT, hemoglobin concentration before any treatment, and a double cancer were assessed for their impact on overall survival (OS) and locoregional control (LRC). RESULTS: Among a total of 141 patients enrolled into this retrospective study, the disease of most patients (81%) was stage III or IV. The median follow-up time of the surviving patients was 56 months (range 5-175 months). Radiotherapy was administered in conventional fractionation, and the median RT dose was 66 Gy. Most patients (90%) received systemic chemotherapy. The 5-year estimates of progression-free survival, LRC, and OS were 66.0, 72.7, and 65.1%, respectively. In the univariate analysis, LRC and OS in the lateral wall at the primary site, T-stage 13.0 g/dL groups were also significantly superior to those in the other groups. In the multivariate analysis, age and T-stage remained significant factors for OS. CONCLUSIONS: Primary radiotherapy was recommended for OPC patients with the lateral wall at the primary site because of good LRC. The treatment method to the older population and T4 tumor is future tasks.

Anterior decompression for myelopathy resulting from thoracic ossification of the posterior longitudinal ligament.

STUDY DESIGN: A retrospective study was conducted to investigate the anterior decompression and fusion of 12 patients with thoracic ossification of the posterior longitudinal ligament. OBJECTIVE: To evaluate the effect of myelopathy management in which the thoracic ossification of the posterior longitudinal ligament is removed. SUMMARY AND BACKGROUND DATA: Very few reports have described operative treatments for thoracic ossification of the posterior longitudinal ligament. The condition is extremely rare, even in Japan. Consequently, operative procedures for myelopathy resulting this disorder have not been established. METHODS: This study involved 12 patients with thoracic ossification of the posterior longitudinal ligament. All the patients underwent direct removal of the ossification and spinal fusion using an anterior approach. A scapula-releasing technique was used in five patients who had major ossification of the posterior longitudinal ligament at Th4. The follow-up period ranged from 2.5 to 10 years (mean, 6.5 years). The clinical effect of the decompression was evaluated with a Japanese Orthopedic Association score for cervical myelopathy. The efficacy of the decompression was determined by postoperative computed tomography scan. RESULTS: Complete removal of the ossification was achieved in eight patients. In four patients, however, residual ossification was noted. The Japanese Orthopedic Association score before the operation ranged from 4 to 7 points (mean, 5.3 +/- 0.4 points). It showed a change 3 months after the operation, ranging from 1 to 8 points (mean, 6.9 +/- 0.5 points). At 1 year after the operation, it had changed to a range of 1 to 10 points (mean, 7.2 +/- 0.6 points). At the final consultation, it had changed further to a range of 1 to 10 points (mean, 6.9 +/- 0.5 points). Patients whose ossification was not completely removed showed severe or minor postoperative deterioration. CONCLUSIONS: Total removal of the ossification might be required to manage severe myelopathy in patients with thoracic ossification of the posterior longitudinal ligament. Complete removal of the ossification gave good results in eight patients. Patients whose ossification of the posterior longitudinal ligament had not been completely removed, however, had a poor outcome.