[Clinical outcomes of salvage surgery for nasopharyngeal carcinoma after irradiation failure].

OBJECTIVE: To study salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure. METHODS: A total of 84 cases underwent salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure between 1993 and 2009 was reviewed. rTNM stage: rT1 34 cases, rT2 27 cases, rT3 12 cases and rT4 11 cases; rN0 70 cases, rN1 9 cases and rN2 5 cases; No with distance metastatic. The salvage surgeries were performed using maxillary swing approach (47 cases), transcervical-mandibulo-palatal approach (21 cases), palate nasopharyngectomy (6 cases), lateral rhinotomy (7 cases), and maxillectomy (3 cases). RESULTS: Persistent or recurrent nasopharyngeal carcinoma after irradiation failure was resected completely in 57 patients (67.9%) and there were microscopic residual diseases in 27 patients (32.1%). The median follow-up was 27 months. Postoperative recurrence occurred in 35 cases. Thirty-six patients died of recurrence, metastasis and other diseases. The overall 5 year survival rate was 43.6%. Cox regression analysis indicated the complete resection for persistent or recurrent disease and no cervical metastasis were two independent factors affecting survival. CONCLUSIONS: Salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure is an effective treatment.

[Fatal hemorrhage following surgery for head and neck carcinoma].

OBJECTIVE: To study the surgical management of fatal hemorrhage following head and neck surgery for cancer. METHODS: The clinical data of 32 cases of fatal hemorrhage following head and neck surgery from 1976 to 2008 in our department were analyzed retrospectively. RESULTS: Hemorrhage was caused by carotid blowout in 20 cases. The carotid ligation was performed in 13 cases, only 6 cases got long-term survival. In 12 cases, hemorrhage was caused by tracheo-innominate artery fistula, only 2 cases received surgical management, and no long-term survivors. CONCLUSION: Fatal hemorrhage following head and neck surgery is an uncommon but frequently fatal complication, and the successful management of it depends on early diagnosis and correct treatment.

[Clinical study of carotid artery rupture in head and neck cancer].

OBJECTIVE: To assess the efficacy and safety of carotid ligation in the treatment of the carotid artery rupture(CAR). METHODS: A series of 30 patients who had CAR treated with carotid ligation were reviewed. There were 24 males and 6 females ranging in age from 32 to 76 years, with a mean of 53.9 years. The original sites of tumours were hypopharynx (n = 11), larynx (n = 5), thyroid (n = 6) and others (n = 8). Of the 30 patients, 24 patients had received radiotherapy from 40 - 126 Gy and 10 patients underwent one or more surgical treatments. CAR in all cases occurred after surgical operation. CAR occurred in 5 - 21 days after operation. RESULTS: By pressing the carotid and keeping breathe of the patients immediately after CAR, 25 patients were conscious, 2 patients in coma, and 3 patients died before carotid ligation. Seven cases were applied with carotid ligation, 3 cases with the combined ligation of carotid and brachiocephalic arteries, and 17 cases with carotid ligation plus the repair by pectoralis major myocutaneous flap. The causes of CAR concluded fistula, wound dehiscence, wound infection and transferred flap necrosis. The mende hemorrhage occurred in 14 patients. Of 25 cases with the treatments of carotid ligation, 22 patients survived with no complication, 1 with brief muscle weakness and 2 with unconscious. Clinical follow-up period lasted more than 5 years at least in 6 patients. CONCLUSIONS: CAR is the most dangerous complication in advanced carcinoma of the head and neck. The prompt hemostasis and carotid ligation are effective methods to rescue patients of CAR. It is important to keep patients conscious before carotid ligation surgery, with low rates of death and hemiplegia postoperatively.

[Cooperation management by head and neck surgery and neurosurgery for skull base tumors].

OBJECTIVE: To present the experience and advantage of cooperation management by head and neck surgery and neurosurgery for communicating skull base tumors. METHODS: A review of 54 communicating skull base tumors (benign tumor 21, malignant tumor 33) cooperation resection by head and neck surgery and neurosurgery from July 2005 to July 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences was presented. The tumor originated in the anterior skull base in 19 cases, originated in the lateral skull base in 12, in the central skull base in 17, and in the posterior skull base in 6. RESULTS: All procedures were conducted in a single stage by a multidisciplinary team. Total resection of tumor was achieved in 45 cases, and subtotal resection was achieved in 9. There was no operative death. There were 2 cases postoperative hemorrhage. All cases except 3 were followed up with a period of 8 to 43 months (median, 19.1 months for benign tumor and 21.0 months for malignant tumor). Three patients with malignant tumor were lost. Twelve cases of malignant tumor and one case of benign tumor recurred postoperatively. Nine patients with malignant tumor had died (one of these died from heart trouble). Three-year disease-free survival rates and overall survival rates of malignant tumor were 52.7% and 53.0%, respectively. CONCLUSIONS: It suggested that a special operative team constituted of head and neck surgeon and neurosurgeon may improve the outcome of the difficult skull base tumors.

[Clinical analysis of 40 cases with sinonasal adenoid cystic carcinoma].

OBJECTIVE: To study the clinical characters and the mode of treatment, and to analyze the prognosis of patients with sinonasal adenoid cystic carcinoma. METHODS: The clinical data were analyzed retrospectively in 40 patients with sinonasal adenoid cystic carcinoma. The characters of survival rate, local recurrence and distant metastasis in these patients were analyzed using Kaplan-Meier method and Log-rank test. RESULTS: The maxillary sinus was the most common site of origin and account for 80% of all patients. Five-year and ten-year overall survival rate were 76.9% and 61.6% respectively. Five-year and ten-year disease-free survival rate were 44.2% and 23.0%. Five-year local recurrence rate and distant metastasis rate were 45.0% and 23.0%, respectively. The most common site of distant metastasis was lung. Presence of distant metastasis correlated with decreased 5-year survival (chi2=7.26, P=0.007). The distant metastasis rate of preoperative treatment (18.2%) seemed lower than that of postoperative treatment (38.9%), but there was no significant difference in the two groups (chi2=1.37, P=0.24). The combined therapy mainly composed of surgery was adopted to treat the local recurrence. Five-year survival rate after development of local recurrence was 60.0%. CONCLUSIONS: Distant metastasis is an important factor affecting the prognosis of the patients with sinonasal adenoid cystic carcinoma. Combined therapy composed of surgery and radiation was the first choice of treatment to the patients with sinonasal adenoid cystic carcinoma. Radiation can play an important role in the treatment. The combined therapy mainly composed of surgery should be adopted in the patients with local recurrence to improve the survival rate.

[Malignant minor salivary gland tumors of the larynx].

OBJECTIVE: To study the clinical features, treatment and prognosis of malignant minor salivary gland tumors of the larynx. METHODS: Treatment and outcome were retrospectively analyzed in a consecutive series of 15 patients with malignant minor salivary gland tumors of the larynx treated in this hospital from 1959 to 2005. Ten patients (66.7%) had adenoid cystic carcinoma and 2 (13.3%) had adenocarcinoma. The other three patients had mucoepidermoid carcinomas, polymorphic adenocarcinoma and base cell carcinoma respectively. Eleven (73.3%) were located in the supraglottis and 4 (26.7%) in the subglottis. Fourteen had surgery (7 with adjuvant radiotherapy) and one was treated with radiotherapy plus chemotherapy. Five patients were found to have recurrent disease, 4 of whom underwent salvage surgery, 1 of whom had palliation radiotherapy. RESULTS: With a median follow-up of 8 years (ranging from 2 to 16 years), 7 patients are alive. Five patients have no evidence of disease, 1 of whom had surgery alone, 4 of whom were treated with surgery plus radiotherapy. Four patients died of distant metastases in a range of 2 to 10 years. The other 4 patients were lost to follow-up after treatment (ranging from 2 years to 16 years). Seven patients developed recurrent disease, 1 of whom had local recurrence alone, 1 had regional recurrence alone, 2 had distant metastases alone, and 3 had local and distant metastases. CONCLUSIONS: Minor salivary gland carcinomas of the larynx are rare and they are prone to the local recurrence and the distant metastasis in advanced stage. Distant metastases remain the principal cause of treatment failure. Surgery is the primary treatment modality used in most cases and the radiotherapy combining surgery has better local and regional control rate.

[Surgical treatment of thyroid carcinoma with the upper mediastinal metastasis].

OBJECTIVE: To study the clinical characteristics and management of thyroid cancer with the upper mediastinal metastasis. METHODS: A retrospective study was performed to analysis the clinical characteristics, treatment and prognosis of 122 cases who underwent mediastinal dissection for thyroid cancer invasion in Cancer Hospital of Chinese Academy of Medical Science from Jan. 1985 to Oct. 2004. RESULTS: According to postoperative pathological diagnosis, upper mediastinal(2R/2L) were the most common areas invaded, 98.4%. The incidence rate of lower mediastinal invasion was 20.5%, which often occurred in the area of lower paratracheal (4R/4L). The complication rate of the sternotomy group (38.2%)was higher than the other (28.4%), but complications associated with mediastinal operation were rare, including pleural effusion (3 cases), mediastinal infection (1 case) and superior vena cava rupture (1 case), which were all cured. After a median follow-up of 60 months (range from 12 to 249 months), 9 patients were lost in the follow-up, the follow-up rate was 92.6%. The anticipate 5-year survival rate of differentiated thyroid carcinoma and medullary carcinoma in the sternotomy group from Kaplan-Meier curve were 90.9%, 87.1% while the other group 85.4%, 92.3% (P > 0.05). Three-year and 5-year mediastinal recurrence rate of sternotomy group were 3.8%, 12.2%, while transcervical operation group 7.9%, 14.2%. CONCLUSIONS: It is noticed that there is a big percentage of patients with lower mediastinal invasion as well as upper area lesions. Radical operation is needed via sternotomy for these patients. For those who have many lymph nodes or the condition that lymph nodes adhere to the vessels , sternotomy also should be considered.

[Surgical approach for intrathoracic goiter].

OBJECTIVE: To explore the Surgical approach and management of intrathoracic goiter. METHODS: Seventy patients were operated on for thyromegaly extending to the thorax in an 15-year period at the department of Head and Neck surgery, Cancer Hospital, Chinese Academy of Medical Sciences. The median age of the 70 patients (44 women and 26 men) was 55 years, with a range of 23 to 71 years. Sixty cases were benign intrathoracic goiter and ten cases were malignancy. To help choice of operative approach, the intrathoracic goiter was divided into three types to based on chest film, computed tomography or magnetic resonance imaging and clinical symptom. I type: the inferior extremity of goiter is on the aortic arch. II type is the goiter to enter intrathoracic and portion located behind aortic arch, or the goiter enter posterior mediastinum. For III type, intrathoracic goiter intrude thoracic cavity, or accompany superior vena caval syndrome. Operative method, surgical access and treatment effect were discussed in this essay. RESULTS: A cervical incision alone was performed in 62 cases (I type 41 cases, II type 21 cases), and sternotomy in 8 (II type 3 cases, III type 5 cases). There was low morbidity and no deaths. Removal rate by cervical approach for intrathoracic benign and malignant goiter were 95% (57/60) and 50% (5/10) respectively. The Complication rate of cervical approach was significantly lower (8.1%) than that sternotomy approach (37.5%, P < 0.01). CONCLUSIONS: Most cases of intrathoracic goiter can be managed by cervical incision alone. Only a few cases, a median sternotomy approach may be needed when adhesions or an anomalous blood supply are present or carcinoma is suspected.

[Therapeutic modalities of nasopharyngeal adenoid cystic carcinoma].

OBJECTIVE: To grasp clinical characteristics, therapeutic methods and prognosis of the patients with nasopharyngeal adenoid cystic carcinoma, and explore the optimal therapeutic modalities. METHODS: Twenty one cases with nasopharyngeal adenoid cystic carcinoma were retrospectively reviewed. The treatment results were compared between radiotherapy alone and combined therapy. RESULTS: The cases with nasopharyngeal adenoid cystic carcinoma in T1, T2 phases was 28.6%, the cases in T3, T4 phases was 71.4%. The lymphatic node metastasis rate was 14.3%. The present symptoms were nasal discharge with blood, headache, nasal obstruction, deafness, double vision, facial insensibility, etc. One of 21 cases was lost follow up. Five years free-disease survival rates of the patients with nasopharyngeal adenoid cystic carcinoma was 42.9% (9/21). Five years free-disease survival rate of the patients with radiotherapy alone (RA) and the patients with radiotherapy combining surgery (R + S) were respectively 38.5% (5/12) and 50.0% (4/8), P = 0.472. Ten years free-disease survival rates of the patients was 16.7% (3/18). Ten years free-disease survival rates of the patients with RA and the patients with R + S were respectively 0/12 and 3/6, P = 0.025. The local recurrent rate was 50.0% (10/20). The local recurrent rates of the patients with RA and the patients with R + S were respectively 66.7% (8/12) and 25.0% (2/8), P = 0.085. The distant metastasis rate was 30. 0% (6/20). The distant metastasis rates of the patients with RA and the patients with R + S were respectively 25.0% (3/12) and 37.5% (3/8), P = 0.455. CONCLUSIONS: The course of nasopharyngeal adenoid cystic carcinoma is long, and it is prone to the local recurrence and the distant metastasis in advanced stage. Comparing with the radiotherapy alone, the radiotherapy combining surgery has better 10 years free-disease survival rate.

[Reconstruction with free jejunal interposition for defect after tumor resection of hypopharyngeal and cervical esophageal cancer].

OBJECTIVE: To discuss the use of free jejunal flap in reconstruction for circumferential defect after tumor resection of hypopharyngeal and cervical esophageal cancer. METHODS: Retrospective review of 51 patients who underwent circumferential pharyngoesophageal reconstruction with free jejunal flap after tumor ablation. RESULTS: In 51 patients, 5 had flap failure and the flap success rate was 90% (46/51). Forty-five patients had oral intake after operation excluding one who had anastomosis stenosis and 5 who had flap failure. The 1-year and 3-year survival rate was 62% and 48% respectively. Positive surgical marginal status and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area were indicators for bad prognosis. Except 5 patients who had flap failure, one of which died from mediastinal infection, no other severe complications occurred. CONCLUSIONS: Patients reconstructed with free jejunal flap after resection of hypopharyngeal and cervical esophageal cancer had low mortality and few complications. Those without positive surgical margin and external invasion including thyroid gland, carotid artery, skin and pre-vertebral area had higher survival rate. Most of them had good quality of life. The choice of free jejunal flap for reconstruction of hypopharyngoesophageal defect was appropriate in selected patients who had guarantee of negative surgical margin and no external invasion.

[Application of maxillary swing approach in operation of para-pharynx and cranial base].

OBJECTIVE: The efficacy of the maxillary swing approach to the nasopharynx and its vicinity was evaluated. METHODS: Using maxillary swing approach, the tumors in the nasopharyngeal region and infratemporal fossa in 60 patients were removed at the Department of Head and Neck Surgery, Cancer hospital, Chinese Academy of Medical Sciences during the period 1995 to 2005. Among them, 51 suffered from primary nasopharyngeal and cranial base tumor, and 9 had tumor of primary infratemporal fossa. Thirteen patients had benign and 47 patients had malignant tumor. Twenty eight cases were received preoperative radiotherapy. RESULTS: The facial wounds in all 60 patients healed primarily with no evidence of necrosis of the maxilla Twelve patients developed palatal fistula, six of them subsequently healed, two patients did not request surgical closure, whereas two patients required to wear a dental plate. Patients were followed up from 5 to 85 months (median interval, 38 months). Fourteen patients had local recurrence after treatment and five of them died. Three patients developed pulmonary metastasis. Five year survival and free tumor survival of malignant tumor were 76.4% and 36.3%, respectively. CONCLUSIONS: The maxillary swing approach is a proven method for access to the nasopharynx, middle cranial base and infratemporal fossa. The tumors in these regions can be adequately exposure and safely resected. The associated morbidity is low and there is no postoperative disturbance of cosmetic appearance using this approach.

[Result analysis of perioperative radiotherapy and laryngeal preservation in hypopharyngeal and pyriform sinus squamous cell carcinoma].

OBJECTIVE: To evaluate perioperative radiotherapy and laryngeal preservation clinical result of hypopharyngeal pyriform sinus squamous cell carcinoma. METHODS: A retrospective review was undertaken of 134 pyriform sinus squamous cell carcinoma cases who were treated at this institute in Department of Head and Neck Surgery from September 1985 to July 2001. One hundred patients received preoperative radiotherapy and surgery (R + S). Thirty-four patients received surgery and postoperative radiotherapy (S + R). The median follow-up interval was 38.1 months. RESULTS: (R + S) and (S + R) group 3-year and 5-year survival according to Kaplan-Meier were 54.8%, 50.1%; 51.1%, 45.9% respectively, and had no significant differences (all P > .05). The laryngeal function preservation of T1, T2, T3, T4 in (R +S) and (S + R) were 4/5, 3/3; 66.7% (32/48), 6/6; 32.4% (12/37), 0 (0/16); 0 (0/10), 0/9 respectively. T3 stage in (R + S) was good and significant different than in (S + R) (P < 0.05) and laryngeal preservation didn't increase hazard of survival and local recurrence. The two group Pathology( + ,P + ) in specimen margin were 7.0% (7/100); 20.6% (7/34) and had significant difference (P <0. 05). P + in specimen margin and clinical N stage are obvious interrelated in prognosis(P < 0. 05). CONCLUSIONS: Combined therapy (R + S) and (S + R) are equal in treat result. T3 (only paraglottic space is invaded) stage of (R + S) could increase preserved laryngeal ratio if condition is permitted and didn't add hazard. P + in specimen margin could be receded in (R + S) and profit to prognosis and function. Clinical N stage is obvious hazard and is an emphasis in combined therapy.

[Clinical analysis of posterior hypopharyngeal wall squamous cell carcinoma: a report of 36 cases].

BACKGROUND & OBJECTIVE: Posterior hypopharyngeal wall squamous cell carcinoma is few in clinic. This study was to discuss its treatment and the simultaneous reconstruction and function of hypopharyngeal wall. METHODS: Clinical data of 36 posterior hypopharyngeal wall squamous cell carcinoma patients (24 men and 12 women; 4 in stage I, 4 in stage II, 9 in stage III, 19 in stage IV), treated in Cancer Hospital of Chinese Academy of Medical Sciences between Jun. 1967 and Jan. 2000, were retrospectively analyzed. Of the 36 patients, 20 received combined therapy (surgery plus radiotherapy), 10 received radical radiotherapy, 3 received surgery alone, 3 received salvage surgery after failure of radiotherapy (2 at neck, 1 at hypopharynx and neck). Simultaneous reconstruction of hypopharyngeal wall used gastric tissue, jejunum tissue, ileum tissue, musculi pectoralis majoris flap, forearm flap, larynx tissue, gastroepiploic tissue, platysmal flap, and musculus trapezius flap. RESULTS: The 5-year survival rates were 40% in combined therapy group, and 30% in radical radiotherapy group. In surgery alone group, 2 patients were died, and 1 was lost of follow-up. All 3 patients in salvage surgery group were died within 3 years. Of the 24 patients underwent surgery, 4 (17%) underwent local resection, 20 (83%) underwent hypopharyngeal reconstruction; of the 20 patients, 11 (55%) patients used gastric tissue or jejunum tissue, and 9 (45%) patients used other tissues; no patient died during perioperation; the occurrence of complications was 15%; the reconstruction success rate was 85%; the mean time to eating was 2-3 weeks; 3 patients suffered local recurrence. CONCLUSIONS: The combined therapy, emphasized on resume swallow function, has good effect on posterior hypopharyngeal wall squamous cell carcinoma. Simultaneous reconstruction of hypopharynx may resume swallow function without increase of prognosis hazard. Gastric and jejunum tissues are mainly used in reconstruction. Local resection could be applied to some patients to preserve swallow function.

[Surgical therapy of subglottic carcinoma].

OBJECTIVE: To analyze the clinical characteristics, surgical procedures and correlated prognostic factors of the cases with subglottic carcinoma; to seek for the optimal surgical treatment for the patients suffering from subglottic carcinoma. METHODS: Twenty-four cases with subglottic carcinoma were retrospectively reviewed, the disease-free survival rates of the patients at 3 years were analyzed according to the different T N phases and the surgical modalities. RESULTS: The free-disease survival rate at 3 years was 50.0% (12/24) for 24 cases with subglottic carcinoma. The survival rates of 19 cases with total laryngectomy was 47.4% (9/19), and the survival rates in T2, T3, T4 phases were respectively 1/1, 6/11, 2/7. The survival rates of 5 cases with partial laryngectomy was 3/5, the survival rates in T2, T3 phases were respectively 3/4, 0/1, and the surgical margins were verified to be positive in 2 of 5 cases being performed partial laryngectomy. The metastasis rate of lymph nodes was 33.3% (8/24). The survival rates of patients with N0, N1, N2 disease were respectively 10/16, 1/4, 1/4. The positive lymph nodes were verified in the neck regions of II-VI and superior mediastinum. CONCLUSIONS: Prognoses of the cases with subglottic carcinoma were poor, early treatment could result in good effect. Until now total laryngectomy still the mainly treatment of subglottic carcinoma. Only the patients with earlier subglottic carcinoma are amenable to partial laryngectomy and should be given postoperative irradiation. Lymph node metastasis was a very important prognostic factor. Paratracheal lymph nodes are the sentinel nodes for subglottic carcinoma, and it is reasonable to probe the nodes. Once verifying positive lymph node, the typical neck dissection involving I-VI regions and superior mediastinum should be performed.

[Supracricoid partial laryngectomy for the treatment of laryngeal cancer].

OBJECTIVE: To evaluate the oncological and functional outcomes in patients undergoing supracricoid partial laryngectomy (SCPL). METHODS: Forty-three cases underwent supracricoid partial laryngectomy with functional reconstruction in stage T1b-T4. In these cases, 16 were supraglottic cancers, 21 were glottic cancers, and 2 were subglottic cancers. Three types of supracricoid partial laryngectomy (cricohyoidopexy CHP, cricohyoidoepiglottopexy CHEP and tracheocricohyoidoepiglottopexy TCHEP) were employed accordingly. RESULTS: The 3- and 5-year accumulative survival rates were 90.7% and 83.7% respectively (Kaplan-Meier method). Median follow-up time was 57 months. Decannulation rate was 95.3% (41/43) in those. The mean time of decannulation was 14 days in patients preserved both cricoarytenoid units and 43 days in those only preserved one cricoarytenoid unit. The removal of epiglottis increased the risk of aspiration and prolonged time of decannulation (P < 0.05). CONCLUSIONS: Supracricoid partial laryngectomy for selected laryngeal cancer is feasible. The patients can gain satisfied survival rate and quality of life.

[Transmaxillary approach for surgical removal of clival chordomas: study of 10 cases].

OBJECTIVE: To study the effectiveness and clinical significance of transmaxillary approach for surgical removal of Al-Mefty type III clival chordomas. METHODS: Ten cases of Al-Mefty type III clival chordoma were treated via the transmaxillary approach and followed up for 34 months on average (10 approximately 56 months). RESULTS: Microscopic total removal of the tumors was achieved in 8 patients, and subtotal removal was achieved in the rest 2 patients. Three patients had tumor recurrence but still lived with tumors 26, 36, and 40 months after operation. The other 7 patients resumed their routine life without tumor. The postoperative complications included infection in 1 case that was cured by antibiotic therapy, postoperative obstructive dyspnoea in 1 case that required tracheostomy, and CSF leakage in 1 case that stopped spontaneously 3 weeks after operation. CONCLUSION: With better exposure, complete removal, and with less brain damages and satisfactory results, transmaxillary approach is effective for surgical treatment of Al-Mefty type III clival chordomas.

[Clinical analysis of 57 patients with poorly differentiated carcinomas of the supraglottic larynx].

OBJECTIVE: To investigate the clinical characteristics, treatment and prognosis for poorly differentiated supraglottic carcinomas. METHODS: A retrospective study was conducted in 57 cases of poorly differentiated supraglottic carcinomas treated in our hospital from 1980 to 1998. The distribution of the patients according to UICC in 1997 was as follows: stage I 4, stage II 15, stage III 18, stage IV 30. Of the 57 patients, 25 were treated with surgery alone, 9 with irradiation alone, 14 with surgery following preoperative radiation, 7 with postoperative radiation following surgery and 2 with surgery following preoperative chemotherapy. Total laryngectomy was performed on 23 patients and partial laryngectomy on 25 patients. The concurrent neck dissections were undergone for 31 cases (17 unilateral side, 14 bilateral side) and the upper neck dissections for 12 cases. RESULTS: The overall 5-year survival rate, accumulated cervical metastasis rate, metastasis rate of bilateral side of neck, distant metastasis rate, cervical recurrent rate and locally recurrent rate were 47.4% (27/57), 63.2% (36/57), 24.6% (14/57), 21.1% (12/57), 28.1% (16/57) and 10.5% (6/57), respectively. In addition, the local recurrent rate for partial laryngectomy was 12% (3/25). 5-year survival rate for each TNM staging decreases gradually. The difference in 5-year survival rate between T1 + T2 and T3 + T4 and the difference between N0 + N1 and N2 + N3 were statistically significant (chi2 = 4.942, P = 0.026; chi2 = 4.306, P = 0.038). No evidence in our analysis was found about the difference in 5-year survival rate between surgery alone and surgery combined with radiotherapy. The effect of surgery combined with radiotherapy on patients at N2 and N3 was relatively superior to that of surgery alone. CONCLUSIONS: Poorly differentiated carcinomas of the supraglottic larynx had characteristics of the advanced stage in terms of earlier lymph node metastasis and a relatively high rate of cervical and distant metastasis. Surgery was still the primary treatment for this disease and it was feasible to perform partial laryngectomy on certain patients. For patients with T3 who need partial laryngectomy and patients with advanced N stage, the combination of surgery with radiotherapy was supposed to be a priority.

[Gene expression of matrix metalloproteinase 14 in laryngeal squamous cell carcinoma].

OBJECTIVE: To investigate the role of expression of matrix metallo-proteinase 14 (MMP14) in laryngeal carcinomas and the relationship between MMP14 expression and the laryngeal biological behavior. METHODS: The gene expression differences of MMP14 between fresh laryngeal cancer tissues and their surrounding normal mucosa was analyzed by RT-PCR. The expression of MMP14 protein in paraffin-embedded tissues was determined immunohistochemically. All statistical analyses were performed by SPSS version 10.0. RESULTS: In the 33 cases of matched specimens, MMP14 gene expression was much higher in tumor tissues than that in surrounding ing normal tissues in 26 cases and lower in 2 cases, whereas in other 5 cases, no significant difference was observed between the cancer tissue and the surrounding normal tissue. MMP14 gene expression was not different in different stages in laryngeal glottic cancers, but correlated to the differentiation and lymph node metastasis (P < 0.05). There was correlation between MMP14 gene expression and the stage, differentiation and lymph node metastasis in the laryngeal supraglottic cancers (P < .05). MMP14 protein was localized predominantly in the carcinoma cell cytoplasm and in the stromal fibroblast cytoplasm, and weakly or not expressed in surrounding normal tissue. MMP14 protein expression was much higher in tumor tissue than that in surrounding normal tissue in most of the cases. In general, MMP14 protein expression was the same as MMP14 gene expression and related to the stage, differentiation and lymph node metastasis in the laryngeal cancers. There was no survival difference at 3, 5 and 7-year between the group with higher MMP14 protein expression in tumor tissues than surrounding normal tissues and the group with no difference of MMP14 protein expression (Log Rank, P=0.5535). CONCLUSIONS: The protein MMP14 may play role in laryngeal cancer invasion in a certain extent, but important role in lymph node metastasis of laryngeal cancer. The over-expression of MMP14 protein may be a marker for lymph node metastasis of laryngeal cancer.

[Diagnosis, treatment and prognostic factors of adenoid cystic carcinoma of the palate].

OBJECTIVE: To explore the clinical characteristics, diagnosis, treatment and prognosis of adenoid cystic carcinoma of the palate. METHODS: A retrospective review was conducted in 42 patients with adenoid cystic carcinoma of the palate treated in our hospital from 1967 to 1998. Statistical analysis was performed using the Kaplan-Meier method. Prognostic factors were analyzed by Log Rank test. RESULTS: The overall 5-, 10-, 15-year accumulative survival rates were 85.0%, 61.8% and 28.1%, and the 5-, 10-, 15-year accumulative disease-free survival rates were 52.4%, 32.7% and 22.4%, respectively. The 5-, 10-, 15-year accumulative local recurrence rates were 25.2%, 50.9% and 73.1%, and the 5-, 10-, 15-year accumulative distant metastasis rates were 28.5%, 50.4% and 66.0% respectively. T stage, bone invasion, extent of tumor, local recurrence and distant metastasis were significant prognostic factors. Treatment method, dose and area covered by radiotherapy were related to the prognosis. CONCLUSION: Surgery alone can be done for early lesions, and combination of surgery with radiotherapy should be adopted for advanced lesions in adenoid cystic carcinoma of the palate. Radiotherapic salvage could prolong the survival of the locally recurrent patients.

[Evaluation of sentinel lymph node in squamous cell carcinoma of the head and neck].

OBJECTIVE: To assess the feasibility of sentinel lymph node (SLN) radiolocalization in stage in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel lymph node could be prognostic of regional micrometastatic disease. METHODS: A prospective trial was made on the application sentinel lymph node radiolocalization in 10 patients with NO squamous cell carcinoma of the head and neck region. For each patient a peritumoral submucosal injection of filtered technetium 99m prepared with dextran colloid (99mTc-DX) was performed immediately. After 30 minutes, focal areas of accumulation corresponding to sentinel lymph nodes (SLN) were marked on the skin surface. The SLN was localized by lymphoscintigraphy and intraoperatively through the intact skin by a hand-held gamma-probe. SLN was defined as the count of lymph node could be detected 4 times more than that of background. Complete neck dissections were performed, and SLNs were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen. RESULTS: SLN radiolocalization accurately identified one or more SLNs in the ten cases. 3 of 10 cases revealed occult metastatic disease. Therefore the negative metastasis rate was 30% (3/10). The positive rate of SLN and nonsentinel lymph node (NSLN) were 22.7% (5/22) and 0.4% (1/247) respectively. Serial sectioning (SS) and immunohistochemical (IHC) on SLNs would reduce the false-negative rate of sentinel lymph node biopsy (SLNB). There was no instance in which SLN was negative for micrometastatic disease while being positive in a nonsentinel lymph node. CONCLUSIONS: SLN evaluation in NO neck in squamous cell carcinoma of the head and neck is accurately feasible and seems to adequately predict the presence of occult metastasis. Although SLN radiolocalization in head and neck squamous cell carcinoma may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined.