Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27
Filtrar
1.
PLoS One ; 13(6): e0198391, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29883463

RESUMO

BACKGROUND: Chemoradiotherapy (CRT) has improved organ preservation or overall survival (OS) of locoregionally advanced head and neck squamous cell cancer (LAHNSCC), but in clinical trials of conventional CRT, increasing CRT intensity has not been shown to improve OS. In the Adjuvant ChemoTherapy with S-1 after curative treatment in patients with Head and Neck Cancer (ACTS-HNC) phase III study, OS of curative locoregional treatments improved more with adjuvant chemotherapy with S-1 (tegafur gimeracil oteracil potassium) than with tegafur/uracil (UFT). ACTS HNC study showed the significant efficacy of S-1 after curative radiotherapy in sub-analysis. We explored the efficacy of S-1 after curative CRT in a subset of patients from the ACTS-HNC study. METHODS: Patients with stage III, IVA, or IVB LAHNSCC were enrolled in this study to evaluate the efficacy of S-1 compared with UFT as adjuvant chemotherapy after curative CRT in the ACTS-HNC study. Patients received S-1 at 80-120 mg/day in two divided doses for 2 weeks, followed by a 1-week rest, or UFT 300 or 400 mg/day in two or three divided doses daily, for 1 year. The endpoints were OS, disease-free survival, locoregional relapse-free survival, distant metastasis-free survival (DMFS), and post-locoregional relapse survival. RESULTS: One hundred eighty patients (S-1, n = 87; UFT, n = 93) were included in this study. Clinical characteristics of the S-1 and UFT arms were similar. S-1 after CRT significantly improved OS (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.22-0.93) and DMFS (HR, 0.50; 95% CI, 0.26-0.97) compared with UFT. CONCLUSION: As adjuvant chemotherapy, S-1 demonstrated better efficacy for OS and DMFS than UFT in patients with LAHNSCC after curative CRT and may be considered a treatment option following curative CRT. For this study was not preplanned in the ACTS-HNC study, the results is hypothesis generating but not definitive.


Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Ácido Oxônico/administração & dosagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/tratamento farmacológico , Tegafur/administração & dosagem , Adulto , Idoso , Antimetabólitos Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Esquema de Medicação , Combinação de Medicamentos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Ácido Oxônico/uso terapêutico , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Tegafur/uso terapêutico , Resultado do Tratamento , Uracila/administração & dosagem , Uracila/uso terapêutico
2.
Jpn J Clin Oncol ; 46(1): 51-6, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26491205

RESUMO

OBJECTIVE: To estimate selective neck irradiation omitting surgical Sublevel IIb. METHODS: Bilateral necks of 47 patients (94 necks) were subjected to definitive radiotherapy for supraglottic cancer. Sixty-nine and 25 necks were clinically node negative (cN-) and clinically node positive (cN+), respectively. We subdivided Sublevel IIb by the international consensus guideline for radiotherapy into Sublevel IIb/a, directly posterior to the internal jugular vein, and Sublevel IIb/b, which was behind Sublevel IIb/a and coincided with surgical Sublevel IIb. Bilateral (Sub)levels IIa, III, IV and IIb/a were routinely irradiated, whereas Sublevel IIb/b was omitted from the elective clinical target volume in 73/94 treated necks (78%). RESULTS: Two patients presented with ipsilateral Sublevel IIb/a metastases. No Sublevel IIb/b metastasis was observed. Five patients experienced cervical lymph node recurrence; Sublevel IIb/a recurrence developed in two patients, whereas no Sublevel IIb/b recurrence occurred even in the cN- necks of cN+ patients or cN0 patients. The 5-year regional control rates were 91.5% for Sublevel IIb/b-omitted patients and 77.8% for Sublevel IIb/b treated patients. CONCLUSIONS: Selective neck irradiation omitting Sublevel IIb/b did not compromise regional control and could be indicated for cN- neck of supraglottic cancer.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias Laríngeas/radioterapia , Linfonodos/patologia , Recidiva Local de Neoplasia/radioterapia , Adulto , Idoso , Feminino , Humanos , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Esvaziamento Cervical , Carcinoma de Células Escamosas de Cabeça e Pescoço , Resultado do Tratamento
3.
Gastrointest Endosc ; 82(6): 1002-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26234696

RESUMO

BACKGROUND AND AIMS: Although endoscopic submucosal dissection (ESD) has been applied for superficial pharyngeal cancer, no prospective trials have been reported. To investigate the efficacy and safety of ESD for superficial pharyngeal cancer, we conducted a prospective phase II trial. METHODS: Fifty-four patients with 73 lesions were enrolled from September 2010 to August 2014, and ESD was performed. The primary endpoint was the complete resection rate. Secondary endpoints were safety, recurrence-free survival, overall survival, and incidence of metachronous pharyngeal cancer. RESULTS: Fifty-four patients had stage 0-III cancer: stage 0, n = 22; stage I, n = 14; stage II, n = 17; and stage III, n = 1. The en bloc resection rate was 100%, and the complete resection rate was 79.5% (58/73 lesions; 95% confidence interval, 68%-88%). No serious adverse events related to ESD were encountered. Four patients required nasogastric intubation and feeding. No patients required percutaneous endoscopic gastrostomy and tracheotomy. Swallowing, speech, and airway functions were preserved in all patients. One of the 54 patients died of an unrelated illness. Median follow-up was 27 months (range 6-55 months). Local cervical lymph node metastasis was observed in 1 patient, and the case was salvaged successfully with lymph node dissection. The 3-year overall and recurrence-free survival rates were 97.7% and 98.1%, respectively. Cumulative development of multiple cancers of the pharynx at 3 years was 18.4%. CONCLUSIONS: ESD appears to be a safe and effective minimally invasive treatment in patients with superficial pharyngeal cancer. ( CLINICAL TRIAL REGISTRATION NUMBER: UMIN000003623.).


Assuntos
Carcinoma de Células Escamosas/cirurgia , Dissecação/métodos , Endoscopia/métodos , Neoplasias Faríngeas/cirurgia , Mucosa Respiratória/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/mortalidade , Estudos Prospectivos , Análise de Sobrevida , Resultado do Tratamento
4.
PLoS One ; 10(2): e0116965, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25671770

RESUMO

BACKGROUND: We conducted a phase III study to evaluate S-1 as compared with UFT as control in patients after curative therapy for stage III, IVA, or IVB squamous-cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Patients were randomly assigned to the UFT group (300 or 400 mg day-1 for 1 year) or the S-1 group (80, 100, or 120 mg day-1 for 1 year). The primary end point was disease-free survival (DFS). Secondary end points were relapse-free survival, overall survival (OS), and safety. RESULTS: A total of 526 patients were enrolled, and 505 were eligible for analysis. The 3-year DFS rate was 60.0% in the UFT group and 64.1% in the S-1 group (HR, 0.87; 95%CI, 0.66-1.16; p = 0.34). The 3-year OS rate was 75.8% and 82.9%, respectively (HR, 0.64; 95% CI, 0.44-0.94; p = 0.022). Among grade 3 or higher adverse events, the incidences of leukopenia (5.2%), neutropenia (3.6%), thrombocytopenia (2.0%), and mucositis/stomatitis (2.4%) were significantly higher in the S-1 group. CONCLUSIONS: Although DFS did not differ significantly between the groups, OS was significantly better in the S-1 group than in the UFT group. S-1 is considered a treatment option after curative therapy for stage III, IVA, IVB SCCHN. TRIAL REGISTRATION: ClinicalTrials.gov NCT00336947 http://clinicaltrials.gov/show/NCT00336947.


Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Ácido Oxônico/uso terapêutico , Tegafur/uso terapêutico , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Quimioterapia Adjuvante , Combinação de Medicamentos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Ácido Oxônico/efeitos adversos , Segurança , Carcinoma de Células Escamosas de Cabeça e Pescoço , Tegafur/efeitos adversos , Resultado do Tratamento
5.
Head Neck ; 37(4): 537-42, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24715544

RESUMO

BACKGROUND: The purpose of this retrospective analysis was to evaluate ocular function and survival rates among treatment modalities in patients with maxillary sinus cancer with orbital invasion. METHODS: Eighty-seven patients were classified according to the main treatment modality. Ocular function preservation rates and survival rates were evaluated for each therapeutic modality. RESULTS: The 5-year overall survival rate for the en bloc resection, conservative surgery, superselective intra-arterial chemotherapy, and radiotherapy (RADPLAT), intravenous chemoradiotherapy (IV-CRT) was 70%, 35%, 49%, and 31%, respectively. The ocular function preservation rate for each group was 15%, 27%, 30%, and 17%, respectively. In the en bloc resection group, there was no significant difference in the 5-year overall survival rate between patients with orbital exenteration and those without orbital exenteration (72% vs 71%; p = .9321). CONCLUSION: The en bloc resection group showed a favorable survival rate but a low preservation rate. Preservation of orbital contents did not reduce the survival rate.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Olho/fisiopatologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Neoplasias do Seio Maxilar/terapia , Órbita/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Quimiorradioterapia , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Infusões Intra-Arteriais , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Neoplasias do Seio Maxilar/mortalidade , Neoplasias do Seio Maxilar/patologia , Neoplasias do Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Exenteração Orbitária , Neoplasias Orbitárias/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço
6.
Nihon Jibiinkoka Gakkai Kaiho ; 117(7): 907-13, 2014 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-25158560

RESUMO

A retrospective analysis of 263 patients with previously untreated squamous cell carcinoma of the tongue between 2000 and 2010 was performed. Those patients, who received preoperative chemotherapy, had a history of head and neck cancer or had previously received radiotherapy for the other disease, were excluded. All patients underwent a surgical procedure as a part of the initial treatment. Patients with close or microscopically involved margins of resection, INF (Infiltrative growth pattern) gamma or at least two involved nodes were classified as high risk patients. Postoperative radiotherapy (PORT) was undertaken for the high risk patients. After a median follow-up of 72 months, the 5-year overall survival and 5-year cause-specific survival were as follows: 79.1%, 85.0% in all stages, 82.7%, 91.2% in Stage I (n = 76), 86.7%, 89.0% in Stage II (n = 98), 71.5%, 78.6% in Stage III (n = 57), and 61.5%, 69.1% in Stage IV (n = 32). Patients without high risk features had significantly higher overall survival rate than those in the case of high risk patients, despite receiving no PORT. For high risk patients, PORT significantly improved the locoreginal control rate, but the overall survival rate did not improve.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Neoplasias da Língua/radioterapia , Neoplasias da Língua/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Recidiva , Estudos Retrospectivos , Neoplasias da Língua/mortalidade , Resultado do Tratamento , Adulto Jovem
7.
Oral Oncol ; 50(7): 657-61, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24726547

RESUMO

BACKGROUND: The current study sought to assess the role of initial neck dissection (ND) for patients with node-positive oropharyngeal squamous cell carcinomas (OPSCC). METHODS: The data for 202 patients with previously untreated node-positive OPSCC were gathered from 12 institutions belonging to the Head and Neck Cancer Study Group in the Japan Clinical Oncology Group. These patients were categorized into two groups, consisting of the initial ND group and the wait-and-see group, according to treatment policy. RESULTS: Regional recurrence was observed in 17 of 93 patients undergoing initial ND, whereas, recurrent or persistent diseases were observed in 40 of 109 patients who did not undergo initial ND. The 4-year overall survival rates (OS) for the wait-and-see group and initial ND groups were 74.0% and 78.7%, respectively, and the 4-year regional control rates (RC) for each group were 77.6% and 84.9%. There were no significant differences in either OS or RC (p=0.3440 and p=0.2382, respectively). However, for patients with N3 disease, the 4-year OS of the initial ND group (100%) was favorable. For patients with N2a disease, the 4-year RC of the initial ND group was higher than that of the wait-and-see group statistically (100% vs 62.5%, p=0.0156). CONCLUSIONS: The role of initial ND was limited in patients with node-positive OPSCC. The treatment strategy not involving initial ND is considered feasible and acceptable when nodal evaluation after definitive radiotherapy or chemoradiotherapy is applied adequately. However, it is possible that initial ND improves outcomes in patients with resectable large-volume nodal disease.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Linfonodos/cirurgia , Esvaziamento Cervical/métodos , Recidiva Local de Neoplasia/mortalidade , Neoplasias Orofaríngeas/mortalidade , Carcinoma de Células Escamosas/secundário , Feminino , Humanos , Metástase Linfática , Masculino , Neoplasias Orofaríngeas/patologia , Taxa de Sobrevida , Resultado do Tratamento
8.
Ann Surg Oncol ; 21(5): 1706-10, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24554063

RESUMO

BACKGROUND: The purpose of this study was to evaluate the incidence of lymph node metastasis among patients with T4 maxillary sinus squamous cell carcinoma (MS-SCC) as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. METHODS: Consecutive series of all patients (n = 128) with previously untreated T4 maxillary sinus SCC between 2006 and 2007 were obtained from 28 institutions belonging to or cooperating in the Head and Neck Cancer Study Group of the Japan Clinical Oncology Group. RESULTS: Of the 128 patients, 28 (21.9 %) had lymph node metastasis, and six patients (4.7 %) had distant metastasis at diagnosis. Among the 111 patients who were treated with curative intent, 98 had clinically N0 neck disease and did not receive prophylactic neck irradiation. A total of 11 patients (11.2 %) subsequently developed evidence of lymph node metastasis, of whom eight were among the 83 patients with an N0 neck and had not received elective neck treatment. There were 15 patients who received an elective neck dissection as part of the initial treatment, of whom three had pathologically positive for lymph node metastases. Of 11 patients, six patients with nonlateral retropharyngeal lymph node metastasis without primary or distant disease were successfully salvaged. CONCLUSIONS: This study identified the incidence of lymph node metastasis among patients with T4 MS-SCC as well as the delayed metastasis rate and the treatment outcome for untreated N0 neck in patients with T4 MS-SCC. These results will be of assistance in selecting treatment strategy for T4 MS-SCC in the future.


Assuntos
Carcinoma de Células Escamosas/epidemiologia , Linfonodos/patologia , Seio Maxilar/patologia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias dos Seios Paranasais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Esvaziamento Cervical , Gradação de Tumores , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Prognóstico , Estudos Retrospectivos
9.
Head Neck ; 36(11): 1567-72, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23996685

RESUMO

BACKGROUND: We analyzed the effects of local extension sites on survival in patients with locally advanced maxillary sinus cancer. METHODS: The criteria for inclusion in this study were as follows: (1) previously untreated maxillary sinus cancer; (2) squamous cell carcinoma; (3) T4 disease; and (4) curative-intent treatment. The data for 118 patients were obtained from 28 institutions across Japan and analyzed for overall survival and local control rates by local extension site. RESULTS: Sites with a poor prognosis included the cribriform plate, dura, nasopharynx, middle cranial fossa, and cranial nerves other than V2. There was a significant correlation among these sites, except for the cranial nerves. Additionally, the hard palate was the only site that correlated with nodal involvement and showed a poor treatment outcome. CONCLUSION: Even in cases presenting with similar T4 maxillary sinus cancer, treatment should be performed in consideration of the local extension site.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Neoplasias do Seio Maxilar/mortalidade , Neoplasias do Seio Maxilar/patologia , Seio Maxilar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Distribuição de Qui-Quadrado , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Neoplasias do Seio Maxilar/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
10.
Surg Today ; 44(8): 1569-72, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23907356

RESUMO

Boerhaave's syndrome is still associated with a high mortality rate and remains a therapeutic challenge. Pharyngo-laryngo-esophagectomy is performed as the standard treatment for advanced hypopharyngeal cancer and tracheoesophageal speech is an option for esophageal speech rehabilitation. We report what, to our knowledge, is the first case of Boerhaave's syndrome developing in a tracheoesophageal speaker.


Assuntos
Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Doenças do Mediastino/etiologia , Doenças do Mediastino/cirurgia , Voz Esofágica , Esofagectomia , Humanos , Neoplasias Hipofaríngeas/reabilitação , Neoplasias Hipofaríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Faringectomia , Procedimentos de Cirurgia Plástica , Fatores de Tempo , Resultado do Tratamento
13.
Oncology ; 84(5): 290-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23485940

RESUMO

OBJECTIVE: The current study aimed to compare the therapeutic outcomes of surgery with those of chemoradiation for patients with advanced oropharyngeal cancer (OPC). METHODS: The data for 523 patients with previously untreated OPC were obtained from 12 institutions belonging to the Head and Neck Cancer Study Group in the Japan Clinical Oncology Group from April 2005 to March 2007. In this study, we matched a group of patients who underwent surgery with a second group treated with chemoradiation according to age, gender, subsite, and T and N classification, and analyzed the overall survival, progression-free survival, local control and swallowing function. RESULTS: The final matched-pair analysis included 186 patients. The 5-year overall survival, progression-free survival and local control rates were 69.8 and 71.4% (p = 0.762), 51.0 and 54.4% (p = 0.531), and 75.2 and 80.3% (p = 0.399), respectively, in patients treated with surgery and those treated with chemoradiation. Swallowing function in patients treated with chemoradiation was significantly better than that in patients treated with surgery (p = 0.015). CONCLUSION: Although this study was not randomized, this matched-pair analysis of patients treated with surgery or chemoradiation showed that chemoradiation is as effective as surgery in the treatment of OPC.


Assuntos
Quimiorradioterapia/métodos , Neoplasias Orofaríngeas/tratamento farmacológico , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Modelos Estatísticos , Modelos de Riscos Proporcionais , Projetos de Pesquisa , Fatores de Tempo , Resultado do Tratamento
14.
Head Neck ; 35(9): 1248-54, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22941930

RESUMO

BACKGROUND: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been introduced for the treatment of superficial pharyngeal cancer. METHODS: Sixty superficial pharyngeal cancers in 45 patients were treated by EMR or ESD. Resectability and curability, complications, and survival were analyzed retrospectively. RESULTS: The en bloc resection and curative resection rate were higher with ESD (100; 81.6%) than with EMR (59; 50%). In subgroup analysis with regard to tumor size ≤ 10 mm, both resection rates were comparative. All the patients had preserved larynx and swallowing, speech, and airway function. Two of the 45 patients died of other diseases, local recurrence was observed in 4 of 18 patients with noncurative resection with a median observation period of 38 months. No recurrence was observed in patients with curative resection. CONCLUSIONS: ESD or EMR for superficial pharyngeal cancer is minimally invasive treatment and lesions larger than 10 mm should be referred for ESD.


Assuntos
Carcinoma in Situ/cirurgia , Endoscopia do Sistema Digestório/métodos , Neoplasias Faríngeas/cirurgia , Idoso , Carcinoma in Situ/mortalidade , Carcinoma in Situ/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Faríngeas/mortalidade , Neoplasias Faríngeas/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
15.
Int J Clin Oncol ; 18(5): 817-23, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22829207

RESUMO

BACKGROUND: The current study aimed to assess the role of salvage surgery for failure cases of oropharyngeal cancer (OPC) undergoing initial chemoradiotherapy (CRT). METHODS: The data for 523 patients with previously untreated OPC were gathered from 12 institutions belonging to the Head and Neck Cancer Study Group in Japan Clinical Oncology Group (JCOG). RESULTS: Of the 170 patients who received CRT, 35 patients (21%) had local recurrence or residual disease. Only 11 patients underwent further salvage surgery, and 24 patients received nonsurgical treatment. There were statistically significant differences between the two groups in terms of patient age and the presence of a simultaneous regional recurrence. The 5-year overall survival rates for the patients who underwent salvage surgery were 49.1%, whereas those for the patients who received nonsurgical treatment were 16.3%. CONCLUSION: The initial treatment method for OPC should be decided carefully and the limitations of salvage surgery should be fully considered.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Orofaríngeas/cirurgia , Terapia de Salvação , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasia Residual/patologia , Neoplasia Residual/terapia , Neoplasias Orofaríngeas/tratamento farmacológico , Neoplasias Orofaríngeas/patologia , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento
16.
Nihon Jibiinkoka Gakkai Kaiho ; 115(10): 902-9, 2012 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-23214048

RESUMO

Concurrent chemoradiotherapy (CCRT) has been widely used in organ preservation for advanced head and neck squamous cell carcinoma. Malnutrition, one of the most detrimental side effects concerned with CCRT, occurs frequently in patients with CCRT, but few studies have reported on the nutritional status in detail during CCRT. The aim of this study was to evaluate the changes in the nutritional status during CCRT compared with radiotherapy alone (RT). We introduce hypopharyngeal cancer patients as the subjects that include 26 cases who underwent CCRT with high dose cisplatin (80 mg/m2 x 3: goal 240 mg/m2 in total) and also 26 cases who underwent RT during the same period. For evaluation, we examined the rate of body weight change, serum albumin, total lymphocyte counts and hemoglobin. In this context, the rate of body weight change is the most reliable indicator, and the rate of change at the end of treatment as compared to before the start of treatment was 3.8% in patients treated with RT and 8.1% in patients treated with CCRT. This result suggests that improvement in nutritional status is necessary when considering patients undergoing CCRT. However, regarding completion of treatment, when radiotherapy was not interrupted due to adverse events the median total dose of cisplatin of 240 mg/m2 seemed satisfactory. In addition, regarding the route for energy intake, tube feeding was required only in 2 patients (7.7%) in the RT group and 4 patients (15.4%) in the CCRT group, and no significant difference was found between them. Therefore, percutaneous endoscopic gastrostomy (PEG) for CCRT in advance would be unnecessary at least for hypopharyngeal cancer patients.


Assuntos
Antineoplásicos/uso terapêutico , Quimiorradioterapia/métodos , Cisplatino/uso terapêutico , Neoplasias de Cabeça e Pescoço/terapia , Avaliação Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante/métodos , Resultado do Tratamento , Redução de Peso
17.
Jpn J Clin Oncol ; 42(6): 491-7, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22547728

RESUMO

OBJECTIVE: Hot spots of F-18 fluorodeoxyglucose positron emission tomograms are variable in size according to window settings of standardized uptake values. The purpose of this study was to determine the standardized uptake value threshold that represents the target volume. METHODS: Sixty-three patients who underwent fluorodeoxyglucose positron emission tomographic computed tomography and were diagnosed as having head and neck cancer with cervical lymphadenopathy were studied. The horizontal and vertical diameters of metastatic lymph nodes (LN-CT) were measured at the center of computed tomographic images. Of the corresponding nodes, the maximal standardized uptake value (SUVmax) and standardized uptake value profiles along the central horizontal and vertical axes were calculated on positron emission tomographic images (LN-PET). On the standardized uptake value profiles, the standardized uptake value levels (SUVeq) where the size of LN-PET was equivalent to the diameters of LN-CT were obtained. The regression formula between SUVeq and SUVmax was obtained. The regression formula of SUVeq was validated in subsequent 30 positron emission tomographic computed tomography studies. RESULTS: The mean horizontal and vertical diameters of LN-CT were 14.9 and 16.4 mm, respectively. SUVmax ranged from 1.88 to 9.07, and SUVeq was between 1.16 and 6.42. The regression formula between SUVeq and SUVmax was as follows: SUVeq = 1.21 + 0.34 × SUVmax (coefficient of correlation: R = 0.69). The validation study resulted in a good correlation between the volume of lymph nodes on computed tomography and positron emission tomographic computed tomography (R(2) = 0.93). CONCLUSIONS: The formula with a relatively high coefficient of correlation is considered to indicate that SUVeq is not constant, but is a complex of an absolute standardized uptake value and is proportional to SUVmax.


Assuntos
Fluordesoxiglucose F18/metabolismo , Neoplasias de Cabeça e Pescoço/metabolismo , Neoplasias de Cabeça e Pescoço/patologia , Linfonodos/metabolismo , Linfonodos/patologia , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/metabolismo , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Modelos Lineares , Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Pescoço , Reprodutibilidade dos Testes
18.
Int J Clin Oncol ; 17(4): 390-4, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21830085

RESUMO

Myxofibrosarcoma (MFS) is a very rare fibroblast-derived sarcoma that occurs in the head and neck region. Here, we report the case of a 52-year-old man in whom MFS generated from the maxilla and whose beginning of treatment was considerably delayed because he was initially diagnosed as having a benign inflammatory lesion. Because a definite diagnosis was not obtained via 2 independent biopsies, total maxillectomy was used for both diagnosis and treatment. Histopathological and immunohistochemical analyses suggested that the tumor was a low-grade MFS. Because soft tissue tumors in the head and neck region are rare and a definite diagnosis is relatively difficult, surgical excision is indispensable if malignancy of the tumor is suspected.


Assuntos
Fibroma , Fibrossarcoma , Neoplasias de Cabeça e Pescoço , Fibroma/diagnóstico , Fibroma/patologia , Fibroma/cirurgia , Fibrossarcoma/diagnóstico , Fibrossarcoma/patologia , Fibrossarcoma/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório
19.
Int J Radiat Oncol Biol Phys ; 82(2): e129-35, 2012 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-21640496

RESUMO

PURPOSE: To analyze the outcome in T1-2 hypopharyngeal cancer (HPC) patients treated with definitive radiotherapy (RT). PATIENTS AND METHODS: A total of 103 patients with T1-2 hypopharyngeal squamous cell carcinoma treated with radical RT between March 2000 and June 2008 at our institution were analyzed. Pre-RT neck dissection (ND) was performed in 26 patients with advanced neck disease. Chemotherapy was used concurrently with RT in 14 patients. Sixty patients were associated with synchronous or metachronous malignancies. The median follow-up for surviving patients was 41 months. RESULTS: The 3-year overall and cause-specific survival rates were 70% and 79%, respectively. The 3-year local control rates were 87% for T1 and 83% for T2 disease. The ultimate local control rate was 89%, including 7 patients in whom salvage was successful. The ultimate local control rate with laryngeal preservation was 82%. Tumors of the medial wall of the pyriform sinus tended to have lower control rates compared with tumors of the lateral or posterior pharyngeal wall. Among patients with N2b-3 disease, the 3-year regional control rates were 74% for patients with pre-RT ND and 40% for patients without ND. The 3-year locoregional control rates were as follows: Stage I, 100%; Stage II, 84%; Stage III, 67%; Stage IVA, 43%; Stage IVB, 67%. Forty-two patients developed disease recurrence, with 29 (70%) patients developing recurrence within the first year. Of the 103 patients, 6 developed late complications higher than or equal to Grade 3. CONCLUSIONS: Definitive RT accomplished a satisfactory local control rate and contributed to organ preservation.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Hipofaríngeas/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Quimiorradioterapia/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/patologia , Neoplasias Hipofaríngeas/terapia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/métodos , Dosagem Radioterapêutica , Terapia de Salvação/efeitos adversos , Terapia de Salvação/métodos , Taxa de Sobrevida , Resultado do Tratamento
20.
Acta Radiol ; 52(9): 951-3, 2011 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-21828002

RESUMO

Ascending pharyngeal-vertebral anastomosis has been identified by angiography of the carotid artery in several cases. We present a case of ascending pharyngeal-vertebral anastomosis that was found incidentally in computed tomography angiography of the ascending pharyngeal artery. Images revealed that the anastomosis formed through the hypoglossal branch of the neuromeningeal trunk. The anastomosis seemed to be associated with hypoplasia of the right vertebral artery. Interventional radiologists should be aware of this dangerous anastomotic route of the APA to the VA. Discovery of hypoplasia of the major intracranial arteries before intra-arterial chemotherapy or embolization in head and neck area may avoid subsequent complications.


Assuntos
Angiografia , Faringe/irrigação sanguínea , Tomografia Computadorizada por Raios X , Artéria Vertebral/anormalidades , Artéria Vertebral/diagnóstico por imagem , Malformações Arteriovenosas/diagnóstico por imagem , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...