Advanced stage laryngeal chondrosarcoma

Chondrosarcoma is a tumor very seldom encountered in the larynx. In this location chondrosarcomas have typical features: slow growing, metastasis rares and scarce tendency to recur. But recurrences occurs at long-term and often can be controlled. We report a case diagnosed and treated in our Hospital which, on the contrary, recurrences presented in a short-term after first surgical removal. Clinical management and treatment of these neoplasms are reviewed.     

Increasing incidence of advanced stage head and neck tumours

The aim of this study was to determine whether the incidence of advanced stage (T4) head and neck tumours has increased. We analysed retrospectively 3178 patients diagnosed with oral, pharyngeal or laryngeal cancer in the period 1980-2000 at the University Medical Center Utrecht (UMCU), The Netherlands. There was a statistically significant increase in the proportion of T4 head and neck tumours compared with non-T4 tumours over the period 1980-2000. Linear regression analysis estimated an increase of 0.9% every year. The observed increase in T4 tumours at UMCU shows up in figures from the Netherlands Regional Cancer Registry (IKMN) and the National Cancer Registration (NCR). Although these bodies report for fewer years, this finding refutes the possibility of selected referral to the University Medical Center Utrecht. In conclusion, the number of head and neck cancer patients presenting with an advanced stage carcinoma (T4) has increased over a period of 21 years.     

Juvenile nasopharyngeal angiofibroma: stage and surgical approach

Juvenile nasopharyngeal angiofibromas (JNAs) are benign tumors that occasionally invade the pterygopalatine fossa, infratemporal fossa, or middle cranial fossa. Several surgical approaches have been used based on the location of the tumor, including transpalatal, transmaxillary, and lateral rhinotomy, midfacial degloving, and Le Fort type I osteotomy. We reviewed 4 cases of JNA that had been treated by resection in the Department of Otolaryngology of Kagoshima City Hospital and 31 cases of JNA reported in the Japanese literature between 1990 and 2003. We analyzed the outcome of the surgical treatment of JNA in these cases to identify the surgical approaches that were most effective in removing tumors at several different stages. Radkowski staging showed that 17 (48.6%), 2 (5.7%), 4 (11.4%), 9 (25.7%) and 3 (8.6%) patients had stage IA, IB, IIA, IIC, and IIIA tumors, respectively. A transpalatal approach was employed in 11 cases (31.4%), a transmaxillary approach in 9 cases (25.7%), a transnasal approach in 6 cases (17.1%), and other approaches, (25.7%). The recurrence rate was, 5% in the stage I cases, 38% in the stage II cases, and 33% in the stage III cases. The transpalatal approach was followed by a high recurrence rate in the cases of stage II and higher stage. Several factors are critical when choosing the surgical approach to JNA: adequate exposure of the tumor, ability to control bleeding, prevention of postoperative facial deformity, and avoidance of interference with growth of the face.     

头颈晚期肿瘤的围手术期放射治疗

恶性肿瘤的综合治疗开始在上世纪50年代。这是因为经过20世纪前50年的治疗探索，肿瘤医师们发现，手术或深部X线的单一治疗手段难以有效控制肿瘤。1956年^60Co治疗机的出现，使放疗进入高能射线时代，3cm以上实体瘤的放疗治愈率提高，肿瘤周边正常组织及皮下组织受量的下降，使得晚期肿瘤可以应用放疗加手术的综合治疗。20世纪前50年，肿瘤外科原则是：牺牲患癌器官来获取生存率。到50年代，已经有人用肿瘤局部切除加放疗以缩小手术范围，保存器官功能。到60年代，肿瘤化学药物治疗在临床应用成熟，补充了综合治疗手段。虽然当前免疫治疗或生物治疗或基因治疗已经在临床应用，也有几十年的经验，但对头颈肿瘤来说，尚无可供临床应用的根治性措施。临床报告化疗的应用、不论单独或联合，对头颈部实体瘤有一定作用，但还没有如放疗或手术的根治效果，尚不作为常规应用。对于晚期肿瘤或低分化肿瘤，加用化疗可以起到辅助作用。     

鼻息肉中嗜酸性粒细胞浸润和活化状况的研究

目的 :观察鼻息肉组织中嗜酸性粒细胞浸润和活化状况 ,探讨嗜酸性粒细胞在鼻息肉发病机制中的作用。方法 :16例鼻息肉组织标本 ,采用组织化学染色 Chromotrope 2R染色法 ,标记鼻息肉组织中的嗜酸性粒细胞 ,结合应用嗜酸性粒细胞阳离子蛋白抗体EG2 的免疫组织化学染色结果 ,观察鼻息肉中嗜酸性粒细胞的浸润和活化状况。结果 :①鼻息肉组织中有较多嗜酸性粒细胞浸润 ,且多处于活化状态 ;②变应性患者鼻息肉组织中EG2 阳性细胞密度、Chromotrope 2R阳性细胞的密度及嗜酸性粒细胞活化比率 ,分别与非变应性患者相比较 ,均无显著性差异 (P >0 .0 5 )。结论 :①Chromotrope 2R特染法结合应用EG2 抗体的免疫组化染色法简便易行 ,适合临床应用观察鼻息肉中嗜酸性粒细胞的浸润和活化状况 ;②活化嗜酸性粒细胞在鼻息肉的发病机制中可能起重要作用。     

颌骨放射性骨坏死的临床分期和治疗程序

颌骨放射性骨坏死是头颈恶性肿瘤放射治疗的严重并发症,临床治疗十分困难。本文系统地总结了22例颌骨放射性骨坏死病例,提出临床分期和三阶段治疗程序。22例中3例因肿瘤局部复发停止治疗;5例经第一阶段治疗达到临床治愈;14例经三阶段的系统治疗后4例好转,10例临床治愈。作者认为,对颌骨放射性骨坏死的手术治疗应持积极态度,为保证手术的成功,术前术后有计划的进行高压氧治疗是必不可少的;手术成功的关键在于扩大截骨术,截骨范围应包括硬化区;抗感染＋高压氧治疗－扩大截骨术－术后高压氧治疗是颌骨放射性骨坏死较合理的治疗程序。     

Epidermoid carcinoma larynx in stage IV

ObjectiveTo determine the survival, loco-regional control, distant metastases and second primary in stage IV laryngeal carcinoma treated by surgery and radiotherapy.MaterialRetrospective study of 147 patients treated with surgery and radiotherapy with a 5 year minimun follow-up.ResultsOverall and cause specific survival at 5 and 10 years was 42%, 35% and 49%, 45.8% respectively. Loco-regional control was 57.7 % and 54.7% at 5 and 10 years. Local recurrences presented in 25.7%, regional recurrences in 74.2%, and distant metastases 10.9%. Second primary tumors developed in 12% of the patients, 50% of the cases in the lungs. Factors related to survival are evaluated.ConclusionsIn our experience, surgery with postoperative radiotherapy in N+, controls 45% of stage IV laryngeal carcinoma. Regional recurrencies are the main cause of failure, more frequent in N+ patientes, present in the first 36 months after treatment.     

下咽及颈胸段食管多原发癌一期手术

目的 探讨下咽、颈胸段食管多原发癌（multiple primary carcinoma,MPC）在胸腔镜辅助下行全喉、下咽、食管切除并管状胃重建一期手术的应用及疗效。方法 胸科组行胸腔镜辅助下分离食管及纵膈淋巴结清扫后开腹行管状胃成形,头颈组行颈部淋巴结清扫、全喉下咽切除、咽胃吻合术。术后常规补充放化疗。结果 本组全部病例均一期完成手术,肺部感染3例,胸腔积液2例、气管撕裂1例;无吻合口瘘及围手术期死亡病例;3年生存率63.6%,5年生存率50.0%。结论 下咽癌应常规行胃镜检查以免MPC的漏诊;胸腔镜辅助下全喉、下咽、食管切除并管状胃重建术可一期完成以往分次手术难以完成的手术治疗,有效提高下咽颈胸段食管多重癌的治疗效果。     

Blood transfusion and outcome in stage III head and neck carcinoma

Treatment outcome was correlated retrospectively with blood transfusions received in 179 surgical patients with stage III squamous cell carcinoma of the head and neck. Seventy-three percent of patients requiring no blood transfusion survived three years with no evidence of disease (NED). By comparison, patients receiving 3 or 4 U of transfused blood experienced a 47% three-year NED survival. Patients receiving 5 U or more of blood perioperatively experienced a 40% two-year NED survival. Seventy patients underwent surgery and postoperative radiation therapy. Life-table analysis demonstrated statistically significant differences in survival for patients who received 2 U or fewer of blood when compared with patients who received more than 2 U. These differences were not present in patients having surgery subsequent to previous radiation therapy or surgery alone. Blood transfusion may be detrimental to the management of patients with malignant neoplasms. The mechanisms through which blood transfusion affects malignant neoplasm is unknown.