Treatment Effects in Patients with Squamous Cell Carcinoma of the Oral Cavity

A total of 221 patients (155 males, 66 females; stage I, n ¾ 55; stage II, n ¾ 58; stage III, n ¾ 57; stage IV, n ¾ 51) with squamous cell carcinoma of the oral cavity were studied. Tumor localization was as follows: cancer of the tongue, n ¾ 161; cancer of the oral floor, n =28; cancer of the hard palate, n ¾ 12; cancer of the buccal mucosa, n ¾ 11; and cancer of the gingiva, n ¾ 9. In order to compare the effect of different treatments, three major treatment groups were defined, namely a surgery group, a radiotherapy group and a combination treatment group. Five-year cumulative survival rates showed significant differences between stage classifications (stage I=91%, stage II=73%, stage III=63%, stage IV=47%; p <0.01) but not between tumor sites. The 5-year cumulative survival rate was highest for oral floor cancer (80%). In the early-cancer group, the 5-year cumulative survival rate for the surgery group (92%) was significantly higher ( p <0.05) than those for both the radiation (69%) and combination (71%) groups. In the advanced-cancer group, the 5-year cumulative survival rate for the surgery group (74%) was significantly higher ( p <0.05) than those for both the radiation (37%) and combination (51%) groups. No significant difference in regional control rates was observed between the treatment groups. Five-year regional control rates were 86% for cervical untreated patients with T1N0 tumors and 60% for cervical untreated patients with T2N0 tumors. Fourteen N0 cases were treated with neck dissection. Cervical metastasis was found pathologically in 2/14 (14%) of these cases. The 5-year survival rate for patients with cervical recurrences after primary tumor resection was 70% ( n ¾ 15). In contrast, the 5-year survival rate for patients with both primary tumor resection and neck dissection was 74% ( n ¾ 14) but no significant difference was observed between these 2 groups.rate .     

Free Flap Reconstructions in the Management of Oral and Pharyngeal Cancer

Fifty patients who had undergone microvascular free flap reconstruction of the oral cavity or pharynx for malignancy between 1989 and 1995 were retrospectively analysed to find factors predicting postoperative complications and outcomes. The mean follow-up time was 2.6 years. More than half (26/50) of the patients had a stage IV malignancy and 10 patients had a recurrent tumour. The overall flap success rate, with 2 flap losses, was 96%. Postoperative medical complications occurred in 29/50 (58%) cases. The recipient site of 10/50 (20%) flaps required re-exploration. Mortality was 2%, with 1 death occurring within 30 days. The mean survival rate after the microvascular operation was 1.6 years, and the 3- and 5-year survival rates were 42% and 23%, respectively. Patients with an oropharyngeal tumour seemed to have the best prognosis and those with a hypopharyngeal tumour the poorest. Men had a threefold greater risk of dying within &lt;1 year postoperatively compared with women. Tumour stage was the strongest attribute influencing survival. The risk of death after the microvascular procedure increased 2.8-fold when the stage advanced from II to III or from III to IV. None of the tested variables alone could predict complications.     

Treatment Outcomes and Quality of Life in Oropharyngeal Cancer after Surgery-based versus Radiation-based Treatment

Objectives

Advances in reconstruction and conservative surgery and the importance of quality of life (QOL) encouraged this reevaluation of surgery-based treatments for oropharyngeal cancer. We tried to compare treatment outcome and QOL after surgery-based versus radiation-based treatment in oropharyngeal cancer.

Methods

The 133 eligible patients were divided into surgery-based and radiotherapy (RT)-based treatment groups. Medical records were reviewed, and EORTC QLQ-C30 and HN65 questionnaires were completed for survivors. Three-year overall survivals, disease-free survivals, locoregional control rates, and QOL scores were compared between the two groups.

Results

Demographic data and overall stages were not significantly different between the two groups, and all survival rates were non-significantly different, either. The scores for most QOL items were equivalent, however, for a few items, scores were significantly better in surgery-based group.

Conclusion

The surgery-based group achieved equivalent treatment outcomes and slightly better QOL scores than the RT-based group. The results of this study suggest that surgery could still be considered as a first-line therapy for oropharyngeal cancer.     

Oropharyngeal trauma mimicking a first branchial cleft anomaly

We present a unique and challenging case of a remnant foreign body that presented to us in a child disguised as a strongly suspected congenital branchial cleft anomaly. This case entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case. Laryngoscope, 126:E224–E226, 2016     

Oropharyngeal atresia in a preterm infant: a case report and review of the literature

Oropharyngeal atresia is a rare and often fatal condition that presents soon after birth with severe respiratory distress. We present a case of a premature infant who initially was suspected to have tracheo-esophageal atresia due to prenatal ultrasound findings of polyhydramnios and absent stomach bubble, but was found instead to have oropharyngeal atresia and a complete persistent buccopharyngeal membrane. This case is the first described in which the patient was successfully intubated through a small slit in the persistent membrane.     

A nationwide study of the epidemiology,treatment and survival of oropharyngeal carcinoma in the Netherlands

Seven head and neck oncology cooperative groups in the Netherlands have reviewed the epidemiology, staging, treatment and survival of oropharyngeal carcinoma patients treated between 1986 and 1990. In all, 640 patients with squamous cell carcinoma (628, 98%) or undifferentiated carcinoma (12, 2%) referred for primary treatment were analyzed. The total group included 441 males (69%) and 199 females (31%), with a median age of 59 years (range, 30–92). Tumor distribution by subsite was the tonsillar region (372 patients, 58%), base of the tongue/vallecula (179, 28%), soft palate/uvula (62, 10%) and posterior oropharyngeal wall (27, 4%). Forty-four patients (7%) had stage I disease, 106 (17%) had stage II disease, 157 (24%) stage III, and 319 (50%) stage IV Staging was unknown in 14 patients (2%). Radiotherapy was given to the primary tumor in 408 patients (64%), surgery and radiotherapy to 147 (23%), surgery alone to 42 (7%), other treatments to 14 (2%) and no treatment to 29 patients (4%). The 5-year overall survival was 28% and the 5-year disease-specific survival was 41%. This latter survival was 35% in males and 51% in females (P = 0.003). Five-year survival by subsite was 54% in the soft palate/uvula, 42% in the tonsillar region, 33% in the base of the tongue and 32% in the posterior oropharyngeal wall (P = 0.003). When analyzing survival by stage, 5-year survival in patients with stage I disease was 68% and decreased significantly to 27% in stage IV disease (P < 0.001). Best survival occurred in patients treated with surgery alone (80%), was less in the group treated by surgery and radiotherapy (51 %), and decreased further in patients treated by radiotherapy alone (36%) (P < 0.0001). By multivariate analysis, stage, sex and midline localization were found to be significant prognostic factors.Presented at the combined meeting of the Society of Head and Neck Surgeons and the European Organization for Research and Treatment of Cancer, Paris, France, 25–28 May 1994     

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-institutional Analysis of 1,033 Cases

ObjectivesHead and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group).MethodsWe reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016.ResultsAmong 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780).ConclusionA survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.     

Mucoepidermoid carcinoma of the parotid gland: A National Cancer Database study

Objective

To describe the demographics, tumor characteristics, and prognostic features of mucoepidermoid carcinoma of the parotid gland.

保留喉功能喉咽癌的综合治疗

目的 探讨保留喉功能的综合治疗对喉咽癌的治疗效果。方法 对1990-2000年我院收治的88例经保留喉功能的综合治疗的喉咽鳞状细胞癌进行回顾性分析。结果 患者总5年生存率是50％,其中Ⅰ级患者为87．5％,Ⅱ级患者为68．19％,Ⅲ级患者为39．62％,Ⅳ级患者为20％;有56例（63．64％）患者喉功能完全（发音,呼吸和吞咽）得以保留,32例（36．36％）患者喉功能部分（发音和吞咽）得以保留;诱导化疗后总缓解率为77．27％,其中完全缓解率为9．09％,部分缓解率为68．18％。结论 诱导化疗是喉咽癌有效的治疗手段,保留喉功能的综合治疗在喉咽癌治疗中十分主要。     

喉部分切除术术中冰冻切片对预后评估的意义

目的初步探讨术中冰冻切片对喉部分切除术手术范围的指导价值以及阳性切缘对预后的影响。方法以回顾性分析的方法,查阅我院自1996年1月～2001年12月行喉部分切除术病例中具有术中冰冻切片或有明确切缘距离记录的77例资料,将肉眼切缘距离、术中冰冻切片与术后病检切缘情况以及术后喉癌复发率和患者生存率评价加以分析。结果肉眼切缘0.5cm以内是否行术中冰冻切片对术后病理检查切缘的阳性率影响有统计学意义（P〈0.05）;肉眼切缘0.5cm以外是否行冰冻切片对术后病检切缘的阳性率影响无统计学意义（P〉0.05）。是否行术中冰冻切片对患者术后喉癌复发率（包括局部复发与远处转移）影响有统计学意义（P〈0.05）。术中冰冻切片组与单纯肉眼观察组生存曲线差异有显著性：行logRank统计,Kaplan-Meier法值=7.812,P=0.005〈0.05,5年累积生存率分别为78.9%与66.7%。冰冻切片组与单纯肉眼观察组的平均生存时间分别为（102.336±4.606）个月与（77.782±4.362）个月。结论对于肉眼切缘〈0.5cm的喉部分切除术,术中行冰冻切片能降低喉癌复发率（包括局部复发与远处转移）,提高患者生存时间,应常规行术中冰冻切片。     

青少年分化型甲状腺癌治疗及预后

目的探讨青少年分化型甲状腺癌(different-iated thyroid carcinoma,DTC)治疗模式的疗效和影响预后的因素。方法回顾性分析1981～2001年我科收治的年龄≤18岁DTC的随访资料74例(﹥13岁42例,≤13岁32例),均行手术加术后左旋甲状腺素治疗,13例伴肺转移患者行131I核素放射治疗。结果38例随访10年以上,6例随诊时间小于5年失访,中位随访时间(12～264)108个月;全组2例死于甲状腺癌局部复发;Kaplan-Meier法计算10年累积生存率和无瘤生存率分别为96.43%和78.90%。Cox多因素分析没有发现影响生存率的独立因素。Logistic回归分析发现原发灶累及双侧甲状腺腺叶是与复发相关的独立因素;原发灶外侵是影响并发症发生的独立因素;年龄≤13岁的青少年DTC更易发生肺转移,转移率为71.43%。结论在本组青少年DTC的治疗资料中,未发现影响生存率的独立因素。原发灶外侵和年龄≤13岁分别影响并发症发生和肺转移,此类患者应在术后行131I治疗。原发灶累及双侧甲状腺是复发的主要因素,对此类患者加强术前检查同时扩大手术范围。     

Resultados de la radioterapia en los carcinomas de orofaringe

ObjectiveTo present the results of radiotherapy treatment in patients with oropharyngeal carcinomas.Material and methodsRetrospective study of a cohort of 359 patients treated with radiotherapy, including chemo- and bio-radiotherapy, during the period 2000-2019. Information on human papillomavirus (HPV) status was available for 202 patients, of whom 26.2% were HPV-positive.ResultsFive-year local recurrence-free survival was 73.5% (95% CI: 68.8-78.2%). The variables that were related to local disease control in a multivariate study were the local tumor extension category and the HPV status. Five-year local recurrence-free survival for patients with cT1 tumors was 90.0%, for cT2 88.0%, for cT3 70.6%, and for cT4 42.3%. Five-year local recurrence-free survival for HPV-negative tumors was 67.2% and for HPV-positive tumors 93.3%. Five-year specific-disease survival was 64.4% (95% CI: 59.1-69.7%). Variables that were related to specific survival in a multivariate study were the patient's general condition, local and regional extent of the tumor, and HPV status.ConclusionsFive-year local recurrence-free survival of patients with oropharyngeal carcinomas treated with radiotherapy was 73.5%. Variables that were related to local control were local tumor extension and HPV status.     

Staging and survival for sinus cancer in the pediatric population

Objective

To determine histology, staging, and survival for pediatric sinus cancer.

Methods

Cases of pediatric sinus cancer (maxillary, ethmoid, and frontal/sphenoid) were extracted from the Surveillance, Epidemiology, and End Results database (1988-2005). Demographic data were tabulated and non-lymphoid malignancies were staged according to the TNM system. Kaplan-Meier survival analyses were conducted for the cohort and individual histologies.

Results

63 pediatric sinus cancers were identified (38 maxillary sinus, 19 ethmoid sinus, and 6 frontal/sphenoid sinus) with a mean age at diagnosis of 10.5 years and a 1:1 male to female ratio. After exclusion of 11 lymphomas (17.5%), rhabdomyosarcoma was the most commonly encountered malignancy (52.0%) followed by sarcoma (17.3%) and olfactory neuroblastoma (13.5%). 41.4% and 42.1% of maxillary sinus and ethmoid sinus tumors presented as T4 tumors, respectively. At 47 months of follow-up, cumulative survival was 54.1% with a maximum follow-up of 196 months. Median survival for pediatric sinus rhabdomyosarcoma cases was estimated at 33.0 months.

Conclusions

Pediatric sinus malignancy commonly presents with advanced stage, and rhabdomyosarcoma is the most commonly encountered histology. Due to the rarity of pediatric sinus cancer, survival estimates are difficult to obtain. The SEER database provides large population-based data, although limitations of such a data set impact the analysis.