Role of chemotherapy in 5000 patients with head and neck cancer treated by curative surgery: A subgroup analysis of the meta-analysis of chemotherapy in head and neck cancer.

OBJECTIVE: To evaluate the effect of chemotherapy added to a surgical locoregional treatment (LRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: We studied the sub-group of trials with surgical LRT included in the meta-analysis on chemotherapy in head and neck cancer (MACH-NC). Data from published and unpublished randomized trials comparing the addition of chemotherapy to LRT in HNSCC patients were sought using electronic database searching for the period 1965-2000, hand searching and by contacting experts in the field. Trials with less than 60 patients, or preoperative radiotherapy or where the type of LRT could not be individually determined were excluded. All individual patient data were checked for internal consistency, compared with published reports, and validated with trialists. Data were pooled using a fixed-effect model. Heterogeneity was assessed using Cochrane test and I2 statistic. RESULTS: Twenty-four trials were eligible (5000 patients). Chemotherapy improved overall survival (HR = 0.92 [95%CI: 0.85-0.99] p = 0.02). There was a significant interaction between treatment effect and timing of chemotherapy (p = 0.08 at pre-specified threshold of 0.10) with a greater effect for concomitant chemotherapy (HR = 0.79, 95%CI: 0.69-0.92). The benefit of chemotherapy was greater in women (HRwomen = 0.63, 95%CI: 0.50-0.80) compared to men (HRmen = 0.96, 95%CI: 0.89-1.04; p for interaction = 0.001). CONCLUSIONS: This analysis confirmed the benefit of concomitant chemotherapy added to surgical LRT. The role of induction therapy as yet to be determined as it did not improve OS. Women may benefit more than men from chemotherapy.

Recurrent hearing loss after myelography treated with epidural blood patch.

Transient hearing impairment is a known sequel after various procedures that result in loss of cerebrospinal fluid, such as lumbar puncture, spinal anesthesia and myelography. But persistent or recurrent hearing loss after dural puncture is a rare entity. We present a case with recurrent low-frequency sensorineural hearing loss after myelography. The patient was treated successfully by means of an epidural blood patch, although the conservative treatment was ineffective.

Schwannoma of the trachea; a new resection technique.

Tumors of the trachea are rare, especially schwannoma. We diagnosed a 27-year-old man with schwannoma of the trachea after he was admitted to our hospital with complaints of progressive dyspnea and wheezing. He was treated as having bronchial asthma initially, but his signs and symptoms did not improve with conventional therapy. Flexible fiberscopy revealed the presence of a submucosal tumor in the subglottic area. Tracheal tomography, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a mass in the trachea that extended from the cricoid cartilage level to the second tracheal ring. After tracheostomy, we removed the tumor from a tracheostoma upwards to the larynx without a laryngofissure, using forceps and scissors usually used for laryngomicrosurgery and endoscopes usually used for sinus surgery. No complications developed during or after the procedure. To our knowledge, this is the first report of the removal of a tracheal schwannoma by this technique.

[Clinical investigation of acute sensorineural hearing impairment due to rifles].

This study examined 53 patients (74 ears) with acute sensorineural hearing impairment due to rifles. After patients were admitted, 16 were treated by steroid alone and 37 by steroid and PGE1 through intravenous drip injection. The therapeutic ratio was 19% and the recovery ratio 66% with no significant difference seen between treatment types in hearing improvement. Forty-two patients were treated within 7 days of injury and 32 8 or more days after injury. The therapeutic ratio was 21% and the recovery ratio 78% among patients treated sooner and a significant difference was seen between in hearing improvement early and later (8 or more days) treatment. We studied average hearing improvement between pre- and post treatment across the frequency spectrum. The average hearing improvement of 500 Hz and 1 kHz was significantly high compared to that of 8 kHz. This suggests that impairment of middle-pitched tones is improved more easily than high-pitch tones in hearing injuries due to rifles, and that early treatment after injury is extremely important.