Results and Survival of Locally Advanced AJCC 7th Edition T4a Laryngeal Squamous Cell Carcinoma Treated with Primary Total Laryngectomy and Postoperative Radiotherapy.

PURPOSE: The objective of this study was to analyze the results and survival of patients with T4a laryngeal squamous cell carcinoma (SCC) treated, according to clinical practice guidelines, with total laryngectomy and postoperative radiotherapy (TL-PORT) in a large and homogeneous series. METHODS: Initial staging assessment, treatment details, pathologic features, follow-up, and patterns of recurrence were retrospectively reviewed in a large series of 100 patients treated in our center between 2001 and 2013 for T4a laryngeal SCC with TL-PORT. RESULTS: Two-, 5-, and 10-year overall survival rates were 65, 52.4, and 33.3 %, respectively, while 2-, 5-, and 10-year disease-free survival rates were 55, 42.6, and 31.8 %, respectively. In addition, 2-, 5-, and 10-year locoregional control rates were 77, 74, and 65.9 %, respectively. Central lymph node involvement was associated with pathologic subglottic extension (p = 0.01), lysis of the cricoid cartilage (p = 0.03), and tracheal extension (p = 0.02). Extracapsular spread of central lymph node metastases, the main prognostic factor identified by multivariate analysis, was associated with decreased locoregional control and survival rates. CONCLUSION: In this homogenously treated cohort, with consistent guideline application, surgery for T4a larynx cancer remains a standard of care, with current results used as a benchmark.

Subperiosteal orbital abscess: volumetric criteria for surgical drainage.

OBJECTIVE: To investigate predictive factors of surgical management of subperiosteal orbital abscess in children. METHODS: A retrospective monocentric study was conducted between 2000 and 2011 with children hospitalized for acute pediatric orbital cellulitis (APOC). Clinical, biological and radiological data as well as medical and surgical management were collected and analyzed. All patients received intravenous antibiotics and underwent a CT-scan. Orbit and subperiosteal intraorbital abscess dimensions were measured on axial and coronal planes and the abscess volume was calculated using a spheroid model. RESULTS: Eighty-three children with APOC (mean age: 4.5 years) were included, 53 were boys (63.9%). Thirty-two children (38.6%) presented with a subperiosteal orbital abscess. Mean abscess volume was 570mm(3) and mean exophthalmos was 4.7mm. Twenty patients were treated surgically, 11 of which by an endoscopic approach. A positive correlation was observed between the volume of the abscess or exophthalmos and surgical drainage: 57.9% of patients underwent surgery when exophthalmos was >4mm, 29.4% between 2 and 4mm, and none when <2mm. All patients with an abscess volume >500mm(3) or >5% of orbital volume were operated on whereas only 30% or 39% of patients, respectively, in case of smaller volumes (P<0.05). CONCLUSION: Surgery for subperiosteal orbital abscess is usually performed in case of visual complications or unfavorable medical outcome. The importance of the exophthalmos and the volume of the abscess measured on the CT-scan are predictive factors of surgery in children with subperiosteal orbital abscess without visual complications.