RESUMO
Nine patients with recurrent cutaneous cancers of the midface were treated by definitive surgery (with adjuvant radiotherapy in five individuals). The clinical courses were marked by local and regional relapses in six cases. Although the prognosis may be generally poor, aggressive therapy, as feasible, seems warranted in these patients because death was not typically rapid after reappearance of disease in several patients.
Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Recidiva Local de Neoplasia/radioterapia , Recidiva Local de Neoplasia/cirurgia , Terapia de Salvação , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/radioterapia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Face , Humanos , Pessoa de Meia-Idade , Radioterapia Adjuvante , Análise de SobrevidaRESUMO
OBJECTIVE: We sought to determine whether induction chemotherapy followed by concomitant chemoradiation (ICCR)-induced advanced neck disease regression could predict outcome, especially the need for complete neck dissection in patients with N2-3 stage IV head and neck cancer (HNC). METHODS: A retrospective study of 339 patients evaluated for treatment of stage IV HNC during the years 1988 to 1997 revealed 36 individuals with N2-3 cervical lymphadenopathy who were treated with ICCR. Responses to treatment, patterns of failure, and survival rates were analyzed. RESULTS: Primary and regional tumor regressions were complete in 21 patients (58%), partial in 9 (25%), and absent in 6 (17%); the corresponding local failure rates were 5%, 44%, and 33% (P < 0.02). The regional failure rates were 24%, 89%, and 83%, respectively (P < 0.001); distant failure rates were 10%, 0%, and 0% (P > 0.99). The estimated 2-year survival rates for complete and partial/nonresponders were 57% and 20%, respectively (P < 0.02). CONCLUSION: Patients with advanced regional metastases of HNC who respond completely to ICCR have an excellent chance for survival. However, such ICCR-induced complete regression of regional tumor cannot reliably predict ultimate neck disease control.
Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Linfonodos/patologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Linfonodos/efeitos dos fármacos , Linfonodos/efeitos da radiação , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Doses de Radiação , Radioterapia Adjuvante , Indução de Remissão , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: The study goal was to review our experience with patients with bone or cartilage invasion (BCI) by adjacent head and neck cancer (HNC) who were treated with curative surgery and postoperative radiotherapy (SPR). PATIENTS AND METHODS: Thirty-eight individuals treated with SPR for HNC with BCI were identified after review of the radiation oncology charts and pathology reports for the period 1981 through 2000. RESULTS: The thyroid cartilage and mandible were predominantly invaded by HNC. The follow-up time for the surviving patients was 65.5 months (range, 17 to 106 months). The local, regional, and distant relapse rates were 5%, 11%, and 13%, respectively. The overall disease-free survival rates at 3 and 5 years were 54% and 41%, respectively. CONCLUSION: Although these results were not obtained from a randomized trial, the present observations may be beneficial in clinical decision making concerning patients with HNC and contiguous invasion of bone or cartilage.