Laryngeal preservation in stage III/IV resectable laryngo-hypopharyngeal squamous cell carcinoma following concurrent chemoradiotherapy with capecitabine/cisplatin.

Concurrent chemoradiotherapy has become the standard of care for advanced head and neck cancers in organ preservation strategies. However, the optimal regimen for concurrent chemoradiotherapy to maximise treatment response and minimise toxicity has not been determined. The purpose of the present clinical study was to review our experience with concurrent chemoradiotherapy by using the capecitabine and cisplatin (XP) regimen with the aim of organ preservation in patients with locoregionally advanced laryngo-hypopharyngeal squamous cell carcinoma (LHSCC). Thirty-one patients with stage III/IV resectable LHSCC treated with concurrent chemoradiotherapy using the XP regimen were enrolled in the present study. The patients fulfilled the criteria for total laryngectomy when surgery was selected. The primary endpoint of this study was disease-free survival with a functional larynx, which was indicated by the following conditions: survival, disease-free status at all sites and retention of a functional larynx. Following concurrent chemoradiotherapy, 23 patients (74.2%) exhibited complete response (CR) at the primary site and 18 (69.2%) exhibited CR at the lymph nodes. CR at the primary site and lymph nodes was identified in 19 patients (61.3%). The Kaplan-Meier 2- and 3-year cumulative disease-free survival rates were 71.5 and 59.6%, respectively. Anatomical laryngeal preservation was feasible in 27 patients (87.1%) during the 36-month follow-up period. Permanent gastrostomy was required in 1 disease-free patient with an intact larynx. For the entire cohort, the 2- and 3-year cumulative disease-free survival with a functional larynx was 58.5 and 50.7%, respectively. The most frequent grade 3-4 haematological and non-haematological toxicities of concurrent chemoradiotherapy were leucopenia and mucositis, which developed in 4 (12.9%) and 8 (25.8%) patients, respectively. There was no treatment-related death. Concurrent chemoradiotherapy with the XP regimen resulted in functional laryngeal preservation accompanied by disease-free survival and the toxicities were more tolerable and manageable compared to those reported by previous studies.

Endoscopic repairment of septal perforation with using a unilateral nasal mucosal flap.

OBJECTIVES: Nasal septal perforation is an anatomic defect of the cartilaginous and bone tissues of the nasal septum. Many approaches and techniques to repair nasal septal perforations have been reported on. The purpose of this paper is to report on our surgical technique and the results of the treatment for nasal septal perforations. METHODS: From May 2001 to March 2008, 14 patients (12 males and 2 females; mean age: 41.3 yr) were enrolled. The mean perforation size was 15 mm, and all the perforations were located at the cartilaginous portion. Our surgical technique is based on an endoscope-assisted endonasal approach, with dissection of unilateral advanced mucosal flaps with using a temporalis fascia graft. The follow-up periods ranged from 3 to 23 months (mean follow-up period: 8 months). RESULTS: Using our surgical technique on 14 patients, 12 cases (85.7%) of septal perforation were closed without complication. The remaining two patients (14.3%) had incomplete closures (about 2-3 mm) without any significant symptoms related to the remaining perforation. CONCLUSION: Our technique is a viable procedure with a high success rate for achieving closure of nasal septal perforations. It has the advantages of shortening the operative time, no external incision and avoiding any other perforation during the operation. Therefore, we consider it to be a good alternative for repairing nasal septal perforations.