Prognostic significance of parapharyngeal space venous plexus and marrow involvement: potential landmarks of dissemination for stage I-III nasopharyngeal carcinoma.

PURPOSE: To determine whether the parapharyngeal space venous plexus and marrow of the skull base bones are anatomic landmarks of the potential routes for the spread of disease for Stage I-III (American Joint Commission on Cancer 1997 staging system) nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: A total of 364 patients with NPC were enrolled in this study. The selection criteria were Stage I-III disease and primary radiotherapy at our hospital between 1990 and 2001. All patients had undergone MRI to evaluate the head-and-neck tumors. Patients who had undergone inadequate radiotherapy at a dose of <60 Gy and/or preradiotherapy chemotherapy before the imaging evaluation were excluded from the study. RESULTS: Of the 364 patients treated between 1990 and 2001, 163 (44.8%) had low-risk Stage I-III NPC (without parapharyngeal space extension or T3 disease). The 5-year distant metastasis-free survival rate, with and without adjuvant chemotherapy, was 97% and 96%, respectively. The remaining 201 patients had Stage II-III with parapharyngeal space extension or T3 disease. Their 5-year recurrence-free survival rate, with and without adjuvant chemotherapy, was 76.8% and 53.2% (p = 0.01), respectively. CONCLUSION: Our findings suggest that the risk of distant metastasis in Stage I-III NPC patients without parapharyngeal space extension or T3 disease is extremely low. Invasion into the parapharyngeal space venous plexus and marrow of the skull base bones is associated with distant metastasis, and involvement of these anatomic sites is considered a potential route for hematogenous disease spread in patients with Stage I-III NPC.

Self-expandable metallic tracheobronchial stent insertion and endobronchial electrocautery with flexible bronchoscopy: preliminary results at a cancer center.

BACKGROUND AND PURPOSE: Technical developments have facilitated the implantation of metallic stents and the use of endobronchial electrocautery through a flexible bronchoscope to reestablish airway patency in patients with airway obstruction. Their application in a 180-bed cancer center is described. PATIENTS AND METHODS: From August 2000 to December 2001, 12 patients (2 women, 10 men, mean age 53.3 yr) were treated by insertion of a self-expandable metallic tracheobronchial stent (SEMS). Malignant airway obstruction was the indication for the procedure in nine patients, two of whom underwent preliminary debulking using SEMS with or without electrocautery. Severe benign subglottic or tracheal stenosis was the indication for the procedure in two patients. The remaining patient with esophageal cancer received a double bronchial and esophageal SEMS due to involvement of a non-obstructing bronchoesophageal fistula. RESULTS: Symptomatic improvement was seen in all 12 patients. Removal was performed in one patient. Five patients died during follow-up with a median survival of 44 days, attributed to the advanced stage of recurrent disease. The median follow-up for the six surviving patients was 23 weeks. No major short-term complications of the procedure were found. CONCLUSIONS: SEMS is a promising technique for the management of airway obstruction. The stent is selected according to the specific clinical situation. Metallic and silicone stents are complementary. SEMS should not be used in patients who require only temporary relief of tracheobronchial obstruction.