Long-term outcomes of induction chemotherapy followed by chemoradiotherapy vs chemoradiotherapy alone as treatment of unresectable head and neck cancer: follow-up of the Spanish Head and Neck Cancer Group (TTCC) 2503 Trial.

BACKGROUND: Our previous phase-3 study (TTCC 2503) failed to show overall survival advantage of 2 induction chemotherapy (IC) regimens followed by standard concurrent chemoradiotherapy (CRT) over CRT alone in patients with unresectable locally advanced head and neck squamous-cell carcinoma (LAHNSCC). This study described the long-term survival of those patients. MATERIALS AND METHODS: Long-term follow-up study of patients with untreated LAHNSCC assigned to IC (three cycles), with either docetaxel, cisplatin and 5-fluorouracil (TPF arm) or cisplatin and 5-fluorouracil (PF arm), followed by CRT, or CRT alone, included in the previous TTCC 2503 trial. RESULTS: In the intention-to-treat population (n = 439), the median OS times were 25.4 (95% CI, 16.8-34.4), 26.2 (95% CI, 18.2-36.6) and 25.4 months (95% CI, 17.4-36.0) in the TPF-CRT, PF-CRT and CRT arms, respectively (log-rank p = 0.51). In the per-protocol population (n = 355), patients with larynx-hypopharynx primary tumors treated with IC (TPF or PF) followed by CRT had a longer median PFS than those who received CRT alone. Moreover, patients with ECOG 0 treated with IC (TPF or PF) followed by CRT had a better TTF than those with CRT alone. There were no statistically significant differences in terms of OS, PFS or TTF, according to the tumor load or affected nodes. CONCLUSION: After a long follow-up, the TTCC 2503 trial failed to show the benefit of IC-CRT in unresectable LAHNSCC regarding the primary end point. However, fit patients with ECOG 0 and primary larynx-hypopharyngeal tumors may benefit from the use of IC if administered by an experienced team. ClinicalTrials.gov identifier NCT00261703.

Oral cavity colon adenocarcinoma metastases: case report with surgical approach and review of more than 30 years literature.

INTRODUCTION: Metastatic oral tumours are rare, contributing to 1% of all malignant oral cavity tumours. CASE REPORT: We report the case of a 59-year-old man with colon cancer at an advanced disease stage, with progression to the peritoneum and maxillary gingiva. Palliative surgery was indicated to improve the patient's quality of life. DISCUSSION: In a review of the literature, we compiled a list of 27 cases (including the present case) reflecting some 30 years of literature on oral cavity metastatic disease originating in colon cancer. CONCLUSION: Oral cavity metastasis should be taken into account in the differential diagnosis of a synchronous or metachronous oral cavity lesion. The therapeutic goal should include palliative alternatives when necessary. Intraoral reconstruction using local flaps may be a simple and reliable palliative resection option aimed at improving the patient's quality of life.

Pharyngeal closure after a total laryngectomy: mechanical versus manual technique.

OBJECTIVE: To verify the main advantages and drawbacks of mechanical suturing for pharyngeal closure after total laryngectomy versus a manual suturing technique. METHODS: A retrospective review was carried out of 126 total laryngectomies performed between 2008 and 2018. Manual closure was performed in 80 cases (63.5 per cent) and mechanical suturing was performed in 46 cases (36.5 per cent). RESULTS: Mechanical suturing was used significantly more frequently in patients with: glottic tumours (p = 0.008), less local tumour extension (p = 0.017) and less pre-operative morbidity (p = 0.014). There were no significant differences in the incidence of pharyngocutaneous fistula between the manual suture group (16.3 per cent) and the mechanical suture group (13.0 per cent) (p = 0.628). None of the patients treated with mechanical suturing had positive surgical margins. Cancer-specific survival for the mechanical suture group was higher than that for the manual suture group (p = 0.009). CONCLUSION: Mechanical suturing of the pharynx after total laryngectomy is an oncologically safe technique if used in suitable cases.

[Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses]. / Análisis epidemiológico de 72 carcinomas de fosas y senos paranasales.

OBJECTIVE: The aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinuses. MATERIAL AND METHODS: We performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported. RESULTS: The average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity. Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-year adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p = 0.0002). CONCLUSIONS: Carcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck.

[Laryngeal rhabdomyoma]. / Rabdomioma laríngeo.

Adults Rhabdomyoma are benign and rare tumors of skeletal muscle. The bibliography gathers about 60 cases, sitting on the head and the neck (95%), specially on the floor of the mouth, larynx or pharynx. Two exceptional case has been reported, one in the abdominal wall, the other on the retroperitoneal space, the latter being a mixed rhabdomyoma (either foetal and adult). Although the condition shows typical morphological features, the interest of the case reported, rely, apart of its scant presentation, on the possibility of leading to a mistaken clinic-macroscopic diagnosis of malignant mesenchymal tumor, because of its outward appearance.

[Active duration: new parameters in quantitative assessment of post-caloric nystagmus]. / Duración activa: un nuevo parámetro en la valoración cuantitativa del nistagmo postcalórico.

This study describes a new parameter for quantifying the post-caloric nystagmus, the active duration, or the total periods where appropriate nystagmic response existed due to caloric stimulation. On a pathological population of 211 cases, the new parameter records a diagnostic sensitivity of 56% for the canal paresis and 59% for the directional preponderance, improving the sensitivity levels corresponding to the duration of the response according to classical criterion. Being easy to calculate, the active duration parameter is considered to be appropriate for the quantity valoration of the post-caloric nystagmus by means of computerized technics.

[Laryngocele: clinical and therapeutic study of 60 cases]. / Laringoceles: estudio clínico y terapéutico de 60 casos.

Sixty patients with laryngocele were diagnosed in the last seven years: 25 of them without previous laryngeal pathology (group A) and the rest 35 with laryngeal or pharyngeal cancer (group B). The laryngocele was unilateral in the majority of the 25 patients of group A (68%). The internal laryngoceles were the most common type (63%). The initial symptom was hoarseness in 56% of these patients and 20% developed, in their evolution, an acute respiratory distress. The diagnosis was clinical in 16 patients and radiological in the rest. Endoscopically marsupialization with laser-CO2 was performed to remove internal laryngoceles. The mixed and external laryngoceles were completely removed via an external cervical approach without the need to perform any thyrotomy. The diagnosis was radiological by CT in the 35 patients of the group B. In 30 of them the CT was performed to evaluate the local extension of the laryngeal or pharyngeal cancer before its treatment. Supraglottic carcinoma was the most common laryngeal tumor (50%). The anatomic relationship between laryngocele and laryngeal cancer was ipsilateral to each other only in 50% of the patients. In the other 5 patients, no laryngocele was found in the radiological study previous to the treatment of the laryngeal or pharyngeal cancer. The diagnosis was made after chemotherapy and/or radiotherapy treatment.

[Cervical metastasis of squamous cell carcinoma of unknown origin: experience at Hospital de Sant Pau, Barcelona, Spain]. / Metástasis cervical de carcinoma escamoso sin primario conocido: experiencia en el HSCSP.

Between 1984 and 1992, 18 cases of cervical metastasis of squamous cell or anaplastic carcinoma (1% of all head and neck tumors) were seen at the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). Fifteen patients underwent radical surgery: 1 N1, 4 N2A and 10N3, N1 and N2A patients underwent surgery followed by radiotherapy. The 10 N3 patients began with neoadjuvant chemotherapy (cisplatin and 5-fluorouracil), then 8 had radical neck dissection and 2 had palliative radiotherapy. The primary tumor was found in 11%. The 5-year survival rate was 40% in N1+2A and 11% in N3. Chemotherapy did not improve survival in advanced disease, but it facilitated neck dissection and selection of the group with the prognosis.

Treatment results for ethmoid sinus carcinoma.

OBJECTIVE: The aim of this study was to describe the results of treatment in patients with ethmoid sinus carcinoma. MATERIALS AND METHOD: We performed a retrospective study of 34 patients with carcinoma of the ethmoid sinus, and collected the following data: age, sex, employment, tobacco and alcohol consumption, tumour-node-metastasis stage, treatment, and survival. RESULTS: The mean patient age was 64 years. Seventy-six per cent of patients were men and 24 per cent women. Squamous cell carcinoma was the most frequent histological tumour type (44 per cent). Eleven patients were classified as T(2), six as T(3), six as T(4a) and 11 as T(4b). Two patients (6 per cent) had nodal metastasis at the time of diagnosis. The anterior skull base was involved in 17 patients (50 per cent) and the anterior orbital contents were affected in seven patients (21 per cent). The five-year actuarial observed survival rate for all patients was 44 per cent. CONCLUSIONS: Combined treatment with surgery and post-operative radiotherapy permitted good local control in patients with ethmoid sinus carcinoma. We do not recommend prophylactic neck treatment for ethmoid sinus carcinoma.

Análisis epidemiológico de 72 carcinomas de fosas y senos paranasales / Epidemiologic analysis of 72 carcinomas of the nasal cavity and paranasal sinuses

Objetivo: Analizar las principales características epidemiológicas de los pacientes afectos de un carcinoma de fosas y senos paranasales. Material y métodos: Se realizó un estudio de forma retrospectiva a partir de 72 carcinomas localizados en las fosas y senos paranasales. Se analizaron las distintas localizaciones, distribución por edad y sexo, consumo de hábitos tóxicos, clasificación TNM y tipo de tratamiento realizado. Resultados: La edad media de los pacientes en el momento del diagnóstico fue de 63 años. El 75% de los pacientes (54/72) fueron varones y el 25% (18/72) mujeres. En el 64% de los casos (46/72) el origen fue los senos paranasales, diagnosticándose un total de 30 carcinomas de etmoides, 15 carcinomas de senos maxilares y 1 carcinoma de esfenoides. En el 36% restante (26/72) el tumor tenía su origen en la fosa nasal, localizándose la gran mayoría en el vestíbulo nasal (21/26). El carcinoma escamoso fue el tipo histológico más frecuente en ambas localizaciones. La supervivencia ajustada a los 5 años, para los 72 carcinomas estudiados, fue del 60% (IC: 54-66), del 36% para los carcinomas de senos paranasales (IC: 28-44) y del 86% (IC: 79-93) para los carcinomas de fosas nasales. Según el tamaño tumoral la supervivencia ajustada en los 46 carcinomas de senos paranasales a los 5 años fue del 80% en los T2, del 71% en los T3, del 19% en los T4a y del 6% en los T4b (p=0,0002). Conclusiones: Los carcinomas de fosas y senos paranasales representan un grupo de tumores con unas características epidemiológicas diferentes del resto de tumores de cabeza y cuello

Objective: The aim of this study is to define the epidemiological aspects of carcinoma of the nasal cavity and paranasal sinuses. Material and methods: We performed a retrospective study of 72 carcinomas of the nasal cavity and paranasal sinuses. Various sites, age and sex distribution, drug consumption, TNM stage grouping and treatment were reported. Results: The average age was 63. Seventy- five percent of patients (54/72) were male and 25% (18/72) female. The site of origin was paranasal sinuses in 46 patients (64%), 30 in ethmoid sinus, 15 in maxillary sinus and 1 in sphenoid sinus. Twenty-six patients (36%) were located in nasal cavity.Squamous cell carcinoma was the most frequent histological type in both localizations. The 5-year adjusted survival rate for all patients was 60% (IC: 54-66), 36% (IC: 28-44) for paranasal sinus carcinoma and 86% (IC: 79-93) for nasal cavity carcinoma. The 5-year adjusted survival rate according to the T distribution in 46 carcinomas paranasal sinus was 80% T2, 71% T3, 19% T4a and 6% T4b.(p=0.0002). Conclusions: Carcinoma of nasal cavity and paranasal sinuses represent a group of tumors that differ from the rest of carcinomas of the head and neck