RESUMEN
PURPOSE: For patients with advanced head and neck cancer, various combined chemoradiotherapy regimens have been used to improve local control. This study was carried out to assess the outcome of concomitant chemotherapy with a "concomitant boost" radiotherapy in the treatment of advanced unresectable head and neck cancer patients. MATERIALS AND METHODS: Forty-eight patients were treated with combined chemoradiotherapy between the years of 1990 and 1995. Cisplatinum (100 mg/m2) was given intravenously during week 1 and week 5. A "concomitant boost" external beam radiotherapy approach was used with twice-daily treatment delivered during the last 2 weeks. A total of 70 Gy was delivered over 6 weeks. Median follow-up was 23.5 months (2-79 months). RESULTS: Thirty-one (65%) and 17 (35%) patients achieved complete and partial response, respectively. Median survival in complete responders has not been reached. Overall survival at 2 years, 3 years, and 5 years were 58.7%, 52.8%, and 42.4%, respectively. Median overall survival was 38.8 months. Acute confluent mucositis (Radiation Therapy Oncology [RTOG] grade 3) developed in 50% of patients, but there was no severe long-term treatment-related toxicity. CONCLUSION: This combined chemoradiotherapy approach is safe and efficacious for advanced unresectable head and neck cancer. Treatment-related toxicity was acceptable with 50% of patients developing acute confluent mucositis. There was no severe long-term treatment-related toxicity.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Terapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
OBJECTIVES: We studied the association between the severity of pretreatment CT scan findings and the improvement in symptoms of chronic sinusitis after treatment. METHODS: We analyzed data from an ongoing prospective, nonrandomized clinical outcomes study of patients treated for chronic sinusitis at a tertiary-care academic medical center (n = 57, mean age 46.8 years). Disease-specific symptom severity was measured with a validated health status instrument, and CT stage was quantified with the Harvard CT staging system. RESULTS: In a multivariate analysis, symptom severity based on CT findings emerged as a strong predictor of both improvement in symptom score outcome (beta = 0.47, P = 0.01) and absolute symptom level after treatment (beta = -0.58, P = 0.001). CONCLUSIONS: Severity as assessed by a pretreatment CT scan is a strong predictor of outcome. Patients with higher symptom severity based on CT scans showed significantly larger improvement and lower absolute levels of symptom severity after treatment. This study links CT scan findings and subjective patient-based outcomes (symptom scores) using a validated outcomes instrument.
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Sinusitis/cirugía , Tomografía Computarizada por Rayos X , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pólipos Nasales/clasificación , Pólipos Nasales/diagnóstico por imagen , Pólipos Nasales/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Pronóstico , Estudios Prospectivos , Sinusitis/clasificación , Sinusitis/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Surgical decompression of the optic canal is indicated in patients with traumatic optic neuropathy who fail to respond to corticosteroids. Traditional surgical approaches to the orbital apex have been effective in achieving optic nerve decompression but require either a craniotomy, provide limited exposure with late identification and protection of the optic nerve, or require external incisions. The combined transconjunctival/intranasal endoscopic approach to the optic canal offers sufficient exposure, allows early identification and protection of the optic nerve, provides space for the use of multiple surgical instruments, obviates a craniotomy and external incisions, and can be performed quickly with minimal morbidity. The technique of combined transconjunctival/intranasal endoscopic optic nerve decompression will be described and the experience with nine cases will be presented.
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Conjuntiva/cirugía , Endoscopía , Nariz/cirugía , Traumatismos del Nervio Óptico , Órbita/cirugía , Hueso Esfenoides/cirugía , Adolescente , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Adulto , Pérdida de Sangre Quirúrgica , Craneotomía , Electrocoagulación/instrumentación , Electrocoagulación/métodos , Endoscopios , Endoscopía/métodos , Femenino , Humanos , Aparato Lagrimal/cirugía , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/cirugía , Nervio Óptico/cirugía , Enfermedades del Nervio Óptico/etiología , Enfermedades del Nervio Óptico/cirugía , Estudios Retrospectivos , Fracturas Craneales/complicaciones , Seno Esfenoidal/cirugía , Factores de Tiempo , Cornetes Nasales/cirugía , Trastornos de la Visión/cirugíaAsunto(s)
Adenoma/complicaciones , Hiperparatiroidismo/etiología , Neoplasias de las Paratiroides/complicaciones , Adenoma/patología , Adenoma/cirugía , Anciano , Anciano de 80 o más Años , Quistes/patología , Femenino , Humanos , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/cirugíaRESUMEN
Fifteen patients with juvenile nasopharyngeal angiofibroma (JNA) were treated in the Department of Radiation Oncology, Baylor College of Medicine between 1973 and 1986. All patients underwent radiographic evaluation including CT scanning, selective digital subtraction angiography, tomograms, or MRI. Patients referred for definitive irradiation exhibited extensive tumor involvement. Eleven of 15 patients had middle cranial fossa involvement; cavernous sinus extension was observed in six patients. Ten patients were treated with primary radiation therapy; five patients had surgical resection initially and were referred for radiation therapy upon local recurrence. Follow-up ranges from 1 1/2-13 years. Four of the 5 patients who received 3200 cGy in 200 cGy fractions demonstrated tumor recurrence within 2 years after irradiation. All recurrences were ultimately controlled by either further irradiation and/or resection. No tumor recurrence was encountered among the patients treated at the higher tumor doses (36-46 Gy). No severe complications have been observed. Radiation therapy utilizing carefully tailored fields is an appropriate therapeutic approach to patients with extensive disease or intracranial extension. A total dose of greater than 40 Gy may allow improved local control for advanced lesions.
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Histiocitoma Fibroso Benigno/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Adolescente , Adulto , Angiografía de Substracción Digital , Niño , Histiocitoma Fibroso Benigno/irrigación sanguínea , Histiocitoma Fibroso Benigno/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Nasofaríngeas/irrigación sanguínea , Neoplasias Nasofaríngeas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Distant metastatic disease from thyroid carcinoma is becoming a rare problem. Physicians and the public are increasingly aware of minimally invasive methods of early diagnosis of thyroid malignancy, such as fine-needle aspiration with cytologic examination. Total thyroidectomy itself has become less associated with morbidity than it once was. We describe three patients with follicular thyroid carcinoma metastatic to the skull who were seen recently. Two of these patients had masses neglected for 20 and 50 years, respectively. The management of this disease entity is discussed.
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Adenocarcinoma/secundario , Neoplasias Craneales/secundario , Neoplasias de la Tiroides/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Angiografía , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Craneales/diagnóstico , Neoplasias Craneales/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tomografía Computarizada por Rayos XAsunto(s)
Infecciones Bacterianas/patología , Enfermedades Mandibulares/patología , Osteomielitis/patología , Infecciones Bacterianas/cirugía , Terapia Combinada , Humanos , Masculino , Mandíbula/patología , Enfermedades Mandibulares/cirugía , Persona de Mediana Edad , Osteomielitis/cirugía , Propionibacterium acnes/aislamiento & purificación , RecurrenciaRESUMEN
Rehabilitation of major resections of the tongue has always posed a serious problem. This paper presents the feasibility and rational of rehabilitating partial glossectomies by the use of the pectoralis major myocutaneous flap and the fabrication of a "new tongue" by the use of this flap. The criteria for these techniques in benign and malignant tumors of the tongue are outlined. The segmental innervation of the pectoralis major muscle from a variety of three to five nerve branches permits the development of a skin-muscle flap that may be transposed with its nerve supply intact or totally denervated, depending upon the status of the hypoglossal nerves and tongue in the operative field. This presents the possibility of transposing a skin-muscle flap into a glossal wound with a completely intact nerve supply where the new flap is under constant instruction in its new physiologic environment. It also presents the possibility of neurotization of the denervated section of the muscle flap by axones from the intact segment of tongue. A third possibility is the fabrication of a "new tongue" by the transfer of the hypoglossal nerves into the denervated segment of the peripheral aspect of the myocutaneous flap. This variety and combination of rehabilitative techniques introduces a new phase into the rehabilitation of the tongue.
Asunto(s)
Glosectomía/rehabilitación , Colgajos Quirúrgicos , Neoplasias de la Lengua/cirugía , Humanos , Métodos , Lengua/anatomía & histologíaRESUMEN
Radical resection of the anterior portion of the oral cavity, including a portion of the tongue, floor of the mouth, mandible, and neck, has always been, and remains, a perplexing problem in immediate rehabilitation of the area of the oral cavity and mentum. In the past, these deformities were classified as "Andy Gump." Attempts at correction of this deformity are protracted and complex. The use of the pectoralis myocutaneous flap offers an improvement in the concept of mamagement in that it supplies a skin lining for the oral cavity and augments the chin and neck in a single-stage procedure that may be combined with the primary operation.