[Oral SCC regional metastatic disease patterns revealed by preventive neck dissections].

One hundred and seventy-two preventive neck dissections were performed in 159 oral SCC patients. The study revealed the possibility of skip metastases in the lower cervical lymphatic nodes thus confirming the necessity for their removal in elective neck dissections.

[Regional metastatic disease in oral SCC identified by preventive lymphatic nodes dissection].

The study included 159 patients with oral SCC in which metastatic patterns were evaluated after preventive lymphatic node dissection. Lymphatic node metastasis were found out in 24.5% of patients with the most common sites in subdigastrial (IIA) (69.2%) and submandibular (IB) (34.2%) and medium deep jugular (III) (28.2%) nodes. Involving of the IV level (lower deep jugular nodes) was noted in 5.2% of cases, both VA and VB - 2.6%. These results advocate preventive neck dissections in order to eliminate possible metastasis on all levels.

[Choosing combined or complex treatment approach in oral SCC patients].

The aim was to determine the different regiments of adjuvant therapy after radical surgery in patients with oral cancer based on the prognostic factors. 2-years disease-free survival in group with adjuvant chemoradiotherapy was 71.4%; in the adjuvant radiotherapy group - 66.2%. The neoadjuvant chemoradiotherapy demonstrated only 57% 2-years disease-free survival. Our results demonstrate that adjuvant radiotherapy or chemoradiotherapy combined with cisplatin is more effective in treatment of the patients with oral cancer.

[The importance of DNA-cytometry for the prediction of nasopharyngeal malignancy].

The method of DNA-cytometry was applied to examine patients presenting with nasopharyngeal malignancy. The results obtained in laboratory studies were compared with clinical observations and data of medical histories. It was shown that diploid and aneuploid nasopharyngeal tumours are represented in an equal proportion. The number of the latter tumours increased with the progress of the neoplastic process. The diploid and aneuploid tumours were characterized by the equally frequent occurrence of metastasis. The survivorship rate of patients presenting with diploid tumours during the first year after the onset of the disease was significantly higher than in the patients having aneuploid nasopharyngeal cancer. The results of the study indicate that DNA-ploidy can not be used as a predictor of the development of the neoplastic process in patients with nasopharyngeal cancer, nor does it have a predictive value for the evaluation of the efficacy of chemo/radiotherapy. Nevertheless, the data obtained may be useful for the selection of patients for the more intensive adjuvant therapy.

[Docetaxel as a component in the combined therapy of locally advanced squamous cell carcinoma of the glottis and oral cavity].

Two modalities of chemoradiotherapy for locally advanced squamous cell cancer of oro-hypopharynx and oral cavity were compared in the treatment of 34 patients. Five-year survival after cisplatin, 5-FU, taxotere, and carboplatin plus irradiation with TTD of 68-72 Gy (group 1) was 59.5% versus 13.8% without taxotere (group 2). Relapse was in 9 cases (60%) (4 - group 1 and 5 - group 2). Post-therapeutic complication stage III-IV was 57.8% (group 1) and 48% (group 2).

[Restoration of speech function in oncological patients with maxillary defects].

Speech quality was evaluated in 188 patients with acquired maxillary defects. Prosthetic treatment of 29 patients was preceded by pharmacopsychotherapy. Sixty three patients had lessons with a logopedist and 66 practiced self-tuition based on the specially developed test. Thirty patients were examined for the quality of speech without preliminary preparation. Speech quality was assessed by auditory and spectral analysis. The main forms of impaired speech quality in the patients with maxillary defects were marked rhinophonia and impaired articulation. The proposed analytical tests were based on a combination of "difficult" vowels and consonants. The use of a removable prostheses with an obturator failed to correct the affected speech function but created prerequisites for the formation of the correct speech stereotype. Results of the study suggest the relationship between the quality of speech in subjects with maxillary defects and their intellectual faculties as well as the desire to overcome this drawback. The proposed tests are designed to activate the neuromuscular apparatus responsible for the generation of the speech. Lessons with a speech therapist give a powerful emotional incentive to the patients and promote their efforts toward restoration of speaking ability. Pharmacopsychotherapy and self-control are another efficacious tools for the improvement of speech quality in patients with maxillary defects.

[Sentinel lymph nodes in squamous cell cancer of the head and neck].

Twenty five patients with squamous cell oral cancer and without clinical evidence of regional cervical metastases have undergone 99mTc lymphoscintigraphy of cervical lymph nodes to localize the sentinel node 24 hours before surgery. Intraoperative localization of the sentinel node with gamma-probe (the probe was removed afterwords) was followed by operation on the primary focus and radical neck fat dissection. The removed tissues were examined histologically. The sentinel nodes were detected in 22 (88%) patients. A total number of the sentinel lymph nodes was 44. Six patients had metastases in the sentinel nodes, in 3 of them metastases were detected in the removed fat. The results of the study show that the technique is informative in localization of the sentinel lymph node.

[A comparison of two modalities of complex chemoradiotherapy for locally advanced nasopharyngeal carcinoma]. / Sravnitel'naia otsenka variantov kompleksnogo lecheniia nedifferentsirovannogo mestnorasprostranennogo raka nocoglotki.

Two modalities of complex chemoradiotherapy for locally advanced nasopharyngeal carcinoma stage III-IV were compared in the treatment of 52 patients. Thirty-four patients (group I) received polychemotherapy: cisplatin--100 mg/sq.m, i.v., dropwise, on day 4, plus ACOP (adriamycin 35 mg/sq.m, i.v.--4; cyclophosphamide 750 mg/sq.m, i.v.--4, day 1; vincristine 1.4 mg/sq.m, i.v.--4, and prednisolone 100 mg/sq.m, per os, days 1-5; group II (18)--cisplatin 100 mg/sq.m, day 4, plus 5-FU 1,000 mg, i.v.--4, injection, days 1-3. Full response was registered in 93.7% (group I) and 93.3% (group II). Overall 5-year and relapse-free survival was 85 and 63% (group I), and 83 and 56% (group II), respectively. There were no significant differences in radiation-related injury incidence in both groups. The best results were reported with chemoradiotherapy using two courses: an induction one and an adjuvant cisplatin drugs treatment concurrent with ACOP or 5-FU.

[Choice of the optimal variant of plastic surgery in head and neck tumors]. / Vybor optimal'nogo varianta plastiki pri opukholiakh golovy i shei.

Indications for planning primary and delayed operations for head and neck tumors have been evolved on the basis of our 15-year experience with 667 reconstructive surgeries (550 patients) 425 of which (77%) were conducted in one stage.