Postoperative adjuvant radiation therapy in the treatment of primary head and neck mucosal melanomas.

BACKGROUND/AIMS: The role of postoperative radiotherapy (PORT) in head and neck mucosal melanomas (HNMM) is not yet clearly defined. The aim of this study is to report the 21-year experience of the Brazilian National Cancer Institute in such treatment. METHODS: From January 1983 to December 2003, 31 patients with confirmed histological diagnosis of HNMM underwent treatment at the Brazilian National Cancer Institute. Of these, 20 received radical treatment with surgery alone (8 patients--group 1) or surgery and PORT (12 patients--group 2). RESULTS: Local control and the median time to local failure at 5 years were 75% and 14 months for group 1 and 83.5% and 40 months for group 2 (p = 0.06). The overall survival rates at 3 years were 37.5% for group 1 and 58% for group 2. At 5 years the survival rates were 25% for both groups (p = NS). When PORT was initiated within 60 days after surgery, there was a trend towards improvement in overall survival (p = 0.08). After univariate analysis, distant metastasis, location of primary disease and tobacco smoking were important prognostic factors. CONCLUSION: Early (<60 days) PORT for HNMM provides better local control with a longer disease-free survival.

Predictive value of sentinel node biopsy in head and neck cancer.

CONCLUSIONS: The negative predictive value (NPV) of sentinel lymph node biopsy (SNB) in this study was 95%. The accuracy of SNB compared to histopathologic evaluation of surgical specimen of subsequent neck dissection (ND) was 96%. OBJECTIVE: To evaluate NPV of SNB in head and neck cancer. PATIENTS AND METHODS: This was a prospective clinical study comprising 35 patients (50 necks) with squamous cell carcinoma (SCC) of head and neck with clinically (cN0) and radiologically negative necks, without previous treatment, who underwent SNB with gamma probe and subsequent ND. The NPV, accuracy, sensitivity, and specificity of SNB were compared to histopathologic assessment of surgical specimens from NDs. Negative sentinel lymph nodes (SLNs) on histopathology were evaluated with step serial section (SSS) and immunohistochemistry (IHC). When a neck had a positive SLN, all lymph nodes of subsequent NDs were studied with SSS and IHC. RESULTS: There were primaries of the oral cavity (n=24), lip (n=3), oropharynx (n=3), and larynx (n=5). All patients had detected SLNs. In all, 41 necks were SLN-negative on histopathologic evaluation but 2 (5%) had metastases in non-SLNs after ND. Of these 41 necks, SLNs were level Ib (26%), IIa (45%), III (21%), and IV (8%). Nine necks presented positive SLN on histopathologic evaluation, level Ib (n=3), IIa (n=5), and III (n=2), and subsequent NDs were negative on conventional histopathologic analysis, but after SSS and IHC, two presented micrometastases.

Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract.

CONTEXT AND OBJECTIVE: Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. DESIGN AND SETTING: Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). METHODS: We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). RESULTS: Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. CONCLUSIONS: SND may be a good option for treating node-positive necks in selected cases.

Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract / Esvaziamento cervical seletivo para o tratamento do pescoço positivo em carcinomas epidermóides do trato aerodigestório alto

CONTEXT AND OBJECTIVE: Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. DESIGN AND SETTING: Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). METHODS: We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). RESULTS: Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. CONCLUSIONS: SND may be a good option for treating node-positive necks in selected cases.

CONTEXTO E OBJETIVO: O esvaziamento cervical radical modificado (ECRM) é o tratamento clássico para as metástases cervicais do carcinoma espinocelular (CEC) do trato aerodigestório alto (TADA). Este procedimento é considerado oncologicamente satisfatório, porém pode ser acompanhado de seqüelas significativas devido à extensão do procedimento e a grande manipulação de estruturas nobres, especialmente as nervosas. Assim, tem sido proposto o esvaziamento cervical seletivo (ECS) para o tratamento de casos selecionados, pN1, pN2 sem ruptura capsular, minimizando, ou mesmo evitando, deste modo, as seqüelas do ECRM. O grande questionamento atual é a definição de quais casos seriam eleitos para este procedimento, sem alterar o resultado oncológico de médio e longo prazo. TIPO DE ESTUDO E LOCAL: Estudo clínico retrospectivo realizado na Disciplina de Cirurgia de Cabeça e Pescoço do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. MÉTODOS: Estudamos 67 doentes portadores de CEC do TADA de 1990 a 2001 dividindo-os em dois grupos: 1) 47 doentes tratados com ECS e 2) 20 doentes tratados com ECRM (todos N+). Os casos do grupo 1 eram clinicamente N0 e, 11 tornaram-se pN+, após o exame histopatológico. Assim, no grupo 1 obtivemos doentes pN+ tratados com ECS e seguimos estes grupos por, no mínimo, 2 anos. O grupo 2 serviu como controle da evolução dos doentes pN+. RESULTADOS: Nossos resultados mostraram que na comparação do ECS com o ECRM, não houve diferença significativa quanto à evolução (sobrevivência ou recidiva), no entanto, foi possível evidenciar uma pior evolução nos doentes N+ quando comparados aos N0, demonstrando que o principal fator prognóstico é o comprometimento linfonodal. Além disso, apesar do pequeno número de doentes, observamos que os doentes mais idosos e com CEC de faringe tiveram pior evolução e, por isto, talvez não sejam candidatos ao ECS. CONCLUSÕES: Concluímos, portanto, que o ECS pode...

Prótesis faciales: imaginación e ingenio para alcanzar una mejor calidad de vida / Face restauring prosthesis: imagination and creative for obtain best quality of life

Antecedentes: La cirugía de cabeza y cuello se halla enfrentada a la necesidad de efectuar la amputación de estructuras visibles para lograr la curación de la enfermedad. Actualmente es inviable dejar secuelas que limiten la calidad de vida. Objetivo: Analizar costos y aceptación alcanzados con prótesis restauratrices de órganos vitales o deformaciones de la cara tras resecciones oncológicas. Lugar de aplicación: Hospital público. Diseño: Prospectivo. Población: 33 enfermos, 72,7 por ciento del sexo masculino, edad media 64,1 años. Las estructuras sacrificadas fueron predominantemente la órbita, el pabellón auricular y la nariz. Método: Confección de prótesis restauratriz con materiales blandos y maquillaje. Los enfermos fueron encuestados sobre el grado de satisfacción. Resultados: Los insumos tuvieron un costo medio de $ 75 (50-280). Se comprobó un 51 por ciento de resultados buenos. El 21,2 por ciento abandonó el uso de la prótesis. Conclusiones: La confección de prótesis restauratrices es práctica, económica y reduce costos operativos. Los resultados alcanzados son aceptables, pero el costo del maquillaje produce una considerable deserción de su uso cotidiano. Es fundamental la integración del protesista en la consideración del tratamiento global de la enfermedad neoplásica avanzada (AU)

Ipsilateral neck cancer recurrences after elective supraomohyoid neck dissection.

DESIGN: Retrospective analysis of a case series. SETTING: Referral center, private or institutional practice, hospitalized care. OBJECTIVE: To analyze the level (site) of ipsilateral neck recurrences after supraomohyoid (SOH) dissection in patients with lip, oral, and oropharyngeal cancer treated in a single institution. INTERVENTION: Supraomohyoid neck dissection. PATIENTS AND METHODS: From 1979 to 1997, 154 patients with oral and oropharyngeal carcinoma and no palpable lymph nodes at the neck underwent ipsilateral elective SOH dissection. RESULTS: Tumor sites were the lip, 5 cases (3.3%); oral cavity, 128 cases (83.1%); and oropharynx, 21 cases (13.6%). Tumor stages were T1, 13 cases (8.4%); T2, 77 cases (50.0%); T3, 40 cases (27.0%); and T4, 22 cases (14.3%). There were 7 cases (4.5%) of ipsilateral neck recurrences. Three were beyond the limits of the SOH dissection, and 4 were inside these limits. There was no association of neck recurrences with the pathological status of the lymph nodes. Six of the 7 recurrences were in patients who underwent postoperative radiotherapy. CONCLUSIONS: The incidence of neck recurrence after selective neck dissection was 4.5%, and it occurred either inside (57.1%) or beyond (42.9%) the limits of the selective neck dissection.

Glioma nasal: reporte de 2 casos y revisión de la literatura / Nasal glioma: report of two cases and review of literature

En el presente artículo se presentan dos casos de Glioma Nasal en el servicio de Otorrinolaringología del Hospital General Centro Médico La Raza. El primero es un niño de 1 año de edad, el cual se clasificó como Glioma Nasal Externo y el segundo, en un niño de 10 años siendo un Glioma Nasal Interno, ambos sin implicación intracraneana y manejados quirúrgicamente con resección local sin presentar recidiva hasta la actualidad. Además se presenta una revision de la literatura.