Neoadjuvant chemotherapy followed by radiotherapy versus concurrent chemoradiotherapy for larynx preservation in patients with advanced laryngeal cancer.

PURPOSE: The efficacy and toxicity of neoadjuvant chemotherapy followed by radiotherapy and concurrent chemoradiotherapy and their impact on larynx preservation have been studied in patients with advanced (stage III, IVa, and IVb) squamous cell cancer of the larynx. PATIENTS AND METHODS: Fifty patients were treated with either 2-4 cycles of induction chemotherapy with cisplatin 100 mg/m(2), day 1 and infusional 5-fluorouracil (5-FU 1000 mg/m(2), days 1-5), followed by radiotherapy 70 Gy, 1.8-2 Gy per fraction, or concurrent chemoradiotherapy (the above-mentioned radiotherapy concurrently with carboplatin 300 mg/m(2) every 21 days or weekly paclitaxel 80 mg/m(2)). Patients were allocated in the 2 arms by 1:1 selection. At the end of both protocols, patients without complete response (CR) underwent laryngectomy and/or neck lymph node dissection. Assessed were response and toxicity rates, overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 31 (62%) patients achieved larynx preservation with acceptable organ function. No statistically significant difference in response rate and OS was found between the two treatment arms. Patients submitted to concurrent chemoradiotherapy showed significantly longer DFS (14 vs. 10 months, p= 0.0397) and higher rates of larynx preservation (p <0.05). All grade IV side effects occurred in the concurrent chemoradiotherapy group. CONCLUSION: Concurrent compared to alternating chemoradiotherapy was more toxic, but achieved significantly longer DFS and higher rate of larynx preservation.

[Volume reduction of tonsil hyperplasia in childhood with a surgical ultrasound device]. / Volumenreduktion bei Tonsillenhyperplasie im Kindesalter durch ein operatives Ultraschallsystem.

BACKGROUND: We present the results of a prospective study concerning the use of a surgical-ultrasound device (use of ultrasound mechanical vibrations in the tonsil tissue with denaturizing effect on collagen and proteins for tonsil ablation, coablation) for the therapy of non-infectious tonsillar hyperplasia resulting in upper airway obstruction in childhood. METHOD: 51 patients with a median age of 6.9 years (3.5-12 years) were treated with surgical ultrasound, under general anesthesia. The intervention did not include tissue excision, but the denaturation of hyperplastic tonsil tissue. Intra- and postoperative bleeding, pain (by visual analog scale), tonsil-to-tonsil diameter and swallowing difficulties were under consideration. Also an bacteriological examination of tonsils was performed. RESULTS: The procedure was generally well tolerated. There was no intra- or postoperative bleeding. Swallowing difficulties were described as not very disturbing. Median follow up was 2.1 years. The postoperative "wound healing" lasted 7-9 days. A reduction of tonsil's size was visible since the first post treatment week with the final results occurring after 3-6 months. Intertonsillar distance was 9 mm preoperatively and 22.14 mm after coablation. A higher incidence of bacterial tonsillitis or development of quinsies were not reported. CONCLUSION: The treatment of tonsilar hyperplasia by means of surgical ultrasound is highly effective and causes relatively mild post surgical complaints without intra- or postoperative bleeding.

5-Fluorouracil and cisplatin in the treatment of advanced oral cancer.

The benefit of the effect of chemotherapy in patients with advanced head and neck squamous cell tumors have been demonstrated by recent meta-analyses of randomized studies. However, the role of chemotherapy-especially in advanced oral cancer-is not fully clear, because of the very small amount of phase II literature available. From January 1994 to December 2000, a total of 44 pts aged 33-75 years (mean age 60 years) with advanced and histologically proved squamous cell carcinoma's of the oral cavity received at least one chemotherapy course. Seven patients had stage III and 37 stage IV disease. The chemotherapy was the initial therapy in a group of 21 patients. In a second group of 23 patients the chemotherapy was delivered after relapse of their disease. The pre-chemotherapy treatment of the second group was radiotherapy in 11, surgery in 4, combination of radiotherapy and surgery in 8 patients. The chemotherapy regimen consisted of cisplatin 100 mg/m(2) in 3-h infusion, day 1 and 5-FU 1000 mg/m(2) in 24-h infusion, days 1-5. Treatment was repeated every 21 days. A total of 154 treatment courses (3.5 per patient, ranged 1-10) were administered. Myelotoxicity, nausea and vomiting were the major treatment complications. The overall response rate to the induction chemotherapy was 52.3%, with 19% complete (CR), and 33.3% partial response's (PR) and to the chemotherapy for recurrent/metastatic disease 30.4% with 8.7% CR, and 21.7% PR. No difference was found in the median survival of the two subgroups (12 months). The median survival of the responders was 15 months (95% CI 11.3-18.7 months), and of the non-responders 9 months (95% CI 5.6-12.4 months) (P = 0.0067). Chemotherapy with cisplatin and 5-FU combination is effective in pts with advanced squamous cell oral cancer and appears to improve the survival of patients who have a good response.

Parotid gland atrophy induced by occlusion of the ductal system with a protein solution.

Nonneoplastic disorders of the parotid gland, such as chronic recurrent parotitis, asymptomatic gland enlargement, or salivary fistulae, are therapeutic problems. Surgical removal of the gland is often difficult, since scar tissue may be present in these benign diseases. Therefore, alternative treatment methods, such as ligation of Stensen's duct, irradiation, or tympanic neurectomy, have been used to induce atrophy of gland parenchyma. This goal can also be attained by intraluminal duct occlusion, which involves instillation of a resorbable protein solution into the duct system, a procedure similar to sialographic injection. Intraluminal duct occlusion is a simple technique with rapid onset of atrophy and low morbidity, and with its use options remain open for other treatment modalities. The authors have used this method in the treatment of various diseases in 26 parotid glands and one submandibular gland. Their experience, which includes three-year patient follow-up data, suggests that this technique may be a useful alternative to salivary gland resection in certain nonneoplastic diseases.