Cancer of the oral cavity: a comparison between institutions in a developing and a developed nation.

BACKGROUND: The literature suggests that the natural history of squamous cell carcinoma of the oral cavity may vary and the prognosis is different in patients from developing and developed nations. The objective of this study was to compare the clinical presentation, management, and outcome of patients with oral cancer treated at tertiary care cancer institutions in a developing nation (Brazil- Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo [HCACC]) with those from a developed nation (United States- Memorial Sloan-Kettering Cancer Center [MSKCC]). METHODS: Between January 1990 and December 1994, 602 patients underwent initial treatment in the study institutions. RESULTS: Overall, patients from HCACC had a higher predominance of men (78.8% vs 54.6%; p <.001) and a higher prevalence of tobacco (88.1% vs 77.8%; p =.002) and alcohol consumption (80.9% vs 69.8%; p =.004). More patients at HCACC had advanced disease (stage III/IV; 73.4% vs 37.4%; p<.001). Even though the overall outcome was poorer in patients from HCACC (p <.001), after controlling for stage, there was not a statistically significant difference in disease-free or overall survival between the two institutions. Only at cancer-specific survival for early-stage disease (stage I/II) patients showed a difference (p =.05). Moreover, clinical stage (RR, 3.7; 95% CI, 2.6-5.5) and definitive treatment (RR, 3.3; 95% CI, 2.4-4.6) were the only factors that remained as significant predictors of outcome on multivariate analysis. Finally, the rate of subsequent second primary cancers was higher in patients from HCACC (p =.03). CONCLUSIONS: Statistically significant differences were found in clinical presentation, tumor characteristics, and outcome in OC patients between the two institutions from a developing and developed nation. Overall outcome was poorer in HACC patients. However, after controlling for site, stage, and treatment, the outcome of these patients was similar, with the exception of a higher rate of occurrence of second primary cancers in patients from HACC. Given that the use of standard protocols of treatment offer similar outcomes, the establishment of education programs and screening measures for early diagnosis might be the best chance to improve overall outcome in OC patients in developing nations.

Cancer of the parotid gland: role of 7th nerve preservation.

Most neoplasms arising in the parotid gland are benign. Patients with cancer of the parotid gland usually present with normal facial nerve function. In these patients, findings at the time of surgery will guide the management of the facial nerve, with most surgeons preserving the nerve unless it is adherent to, or imbedded in, a malignant tumor. In cases where the margins of resection are close to the facial nerve, adjuvant radiotherapy administered postoperatively has significantly improved local control of disease. The minority of patients with parotid cancer who present with facial nerve palsy has a poor prognosis despite extensive surgical resection including the facial nerve.

Hürthle cell carcinoma: a 60-year experience.

BACKGROUND: The aim of this study was to define the clinical behavior and prognostic indicators of outcome in Hürthle cell cancer (HCC). METHODS: Diagnosis was confirmed for 56 patients with HCC treated between 1940 and 2000, who form the basis of this study. Primary end points were relapse-free survival (RFS) and disease-specific survival (DSS). Data were analyzed with the Kaplan-Meier method and by log-rank test. RESULTS: The extent of thyroid resection did not predict outcome. Recurrence was a significant predictor of tumor-related mortality. Significant adverse predictors of RFS and DSS were degree of invasion, size >4 cm, extrathyroidal extension, and initial nodal or distant metastases. The most significant predictor of outcome was extent of invasion. Eight-year RFS values for low- and high-risk groups were 100% and 24%. Corresponding rates of 8-year DSS were 100% and 58%. CONCLUSIONS: Widely invasive HCC is an aggressive malignancy that identifies patients who are at high risk for recurrence and tumor-related death. Patients with HCC have a prognosis that is reliably predicted by degree of invasion, tumor size, extrathyroidal disease extension, and initial nodal or distant metastasis. Recurrence portends a poor outcome. High-risk patients and those with recurrence should be considered for adjuvant therapy.

Using Lasers in Head and Neck Oncologic Surgery.

Few technologic advances in medicine have captured the imagination of the general public, and physicians, to the extent that the laser has. The laser clearly evokes images of space-age technology, and is frequently regarded as a panacea by patients. The reality is, of course, that the laser has no inherent special ability to cure diseases, and is simply another tool available to contemporary surgeons. We will review the current application of lasers in head and neck oncologic surgery. The basic mechanism of lasers will be discussed, with emphasis on the carbon dioxide (C02) laser. This discussion will include analysis of photodynamic therapy for cancer of the upper aerodigestive tract, which is rapidly evolving as a means of incorporating lasers in the treatment of head and neck cancer.