A randomized phase III trial comparing induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as treatment of unresectable head and neck cancer.

BACKGROUND: Concurrent chemoradiotherapy (CCRT) is the standard treatment for patients with unresectable, nonmetastatic locoregionally advanced squamous-cell carcinoma of the head and neck (LASCCHN). This randomized, open-label, phase III clinical trial compared the efficacy between standard CCRT and two different induction chemotherapy (ICT) regimens followed by CCRT. PATIENTS AND METHODS: Patients with untreated LASCCHN were randomly assigned to ICT (three cycles), with either docetaxel (Taxotere), cisplatin and 5-fluorouracil (TPF arm) or cisplatin and 5-fluorouracil (PF arm), followed by CCRT [7 weeks of radiotherapy (RT) with cisplatin 100 mg/m(2) on days 1, 22 and 43]; or 7 weeks of CCRT alone. The primary end points were progression-free survival (PFS) and time-to-treatment failure (TTF). RESULTS: In the intention-to-treat (ITT) population (n = 439), the median PFS times were 14.6 (95% CI, 11.6-20.4), 14.3 (95% CI, 11.8-19.3) and 13.8 months (95% CI, 11.0-17.5) at TPF-CCRT, PF-CCRT and CCRT arms, respectively (log-rank P = 0.56). The median TTF were 7.9 (95% CI, 5.9-11.8), 7.9 (95% CI, 6.5-11.8) and 8.2 months (95% CI, 6.7-12.6) for TPF-CCRT, PF-CCRT and CCRT alone, respectively (log-rank P = 0.90). There were no statistically significant differences for overall survival (OS). Toxic effects from ICT-CCRT were manageable. CONCLUSION: Overall, this trial failed to show any advantage of ICT-CCRT over CCRT alone in patients with unresectable LASCCHN.

[Second primary tumors in patients with pharyngo-laryngeal carcinoma]. / Segundos tumores primarios en pacientes con carcinoma faringolaríngeo.

The risk of second primary tumors of the respiratory and upper digestive tract developing in patients treated for head and neck cancer is well known. In these cases, the entire mucous membrane surface of the tract is affected and predisposed to metachronous or synchronous neoplasms. The mucosa of these patients is extremely susceptible to external carcinogenic stimuli. We report the results obtained in 83 patients with cancer of the oral cavity, pharynx, or larynx who experienced at least one second primary tumor. The most common site of the second primary was the lung (43.2%). We reviewed tobacco and alcohol use, treatments, and survival.

Primary lingual abscess presenting as acute swelling of the tongue obstructing the upper airway: diagnosis with MR.

We report the sudden development of an inflammatory process thought to be of the floor of the mouth with subsequent involvement of the respiratory airway. MR imaging showed an enhancing posterior lingual lesion, consistent with an abscess. Immediate surgical drainage relieved the symptoms. MR imaging allowed accurate diagnosis, which was essential for surgical planning in a condition that was otherwise difficult to diagnose.

[Orbital cellulitis and permanent amaurosis: clinical case]. / Celulitis orbitaria y amaurosis permanente: caso clínico.

Orbital cellulitis is a rare, potentially serious but complication of acute sinusitis. It is more frequent and benign in children, but in adults usually requieres surgical drainage of the affected sinus. We report a case of aggressive evolution with permanent blindness in an adult without general or local risk factors, in spite of adequate treatment. The literature is reviewed.

[Localized laryngeal amyloidosis. Treatment with CO2 laser]. / Amiloidosis laríngea localizada. Tratamiento con láser CO2.

Amyloidosis of the upper airways is rare. The larynx is the most common site of involvement. Primary amyloidosis may be localized or generalized. We report a case of laryngeal amyloidosis in which amyloid deposits were confined to the larynx (right false vocal cord and subglottis) and successfully treated with CO2 laser.

[Subdural empyema induced by frontal sinusitis]. / Empiema subdural inducido por sinusitis frontal.

Nowadays the complications arising from sinusitis are rare. However its seriousness can even cause death. Intracranial complications are much more uncommon than the orbital ones. However, slight symptoms can appear, which may disjunct the correlation between clinical-radiology and the severity of the infection. The diagnosis is fundamentally based on the TAC, and early treatment with intravenous anti-biotherapy should be implemented, being followed by drainage surgery of the sinus and empyema. We have presented a case which evolved favourably and revised all the literature pertaining to it.

[Adjuvant chemotherapy in the treatment of pharyngolaryngeal cancers in advanced stages]. / Tratamiento quimioterápico adyuvante en carcinomas laringo-faríngeos en estadios avanzados.

Since 1980 we use adjuvant chemotherapy in advanced laryngopharyngeal carcinomas. These cases were resectable and unresectable lesions with tumoral extent to the pharynx as a common characteristic. We analyze the survival of the first 50 cases treated with chemotherapy followed by: A) surgery and radiotherapy (36 cases) and B) radiotherapy alone (14 cases). Results of this not randomized study are compared with a historic group of advanced laryngopharyngeal carcinomas (T4/N+) treated with conventional therapy (surgery +/- radiotherapy). Response to chemotherapy was complete or partial (> 50% reduction) in 56 percent of the patients. There was improvement in overall survival and five-years disease-free survival in the latter group compared with those who did show any response (p < 0.01). We would point out that disease-free survival of the group A was better than historic group (60% vs 36%, p < 0.05), although these result should be carefully interpreted. Laryngeal preservation was achieved in 47 percent in the group A by modification of the initially scheduled radical surgery, in selected cases.