Segundos tumores primarios en cáncer de cabeza y cuello / Second primary tumours in head and neck cancer

Introducción y objetivos: Los segundos tumores primarios afectan más a pacientes con cáncer de cabeza y cuello que a la población general. Con preferencia por cabeza y cuello, pulmón y esófago, afectan la supervivencia a largo plazo. El objetivo es estudiar la incidencia, localización en relación con el tumor índice y su estadio, cronología de aparición, relación con la edad del paciente y supervivencia posdiagnóstico. Material y método: Estudio retrospectivo de 579 pacientes diagnosticados de carcinoma epidermoide de cabeza y cuello, tratados con intención curativa y seguimiento mínimo de 24 meses. El 42,4% (246/579) eran estadios I y II, y el 57,6% (334/579) restante eran estadios III y IV. Resultados: El 15% (87/579) de los pacientes desarrollaron un segundo tumor, y el 9,2% (8/97) desarrollaron un tercer tumor. Las localizaciones más frecuentes fueron cabeza y cuello, 37,9% (33/87), pulmón, 36,8% (32/87), esófago, 5,7% (5/87) y colorrectal, 5,7% (5/87). La supervivencia a 5 y 10 años de pacientes sin segundo tumor fue del 65,1 y 52,7% respectivamente, frente a una 58,7 y 40,2% de los que sí lo desarrollaron. Conclusiones: La incidencia de segundos tumores se ha incrementado en los últimos años y suponen una disminución en la supervivencia de los pacientes. La revisión periódica y la reducción del consumo de alcohol y tabaco son, ante la ausencia de diagnóstico precoz efectivo, la mejor manera de reducir su incidencia (AU)

Introduction and objectives: Head and neck cancer patients have a higher risk of second primary tumours than the general population. The most frequent locations are head and neck, lung and oesophagus, decreasing long-term survival. The aim of this work was to analyse the incidence, location according to index tumour and stage, chronology, patient age, and survival after diagnosis. Method: Retrospective study on 579 patients with head and neck squamous cell carcinoma, treated with curative intent, with a minimum 24-month follow-up. Early stages (I/II) were 42.4%, and 57.6% were stages III and IV. Results: Second primary tumour incidence was 15% (87/579), with 9.2% (8/97) developing a third tumour. The most frequent locations of the second tumours were head and neck, 37.9% (33/87); lung, 36.8% (32/87); oesophagus, 5.7% (5/87); and colon, 5.7% (5/87). Five- and 10-year survival in patients without a second tumour was 65.1% and 52.7% respectively, versus 58.7% and 40.2% in those who developed one. Conclusions: The incidence of second primary tumours increased in the last decade, having a negative effect on survival. Since no specific early diagnosis tool is available, alcohol and tobacco avoidance along with scheduled follow-up are suggested procedures to reduce its incidence (AU)

Second primary tumours in head and neck cancer. / Segundos tumores primarios en cáncer de cabeza y cuello.

INTRODUCTION AND OBJECTIVES: Head and neck cancer patients have a higher risk of second primary tumours than the general population. The most frequent locations are head and neck, lung and oesophagus, decreasing long-term survival. The aim of this work was to analyse the incidence, location according to index tumour and stage, chronology, patient age, and survival after diagnosis. METHOD: Retrospective study on 579 patients with head and neck squamous cell carcinoma, treated with curative intent, with a minimum 24-month follow-up. Early stages (I/II) were 42.4%, and 57.6% were stages III and IV. RESULTS: Second primary tumour incidence was 15% (87/579), with 9.2% (8/97) developing a third tumour. The most frequent locations of the second tumours were head and neck, 37.9% (33/87); lung, 36.8% (32/87); oesophagus, 5.7% (5/87); and colon, 5.7% (5/87). Five- and 10-year survival in patients without a second tumour was 65.1% and 52.7% respectively, versus 58.7% and 40.2% in those who developed one. CONCLUSIONS: The incidence of second primary tumours increased in the last decade, having a negative effect on survival. Since no specific early diagnosis tool is available, alcohol and tobacco avoidance along with scheduled follow-up are suggested procedures to reduce its incidence.

Acroqueratosis de Bazex como síndrome paraneoplásico / Bazex acrokeratosis as a paraneoplastic syndrome

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Replica a la carta «Reconstrucción de orofaringe e hipofaringe. ¿Qué hemos aprendido?» / Reply to the letter «Oropharynx and hypopharynx reconstruction. What have we learnt?»

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Grupos de riesgo en carcinomas diferenciados de tiroides / Risk groups in differentiated thyroid carcinomas

Introducción: El 80% de los carcinomas de tiroides corresponden a tumores diferenciados y la supervivencia causa específica a más de 20 años es superior al 90%. A pesar de su incremento en los últimos años, la supervivencia se mantiene estable. La evaluación de los factores pronósticos y de riesgo ha demostrado su utilidad en la selección de los tratamientos más adecuados a cada paciente. Material: Hemos analizado la incidencia de carcinomas de tiroides, agrupándolos según diferentes tipos de criterios (TNM, GAMES, MACIS) comparándolos con los índices referidos en la literatura. Analizamos así mismo el índice de complicaciones. Resultados: La incidencia de tumores malignos en la población operada de tiroides es del 28,8%, siendo el 88% carcinomas bien diferenciados. El 80% corresponde a grupos de bajo riesgo, equivalentes en los tres sistemas de estratificación. El 16% eran multifocales, y en el 50% la lesión mayor medía menos de 2cm. El índice de parálisis recurrencial definitiva fue del 1,2%, y de 2,7% el de hipoparatiroidismo definitivo. Conclusiones: La incidencia de grupos de riesgo de nuestra serie es similar a la de la literatura. El 80% de los pacientes tienen un expectativa de vida superior al 95% a 20 años. La evaluación de los criterios de riesgo debería determinar la amplitud de la resección, reduciendo el riesgo de complicaciones en aquellos pacientes que no se beneficien de una cirugía más agresiva (AU)

Introduction: Well-differentiated thyroid carcinoma represents 80% of all thyroid malignant tumours, with a survival rate of over 95% at 20 years in 80% of the cases. Although its incidence is increasing, survival remains unchanged. Prognostic factor evaluation allows identifying patients at high or low risk of recurrence, selecting those who will benefit from more aggressive therapy. Material: We have reviewed the incidence of malignant thyroid neoplasm, selecting them according to three different system definitions (TNM, GAMES, MACIS), as well as by post-surgical complication rate. Results: Malignant neoplasm represents 28.8% of the thyroid-operated patients, 88% corresponding to well-differentiated carcinomas. 80% are in the low risk group, with similar numbers in all three staging system definitions. Multicentricity was found in 16%, with 50% of the lesions smaller than 2cm. Permanent recurrent nerve palsy was 1.2% and 2.7% presented permanent postoperative hypocalcaemia. Conclusions: Risk group percentage is similar to that reported in the literature, with 80% having expected survival over 95% at 20 years. Risk factor evaluation should help to individualise treatment options, avoiding overtreatment and complications in patients that will not benefit from more aggressive therapy (AU)

Reconstrucción de orofaringe e hipofaringe. ¿Qué hemos aprendido? / Oropharynx and hypopharynx reconstruction. What have we learnt?

Introducción y objetivos: La reconstrucción de orofaringe e hipofaringe demanda importante recursos técnicos y humanos. El objetivo es analizar nuestro programa de reconstrucción durante los últimos 13 años. Métodos: Se realizó un estudio retrospectivo de 43 procedimientos reconstructivos de orofaringe e hipofaringe realizados entre 1993–2008. Resultado: El 67,4 % (29/43) fueron microvasculares (fasciocutáneo radial 17, recto anterior del abdomen 10, escapular 1, yeyuno 1) y el 42,6% (14/43) miocutaneos (pectoral mayor 13, dorsal ancho 1). El 83% (37/43) eran tumores de orofaringe y el 17% (6/43) de hipofaringe, siendo estadio IV el 70% (30/43), 26% (11/43) estadio III y 4% (2/43) estadio II. La estancia media fue de 54 días. El 74,4% (32/43) presentó algún tipo de complicación postoperatoria, siendo la más frecuente la fístula salivar, 62,5% (20/32). El fracaso por necrosis de los colgajos microvasculares fue del 20% (6/29). Se realizó un microvascular cada 5,5 meses, y un miocutáneos cada 11,1 meses. La radioterapia previa y la cirugía de rescate no influyeron de forma significativa en la incidencia de complicaciones. Conclusiones: La reconstrucción es un reto apasionante y agradecido cuando todo va bien, pero cuando fracasa, es frustrante para el médico, pero mucho más lo es para el paciente. Por ello, la colaboración entre equipos implicados en la reconstrucción de cabeza y cuello es importante sobre todo en centros en los que el volumen de pacientes no permite adquirir, de forma rápida, la destreza y experiencia que este tipo de cirugía requiere (AU)

Introduction and objectives: Oropharyngeal and hypopharyngeal reconstructions require significant human and technical resources. This study analysed our reconstruction program over the last 13 years. Material and Methods: Retrospective study in a tertiary reference centre. Results: Forty-three reconstruction procedures, of which 67.4 % (29/43) were microvascular (radial forearm 17, rectus abdominis 10, scapular 1, jejunum 1) and 42.6% (14/43) myocutaneous (pectoralis major 13, latissimus dorsi 1). Of these reconstructions, 83% (37/43) were for oropharyngeal defects and 17% (6/43) for hypopharyngeal defects, with 70% Stage IV (30/43), 26% Stage III (11/43) and 4% (2/43) Stage II. Mean Hospital stay was 54 days. Complications were present in 74.4% (32/43), salivary fistula being the most frequent (62.5%; 20/32). Ischemic necrosis was present in 20% (6/29) of the microvascular flaps. One microvascular flap was performed every 5.5 months, and one myocutaneous every 11.1 months. Previous radiotherapy and salvage surgery did not significantly increase the rate of complications. Conclusions: Reconstruction of pharyngeal defects is a challenging and demanding task, one that is great when everything runs perfectly and disastrous when failure takes place, mainly for the patient. Disciplines related with head and neck reconstruction should create multidisciplinary teams to increase experience, particularly in centres where the number of patients available makes it difficult to get the expertise and confidence this surgery demands for accomplishing the objectives of patient satisfaction and functional restoration (AU)

[Oropharynx and hypopharynx reconstruction. What have we learnt?]. / Reconstrucción de orofaringe e hipofaringe. Qué hemos aprendido?

INTRODUCTION AND OBJECTIVES: Oropharyngeal and hypopharyngeal reconstructions require significant human and technical resources. This study analysed our reconstruction program over the last 13 years. MATERIAL AND METHODS: Retrospective study in a tertiary reference centre. RESULTS: Forty-three reconstruction procedures, of which 67.4 % (29/43) were microvascular (radial forearm 17, rectus abdominis 10, scapular 1, jejunum 1) and 42.6% (14/43) myocutaneous (pectoralis major 13, latissimus dorsi 1). Of these reconstructions, 83% (37/43) were for oropharyngeal defects and 17% (6/43) for hypopharyngeal defects, with 70% Stage iv (30/43), 26% Stage iii (11/43) and 4% (2/43) Stage ii. Mean Hospital stay was 54 days. Complications were present in 74.4% (32/43), salivary fistula being the most frequent (62.5%; 20/32). Ischemic necrosis was present in 20% (6/29) of the microvascular flaps. One microvascular flap was performed every 5.5 months, and one myocutaneous every 11.1 months. Previous radiotherapy and salvage surgery did not significantly increase the rate of complications. CONCLUSIONS: Reconstruction of pharyngeal defects is a challenging and demanding task, one that is great when everything runs perfectly and disastrous when failure takes place, mainly for the patient. Disciplines related with head and neck reconstruction should create multidisciplinary teams to increase experience, particularly in centres where the number of patients available makes it difficult to get the expertise and confidence this surgery demands for accomplishing the objectives of patient satisfaction and functional restoration.