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

Introducción: El desarrollo de un segundo tumor primario (STP) en el cáncer escamoso de cabeza y cuello (CECC) presenta elevada mortalidad y condiciona la decisión terapéutica. Objetivo: Describir las características clínicas de los STP y determinar su implicación en la supervivencia. Material y método: Revisión de 633 pacientes con CECC entre 1984-2004 describiendo las principales características de los STP. Resultados: Se observan en el 11% de los CECC. Los tumores índice que se asocian más a un STP son los de laringe supraglótica (21%) y cavidad oral (16%). Los STP ocurren sobre todo en el área de cabeza y cuello (47%), pulmón (32%) y esófago (11%). Tienen gran impacto en la supervivencia de los pacientes con CECC, reduciéndola en un 30% (23% versus 53% en el grupo control). Conclusiones: Debido a la alta incidencia de STP es necesario profundizar en su estudio para realizar una prevención adecuada y un tratamiento eficaz

Introduction: The development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions. Purpose: To define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer. Material and method: Records of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT. Results: The overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group). Conclusion: Because of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated

[Lateral crural "J" flap repair to correct nasal valve collapse]. / El colgajo en "J" de la crus lateral del cartílago alar en el tratamiento del colapso de la válvula nasal.

INTRODUCTION: Nasal valve collapse is a common cause of nasal airway obstruction. Although many techniques have been devised to treat this problem, the outcomes of most of them have been disappointing. The aim of this study is to report our experience using the lateral crural J-flap repair to correct the nasal valve collapse. This technique is based on a new view of the structural etiology of nasal valve collapse and it offers excellent functional and aesthetic outcomes. MATERIAL AND METHODS: We present a retrospective study of 19 patients diagnosed of nasal valve collapse that underwent lateral crural J-flap repair from 2003 to 2005. RESULTS: 28 lateral crural J-flap repairs were made. Six patients underwent concomitant nasal surgery. Mean follow-up was 428 days All the patients have reported improvement of the subjective sensation of inspiratory collapse and there has been no noticeable decrement in benefit over time. No complications due to the procedure were observed. CONCLUSION: The lateral crural J-flap repair is an efective treatment for nasal valve collapse with minimal morbidity and a high success rate.

[Distant metastases in head and neck cancer]. / Metástasis a distancia en el cáncer de cabeza y cuello.

INTRODUCTION: The presence of distant metastasis (DM) after the initial treatment of head and neck squamous cell carcinoma (HNSCC) is not considered a common event and it is associated to a poor outcome. PURPOSE: To investigate the prevalence and risk factors associated with the diagnosis of distant metastasis in SCC. METHODS AND MATERIALS: A retrospective study of 633 patients with HNSCC to describe the clinical characteristics of the DM. RESULTS: During the follow-up period after the initial treatment, 6.2% of the patients were diagnosed of having distant metastasis. The site of primary tumor was hypopharynx in 14.4%, unknown origin in 11.8% and oropharynx in 8.5%. The most common sites of DM were the lungs (58%) and the bone (22%). Three year overall survival in patients with DM was 2.5% (versus 49,5% in the control group). CONCLUSIONS: This study confirms that DM have an adverse impact in survival. There is a need of guidelines for screening of distant metastases in patients with HNSCC in order to get an early diagnosis and a more effective treatment. Because of the poor prognosis of DM, protocols including adjuvant chemotherapy should be investigated.

El colgajo en “J” de la crus lateral del cartílago alar en el tratamiento del colapso de la válvula nasal / Lateral crural “J” flap repair to correct nasal valve collapse

Introducción: El colapso valvular nasal es una causa común de obstrucción nasal. Aunque se han descrito muchas técnicas para su tratamiento, la mayoría ha ofrecido resultados desalentadores. Nuestro objetivo es dar a conocer nuestra experiencia con el colgajo en “J” de la crus lateral del cartílago alar, una técnica basada en una nueva teoría acerca del colapso valvular nasal y que ofrece excelentes resultados estéticos y funcionales. Material y métodos: Se presentan 19 pacientes diagnosticados de colapso valvular nasal que fueron intervenidos mediante la realización de un colgajo en “J” entre 2003 y 2005. Resultados: Se realizaron un total de 28 colgajos en “J”. En 6 pacientes se realizó otra cirugía nasal concomitante. El periodo de seguimiento medio desde la intervención fue 428 días. Todos los pacientes han objetivado una mejoría inmediata de su obstrucción nasal, persistiendo esta mejoría durante todo el seguimiento. No hubo complicaciones atribuibles al procedimiento. Conclusiones: El colgajo en “J” es una técnica sencilla que permite el tratamiento del colapso valvular nasal con excelentes resultados y mínima morbilidad

Introduction: Nasal valve collapse is a common cause of nasal airway obstruction. Although many techniques have been devised to treat this problem, the outcomes of most of them have been disappointing. The aim of this study is to report our experience using the lateral crural Jflap repair to correct the nasal valve collapse. This technique is based on a new view of the structural etiology of nasal valve collapse and it offers excellent functional and aesthetic outcomes. Material and methods: We present a retrospective study of 19 patients diagnosed of nasal valve collapse that underwent lateral crural J-flap repair from 2003 to 2005. Results: 28 lateral crural J-flap repairs were made. Six patients underwent concomitant nasal surgery. Mean follow- up was 428 days All the patients have reported improvement of the subjective sensation of inspiratory collapse and there has been no noticeable decrement in benefit over time. No complications due to the procedure were observed. Conclusion: The lateral crural J-flap repair is an efective treatment for nasal valve collapse with minimal morbidity and a high success rate

Metástasis a distancia en el cáncer de cabeza y cuello / Distant metastases in head and neck cancer

Introducción: La presencia de metástasis a distancia (MD) no es un evento muy frecuente en los carcinomas de cabeza y cuello (CECC) y se asocia con muy mal pronóstico. Objetivo: Investigar la las principales características clínicas y factores de riesgo asociados con el diagnóstico de MD en CECC. Material y método: Estudio retrospectivo de 633 pacientes con CECC para describir las características clínicas de las MD. Resultados: Se observan en el 6,2% de los CECC. Las localizaciones que más las originan son la hipofaringe (14,4%), los primarios de origen desconocido (11,8%) y la orofaringe (8,5%), apareciendo con mayor frecuencia en pulmón (58%) y hueso (22%). Determinan un gran impacto en la supervivencia, reduciéndola al 2,5% a los 3 años (49,5% en el grupo control a los 5 años). Conclusiones: Es preciso realizar un seguimiento adecuado para su detección precoz y tratamiento eficaz, investigando nuevos protocolos terapéuticos que incluyan la quimioterapia

Introduction: The presence of distant metastasis (DM) after the initial treatment of head and neck squamous cell carcinoma (HNSCC) is not considered a common event and it is associated to a poor outcome. Purpose: To investigate the prevalence and risk factors associated with the diagnosis of distant metastasis in SCC. Methods and Materials: A retrospective study of 633 patients with HNSCC to describe the clinical characteristics of the DM. Results: During the follow-up period after the initial treatment, 6.2% of the patients were diagnosed of having distant metastasis. The site of primary tumor was hypopharynx in 14.4%, unknown origin in 11.8% and oropharynx in 8.5%. The most common sites of DM were the lungs (58%) and the bone (22%). Three year overall survival in patients with DM was 2.5% (versus 49,5% in the control group). Conclusions: This study confirms that DM have an adverse impact in survival. There is a need of guidelines for screening of distant metastases in patients with HNSCC in order to get an early diagnosis and a more effective treatment. Because of the poor prognosis of DM, protocols including adjuvant chemotherapy should be investigated

[Second primary tumors in head and neck cancer]. / Segundos tumores primarios en el cáncer escamoso de cabeza y cuello.

INTRODUCTION: The development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions. PURPOSE: To define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer. MATERIAL AND METHOD: Records of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT. RESULTS: The overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group). CONCLUSION: Because of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.