RESUMO
BACKGROUND: Dietary habits have been related to the risk of nasopharyngeal carcinoma (NPC), but information on a wide range of macro- and micronutrients is still lacking, particularly for low-incidence countries. METHODS: We conducted a hospital-based case-control study in Italy on 198, histologically confirmed, NPC cases of Caucasian ethnicity of 18-76 years of age. Controls were 594 Caucasian cancer-free patients admitted to general hospitals for acute conditions. Nutrients intake was assessed through a validated food-frequency questionnaire. Adjusted odds ratios (ORs) and the corresponding confidence intervals (CIs) were estimated through logistic regression. RESULTS: Dietary intake of carotenoids were inversely related to NPC risk, notably carotene (OR for highest vs lowest quartile=0.46; 95% CI: 0.26-0.79), α-carotene (OR=0.57; 95% CI: 0.33-0.97), and ß-carotene (OR=0.42; 95% CI: 0.24-0.75). Increased NPC risk was observed for elevate cholesterol intake (OR=1.85; 95% CI: 1.12-3.05). CONCLUSION: Study findings suggest a protective effect of carotenoids against NPC in a low-risk population, adding further support to a possible beneficial role of a diet rich in fruits and vegetables in cancers of the head and neck.
Assuntos
Carotenoides/administração & dosagem , Dieta/estatística & dados numéricos , Neoplasias Nasofaríngeas/epidemiologia , Adolescente , Adulto , Idoso , Carcinoma , Estudos de Casos e Controles , Comportamento Alimentar , Feminino , Humanos , Itália/epidemiologia , Masculino , Micronutrientes/administração & dosagem , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/etiologia , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: The study aimed to investigate the role of medical history (skin warts, Candida albicans, herpetic lesions, heartburn, regurgitation) and medication use (for heartburn; for regurgitation; aspirin) in the aetiology of upper aerodigestive tract (UADT) cancer. METHODS: A multicentre (10 European countries) case-control study [Alcohol-Related CAncers and GEnetic susceptibility (ARCAGE) project]. RESULTS: There were 1779 cases of UADT cancer and 1993 controls. History of warts or C. albicans infection was associated with a reduced risk [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.68-0.94 and OR 0.73, 95% CI 0.60-0.89, respectively] but there was no association with herpetic lesions, heartburn, regurgitation or medication for related symptoms. Regurgitation was associated with an increased risk for cancer of the oesophagus (OR 1.47, 95% CI 0.98-2.21). Regular aspirin use was not associated with risk of UADT cancer overall but was associated with a reduced risk for cancer of oesophagus (OR 0.51, 95% CI 0.28-0.96), hypopharynx (OR 0.53, 95% CI 0.28-1.02) and larynx (OR 0.74, 95% CI 0.54-1.01). CONCLUSIONS: A history of some infections appears to be a marker for decreased risk of UADT cancer. The role of medical history and medication use varied by UADT subsites with aspirin use associated with a decreased risk of oesophageal cancer and suggestive of a decreased risk of hypopharyngeal and laryngeal cancers.
Assuntos
Carcinoma de Células Escamosas/etiologia , Neoplasias de Cabeça e Pescoço/etiologia , Adulto , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Candidíase/complicações , Estudos de Casos e Controles , Suscetibilidade a Doenças , Europa (Continente) , Azia/complicações , Infecções por Herpesviridae/complicações , Humanos , Refluxo Laringofaríngeo/complicações , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Verrugas/complicações , Adulto JovemRESUMO
Undifferentiated Nasopharyngeal Carcinoma (UNPC) is associated with Epstein-Barr Virus (EBV) and characterized by an abundant immune infiltrate potentially influencing the prognosis. Thus, we retrospectively assessed the significance of immunosuppression in the UNPC microenvironment as prognostic biomarker of treatment failure in a non-endemic area, and monitored the variation of systemic EBV-specific immunity before and after chemoradiotherapy (CRT). DNA and RNA were extracted from diagnostic biopsies obtained by tumor and adjacent mucosa from 63 consecutive EBV+ UNPC patients who underwent radical CRT. Among these patients 11 relapsed within 2 years. The expression of the EBV-derived UNPC-specific BARF1 gene and several immune-related genes was monitored through quantitative RT-PCR and methylation-specific PCR analyses. Peripheral T cell responses against EBV and BARF1 were measured in 14 patients (7 relapses) through IFN-γ ELISPOT assay. We found significantly higher expression levels of BARF1, CD8, IFN-γ, IDO, PD-L1, and PD-1 in UNPC samples compared to healthy tissues. CD8 expression was significantly reduced in both tumor and healthy tissues in UNPC patients who relapsed within two years. We observed a hypomethylated FOXP3 intron 1 exclusively in relapsed UNPC patients. Finally, we noticed a significant decrease in EBV- and BARF1-specific T-cells after CRT only in relapsing patients. Our data suggest that a high level of immunosuppression (low CD8, hypomethylated FoxP3) in UNPC microenvironment may predict treatment failure and may allow an early identification of patients who could benefit from the addition of immune modulating strategies to improve first line CRT.
Assuntos
Antígenos CD8/imunologia , Resistencia a Medicamentos Antineoplásicos/imunologia , Fatores de Transcrição Forkhead/imunologia , Carcinoma Nasofaríngeo/imunologia , Neoplasias Nasofaríngeas/imunologia , Tolerância a Radiação/imunologia , Adolescente , Adulto , Idoso , Quimiorradioterapia/métodos , Metilação de DNA , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Microambiente Tumoral/imunologia , Proteínas Virais/imunologia , Adulto JovemRESUMO
A 25-year-old female with high-grade spindle cell sarcoma of the thyroid persistent after thyroidectomy performed at another hospital was referred to our institute. Chemotherapy followed by surgery with intraoperative radiotherapy and postoperative intensity-modulated radiotherapy were planned within the sarcoma board. Chemotherapy was discontinued after two cycles because of local disease progression and surgery with intraoperative radiotherapy, was anticipated. The treatment was completed with postoperative radiotherapy. After 36 months off-therapy, the patient was free of disease without significant late effects. Thyroid sarcomas are very rare and there is no consensus on their clinical management. Hence, case reports are useful to share treatment options. In this patient case, the histotype and the high-grade disease required a combined therapy program, managed in a multidisciplinary setting.
Assuntos
Sarcoma/terapia , Neoplasias da Glândula Tireoide/terapia , Adulto , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Humanos , Terapia Neoadjuvante , Equipe de Assistência ao Paciente , Radioterapia Adjuvante , Sarcoma/patologia , Neoplasias da Glândula Tireoide/patologia , TireoidectomiaRESUMO
Alteration of the short arm of chromosome 3 is one of the most consistent cytogenetic abnormalities found in human head and neck cancers. These alterations, composed of translocations and deletions, have been associated with the presence of a tumor suppressor gene(s), but no clear evidence of the location of this presumptive gene(s) was available. We performed a molecular analysis of the 3p region using a polymerase chain reaction-based approach. Twenty-eight of the 38 cases analyzed (74%) showed the presence of single or multiple areas of allelic loss. Three commonly deleted regions, tentatively mapped to 3p24-ter, 3p21.3, and 3p14--cen, were identified. Our results suggest that at least three oncosuppressor genes mapping on 3p may be involved in head and neck cancer development and support a common oncogenic pathway with squamous cell lung cancer, for which a similar pattern of 3p deletion has been described recently.
Assuntos
Carcinoma de Células Escamosas/genética , Deleção Cromossômica , Cromossomos Humanos Par 3 , Neoplasias de Cabeça e Pescoço/genética , Sequência de Bases , Genes Supressores de Tumor , Humanos , Dados de Sequência MolecularRESUMO
The deregulation of several cell cycle-related genes participates in neoplastic transformation. Cell cycle progression is driven by cyclin-dependent kinases, which are positively regulated by association with cyclins and negatively regulated by binding to inhibitory subunits. The activity of cyclin-dependent kinases is also regulated by the phosphorylation status, which is controlled by the antagonistic action of wee1 kinase and CDC25 phosphatases. Three CDC25 genes are present in human cells: CDC25A, CDC25B, and CDC25C. These three genes function at different phases of the cell cycle. Whereas CDC25A and CDC25B are expressed throughout the cell cycle, with peak expression in G1 for CDC25A and in both G1-S-phase and G2 for CDC25B, CDC25C is predominantly expressed in G2. Several lines of evidence suggest a role for CDC25s as oncogenes. CDC25A and CDC25B cooperate with Ha-ras or loss of Rb1 in the oncogenic transformation of rodent fibroblasts. Moreover, they are transcriptional targets of c-myc, and CDC25A in particular plays an important role as a mediator of myc functions. On the basis of the evidence that CDC25 phosphatases can act as oncogenes, we analyzed the expression of CDC25A, CDC25B, and CDC25C genes in 20 squamous cell carcinomas of the head and neck by quantitative reverse transcription-PCR. Our results show that whereas CDC25C is expressed at a low level with no relevant differences between neoplastic tissue and normal mucosa, CDC25A and CDC25B are overexpressed in a large fraction of tumors.
Assuntos
Proteínas de Ciclo Celular/metabolismo , Fosfoproteínas Fosfatases/metabolismo , Proteínas Tirosina Fosfatases/metabolismo , Fosfatases cdc25 , Carcinoma de Células Escamosas/metabolismo , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Reação em Cadeia da PolimeraseRESUMO
Heal and neck squamous cell carcinomas show frequent cytogenetic alterations involving the long arm of chromosome 13. To define the extent of 13q deletions and to identify the minimal areas of chromosome loss, 48 primary squamous cell carcinomas of the head and neck were analyzed for loss of heterozygosity using 11 different polymorphic loci. About 67% of the tumors displayed loss of genetic material at 13q. Most of the cases showed loss of the entire long arm of the chromosome. However, the presence of partial deletions in 10 cases provided evidence of the existence of two preferential sites of chromosome loss at 13q32-ter and 13q14.2-q14.3. The colocalization of the 13q14 minimal region of deletion with the retinoblastoma (RB) gene, which has been proposed as an oncosuppressor in diverse tumor types, prompted us to verify the involvement of this gene in the development of head and neck cancer. No significant variation in RB protein or RB mRNA expression was detected, thus excluding a role for such a gene in the genesis of this type of tumor. Taken together, our data suggest the existence of two new tumor suppressor genes (one close to and one distal to RB), which play a role in the development and/or progression of head and neck squamous cell carcinomas.
Assuntos
Carcinoma de Células Escamosas/genética , Cromossomos Humanos Par 13 , Neoplasias de Cabeça e Pescoço/genética , Sequência de Bases , Carcinoma de Células Escamosas/patologia , Mapeamento Cromossômico , Deleção de Genes , Genes Supressores de Tumor , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Dados de Sequência MolecularRESUMO
The long-term results of the EORTC 24954 trial comparing sequential versus alternating chemotherapy and radiotherapy (RT) for patients with locally advanced laryngeal and hypopharyngeal cancer are reported. From 1996 to 2004, 450 patients were randomly assigned (1-1) to a sequential arm (SA = induction cisplatin-5fluorouracil followed by a 70Gy-RT for the responders or a total laryngectomy and post-operative RT for the non-responders) and an alternating arm (AA = cisplatin-5fluorouracil alternated with three 2-week courses of 20 Gy-RT for a total dose of 60 Gy). Median follow-up was 10.2 years. Ten-year survival with functional larynx (primary end-point) and overall survival were similar in both arms (18.7% and 33.6% in SA versus 18.3% and 31.6% in AA). Late toxicity was also similar; however, a trend for higher larynx preservation and better laryngeal function was observed in AA.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/terapia , Laringe , Tratamentos com Preservação do Órgão/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Cisplatino/administração & dosagem , Progressão da Doença , Fracionamento da Dose de Radiação , Feminino , Fluoruracila/administração & dosagem , Humanos , Neoplasias Hipofaríngeas/patologia , Neoplasias Laríngeas/patologia , Laringectomia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Adulto JovemRESUMO
A series of 58 primary human squamous cell carcinomas of the larynx (LSCCs) was examined for the expression of the p53 tumor-suppressor gene by a combined immunohistochemical and molecular approach. About 60% of the cases displayed nuclear p53 overexpression as revealed by immunostaining with PAb1801, PAb122 and PAb240 monoclonal antibodies. This phenomenon was associated with the presence of structural and/or transcriptional alterations of the p53 gene. Our results provide evidence that p53 abnormalities constitute the most frequent genetic alteration identified so far in LSCC and indicate that the abnormal accumulation of the protein correlates with the presence of p53-mutated versions. These findings, taken together with the peculiar biochemical properties of p53, support the hypothesis of a possible pathogenetic relationship between smoke carcinogen exposure and p53 inactivation in the development of this tumor type.
Assuntos
Carcinoma de Células Escamosas/genética , Genes p53 , Neoplasias Laríngeas/genética , Mutação , Proteína Supressora de Tumor p53/genética , Anticorpos Monoclonais , Sequência de Bases , Southern Blotting , Carcinoma de Células Escamosas/patologia , DNA de Neoplasias/genética , DNA de Neoplasias/isolamento & purificação , Éxons , Humanos , Imuno-Histoquímica , Neoplasias Laríngeas/patologia , Dados de Sequência Molecular , Peso Molecular , Oligodesoxirribonucleotídeos , Reação em Cadeia da Polimerase/métodos , RNA Neoplásico/genética , RNA Neoplásico/isolamento & purificação , Mapeamento por Restrição , Fumar , Proteína Supressora de Tumor p53/análise , Proteína Supressora de Tumor p53/biossínteseRESUMO
From November 1981 to February 1983, 64 patients with advanced head and neck squamous carcinoma were randomly treated with either high-dose (120 mg/m2) or low-dose (60 mg/m2) cisplatin. Of the 62 eligible patients, 59 were evaluable: the response rate observed in patients receiving high-dose and low-dose cisplatin was 16.1% and 17.8%, respectively. Survival was superimposable in the two treatment arms. No evidence of dose dependency of cisplatin activity in advanced head and neck squamous carcinoma was noted in this randomized trial.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Cisplatino/administração & dosagem , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Cisplatino/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Distribuição AleatóriaRESUMO
PURPOSE: At least in some European Countries, there is still considerable controversy regarding the choice between surgery and radiotherapy for the treatment of patients with early laryngeal-glottic carcinoma. METHODS AND MATERIALS: Two hundred and forty-six patients with laryngeal-glottic neoplasms, Stage I-II, were treated with radical radiotherapy. Before radiotherapy the patients were evaluated to determine the surgical procedure of choice. Either 66-68.4 Gy (33-38 fractions) or 63-65 Gy (28-29 fractions) of radiation therapy (RT) were administered. The overall disease free survival was determined for each subgroup of patients. Univariate and multivariate analyses were performed to determine significant prognostic variables. RESULTS: Five- and 10-year overall survival rates were 83 and 72%, respectively. At a median follow-up of 6 years 204 patients are alive and disease free. No patient developed distant metastases. One patient died of a large local recurrence, 38 patients died of causes unrelated to their tumor, and 3 patients were lost to follow-up. The multivariate analysis confirmed that performance status (PS), macroscopic presentation of the lesion, and persistence of dysphonia after radiotherapy are significant prognostic factors. CONCLUSIONS: According to the multivariate analysis, the patients with PS > 80 and with exophytic lesions are eligible for radical RT. The surgical procedure proposed for each patient was not found to be an independent prognostic factor.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Laríngeas/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Fracionamento da Dose de Radiação , Feminino , Glote , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Terapia de Salvação , Taxa de Sobrevida , Resultado do TratamentoRESUMO
We conducted a follow-up study of 380 incident cases of cancer of the oral cavity, pharynx, or larynx, who had been included in a previous case-control study. Information pertaining to potential risk factors, clinical characteristics, and evolution of the tumor (vital status, metastases, and second primary tumors) was obtained. From a multivariate proportional hazard model including terms for risk factors and clinical variables, the incidence of metachronous second primary tumors occurring in the head and neck was positively associated with employment as a farmer as opposed to white collar (hazard ratio [HR] = 3.3) and with tobacco smoking before first tumor diagnosis (HR = 4.3 for heavy versus never or very light smoker). The risk of second primary tumor decreased with increasing dietary "beta-carotene" intake (HR = 0.4 for high versus low intake in tertiles). Less differentiated first primary tumors were followed more frequently by second tumors as compared to grade 1 tumors. The incidence of metastases was not associated with etiological factors of the first tumor, but with stage.
Assuntos
Neoplasias Laríngeas/epidemiologia , Neoplasias Bucais/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias Faríngeas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Antineoplásicos/administração & dosagem , Carotenoides/administração & dosagem , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Ocupações , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , beta CarotenoRESUMO
There is as yet no evidence to support population screening for oral cancer, although the mouth is easy to examine, and the disease is common in certain parts of the world and/or subsegments of the population. Oral cancer screening programs have been carried out on several hundred thousands of individuals in developing countries (mostly India and Cuba) and several thousands in developed countries (mostly the U.S.A., U.K. and Italy). Especially in developed countries, lesions of the pharynx and larynx were also searched for. Substantial portions of individuals with suspicious lesions (around 10%), mostly leukoplakia, could be identified, but major difficulties were found in targeting highest-risk individuals and referring them to a specialised centre, when necessary. When oral inspection was repeated, relatively high incidence of oral cancer, after removal of prevalent cases, suggested a rather short sojourn time for preclinical cancer (in the order of one year). Oral cancer screening programmes would be greatly facilitated by screening tests able to anticipate the detection of a preclinical phase, compared to visual inspection, thus allowing screening intervals to be prolonged. Finally, even if dysplastic lesions of the oral cavity were better recognised and understood (e.g. as for intra-epithelial lesions of the cervix uteri), surgical control of the disease would be harder than for the uterus, breast, or colon-rectum.
Assuntos
Neoplasias de Cabeça e Pescoço/prevenção & controle , Programas de Rastreamento , Humanos , Neoplasias Bucais/prevenção & controle , Lesões Pré-Cancerosas/diagnóstico , Fatores de RiscoRESUMO
The aim of this study is to assess the impact of prognostic factors in patients with locoregionally advanced nasopharyngeal cancer (NPC), WHO type II-III, treated with two different radiation therapy (RT) schedules: standard radiation therapy (SRT), and accelerated hyperfractionated radiation therapy (HART), with or without sequential chemotherapy. Between January 1986 and December 1999, 78 consecutive NPC patients were treated either with SRT (until August 1993) or with HART (from September 1993). Of the 78 patients, 60 were males and 18 females, the median age was 56 years (range 14-83). Nine patients had a non-keratinizing carcinoma (WHO type II) and 69 an undifferentiated carcinoma (WHO type III). Five-year overall survival rate (OS) was 62%. Two months after RT, 73 patients were in complete remission. Disease-free survival (DFS) rates at 5 years were: 85% for the HART and 59% for the SRT group, respectively. A multivariate analysis, age (hazard ratio, HR=4.17 for > or = 60 vs. <50 years) and N-stage (HR=3.56 for N3a-N3b vs. N0-N1) were significant for survival, whereas N-stage (HR=8.23 for N3a-N3b vs. N0-N1) and RT schedule (HR=0.30 for HART vs. SRT) were significant for DFS. In our experience, HART achieved higher DFS rates than SRT; however, HART did not favourably affect OS. Toxicity was comparable in the two RT schedules.
Assuntos
Carcinoma/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Quimioterapia Adjuvante , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
The aim of this study was to assess the feasibility of concurrent split course radiotherapy and low-dose bleomycin in the treatment of unresectable head and neck cancer with unfavourable prognostic factors and severe symptoms. The clinical outcome of the treatment was assessed in terms of local disease control, symptom relief and toxicity. Between 1990 and 1996, 58 patients with squamous cell carcinoma of the head and neck, stage III or IV, were treated by radiotherapy (50 Gy/20 fractions) and simultaneous bleomycin (60 mg/6 fractions). Local control of disease, overall response, symptom relief and acute toxicity were evaluated. The rate of disease local control was 69% with a median response duration of 7 months (range 2-43+). The symptom relief rate was 81%. Mucositis was the prominent toxicity: G3 mucositis was reported in 27 patients. In conclusion, the treatment was feasible. A good palliation of symptoms and a good rate of local response were obtained. Moreover, toxicity was tolerable and the rate of hospitalisation was low.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Idoso , Idoso de 80 Anos ou mais , Bleomicina/uso terapêutico , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Prognóstico , Taxa de Sobrevida , Resultado do TratamentoRESUMO
When resection of the posterior hypopharyngeal wall is undertaken for treatment of pyriform sinus carcinoma, a very narrow mucosal strip may be left for reconstruction. A surgical technique for carcinoma which has invaded the whole lateral hypopharyngeal wall is described. It consists of resecting half the larynx and half the hypopharynx and reconstructing the food canal using the mucosa of the unaffected half of the larynx and the remnant hypopharynx. A series of 34 patients treated by this technique is presented. No hypopharyngeal stenosis was observed. Local recurrences developed in 9 cases and distant metastases in 6. A specific disease mortality rate of 44% was encountered. At present, 15 patients are disease-free after a median follow-up of 48 months.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Hipofaringe/cirurgia , Laringectomia/métodos , Laringe/cirurgia , Neoplasias Faríngeas/cirurgia , Faringectomia/métodos , Traqueostomia , Adulto , Idoso , Cartilagem Cricoide/cirurgia , Seguimentos , Humanos , Osso Hioide/cirurgia , Mucosa Laríngea/cirurgia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Músculos Faríngeos/cirurgia , Retalhos Cirúrgicos/métodos , Taxa de Sobrevida , Cartilagem Tireóidea/cirurgiaRESUMO
Superficial extending carcinoma of the hypopharynx is a recently recognized form of carcinoma regarded as a possible pharyngeal counterpart to early gastric cancer and superficial esophageal carcinoma. In this study we report the radiological, clinical, and pathological features of three carcinomas of the larynx, which show architectural and histopathological features similar to those previously described in superficial extending carcinoma of the hypopharynx. These cases were singled out from a series of 37 consecutive laryngectomy specimens of primary infiltrating laryngeal carcinomas that were uniformly studied by means of a whole-organ sections technique. Pathologically, these cases showed a clearly invasive growth through the basal membrane into the lamina propria and an entire or predominant, extensive, superficial type of spread; infiltration of underlying muscle or gland structures was restricted to a few microscopic foci, regardless of the presence of lymph node metastases. The present study demonstrates that infiltrating carcinomas with a preferential superficial type of growth may also be encountered in the larynx. Differences between the histological features of these carcinomas of the larynx and the histopathological spectrum of so-called early laryngeal cancer are emphasized.
Assuntos
Carcinoma/patologia , Neoplasias Laríngeas/patologia , Laringe/patologia , Idoso , Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
The clinical records of 207 patients with squamous cell carcinoma of the head and neck, diagnosed and surgically treated at the Otolaryngology Division of Pordenone General Hospital and Aviano Cancer Centre, northeast of Italy, from January 1982 to December 1987, were retrospectively reviewed to gather information on blood transfusions and other characteristics potentially related to survival. The group of patients (mean age = 59 years) included 85 cases (41%) of laryngeal cancer, 80 cases (39%) of oropharyngeal and hypopharyngeal cancer, and 34 cases (16%) of cancer of the oral cavity. Fifty-five patients (27%) did not receive any blood transfusion while 152 patients were transfused with different amounts of blood. At the univariate analysis, nodal involvement, clinical stage, type of therapy, status of surgical margins, and metastatic spread beyond the nodal capsule appeared to be significantly linked to prognosis. After adjustment for other prognostic variables, transfused patients showed a twofold higher hazard ratio as compared to nontransfused patients, but such an unfavorable predictive value should be evaluated in the context of the other prognostic correlates of cancer of the head and neck.
Assuntos
Transfusão de Sangue , Carcinoma de Células Escamosas/mortalidade , Neoplasias de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Feminino , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Fatores de TempoRESUMO
One hundred fifty-two unselected, consecutive patients with T1-2N0 laryngeal squamous cell carcinoma received radical radiation therapy at the Division of Radiotherapy, Centro di Riferimento Oncologico, Aviano, Italy. Thirty-one (20.4%) of the patients showed disease recurrence or persistence (R/P) after radiotherapy. Flow-cytometric DNA ploidy measurements were performed in 72 cases; 20 had tumor R/P and 52 did not. Tumor R/P occurred more frequently (in 17 [85%] of 20 cases) in patients with diploid tumors. The hazard ratio of recurrence in diploid tumors as compared with aneuploid tumors, after inclusion of all the other significant prognostic factors in a Cox proportional hazards model, was 8.9 (P < .01). Therefore DNA ploidy seems to be an important marker of tumor R/P in patients with T1-2N0 laryngeal carcinoma after radiotherapy.
Assuntos
Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/radioterapia , DNA de Neoplasias/análise , Neoplasias Laríngeas/genética , Neoplasias Laríngeas/radioterapia , Recidiva Local de Neoplasia/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Feminino , Citometria de Fluxo , Seguimentos , Humanos , Neoplasias Laríngeas/epidemiologia , Masculino , Ploidias , Prognóstico , Modelos de Riscos Proporcionais , Radioterapia de Alta Energia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To analyze retrospectively several characteristics to verify the existence of further prognostic factors besides those already known for recurrence after neck dissection. DESIGN: From 1976 to 1993, 1 surgeon performed 1097 neck dissections as single surgical events in 705 patients. Radical neck dissection was performed only in the presence of fixed nodes and functional neck dissection in cases with mobile nodes or without detectable nodes (N0). Functional neck dissection was performed on laryngeal or hypopharyngeal N0 tumors without the dissection of the first level. External beam radiotherapy (RT) was performed based on the following conditions: microscopically positive margins of tumor, more than 2 positive nodes without capsular rupture (pN+R-), or capsular rupture (pN+R+). SETTING: Division of Otolaryngology, General Hospital of Pordenone, northeastern Italy. RESULTS: Nodal recurrences were observed in 38 patients (5.4%). Patient sex and age, histological grading and staging of primary tumor, second tumors, number of nodes, type of neck staging, surgeon's experience, type of dissection, alterations to the dissection, number of pN+R-, and postoperative RT were not significantly related to the recurrence. The clinical staging of nodes at greater than N1 and/or fixed; the neck levels IV, V, and multiple levels; previous RT with or without chemotherapy; the absence of a synchronous tumor operation; the assessment of the dissection as less than radical; the overall number of pN+ at 2 or more; and the presence of pN+R+ were related to higher recurrence rates. CONCLUSION: The treatment policy used herein is effective for pN+R-. A more aggressive multidisciplinary approach might be suggested for N2 and N3 and/or fixed nodes; nodes at levels IV, V, or multiple; nodes dissected less than radically; or pN+R+.