Joaquim Castro Silva

Positron emission tomography in the detection of occult primary head and neck carcinoma: a retrospective study

BackgroundThe management of cervical lymph node metastases from an unknown primary tumor remains a controversial subject. Recently, Positron Emission Tomography (PET) has proved useful in the detection of these tumors, even after an unsuccessful conventional diagnostic workup. This study was performed to assess the role of PET in the detection of occult primary head and neck carcinomas.MethodsA retrospective analysis of a four year period at a tertiary referral oncology hospital was conducted.ResultsOf the 49 patients with cervical metastases of carcinoma from an unknown primary, PET detected a primary in 9 patients and gave 5 false positive and 4 false negative results. Detection rate, sensitivity, specificity and accuracy were of 18.4%, 69.2%, 86.1% and 81.6%, respectively. PET was also of substantial benefit in detecting distant metastatic disease and, thus, altered therapeutic strategies in a significant amount of patients.ConclusionsTherefore, PET is a valuable tool in the management of patients with occult primary head and neck carcinoma, not only because it provides additional information as to the location of primary tumors, but also due to the fact that it can detect unexpected distant metastases.

Postoperative stroke in head and neck cancer patients submitted to surgery

Background: Stroke is a highly morbid complication after head and neck surgery (HNS). Our purpose was to report the casuistic of postoperative stroke (POS) in ENT Department of Oporto Cancer Institute, discuss predictable causes and prognosis. Methods: Retrospective study that included cases of POS in our Department, between 2012 and 2017. Medical files were reviewed and perioperative aspects were analysed. Results: We identified 8 cases of POS in 293 HNS performed. All underwent to HNS including bilateral ND as primary treatment. Several cardiovascular risk factors (CVRF) were present, especially carotid artery stenosis (CAS). Complete internal carotid artery (ICA) encasement was present in 2 patients, in whom artery ligation was performed. Acute drop of bispectral index (BIS) occurred in 1 patient. Stroke occurred at 2.8 post-operatory day (in mean) and was ischemic in 7 patients and haemorrhagic in 1. The most affected vessel was cerebral media artery (87.5%). Hemiparesis was the main clinical manifestation (63%). Incidence of POS was 2.7%. Functional and neurologic recovery occurred in 50%. Mortality rate was 37.5%. Conclusions: Our findings suggest that worst outcomes were observed in patients with advanced tumour stages, vessel tumour involvement or carotid artery stenosis presence with requirement ligation of ICA, higher number of CVRF, and low or sudden decrease in BIS values during surgery. According to our results we recommend to screen, select and optimize patients to minimise the incidence and severity of this complication.

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis

OBJECTIVE To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries. METHODS A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate. RESULTS In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization. CONCLUSION The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

SP242 – Dendritic cell behavior after radiotherapy of the larynx

Objectives: 1)Count Langerhans cell infiltration in laryngeal tumors before treatment. 2)Determine the effect of radiotherapy on Langerhans cell infiltration in laryngeal tumors Methods: Retrospective review of 33 patients with laryngeal tumors treated with radiotherapy as primary intention and salvation surgery for local recurrence, between 1990 and 1993 . Patients had a minimum 3-year postoperative follow-up. Langerhans cell infiltration, graded +0(no cells), +1(1-5 cells), +2(6-10 cells) or +3(> 10 cells), was determined with the streptavidin – biotin method. Histopathologic examinations were carried by two different pathologists on biopsy (before radiotherapy) and on tumor (after surgery). Statistically, the significance level was taken as p<0,05. Results: Langerhans cell infiltration was determined as +0 in 10(30,3%), +1 in 18(54,5%), +2 in 3(9,1%) and +3 in 2(6,1%) patients before treatment. After surgery, 7(21,2%) patients were +0, 8(24,2%)were +1, 10(30,3%) were +2 and 8(24,2%) When the relation between Langerhans cell infiltration before radiotherapy and after surgery was analyzed, the difference in group distribution was found to be statistically significant (p=0,0083). Conclusion: Antigen presenting cells, namely Langerhans cells, infiltration has been previously shown in laryngeal cancer. Several reports found prognostic significance between cell infiltration and locoregional recurrence, node metastasis and disease free-survival. Radiotherapy doesn’t inhibit tumor inflammatory response. Having observed an increase in dendritic cell count, radiotherapy may induce a more potent anti-tumor immune response. Dendritic Cell Behavior After Radiotherapy Of The Larynx Laurentino Mendes Leal1,2, Eurico Monteiro1, Joaquim Castro Silva1, Marta Cardoso1,2, Eduardo Ferreira1 1Serviço de Otorrinolaringologia, Instituto Português de Oncologia do Porto Francisco Gentil, EPE , 2Serviço de Otorrinolaringologia, Hospital de São João, EPE REPLACE THIS BOX WITH YOUR ORGANIZATION’S HIGH RESOLUTION LOGO