José Luis Llorente

Prognostic factors in sinonasal tumors involving the anterior skull base

Anterior craniofacial resection is a standardized procedure for the treatment of ethmoid and frontal orbital tumors with intracranial invasion.

ONCOLOGIC OUTCOMES OF TRANSORAL LASER SURGERY OF SUPRAGLOTTIC CARCINOMA COMPARED WITH A TRANSCERVICAL APPROACH

To evaluate the oncologic effectiveness of transoral laser surgery of supraglottic cancer, we compared a group of patients treated with laser surgery, with a stage‐matched group treated with a transcervical approach.

Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy

The definitive treatment for head and neck paraganglioma (PG) is surgical excision. Unfortunately, surgery, particularly of vagal paraganglioma (VPG; “glomus vagale”) and foramen jugulare (“glomus jugulare”) tumors, may be complicated by injuries to the lower cranial nerves, a high price to pay for treatment for a benign tumor. Alternatively these tumors may be followed without treatment, or irradiated. The purpose of this review was to compare the existing evidence concerning the efficacy and safety of surgery, external beam radiotherapy (EBRT), and stereotactic radiosurgery (SRS), for jugular paragangliomas (JPGs) and VPGs.

Management of the orbit in malignant sinonasal tumors

Malignant ethmoid and maxillary sinus tumors frequently involve the orbit. Orbital involvement is an important prognostic predictor of recurrence‐free, disease‐specific, and overall survival. Most authors agree that orbital preservation as opposed to orbital exenteration or clearance does not result in significant differences in local recurrence or actuarial survival. The eye can be safely preserved in most patients with ethmoid or maxillary sinus cancer invading the orbital wall, including malignancies that invade the orbital soft tissues with penetration through the periorbita provided that they can be completely dissected away from the orbital fat. Malposition of the globe and nonfunctional eyes frequently result when patients have not had adequate rigid reconstruction of the orbital floor, particularly if they have received postoperative radiotherapy. This underscores the importance of such reconstruction. Isolated defects following orbital exenteration may be reconstructed with a temporalis muscle flap. Microvascular free‐tissue transfer is the best option for repair of defects following orbital exenteration and total maxillectomy, although an obturator still has a role in selected patients.

Functional outcomes of transoral laser surgery of supraglottic carcinoma compared with a transcervical approach: Transoral Versus Transcervical Supraglottic Laryngectomy

Several functional advantages have been described for the transoral laser supraglottic laryngectomy as compared with open techniques. However, comparative studies have been rarely performed.

Sinonasal carcinoma: clinical, pathological, genetic and therapeutic advances

The sinonasal cavities represent an anatomical region affected by a variety of tumours with clinical, aetiological, pathological, and genetic features distinct from tumours at the main head and neck cancer localizations. Together, squamous-cell carcinoma and adenocarcinoma account for 80% of all sinonasal tumours, and are aetiologically associated with professional exposure to wood and leather dust particles and other industrial compounds, and therefore, are officially recognized as an occupational disease. Owing to their distinctive characteristics, sinonasal tumours should be considered as separate entities, not to be included in the miscellany of head and neck cancers. Sinonasal tumours are rare, with an annual incidence of approximately 1 case per 100,000 inhabitants worldwide, a fact that has hampered molecular-genetic studies of the tumorigenic pathways and the testing of alternative treatment strategies. Nevertheless, the clinical management of sinonasal cancer has improved owing to advances in imaging techniques, endoscopic surgical approaches, and radiotherapy. Genetic profiling and the development of in vitro cell lines and animal models currently form the basis for future targeted anticancer therapies. We review these advances in our understanding and treatment of sinonasal tumours.

Supraglottic Laryngectomy with or without Postoperative Radiotherapy in Supraglottic Carcinomas

A retrospective review of 193 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. All the patients received a supraglottic laryngectomy, and patients received a total of 284 elective or therapeutic neck dissections. Ninety-four (48.7%) of the patients received postoperative radiotherapy. The incidence of local recurrence was 8.2%, but the recurrence rate was unrelated to the use of postoperative radiotherapy. Neck recurrence was observed in 12.9% of patients, with no influence of postoperative radiotherapy in the dissected neck. The incidence of locoregional recurrences by stage in irradiated and nonirradiated patients did not reach significant difference. The 3-year survival was 74.3%. The overall survival of the whole series and by stage was not statistically altered in combined therapy compared to surgery.

Neck dissection with or without postoperative radiotherapy in supraglottic carcinomas.

A retrospective review of 302 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. The 302 patients underwent a total of 383 functional neck dissections and 45 classic radical neck dissections. Pathological examination revealed nodal involvement in 117 patients (39%). In the histologically N0 group, the incidence of contralateral neck recurrence when a unilateral neck dissection and postoperative radiotherapy were carried out was 8%, rising 21% when no postoperative radiation was given. There was no difference in the ipsilateral recurrence rate in the N0 group, radiated patients (3%) and nonradiated patients (2%). Similar figures were found in the N1 group. Bilateral functional neck dissection in histologically N0, N1, and N2 necks had similar recurrence rates with or without radiotherapy. Distant metastasis appeared in 10% of N0 patients and in 35% of N3 patients. Patients who received postoperative radiotherapy showed a significantly higher rate of distant metastasis (21%) than patients who did not (8%). The number of involved lymph nodes had no relevance both in neck recurrence and distant metastasis.

Squamous Cell Carcinoma of the External Auditory Canal

OBJECTIVES This study aims to analyze the treatments, prognostic variables, and outcomes of patients with squamous cell carcinomas (SCC) of the external auditory canal (EAC) and middle ear treated in our department over a 15-year period. DESIGN A retrospective analysis of 19 patients treated in our department between 1990 and 2006. The patients were staged according to the Pittsburgh classification. Patients were treated with either a lateral (LTBR) or an extended temporal bone resection (total or subtotal). Parotidectomy was performed in patients with suspected clinical or radiological invasion and postoperative radiotherapy was the adjuvant treatment in most patients in advanced stages. RESULTS The overall 5-year survival was 37%. There were no patients in stage I. The survival rates were 100%, 25%, and 16% for stages II, III, and IV, respectively. Facial nerve paralysis (p = 0.007) and lymph node involvement (p = 0.006) were associated with decreased survival rates. CONCLUSION SCC of the temporal bone are rare but have a poor prognosis. Lymph node involvement and facial nerve palsy are associated with a poorer outcome. These tumors must initially be treated radically, for which an early diagnosis is important.

Genetic and clinical aspects of wood dust related intestinal-type sinonasal adenocarcinoma: a review

Intestinal-type sinonasal adenocarcinoma (ITAC) is a rare epithelial cancer of the nasal cavities and paranasal sinuses. Exposure to wood dust particles is a strong etiological factor making it a professional disease. These tumors are locally aggressive with frequent local recurrences in up to 50% of cases. Metastasis to regional lymph nodes and distant metastasis are less frequent (10%). Invasion of the duramater and local recurrence are frequent and the major cause of death. Standard therapeutic modalities include surgery followed by radiotherapy in advanced stages, sometimes with chemotherapy treatment. The molecular genetic mechanisms underlying the development and progression of this tumor is not understood. Histopathologically, ITAC resembles colorectal adenocarcinoma and have directed early genetic studies to search for similar genetic alterations. Recently, genome-wide studies have identified a recurrent pattern of chromosomal aberrations. This review aims to describe the clinico-pathological characteristics of this relatively unknown tumor and to summarize the knowledge on genetic and chromosomal analyses up to the present time.