Luis de Andrés

Prevention of stomal recurrence.

The authors reviewed the incidence of stomal recurrence (SR) in a population of laryngectomized patients to study associated risk factors and determine the usefulness of certain preventive procedures.

Hypothyroidism in patients treated with total laryngectomy. A multivariate study

Abstract One of the complications of the treatment of head and neck carcinoma patients is hypothyroidism. The objective of our study was to quantify the prevalence of hypothyroidism in patients with laryngeal or hypopharyngeal cancer treated with a total laryngectomy and to evaluate the importance of different variables in the appearance of hypothyroidism in this group of patients. A transversal study in 182 patients treated with total laryngectomy between 1986 and 1998 was carried out. TSH and FT4 were determined in all patients. Hypothyroidism was classified as subclinical (increased TSH and normal T4 levels) and clinical (increased TSH and decreased T4 levels). Univariate and multivariate analysis was carried out to examine the relationship between hypothyroidism and different variables. Our results showed that the prevalence of hypothyroidism in our group of patients was 52% (27% subclinical and 25% clinical). Sex, initial extension of the tumour, hemithyroidectomy, use of chemotherapy and radiotherapy were variables associated with the appearance of hypothyroidism in the univariate analysis (P < 0.05). When all these variables were included in a multivariate study, only hemithyroidectomy (RR 3,6; CI 95% 1,7–7,2) and combined treatment with radiotherapy (RR 3,4; CI 95% 1,2–9,6) appeared as prognostic factors. In conclusion, hypothyroidism is a frequent complication in patients treated with a total laryngectomy (52%), especially when this treatment includes hemithyroidectomy and/or radiotherapy. We consider that it is important to check the thyroid function periodically in these patients to obtain early diagnosis and appropriate treatment.

Carboplatin for advanced bladder cancer

not that robust in that only 22 of the 45 eligible patients actually were able to receive one or more courses of MGBG. 46 patients were entered in the study because in the first 21 patients we noted hints of antitumour activity (i.e. short-lived tumour shrinkage). However, additional patient accrual indicated that the agent has no appreciable antitumour activity in this population of patients with bladder cancer.

CHOP chemotherapy of intermediate and high-grade non-Hodgkin's lymphoma.

The results of CHOP treatment in 63 patients with intermediate and high-grade non-Hodgkins lymphoma (Working Formulation D to I), Ann Arbor stage I to IV were analyzed. The response rate was 87%, 71% complete remission and 16% partial remission with a mean duration of 22 months. The 5-year actuarial survival was 61% (95% confidence interval, 51-70%). The treatment was well tolerated and no deaths due to acute toxicity were observed. Poor prognostic factors in univariate analysis were: high-grade histology, stages III and IV, B symptoms, > or = 4 affected lymph node regions, Karnofsky index < or = 70, erythrocyte sedimentation rate (ESR) > 60 mm, haemoglobin < 100 g/l and elevated lactic dehydrogenase (LDH). Poor prognostic factors in multivariate analysis were: high-grade histology, stages III and IV, haemoglobin < 100 g/l and elevated LDH. In summary, good results were obtained with CHOP chemotherapy, without severe toxicity.

Visualisation of sodium-iodide symporter.

A 60-year-old man with an 11-year history of mucinous adenocarcinoma of the salivary gland and a 4-year history of pulmonary metastases underwent pertechnetate (TcO4 ) scintigraphy of the thyroid gland. As abnormal pulmonary TcO4 − uptake was observed, whole-body (a) and thoracic SPECT-CT (b) studies were performed, which showed images of focal pulmonary tracer uptake matching radiological images of pulmonary metastases. At the time of these studies, tumour marker levels were: CA 19-9, 2,761 kU/l; CA-125, 1,170 kU/l; CA 15-3, 172 kU/l. The sodium-iodide symporter (NIS) is an integral plasma membrane glycoprotein involved in the active transport of iodide into the thyroid follicular cells [1, 2]. In addition to the thyroid gland, NIS is expressed in non-thyroid tissues, including salivary glands, stomach, thymus and breast [2, 3]. Recently, NIS has been proposed as a target for non-thyroid malignancies that express the symporter [4, 5]. Since the transport of pertechnetate, like that of iodide, is NISmediated, pertechnetate could have a role in the assessment of tumours derived from organs expressing NIS and their metastases.

A phase II trial of carboplatin in untreated patients with extensive stage small cell lung cancer

Twenty‐five untreated patients with extensive stage small cell lung cancer (ESSCLC) were treated with carboplatin (CBDCA) (500 mg/m2) given as a 24‐hour infusion every 21 days. Thirteen patients responded for an overall response rate of 52% (95% confidence limits, 32% to 72%) with 3 complete responses (CR) (12%; 95% confidence limits, 0% to 25%). The median duration of response was 4.5 months. The median survival time was 8 months with three long‐term survivors (12%) at 27, 33, and 43 months from the start of CBDCA treatment. Ninety‐two courses of CBDCA were administered and one treatment‐related death occurred. The main toxicity was myelosuppression. Grade 3 or 4 hematologic toxicity (hemoglobin level, < 8 g/dl; granulocyte count, < 1900/μl; and platelet count, < 49,000/μl) was observed as follows: neutropenia in 7 courses (8%) and in 7 patients (28%), decreased hemoglobin level in 13 courses (15%) and in 7 patients (28%), and decreased platelet count in 10 courses (11%) all Grade 3 and in 8 patients (32%). This study demonstrates that at this dose and schedule CBDCA is a highly active drug in ESSCLC and it has tolerable toxicity.

Anemia hemolítica microangiopática y metástasis cardiaca por carcinoma de cabeza y cuello

Microangiopathic haemolytic anemia (MAHA) complicates occasionally clinical evolution of disseminated tumors, usually adenocarcinoma-type, but is association with a squamous cell cancer of head and neck origin is rare. Additionally, head and neck cancer is an unusual origin of cardiac metastases. We present a patient with head and neck squamous cell cancer who developed intravascular haemolysis with thrombopenia. Postmortem study showed tumor cells into the heart and tumor emboli in pulmonary arterioles, the later often described in the cases of MAHA. We discuss the physiopathology of MAHA and its association with cancer. We briefly discuss epidemiology and pathogeny of cardiac metastases.