M.A. Kuriakose

Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers

BACKGROUND Chemo-radiotherapy has become the standard of care for loco-regionally advanced head and neck cancers. Platinum based regimens are the most effective. Although benefits are proven with chemo-radiation, acute toxicities are markedly increased. The dose and delivery schedules of Cisplatin have ranged from intermittent higher dose [100 mg/m2] every 3 weeks to low dose [6 mg/m2] daily administration. At present there is no data indicating which regimen is superior. PURPOSE To compare acute toxicities of two chemotherapy schedules for head and neck cancers. MATERIALS AND METHODS A total of 83 head and neck cancer patients treated with two schedules of concurrent chemo RT were analyzed, retrospectively, for treatment toxicity. In group A [51 patients], chemotherapy [CT] was administered on week 1, 4 and 7 [cisplatin 100 mg/m2] over a period of 2-3 days. In group B [32 patients], CT was delivered weekly [cisplatin 40 mg/m2]. Radiotherapy dose was 7000 cGy in 35 fractions for definitive concurrent chemo-radiation and 6600 cGy in 33 fractions for adjuvant treatment. RESULTS Group B patients had increased grade III skin and hematological toxicity, where as patients in group A had more pharyngeal toxicity. Treatment interruptions and percentage of weight loss were higher in group B. Weekly CT schedule had higher rate of severe mucositis, which was statistically significant on both univariate [P = 0.005] and multivariate [P = 0.007] analysis. CONCLUSIONS Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.

INCREASED PLATE AND OSTEOSYNTHESIS RELATED COMPLICATIONS ASSOCIATED WITH POSTOPERATIVE CONCURRENT CHEMORADIOTHERAPY IN ORAL CANCER

Plate osteosynthesis is a widely used technique in head and neck reconstructive surgery. The objective of this study was to determine whether postoperative chemoradiotherapy, which was recently introduced for high‐risk head and neck cancer, affects plate and osteosynthesis related complications.

The concepts in poorly differentiated carcinoma of the thyroid: a review article.

Poorly differentiated carcinomas of the thyroid have evolved over the past half century into a specific entity in the classification of thyroid carcinomas. The need for a consensus diagnostic criteria has been stressed in view of the wide discrepancies and confusion among pathologists and clinicians. This review attempts to understand the concept, the evolution, clarity and validity of the concepts in poorly differentiated carcinomas of the thyroid. J. Surg. Oncol. 2011;103:818–821.

Vascularised fibula osteocutaneous flap for cervical spinal and posterior pharyngeal wall reconstruction

We report a case of vascularised fibula osteocutaneous flap used for composite cervical spinal and posterior pharyngeal wall reconstruction, in a patient with recurrent skull base chordoma, resected by an anterior approach via median labio-mandibular glossotomy approach. Bone stability and pharyngeal wall integrity were simultaneously restored

Free radial forearm adiposo-fascial flap for inferior maxillectomy defect reconstruction.

A free radial forearm fascial flap has been described for intraoral reconstruction. Adiposo-fascial flap harvesting involves few technical modifications from the conventional radial forearm fascio-cutaneous free flap harvesting. We report a case of inferior maxillectomy defect reconstruction in a 42-year-old male with a free radial forearm adiposo-fascial flap with good aesthetic and functional outcome with minimal primary and donor site morbidity. The technique of raising the flap and closing the donor site needs to be meticulous in order to achieve good cosmetic and functional outcome.

Stomaplasty--anterior advancement flap and lateral splaying of trachea, a simple and effective technique.

BACKGROUND Stomal stenosis after laryngectomy is a common and distressing complication. Once sets in, it is generally progressive, causes problems and needs active intervention. AIM To evaluate effectiveness of new simple method of stomaplasty in solving troublesome complication of stoma stenosis. SETTINGS AND DESIGN Charts of eight patients who underwent modified stomaplasty and completed 1 year were reviewed. MATERIALS AND METHODS A modified anterior advancement flap and lateral splaying of trachea for stoma plasty are described. This involves excision of scar tissue of the anterior two-third of trachea and interposition of the defect with an inferiorly based triangular skin flap. The tracheo-esophageal-prosthesis (TEP) site is left untouched. STATISTICAL ANALYSIS Outcome were measured in relation with need for further stenting or any other revision procedure required and ability to use TEP for speech production. RESULTS Eight patients underwent stoma revision surgery. Median preprocedure stoma diameter was 10 mm vertically (range 8-12 mm) and 6 mm horizontally (range 5-10 mm). This could be improved to 25 mm (range 22-30 mm) vertically and 16 mm (range 14-20 mm) horizontally after stoma revision. At 1-year follow-up, the median measurements were 20 mm (range 16-26) vertically and 14 mm (range 12-18) horizontally. Postprocedure, one patient required intermittent stenting at nighttime. All patients could use the TEP effectively. One patient who underwent salvage laryngectomy following chemoradiotherapy developed flap dehiscence. CONCLUSIONS This is a simple and effective technique for stomaplasty. All patients treated with this technique had adequately large stoma for breathing and use of TEP.

Tensor Facia Lata-iliac crest osteocutaneous flap for orbitomaxillary reconstruction: A preliminary report

Tensor Fascia Lata muscle and musculocutaneous flap has been used in the past for reconstruction of trunk defects and also as a free flap for soft tissue reconstruction elsewhere in the body. Transferring the iliac crest along with the muscle as a free flap has been described earlier, reported for bridging calcaneal defect and small mandibular defects. The use of this flap as a source of free vascularised bone has not been widely practised since these initial few reports. Anatomical studies were carried out to assess the feasibility of using this flap for reconstructing maxillary and other head and neck defects, following which it was successfully used for these indications. The preliminary report describes the flap anatomy, method of harvest and its potential uses in head and neck reconstruction.

A simplified technique of free flap pedicle transfer for reconstruction of defects following head and neck cancer ablation

Free flaps are being widely used for reconstruction of defects following head and neck cancer ablation. The pedicle of the flap is usually tunneled into the neck wound for anastomosis to the neck vessels. This transfer of the pedicle can be technically difficult to execute and associated with difficulties of torsion and kinking. No effective method has been so far reported to make this procedure easy and safe. A very easy and effective method for the pedicle transfer is described in this report, which has been practiced successfully in our head and neck service in more than 175 free flaps. J. Surg. Oncol. 2009;99:80–81.