Mario Augusto Ferrari de Castro

Comorbidity Measurement in Patients with Laryngeal Squamous Cell Carcinoma

Introduction: The evaluation of a cancer patient can be affected by many factors. Cancer patients often have other diseases or medical conditions in addition to their cancer. These conditions are referred to as comorbidities. They can influence the treatment option, the rate of complications, the outcome, and can confound the survival analysis. Objective: It was the aim of this study to measure comorbidities in patients with laryngeal squamous cell carcinoma. Patients and Methods: Ninety adult patients treated for newly diagnosed laryngeal squamous cell carcinoma were studied. We measured comorbid illness applying the following validated scales: the Cumulative Illness Rating Scale (CIRS), the Kaplan-Feinstein Classification (KFC), the Charlson index, the Index of Coexistent Disease (ICED), the Adult Comorbidity Evaluation-27 (ACE-27), the Alcohol-Tobacco-Related Comorbidities Index (ATC), and the Washington University Head and Neck Comorbidity Index (WUHNCI). Survival analysis was performed using the Kaplan-Meier method (with the log-rank test value being used to compare groups). The Cox proportional hazards model was chosen to identify independent prognostic factors. Results: The mean age was 62.3 years. The majority of patients (36.7%) had early tumors. Forty patients were treated by surgery only, while the remaining 49 patients also received postoperative radiation therapy. Only 5 patients (5.6%) were lost to follow-up. Median follow-up time was 42.5 months. The 4-year overall survival was 63%. There was a statistically significant difference between survival rates according to clinical stage (CS I 87.3%, CS II 48.9%, CS III 74.7%, CS IV 23.9%; p < 0.001). Patients treated by surgery only presented a better survival rate (79.6%) than those receiving postoperative radiation therapy (48.9%; p = 0.001). A statistically significant difference in survival rates was also noted when patients were analyzed according to the type of surgical procedure. In a univariate analysis, comorbidity had impact on prognosis, no matter which scale was utilized: CIRS (p = 0.008), ACE-27 (p = 0.010), ATC (p = 0.004), WUHNCI (p = 0.003), Charlson index (p = 0.020), KFC (p = 0.001), and ICED (p = 0.010). However, in the multivariate analysis, only CIRS and TNM staging were identified as independent prognostic factors. Conclusion: The comorbidity is an independent prognostic factor in patients with surgically treated laryngeal cancer. In the univariate analysis, all indexes were able to stratify patients. However, in the multiple analysis, only the CIRS was predictive of death. Comorbidities are an important factor in the analysis of overall survival.

Efficacy of stapler pharyngeal closure after total laryngectomy: A systematic review.

Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure.

Complicações dos esvaziamentos cervicais

UNLABELLED Because of the proximity of vital structures, certain complications are inherent to neck dissection (ND) for the treatment of patients with squamous cell carcinoma of the upper aerodigestive tract. AIM To establish the incidence of complications of ND. METHODS A cross-sectional retrospective study of patient registries. ND with curative intention was evaluated in 480 patients with squamous cell carcinoma of the upper aerodigestive tract from January 1995 to December 2008 to identify perioperative complications. RESULTS Considering the total quantity of dissected neck sides, 413 radical ND and 295 selective ND were studied, of which 220 were supraomohyoid ND and 75 were jugular ND, totaling 708 sides. There were no deaths. The most frequent complication was marginal mandibular nerve injury (5.5%), followed by accessory nerve injury (5.1%). However, in 18 out of 21 cases this nerve was sacrificed for oncological completeness. CONCLUSIONS There were no perioperative deaths. Nerves were the most commonly injured structures; the marginal mandibular branch is injured most (5.5%).

Pharyngocutaneous fistula following total laryngectomy

Pharyngocutaneous fistula is the most common complication after total laryngectomy. The aim of the study was to establish the incidence of this complication in our series and analyse the predisposing factors. This is a retrospective study comprising 55 patients who underwent total laryngectomy. The following aspects were considered: sex, age, tumour site, pathologic staging according to TNM, performance and type of neck dissection, previous radiation therapy, previous tracheotomy, Cumulative Illness Rating Scale for comorbidity analysis, the use of stapler for pharyngeal closure, and peri-operative blood transfusion. In the cases of pharyngocutaneous fistula, we considered the post-operative period in which it was diagnosed, duration, period of hospitalization, as well as therapeutic approach and the eventual result of this treatment. Pharyngocutaneous fistula was diagnosed in 7 patients (12.7%). There were no statistically significant associations between fistula development and sex (p = 1.000), previous radiation therapy (p = 0.354), stapler closure (p = 0.577), comorbidity (p = 1.000) or tumour site (p = 0.926). Patients previously submitted to tracheotomy presented higher fistula incidence (60%), compared to those that had not undergone this procedure (8%) (p = 0.012). Elderly patients (>60 years) were also more predisposed to fistula development (p = 0.051). Although without statistical significance, fistula development was also associated with peri-operative blood transfusion, T stage, and type of neck dissection.

Fatores de risco para metástases à distância no câncer de cabeça e pescoço

OBJECTIVE To identify risk factors for the development of distant metastasis (MD) among patients with head and neck squamous cell carcinoma (SCC) surgically treated. METHODS A retrospective study of 253 patients from January, 1997 to December, 2002 was performed. Out of them, 10 patients presented DM during the follow up. The following aspects were analyzed: gender, age, tumor primary site, TNM classification, cervical lymph node status, and the presence of extracapsular spread - gross or microscopic. RESULTS The survival average for the patients with DM, after finishing the oncological treatment, was 16 months (standard deviation = 2.256). The presence of both gross extracapsular spread (Odd ratio = 14.429) and the microscopic one (OR = 17.471) and the both the neck advanced pathological staging (OR = 4.409) and the primary tumor staging (RR = 2.929) presented statistical significance as risk fators for the occurrence of DM. CONCLUSION The risk factors for DM were: microscopic and gross extracapsular spread, the pathological presence of positive neck lymph node and advanced primay tumor.

Original ArticleVideolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

UNLABELLED Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. OBJECTIVE This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. METHODS This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. RESULTS Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). CONCLUSION Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

UNLABELLED Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. OBJECTIVE This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. METHODS This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. RESULTS Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). CONCLUSION Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Fatores prognósticos e impacto da comorbidade na laringectomia fronto-lateral

OBJETIVO: Avaliar sobrevida, impacto da comorbidade, complicacoes e fatores de falha da laringectomia como tratamento de tumores malignos gloticos. METODOS: Foram analisadas 38 pacientes com tumor glotico sob estadiamento clinico T1b/T2N0M0 submetidos a laringectomia fronto-lateral com reconstrucao, de janeiro de 1995 a dezembro de 2006. Foram avaliados os resultados oncologicos, comorbidades (atraves da escala Adult Comorbidity Evaluation - 27 ACE-27) e complicacoes, sendo correlacionados com dados demograficos e caracteristicas do tumor. RESULTADOS: Oito pacientes apresentaram recidiva local e foram resgatados cirurgicamente. Complicacoes nao foram verificadas em 33 pacientes. Nao houve diferenca significativa das sobrevidas global em cinco anos e livre de doenca ao considerarem-se as diferentes categorias de comorbidades. Somente o envolvimento patologico das margens mostrou diferencas significativas na sobrevida global (p=0,0033) e sobrevida livre de doenca (p<0,0001). CONCLUSAO: A sobrevida global em cinco anos foi de 67,6% e a sobrevida livre de doenca de 73,7%; a comorbidade nao representou fator prognostico independente; o indice de complicacoes pos-operatorias foi de 13,2% e somente o envolvimento patologico das margens mostrou diferencas significativas na sobrevida global e livre de doenca.

Comorbidity Measurement in Patients with Oral Cancer

Objective: To measure comorbidity in patients with oral or oropharyngeal squamous cell carcinoma. Method: Prospective cohort study performed in 2 hospitals in Santos. A total of 116 adult patients treated for a newly diagnosed oral or oropharyngeal squamous cell carcinoma were evaluated on this study from 1996 to 2007. We measured comorbidity illness applying the some validated scales. Results: After 4 years of follow-up the mortality rate was 47.4%. Patients with high values in ACE-27 and WUHNCI showed increased absolute risk of death in 25% and 31%, respectively. Of the 55 deaths in the period, 30.9% were due to other causes than cancer. Four indexes had predictive value on mortality due to other causes than cancer. Thus, patients who have high indexes on CIRS, KFC, ACE-27, and WUHNCI had increased risk of death of 33%, 23%, 44%, and 51%, respectively. Thirty-eight patients (69.1%) presented cancer-related mortality. Only the WUHNCI presented significant difference capable of predicting mortality. Conclusion: Comorbidity is an independent prognostic factor in patients with oral or oropharyngeal cancer. Higher values in ACE-27 and WUHNCI showed increased absolute risk of death. WUHNCI were capable of predicting cancer-related mortality. Patients who have high indexes on CIRS, KFC, ACE-27 and WUHNCI had increased risk of death due to noncancer causes.

Structures constituting the sound source after the treatment of early glottic cancer.

INTRODUCTION We indicate the exclusive radiation therapy as initial approach for T1a glottic tumors, and the frontolateral laryngectomy for the tumors staged as T1b and selected T2 glottic tumors. The videolaryngostroboscopy is a useful tool to analyze the laryngeal structural changes and compensatory motion after the therapeutic approach. OBJECTIVES To evaluate the endolaryngeal structures of patients who participate in the vibratory sound source after the early glottic cancer treatment through the videolaryngostroboscopy. METHODS It was a retrospective transversal study in which 20 patients who underwent exclusive radiation therapy and 25 patients who underwent frontolateral laryngectomy were analyzed by means of videolaryngostroboscopy. The radiation doses ranged from 5000 to 7020 cGy in the radiation therapy group. The mucosal wave and the vibratory source components were evaluated. RESULTS All of the irradiated patients presented vibratory behavior, and hyperfunction was occasionally observed in four cases. The mucosal wave source was glottic in 18 cases and mixed in two cases. In the laryngectomy group, 10 supraglottic sources, 10 glottic sources, and five mixed sources were identified. Among the 10 cases of supraglottic source, eight patients presented global constriction and two patients presented medial constriction. Among the five cases of mixed source, two patients presented global constriction, one patient presented medial constriction, and one patient presented anteroposterior constriction. Regarding the number of anatomical structures presenting vibratory pattern, five patients had two structures, four patients had three structures, and one patient had four structures. CONCLUSION Patients who underwent radiation therapy recruit less supraglottic structures as vibratory source than the patients undergoing vertical laryngectomy.