Mauro Marques Barbosa

Clinical prognostic factors in malignant parotid gland tumors.

OBJECTIVE: To analyze the factors in parotid malignant epithelial tumors influencing recurrences and disease-specific survival. METHODS: We retrospectively reviewed the files of 150 patients treated at our institution, from 1974 to 1998. Twenty-four patients were not treated by surgery and were excluded from this study. The remaining 126 patients were treated with surgery and 74 patients had postoperative radiotherapy. Thirty-three patients were treated with parotidectomy plus neck dissection. Neck lymph node metastasis was found in 22 patients, 5 patients had occult neck metastasis, and 4 periparotid lymph nodes metastasis. The mean age was 49 years old. According to the UICC/1997 TNM Classification, 49 patients were stage I, 27 stage II, 22 stage III, and 28 stage IV. The influence of selected factors on the 10 year disease-specific survival was analyzed using the Kaplan-Meier actuarial method and the log-rank test. RESULTS: Forty patients had mucoepidermoid carcinoma, 18 patients adenocarcinoma NOS, 18 patients acinic cell carcinoma, 15 patients adenoid cystic carcinoma, 11 patients malignant mixed tumor, 11 patients salivary duct carcinoma, and 13 patients other pathology. Twenty-five patients had recurrences: 17 had local recurrences, 4 patients had neck recurrences, and 4 were loco-regional recurrences. Five factors influenced negatively the prognosis: 1) T stage (p.00001), 2) grade (p.00001), 3) + lymph nodes (p.0007), 4) facial nerve dysfunction (p.0001), and 5) age (p.004). Patients with high-grade tumors and high-stage tumors had the worst prognosis according to the multivariate analysis. The 10-year disease-specific survival was 97% for stage I, 81% for stage II, 56% for stage III, and 20% for stage IV. CONCLUSION: The grade of the tumor and stage were the most important prognostic factor.

Supracricoid laryngectomy with cricohyoidoepiglottopexy for advanced glottic cancer

Supracricoid laryngectomy with cri‐cohyoidoepiglottopexy (CHEP) is a conservative surgical procedure indicated in selected cases of advanced glottic carcinoma.

Supracricoid Laryngectomy with CHEP: Functional Results and Outcome:

OBJECTIVES: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. STUDY DESIGN: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.

SUBLINGUAL GLAND TUMORS: CLINICAL, PATHOLOGIC, AND THERAPEUTIC ANALYSIS OF 13 PATIENTS TREATED IN A SINGLE INSTITUTION

Sublingual gland tumors are rare, although frequently malignant. This study describes the clinicopathologic features and treatment results and reviews the literature.

Neaivtotal laryngectomy for treatment of advanced laryngeal cancer

BACKGROUND In order to assess whether near-total laryngectomy (NTL) could successfully reach the cure and preserve the voice in advanced laryngeal cancer, we studied 28 patients with T3/T4 squamous cell carcinoma of the larynx treated with NTL in our institution. METHODS A retrospective analysis has been carried out from 1990 through 1994. We classified 24 patients as Stage III and 4 patients as Stage IV. All patients had lateral neck dissection. Survival was analyzed under the Kaplan-Meier method. RESULTS Twenty-six patients achieved voice preservation. Two patients in the bilateral neck dissection group had a metastatic lymph node on the opposite side. No patient had local recurrence. Three patients died of the disease, and 1 patient was salvaged with neck dissection. Three-year disease-free survival was 85%. CONCLUSION This technique is useful in the treatment of selected cases of advanced laryngeal cancer and achieves local control of the lesion in all cases. The survival is comparable with that of patients submitted to total laryngectomy, regarding the extent of lesion. Voice preservation can be achieved in most cases.

Management of the N0 neck in moderately advanced squamous carcinoma of the larynx

Objective: To assess the oncological efficacy of selective neck dissection (SND) in patients with T3-4 N0 laryngeal squamous carcinoma. Subjects and Methods: A total of 327 patients underwent 654 neck dissections; each side of the neck was individually evaluated. Results: Three percent of patients who had SND developed regional recurrence (RR) in comparison with 11.7 percent of patients who underwent modified radical neck dissection (MRND) (P = 0.005). Only 3 (0.9%) patients developed RR outside the field of SND. The presence of extracapsular extension (P = 0.002) in node-positive (pN+) group and of microvascular invasion (P = 0.007), together with the type of neck dissection (ND) (P = 0.0003) in node-negative (pN0) group had statistical impact on RR. The development of RR significantly affected disease-specific survival (P = 0.0001). Equivalent rates of RR were found in pN+ (2.6%) or pN0 (3.2%) patients treated with SND (P = 0.98) as well as in pN+ patients who underwent SND (2.6%) or MRND (4.7%) (P = 0.85). Conclusion: This study confirmed the adequacy of SND as a satisfactory staging and therapeutic procedure, and suggests its use in the treatment of limited node-positive (N+) neck.

Metástase cervical nos tumores malignos da parótida

BACKGROUND: Factors influencing the occurrence of neck metastasis and survival in patients with parotid malignant epithelial tumors are analyzed. METHODS: One hundred fifty patients treated at our institution from 1974 to 1998 were retrospectively reviewed. Twenty four patients were not treated by surgery and were excluded from this study. The remaining 126 patients were operated on and 74 patients had postoperative radiotherapy. Thirty four patients were treated with parotidectomy plus neck dissection. The mean age was 49 years old. According to the UICC/1997 TNM Classification 49 patients were Stage I, 27 were Stage II, 22 were Stage III, and 28 were Stage IV. The influence of selected factors on 10 years disease-specific survival was analyzed using Kaplan-Meier actuarial method and log-rank test. RESULTS: Forty patients had mucoepidermoid carcinoma, 18 patients adenocarcinoma, 18 patients acinic cell carcinoma, 15 patients adenoid cystic carcinoma, 11 patients carcinoma ex pleomorphic adenoma, 11 patients salivary duct carcinoma, and 13 patients other pathology. Recurrences occurred on 27 patients, 17 local, 4 had neck recurrences, and 4 loco-regional recurrences. Overall incidence of neck metastasis was 17.5%. Occult neck metastasis occurred in 5 patients who underwent elective neck dissection. Facial nerve dysfunction, age, T stage, grade, and histology were related to the recurrence of neck metastasis in univariate analysis. Prognoses were negatively influenced by five factors: T3- T4 stage, high malignancy grade, presence of cervical metastases, facial nerve palsy at first presentation and age higher then 50 years old. Ten years disease-specific survival was 97% for stage I, 81% for stage II, 56% for stage II, and 20% for stage IV. CONCLUSION: Tumor grade and stage were the most important prognostic factors. In spite of lack of prospective randomized published studies, recommendations to do elective neck dissections in high grade tumors, T3- T4 stage tumors, and facial nerve palsy at presentation should be considered.

Metástase cervical de carcinoma epidermóide com tumor primário desconhecido

Revisamos nossa experiencia com carcinoma epidermoide metastatico (CEM) para o pescoco com tumor primario desconhecido com a intencao de evidenciar quando o tratamento radioterapico exclusivo ou o tratamento cirurgico seguido de radioterapia teriam impacto positivo sobre a sobrevida. Este e um estudo retrospectivo de 54 pacientes com CEM tratados na Secao de Cirurgia de Cabeca e Pescoco do Hospital do Câncer/INCa entre 1986 e 1992. Quarenta e oito pacientes (89%) eram do sexo masculino, a idade media foi de 54 anos. Quarenta pacientes tinham metastase para linfonodos cervicais da cadeia jugular interna alta (nivel 2). Utilizamos a classificacao TNM da UICC de 1992 para estagiar os pacientes, onde oito pacientes foram classificados como N1, vinte como N2, 22 como N3, sendo que quatro pacientes permaneceram nao classificados. Todos foram submetidos a endoscopia do trato aerodigestivo superior e raio X de torax. Trinta e cinco pacientes foram submetidos a biopsia de aspiracao com agulha fina. Trinta e oito pacientes tiveram tratamento com intencao curativa e 1.6 tiveram tratamento paliativo com radioterapia. Dos pacientes tratados com intencao curativa, dez foram submetidos a esvaziamento cervical e 28 tiveram tratamento exclusivo com radioterapia. Os 16 pacientes tratados com intencao paliativa foram excluidos dos calculos de sobrevida e analise das recidivas. As recidivas cervicais foram analisadas usando o metodo do qui-quadrado, e as curvas de sobrevida foram comparadas usando-se o teste de Wilcoxon. A biopsia aspirativa com agulha fina alcancou o diagnostico em 85% dos casos. Oito pacientes (15%) apresentaram metastase a distância. O tumor primario foi identificado subsequentemente em 9% dos pacientes. Dezoito pacientes (64%) tratados com radioterapia exclusiva tiveram recidivas no pescoco, e tres pacientes (33%) tratados com cirurgia + radioterapia tiveram recidivas no pescoco. (p=0,05) Os pacientes classificados como N2/N3 tratados com cirurgia + radioterapia tiveram melhores resultados do que os tratados com radioterapia exclusiva (respectivamente p=0,05 e p=0,09). Os pacientes Nl tiveram melhor sobrevida livre de doenca do que os pacientes N2/N3 (respectivamente p=0,007 e p=0,OO7). A sobrevida livre de doenca em cinco anos foi de 69% para os pacientes Nl, 11 % para os pacientes N2 e 15% para os pacientes N3. A sobrevida livre de doenca para todos os estagios foi de 28%. A biopsia aspirativa com agulha fina e um bom meio para diagnostico e deve ser usada rotineiramente.

Salvage Supracricoid Laryngectomy Oncologic and Functional

Objective: Evaluate the oncologic outcome and functional results of SCPL with CHEP or CHP in selected cases of glottic/supraglottic carcinoma recurrence after primary (surgery or radiotherapy) treatment. Method: Retrospective analysis of medical records. Twenty-three consecutive patients treated with salvage intent by SCPL from 1998 to 2007 were collected. Main outcomes measures were recurrence, overall survival, disease-specific survival, cause of death, and functional results. Results: Most of our patients were males (20/86.9%), with a mean age of 57 years. Eighteen (78%) were primarily treated with endoscopic laser resection, while 5 (22%) patients received external beam radiation. Disease-free interval ranged between 2 and 59 months (mean, 10.2 months) after primary treatment and recurrence. SCL-CHEP was carried out in 20 patients, whereas 3 patients underwent SCL-CHP. Tracheostomy tube was removed in 20 patients (86.9%) between 7 and 300 days (mean, 30.1 days) after surgery. Mean swallowing recovery time was 9 days (range 7 to 185 days) and was achieved in 20 patients (86.9%). The 5-year overall survival was 82.6% Conclusion: SCPL with CHEP/CHP is a feasible, oncologically safe, functionally valid alternative to total laryngectomy in selected laryngeal recurrence.

S167 – Supportive Physical Therapy on Head and Neck Cancer Patients:

Objectives 1) The aim of this paper is to identify the supportive profile of physical therapy attendments at Brazilian National Cancer Institute. 2) Look for patients’ main demands and their dysfunctional characteristics. Methods The physiotherapeutic consultations for head and neck cancer patients performed between 02/01/2007 and 12/31/2007 were retrospectively analyzed in their quantitative and qualitative aspects. Results 1405 attendments were reviewed including 15% of first-time patients. 60% of the consultations were to male patients. The main dysfunctions identified were on accessory nerve (27, 7%), followed by TMJ disorders (27, 6%), breathing complications (10, 6%), and restricted neck movement (10, 5%). The less frequent complications were paresis of facial nerve mandibular branch (4, 7%) and donor site dysfunctions (2, 5%). Pain was a complaint present in 39 (7%) of these attendments, and analgesia was responsible for 21 (2%) of the total procedures performed. In 24% of realized consults, 3 or more procedures were necessary, representing multiple dysfunctions on each patient. Conclusions Secondary dysfunctions caused by head and neck cancer and/or its indicated treatment are important and quite frequent. Shoulder and TMJ dysfunctions as well as breathing disorders were the most frequent complications observed. Pain was seen in a significant number of patients under physical therapy. Patients’ total care has the intention of preventing known complications, and to allow early rehabilitation and sequelae management of installed dysfunctions.