Montserrat López

Distant metastases in head and neck cancer patients who achieved loco-regional control.

One of the reasons for failure in patients with head and neck carcinoma who achieve locoregional control with treatment is the appearance of distant metastases. The objective of this study was to evaluate the frequency of distant metastases in this group of patients and to determine the relative role of several prognostic factors in the subsequent development of distant metastases.

Influence of the persistence of tobacco and alcohol use in the appearance of second neoplasm in patients with a head and neck cancer. A case-control study

ObjectiveTo evaluate the influence of persistent tobacco and alcohol use on the risk of a second metachronous neoplasm in the aerodigestive tract in head and neck squamous cell carcinoma (HNSCC) patients.MethodsA matched case–control study was carried out in 514 patients with HNSCC. Case patients developed a second metachronous neoplasm in the aerodigestive tract after treatment of an index HNSCC. A patient free of second neoplasm was individually matched to every case patient by location of the index tumor, tumor stage, sex, previous tobacco and alcohol consumption, age, general health status, and treatment. Data about persistence in tobacco and alcohol consumption after treatment of the index tumor was collected retrospectively. A validation study was carried out to confirm the adequacy of this retrospective information.ResultsPersistent tobacco smoking and alcohol drinking after treatment of a HNSCC contributed to the risk of appearance of second neoplasm. The odds ratio of a second neoplasm for patients who continued to smoke was 2.9 (95% CI OR 1.8–4.1), and for patients who continued to use alcohol it was 5.2 (95% CI OR 3.3–7.9). There was a strong association between persistence of tobacco and alcohol use after treatment of the HNSCC index tumor. According to the attributable risk estimation, persistent tobacco and alcohol consumption would be responsible for one-third of the second neoplasms in the patients with a HNSCC index tumor.ConclusionsPersistence of tobacco and alcohol use after treatment of a HNSCC had a significant influence on the appearance of a second neoplasm in the aerodigestive tract. Cessation of tobacco and alcohol use should be a major goal after treatment of a HNSCC.

Endoscopic laser surgery in the treatment of radiation failure of early laryngeal carcinoma

This study was undertaken to analyze the local control rates and survival of patients undergoing endoscopic laser surgery for squamous cell carcinoma of the larynx as a salvage procedure for recurrent tumors after radiotherapy.

Inclusion of extracapsular spread in the pTNM classification system: a proposal for patients with head and neck carcinoma.

IMPORTANCE The inclusion of data about the presence of metastatic neck nodes with extracapsular spread (ECS) in the neck dissection improves the prognostic classification of patients with head and neck squamous cell carcinoma (HNSCC). OBJECTIVE To evaluate the prognostic capacity of ECS in patients with HNSCC, and to analyze the usefulness of including this information in the pathological classification of patients treated with a neck dissection. DESIGN Retrospective unicenter study performed from 1985 through 2007. SETTING Tertiary referral center. PARTICIPANTS A total of 1190 patients with HNSCC treated with a neck dissection. INTERVENTION Unilateral or bilateral neck dissection . MAIN OUTCOMES AND MEASURES Adjusted survival and local, regional, and distant metastases-free survival. Patients were classified according to a recursive partitioning analysis (RPA) method, considering pN category and number of neck nodes with ECS as the independent variables. RESULTS Five-year adjusted survival for patients without metastatic nodes in the neck dissection (pN0) was 85.5%, for patients with neck node metastases without ECS (pN+/ECS-) it was 62.5%, and for patients with neck node metastases with ECS (pN+/ECS+) it was 29.9%. There were significant differences in survival between patients with pN0 lesions and pN+/ECS- (P < .001), and between patients with pN+/ECS- and those with pN+/ECS+ (P < .001). According to the RPA method, we propose classifying patients according to 4 categories: category I, pN0 lesions; category II, pN1/ECS+ or pN+/ECS-; category III, pN2-3/1 node and ECS+; and category IV, pN2-3/2 or more nodes and ECS+. The RPA-derived classification achieved a better prognostic discrimination than the pTNM classification. CONCLUSIONS AND RELEVANCE The inclusion of information about ECS in the neck dissection improved the prognostic classification of patients with HNSCC in relation to the pTNM classification.

Utilidad de la monitorización del nervio facial en la cirugía de la glándula parótida

Resumen Objetivo analizar la utilidad de la monitorizacion del nervio facial por electromiografia continua en la cirugia de la glandula parotida. Pacientes y metodos 52 parotidectomias realizadas consecutivamente entre 1987 y 1998. Diferenciamos dos grupos: uno constituido por 25 pacientes en que se monitorizo el nervio facial durante la cirugia y el otro de 27 pacientes sin monitorizacion. La distribucion segun el tipo de cirugia (parotidectomia suprafacial o total) era similar en ambos grupos. Resultados la monitorizacion del nervio facial disminuyo la frecuencia y severidad de la paralisis facial postoperatoria independientemente del tipo de cirugia realizado. El 36% de los pacientes del grupo monitorizado presento algun grado de paralisis facial inmediata, frente al 70% del grupo no monitorizado (p=0,013). Al ano, el porcentaje de pacientes con alteracion de la funcion facial fue del 4 y del 30% para cada grupo, respectivamente (p= 0,025).Discusion: la monitorizacion del nervio facial durante la parotidectomia ha disminuido la incidencia de la paralisis facial postoperatoria. Su uso rutinario en la cirugia de la parotida es discutible, pero se considera util en intervenciones donde el riesgo de lesion del nervio facial esta aumentado (parotidectomia total, reintervencion y parotiditis cronica).

Gene expression signatures and molecular markers associated with clinical outcome in locally advanced head and neck carcinoma

The purpose of this study was to identify molecular markers associated with tumor recurrence and survival in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We studied the expression profile of 63 pre-treatment tumor biopsies obtained from locally advanced HNSCCs treated with standard treatments. Cluster analysis identified three tumor subtypes associated with significant differences in local recurrence-free survival (LRFS) (P<0.001), progression free-survival (PFS) (P<0.009) and overall survival (OS) (P<0.004). Tumor subtype 1, associated with short LRFS, PFS and OS, showed features of epithelial-mesenchymal transition and undifferentiation. It also overexpressed genes involved in cell adhesion, NF-κB and integrin signalling. Tumor subtype 3, associated with longer LRFS, PFS and OS, showed a high degree of differentiation and overexpressed genes located in chromosomal regions 19q13 and 1q21. Tumor subtype 2, which had an intermediate clinical outcome between subtype 1 and subtype 3, overexpressed genes involved in branching morphogenesis. Finally, we validated the association between gene cluster classification and patient survival using Gene Set Enrichment Analysis and two HNSCC data sets obtained from two independent patient cohorts. In conclusion, we generated a gene prognostic signature associated with survival in locally advanced patients using the expression profile of the pre-treatment tumor biopsy. Independent prospective studies would be necessary to assess if the proposed survival signature could help to guide clinical management of HNSCC.

Second, third, and fourth head and neck tumors. A progressive decrease in survival.

Patients with a first head and neck carcinoma have a high risk of successive neoplasms, many of which appear again in the head and neck. Second head and neck tumors have a poorer prognosis than first tumors, but data about the prognosis of third and fourth tumors in the head and neck are lacking.

Pretreatment count of peripheral neutrophils, monocytes, and lymphocytes as independent prognostic factor in patients with head and neck cancer

The purpose of this study was to analyze the prognostic value of pretreatment count of peripheral neutrophils, lymphocytes, monocytes, and neutrophil‐to‐lymphocyte ratio (NLR) in patients with head and neck squamous cell carcinoma (HNSCC).

Risk of third and fourth tumors in patients with head and neck cancer

The objective of our study was to analyze the incidence and location of second and subsequent tumors in patients after an index head and neck carcinoma.

External validation of a risk group defined by recursive partitioning analysis in patients with head and neck carcinoma treated with surgery and postoperative radiotherapy

Several clinical trials have proved that concurrent chemoradiotherapy is more efficacious than radiotherapy alone among high‐risk patients with head and neck squamous cell carcinoma (HNSCC) who undergo surgery. A risk‐group classification defined according to a recursive partitioning analysis (RPA) for these patients has been recently proposed. The objective of the present study was to carry out an external validation of this RPA‐derived classification system.