Olavo Feher

Bisphosphonate-Related Osteonecrosis of the Jaws–An Initial Case Series Report of Treatment Combining Partial Bone Resection and Autologous Platelet-Rich Plasma

PURPOSE Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a well-recognized pathologic entity that is challenging and difficult to manage. Recent literature contains several articles, with most recommending conservative management. This report describes a treatment modality for advanced cases of BRONJ that involves bone resection and autologous platelet-rich plasma (PRP). PATIENTS AND METHODS This case series consisted of 25 patients with BRONJ lesions and a history of intravenous bisphosphonate therapy for metastatic bone diseases that did not respond to conservative treatment. All patients were surgically managed by a standardized protocol combining bone resection and PRP. RESULTS Of the 25 patients, 20 (80%) showed complete wound healing during follow-up. Median follow-up was 36 months. Microscopic examination showed actinomyces in 15 specimens. CONCLUSION BRONJ has been shown to be refractory to conservative management. Treatment of refractory BRONJ with a combination of bone resection and PRP was found to be an effective therapy in most patients and should be considered an alternative treatment modality for management of advanced cases.

Deglutição após quimioterapia e radioterapia simultânea para carcinomas de laringe e hipofaringe

The main goals of the larynx preservation protocol are eradication of cancer and preservation of a functional larynx with maintenance of respiration, phonation and swallowing. Few studies, however have addressed functional outcomes. OBJECTIVE: Functional evaluation of oropharyngeal swallowing in patients enrolled in a larynx preservation protocol at the Hospital do Câncer AC Camargo. METHODS: Evaluation of swallowing was performed by videofluoroscopy in 31 patients, focusing on: oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration and severity of dysphagia. RESULTS: Swallowing analysis: 5 patients showed inefficient bolus preparation, 14 had changes in the bolus propulsion; 23 patients had a reduced laryngeal elevation, 26 presented with stasis in the valecula and 14 with stasis in hypopharynx. Nine patients presented silent aspiration. We detected functional swallowing in 11 patients; mild dysphagia in 7; mild/moderate in 7; moderate in 3 and severe dysphagia in 3. CONCLUSION: larynx preservation results in changes of swallowing, ranging in their majority from discrete to moderate. Some patients, however, developed severe dysphagia, and oral feeding was not possible.

Pilot trial of concomitant chemotherapy with paclitaxel and split-course radiotherapy for very advanced squamous cell carcinoma of head and neck†

The combination of chemotherapy and irradiation is considered the standard of care for the treatment of advanced squamous cell carcinoma of head and neck (SCCHN). Paclitaxel has shown a single‐agent activity in SCCHN. Besides, this drug is a promising radiosensitizer for some human solid tumors. This is a phase II trial to evaluate the feasibility, efficacy, and toxicity of paclitaxel administered concurrently with split‐course radiotherapy in advanced unresectable SCCHN.

Induction chemotherapy for oral cavity cancer patients: Current status and future perspectives.

There is a lack of data from phase III randomized studies to support an ideal approach for locally advanced oral cavity cancer patients. In general, surgery, radiotherapy and chemotherapy are valid treatment options, and combined approach is usually indicated given poor clinical outcomes with single modality therapy. The aim of this study is to review the current status and future perspectives of induction chemotherapy for locally advanced oral cavity cancer patients.

Perioperative chemotherapy with and without high-dose methotrexate in adult osteosarcoma

Treatment of adult osteosarcoma (AOS) includes perioperative chemotherapy and surgery. Standard chemotherapy consists of cisplatin (CP) and doxorubicin (DOX). Although considered the standard of care for pediatric patients, high-dose methotrexate (HDM) remains controversial in adults. We aimed to evaluate the role of HDM in AOS treated with curative intent. This study included patients with AOS who received perioperative chemotherapy with DOX and CP (group 1; N=16) and DOX, CP, and HDM (group 2; N=10). The primary endpoint was grade 3 or superior toxicities. The secondary endpoints included overall survival (OS) and disease-free survival. Despite lower average age (35.0±12.1 vs. 18.9±2.1 years), group 2 presented more grade 3–4 thrombocytopenia (0 vs 50%) and mucositis (0 vs 40%), whereas group 1 presented more grade 3–4 neutropenia (43.75 vs 40%). No grade 3–4 renal toxicities occurred. Two grade 5 toxicities occurred in group 2, both after the first HDM cycle. Disease-free survival (4.38±0.61 vs. 2.3±0.54 years, P=0.228) and OS (4.70±0.56 vs 2.52±0.57 years, P=0.107) were not statistically different, but presented a trend toward better outcomes in group 1. The 4-year OS was 65.6 and 32.8% for groups 1 and 2, respectively. In conclusion, HDM was associated with greater severe and lethal toxicity when added to CP and DOX in AOS. Also, it does not seem to impact on treatment efficacy. These data do not support the use of HDM for the perioperative treatment of AOS.

Complete Response to Radiotherapy in a Pineal Parenchymal Tumor ofIntermediate Differentiation

Background and Importance: Approximately 20 percent of parenchymal pineal tumors (PPT) arise from the epithelial cells and are extremely rare, especially in adults, accounting for less than 1 percent of all primary brain tumors in Europe and North America. PPT of intermediate differentiation (PPTID) was recognized as a new entity and introduced in the 2007 WHO classification, corresponding to grades II (GII) or III (GIII). Previous studies had suggested its potentially aggressive behavior and tendency for cerebrospinal fluid seeding. A standard treatment for these tumors has not yet been defined. The gross total surgical resection is indicated whenever technically feasible and the impact of adjuvant radiotherapy and chemotherapy is not established. In fact, little is known about the radiation and chemotherapy sensitivity of these tumors. Clinical Presentation: We describe a case of a recurrent PPTID (G II, Ki67:10%) which underwent to an endoscopic third ventriculostomy, biopsy and a two conformal radiation therapy course (25 fractions of 180 cGy over 4 weeks and, 3 fractions of 180 cGy, total of 5400cGy). After that, the patient was completely asymptomatic and an MRI revealed no residual mass. There was no sign of relapse by the 27-months follow-up. Conclusion: Given the paucity of good clinical evidence for a standard therapy and the fact that the currently PPTID treatment is experience-based, we conclude that radiotherapy can be considered as suitable possibility of primary treatment. Due to its rarity, prospective multi-institutional studies should be arranged to establish the optimal PPTID management.