Orlando Parise

A case-control study on complications and survival in elderly patients undergoing major head and neck surgery

BACKGROUND Several studies in the literature have shown that older patients have a poor prognosis after the treatment of cancer. They are frequently considered to have a high surgical risk and undergo substandard treatment. PATIENTS AND METHODS This case-control study analyzes complications, mortality, and survival in 115 patients 70 years of age or older and 115 controls matched by site and clinical stage. Most tumors were located at the oral cavity, salivary glands, pharynx, or larynx. RESULTS The frequency of postoperative complications, mortality, and recurrences were similar in both groups. Twenty elderly patients and 9 controls died due to causes not related to cancer. The 5-year survival rates were 43% for the elderly patients and 55.6% for the control patients (P = 0.1038). CONCLUSION The main causes of death in the elderly patients were not related to cancer or treatment complications. This emphasizes the need for the use of standard treatment for all patients who remain in good medical status.

Surgical salvage treatment of T1/T2 glottic carcinoma after failure of radiotherapy

PURPOSE To evaluate the use of conservative surgical salvage techniques (eg, vertical partial laryngectomy and subtotal laryngectomy with cricohyoidopexy) versus total laryngectomy for radiotherapeutic failure of early glottic cancer by retrospective review of medical records. PATIENTS AND METHODS Of 950 previously untreated endolaryngeal carcinomas managed at the Gustave-Roussy Institute in France between 1975 and 1984, 259 of 344 early glottic cancers (T1, N0 and T2, N0) received radiation therapy. Local failure rates were 14% in T1a cancers, 16% in T1b cancers, and 36% in T2 cancers with normal vocal-cord mobility. RESULTS Nine of 54 patients with treatment failure were ineligible for salvage surgery. Among the remaining 45 patients, 35 underwent a total laryngectomy; these patients had a 77% 5-year survival rate. Ten patients treated with partial surgery (6 vertical partial laryngectomies and 4 subtotal laryngectomies with cricohyoidopexy) had a 100% survival rate at 5 years. Seven of the 10 patients treated with partial surgery had healing problems that delayed canula and nasogastric tube removal for 30 to 60 days. CONCLUSIONS Salvage surgery is effective for radiotherapeutic failures of early glottic cancers. In some cases, partial surgery can be performed with good tumor control and satisfactory laryngeal functions. Subtotal laryngectomy is an alternative to total laryngectomy if vertical partial surgery is not suitable.

NECROTIZING FASCIITIS AS A LATE COMPLICATION OF MULTIMODAL TREATMENT FOR LOCALLY ADVANCED HEAD AND NECK CANCER: A CASE REPORT

Late complications of novel organ preservation multimodal protocols for the treatment of locally advanced head and neck cancer may be underreported in the literature.

Principal drug-metabolizing enzyme systems in L1210 leukemia sensitive or resistant to BCNU in vivo.

1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU) resistance has been mostly studied in vitro. In an attempt to better understand BCNU resistance in the in vivo situation, we compared the principal drug-metabolizing enzyme systems in two L1210 leukemia lines, one sensitive and one resistant to BCNU (L1210/BCNU), passaged in vivo in mice. The following enzymes were assayed by immunoblotting: cytochromes P-450 (1A1/1A2, 2B1/2B2, 2C8-10, 2E1, 3A), epoxide hydrolase (EH) and glutathione S-transferase (GST-alpha, -mu and -pi). The following enzymes and cofactors were assayed fluorometrically or spectrophotometrically: 1-chloro-2-4 dinitrobenzene-GST (CDNB-GST), total glutathione (GSH), UDP-glucuronosyltransferase, beta-glucuronidase, sulfatase and sulfotransferase. Results showed that cytochrome P-450 1A1/1A2 was the only isoenzyme detected in both L1210 and L1210/BCNU. CDNB-GST activity was significantly higher in L1210/BCNU compared with L1210. The isoenzyme GST-alpha was more abundant in L1210/BCNU compared with L1210, whereas GST-pi was expressed less in the BCNU-resistant leukemia line. GST-mu was not detected in either L1210 leukemia lines. GSH levels were similar in the two L1210 lines. No significant difference was observed between the two leukemia lines for the conjugative enzymes UDP-glucuronosyltransferase and sulfotransferase, whereas their corresponding hydrolytic enzymes beta-glucuronidase and sulfatase were about two-fold lower in the BCNU-resistant leukemia line. Epoxide hydrolase was 1.3-fold higher in L1210/BCNU compared with L1210 and this level was about three-fold higher than in mouse liver. In conclusion, these studies showed the presence of cytochrome P-450 1A1/1A2 in the two L1210 leukemia lines studied, and indicated noteworthy differences between the two leukemia lines for many enzyme systems such as GST, beta-glucuronidase, sulfatase and epoxide hydrolase. These data are of importance to better understand the mechanisms of drug resistance to nitrosoureas in vivo.

Thymidylate synthase activity and Folate levels in head and neck squamous cell carcinomas

Currently, the choice of the treatment strategy in head and neck squamous cell carcinoma (HNSCC) is based on the following clinical characteristics: tumor volume and site, loco-regional spread and/or metastatic dissemination of the primary. However, these clinical parameters may not take into account biological factors that could better predict the outcome of therapy.