Sergio Altino Franzi

Head and neck squamous cell carcinoma in childhood

BACKGROUND Squamous cell carcinoma (SCC) of the head and neck region is rare in young patients and even less frequent in children 15 years or younger children. The patients reported in the literature are isolated cases and their management is always difficult because there is no large experience or a convincing theory to support treatment decisions for every child. PROCEDURES AND RESULTS Four patients aged 15 years or younger were treated for SCC of head and neck between 1977 and 1995 at the Head and Neck Service of Heliópolis Hospital, São Paulo, Brazil, and with this paper we are reporting our experience with their treatment, including a genetic investigation in two cases (immunohistochemical analysis using monoclonal antibodies against p53 and c-erbB-2 oncogenes). These patients had no history of tobacco or ethanol abuse and no history of cancer in their families. Many authors attribute an unusual aggressiveness to SCC in childhood, with propensity to locoregional recurrence and high death rates and therefore, propose aggressive multidisciplinary therapy. Our cases, with the exception of one, had an early diagnosis and were treated using the same method we use for adults; the results were very good. CONCLUSIONS We recommend for these cases the same protocol as for older patients. In these cases, however, the primary lesion is resected with a safety margin which is usually 2 to 3 mm larger than usual safety margins and selective neck dissection is routinely indicated. This management is adopted in an attempt to avoid postoperative irradiation which may prove to be dangerous in the future for young patients. On the other hand, we recognize that due to a small number de patients, definitive treatment recommendations cannot be made at this time.

Qualidade de vida e prognóstico nos carcinomas epidermóides de cabeça e pescoço

Aim: a quality life questionnaire (QLQ) assessment and its relationship with prognostic of patients with head and neck cancer. Study design: prospective clinical. Material and method: a study of 31 patients with squamous cell carcinoma of upper aerodigestive tract submitted to therapy in Head and Neck Surgery and Otorhinolaryngology Department of Heliopolis Hospital, Hosphel between August,1999 and November, 2000. For evaluation of quality of life it was used the questionnaire QLQ-C30 and the module QLQ-H&N35, both supplied by EORTC, accomplished previously to the treatment. The differences of scores among patients with controlled disease and those with recurrence in the first 12 months after treatment was evaluated. Results: a significant difference was observed in scores between assimptomatic patients and those with recurrence, when related to the fadiga, problems of eating in public and global quality of life (p £ 0,05). The scores in this group were similar to those observed in other populations. Conclusion: the pre-treatment quality of life can be a prognostic indicator for patients with head and neck cancer.

Evolution of patients with squamous cell carcinoma of upper aerodigestive tract

CONTEXT Local and regional recurrences are frequent in patients with squamous cell carcinoma of the upper aerodigestive tract and early diagnosis is important for salvage treatment. OBJECTIVE To identify the period of highest risk for the development of recurrences after surgical treatment of squamous cell carcinoma of the upper aerodigestive tract, in spite of radical therapy, in order to plan the follow-up for these patients. TYPE OF STUDY Cross-sectional, descriptive. SETTING Department of Head and Neck Surgery/Otorhinolaryngology, Heliópolis Hospital (Hosphel), São Paulo, Brazil. PARTICIPANTS A review was made of the hospital records of 889 patients with squamous cell carcinoma of the upper aerodigestive tract surgically treated between October 1977 and December 1996: 364 had oral cavity tumors, 107 had tumors of the oropharynx, 152 of the hypopharynx and 266, larynx tumors. The disease was stage I in 14 patients, stage II in 117, stage III in 352, stage IV in 397 and 9 patients were not staged. MAIN MEASUREMENTS The interval between treatment and recurrence of disease was evaluated. The results were expressed as medians, quartiles (25% to 75%) and percentiles (10% to 90%). The annual incidence of recurrences and second tumors was calculated. RESULTS Seventy-four percent of the recurrences were diagnosed within 18 months post-treatment. The local and regional recurrences and distant metastases showed medians of 270, 210 and 435 postoperative days respectively. The incidence of a second primary tumor varied from 2 to 3.1% a year. CONCLUSION The majority of recurrences occurred within 18 months after the initial surgical treatment. The incidence of a second tumor remained stable after the first post-treatment year.

Diagnostic and therapeutic delay in patients with larynx cancer at a reference public hospital

O carcinoma epidermoide da laringe, apesar dos sintomas precoces, ainda e frequentemente diagnosticado em estadio avancado. Apesar da demora ate chegar ao atendimento especializado, o tempo despendido no diagnostico e a espera para o tratamento definitivo tambem sao importantes para o resultado final. OBJETIVO: Avaliar o intervalo de tempo entre a primeira consulta no especialista e o tratamento nos pacientes com carcinoma epidermoide da laringe. FORMA DE ESTUDO: Coorte historica longitudinal. MATERIAL E METODO: Estudo de 272 pacientes com carcinoma epidermoide da laringe atendidos consecutivamente entre janeiro de 1996 e dezembro de 2004. Avaliadas as caracteristicas clinicas e epidemiologicas, assim como sua relacao com o tempo despendido entre a consulta inicial e o tratamento. RESULTADO: O intervalo de tempo entre a primeira consulta e o inicio do tratamento apresentou mediana de 49 dias e media de 57 dias. Nao houve diferenca em relacao ao estadiamento, faixa etaria, sexo, naturalidade ou escolaridade. CONCLUSAO: O tempo entre o atendimento inicial com especialista e o inicio do tratamento apresentou mediana de 49 dias, similar ao relatado em outros estudos.UNLABELLED Laryngeal squamous cell carcinoma is very often diagnosed at advanced stages. The time interval between the specialist consultation and the start of treatment may contribute to better outcomes. AIM the interval assessment between the first specialist evaluation and the treatment of patients with laryngeal squamous cell carcinoma. STUDY DESIGN longitudinal historical cohort. MATERIALS AND METHODS 272 consecutive patients with laryngeal squamous cell carcinoma seen between January, 1996 and December of 2004. Clinical and epidemiological data were evaluated, as well as their association with the time interval between the first specialist visit and the start of treatment. RESULT the median time between first evaluation and treatment was 49 days. There was no relationship with gender, age, birth place, disease stage or education. CONCLUSION the treatment median delay was 49 days, similar to what has been reported in other studies.

Correlação entre os achados clínicos e imaginológicos nas disfunções temporomandibulares

OBJECTIVE: To correlate the signals and symptoms observed on clinical examination of patients with temporomandibular disorder with the results demonstrated by magnetic resonance imaging. MATERIALS AND METHODS: Thirty patients presenting with signs and symptoms of temporomandibular disorders underwent clinical evaluation and subsequent magnetic resonance imaging. The magnetic resonance imaging studies were independently evaluated by two experienced radiologists. Magnetic resonance imaging studies consisted of 12 images in coronal, T1-weighted sequences with 3 mm-thick slices with the mouth closed, sagittal, T1- and T2-weighted sequences with both open and closed mouth positions, and on progressive opening/closing movement at 5 mm intervals, in order to demonstrate the full mandibular movement. The statistical significance between the clinical findings in the evaluation of the patients and results found on the magnetic resonance imaging studies was analyzed by means the kappa test. RESULTS: Interobserver agreement was respectively 56.7% (kappa = 0.1) and 56.7 (kappa = 0) for the left and right sides. CONCLUSION: No correlation was found between the clinical and magnetic resonance imaging findings in the diagnoses of disc displacement.

Assessment of demographics factors and clinical staging in patients submitted to salvage surgery for oropharyngeal squamous cell carcinoma

UNLABELLED The usual management of upper aero digestive tract squamous cell carcinoma is surgery associated or not to post surgical radiotherapy. Loco-regional relapses constitute the main failure of the initial treatment and early diagnosis justifies the indication of salvage surgery. AIM Descriptive analysis of demographic data and staging for salvage surgery of oropharynx tumors. MATERIALS AND METHODS We studied retrospectively 78 patients submitted to surgery in all cases; however, just 37 patients received post surgical radiotherapy. RESULTS There was a predominance of males in 70 cases, with mean age of 54.2 years, and 54 patients were Caucasian. The patients were classified as T3 and T4 in 38 cases and 40 patients were classified as N0 neck. 35 patients developed loco-regional distant relapses. 17 patients were submitted to salvage surgery and 12 patients were reclassified as T1; 2 patients T2 and in relation to the clinical stage N, 2 patients were N2a and 2 patients N2b. The average age of the patients submitted to salvage surgery was 52.8 years, with predominance of male Caucasians. CONCLUSION Clinical stage I and II were accorded salvage surgery.

Avaliação de fatores demográficos e estadiamento clínico nos pacientes submetidos a resgate cirúrgico por carcinomas epidermóides de orofaringe

The usual management of upper aero digestive tract squamous cell carcinoma is surgery associated or not to post surgical radiotherapy. Loco-regional relapses constitute the main failure of the initial treatment and early diagnosis justifies the indication of salvage surgery. AIM: Descriptive analysis of demographic data and staging for salvage surgery of oropharynx tumors. MATERIALS AND METHODS: We studied retrospectively 78 patients submitted to surgery in all cases; however, just 37 patients received post surgical radiotherapy. RESULTS: There was a predominance of males in 70 cases, with mean age of 54.2 years, and 54 patients were Caucasian. The patients were classified as T3 and T4 in 38 cases and 40 patients were classified as N0 neck. 35 patients developed loco-regional distant relapses. 17 patients were submitted to salvage surgery and 12 patients were reclassified as T1; 2 patients T2 and in relation to the clinical stage N, 2 patients were N2a and 2 patients N2b. The average age of the patients submitted to salvage surgery was 52.8 years, with predominance of male Caucasians. CONCLUSION: Clinical stage I and II were accorded salvage surgery.

Neck dissection in squamous cell carcinoma of the tongue

AIM The purpose of this study was to assess the prognosis of patients with tonsillar squamous cell carcinoma with different stages of lymph node involvement and to determine the best elective neck dissection for those cases. STUDY DESIGN Case series. MATERIAL AND METHOD 51 patients with tonsillar tumors were treated between 1992 and 2001. The incidence of different tumor-node-metastasis stages was evaluated according to primary tumor extension. RESULTS cN0 patients had metastases in stages I and II only. Among pN+ subjects with stage I metastases, 6/7 had primary tumor extending to oral cavity. CONCLUSION Supraomohyoid neck dissection (stages I, II and III) is the elective treatment of choice when tonsillar primary tumor extends to oral cavity. When primary tumors are limited to the oropharynx, selective neck dissection of stages II and III proved to be more adequate.

Esvaziamento cervical no tratamento do carcinoma epidermóide de lábio

Squamous cell carcinoma of the lip is usually early diagnosed and shows low incidence of neck metastases. AIM: The study aimed at assessing the incidence and location of lymph node metastases in squamous cell carcinoma of the lip. STUDY DESIGN: Retrospective case-series study. MATERIAL AND METHOD: A review of 78 case records of patients treated between 1990 and 2001. The relation between primary tumor size, histological grading and commissure involvement with presence and location of lymph node metastases was evaluated. RESULTS: Lymph node metastases were detected in 7% of lesions 3 cm (p=0.002). Ten patients had metastases, out of which 8 were level I, and only 2 were of other levels. After elective treatment of the neck, only level I metastases were found. CONCLUSION: Metastases are not commonly found in lesions < 3 cm. If present, they are usually level I and, in this case, suprahyoid neck dissection can be indicated for elective treatment.

Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral

UNLABELLED Unilateral or bilateral neck dissection must be considered in the treatment of laryngeal cancer AIM To evaluate the prevalence of contralateral metastases in larynx cancer and distribution of these metastases according to lymph node levels in the neck. METHOD Retrospective longitudinal study of 272 charts from patients with squamous cell cancer of the larynx treated between 1996 and 2004; and we selected 104 surgical cases submitted to neck dissection. We evaluated the incidence of bilateral or contralateral metastases, according to the location and extension of the primary tumor, considering the anatomical sub-sites and the midline. RESULTS Contralateral metastases in lateral tumors were observed in 3.5% of glottic lesions and in 26% of supraglottic lesions. Contralateral metastases were uncommon in N0 patients. Lymph nodes levels IIa and III were the most commonly involved in the neck. CONCLUSION In lateral glottic tumors there is no need for elective contralateral neck dissection. In supraglottic lesions without ipsilateral metastases, the incidence of hidden metastasis does not justify elective contralateral dissection. The midline is not a reliable indicator of the risk of contralateral laryngeal tumors.