Sonia Pereira

Outcomes for Patients at Head and Neck Cancer Consultation

Objective: Head and neck cancer outpatient departments have to deal with challenging, impairing, and highly lethal diseases. As the search for better treatments continues, we aimed to analyze the clinical outcomes of our patients and to identify factors that may affect short-term survival. Method: We performed a retrospective cohort study concerning all patients referred to the head and neck consultation of a Portuguese cancer center (Lisbon’s Instituto Português Oncologia) during 2008. Clinical and demographic data were obtained from medical records of those patients, from their first appointment until December 2011. Results: Four hundred forty-four patients were referred to our consultation over the study period. Most of them were men (87%) and the mean age was 60.4 years (range, 14-86 years). The most common cancers were laryngeal (37%) and oropharyngeal (23%), and the majority (58%) were advanced (stage IVa or higher). Sixty percent of our patients were treated with surgery and adjuvant radiotherapy. The average time elapsed between treatment and first appointment was 80 days (range, 2-275 days). The overall 2-year survival rate was 58% and the 2-year disease-specific survival rate was 64%. The overall recurrence rate was 25%, mostly at the primary site. Conclusion: Most of our patients had advanced tumors at the time of referral. Despite the early beginning of treatment at our center, survival, locoregional control, and treatment options are compromised. Public health policies should be developed to improve public health education regarding head and neck cancer prevention and early referral.

Canal Wall-up Tympanomastoidectomy: Recurrence Factors

Objective: Canal wall-up tympanomastoidectomy is gaining popularity in the treatment for cholesteatoma. The choice remains controversial because of the significant recurrence rate of this disease. We aimed to analyze tympanomastoidectomy success rate, to establish eventual predictive factors for failure, and to evaluate the computed tomography (CT) scan’s value in this pathology. Method: We performed a retrospective cohort study regarding all patients submitted to tympanomastoidectomy for cholesteatoma at the otolaryngology department of Hospital São José, Lisbon, from January 1, 2005, to December 31, 2009. Clinical and demographic data were obtained from medical records. Results: One hundred nineteen patients were submitted to tympanomastoidectomy. In most cases, preoperative CT scans showed cholesteatoma in the attic (50%) and large extension of the disease (tegmen, semicircular or fallopian canal erosion in 51%), not always confirmed during surgery (75%). Sixty percent had a canal wall-down procedure. The overall postoperative air-bone gap was within 20 dB in 44%. Second-look surgery was performed in 24 patients: the overall recurrence rate was 23%, with conversion to canal wall-down procedure in 67%. Factors identified as related to failure: cholesteatoma in the sinus tympani (33%), scutum erosion (29%), and large extension of disease (40%). Conclusion: The recurrence rate was significant, despite the high percentage of canal wall-down procedures. Factors for failure remain uncertain and CT scans presented limited value in the diagnosis and evaluation of cholesteatoma, especially postoperatively. In the absence of better diagnostic procedures, we recommend second look surgery to control cholesteatoma’s recurrence.