Stanisław Bień

Comorbidity in head and neck cancer: A critical appraisal and recommendations for practice

Comorbidity, the presence of additional illnesses unrelated to the tumor, has a significant impact on the prognosis of patients with head and neck cancer. In these patients, tobacco and alcohol abuse contributes greatly to comorbidity. Several instruments have been used to quantify comorbidity including Adult Comorbidity Evaluation 27 (ACE 27), Charlson Index (CI) and Cumulative Illness Rating Scale. The ACE 27 and CI are the most frequently used indices. Information on comorbidity at the time of diagnosis can be abstracted from patient records. Self-reporting is less reliable than record review. Functional status is not a reliable substitute for comorbidity evaluation as a prognostic measure. Severity as well as the presence of a condition is required for a good predictive instrument. Comorbidity increases mortality in patients with head and neck cancer, and this effect is greater in the early years following treatment. In addition to reducing overall survival, many studies have shown that comorbidity influences disease-specific survival negatively, most likely because patients with high comorbidity tend to have delay in diagnosis, often presenting with advanced stage tumors, and the comorbidity may also prompt less aggressive treatment. The impact of comorbidity on survival is greater in younger than in older patients, although it affects both. For specific tumor sites, comorbidity has been shown to negatively influence prognosis in oral, oropharyngeal, laryngeal and salivary gland tumors. Several studies have reported higher incidence and increased severity of treatment complications in patients with high comorbidity burden. Studies have demonstrated a negative impact of comorbidity on quality of life, and increased cost of treatment with higher degree of comorbidity. Our review of the literature suggests that routine collection of comorbidity data will be important in the analysis of survival, quality of life and functional outcomes after treatment as comorbidity has an impact on all of the above. These data should be integrated with tumor-specific staging systems in order to develop better instruments for prognostication, as well as comparing results of different treatment regimens and institutions.

Proposal for A Rational Classification of Neck Dissections

Alfio Ferlito, MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP, K. Thomas Robbins, MD, FRCSC, Jatin P. Shah, MD, PhD (Hon), MS, FRCSEd (Hon), FRACS (Hon), FDSRCS, Jesus E. Medina, MD, Carl E. Silver, MD, Shawkat Al-Tamimi, MD, Johannes J. Fagan, MBChB, FCS (SA) MMed, Vinidh Paleri, MS, FRCS (ORL-HNS), Robert P. Takes, MD, PhD, Carol R. Bradford, MD, Kenneth O. Devaney, MD, JD, FCAP, Sandro J. Stoeckli, MD, Randal S. Weber, MD, Patrick J. Bradley, MB, BCh, BAO, DCH, MBA, FRCS (Ed, Eng, Ir), FHKCORL, FRCSLT (Hon), FRACS (Hon), Carlos Suarez, MD, PhD, C. Rene Leemans, MD, PhD, H. Hakan Coskun, MD, Karen T. Pitman, MD, Ashok R. Shaha, MD, Remco de Bree, MD, PhD, Dana M. Hartl, MD, PhD, Missak Haigentz, Jr, MD, Juan P. Rodrigo, MD, PhD, Marc Hamoir, MD, Avi Khafif, MD, Johannes A. Langendijk, MD, PhD, Randall P. Owen, MD, MS, Alvaro Sanabria, MD, MSc, PhD, Primož Strojan, MD, PhD, Vincent Vander Poorten, MD, PhD, Jochen A. Werner, MD, Stanislaw Bien, MD, PhD, Julia A. Woolgar, FRCPath, PhD, Peter Zbaren, MD, Jan Betka, MD, PhD, FCMA, Benedikt J. Folz, MD, Eric M. Genden, MD, Yoav P. Talmi, MD, Marshall Strome, MD, MS, Jesus Herranz Gonzalez Botas, MD, Jan Olofsson, MD, Luiz P. Kowalski, MD, PhD, Jon D. Holmes, DMD, MD, Yasuo Hisa, MD, PhD, Alessandra Rinaldo, MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg

The effect of a Heat and Moisture Exchanger (Provox® HME) on pulmonary protection after total laryngectomy: a randomized controlled study

The goal of this randomized controlled study was to investigate the effect of Heat and Moisture Exchanger use on pulmonary symptoms and quality of life aspects in laryngectomized patients. Eighty laryngectomized patients were included and randomized into an HME and Control group. The effect of the HME was evaluated by means of Tally Sheets and Structured Questionnaires. The results showed a significant decrease in the frequency of coughing, forced expectoration, and stoma cleaning in the HME group. There were trends for the prosthetic speakers to report more fluent speech with the HME and for the HME group to report fewer sleeping problems. In conclusion, this study, performed in Poland, confirms the results of previous studies performed in other countries, showing that pulmonary symptoms decrease significantly with HME use and that related aspects such as speech and sleeping tend to improve, regardless of country or climate.

European Surgeons Were the First to Perform Neck Dissection

The history of the surgical treatment of cervical lymph node metastases began in the 19th century, and, unfortunately, the initial attempts at surgical treatment of neck metastases were disastrous. Although some European surgeons reported few cases of radical en bloc dissection, the first successful surgical procedure was performed and described in detail by Franciszek Jawdyński, a Polish surgeon, in 1888. George Washington Crile popularized and illustrated radical en bloc neck dissection in the early 20th century.

History of voice rehabilitation following laryngectomy.

Introduction: The history of voice rehabilitation following laryngectomy is as long as the history of laryngectomy itself. The multitude of methods which have been employed to reduce the disability associated with the loss of the larynx, illustrate the difficulty of finding an optimal method of reestablishing verbal communication while preserving the ability to breathe and swallow.

Nowotwory złośliwe jam nosa i zatok przynosowych w materiale własnym – charakterystyka epidemiologiczna i kliniczna ☆

Summary Introduction Sinonasal malignances (SNM) usually present as a difficult diagnostic and therapeutic problem. In the paper presented, the epidemiological and clinical characteristics of SNM, diagnosed in Holy Cross Cancer Center in Kielce (Dept. of Otolaryngology, Head and Neck Surgery), from 2001 to 2007, as well as a calculated survival rates are discussed. Material and methods From the hospital data and current clinical observations of 87 patients with SNM the age, sex, localization, stage of the disease, pathology and treatment applied, was taken for analysis. In cases with at least 3 year observation, the Kaplan-Meier survival curves were calculated. Results In the analyzed group of 87 cases, ranging from 8 to 82 years of age (average 62,3 years), there was 48 male, and 39 female patients (M : F = 1,2 : 1). 59,8% of all group was in the age above 60 years, with the most common age group 71–80 years (33,3%). The most common defined localization was a maxillary sinus (33,3%), but due to very advanced stage at time of diagnosis in 37,9% of cases, the precise localization within the region was not possible to define. The primary epithelial tumors were diagnosed in 52,9% (n = 46), of all SNM, the non epithelial malignant tumors in 42,5% (n = 37), and metastatic tumors to the nose and paranasal sinuses in 4,6% (n = 4). In the group of epithelial SNM the Squamous cell carcinoma dominated (26/46–56,5%), and in the non epithelial SNM the most common group was a malignant lymphoma (10/37–27,0%). At time of diagnosis the majority of patients with epithelial SNM (80,4%) presented with advanced local stage of the disease (T3 + T4a + T4b). The combined modality treatment was applied in the most of patients in the analyzed group (79,3%). The probability of 3 years disease free survival, calculated with Kaplan-Meier method was 64,0%, and 5-years survival – 45,0%. Conclusions 1. The SNM present as a very heterogeneous group of tumors 2. The most common SNM are a Squamous cell carcinoma, and malignant lymphoma. 3. The majority of SNM are diagnosed at then advanced stage of local disease. 4. The calculated probability of 3-years survival was 64,0%, and 5-years survival 45,0%. 5. The diagnostic, as well as therapeutic approach to SNM requires a multidisciplinary cooperation.INTRODUCTION Sinonasal malignances (SNM) usually present as a difficult diagnostic and therapeutic problem. In the paper presented, the epidemiological and clinical characteristics of SNM, diagnosed in Holy Cross Cancer Center in Kielce (Dept. of Otolaryngology, Head and Neck Surgery), from 2001 to 2007, as well as a calculated survival rates are discussed. MATERIAL AND METHODS From the hospital data and current clinical observations of 87 patients with SNM the age, sex, localization, stage of the disease, pathology and treatment applied, was taken for analysis. In cases with at least 3 year observation, the Kaplan-Meier survival curves were calculated. Results. In the analyzed group of 87 cases, ranging from 8 to 82 years of age (average 62.3 years), there was 48 male, and 39 female patients (M:F = 1.2:1). 59.8% of all group was in the age above 60 years, with the most common age group 71-80 years (33.3%). The most common defined localization was a maxillary sinus (33.3%), but due to very advanced stage at time of diagnosis in 37.9% of cases, the precise localization within the region was not possible to define. The primary epithelial tumors were diagnosed in 52.9% (n=46), of all SNM, the non epithelial malignant tumors in 42.5% (n=37), and metastatic tumors to the nose and paranasal sinuses in 4.6% (n=4). In the group of epithelial SNM the Squamous cell carcinoma dominated (26/46-56.5%), and in the non epithelial SNM the most common group was a malignant lymphoma (10/37-27.0%). At time of diagnosis the majority of patients with epithelial SNM (80.4%) presented with advanced local stage of the disease (T3+T4a+T4b). The combined modality treatment was applied in the most of patients in the analyzed group (79.3%). The probability of 3 years disease free survival, calculated with Kaplan-Meier method was 64.0%, and 5-years survival--45.0%. CONCLUSIONS (1) The SNM present as a very heterogeneous group of tumors. (2) The most common SNM are a Squamous cell carcinoma, and malignant lymphoma. (3) The majority of SNM are diagnosed at then advanced stage of local disease. (4) The calculated probability of 3-years survival was 64.0%, and 5-years survival 45.0%. (5) The diagnostic, as well as therapeutic approach to SNM requires a multidisciplinary cooperation.

Przerzuty nowotworowe do jam nosa i zatok przynosowych z narządów odległych

Summary Introduction The metastases from below the clavicles, to the head and neck region, are relatively uncommon, and usually demonstrate during the progression of the primary disease. At that time, the correct diagnosis requires only to compare the pathology report from the primary biopsy, with the biopsy from the lump in the head and neck. The majority of distant metastases to the head and neck region are localized within the lymph nodes. The metastases to nasal cavity and paranasal sinuses are very rare and usually localized within the maxillary sinus. Material 4 cases, out of 46 all distant metastases to the head and neck region, localized in the nasal cavity and paranasal sinuses, diagnosed and treated in Dept. of ORL HN the metastasis of colonic carcinoma to the sphenoid sinus (as a first symptom of the disease). The palliative Rtg-therapy was applied, and patient died in 2 months after diagnosis was established. Case II. M. 69 y with metastasis of kidney cancer (Ca clarocellulare) to the nasal cavity, during a palliative stage of the disease due to multiple lung metastases. Patient was treated with multiple courses of chemotherapy due to generalization of the disease. The nasal cavity metastasis was treated with repeated local resections. At present with no metastasis within the head and neck region – alive, in relatively good condition, with 23 months of observation. Cases III. E 50 years in palliative stage of the breast cancer, with metastases to the bones and hepar and with metastasis to the maxillary sinus. Received palliative Rtg. therapy on the region of metastasis. Died in 5 months after diagnosis of maxillary sinus metastasis. Case IV. F 54 years in palliative stage of the colonic cancer, with multiple metastases to the lungs and hepar; with metastasis to the maxillary sinus. During hemotherapy a symptoms of tumor of the maxillary sinus appeared, confirmed as a metastasis. The palliative Rtg-therapy on the region of metastasis. Died in 18 months, after diagnosis of maxillary sinus metastasis. Conclusions The prognosis of metastases from distant organs, to the nasal cavity and paranasal sinuses is miserable. In the majority of distant metastases to the nose and paranasal sinuses, the palliative therapy is the only possible option of treatment.

Neck dissection in the nineteenth century

The nineteenth century brought great progress in several Welds of surgery and medicine. In addition to the fact that insights, which were gained in the laboratory or during anatomic dissection studies, were, for the Wrst time, correlated to bedside Wndings and could then be used to improve the treatment of patients, the medical world struggled to discard the baggage of useless and counterproductive traditional treatments such as venesection (bleeding) and purging, previously employed to treat almost any ailment. It was the beginning of modern, science-based medicine. The Wrst half of nineteenth century medicine was dominated by the “Paris School” of French physicians and surgeons. Dominique Jean Larrey (1766–1842) and Pierre Francois Percy (1754–1825) accompanied Napoleon through many of his campaigns while acquiring extensive military surgical experience. Guillaume Dupuytren (1777–1835) accomplished numerous surgical innovations as chief surgeon at the Hotel Dieu. Laennec, Bretonneau and Bouillaud among many others developed a scientiWc basis of examination of patients and explanation of the cause of many diseases. In the second half of the nineteenth century while Paris was still paramount in the world of medicine, the “New Vienna School” as well as a generation of German surgeons were instrumental in the development of modern surgical treatment as well as understanding of the cellular basis of disease. The English speaking world produced pioneers of medicine throughout the nineteenth century including the “Irish School” of Graves, Stokes and Corrigan, and the great physicians of Guy’s Hospital in London including Bright, Addison,

Obraz epidemiologiczny i kliniczny czerniaka złośliwego jam nosa i zatok przynosowych – analiza 6 przypadków

Summary Introduction The mucosal malignant melanoma (MM), represent a rare group of tumors (0,2%–8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival. Materials and methods 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL HN lateral wall of nasal cavity – 2; and paranasal sinuses – 2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4–96 months) 3 patients died, all due to the fatal progression of the MM. Conclusions 1. Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. 2. The surgery, followed by Rtg-therapy is still the treatment method of choice. 3. The prognosis of mucosal MM in the nose and paranasal sinuses is bad.INTRODUCTION The mucosal malignant melanoma (MM), represent a rare group of tumors (0.2%--8% of all MM), with predominant localization on the mucosal surface of head and neck region, where the localization on the mucosa of nasal cavity, paranasal sinuses and oral cavity are the most common. The mucosal MM within the nose and paranasal sinuses represent approximately 4% of all malignant tumors in these localizations, affecting predominantly the age group over 60-es, equally in both sexes. The treatment of choice in mucosal MM is surgery followed by Rtg-therapy in cases of small or doubtful margins of resection. The prognosis of mucosal MM is poor with 8% to 30% of 5-years survival. MATERIALS AND METHODS 6 cases of mucosal MM, selected from 72 of all MM in the head and neck region, diagnosed and treated from 2001 to 2007 in Dept. of ORL H&N Surgery, Holy Cross Cancer Center in Kielce. RESULTS In group of mucosal MM which was taken to analysis there was 5 female and 1 male patient, with range of age from 55 to 80 (mean--69.4) with following localization: nasal septum--2 cases; lateral wall of nasal cavity--2; and paranasal sinuses--2. In 1 case an extremely rare pathologic form of amelanotic MM was diagnosed. The surgical resection of tumor followed by Rtg-therapy was performer in 4 cases. In 1 case, the radical surgery was the only method of treatment, and in 1 case the palliative Rtg-therapy was only applied. Within the observation period (4-96 months) 3 patients died, all due to the fatal progression of the MM. CONCLUSIONS (1) Mucosal MM localized in the nasal cavity and paranasal sinuses, present a very rare, but highly diversified group of malignant tumors. (2) The surgery, followed by Rtg-therapy is still the treatment method of choice. (3) The prognosis of mucosal MM in the nose and paranasal sinuses is bad.

Przerzuty nowotworów złośliwych do ślinianki przyusznej i regionu przyusznicy

Summary Introduction Among the malignant tumors found within the parotid gland, the primary tumors, as well as a metastatic tumors may be found. Aim Epidemiological and clinical characteristic, and preliminary assessment of treatment results of metastatic tumors to the parotid gland and the parotid region. Material and methods The retrospective analysis of 60 cases with metastatic tumors to the parotid gland and parotid region, selected from the material of Dept. ORL HN Malignant Melanoma 25,0%). The therapy with radical intention was applied in 75,0% of patients treated, mostly combined surgery and radiotherapy. 25,0% of patients received symptomatic and palliative treatment only. In the group with 3 (17 cases) and 5 years (6 cases) of observation accordingly, 53,1% and 33,3% total survival was achieved. Conclusions The most common primary localization of metastases to the parotid region are Squamous Cell Carcinoma and Malignant Melanoma of the head and neck skin. Metastases to the parotid gland and region are usually diagnosed in the advanced local stage of the disease. The treatment of choice in mentioned above metastases are surgery followed by radiotherapy. The unfavorable prognosis of metastatic tumors to the parotid gland and parotid region may be improved, with systematic follow up of the patients with the skin cancer.