Clinical and biological prognostic factors in 135 patients affected by sinonasal carcinoma treated in Piedmont. Long-term survival of patients with sinonasal carcinoma remains disappointing in spite of aggressive treatment. The aim of the study is the assessment of overall survival in a group of patients treated with a fixed protocol and the positivity of proliferation and neoangiogenesis markers (Ki-67 and VEGF). From our data it comes out that staging, histological type and treatment are the most important clinical and pathological prognostic factors, moreover surgery +/- radiotherapy is the first line treatment for these tumors. Proliferation index and neoangiogenesis plays a pivotal role in the natural history of such neoplasms.
In head and neck cancer, the locoregional failure of patients with positive margins, vascular or perineural invasion, and extracapsular spread is high and results in poor survival.
Objective
To assess the effect of adjuvant chemoradiotherapy in improving treatment outcomes among older patients with head and neck cancer.
Methods
Forty patients undergoing radical surgery (median age, 73.5 years [range, 70-78 years]) were enrolled (35 men and 5 women; Eastern Cooperative Oncology Group performance status, grade 0-2). Disease sites included the oral cavity (10 patients), oropharynx (12 patients), hypopharynx (8 patients), and larynx (10 patients); pathological TNM classifications included T1 N2 (8 patients), T2 N1-2 (12 patients), T3 N0-2 (8 patients), and T4 N0-2 (12 patients), with the following poor prognostic factors: positive margins (6 patients), vascular invasion (14 patients), neural invasion (16 patients), and extracapsular spread (26 patients). All patients were treated with carboplatin (30 mg/m2on days 1-5 of weeks 1, 3, and 5) concomitant with radiotherapy (54.0 Gy to all risk volumes plus 10.0 Gy to high-risk volumes; 5 daily fractions of 1.8 Gy each per week).
Results
No grade 4 toxicity was observed. Grade 3 toxicity included mucositis (10 patients), neutropenia (6 patients), dermatitis (2 patients), and thrombocytopenia (1 patient). The radiotherapy dose administered was 52.0 Gy to all risk volumes plus 10.0 Gy to high-risk volumes. Thirty-two patients (80%) received 3 cycles, 6 (15%) received 2 cycles, and 2 (5%) received 1 cycle. Three-year survival was as follows: disease-free survival, 58%; overall survival, 64%; and local control, 79%.
Conclusions
Adjuvant chemoradiotherapy may be successful in fit older patients. The results of adjuvant chemoradiotherapy were better than those observed in a comparable group treated with radiotherapy alone and were similar to those observed in a younger group with the same poor prognostic factors treated with adjuvant carboplatin plus radiotherapy.
We conducted a study to evaluate the hypothesis that the preservation of cervical root branches of the cervical plexus is associated with greater shoulder mobility, less loss of face and neck sensation, and better quality of life (QoL) following functional neck dissection in which the spinal accessory nerve is spared. We also investigated the impact of postoperative physiotherapy on these three outcomes. Our study population was made up of 54 patients-47 men and 7 women, aged 34 to 78 years (mean: 53.4)-who had undergone functional neck dissection as a treatment for head and neck cancer over a 3-year period at our institution. Patients were divided into two groups: 23 patients whose cervical root branches were preserved during surgery (preservation group) and 31 whose branches were removed (removal group). Shoulder mobility was measured by the Arm Abduction Test (AAT), face and neck sensation was assessed by fingertip touch in eight areas of the head and neck, and QoL was determined by the University of Washington-Quality of Life questionnaire (UW-QoL4). The AAT revealed that the preservation group had significantly better shoulder mobility. The fingertip touch evaluation revealed significantly less loss of sensation in Saffold regions A and D. Analysis of the UW-QoL4 results revealed that the preservation group experienced significantly less pain, significantly fewer shoulder complaints, and significantly fewer limitations on activities and recreation, as well as significantly better health-related and overall QoL. The preservation group also had a significantly better composite score, global score, social function score, and mood and anxiety score on the UW-QoL4 assessment. Finally, we found that physiotherapy improved both QoL and shoulder mobility, although these improvements were not statistically significant. We conclude that preservation of the cervical root branches significantly improves outcomes in patients who undergo functional neck dissection.
Objective Providing good vocal outcomes to vocal fold cancer patients, after open or endoscopic cordectomy, is a hot topic. Several authors compared different phono‐surgical techniques focusing their attention on feasibility. The aim of our study was to evaluate objective and subjective vocal outcomes after Montgomery thyroplasty. Method In 2011, at the I ENT Division of Turin University, 8 patients underwent Montogomery thyroplasty followed by 6 months of speech rehabilitation. Inclusion criteria were: glottic incompetence and 3 years of follow‐up after cordectomy. Voice evaluation was performed using videolaryngostroboscopy, Multidimensional Voice Program (MDVP), and VHI‐10. Results Six months after the surgical procedure, the laryngostroboscopy showed an improved glottic closure during phonation even if irregular and incomplete. Preoperative and postoperative MDVP parameters were compared by means of Student t test, observing a statistically significant improvement of all parameters ( P <. 05). The most relevant improvements were observed in: average fundamental frequency (192 Hz vs 161.7 Hz), absolute jitter (645 µs vs 57 µs), shimmer (2.1 dB vs 0.82 dB), amplitude perturbation quotient (17.6% vs 6.1%), and medium phonation time (3.5 s vs 5.12 s). VHI‐10 mean score improved from 33.4 to 25.7 ( P <. 05). Conclusion Our data suggest that Montgomery thyroplasty, associated with speech rehabilitation, is an efficient and well‐ tolerated rehabilitative approach in order to improve vocal outcomes of vocal fold cancer patients treated with open or endoscopic laser cordectomies.
The aim of this study was to assess the outcomes after radiofrequency inferior turbinate reduction (RITR) on objective and subjective nasal function in patients with nasal obstruction caused by turbinate hypertrophy and to evaluate the possible effect on olfactory function.Case series with planned data collection.ENT division, university hospital.Forty consecutive patients who underwent RITR for allergic or nonallergic chronic rhinitis with inferior turbinate hypertrophy were tested before and two months after the surgical procedure, using the Sniffin' Sticks test battery, anterior rhinomanometry, and the nasal obstruction symptom evaluation (NOSE) scale.The total basal nasal resistance at 150 Pa diminished significantly two months after surgery. Preoperative olfactory tests showed anosmia in five percent (n = 2) of the patients, hyposmia in 82 percent (n = 33), and normosmia in 12 percent (n = 5). At two months from the intervention, two percent (n = 1) were diagnosed as anosmic, 12 percent (n = 5) as hyposmic, and 85 percent (n = 34) as normosmic. The means of preoperative odor threshold (T), discrimination (D), identification (I), and the overall TDI score improved significantly postoperatively (P < 0.001). The NOSE score in the two-month follow-up improved in 97.5 percent (n = 39) of patients, with a mean difference in pre- vs. postintervention score of 40.12 (95% confidence interval 35.75-44.25; P < 0.001).RITR may provide excellent outcomes in terms of improvement in olfactory function and nasal flow in patients affected by turbinate hypertrophy refractory to medical therapy.
Tobacco smoke is a well-known source of toxic, mutagenic and carcinogenic agents. The aim of the present preliminary study was to investigate the effects of cigarette smoking on lymphoid and non-lymphoid tonsillar tissue.The study group consisted of 12 smoker and 10 non-smoker patients complaining recurrent tonsillitis. Clinical data, histological findings and scanning electron microscopic analyses were considered. To the best of our knowledge, such an approach has not been previously adopted in a similar experimental model.Smoker patients showed a longer history of recurrent tonsillitis, difficulties in clinical management and evident morphostructural changes than non-smokers.These preliminary results suggest a possible interference of cigarette smoking with the therapy response as well as a possible role of tobacco smoke in impairment of inflammatory response. Results are critically analysed and discussed. Literature data on this subject are reviewed.
To evaluate the pharmacokinetic parameters, efficacy and toxicity of a combination of gemcitabine (GEM) and vinorelbine (VNB) in recurrent heavily pre-treated squamous cell head and neck carcinoma.Twenty-four patients previously treated with concomitant chemo-radiotherapy (n = 13), surgery plus radiotherapy (n = 10) and surgery + concomitant chemo-radiotherapy (n = 1) were enrolled; 7 patients had received one or more courses of palliative chemotherapy. Twenty patients had a local-regional recurrence and 4 patients had metastases. The doses were 1200 mg/m2 for GEM and 30 mg/m2 for VNB on days 1 and 8 every 21 days; a maximum of 6 cycles was allowed. Pharmacokinetic investigations were performed on 9 patients receiving GEM and VNB. As a PK control, a second group of 5 patients was given GEM as single agent, at the same doses and with the same i.v. infusion length.Twenty-four patients received a total of 135 cycles (median per patient, 5). Neutropenia was the most frequent side-effect (92% of patients; grade 3-4 in 50%). The overall response rate was 25% which included 1 of 24 complete responses (4%) and 4 of 24 partial responses (21%). Responses were observed only in patients with good prognostic characteristics. The median response duration was 5.5 months (2-16 months) and the overall median survival was 9 months (range, 2-25+). Vinorelbine serum levels showed no evidence of any pharmacokinetic interaction with GEM; most of all, no rebound in VNB disposition can be produced by GEM pre-administration.The GEM-VNB combination has a palliative role in patients with favourable characteristics; the results seem no better than those observed with VNB alone. Moreover, this drug association does not alter the pharmacokinetic profile of both drugs, also compared to GEM monotherapy.
