Search

Purpose of Review: The management of orbital tumours has evolved significantly over the last two decades, as the body of knowledge about these tumours grows and new techniques are introduced that reduce surgical morbidity. The purpose of this review is to highlight and evaluate the most recent advancements in the management of these tumours., Recent Findings: Several recent retrospective series emphasize the broad range of pathologic processes that can arise within the orbit. In addition, there have been a number of recent studies describing advances in endonasal endoscopic techniques for resection of orbital tumours., Summary: This articles summarizes the current opinion regarding the management of orbital tumours. Recent studies reviewing the range of diseases that affect the orbit and technical advances are summarized.

Purpose: An increasing proportion of patients with head and neck cancer have no history of smoking. The purpose of this analysis was to compare the clinical outcomes between patients without a history of smoking (never-smokers) and those with a previous history of smoking (ever-smokers) treated by radiation therapy., Methods and Materials: Seventy patients with newly diagnosed squamous cell carcinoma of the oropharynx or oral cavity without a previous history of smoking were matched to a control ever-smoker with a positive tobacco history (>10 pack-years) based on age, gender, ethnicity, Karnofsky Performance Status, primary tumor site, disease stage, primary treatment, radiation dose, and start date. Outcome was compared using Kaplan-Meier analysis. Normal tissue effects were graded according to the Radiation Therapy Oncology Group/European Organization for the Treatment of Cancer radiation toxicity criteria., Results: With a median follow-up of 33 months, lifelong never-smokers had an increased 3-year overall survival (86% vs. 69%), disease-free survival (82% vs. 65%), and local-regional control (85% vs. 70%) compared with the ever-smoker control population (P < 0.05, for all). These differences remained statistically significant when patients treated by postoperative or definitive radiation therapy were analyzed separately. The incidence of grade 3+ complications was also significantly lower among never-smokers compared with ever-smokers (10% vs. 29%, P = 0.01)., Conclusions: Prognosis differed significantly between never-smokers and ever-smokers with head and neck cancer treated by radiation therapy. Further studies analyzing the biologic and molecular reasons underlying these differences are planned.

Background: Due to concerns of radiation-related toxicity and hindered wound healing, the presence of a fistulous tract from the aerodigestive airway to the skin is commonly considered a contraindication for the initiation of postoperative radiation therapy (RT)., Methods and Materials: Seventeen patients with an orocutaneous (9 patients) or pharyngocutaneous (8 patients) fistula underwent postoperative RT for head and neck cancer to a median dose of 60 Gy (range, 60-70 Gy). The median time period from surgical resection to the first day of RT was 39 days (range, 23-77 days). All patients were irradiated over an open orocutaneous or pharyngocutaneous fistula using intensity-modulated (10 patients) or conventional (7 patients) techniques. The median size of the fistula at the initiation of RT was 2 cm (range, 0.5-5 cm)., Results: All 17 patients completed postoperative RT without any treatment breaks. However, 4 patients developed serious complications within 3 months after completion of treatment (1 osteomyelitis requiring intravenous antibiotics; 1 flap necrosis requiring surgical debridement; 1 oral commissure dihiscence requiring reconstruction; 1 tracheoesophageal fistula) resulting in a 24% rate of grade 3+ acute toxicity. Closure of the fistulous tract eventually occurred either spontaneously (9 patients) or after additional surgical intervention (8 patients). Late complications included 1 case of severe trismus requiring permanent gastrostomy tube and 1 case of osteoradionecrosis., Conclusion: Postoperative RT in the setting of orocutaneous and pharyngocutaneous fistula should be considered after judiciously weighing the potential benefits and risks. Since excessive delays in starting postoperative RT can portend worse oncologic outcomes, however, this treatment approach seems warranted in selected cases.