Search

Clin. Otolaryngol. 2010, , 402-408 To investigate the prognostic significance of positive margin and disease course in partial laryngectomy for advanced laryngeal carcinoma and radiation failure. Retrospective case control study. A major tertiary referral centre. Patients who underwent partial laryngectomy for advanced laryngeal carcinoma or for radiation failure with at least 2 years of follow-up Margin status versus primary treatment and salvage treatment versus disease-free survival and overall survival. Twenty nine patients with sufficient follow-up data were found. Twelve patients had histological positive margin. Five of the 12 patients with a histological positive margin failed surgery as did four patients with clear margins. A positive margin had no effect on disease-free survival ( P = 0.287) but was associated with poorer overall survival ( P = 0.051). Of 11 patients treated primarily with surgery, recurrence was documented in one of eight with a positive margin and none of three with clear margins. Of 18 patients who underwent surgery secondary to radiation failure, recurrence was documented in all four with a positive margin and 4 of 14 with negative margins. Extended frontolateral resection, performed only in radiation failures, was associated with worse disease-free survival. Non-irradiated patients with involvement of a single margin after partial laryngectomy may be spared total laryngectomy if adjuvant radiation is administered. Patients who fail radiation should undergo radical partial laryngectomy, with conversion to total laryngectomy in those with a positive margin. [ABSTRACT FROM AUTHOR]

Clin. Otolaryngol. 2010, 35, 307–312 Objective: To assess the possible effect of young age on clinical behaviour and survival outcome of squamous cell carcinoma of the oral tongue. Design: Retrospective, case control study. Setting: A major tertiary referral centre. Participants: Eighty-five patients with oral tongue squamous cell carcinoma with at least 2 years of follow-up. Main outcome measurements: Clinical and histopathological staging, disease-free survival, disease-specific survival and overall survival. Results: Eleven patients (13%) were younger than 30 years. Compared to the older patients, they had a significantly worse N stage ( P = 0.041), more perineural invasion ( P = 0.012), and higher rates, though not significant, of treatment failure (46%, including 60% with distant metastases, versus 35%, nearly all locoregional) and mortality (100% of treatment failures versus 73%). There were no significant between-group differences in 5-year disease-free, disease-specific, and overall survival. Conclusion: In this study, patients younger than 30 years of age presented with advanced tumour stages and with a different failure pattern compared to the older age group. This may be attributable to age-related biologic behaviour or delayed cancer diagnosis. Differences in disease free survival and overall survival could not be established. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Despite advances in radiotherapy and chemotherapy treatments for head and neck cancers, the local failure rate is high. In most radiotherapy-resistant cases, surgery is performed; however, some cases are considered unresectable. No standard treatment for these situations has been established. In this study, we review our experience with brachytherapy (BT), which has a different biological mechanism than standard radiotherapy., Methods: All patients received prior radiation to the recurrence area. Median high-dose radiation BT dose was 50 Gy, administered in 5 to 10 Gy fractions twice daily for 5 days. High-dose radiation was given via four to 10 catheters inserted under local anesthesia (3 patients) or general anesthesia with preventive tracheostomy (10 patients)., Results: Thirteen patients received BT from 2010 to 2014. Male:female ratio was 1.6:1, and median age was 66 years (range 23-89). Of those 13 patients, 10 patients were diagnosed with squamous cell carcinoma (SCC) of the oral cavity, two patients with SCC of the nasal mucosa, and one patient with eccrine duct carcinoma. Prior radiation dose ranged from 60 to 70 Gy. Local control was achieved in 11 of 13 patients; only 15.3% (2 of 13) had in-field recurrence. Five patients developed local out-of-field recurrence, and two developed distant metastases. Five patients are alive with no evidence of disease. No major toxicities were encountered. Two patients had severe mucositis and recovered within several weeks., Conclusion: Brachytherapy for radiotherapy-resistant head and neck cancers is feasible with minor adverse events, which enables good local control. However, many advanced head and neck cancers develop regional or distant metastases; therefore, additional treatment should be suggested., Level of Evidence: 4. Laryngoscope, 126:2246-2251, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: A third window in the vestibular apparatus has been investigated in both animals and humans, specifically in superior semicircular canal dehiscence. There are as yet no animal model studies of the effect of a third vestibular window of the posterior semicircular canal., Study Design: Original basic research study., Methods: A fenestration was drilled in the bony labyrinth over the posterior semicircular canal, preserving the membranous labyrinth, in seven healthy, 6-month-old, fat sand rats (total 10 ears). Auditory brain stem responses to low- and high-frequency acoustic stimuli delivered by air conduction and bone conduction were recorded before and after fenestration., Results: On the preoperative auditory brainstem recordings, air-conduction thresholds to clicks and tone bursts averaged, respectively, 6.5 dB and 7.5 dB, and bone-conduction thresholds, 8 dB and 4.5 dB. Postoperatively, air-conduction thresholds averaged 14.5 dB, and bone-conduction thresholds 10.5 dB and 5 dB. The change in air-conduction thresholds was statistically significant (P < .01), whereas the bone conduction thresholds remained unchanged., Conclusions: A vestibular third window in the posterior semicircular canal decreases the sensitivity to air-conducted sound stimuli, raising the air-conduction threshold. There is no change in the bone-conduction threshold. These findings agree with the theoretical model and clinical findings.

Objectives/hypothesis: The posterior commissure is an uncommon site of glottic carcinoma. The aim of the study was to compare the clinical and prognostic characteristics of glottic carcinoma of the posterior commissure and the vocal cords., Study Design: Retrospective case control study., Methods: The study group consisted of 40 patients aged 32 to 84 years (mean, 62.7 +/- 10.7) diagnosed with T1 glottic carcinoma involving the posterior commissure from 1960 to 2008. Data on clinical features and outcome were collected from the medical files and compared with the data for 42 patients aged 30 to 87 years (mean, 64.4 +/- 11.8) with T1 vocal cord carcinoma., Results: : There were no significant differences in clinical characteristics between the groups except for the higher rate of smokers among the patients with vocal cord carcinoma (95% vs. 65%, P = .01). All patients were treated primarily with radiotherapy. Disease-free survival in the posterior commissure carcinoma group was 76.1% after 5 years and 72.3% after 10 years, and in the vocal cord carcinoma group, 95% after 5 and 10 years (P = .012). The risk of recurrence was higher when the tumor involved the posterior commissure (hazard ratio, 8.78; 95% CI, 1.12-68.5, P = .038)., Conclusions: T1 glottic carcinoma involving the posterior commissure has a more aggressive biological behavior and a worse prognosis than T1 glottic carcinoma of the vocal cords. Smoking, which is an important pathogenetic factor in vocal cord carcinoma, plays a lesser role in posterior commissure carcinoma. Laryngoscope, 2009.

Objectives/hypothesis: Hereditary hemorrhagic telangiectasia (HHT) is associated with recurrent epistaxis in 90% of cases. Good response to hormone treatment has been documented, although its use remains controversial. The aim of this study was to examine the efficacy of an antiestrogenic agent, Tamoxifen, in the treatment of HHT-associated epistaxis., Methods: Twenty-five patients (11 men, 14 women; mean age 51 years) with a diagnosis of epistaxis due to HHT were randomly assigned to receive treatment with oral tamoxifen 20 mg/d or placebo for 6 months. Follow-up consisted of physical examination and once-monthly blood tests., Results: The groups were similar in age and sex distribution. Of the 21 participants who completed the trial, alleviation of the epistaxis was noted in 9 of 10 tamoxifen-treated patients and 3 of 11 placebo-treated patients (including 2 with only temporary improvement). The difference between the groups at the trial end point was significant for both frequency (P = .01) and severity (P = .049) of the disease. Hemoglobin concentration rose in 4 tamoxifen-treated patients and decreased in 5 controls., Conclusions: Tamoxifen appears to be an effective agent for the treatment of epistaxis due to HHT.

Sinonasal-inverted papilloma is a benign tumour with a high rate of recurrence, but possible malignant transformation. Therefore, investigation of predisposition to malignant transformation of sinonasal-inverted papilloma gives clinicians the opportunity for adequate treatment. Topoisomerase II-alpha (topoII-alpha) and Ki67 are markers of cell proliferation in both normal and neoplastic tissues and its level o expression could be used as a predictive parameter. Our goal was to investigate by immunochemistry the expression level of topoII-in inverted papilloma, inflammatory nasal polyp and normal sinonasal epithelium and to compare it with expression level of Ki67. TopoI alpha nuclear immunostaining showed a differential positivity in the investigated cases. The topoII-alpha index was 30.6 +/- 12.8 in inverte papilloma, 10.7 +/- 6.6 in the adjacent epithelium of inverted papilloma, but only 2.3 +/- 2.0 in the normal sinonasal epithelium. The differences in topoII-alpha expression between inverted papilloma and normal sinonasal epithelia were statistically significant. In inflammatory nasal polyp group, topoII-alpha index was 2.4 +/- 2.1, and the difference in the topoII-alpha index between inverted papilloma and inflammatory polyp group was also statistically significant. Nuclear immunostaining for Ki67 followed a similar variation. The Ki67 index was 50.0 +/- 20. in inverted papilloma, 9.0 +/- 6.6 in the adjacent epithelium of inverted papilloma and 2.4 +/- 0.9 in normal sinonasal epithelium. The differences in Ki67 expression between inverted papilloma and either adjacent or normal sinonasal epithelia were statistically significant. Significant correlation coefficients were found between topoII-alpha and epithelial thickness (r = 0.70, P > 0.0001), and between Ki67 index and epithelial thickness (r = 0.71, P> 0.0001). In the inflammatory nasal polyp group Ki67 index was 5.9 +/- 3.4. The difference in th Ki67 index between inverted papilloma and inflammatory nasal polyp groups was statistically significant. Significant correlation coefficient was found between topoII-alpha index and Ki67 index in inverted papilloma (r = 0.42, P > 0.05). These results suggest that the inverte papilloma contains a significantly higher cell population with proliferative activity by comparison with normal sinonasal and inflammatory polyp epithelia, showing a significant correlation between topoII-alpha and Ki67 expression, and indicating that topoII-alpha could be a independent prognostic factor for a putative malignant transformation.

Fifty of the 810 patients who underwent stapedotomy for otosclerosis from 1969 through 1988 were randomly chosen for follow-up of at least 5 years. Most of the patients (65%) had follow-up of 10 years after stapedotomy, but another 50 patients who underwent stapedectomy had follow-ups of longer than 10 years. In 50 patients, stapedectomy under local anesthesia was performed by removal of the footplate of the stapes, using an endaural incision, and covering the oval window with Gelfoam. In the other 50 patients, stapedotomy was performed under general anesthesia, using an endopreauricular incision, making a small hole in the footplate, and covering the hole only with blood from the surgical area. Although both groups showed improvement in hearing after the operation, the air-bone gap in the stapedotomy group was significantly better than that in the stapedectomy group. The use of the endopreauricular incision under general anesthesia was preferable to endaural incision under local anesthesia because the operative field was wider, more convenient for the surgeon, and conducive to patient safety. There were no significant complications in either group.