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Background: After oral tumor resection, structural and functional rehabilitation by means of dental prostheses is complex, and positive treatment outcome is not always predictable., Purpose: The objective of the study was to report on oral rehabilitation and quality of life 2-5 years after resection of malignant oral tumors., Materials and Methods: Data of 46 patients (57 ± 7 years) who underwent oral tumor surgery were available. More than 50% of tumors were classified T3 or T4. Open oro-nasal defects resulted in 12 patients and full mandibulary block resections in 23 patients. Comprehensive planning, implant placement, and prosthetic rehabilitation followed an interdisciplinary protocol. Analysis comprised tumor location, type of prostheses, implant survival, and quality of life., Results: Because of advanced tumor status, resections resulted in marked alteration of the oral anatomy requiring complex treatment procedures. Prosthetic rehabilitation comprised fixed and removable prostheses, with 104 implants placed in 28 patients (60%). Early implant loss was high (13%) and cumulative survival rate of loaded implants was <90% after 5 years. Prosthetic plans had to be modified because of side effects of tumor therapy, complications with implants and tumor recurrence. The majority of patients rated quality of life favorable, but some experienced impaired swallowing, dry mouth, limited mouth opening, appearance, and soreness., Conclusions: Some local effects of tumor therapy could not be significantly improved by prosthetic rehabilitation leading to functional and emotional disability. Many patients had passed away or felt too ill to fill the questionnaires. This case series confirms the complex anatomic alterations after tumor resection and the need for individual treatment approaches especially regarding prosthesis design. In spite of disease-related local and general restrictions, most patients gave a positive assessment of quality of life., (© 2011 Wiley Periodicals, Inc.)

The present study reports on the surgical and prosthodontic rehabilitation of 46 patients, 31 male and 15 female, after resection of oral tumors. The treatment was carried out from 2004 to 2007 at the Department of Prosthodontics, University of Bern, with a follow-up time of 3 to 6 years. The average age at diagnosis was 54 years. 76% of all tumors were squamous cell carcinoma, followed by adenocarcinoma. Resection of the tumors including soft and/or hard tissues was performed in all patients. 80% of them additionally underwent radiotherapy and 40% chemotherapy. A full block resection of the mandible was perfomed in 23 patients, and in 10 patients, the tumor resection resulted in an oronasal communication. 29 patients underwent grafting procedures, mostly consisting of a free fibula flap transplant. To enhance the prosthetic treatment outcome and improve the prosthesis stability, a total of 114 implants were placed. However, 14 implants were not loaded because they failed during the healing period or the patient could not complete the final treatment with the prostheses. The survival rate of the implants reached 84.2% after 4 to 5 years. Many patients were only partially dentate before the tumors were detected, and further teeth had to be extracted in the course of the tumor therapy. Altogether, 31 jaws became or remained edentulous. Implants provide stability and may facilitate the adaptation to the denture, but their survival rate was compromised. Mostly, patients were fitted with removable prostheses with obturators in the maxilla and implant-supported complete dentures with bars in the mandible. Although sequelae of tumor resection are similar in many patients, the individual intermaxillary relations, facial morphology and functional capacity vary significantly. Thus, individual management is required for prosthetic rehabilitation.

We investigated the cell-death mechanisms induced in esophageal cancer cells in response to the chemotherapeutic drugs, 5-fluorouracil (5-FU) and cisplatin. Chemosensitive cell lines exhibited apoptosis whereas chemoresistant populations exhibited autophagy and a morphology resembling type II programmed cell death (PCD). Cell populations that respond with autophagy are more resistant and will recover following withdrawal of the chemotherapeutic agents. Specific inhibition of early autophagy induction with siRNA targeted to Beclin 1 and ATG7 significantly enhanced the effect of 5-FU and reduced the recovery of drug-treated cells. Pharmacological inhibitors of autophagy were evaluated for their ability to improve chemotherapeutic effect. The PtdIns 3-kinase inhibitor 3-methyladenine did not enhance the cytotoxicity of 5-FU. Disruption of lysosomal activity with bafilomycin A 1 or chloroquine caused extensive vesicular accumulation but did not improve chemotherapeutic effect. These observations suggest that an autophagic response to chemotherapy is a survival mechanism that promotes chemoresistance and recovery and that selective inhibition of autophagy regulators has the potential to improve chemotherapeutic regimes. Currently available indirect inhibitors of autophagy are, however, ineffective at modulating chemosensitivity in these esophageal cancer cell lines.

Results are submitted of study into effects of microwave resonance therapy (MRT) on parameters characterizing cell immunity in those lung cancer patients having undergone a radical operation. This study comprised 58 patients as the main group, with 31 patients being controls. Indices for cell immunity were also studied in 20 donors. There was a rise in T-lymphocytes after MRT in the postoperative period. MRT contributed to prolongation of patients' lives, reduction of the incidence of chemotherapy-related dyspeptic complications and that of leukopenia cases by 8 and 9 percent respectively.

Hormonal replacement therapy in women following primary treatment for squamous cell carcinoma of the cervix uteri is harmless. In case of adenocarcinoma of the cervix, guidelines for hormonal replacement therapy according to those valid for endometrial cancer are recommended. In women treated for ovarian cancer, a combined cyclic or continuous estrogen/gestagen substitution - the latter also in hysterectomized women - is to be favored. Signs of androgen deficiency are to be respected. Short-term clinical, sonographical, and biochemical control investigations are recommended.

The central issue in elderly surgery remains the operative risk, which is usually a direct factor of age, ASA classification, and other pathologies, especially cardiovascular diseases. It is the surgeon's role to define properly the risks involved with a patient and to anticipate the involved operative mortality. Based on this, we performed CO2 laser fulguration of anal canal tumors in 10 patients suffering from either squamous cell or adenocarcinoma localized up to 4 cm from the anus. The rationale was to avoid prohibitive operative and anesthetic risk, achieve local control of disease and improve quality of life by avoiding surgical convalescence and an otherwise certain colostomy. All patients underwent fulguration (25-30 W) every 3-4 months. Complications included minor pain and bleeding. Three patients required operation (Hartman's pouch) within 2 1/2 years due to continuous tumor bleeding and stricture of the anal canal. The remaining 7 patients were treated regularly and satisfactorily by fulguration and the mean survival in this group was 8 years (in all cases the causes of death were unrelated to the procedure or the tumor). We conclude that CO2 laser fulguration of anal canal tumors in elderly, high-risk patients represents an invaluable option of treatment, while avoiding major operative risk, controlling the local spread of disease, maintaining physiological bowel function, and avoiding colostomy. Most importantly, the main dividends of the study are patient satisfaction and maintenance of good quality of life.

Over the past 15 years, reconstruction following excision of malignant oral tumors was performed on 27 patients with segmental resection and five patients with hemiresection of the mandible. Following segmental resection, the mandible was reconstructed using an autogenous bone graft in eight patients in whom the surrounding soft tissues were fairly well preserved. Bony union was achieved in six of them. In the remaining two, the graft was removed because of postoperative infection, and one patient underwent secondary bone grafting. A pedicled myocutaneous flap and bone graft was used in seven patients who underwent extensive resection of the surrounding soft tissue. Bony union was achieved in three patients, and one developed pseudoarthrosis. The graft was removed in the remaining three because of postoperative infection. Reconstruction with only a metallic plate for stabilization of the mandible was carried out in six aged or sarcoma-affected patients. In two of them, the postoperative course was uneventful for 4 to 7 years. In the remaining four patients, plate removal was required because of exposure or tumor recurrence. In 5 of 11 patients in whom reconstruction was carried out with a combination of a pedicled myocutaneous flap and metallic plate, the postoperative course was uneventful for 2 to 8 years. Two of these five patients underwent secondary bone grafting. In four of the remaining six patients, the plate was removed because of exposure or improper adaptation to the stump. Two others died of disseminated intravascular coagulation syndrome within 1 month. A prosthesis was used more frequently by patients when reconstruction was performed using a pedicled osteomyocutaneous flap. The metallic reconstruction plate was helpful for restoring mandibular contour.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors present their own experience in the management, methods of treatment and follow-up results of 128 patients with malignant tumours of the maxilla. There were 77 males and 53 females (sex ratio 1.5: 1). Patients ages ranged from 3 to 83 years with an average of 53 years. Epithelial tumours were diagnosed in 69.5% and nonepithelial in 30.5%. In most cases the maxillary sinus was the primary focus of the tumour (40.3%). 94.4% of patients had epithelial tumours in stages III and IV (UICC classification, 1973). Radical treatment was carried out in 94 patients in 4 radiotherapy only (lymphatic tumours), in 90 patients surgery with adjuvant radio- and/or chemotherapy mainly in the postoperative stage. During the follow-up local recurrence was diagnosed in 36.5% of radically treated patients, who subsequently underwent reoperation. A five-year survival rate was obtained in 45.1% of patients with epithelial tumours and in 14.3% of patients with nonepithelial tumours. The authors carried out their own method of prosthetic rehabilitation, mainly immediate, in 82 patients operated on. Immediate prosthetic rehabilitation is a final step in the surgical procedure. This method significantly diminishes functional disturbances, mainly in speech and mastication and remarkably improves the aesthetic result.