Atypical Metastasis to the Head and Neck Region: An Analysis of 11 Patients

Objective:We present 11 patients with distant metastases to the head and neck from an infraclavicularly located primary tumor and discuss the management strategies including the clinical presentation, treatment modalities, and prognosis.Methods:The retrospective data of the pathology reports and operation notes of 1239 patients who had undergone any kind of oncological surgical intervention between 2005 and 2017 were analyzed. All of the 11 patients included in the study were evaluated in our department’s tumor board, and all patients with an operable lesion had undergone surgery. Inoperable patients were treated with chemotherapy and/or radiotherapy.Results:The average age of the patients was 64.3 (48– 88) years. Primary tumors were located in the lung (2), breast (2), ovary (2), prostate (2), kidney (1), and colon (1) and the primary lesion could not be determined in one patient. The most common symptom was newly occurred painless swelling (9/11, 81.8%) at the metastatic site. Four patients without any other distant metastases were operated. Of these four patients, two died during follow-up due to systemic disease, and the other two are alive and disease-free. Three of the seven inoperable patients were treated with chemotherapy and the other four with radiotherapy. The prognosis of this group was worse.Conclusion:Although metastasis to the head and neck is not common, it is vital to keep in mind while approaching a patient with a lesion at the head and neck region especially if there is a history of lung, breast, and genitourinary cancers. Despite the poor prognosis, diminishing the tumor burden would increase the treatment success

Surgical treatment of hypopharyngeal cancer

Objectives: This study aims to evaluate our department’s approach to the treatment of hypopharyngeal tumors, the features of the tumors, the survival analyses and to present our results in the light of the literature. Patients and Methods: Eighty-one hypopharyngeal tumor patients and four patients with undefined primary origin, those patients with undefined origin have tumors that infiltrate both hypopharynx and cervical esophagus, totally 85 patients (56 males, 29 females; mean age 54.6±13.4 years; range, 23 to 81 years) who underwent surgical treatment, were included in this study. Demographic data, tumor characteristics, and treatment protocols were recorded retrospectively. Results: Patients were classified on the primary subsite of the hypopharynx: 51% originated from the sinus piriformis, 29% from the postcricoid area, 15% from the posterior wall of the pharynx and only 5% from the cervical esophagus. The relationship between sex and hypopharyngeal subsite was statistically significant (p<0.001); postcricoid tumors were more prominent in female patients. Also, patients with a history of tobacco use had a tendency for tumors originating from the piriform sinus (p<0.001). Additionally, highly significant differences were revealed between clinical and pathological T and N staging (p<0.001). Estimated 60-month survival rate was 45%. Conclusion: The majority of patients in the study group were not old-aged or alcohol consumers; particularly none of the female patients had any bad habit as a predisposing factor suggested in the etiology. The relationships between tumor site and smoking show that if the campaign against smoking is successful, the rate of sinus piriformis cancer will decrease. For a significant number of patients, primary surgical reconstruction was possible, which shortens postoperative recovery time and accelerates postoperative adjuvant therapy. Therefore, survival rates were found to be high

A rare late complication of radiation therapy: Bilaterally recurrent laryngeal nerve paralysis

Radyoterapiye bağlı periferik nöropati, radyoterapinin geç komplikasyonları içinde en az bilineni ve belki de en korkutucu olanıdır. Hastalık remisyonundan yıllar sonra ortaya çıkması ve çoğu zaman klinik tablonun geri dönüşsüz olması, kanser ile mücadelede başarılı olmuş hastalarda morbiditeyi önemli düzeyde artırmakta ve yaşam kalitesini olumsuz etkilemek- tedir. Bu yazıda, T1b evreli glottik larenks kanseri nedeniyle primer radyoterapi gördükten sekiz yıl sonra iki taraflı reküren larengeal sinir paralizisi gelişen ve transvers lazer kordotomi ile tedavi edilen 39 yaşında bir erkek hasta sunuldu.Peripheral neuropathy is a late complication of radiation therapy, which is least and probably threatening. As it occurs many years after the remission is achieved with a usually irreversible clinical presentation, it significantly increases morbidity in cancer survivors and has an adverse effect on the quality of life. In this article, we report a 39-year-old male patient of bilateral recurrent laryngeal nerve paralysis which developed eight years after the treatment of stage T1b glottic laryngeal carcinoma with primary radiation therapy and was treated by transverse laser cordotomy