Head and neck cancer in the elderly: a retrospective study over 10 years (1999 - 2008)

INTRODUCTION: Treatment of elderly patients is in many ways different from that for younger ones. The aim of the present study was to identify the particular characteristics and needs of elderly patients suffering from head and neck cancer. From these patterns, considerations for this special group can be deduced. Patients and Material The subjects for this study consisted of 376 patients suffering from head and neck cancer that were treated between 1999 and 2008, 99 (26.3.%) of whom were older than 70 years and were evaluated retrospectively concerning smoking/alcohol abuse, ASA status, kind of malignant neoplasm, localization and treatment. RESULTS: The male-female ratio was 53:46, and mean age, 79 years (71 - 98). Out of 95 patients with a squamous cell carcinoma, 4 patients had a verrucous form. Out of 99 patients, 26 had a maxillary carcinoma and 12 patients had experienced previous non-head-and-neck cancer. An ASA score of 2 or 3 was found in 86 of the patients. CONCLUSION: The group of patients with head and neck cancer who were older than 70 years was characterized by a higher portion of female patients, a higher number of maxillary carcinomas, and a higher prevalence of previous second cancer. Making decisions in cancer therapy for elderly patients is challenging. Patients suffering from operable head and neck cancer should be treated with curative intent and with regard to quality of life if a careful assessment of comorbidities is performed preoperatively

Screening recurrence and lymph node metastases in head and neck cancer: the role of computer tomography in follow-up

Introduction Follow-up of patients with oral cancer is being questioned with regard to financial costs and effectiveness. Therefore, the aim of the present study was to evaluate whether local recurrence and cervical lymph node metastases were first discovered clinically or by routine computer tomography. Materials and methods The records of all 317 patients that were treated for an oral cancer between 1998 and 2008 were systematically reviewed. Criteria for inclusion were tumor histology with a squamous cell carcinoma of the head and neck, and regular follow-up examinations with a minimum follow-up time of 12 months, including clinical and radiological (CT) controls. All patients had the first CT after 6 months, followed by yearly CT controls. Results Out of 315 patients with an oral squamous cell carcinoma, 294 were evaluated. Those experiencing neither recurrence of the tumor nor lymph node metastases constituted 62%. Local recurrence was seen in 36 (12%), lymph node metastases in 32 (11%), and both in 16 (6%). Of the 32 patients with lymph node metastases, 25 were recognized first clinically, and 7 were detected by routine CT scans; concerning local recurrence, 32 appeared clinically, and 4 were detected by routine CT scans. Conclusion Routine CT for follow-up is still indicated for detecting lymph node metastases as well as local recurrence

Evaluation of the pectoralis major flap for reconstructive head and neck surgery

PURPOSE: The pectoralis major myocutaneous flap (PMMF) is a commonly used flap in reconstructive head and neck surgery, but in literature, the flap is also associated with a high incidence of complications in addition to its large bulk. The purpose of the study is the evaluation of the reliability and indication of this flap in reconstructive head and neck surgery. PATIENTS AND METHODS: The records of all patients treated with a PMMF between 1998 and 2009 were systematically reviewed. Data of recipient localization, main indication, and postoperative complications were analyzed. RESULTS: The male to female ratio was 17:3, with a mean age of 60 years (45-85). Indications in 7 patients were recurrence of a squamous cell carcinoma, in one case an osteoradionecrosis and in 12 cases an untreated squamous cell carcinoma. In 6 male patients (30%), a complication appeared leading to another surgery. CONCLUSION: The PMMF is a flap for huge defects in head and neck reconstructive surgery, in particular when a bulky flap is needed in order to cover the carotid artery or reconstructive surgery, but the complication rate should not be underestimated in particular after radiotherapy

Aggressive fibromatosis of the head and neck: a new classification based on a literature review over 40 years (1968-2008)

BACKGROUND: Fibromatosis is an aggressive fibrous tumor of unknown etiology that is, in some cases, lethal. Until now, there has been no particular classification for the head and neck. Therefore, the aim of the present study was to review the current literature in order to propose a new classification for future studies. METHODS: An evidence-based literature review was conducted from the last 40 years regarding aggressive fibromatosis in the head and neck. Studies that summarized patients' data without including individual data were excluded. RESULTS: Between 1968 and 2008, 179 cases with aggressive fibromatosis of the head and neck were published. The male to female ratio was 91 to 82 with a mean age of 16.87 years, and 57.32% of the described cases that involved the head and neck were found in patients under 11 years. The most common localization was the mandible, followed by the neck. All together, 143 patients were followed up, and in 43 (30.07%), a recurrence was seen. CONCLUSION: No clear prognostic factors for recurrence (age, sex, or localization) were observed. A new classification with regard to hormone receptors and bone involvement could improve the understanding of risk factors and thereby assist in future studies

Healthcare Engineering Defined: A White Paper

Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects

Pretreatment thrombocytosis: a prognostic marker for oral squamous cell carcinoma?

PURPOSE: Thrombocytosis associated with poorer prognoses seems to be a frequent preoperative finding in different kind of cancers. The aim of the present study was to evaluate whether thrombocytosis can be used as a prognostic marker for oral squamous cell carcinoma (SCC). METHODS: Altogether, 288 patients with oral SCC were considered, as well as all platelet counts between 1 and 5 days prior to surgical treatment, recurrence rate, and lymph node metastasis. The minimum follow-up time was 12 months. RESULTS: The mean preoperative thrombocyte score of the patients who received surgery was 259.55 ± 83.8 Tsd/μl; 273 out of 288 patients were in the normal thrombocyte range, and 12 had a thrombocytosis. From 51 patients with recurrence, three were in the thrombocytosis group, and 45 patients with recurrence were in the normal thrombocyte range. CONCLUSION: The present results do not confirm that thrombocytosis can be seen as marker for poor tumor prognosis