The impact of the time factor on the outcome of a combined treatment of patients with laryngeal cancer

PurposeTo investigate the impact of the time factor on the locoregional control in combined treatment (surgery and postoperative radiotherapy) in patients with advanced laryngeal cancer.Materials and MethodsBetween January 1993 and December 1996, 254 patients with pT3 or pT4 and pN0-pN2 laryngeal cancer were treated by surgery and postoperative radiotherapy (RT). The median age of patients was 56.3 years (range: 30–70 years). The analyzed group consisted of 236 males (92%) and 18 females (8%). In all cases total laryngectomy was performed. 196 out of 254 patients underwent homolateral neck dissection and 58 out of 254 bilateral neck dissection. RT began 45 days postoperatively (range: 22 to 78 days) and continued for 47 days (range: 40–74 days). The primary tumour bed was irradiated to the median total dose of 61.2 Gy (range: 57 – 64 Gy) and all regional lymph nodes were treated in all patients to a dose of 50 Gy. Postoperative RT was indicated in case of close postoperative margins at the tumour site or pathological status of lymph nodes described as pN1 or pN2. Univariate and multivariate analyses were used to determine the predictors for locoregional failure. The following factors were studied for their prognostic importance of locoregional outcome: the overall treatment time (OTT), radiotherapy treatment time (RTT), the interval between surgery and the beginning of radiotherapy, age, sex, pT and pN categories.Results: The actuarial 5-year overall survival rate was 49%, the actuarial loco regional control rate was 70%. The univariate analysis, using a log-rank test indicated that prolongation of the overall treatment time (OTT), the time of radiotherapy (RTT), the interval time between surgery and radiotherapy, and the pN status were predicted for the loco regional control of postoperative radiotherapy. The multivariate analysis using Cox proportional hazard model indicated that only RTT, OTT, and the pathological status of lymph nodes were independent prognostic factors for the loco regional control.Conclusions: The analysis showed that the prolongation of the overall treatment time of the combined modality (OTT) and the time of radiotherapy course (RTT) were independent prognostic time factors correlated with lower loco regional control

Adjuvant radiotherapy in laryngeal cancer over the last few decades: the evolution of treatment policy in the great poland cancer centre

Aimto evaluate changes in the treatment trends of the larynx cancer over the last few decades concerning the time factor in postoperative radiotherapy (OTT) after total laryngectomy and defining the target in adjuvant radiotherapy after partial laryngectomy with the reconstruction of the larynx.Material and methodsThe first part of the analysis was based on the comparison of OTT in two groups of patients (group A and B) irradiated postoperatively after total laryngectomy. Group A consisted of 311 patients who were treated between 1986 and 1990. The postoperative radiotherapy (RT) was given 5 times a week at the daily dose of 2 Gy per fraction to the mean total dose of 61.2 Gy (range: 57–66 Gy), the mean time of the RT course was 47 days (range: 40–74 days). Group B encompassed 270 patients treated with a similar technique in the years 2000–2002 with the same fraction and total dose.The second part of the analysis concerning the change of strategy in relation to the indication for adjuvant radiotherapy after partial laryngectomy (supracricoid laryngectomy with cricohyoidopexy, cricohyoidoepiglottopexy, horizontal laryngectomy, and fronto-lateral laryngectomy) during the last decade. The analysis was based on the review of patients who were treated between 1996 and 2002 at our department. One of the main aims of radiotherapy technique was to avoid the irradiation of a newly reconstructed larynx. All patients were irradiated postoperatively in a conventional way to the elective dose of 50 Gy to the neck with a boost dose from 10 to 16 Gy to the bed of the removed lymph nodes. Acute and late morbidities were evaluated according to the RTOG/EORTC morbidity scoring system.Results and conclusionIn group A gaps were observed in 52% of all the treated patients and their mean time was 8.2 days (range: 1–16 days). In group B gaps occurred in 26% of all treated patients with the mean gaps duration of 4.2 days (range: 1–15 days). The first part of the analysis revealed a significant time reduction in gap duration (4.2 days) and their frequency (26%) in the last decade (p=0.002).The second part of the analysis showed that the protection of the newly reconstructed larynx led to the avoidance of significant side effects. Combined treatment, which consisted of partial laryngectomy and adjuvant RT of the neck with the protection of larynx, plays an important role in the decrease of treatment morbidity and makes it possible to preserve laryngeal function

Doświadczenia w leczeniu rozległych zwężeń krtaniowo-tchawiczych z zastosowaniem metody poprzecznej resekcji tchawicy

The aim of this study is to evaluate the results obtained in Department of Otolaryngology et Oncology with transversal resection of trachea acc. to Pearson technique for postintubation stenosis. Methods. from January 2000 to January 2008 ten patients with subglottic postintubation stenosis underwent surgical treatment, using Pearsons method of operation with preservation of recurrent nerves and no postopereative tracheostomy. Mean stenosis length was 2 cm, the length of of airway resection was 1,5–4 cm. Results. There was no surgical or postoperative complications, all the patients get totally health, no restenosis was observed. The results confirm that the Pearsons method of operation is an adequate treatment for subglottic stenosis

Bliznowaty zanik odcinka szyjnego tchawicy w następstwie przedłużonej intubacji

Tracheal intubation is presently one of the basic medical procedures. It is connected with many different complications. One of them is tracheal stenosis, which occurs in 6–21 percent of patients after intubation of the trachea. In contrast to this high frequency of tracheal stenosis we didn’t find any publications about complete atrophy of a big part of trachea after prolongated intubation and we describe a first case of such complication. The reasons and the possibilities of treatment in such situation are discussed

Development of intracranial sinusogenic complications in the period of increased incidence of influenza infections – analysis of 6 patients hospitalized in the Department of Otolaryngology, Head and Neck Surgery of Poznan University of Medical Sciences in the year 2013

W okresie od stycznia 2000 r. do końca grudnia 2013 r. w Klinice Otolaryngologii i Onkologii Laryngologicznej Uniwersytetu Medycznego w Poznaniu leczono 21 chorych z zatokopochodnymi powikłaniami wewnątrzczaszkowymi. Podkreślenia wymaga fakt, że aż 6 pacjentów z tej grupy hospitalizowano w 2013 r. We wcześniejszych analizowanych latach było od 1 do 2 pacjentów rocznie. Skłoniło to autorów do szczegółowego przedstawienia każdego chorego leczonego w 2013 r.In the period from January 2000 to the end of December 2013 in the Department of Otolaryngology, Head and Neck Surgery of Poznan University of Medical Sciences 21 patients with sinusogenic intracranial complications were treated. It should be emphasized that 6 patients in this group were hospitalized in 2013. In the previous analyzed years there were from 1 to 2 patients per year. This prompted the authors to a detailed presentation of all patients treated in 2013

Case reportAntiplatelet therapy can unmask an inherited bleeding disorder. Aspirin-like defect of platelets does not protect against atherosclerosis

Some inherited platelet disorders may be revealed late, as in the presented case of a 68-year-old-man. Recurrent epistaxis following peri-interventional antiplatelet therapy (after three elective percutaneous coronary interventions) and an episode of upper gastrointestinal haemorrhage required aspirin withdrawal and less frequent clopidogrel use. Platelet studies showed an aspirin-like defect resulting in a lack of arachidonate-induced platelet aggregation. During dose-reduced (2-3 times a week) clopidogrel administration ADP-induced platelet aggregation was effectively inhibited and neither important bleeding nor stent thrombosis occurred. The inherited defect of cyclooxygenase-1, responsible for platelet thromboxane synthesis, did not protect the patient against coronary and extra-cardiac atherosclerosi