CARCINOMA METASTATIC TO CERVICAL LYMPH NODES FROM AN OCCULT PRIMARY TUMOR: THE OUTCOME AFTER COMBINED-MODALITY THERAPY

BACKGROUND: The aim of this retrospective analysis was to analyze the results of treatment of patients with cervical node metastases from carcinoma of occult primary with a policy including neck dissection and postoperative comprehensive radiotherapy. METHODS: Ninety patients were treated with curative intent from 1990 to 2002. RESULTS: The actuarial rate of neck disease control was 68.8% at 5 years (95% confidence interval [CI], 58.9%-78.7%). On multivariate analysis, the rate of neck disease control was significantly related to lymph nodal metastatic level (P = .006). The actuarial rate of developing head and neck primary tumors at 5 years was 8.9% (95% CI, 2.6%-15.2%). The 5-year actuarial rate of distant metastases was 19.1% (95% CI, 9.4%-28.9%). In multivariate analysis, a statistically significant difference in the rate of distant metastasis was obtained when patients were stratified according to the level of nodal involvement (P = .01) and the presence of extracapsular extension (P = .013). At the time of analysis, 50 of the 90 patients were alive. A total of 32 (35.6%) had died from causes related to their primary disease. Actuarial disease-specific survival at 2 and 5 years was 73.6% (95% CI, 64.3%-82.9%) and 62.8% (95% CI, 51.9%-73.7%), respectively. In multivariate analysis, a statistically significant difference in disease-specific survival was obtained when patients were stratified according to the level of nodal involvement and the presence of extracapsular extension. CONCLUSIONS: Our study seems to support the use of combined-modality therapy in patients with neck metastases from carcinoma of occult primary. However, in the absence of randomized trials, comprehensive irradiation cannot be routinely advised

Pattern of lymph node metastases in squamous cell carcinoma of the tonsil: Implication for selective neck dissection

The aim of this study was to prospectively analyze the distribution of neck metastases and the outcome in patients surgically treated for tonsillar carcinoma in order to deduce implications for selective neck dissection. The criteria for inclusion in the study were (1) previously untreated, histologically proven, resectable squamous cell carcinoma of the tonsil, (2) curative surgical intent on the primary tumor and neck, (3) no history of prior head and neck cancer, (4) absence of synchronous second primary in the upper aerodigestive tract, lung and esophagus, (5) absence of distant metastases. Fifty-eight previously untreated consecutive patients with tonsillar squamous cell carcinoma were included in this prospective study. Among 22 patients with clinically negative cervical lymph nodes, 4 patients (18.2%) had metastatic lymph nodes on pathologic examination. Occult node metastases were mainly located in ipsilateral II level. No occult metastases occurred at levels I and V. Among 36 patients with clinically positive cervical lymph nodes, 3 patients (8.3%) had an occult pathologic metastatic involvement of cervical lymph nodes of ipsilateral level V. Level I was free of lymph node metastases. Clinical N category >N2a (p=0.003), nodal metastases to levels III (p=0.026) and IV (p=0.009) were significantly related to level V nodal metastases. The 2 and 5 years actuarial disease-free survival was 82.7% (95% CI 71.2-93.5%) and 58.3% (95% CI 36.7-79.9%), respectively. The actuarial recurrence-free survival was 87.9% (95% CI 78.9-96.8%) and 72.2% (95% CI 53.9-90.5%) at 2 and 5 years, respectively. Our findings support the role of a selective lateral neck dissection in the management of clinically N0 necks and in selected N+ necks (N1 and N2a disease located at level II) in patients with tonsillar carcinoma without oral involvement

Sinonasal spindle-cell myoepithelioma

Myoepithelioma is a rare benign neoplasm of salivary gland derivation. Pure myoepithelioma accounts for less than 1% of all salivary gland tumors. Only three cases of sinonasal myoepithelioma have been reported. Diagnosis of myoepithelioma is not easy by light microscopy alone and immunocytochemistry is indispensable. The treatment of myoepithelioma should be complete surgical excision A rare case of sinonasal spindle-cells myoepithelioma is reported in a 68-year-old woman

Long-term Results with Tracheoesophageal Voice Prosthesis: Primary versus secondary TEP

The aim of this study was to evaluate the influence of timing of tracheoesophageal puncture (TEP)with indwelling voice prosthesis insertion regarding long-term success rate and postoperative complication. We conducted a Retrospective clinical study at tertiary academic center. There were 75 patients with primary TEP (80.6%) and 18 with secondary TEP (19.3%). Long-term success rate was 81.7%, with 80.0% in primary TEP and 88.9% in secondary TEP. No significant difference in Harrison-Robillard-Schultz Rating Scale success assessment were observed between patients with primary and secondary TEP (P = .596). The use of postoperative radiotherapy did not significantly influence the success rate. The age of patients who were older or younger than 60 years significantly influence the success rate in primary TEP (P = .012). The higher rate of complications in primary TEP was not statistically significant. These findings suggest that primary and secondary TEP are equally safe and effective procedures. Primary TEP should be preferred because of avoiding a second surgical intervention and allowing early voice restoration with a considerable psychological impact

The impact of radiotherapy and GERD on in situ lifetime of indwelling voice prostheses

The aim of this study was (1) to analyze the in situ lifetime of indwelling voice prostheses (VPs) and (2) to investigate the role of some variables on device lifetime. We conducted a retrospective clinical study of patients visiting our outpatient clinic for problems related to their VP from August 1998 to March 2006. The mean in situ VP lifetime was 180.9 days (95% CI 162.6-199.2). The mean in situ VP lifetime was 163.3 and 202.9 days in patients irradiated and not irradiated, respectively (P = 0.008). The mean in situ VP lifetime was 126.5 and 215.7 days in patients with and without endoscopic evidence of erosive-ulcerative gastroesophageal reflux disease (GERD), respectively (P < 0.001). Multivariate analysis confirmed that radiotherapy and presence of GERD significantly affected the in situ VP lifetime. This study confirmed the relationship between short VP lifetime and radiation therapy. In addition, a possible association between GERD and limited device lifetime was identified

Conchomeatoplasty: a new technique

Stenosis of the cartilaginous auditory canal is still difficult to resolve and many techniques of plastic surgery have been proposed. Our experience was first built up in treatment of stenosis of the tracheostomy in patients who had undergone laryngectomy. Since it is simple and effective, we have transferred and modified the technique to the treatment of stenosis of the external auditory canal and of the concha. Fourteen patients with stenosis of the cartilaginous auditory canal (diameters of the stenosis prior to surgery varied from 19 to 78.5 mm2) underwent daysurgery conchomeatoplasty under local anaesthesia. Eight months after the operation, the results are good. Following surgery, the surface of the auditory canal, measured at the narrowest point of the external auditory meatus, varied from a minimum of 113 mm2 to a maximum of 254 mm2. The technique we propose to correct the stenosis of the external auditory canal is easy to carry out, short, and may be performed under local anaesthesia. Lastly, the auditory canal and the ear auricle have a good blood supply, thus ensuring the flaps will survive