The study objective is to establish the capabilities of ultrasound (US) examination in evaluation of the advancement of squamous-cell carcinoma of the larynx and hypopharynx compared to histological examination and other diagnostic methods.Materials and methods. US examination was performed in 86 patients with squamous-cell carcinoma of the larynx and hypopharynx. The study included 14 (16.3 %) patients with stage I disease, 29 (33.7 %) patients with stage II, 19 (22.1 %) patients with stage III and 24 (27.9 %) patients with stage IV. Patients with primary tumors of the larynx and hypopharynx comprised 75.6 % of the study population, patients with recurrent tumors – 24.4 %. During diagnosis advancement of tumors to the anatomical structures in the laryngeal space and beyond was evaluated. In all cases histological verification of the diagnosis was performed. Comparison of the data on advancement of laryngeal and hypopharyngeal tumors from different diagnostic methods with the results of histological examination depending on the T-category (TNM) was performed.Results. For small tumors (Т1), frequency of agreement between advancement of laryngeal and hypopharyngeal tumors measured by US examination and histological examination was 66.7 %, by endoscopic laryngoscopy (ELS) – 80.0 %; for T2 tumors, results of US examination and ELS were identical, frequency of agreement with histological examination data was 87.2 % for both methods; for T3 tumors, US examination data agreed with histological examination data in 83.3 % of cases, ELS data – in 75.0 %; for T4 tumors, frequency of agreement between US examination and histological examination data was only 44.4 %, between ELS and histological examination – 66.7 %. Therefore, US examination was more accurate for evaluation of advancement of T2 and T3 tumors. Results of evaluation of advancement of laryngeal and hypopharyngeal tumors by US examination, computed tomography and magnetic resonance tomography were close, comparable and weren’t statistically different. For T1 and T2 tumors frequency of agreement between the results of histological examination and US examination data was higher than between the results of histological examination and computed tomography data.Conclusions. High accuracy and value of US examination in evaluation of advancement of primary and recurrent tumors of the larynx and hypopharynx were shown.
Reconstruction of head and neck defects after surgery for cancer remains challenging. The choice of the reconstruction technique depends on the tumor size and localization, type of the defect, patient’s age, concomitant diseases, and disease prognosis. Surgeons have currently a broad range of material for reconstructive surgery, from free flaps to revascularized flaps. Microsurgical reconstruction has made a revolution in treatment of patients with complex head and neck defects. However, the use of this technique may not be advisable for some patients. The search for new techniques is needed to improve functional and aesthetic results and reduce traumatism without compromising oncologic outcomes. Thirty-six patients underwent surgery with reconstruction using the submental island flap, a new alternative in the reconstruction of various head and neck defects. The graft was taken after making a neck incision for neck lymph node dissection. A few patients develop total and marginal necrosis of the graft. Short- and long-term results showed no worsening of oncologic outcomes in the selected group of patients.
e16038 Background: The commonly used IGCCCG classification probably underestimates other prognostic factors (tumor markers, stage) for advanced seminoma, which was shown later (Fossa S., 1997). Furthermore, in contrast to nonseminoma different cisplatin-based regimens have not been directly compared in this population. We performed an analysis to review the outcome and prognostic factors of patients (pts) with advanced seminoma treated in our center during the last two decades. Methods: From 1983 to 2005, 250 chemotherapy (CT)-naïve pts with advanced seminoma received induction platinum-based CT, which was divided as an “older” (76 pts) and “modern” (174 pts) one. “Older CT” included cyclophosphamide + cisplatin (46 pts), ifosfamide + carboplatin (12 pts), PVB (8 pts) and other regimens (10 pts). “Modern CT” contained BEP (26 pts) and EP (148 pts) regimens. 227 (91%) pts had primary testicular tumor, 241 (96%) pts belonged to IGCCCG good prognostic group. Median follow-up was 57 (range, 3–276) months for the pts who survived. Prognostic factors were analyzed in “modern CT” group. Progression-free survival (PFS) was an end-point for Cox‘ stepwise regression analysis. Results: “Modern CT” significantly improved PFS (5-years, 91% and 74%, p = 0.002) but not OS (5-years, 92% and 89%, p = 0.28), which could be explained by effective salvage CT. Univariate analysis revealed following factors as significant: number of metastatic sites, presence of pulmonary metastases, RPLN size, hCG level, and LDH level. Cox‘ regression analysis showed pre-CT LDH as the only prognostic factor for PFS (HR 7,6, 95% CI 1,6–36.3). Using cut-off 2 x upper limit of normal for LDH level, “modern CT” group can be divided into favorable (105 [60%] pts) and unfavorable (69 (40%) pts) groups with 5-years DFS 98% vs. 78% (HR 11.1, 95% CI 3.2–33.3) and 5-years OS 99% vs. 80% (HR 11.07, 95% CI 3.09–27.92), respectively. Conclusions: Comparing with older cisplatin-based regimens, the new ones (BEP or EP) improved PFS without significant influence on OS in pts with advanced seminoma. Pre-treatment LDH level is an important independent prognostic factor, which could help stratify pts better into risk groups. Further studies with risk-adapted policy in advanced seminoma are warranted. No significant financial relationships to disclose.
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