Background:Patients with head and neck or esophageal cancer who undergo resection and reconstructive surgery sometimes develop fistulae that exhibit delayed wound healing. We developed a novel negative pressure wound therapy (NPWT) that employs a Penrose drain. This case series report describes its effect on the wound healing and treatment duration of cancer patients with postoperative fistulae.Methods:This consecutive case series consisted of all patients from February 2014 to February 2017 who underwent resection and reconstruction for head and neck or esophageal cancer and who then developed a fistula that was treated with either NPWT or a second flap that did not resolve the fistula or led to fistula recurrence and was then treated with NPWT. A Penrose drainage tube was inserted into the fistula, and a NPWT device was applied.Results:Eleven patients (10 males, 1 female; mean age, 67.4 years) underwent NPWT for fistulae that arose after tumor resection and reconstruction (n = 6) or after fistula reconstruction (n = 5). The resection was for esophageal (n = 4), laryngeal (n = 3), oral (n = 2), and hypopharyngeal (n = 2) cancer. In 9 cases, 1 week of NPWT led to rapid and complete wound healing. In 2 cases, complete healing occurred after 3–4 weeks of NPWT.Conclusions:Our NPWT applies continuous negative pressure inside the fistula only and dramatically promoted fistula healing. This approach may work by cleaning the fistula and promoting mucosal surface adhesion. It is particularly effective when the tissue surrounding the fistula is soft due to fresh tissue transfer.
Background
Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de‐escalating treatment modality has not been established to date.
Methods
The authors conducted a retrospective, nationwide, observational study in patients with HPV‐related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality.
Results
A total of 688 patients who were newly diagnosed with HPV‐related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow‐up data available were included in the current study. In patients with T1‐T2N0 disease (79 patients), both the 3‐year recurrence‐free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3‐year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV‐related OPSCC, the 5‐year recurrence‐free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high‐dose cisplatin (≥160 mg/m2; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low‐dose cisplatin (<160 mg/m2; 17 patients).
Conclusions
Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1‐T2N0 HPV‐related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV‐related OPSCC other than those with T1‐T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2.
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