BackgroundTreatment compliance of elderly patients to intensive multi-modality cancer therapy can be challenging and has not been adequately addressed in developing countries. The present study evaluated compliance of elderly head and neck carcinomas patients to cancer-directed therapy.MethodsForty-seven elderly HNSCC patients were evaluated in the present study. Patients were assessed as per stage and site of disease, general condition, performance status, and any pre-existing co-morbidities. Compliance was defined as patients who were able to complete cancer therapy as intended at primary clinic. Non-compliance to therapy was stratified as early, mid- and late-course non-compliance. Statistical analysis was done using STATA 9.1 software, chi-square/Fischer’s exact test to see strength of association between two categorical variables that could possibly affect compliance in elderly patients.ResultsSixty-eight per cent of elderly patients were subjected to radical treatment, majority (42/47) presented in loco-regionally advanced stage (III–IV), most common site of malignancy was oropharynx (21/47). Sixty-two per cent of elderly HNSCC patients were compliance to cancer therapy. Median overall treatment time for patients subjected to radical radiation therapy was 52 (range 47–99) days, and for radical surgery and adjuvant radiotherapy was 109 (95–190) days. Compliance to therapy for elderly HNSCC patients was not significantly associated with advanced stage, poor general condition, intent of treatment or presence of co-morbidity. As regards to non-compliance, majority (14/18) of elderly patients showed mid-course treatment non-compliance.ConclusionsNearly two-thirds of elderly head and neck carcinoma patients were compliant to cancer-directed therapy.
Issues of complete disease clearance and hearing preservation in cholesteatoma induced labyrinthine fistula cases has been discussed and updated in this article. Successful disease clearance and hearing preservation in a case of cholesteatoma induced isolated cochlear promontory fistula encouraged us to retrospectively analyse 13 more cases of cholesteatoma induced labyrinthine fistula who presented in emergency service as complicated chronic suppurtive otitis media. Pre-operatively nine patients experienced vertigo, two had profound sensori neural hearing loss and radiology was suggestive of labyrinthine fistula in 12 patients. Lateral semicircular canal was involved in 13 cases. In all cases cholesteatoma matrix was completely removed from the fistula site irrespective of the fistula size and hearing status. Hearing was preserved in 11 out of 12 patients. Gentle and meticulous removal of the matrix and careful repair of labyrinthine fistula delivers significant hearing preservation rate along with a safe and dry ear which avoids a second look surgery.
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