In the last few decades, the surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) has undergone enormous changes. Until the 1990s, open surgery was the primary treatment for OPSCC. However, due to the potentially severe functional morbidity of this approach, open surgery was largely displaced by concurrent chemoradiotherapy (CRT) in the 1990s. At the same time, new, less-invasive surgical approaches such as transoral surgery with monopolar cautery began to emerge, with the potential to reduce functional morbidity and avoid the late-onset toxicity of CRT. More recently, the growing incidence of HPV-positive disease has altered the patient profile of OPSCC, as these patients tend to be younger and have a better long-term prognosis. Consequently, this has further bolstered interest in minimally-invasive techniques to de-intensify treatment to reduce long-term toxicity and treatment-related morbidity. In this context, there has been a renewed interest in the primary surgery, which allows for accurate pathologic staging and thus—potentially—de-intensification of postoperative CRT. The continuous advances in minimally-invasive surgical approaches, including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), have also altered the surgical landscape. These minimally-invasive approaches offer excellent functional outcomes, without the severe toxicity associated with intensive CRT, thus substantially reducing treatment-related morbidity. In short, given the increasing prevalence of HPV-positive OPSCC, together with the severe long-term sequela of aggressive CRT, surgery appears to be recapturing its previous role as the primary treatment modality for this disease. While a growing body of evidence suggests that TLM and TORS offer oncologic outcomes that are comparable to CRT and open surgery, many questions remain due to the lack of prospective data. In the present review, we explore the emerging range of surgical options and discuss future directions in the treatment of OPSCC, including the most relevant clinical trials currently underway.
The aim of the study was to assess the effect of three different types of anaesthesia on perioperative bleeding control and to analyse the mean arterial blood pressure and heart rate in patients undergoing endoscopic paranasal sinus surgery. Ninety patients (30 women and 60 men, aged 18–85 years) scheduled to undergo functional endoscopic sinus surgery in the years 2008–2010 were identified as candidates for inclusion in the study. Patients were randomly assigned to one of three groups (30 patients each) according to the type of general anaesthesia to be administered. Groups I and II both received inhalation anaesthesia (sevoflurane for sedation) and intravenous anaesthesia (fentanyl in group I, remifentanil in group II). Anaesthesia was delivered solely via intravenous route (TIVA) in group III, with propofol used for sedation and remifentanil for analgesia. Blood pressure and heart rate were monitored during surgery and post-surgically for 4 h. Mean anaesthesia duration in groups I, II and III was 108.7 ± 20.8, 112.6 ± 22.2 and 103.7 ± 17.5 min and the surgery duration was 71.3 ± 16.7, 78.8 ± 24.2 and 66.5 ± 15.5 min, respectively. Mean blood loss during surgery was 365.0 ± 176.2, 340.0 ± 150.5 and 225.0 ± 91.7 ml, with a mean blood loss rate of 5.1 ± 2.4, 4.5 ± 2.2 and 3.4 ± 1.1 ml/min in groups I, II and III, respectively. Technologically advanced control of the drug dose with the TIVA technique allows for better control of perioperative bleeding.
Intra-nasal glucocorticoids are the most effective drugs available for rhinosinusitis and nasal polyposis treatment. Their effectiveness depends on many factors and not all of them have been well recognized so far. The authors present the basic information on molecular mechanisms of glucocorticoid action, direct and indirect effects of glucocorticoids on transcription of genes encoding inflammatory mediators. They focus on recently proved nongenomic mechanisms which appear quickly, from several seconds to minutes after glucocorticoid administration and discuss clinical implications resulting from this knowledge. Discovery of nongenomic glucocorticoid actions allows for better use of these drugs in clinical practice.
IntroductionRadiotherapy (RT) in combination with chemotherapy is a standard of care for patients with head and neck squamous cell carcinoma (HNSCC). The RT is associated with side effects, which impact on quality of life (QoL). Thus, the aim of this prospective longitudinal study was to investigate the impact of RT on the QoL of patients with HNSCC during RT.Material and methodsFrom September 2008 to February 2010, 205 patients with locally advanced HNSCC were enrolled. The data pertaining to their QoL were collected using the EORTC QLQ-C30 and the EORTC Head and Neck Module (QLQ-H&N35) and then all items were transformed to a 0-100 scale according to the guidelines of the EORTC. The following clinical factors were chosen to study their potential influence on the QoL; site of primary, clinical stage, and methods of therapy: RT vs. chemoradiotherapy (CRT). Additionally, the sociodemographic factors (age, gender, education, habit of smoking) were studied.ResultsDeterioration of almost all scales and items in the QLQ-C30 and QLQ-H&N35 questionnaire were noted at the end of RT. The following factors negatively influenced the QoL: age < 60 years (p < 0.05), female gender (p < 0.05), habit of smoking (p < 0.01), advanced clinical stage (III and IV) (p < 0.05), site of primary (larynx, hypopharynx) (p < 0.01), and CRT (p < 0.01).ConclusionsOur study showed that RT significantly negatively influenced QoL at the end of the RT course. Additionally, this study demonstrated that age, gender, smoking habit, tumor site, and clinical stage of disease showed a significant effect on the QoL of HNSCC patients during RT.
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