Intraoperative brachytherapy, laryngopharyngoesophagectomy, and gastric transposition for patients with recurrent hypopharyngeal and cervical esophageal carcinoma

Abstract

Objective: To evaluate the role of laryngopharyngoesophagectomy (LPE), intraoperative 125I brachytherapy (IOBT), and gastric transposition (GT) in patients with recurrent carcinoma involving the hypopharynx, or cervical esophagus. Methods: Between 1988 and 1994 a total of 21 patients were managed with LPE/IOBT/GT. All patients had documentation of recurrent disease at the hypopharynx or cervical esophagus and had previously been treated with external‐beam radiation (EBRT) to a total median dose of 60 Gy. Median age was 67 years, with 17 male patients and four female. IOBT was performed in all cases with permanent 125I implantation. Medical records were retrospectively reviewed. Overall survival, local control, and complications were evaluated. Median follow‐up was 6 months. Results: The median activity of 125I was 36 mCi, with a median dose of 80 Gy to the region at risk. Fifteen patients had lymph node dissections performed in conjunction with LPE, and 10 patients had nodal involvement on pathologic examination. Margins were microscopically positive in nine patients, and lymphvascular space invasion noted in 13. Actuarial survival at 1 and 3 years was 32% and 14%, respectively, with patients alive and with local control at 6, 24, 36, and 48 months, (negative margins). Actuarial local control at 1 and 3 years was 63%. Complications included fistula in five patients, facial edema in four, protracted facial pain in two, cervical abscess in one, and mucosal hemorrhage in one. Conclusion: Patients with recurrent carcinoma of the hypopharynx or cervical esophagus after EBRT have an extremely poor prognosis. LPE, IOBT, and GT may provide very good local control for all candidates and prolonged survival for a small percentage of patients with an acceptable risk profile. Laryngoscope, 108:1504–1508, 1998

Microsurgical Free Flap Reconstruction Outcomes in Head and Neck Cancer Patients after Surgical Extirpation and Intraoperative Brachytherapy

“…Other studies have also demonstrated wound infection varying from 10% 1 to 32% 3 and fistula formation from 8% 1 to 24%. 15 The total flap necrosis in the IOBT group of 6.67% is slightly higher than that reported for free flap transfer in general, which is between 4% and 5% 23 and is consistent with our incidence of 3.17% in the non‐IOBT group. The overall complication rate of 15.87% in the non‐IOBT group is also consistent with the experience of the Memorial Sloan‐Kettering center, which has reported an incidence of 15% for recipient site complications in their series of 200 consecutive free flap reconstructions.…”

“…Although it has been demonstrated that concomitant IOBT use enhances actuarial survival 14,15 and local control, 16,17 local complications also have been reported varying from 11% 2 to 56%. 1 Martinez et al 2 have reported an overall complication rate of 11% among 55 reconstructions performed in 48 patients, 4 being implant related and 2 surgically induced.…”

Fatores determinantes de complicações do tubo gastrico isoperistaltico para a reconstrução da faringe

“…10 0 A m anobra de Kocher (descolam ento da prim eira e segunda porção do duodeno para facilitar a m obilização duodeno-gástrica) não foi realizada em nenhum dos pacientes desta pesquisa, visto que a anastom ose do tubo gástrico tanto à base da língua, quanto aos retalhos a ele suturados, chegava facilm ente e sem tensão. Vários autores que realizaram a transposição gástrica utilizaram esta m anobra de form a a obter alguns centím etros a m ais para facilitar a anastom ose do estômago à base da língua (SASAKI et al 1995;WILSON et al 1998;AZURIN et al 1997;MARMUSE et al 1994;WIGHT 1992;LAM et al 1980 ;HARRISON et al 1981;SPIRO et al 1983;BALASEGARAN 1968;LEQUESNE & RANGER 1966;UJ IKI et al 1987, MARTINS, 1997.…”

“…Diversos autores tam bém a utilizaram com o parte do procedim ento cirúrgico (SASAKI et al, 1995;WILSON et al,. 1998;AZURIN et al, 1997;MARMUSE et al, 1994;WIGHT 1992;LAM et al,.…”

“…Outro ponto discordante com relação à técnica utilizada neste trabalho e a literatura é o fato de não haver necessidade de duas equipes para confecção da parte abdom inal da cirurgia. Vários autores (SASAKI et al 1995;WILSON et al 1998;AZURIN et al 1997;MARMUSE et al 1994;WIGHT 1992;SPIRO et al 1983;HARRISON 1981;METHA et al 1990, UJ IKI et al 1987…”