Sinonasal mucosal melanomas in Quito, Ecuador

Background: Head and neck mucosal melanoma account for 2 to 8% of head and neck melanomas, the majority of which arises in the nasal cavity or paranasal sinuses. The aim of this report was to review our experience on sinonasal malignant melanomas (SNMM) treated over a long period of time at a tertiary referral hospital.Methods: Clinical records of all of the patients operated on for SNMM at the Social Security Hospital and private clinics in Quito, Ecuador, were reviewed. Nineteen patients had histologically proven diagnosis. Eleven patients were men and mean age was 64. The most common presenting symptoms were nasal obstruction and epistaxis. Most tumors were located at the nasal fossa. Extranasal extension was present in 11 patients. Twelve had stage III- IV tumors. All patients were treated by surgery. Postoperative radiotherapy was given to 7.Results: Local recurrence (11 events) occurred in 9 cases. These 11 events were treated with surgery in 8, eventually associated to radiation therapy (RT) and chemotherapy (CT). Eight out of these 9 patients died. Five overall survival was 46%. Death was related to local disease and distant metastases. All stage I tumor patients are alive.Conclusions: Most sinunasal melanomas have a poor prognosis, mainly attributed to initial advanced local disease, local recurrence and distant metastasis. Surgery is the mainstay treatment, followed by radiotherapy, according to the T category.

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Resultados del tratamiento quirúrgico de sarcomas de partes blandas en adultos

Revista Argentina de Cirugía ◽

10.25132/raac.v111.n3.1427.es ◽

2019 ◽

Vol 111 (3) ◽

pp. 143-161

Author(s):

Matías H. Loccisano ◽

◽

María F. Montesinos ◽

Pedro A. Brégoli ◽

Eugenia Paradeda ◽

...

Keyword(s):

Postoperative Radiotherapy ◽

Soft Tissue Sarcomas ◽

Free Flaps ◽

Distant Metastases ◽

High Rate ◽

High Grade ◽

Mesenchymal Tumors ◽

Reconstructive Procedures ◽

Clinical Records

Background: Soft-tissue sarcomas (STS) are rare mesenchymal tumors with several histologic subtypes and different clinical patterns. Objective: The aim of this study was to describe the clinical and pathological characteristics and surgical outcomes of a series of patients with STS. Material and methods: The clinical records of 2403 undergoing surgery between October 2014 and April 2018 were retrospectively reviewed. Twenty-two patients (0.91%) presented STS. Results: Mean age was 52 years (range: 19-92) and 13 (59%) were women. The tumors were located in the lower extremities in 12 cases, head and neck in five, trunk in three and upper extremities in two. Fourteen cases (63.6%) were high-grade tumors. Pleomorphic sarcoma was the most common histologic type (32%) followed by synovial sarcoma (18%), liposarcoma (14%), and other types (36%). All the tumors were completely resected and five patients (35.7%) required amputation, four in the lower extremity and on in the upper extremity. Different reconstructive procedures were performed accor- ding to tumor size and location, including three free flaps. Those patients with high-grade sarcomas or with positive margins received postoperative radiotherapy. After a mean follow-up of 16 months, six patients presented local recurrences and four patients had synchronous metastatic disease in the lungs; all these patients had high-grade tumors. Overall survival was 86.4%. Conclusion: STS are rare and invasive neoplasms, widely distributed, requiring aggressive and occa- sionally complex surgical procedures. It is necessary to consider adjuvant treatments in selected cases and to maintain regular follow-up due to the high rate of recurrences and distant metastases.

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Role of radiotherapy in adenoid cystic carcinoma of the head and neck

The Journal of Laryngology & Otology ◽

10.1017/s0022215109990338 ◽

2009 ◽

Vol 123 (10) ◽

pp. 1137-1144 ◽

Cited By ~ 41

Author(s):

T A Iseli ◽

L H Karnell ◽

S M Graham ◽

G F Funk ◽

J M Buatti ◽

...

Keyword(s):

Local Recurrence ◽

Adenoid Cystic Carcinoma ◽

Head And Neck ◽

Distant Metastases ◽

Recurrence Free Survival ◽

Free Survival ◽

Prognostic Features ◽

Adenoid Cystic ◽

Radiotherapy Alone ◽

Local Recurrence Free Survival

AbstractThis study retrospectively reviewed 183 cases of adenoid cystic carcinoma treated over 40 years. The local recurrence free survival rate was 68.2 per cent at five years and 40.8 per cent at 10 years. At 10 years, local recurrence free survival was significantly worse following radiotherapy alone (0 per cent), compared with surgery alone (41.8 per cent, p = 0.004) or combined with post-operative radiotherapy (43.5 per cent, p = 0.001). Neither tumour stage three or four, perineural invasion, solid subtype nor involved margins predicted local recurrence. Treatment with radiotherapy alone resulted in worse survival than surgery alone (p = 0.002) or combined with post-operative radiotherapy (p = 0.001). Survival rates following local recurrence (n = 34) were higher following surgery (p = 0.006) but not significantly improved following radiotherapy (p = 0.139). Chemotherapy for distant metastases did not prolong survival (p = 0.747) but did result in improved eating and aesthetics scores, while decreasing overall physical health. These results indicate that surgery is preferable for primary and recurrent adenoid cystic carcinoma of the head and neck. The incidence of local recurrence following surgery and postoperative radiotherapy was similar to surgery alone cases although the latter had less adverse prognostic features. Contemporary chemotherapy may benefit quality of life but not survival in patients with distant metastases due to adenoid cystic carcinoma of the head and neck.

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Does Histologic Grade Have a Role in the Management of Head and Neck Cancers?

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.21.4107 ◽

2001 ◽

Vol 19 (21) ◽

pp. 4107-4116 ◽

Cited By ~ 38

Author(s):

André Fortin ◽

Christian Couture ◽

René Doucet ◽

Michele Albert ◽

Josée Allard ◽

...

Keyword(s):

Head And Neck ◽

Independent Predictor ◽

Cox Model ◽

Postoperative Radiotherapy ◽

Distant Metastases ◽

Histologic Grade ◽

Kaplan Meier ◽

N Stage ◽

Grade 3 ◽

Cox Analysis

PURPOSE: High histologic grade is usually associated with a greater propensity to distant metastases (DM). Its role to predict DM in head and neck cancer is not yet defined. The aim of this study is to evaluate the role of histologic grade as an independent predictor of DM and to determine a subgroup of patients who may benefit from systemic chemotherapy. PATIENTS AND METHODS: This is a retrospective study of 1,266 consecutive patients treated by definitive or postoperative radiotherapy between 1989 and 1997. All patients received at least 50 Gy. All stages and subsites of head/neck were included. DM rates were evaluated by the Kaplan-Meier method with a subsequent Cox analysis. RESULTS: There is a strong correlation of grade with N stage (P < .000001). The metastases-free survival (MFS) was 98%, 90%, and 72% for grades 1, 2, and 3, respectively (P < .000001). In patients with N0 stage, MFS is always greater than 90%, whatever the grade. In the 222 N1 patients, MFS was more than 90% in grade 1 and 2 but dropped to 75% for grade 3 (P = .001). In patients with N2 and N3, MFS was 91%, 79%, and 59% for grades 1, 2, and 3, respectively (P = .008). The same conclusion is applicable when only patients with neck control are analyzed. In a Cox model, grade was an independent predictor of DM (P = .000001) as well as T stage (P = .003), N stage (P = .000001), and neck failure (P = .0003). Higher grade was also an independent predictor of survival (P = .02). CONCLUSION: Patients with histologic grade 1 and grade 2 (except N3) are at low risk of DM. Patients with grade 2 and N3 or patients with grade 3 and N1 to N3 have a higher risk of distant metastases and should be considered for systemic treatment.

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The role of postoperative radiotherapy after radical mastectomy in treatment of early breast cancer

Archive of oncology ◽

10.2298/aoo0201007m ◽

2002 ◽

Vol 10 (1) ◽

pp. 7-12

Author(s):

Jasmina Mladenovic ◽

Nenad Borojevic

Keyword(s):

Breast Cancer ◽

Survival Rate ◽

Adjuvant Chemotherapy ◽

Local Recurrence ◽

Postoperative Radiotherapy ◽

Radical Mastectomy ◽

Distant Metastases ◽

Regional Lymph Nodes ◽

Postoperative Irradiation

BACKGROUND: Radical or modified radical mastectomy was considered for many years the standard therapy for operable patients. Following radical mastectomy, postoperative irradiation of the chest wall and peripheral lymphatics is indicated in selected highrisk patients. Some studies on breast cancer patients who underwent radical mastectomy and received adjuvant chemotherapy tried to find out whether the addition of irradiation treatment to the chest wall and regional lymph nodes increases survival. The hypothesis in favor of irradiation is that chemotherapy can eliminate distant micrometastases, but is less effective against local and regional diseases, which are better controlled by radiotherapy. METHODS: In one year period, 110 patients with early stage of breast cancer were treated with radical mastectomy, and postoperative radiotherapy. Forty one patients had only postoperative radiotherapy, 27 received also adjuvant chemotherapy, 40 received adjuvant hormonal therapy and 2 patients received both adjuvant chemo and hormonotherapy. Postoperative irradiation was given on the regional lymph nodes (supra and infraclavicular, axillary and internal mammary nodes) with the tumor dose 48 Gy in 22 fractions over a period of four and a half weeks. All fields were treated with Cobalt 60. RESULTS After the median follow up of 67 months, 33 patients (30 %) had some kind of failure in form of local recurrence, distant metastases or both Locoregional relapse alone or associated with distant metastases occurred in 10 patients (9.1 %). Only 1.8 % of patients had local recurrence as the first failure. Distant metastases occurred in 32 patients (29.1%). After the end of follow up, 60 % patients are alive without evidence of disease while 16.4 % patients are alive with disease. The 5 year overall survival rate was 78.19% and 5 year disease free survival rate was 67.44%. CONCLUSION: Postoperative radiotherapy after radical mastectomy has important role in adjuvant treatment of early breast cancer in combination with adjuvant chemotherapy and hormonotherapy.

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18F-FDG PET for detecting recurrent head and neck cancer, local lymph node involvement and distant metastases

Nuklearmedizin ◽

10.1055/s-0038-1625597 ◽

2004 ◽

Vol 43 (03) ◽

pp. 91-101 ◽

Cited By ~ 17

Author(s):

M. Schmalenbach ◽

M. Jungehülsing ◽

P. Theissen ◽

M. Dietlein ◽

U. Schröder ◽

...

Keyword(s):

Head And Neck Cancer ◽

Local Recurrence ◽

Head And Neck ◽

Neck Cancer ◽

Predictive Value ◽

Fdg Pet ◽

Visual Analysis ◽

Distant Metastases ◽

Lymph Node Involvement ◽

18F Fdg

Summary Aim: Assessment of the clinical value of 18F-FDG-PET for detection of recurrent head and neck cancer, local lymph node involvement and distant metastases comparing a qualitative visual with a semiquantitative analysis (SUV values). Patients, methods: Retrospective evaluation of 73 18F-FDG PET studies in 55 patients by use of a four-step qualitative visual grading system and calculation of standard uptake values in pathological lesions. Calculation of SUV values in normal regions for generating a map of physiological 18F-FDG distribution. Correlation to histopathological findings and clinical follow-up. Results: 1. Qualitative visual analysis of 18F-FDG PET studies: a) local recurrence sensitivity 79%, specificity 97%, positive predictive value 95%, negative predictive value 85%, and diagnostic accuracy 89%; b) local metastatic lymph nodes 100%, 95%, 85%, 100%, 96%; c) distant metastases 100%, 98%, 86%, 100%, 98%, respectively. 2. Semiquantitative analysis had only little incremental, non-significant value in comparison to qualitative visual analysis for the detection of a local recurrence in two patients: a) local recurrence: sensitivity 83%, specificity 100%, positive predictive value 100%, negative predictive value 88%, and diagnostic accuracy 93%; b) local metastatic lymph nodes or c) distant metastases did not change in comparison to qualitative visual analysis. Conclusion: 18F-FDG PET is an effective tool for re-staging of patients with suspected recurrence after therapy for head and neck cancer.

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Distant Metastases and Local Recurrence in Head and Neck Cancer

Annals of Surgery ◽

10.1097/00000658-196108000-00007 ◽

1961 ◽

Vol 154 (2) ◽

pp. 235-240 ◽

Cited By ~ 30

Author(s):

MARVIN S. ARONS ◽

ROBERT R. SMITH

Keyword(s):

Head And Neck Cancer ◽

Local Recurrence ◽

Head And Neck ◽

Neck Cancer ◽

Distant Metastases

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Distant metastases and local recurrence in head and neck cancer

Plastic & Reconstructive Surgery ◽

10.1097/00006534-196112000-00012 ◽

1961 ◽

Vol 28 (6) ◽

pp. 691

Author(s):

M. S. Arons ◽

R. R. Smith

Keyword(s):

Head And Neck Cancer ◽

Local Recurrence ◽

Head And Neck ◽

Neck Cancer ◽

Distant Metastases

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The Molecular and Pathological Predictors of Loco-Regional Tumor Control and Distant Metastases in a Randomized Clinical Trial on 7-Days-a-Week Postoperative Radiotherapy for Squamous-Cell Head and Neck Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2007.07.365 ◽

2007 ◽

Vol 69 (3) ◽

pp. S202 ◽

Cited By ~ 1

Author(s):

R. Suwinski ◽

M. Jaworska ◽

B. Nikiel ◽

M. Bialas ◽

M. Bankowska-Wozniak ◽

...

Keyword(s):

Clinical Trial ◽

Head And Neck Cancer ◽

Head And Neck ◽

Randomized Clinical Trial ◽

Neck Cancer ◽

Squamous Cell ◽

Postoperative Radiotherapy ◽

Distant Metastases ◽

Tumor Control

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Comparación entre los melanomas de cabeza y cuello con los de tronco y extremidades

Revista Argentina de Cirugía ◽

10.25132/raac.v112.n2.1457.es ◽

2020 ◽

Vol 112 (2) ◽

pp. 157-164

Author(s):

Silvina Verna ◽

◽

Gisela Coliva ◽

Matías Norte ◽

Fernando Dip ◽

...

Keyword(s):

Head And Neck ◽

Multidisciplinary Approach ◽

Distant Metastases ◽

Primary Lesion ◽

Primary Defect ◽

Melanoma In Situ ◽

Clinical Records ◽

Age Range

Background: Head and neck melanomas (HNMs) have been associated with prognostic factors different from those on other locations. Objective: The goal of the present study was to compare the demographic and clinical characteristics and the outcomes of surgical treatment between patients with HNM and those with trunk and extremity melanoma (TEM). Material and methods: The clinical records of patients undergoing surgery for melanoma between October 2014 and April 2018 were retrospectively reviewed. Fifteen patients (22.3%) had HNM and 52 (77.7) presented TEM. Results: There were no differences in age between both groups (63.8 ± 21.1 versus 58.5 ± 16), but there was a trend toward higher percentage of men in the HNM group (80% versus 61.3%). Patients with HNM had lower tumor thickness than those with TEM (2.07 versus 5.5 mm), higher incidence of melanoma in situ [5 (33.3%) versus 8 (15.3%)]; lymph node resection was more common (33% versus 25%) as well as reconstruction of the primary defect with local and musculocutaneous flaps. During follow-up, two patients in the HNM group developed local recurrences that were excised and three presented distant metastases in the lung, small bowel and abdomen and finally died due to the disease. In the TEM group, one patient had local recurrence and five died due to systemic metastases. The sample size was not sufficient to assess statistically significant differences. Conclusion: Head and neck melanomas occur in a wide age range and stages and has some clinical differences with TEM. The defects produced after the excision of the primary lesion often require more complex procedures and should be managed with a multidisciplinary approach.

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