scholarly journals Functional Outcomes with Facial Artery Musculo-Mucosal (FAMM) Flap and Dental Implants for Reconstruction of Floor of the Mouth and Tongue Defects in Oncologic Patients

2021 ◽  
Vol 10 (16) ◽  
pp. 3625
Author(s):  
Carlos Navarro Cuéllar ◽  
Manuel Tousidonis Rial ◽  
Raúl Antúnez-Conde ◽  
Marc Agea Martínez ◽  
Ignacio Navarro Cuéllar ◽  
...  
Keyword(s):  
Success Rate ◽  
Functional Outcomes ◽  
Mouth Opening ◽  
Speech Articulation ◽  
Floor Of The Mouth ◽  
Node Positive ◽  
Osseointegrated Implants ◽  
Oncologic Patients ◽  
Node Positive Disease ◽  
Aesthetic Results

Optimal functional outcomes in oncologic patients with squamous cell carcinoma (SCCA) of the tongue and floor of the mouth require good lingual mobility, adequate facial competence, the cheek suction effect and dental rehabilitation with osseointegrated implants. In this study, twenty-two oncologic patients who had been diagnosed with intraoral SCCA affecting the tongue and the floor of the mouth and who had undergone wide resection of the tumor and immediate reconstruction with an inferiorly pedicled FAMM flap and immediate osseointegrated implants were assessed. Lingual mobility, speech articulation, deglutition, implant success rate, mouth opening, and aesthetic results were evaluated. All patients were staged as T2 and the defect size ranged from 3.7 × 2.1 cm to 6.3 × 4.2 cm. A selective neck dissection was performed in all patients as part of their oncologic treatment, either electively or for node positive disease. Thirteen patients (59%) were diagnosed with node positive disease and underwent adjuvant radiotherapy. A total of 101 osseointegrated implants were placed for prosthetic rehabilitation and 8 implants were lost (7.9%), of which 7 received radiotherapy (87.5%). The implant success rate was 92.1%. Mouth opening was reported as normal in 19 patients (86.3%). Tongue tip elevation was reported as excellent in 19 patients (86.3%) and good in 3 patients (13.6%). Lingual protrusion was referred to as excellent in 15 patients (68.2%) and good in 6 patients (27.2%). Lateral excursion was reported as excellent in 14 patients (63.6%) and good in 7 patients (31.8%). In terms of speech articulation, 20 patients reported normal speech (90.9%). Regarding deglutition, 19 patients (86.3%) reported a regular diet while a soft diet was reported by 3 patients (13.7%). Aesthetic results were referred to as excellent in 17 patients (77.3%). FAMM flaps, immediate implants and fixed prostheses enable the functional rehabilitation of oncologic patients, optimizing aesthetics and functional outcomes even in patients undergoing irradiation, thus returning oncologic patients to an excellent quality of life.

1317: Significance of Lymph Node Positive Disease in Patients Treated with Neoadjuvant Chemotherapy: Is Adjuvant Chemotherapy Beneficial?

2005 ◽  
Vol 173 (4S) ◽  
pp. 358-358
Author(s):  
Wassim Kassouf ◽  
Dan Leibovici ◽  
Xian Zhou ◽  
Colin P.N. Dinney ◽  
G.H. Barton ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Node Positive ◽  
Node Positive Disease ◽  
Lymph Node Positive

Cured of breast cancer?

1995 ◽  
Vol 13 (1) ◽  
pp. 62-69 ◽  
Author(s):  
H Joensuu ◽  
S Toikkanen
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Survival Rates ◽  
Locoregional Therapy ◽  
Short Term ◽  
Node Negative ◽  
Node Positive ◽  
Node Positive Disease ◽  
Histologic Types

PURPOSE That patients can be ultimately cured of breast cancer has been questioned, because late deaths from the disease have been observed even several decades after the diagnosis. The purpose of this study was to investigate late mortality caused by breast cancer. PATIENTS AND METHODS Using the files of local hospitals and the Finnish Cancer Registry, we identified all patients with histologically diagnosed invasive breast cancer in a defined urban area (city of Turku, Finland) from 1945 to 1969 (n = 601). In 563 cases (94%), clinical data and histologic and autopsy slides could be reviewed, and these women had been monitored for a median of 29 years (range, 22 to 44; n = 66) or until death (n = 497). RESULTS Mortality from breast cancer was observed even during the fourth follow-up decade, but if women who were diagnosed with contralateral breast cancer were excluded (n = 30), no deaths from breast cancer were identified after the 27th year of follow-up evaluation. The 30-year survival rates were 62% (95% confidence interval [CI], 54% to 70%), 19% (95% CI, 13% to 25%), and 0% for women with pN0 (node-negative) and pN1 or pN2 (node-positive) disease, respectively. High 30-year survival rates were found in small (pT1N0M0) unilateral cancers (80% alive; 95% CI, 66 to 94%), and in the lobular (45% alive; 95% CI, 31% to 59%) and the special histologic types (81% alive; 95% CI, 67% to 95%). These survival rates were obtained when correcting either for known intercurrent deaths or for mortality in the age- and sex-matched general population. CONCLUSION Breast cancer, node-negative and node-positive, may be permanently cured even if treated with locoregional therapy only. The survival figures listed here may be considered as minimum values, because women with breast cancer diagnosed in the same area from 1970 to 1984 showed significantly improved short-term (< 20 years) survival rates over those diagnosed from 1945 to 1969.

Improvement in the prognosis of breast cancer from 1965 to 1984.

1998 ◽  
Vol 16 (3) ◽  
pp. 1030-1035 ◽  
Author(s):  
M J Edwards ◽  
J W Gamel ◽  
E J Feuer
Keyword(s):  
Breast Cancer ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Parametric Analysis ◽  
Parametric Models ◽  
Node Negative ◽  
Node Positive ◽  
Significant Difference ◽  
Node Positive Disease

PURPOSE The prognosis of breast cancer has improved over the past three decades. It is uncertain, however, whether this improvement results from an increase in the cure rate, extension of the life span of uncured patients, or some combination. METHODS From the Connecticut Tumor Registry, we obtained data on 25,091 patients with localized (node-negative) and regionally metastatic (node-positive) breast cancer who were diagnosed over the two decades between 1965 and 1984, with follow-up through 1993. The data for these patients were analyzed using a variety of parametric models to quantitate likelihood of cure and median survival time among uncured patients. These models incorporate the assumption that time to death from breast cancer follows a specific distribution. RESULTS For patients with node-negative disease, parametric analysis revealed no significant difference in cured-fraction or median survival time over the two decades studied. For patients with node-positive disease, however, a significant increase in median survival time (P < .001) was found during the second decade (1970 to 1979). There was also a trend toward a higher cured-fraction over time, but this was not statistically significant. CONCLUSION This study confirms that patients with node-positive disease had an improved prognosis over the two decades studied. Parametric analysis suggests that this improvement reflects primarily an increase in the median survival time for uncured patients, although there is a trend toward an increase in the likelihood of cure.

Effectiveness of adjuvant chemotherapy in combination with tamoxifen for node-positive postmenopausal breast cancer patients.

1997 ◽  
Vol 15 (4) ◽  
pp. 1385-1394 ◽  
Author(s):  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Postmenopausal Breast Cancer ◽  
Breast Cancer Patients ◽  
Node Positive ◽  
Increased Risk ◽  
Node Positive Disease ◽  
Er Positive ◽  
Risk Of Relapse

PURPOSE Adjuvant tamoxifen has been shown to reduce relapse and mortality among node-positive post-menopausal breast cancer patients. The value of adding chemotherapy to tamoxifen is controversial. PATIENTS AND METHODS Between July 1986 and April 1993, 1,266 postmenopausal breast cancer patients with node-positive disease were randomly assigned to receive one of four adjuvant therapy regimens: (A) tamoxifen alone for 5 years; (B) tamoxifen plus three courses of early cyclophosphamide, methotrexate, and fluorouracil (CMF) on months 1, 2, and 3; (C) tamoxifen plus delayed single courses of CMF on months 9, 12, and 15; (D) tamoxifen plus early and delayed CMF on months 1, 2, 3, 9, 12, and 15. The two-by-two factorial design allowed two direct comparisons: early CMF (B and D) versus no early CMF (A and C), and delayed CMF (C and D) versus no delayed CMF (A and B). Estrogen receptor (ER) status was known for all patients and was used to stratify the randomization. A total of 1, 212 patients (96%) were eligible and assessable. The median follow-up duration was 60 months. RESULTS The results of the two-by-two factorial comparisons were as follows: (1) early CMF added to tamoxifen significantly improved 5-year disease-free survival (DFS; 64% v 57%; hazards ratio [HR], 0.79; 95% confidence interval [CI], 0.66 to 0.95; P = .01); and (2) delayed CMF added to tamoxifen did not improve DFS (5-year DFS, 61% v 60%; HR, 0.97; 95% CI, 0.81 to 1.17; P = .77). For patients with ER-positive tumors, the addition of CMF, either early or delayed or both, reduced the relative risk of relapse by 22% to 36%. In contrast, for patients with ER-negative tumors, tamoxifen with delayed CMF was associated with a nonsignificant increased risk of relapse (HR, 1.27; 95% CI, 0.92 to 1.76; P = .15). CONCLUSION Postmenopausal patients with node-positive breast cancer should be offered combination chemotherapy in addition to tamoxifen. Tamoxifen should not be initiated before CMF, as this might be detrimental, especially for patients with ER-negative tumors.

Screening in the high-risk populations: Stage of breast cancer when detected by combination imaging with MRI and mammogram.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 44-44
Author(s):  
Kendall W. Carpenter ◽  
Mindy L. Merritt ◽  
Matthew Gromet ◽  
Karinn Marie Chambers ◽  
Terry Sarantou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
High Risk ◽  
Early Stage ◽  
Brca Mutation ◽  
Assessment Tools ◽  
Surgical Staging ◽  
Node Positive ◽  
Node Positive Disease ◽  
Malignant Lesions

44 Background: Screening patients at high-risk for the development of breast cancer consists of MRI and mammography. This retrospective review of screening MRIs in patients designated as high-risk for the development of breast cancer--based on family history alone or a calculated lifetime risk of ≥ 20%--seeks to determine the utility of MRI screening in the detection of early-stage breast cancer. The primary outcome evaluated was stage of malignancy detected through screening imaging.  Methods: Results of screening imaging performed between 1/1/08 and 12/31/11 were retrospectively reviewed. Patients who had a personal history of breast cancer were excluded. Remaining screens were categorized based on the following criteria: family history, BRCA mutation or high-risk as calculated by risk assessment tools. Screens with corresponding core biopsies were evaluated for the following: previous imaging obtained, core biopsy pathology and pathologic staging. Results: 118 patients met inclusion criteria and had a subsequent biopsy as a result of screening. Resultant pathology was 75 (64%; 75/118) benign lesions, 19 (16%; 19/118) atypical lesions, and 24 (20%; 24/118) malignant lesions. Of the 24 malignant lesions, 1 (4%; 1/24) were found to be node-positive at the time of surgical staging, and, 23 (96%; 23/24) were node-negative. Conclusions: Four percent (1/24) of patients undergoing high-risk screening had nodal disease at surgical staging, which compares favorably to historical rates of approximately 30% node-positive disease at diagnosis (Krag DN et al., NSABP B-32). Therefore, this study shows that screening high-risk patients can decrease the nodal-positivity rate.

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