50 Gy chemoradiation in locally advanced oral cancer, 50 Gy chemoradiation, Definitive chemoradiation oral cancer, Locally advanced preoperative chemoradiation in locally advanced oral cancer, Oral cancer, Tobacco use
DOI: 10.5005/jp-journals-10001-1555 |
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Shanmugam S, Anandraja G, Ramaswami RP. Multimodality Treatment of Locally Advanced Oral Cancer: Can the Optimal Dose of Chemoradiation be Lowered? A Retrospective Cohort Study. Int J Head Neck Surg 2023; 14 (3):41-46.
Background: Locally advanced oral cancers are treated with a combination of surgery and chemoradiation. Definitive chemoradiation (Def CRT) or concurrent chemoradiation (CCRT) is employed only in rare instances when essential structures are at risk from unresectable tumors. The potential drawback of opting for radiation therapy upfront is the morbidity of surgery for residual tumors after Def CRT. Few centers have employed preoperative 50 Gy chemoradiation followed by surgery for resectable oral cancers. However, there is currently no well-established regimen for preoperative chemoradiation (50 Gy). We practice salvage surgery after Def CRT in our institution for some resectable locally advanced oral cancers due to patient, hospital, or logistical considerations. We found that there was considerable wound morbidity associated with these surgeries. With the knowledge that the preferred treatment approach for these patients would be surgery and adjuvant radiation, or Def CRT in a few patients, we decided to tread in-between the two standard treatment paradigms by treating such patients with preoperative chemoradiation (50 Gy) followed by surgery to reduce wound morbidity. We studied to compare the morbidity, functional (swallow) outcome, clinicopathological response pattern, locoregional recurrence, and disease-free survival between surgery following a definitive dose of chemoradiation (60–70 Gy) and 50 Gy chemoradiation.
Materials and methods: A total of 62 patients of moderately advanced (T4a) oral cancer who underwent surgery for residue following radiotherapy (RT) between 2015 and 2021 were studied. The 50 Gy group consisted of 32 patients, and the conventional radiation group had 30 patients. The patients were followed up for the following outcome measures—wound morbidity, swallowing efficiency, postoperative histopathology, disease progression, locoregional recurrence, distant recurrence, and disease-free survival and death.
Results: Wound morbidity was found to be lower in the 50 Gy preoperative radiation group compared to the conventional radiation group. We found no statistically significant difference in pathological response, swallowing outcomes, disease progression, recurrence, and disease-free survival.
Conclusion: Operating on patients who were treated with 50 Gy was associated with less morbidity in comparison with the conventional dose (60–70 Gy). Since a significant percentage of patients after Def CRT require salvage surgery, the option of multimodality treatment with 50 Gy preoperative chemoradiation may be worth considering. This requires a standard assessment after completing 50 Gy to identify patients not responding to radiation. Large prospective trials are needed to arrive at a definite conclusion.
Nidhi P Chanchlani
The cervical lymphoepithelial or branchial cleft cyst is a developmental lesion that typically manifests in the neck's anterolateral area. These are anomalies that are not frequent. To identify it, proper imaging is needed in addition to a clinical examination and a history of the lesion's course. In this case report, a female patient in her 50s had a history of right-sided neck swelling for 1 year that steadily increased in size until it reached 4 x 3 cm. She got a computed tomography (CT) scan, and fine needle aspiration cytology (FNAC) was performed. The surgical method used to treat her was successful.
Background: Synovial sarcoma of paranasal sinuses (PNSs) is very rare. It is a high-grade malignant tumor of soft tissues. It arises from mesenchymal cells and not from the synovial membrane. The head and neck is the second most common site for synovial sarcoma after the extremities.
Case description: A 72-year-old male with left-sided nasal obstruction, epistaxis, loss of smell, and left eye proptosis. On anterior rhinoscopy, a proliferative mass was seen occupying the left nasal cavity and extending up to the floor of the nose. The mass was nonreducible, bled on touch, and friable on probing. Diagnostic nasal endoscopy showed a friable proliferative mass in the left nasal cavity extending up to the floor of the nose. In contrast Enhanced computed tomography (CECT) of the PNS, a heterogeneous soft tissue density with the central nonenhancing area is noted. Intraorbital extension showed erosion of the medial and inferior wall of the orbit and loss of fat plane with no involvement of orbital apex. An endoscopic biopsy of the sinonasal mass showed a spindle cell variant of synovial sarcoma which was confirmed by immunohistochemistry. The patient underwent concurrent radiotherapy as a treatment modality.
Conclusion: The clinical presentation and management of synovial sarcoma of PNS are presented in this case report, along with a literature review. Though it commonly affects young individuals, it can also affect the elderly.
Background: There is an inconsistent number of road traffic accidents occurring in developing countries, which are a major cause of epidural hematomas, which are usually life-threatening brain compressions that require emergency surgical evacuation. Epidural hematoma is a common sequela of traumatic brain injury (TBI). This case presents an EDH in the temporal-perioral region of a 25-year-old young boy with a traumatic brain injury. A follow-up computed tomography (CT) showed that EDH had manifested on the left side of the brain after being transferred to our hospital with unconsciousness status. The EDH is characterized by a variable clinical presentation in acute situations. In most cases, extradural hematomas are caused by injury to the middle meningeal artery or its branches caused by direct trauma to the temporal bones of the skull. An extradural hematoma in the posterior cranial fossa occurred following a skull fracture in the tempo-perioral region. An injury to the brainstem that is not recognized may cause a rapid respiratory arrest due to brainstem compression if the bleeding is ignored. An attending clinician should be alerted to the possibility of this uncommon but potentially fatal condition in the presence of significant occiput trauma.
Methods: To reduce pressure and drain blood outside, the patient may require a small incision to be drilled in the skull. To remove big hematomas or solid blood clots, an additional incision in the head (craniotomy) may be required. A stereotaxic head CT was used to confirm the locations and volumes of the bleeding before surgery. The angle and depth of the puncture were assessed, and it was found that the largest hematoma region was at the scalp puncture location. A manual skull driller was used to drill the skull and scalp, and a brain puncture needle was used to aspirate the hematoma as much as possible. Drainage tube 10F is placed into the hematoma cavity, the tube core is removed, and drainage tube 1 cm is then placed into the hematoma cavity. After tube suturing and fastening, a closed backflow prevention drainage device was installed. The hematoma was fixed by the neurosurgeons using hemostress skewered with a bipolar device and sponge placement. The following phase involved placing 30 vicryles to secure the dura and draining the area. The brain's skin was closed with 2.0 silk, and the Subtanous layers were sealed off with 2.0 velvet.
Result: The operation took between 15 and 30 minutes to complete. After the hematoma was rinsed with normal saline, the neurosurgeon injected 20,000–40,000 units of urokinase into the hematoma cavity with normal saline (2–3 mL, depending on the size of the hematoma). After thorough surgery and regular checkups to monitor the epidural hematoma, the patient was discharged with no neurological impairments.
Conclusion: The neurosurgeon performed surgery immediately within two hours due30 mL to a single minimally invasive hematoma and removed the hematoma. The hematoma volume WmL, 80 mL and it was significantly reduced to around 30mL. The acute epidural hematoma was drained with the use of a drainage tube, which resolved the acute hematoma.
Trilok C Guleria,
Narender K Mohindroo
Two French physicians, Maurice Klippel and Paul Trenaunay, described two patients with hemangiomatous lesions of the skin and coined the term “nevus variqueux osteohypertrophique.” Klippel–Trénaunay syndrome (KTS) is characterized by a triad of capillary malformations, venous malformations, and soft tissue or bony hypertrophy. The etiology of the syndrome is unknown. Diagnosis of KTS is mainly clinical. An appropriate multidisciplinary approach to treatment and prevention of possible complications of KTS provides optimal care for the patient. KTS with hearing loss is a very rare presentation. We describe a case report of KTS in a 5-year-old boy associated with bilateral conductive hearing loss.