Garavello W, Turati F, Bosetti C, Talamini R, Levi F, Lucenteforte E, Chiesa F, Franceschi S, La Vecchia C, Negri E. Family history of cancer and the risk of laryngeal cancer: a case-control study from Italy and Switzerland. Int J Cancer. 2012 Feb 1;130(3):665-70. doi: 10.1002/ijc.26055. Epub 2011 Apr 27. Three-dimensional conformal postoperative radiotherapy in patients with parotid tumors Salivary gland malignancies are rare. The aim of our study was to investigate radiotherapy-related toxicity and clinical outcome in patients treated at our division with postoperative radiotherapy (pRT) for parotid tumors. Forty-three consecutive patients (32 with primary parotid tumors, 9 with parotid metastases and 2 with recurrent benign diseases) were retrospectively analyzed. The median follow-up was 28 months. Twenty and 5 patients had a follow-up longer than 2 and 5 years, respectively. Thirty-seven patients were alive and most of them (78%) were free from disease. The local and distant control rates were higher in patients with primary parotid tumors (94% and 87.5%) than in patients with parotid metastases (87.5% and 75%). Grade 3 radiotherapy-related acute toxicity of skin and mucosa was recorded in 20.9% and 28% of patients, respectively. Two patients (4.7%) had grade 4 skin toxicity. Late toxicity data were available for 33 (77%) patients. None of the patients developed severe (grade 3 and 4) late toxicity of soft tissues, skin or temporomandibular joints. Postoperative radiotherapy is a feasible treatment that was found to be effective mainly in patients with primary parotid tumors. Toxicity was acceptable but could probably be further reduced using more advanced radiotherapy techniques. Longer follow-up is required to achieve definitive results.
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Alterio D, Jereczek-Fossa BA, Griseri M, D’Onofrio A, Giugliano G, Fiore MR, Vitolo V, Fossati P, Piperno G, Calabrese LS, Verri E, Chiesa FG, Orecchia R. Threedimensional conformal postoperative radiotherapy in patients with parotid tumors: 10 years’ experience at the European Institute of Oncology. Tumori 2011;97:328-34. Ultrasound dye-assisted surgery (USDAS) The evolution of new techniques for cancer surgery has led to important changes in cancer care in recent years. The endpoint of cancer treatment is now to treat the patient with minimum discomfort while respecting quality of life. New techniques, such as mini-invasive surgery, must respect the correct oncological indications, when technically feasible. The surgery for nodal spread or recurrence of disease, after previous surgery on T or T and N for neck cancer, can represent a diagnostic and therapeutic challenge, especially in the neck, which is characterized by small spaces and noble structures. Often lesions become enveloped in scar tissue and can be difficult to visualize during surgery, representing a genuine problem for the surgeon. Ultrasound dyeassisted surgery is a procedure that combines ultrasound localization of pathological nodes with the use of methylene blue to mark diseased structures to simplify their visualization (and thus removal) in the surgical field. The technique is simple and can be used in surgically and oncologically experienced hands, even in hospitals that do not have sophisticated technology. Giugliano G, DE Fiori E, Proh M, Chulam Celestino T, Grosso E, Cattaneo A, Gibelli B, Massaro M, Ansarin M. Ultrasound dye-assisted surgery (USDAS): a promising diagnostic and therapeutic tool for the treatment of cancer recurrences in the neck. Acta Otorhinolaryngol Ital. 2011;31:222-7. Compartmental tongue surgery Compartmental tongue surgery (CTS) is a surgical technique that removes the compartments (anatomofunctional units) containing the primary tumor, eliminating the disease and potential muscular, vascular, glandular and lymphatic pathways of spread and recurrence. Compartment boundaries are defined as each hemi-tongue bounded by the lingual septum, the stylohyoid ligament and muscle, and the mylohyoid muscle. In this non-randomized retrospective study we evaluated the oncologic efficacy of CTS in patients with squamous cell carcinoma (SCCA) of the tongue treated from 1995 to 2008. We evaluated 193 patients with primary, previously untreated cT2-4a, cN0, cN+, M0 SCCA with no contraindication to anesthesia and able
to give informed consent. Fifty patients treated between October 1995 and July 1999 received standard surgery (resection margin >1cm); 143 patients treated between July 1999 and January 2008 received CTS. Study endpoints were: 5-year local disease-free, locoregional disease-free and overall survival. After 5years, local disease control was achieved in 88.4% of CTS patients (16.8% improvement on standard surgery); locoregional disease control in 83.5% (24.4% improvement) and overall survival was 70.7% (27.3% improvement). The markedly improved outcomes in CTS patients, compared to those treated by standard surgery, suggest CTS as an important new approach in the surgical management of tongue cancer Calabrese L, Bruschini R, Giugliano G, Ostuni A, Maffini F, Massaro MA, Santoro L, Navach V, Preda L, Alterio D, Ansarin M, Chiesa F. Compartmental tongue surgery: Long term oncologic results in the treatment of tongue cancer. Oral Oncol. 2011 Mar;47(3):174-9. Epub 2011 Jan 22. Management and follow-up of thyroid cancer in pregnant women. Thyroid cancer, the most common endocrine malignancy, is often detected in young female patients. Therefore, pregnancy following thyroid cancer is not infrequent, and about 10% of thyroid cancers occurring during the reproductive years are diagnosed during pregnancy or in the early post-partum period. Differentiated thyroid cancer (DTC) in young people generally has an excellent prognosis, and disease-free survival among women with DTC diagnosed during pregnancy may not differ from that in age-matched non-pregnant women with similar disease. However, thyroid cancer detected during pregnancy may cause anxiety about the optimal timing of recommended treatments and about both maternal and neonatal morbidity, as weel as pregnancy following a diagnosis of thyroid cancer obviously needs both maternal and foetal management. The main objectives in clinical monitoring of pregnant thyroid cancer patients are: 1) to reach an adequate balance of maternal calcium and thyroid hormones that is absolutely required by the foetal central nervous system for normal maturation; 2) to maintain optimal levels of maternal thyroxin to avoid possible recurrence or spread of disease; and 3) to perform safe follow-up visits for the mother and to plan further therapy when needed. Data from a review of the literature and the authors’ own experience show that in patients undergoing either suppressive or substitutive thyroxine therapy foetal thyroid growth is normal at ultrasound study, newborn thyroid status is normal, and the incidence of maternal morbidity is not influenced
by the pregnancy. In this review, the authors underline that regular adjustment of levo-thyroxine and calcium therapy is of outmost importance for both maternal and foetal well-being and offer some insight, very interesting from a practical point of view, to provide a clear and simple pathway for the management of pregnancyassociated thyroid cancer
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was 2.8 (95% confidence interval [CI], 1.5-5.3) in subjects reporting a first-degree relative with laryngeal cancer, as compared to subjects with no family history. The OR was higher when the relative was diagnosed before 60 years of age (OR = 3.5, 95% CI 1.4-8.8). As compared to subjects without family history, non-smokers, and moderate drinkers, the OR was 37.1 (95% CI 9.9-139.4) for current smokers, heavy drinkers, with family history of laryngeal cancer. Family history of colorectal (OR = 1.5, 95% CI 1.0-2.3) and kidney (OR = 3.8, 95% CI 1.2-12.1) cancer were also associated to an increased risk of laryngeal cancer, while no significant increase in risk was found for family history of cancer at all sites, excluding the larynx (OR = 1.1).
Gibelli B, Zamperini P, Proh M, Giugliano G. Management and follow-up of thyroid cancer in pregnant women. Acta Otorhinolaryngol Ital. 2011;31:358-65. On going clinical researches Locally advanced Head and Neck Squamous Cell Carcinoma: finding new prognostic and predictive factors. Squamous Cell Carcinoma of the Head and Neck (SCCHN) is the sixth most common cancer worldwide, with an estimated annual incidence of approximately 600,000 cases. Patients with locally advanced disease presentation may or may not be amenable to surgery at the time of diagnosis and until now, we have few parameters to design a specific treatment strategy for each patient. What we know is that, compared to radiation, concomitant chemoradiation could offer an 8% improvement of the 5-y Overall Survival (OS), for patients who are candidates for surgical treatment and a 5% improvement for those who are not. Despite great progress in the overall treatment approach and in understanding the mechanisms that lead to head and neck squamous cell carcinoma, many patients (almost 50%) with locally advanced tumor develop a recurrence within three years from treatment, and about 10% of them experience distant metastases. Only 30% of stage III and 15% of stage IV patients are alive and disease-free at 5 years. In order to better select patients who could benefit from non surgical therapies, prognostic and predictive factors for response to chemotherapeutic or biological target drugs and to radiotherapy are therefore required. Actually, only tumor extension (evaluated by TNM parameters) is used in clinical practice to define the therapeutic approach. Recent papers suggest that some defined pathological tumor characteristics, like related-HPV tumor, could be considered as prognostic and predictive factor of response to therapies. In the same way, functional imaging modalities as FDG PET and functional MRI (diffusion weighted MRI -DWI-MRI and dynamic contrast enhanced MRI – DCE-MRI) could improve the correct staging and predict the response
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