PubMed Health⌕ Search

Biomedical subjects

M Quer

Publications and source records attributed to M Quer.

At least 19 recordsLinked to original sources
PubMed2003

[Treatment of T1N0 glottis carcinoma with radiotherapy. Results at our center and review of the literature].

OBJECTIVE: To evaluate the results of radiotherapy in the treatment of patients with T1N0 glottic squamous cell carcinoma. MATERIAL AND METHODS: Retrospective study of a cohort of 338 patients with T1N0 glottic carcinoma treated with radiotherapy at our institution between 1985-1997. A review of the literature published during the last ten years was carried out. RESULTS: Local control with radiotherapy in our patients was 82%, reaching 97% when salvage surgery was included. The local control with radiotherapy in most of the published series ranges between 81.90%. CONCLUSIONS: Treatment with radiotherapy achieves local control in early glottic carcinomas (T1N0) in 80-90% of cases. In our centre such treatment achieved local control in 82% of cases.

Carcinoma, Squamous Cell↗
PubMed2003

[Consequences of the bilateral vagus nerve section at a cervical level].

We present the consequences corresponding to a bilateral section of the main trunk of vagus nerve at cervical level in a patient with an oropharyngeal carcinoma with bilateral neck nodes. As a consequence of the bilateral resection of both vagus nerves during neck dissections, as well as motor and sensitive damage of the larynx and pharynx, we could observe affection of the normal tone of the oesophagus, stomach and duodenum which forced to enteral nutrition by direct jejunal access, and a disorder of the cardiac rhythm due to loss of the parasympathetic innervation appeared.

Bradycardia↗
PubMed2003

[Editorial].

Explore the source record for details and available documents.

Editorial Policies↗
PubMed2002

[Prevalence of tobacco and alcohol use following treatment in patients with head and neck squamous carcinoma: a cross-sectional study].

OBJECTIVE: To evaluate the prevalence of tobacco and alcohol use following treatment in patients with head and neck squamous cell carcinoma, and to determine factors possibly related to this use MATERIAL AND METHODS: A transversal study on tobacco and alcohol use following treatment for head and neck squamous cell carcinoma was performed in patients on ambulatory visits to our center. RESULTS: From 582 patients evaluated, 13% regularly smoked post-treatment, and 21% consumed alcohol. The related variables for tobacco use post-treatment were the kind of treatment received and previous tobacco use. The related variables for alcohol use post-treatment were age, sex and previous use of tobacco and alcohol. CONCLUSIONS: Despite warnings, 13% of patients with previous head and neck squamous cell carcinoma continued smoking and 21% persisted in alcohol use.

Adult↗
PubMed2001

Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy.

BACKGROUND: After treatment of locally advanced laryngeal carcinomas with induction chemotherapy and radiotherapy, some patients suffer a local or regional failure of the tumor, and salvage surgery is required. The aim of this study was to review the results of such salvage surgery in this group of patients. METHODS: A retrospective study of a cohort of 110 patients diagnosed between 1989 and 1996 with a locally advanced laryngeal carcinoma (T3-T4) treated with induction chemotherapy and radiotherapy was performed. The results of salvage surgery in patients with a local and/or regional failure of the treatment were analyzed. RESULTS: Forty-two patients presented a local and/or a regional recurrence of the tumor: 26 patients in the larynx, eight in the neck, and a further eight in both in the larynx and the neck. Salvage surgery was carried out in 28 patients (67%), consisting of total laryngectomies with neck dissections (24 cases), endoscopic resection of the tumor (one case), and radical neck dissections (three cases). Five-year adjusted survival for the 42 patients was 38%. Five-year survival for the 28 patients treated with salvage surgery was 57%. Five patients had postoperative complications: four had pharyngo-cutaneous fistulas and one had wound infection. CONCLUSIONS: After a local and/or regional recurrence, 67% of patients with advanced laryngeal carcinoma treated with induction chemotherapy and radiotherapy were candidates to salvage surgery. Five-year adjusted survival for this group of patients was 57%.

Cohort Studies↗
PubMed2001

Selective dissection of levels II-III with intraoperative control of the upper and middle jugular nodes: a therapeutic option for the N0 neck.

BACKGROUND: Selective neck dissections are accepted elective treatment in N0 patients. We present the results of a dissection of levels II to III and intraoperative pathologic control of a sample of subdigastric and supraomohyoid nodes in a group of patients with laryngeal carcinoma. When intraoperative analysis was positive, dissection of levels IV and V was completed. METHODS: Between 1991 and 1997, 145 neck dissections with intraoperative control were carried out in 79 patients with laryngeal carcinomas. Postoperative radiotherapy was used in 49 patients. RESULTS: There were occult metastases in 29 neck dissections (20%). In 22 cases (15%), tumor was found in the nodes sent to intraoperative pathologic study, and dissection of levels IV and V was completed. In 7 additional cases tumor was found in the postoperative study. The sensitivity of the use of frozen sections in the detection of occult metastases was 76%. In no case were positive nodes found at level V. There was no regional relapse in any of the 145 selective neck dissections. CONCLUSIONS: The lateral selective neck dissection is an effective method in the elective treatment of the neck of N0 laryngeal carcinoma patients. Dissection of level IV can be spared when intraoperative biopsy specimens of a sample of the subdigastric and supraomohyoid nodes are negative. According to our results, at present we do not consider it necessary to dissect level V in selective neck dissections in patients with laryngeal carcinoma.

Biopsy↗
PubMed2001

[Analysis of 2,500 squamous cell carcinoma of the head and neck].

The purpose of this paper is to define the prevalence of squamous cell carcinoma of the head and neck as seen at the ENT Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain in the last years, studying 2500 cases. Relative frequencies at the various sites, age distribution, male to female ratios, TNM stage are reported. From the results we point out that laryngeal squamous cell carcinomas (1297 cases) were more than 50% of all tumors, followed by oropharygeal carcinomas, oral cavity carcinomas and hypopharyngeal carcinomas. The mean age was 61 years, and patients with nasopharyngeal carcinomas were the youngest. 92% of the patients were males, and the highest rate of males was seen in the larynx and hypopharynx (97% males). Only 9% of the patients were non-smokers and 18% were not alcohol drinkers. Hypopharyngeal squamous cell carcinomas concentrated the highest rate of patients with severe toxic consumption. A significant proportion of earlier tumors was only seen in the larynx and oral cavity (54% and 41% Stages I-II, respectively). On the other hand, hypopharyngeal carcinoma, oropharyngeal carcinoma and nasopharyngeal carcinomas were mainly diagnosed in advanced stages.

Adolescent↗
PubMed2001

Can cure be achieved in patients with head and neck carcinomas? The problem of second neoplasm.

The improvement in locoregional control of head and neck carcinomas over the last few decades does not appear to modify the final survival of these patients, mainly due to the appearance of distant metastases and second neoplasms. This article reviews the topic of second neoplasm in patients with an index tumor in the head and neck, making a special point of the incidence and epidemiology of second neoplasms, the influence on prognosis, etiopathogenic theories and the possibility of prevention.

Head and Neck Neoplasms↗
PubMed2000

Endoscopic laser surgery in the treatment of radiation failure of early laryngeal carcinoma.

BACKGROUND: This study was undertaken to analyze the local control rates and survival of patients undergoing endoscopic laser surgery for squamous cell carcinoma of the larynx as a salvage procedure for recurrent tumors after radiotherapy. METHODS: Twenty-four patients underwent endoscopic laser surgery for radiation failure at our hospital from 1988 to 1995. All patients were men, between 45 and 88 years old. The localization of the recurrence was in the supraglottis in 3 cases and in the glottis in 21 cases. The postirradiation recurrences were staged rT1 in 18 patients and rT2 in 6 patients. RESULTS: Local recurrence after laser surgery developed in six patients (25%) who had a total laryngectomy. Voice preservation was thus achieved in 75% of patients. No patient died because of the laryngeal cancer, and the observed 5-year survival rate was 76%. CONCLUSIONS: These results indicate that in selected cases, endoscopic laser surgery may be used successfully for treating radiation failure of early laryngeal carcinomas.

Actuarial Analysis↗
PubMed2000

Distant metastases in head and neck cancer patients who achieved loco-regional control.

BACKGROUND: One of the reasons for failure in patients with head and neck carcinoma who achieve locoregional control with treatment is the appearance of distant metastases. The objective of this study was to evaluate the frequency of distant metastases in this group of patients and to determine the relative role of several prognostic factors in the subsequent development of distant metastases. DESIGN: Retrospective study from a database that collects the information prospectively in a cohort of patients with head and neck carcinoma. Patients and Methods The study was carried out in 1244 patients with oral cavity, pharyngeal, or laryngeal carcinoma who achieved locoregional control. We evaluated the frequency of distant metastases and the influence of different variables in their appearance. RESULTS: Five percent of patients with locoregional control had distant metastases. In the univariate study, the variables that influenced the appearance of distant metastases were tumor site, T stage, N stage, and histologic differentiation. On multivariate analysis, the variables that increased the risk of distant metastases were N stage, T stage, and the location of the tumor at the hypopharynx and the supraglottis. CONCLUSIONS: Five percent of patients with oral cavity, pharyngeal, or laryngeal carcinomas who achieved locoregional control died as a consequence of the development of distant metastases. The factors that significantly increased the risk of distant metastases in this group of patients were the advanced local and regional extension of the tumor and the location at the hypopharynx or supraglottis.

Aged↗
PubMed2000

Histologically negative specimens after induction therapy: frequency and impact on survival.

BACKGROUND: Occasionally in head and neck cancer patients treated surgically after induction chemotherapy, the histologic analysis of the excised tissue does not show evidence of viable tumor cells, a situation that the authors named "negative specimen." The objective of this study was to quantify the frequency of negative specimens in surgery after induction chemotherapy and to analyze the repercussions of this situation. METHODS: A retrospective study of prospectively collected data on 245 patients treated surgically after induction chemotherapy was made to calculate the frequency of negative specimens. An individualized review of the patients with negative specimens was made. The actuarial survival was calculated in relation to the existence of residual tumor. RESULTS: Twenty-five patients (10%) had negative specimens. Five-year adjusted survival for patients with negative specimens was 96%, significantly better than 62% survival in patients with residual tumor. CONCLUSIONS: Ten percent of patients treated surgically after induction chemotherapy had no residual tumor. These patients had a favorable prognosis.

Adult↗
PubMed2000

How much does it cost to preserve a larynx? An economic study.

Various studies report an increase in costs when induction chemotherapy is included in the treatment of advanced laryngeal cancer, but to our knowledge no studies have yet compared the economic costs of total laryngectomy versus induction chemotherapy in the treatment of advanced laryngeal cancer. We have conducted a retrospective study comparing the costs of treatment and survival in 96 patients with a T3N0-1 glottic carcinoma. Findings showed that the average cost per patient in the group of patients treated by total laryngectomy with or without postoperative radiotherapy was 5,853 Eur, while that for the group of patients who began treatment with induction chemotherapy was 6,452 Eur. The adjusted 5-year survival for patients treated with total laryngectomy with or without postoperative radiotherapy was 80%, and 72% for patients who began treatment with induction chemotherapy. Sixteen of the 35 patients (46%) receiving induction chemotherapy were spared laryngectomy. The use of induction chemotherapy in the treatment of patients with advanced laryngeal carcinomas involved an increase in cost of 600 Eur in relation to treatment with total laryngectomy and postoperative radiotherapy. However, from an economic point of view, we consider induction chemotherapy to be an important consideration in an organ-preservation strategy.

Carcinoma↗
PubMed2000

Initial treatment of the early stages (I, II) of supraglottic squamous cell carcinoma: partial laryngectomy versus radiotherapy.

The purpose of this study was to define the treatment of choice (partial laryngectomy vs radiotherapy) in the early stage of supraglottic squamous cell cancer (ESSC). One hundred and fifteen patients with ESSC were treated with either partial laryngectomy (25 patients) or with radiotherapy(90 patients) between January 1984 and December 1996. All patients had a follow-up of over 29 months. Radiotherapy (RT) had a local control rate of 79%, which increased to 90% with salvage surgery, and a high larynx preservation rate (83%). Partial laryngectomy (PL) offered a better initial local control rate of 84%, which increased to 88% with salvage surgery, and functional results were also good (80%). No statistically significant differences were found between RT and PL. RT was less costly, showed better suitability for treatment, produced moderate morbidity and sequelae, and local recurrence was easier to rescue. However, it is a once-only application technique. PL showed higher immediate postoperative morbidity, higher cost and lower suitability for treatment but had fewer sequelae, offered the best initial local control and is multi-applicable. No clear oncological arguments were found in our series to define whether PL or RT is the treatment of choice for ESSC. Both are effective therapies. Secondary factors such as suitability for treatment, morbidity, cost and applicability should be individually evaluated when choosing the type of treatment. As the laser endoscopic approach decreases morbidity and costs and makes the condition more suitable for treatment, it could be the treatment of choice for ESSC, in cases where local tumoral extent and larynx exposure allow radical excision.

Aged↗
PubMed2000

Treatment of neck nodes after induction chemotherapy in patients with primary advanced tumours.

Responsiveness of neck nodes to induction chemotherapy often differs from that of the primary tumour. We have conducted a retrospective study to evaluate the results of treating the neck in a cohort of 350 patients with locally advanced (T3-4) head and neck carcinomas treated with radiation therapy at the primary location of the tumour after induction chemotherapy. One hundred and thirty-nine patients (40%) did not have neck nodes on diagnosis (N0). The treatment of the neck included surgery in 65 patients. Neck dissections were carried out before radiotherapy in 37 patients and after radiotherapy in 28 patients. The frequency of neck treatment failure was 24%. There was a tendency to better neck control when treatment included neck dissection, independently of the neck stage or response to chemotherapy. This tendency was statistically significant in patients with an advanced regional tumour (N2-3) who did not achieve a complete regional response after chemotherapy. In a multivariate analysis the variables that were related to the regional failure were the relapse of the tumour at the primary site, the neck stage (N), the type of treatment used in the neck, and the grade of regional response after induction chemotherapy. Our results lead us to suggest that after induction chemotherapy neck surgery is advisable in all cases with advanced regional disease (N2-3), independently of the grade of response achieved after induction chemotherapy, and is also advisable in N1 patients in whom induction chemotherapy does not achieve a complete response.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Second neoplasm in patients with head and neck cancer.

BACKGROUND: The improvement in locoregional control of head and neck carcinomas over the last decades does not appear to modify the final survival of these patients, mainly due to the appearance of distant metastases and second neoplasms. We ran a study to evaluate the incidence of second neoplasms and their characteristics in patients with head and neck carcinoma treated in our hospital. METHODS: A retrospective study was undertaken to analyze the appearance of second neoplasm, its characteristics, and repercussion on the survival in 1845 patients with carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx diagnosed and treated in our department between 1984 and 1995. RESULTS: A group of 302 patients (16%) developed a second neoplasm. The incidence of second neoplasms was 4% per year and was constant during the follow-up period. Second neoplasms were mainly carcinomas located in head and neck (40%), lungs (31%), or esophagus (9%). Twenty percent of second neoplasms were tumors located outside the aerodigestive tract. The appearance of a second neoplasm significantly worsened the survival. CONCLUSIONS: Four percent per year of patients with carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx develop a second neoplasm, most frequently a carcinoma of the aerodigestive tract. This leads to a significant worsening of survival.

Carcinoma, Squamous Cell↗
PubMed1999

An anatomical study of anastomoses between the laryngeal nerves.

OBJECTIVE: To systematize the anatomy of the connecting branches between laryngeal nerves. METHODS: Microdissection of 90 larynges obtained from necropsies (57 men and 33 women; age range, 41-95 y). RESULTS: Anastomoses between the internal and recurrent nerves appeared in four different patterns: 1) Galen's anastomosis, as the connection between the dorsal branches of both nerves (100%); 2) arytenoid plexus, as the connection between the arytenoid branches of both nerves, in relation with the arytenoid muscle, and divided in a deep part (100%) and a superficial part (86%); 3) cricoid anastomosis, previously only described in cows, located in the front of the cricoid lamina (6/10 cases); and 4) thyroarytenoid anastomosis, as the connection of a descending branch of the internal laryngeal nerve and an ascending branch of the recurrent nerve (14%). Anastomosis between the internal laryngeal and the external laryngeal nerves appeared as a connecting branch throughout the foramen thyroideum (21%). Anastomosis between the external laryngeal and recurrent nerves appeared as a connecting branch throughout the cricothyroid muscle (68%). CONCLUSION: At least two anastomoses (Galen's anastomosis and arytenoid plexus) appeared in 21% of hemilarynges, and 79% of cases had three or more anastomoses between the laryngeal nerves. The different prevalence of this complex anastomotic pattern suggests functional differences in the sensory and motor innervation of individual subjects.

Adult↗
PubMed1999

Montgomery salivary bypass tube in the reconstruction of the hypopharynx. Cost-benefit study.

This study analyzes the postoperative complications and the functional results in 61 patients who underwent total laryngectomy with partial or total (circumferential) pharyngectomy reconstructed with a pectoralis major myocutaneous flap, in relation to the use of the Montgomery Salivary Bypass Tube (MSBPT). There were no significant differences regarding frequency of postoperative cervical complications in relation to the use of the MSBPT. The median hospital stay for patients without the MSBPT (36 days) was significantly higher than that for patients with the MSBPT (25 days). Although the MSBPT did not modify the rate of complications at the cervical level, it did reduce their severity. A financial study showed the cost-effectiveness of using the MSBPT. Systematic use of the MSBPT is recommended after total laryngectomy with partial or total pharyngectomy reconstructed with a pectoralis major myocutaneous flap.

Adult↗