Vol 7, No 2 (2017)

Treatment of recurrent laryngeal cancer remains challenging for clinicians. Peristomal reccurence is one of the severest complications of laryngeal cancer that occurs in 2–15  % of patients after laryngectomy and has a poor prognosis: the two-year survival rate is 45 % in patients with stage I and stage II recurrence (according to G.A. Sisson) and 9 % among patients with stage III and stage IV recurrence. Stomal recurrence usually occurs within 2 years after surgery. The following factors can influence that: location of the tumor in the subglottic region of the larynx, size of the primary tumor, presence of regional metastases, placement of a tracheostoma before laryngectomy, and submucosal spread of the tumor to the trachea. All these factors should be taken into account in patients» management, including prescription of adjuvant therapy and choosing a treatment strategy in patients with primary disease.

Since there are multiple factors that can influence peristomal reccurence development, the disease requires comprehensive evaluation in order to provide the most adequate treatment and to prevent stomal recurrence.

Objective and status of the guidelines. These Clinical guidelines consolidate opinions of the members of the expert task group on current problems of diagnosis and treatment of skin cancer at the modern stage of Russian clinical practice. The guidelines embody experience in diagnosis and treatment of this pathology of the leading specialists of scientific research institutes and large oncological centers of the Russian Federation. The guidelines were composed considering operation of oncological dispensaries with different bed capacities and diagnostic capabilities, and therefore opinions of some members of the group can differ from the version presented below. At the same time, the proposed for discussion guidelines make no claim to fully represent all aspects of the problem and can’t replace guidelines for doctors, textbooks, and scientific papers in this field.

The main objective of the guidelines is to improve early diagnosis of malignant skin pathology, its treatment, functional and social rehabilitation of patients with this pathology.

The Guidelines are based on analysis of the current state of diagnosis and treatment of malignant skin tumors of the head and neck considering experience of the leading specialists in the field and reports presented at the task group meeting on February 17th, 2017 in Kazan.

Introduction. Currently thyroid nodules are a widespread problem in clinical oncology and head and neck cancer, malignant focal lesions constitute more than 15–20  %. Accurate diagnosis is very important and determines treatment, as well as the volume of surgical intervention.

Objective – determination of the diagnostic value of the method of contrast-enhanced ultrasound in the diagnosis of thyroid cancer. Reference materials were the results of the histological study of surgical specimens.

Method. Performed a retrospective analysis of medical records of 42 patients who underwent surgery at the surgical department of head and neck tumors on the verified thyroid cancer in the N.N. Petrov Research Institute of Oncology at the Ministry of Health of Russia. The number of female patients was 36 persons (85.5 %), the number of men was 6 people (14.5 %). The average age of patients among men was 55.5 years, women – 46 years. All patients underwent surgical treatment in the amount of extirpation of the thyroid gland – 16 patients (37.5 %), hemithyroidectomy – 26 patients (62.5 %).

Results. The sensitivity of ultrasound with contrast in the diagnosis of cancer of the thyroid gland was 94.11 %, specificity was 87.5 %, diagnostic accuracy – 92.8 %.

Conclusions. The technique of ultrasound nodules thyroid with intravenous contrast enhancement has an excellent diagnostic properties, allowing to identify and verify thyroid cancer is 8 % more accurately in comparison with standard ultrasound technique.

Introduction. Cancer of the oral cavity comprises 6 % of all malignant tumors. Recurrences occur in 15–30  % of patients, 50 % have local recurrences, 25–30  % – regional. The choice of treatment depends on the location and stage of the recurrence.

Objective. To choose optimal tactics for surgical treatment in patients with recurrent cancer of the oropharyngeal region.

Materials and methods. The study included 314 patients with recurrent squamous cell carcinoma of the oropharyngeal region, who were treated at the N.N. Blokhin Russian Cancer Research Center and underwent surgical, combination, or conservative treatment.

Results. Survival in respect to the time of relapse was 35,0 ± 2.0 % for early (in the course of a year) relapses and 63,0 ± 7.1 % for late (a year after treatment and longer) relapses. Five-year survival in respect to the type of treatment for early recurrences was 34.2 ± 6 % for surgical treatment, 7.7 ± 3.5 % for combination treatment, and 17.6 ± 4.6 % for conservative approach. For late relapses, it was 62.7 ± 5.9 %, 77.8 ± 10.6 %, and 59.2 ± 8.7 %, respectively. Surgical treatment was performed in the form of removal of recurrent tumors, resection and reconstruction using local flaps, extended combined surgeries, and laser or cryodestruction.

Conclusion. The method of choice for treatment of recurrent tumors of oropharyngeal cancer is surgery in the form of an extended combined surgery with defect reconstruction using musculocutaneous flaps including the pectoralis major.

Introduction. The issue of selecting treatment strategy for сT2N0M0 cancer of the oral mucosa remains relevant. Induction chemotherapy (applied in order to evaluate the possibility of organ-preserving chemoradiotherapy) is widely used in clinical practice. In this case, surgical treatment is performed only when chemotherapy (CT) is ineffective or a residual tumor is detected after chemoradiotherapy (CRT). However, many specialists recommend surgical treatment on the first stage of treatment.

Objective: evaluation of the induction chemotherapy feasibility in the treatment of T2N0M0 cancer of the oral mucosa.

Materials and methods. A total of 122 patients with primary Т2N0М0 cancer of oral mucosa without regional metastases (according to clinical examination) were included in the study.

Results. In order to determine the best treatment strategy, we have compared treatment outcomes in three groups of patients. The most favorable outcomes were observed in the group of patients receiving combined treatment according to a scheme «surgery + radiotherapy (RT)/ CRT, where the overall 5-year survival rate and the progression-free 5-year survival rate were 70.4 % and 68.5 % respectively. Survival rate in this group was significantly higher (р < 0.05) than that in the group «induction CT (ICT) ± RT ± surgery» where these parameters comprised 42.2 % and 36.2 % respectively.

Conclusion. Combined treatment with a surgery on the first stage followed by RT or CRT ensures better outcomes of the cancer of the oral mucosa than the strategies that include ICT.

Introduction. Facial nerve paralysis disconnects person»s emotions and expression, causes lagophthalmos, disorders of taste, touch, salivation, and lymph efflux in the damaged area. Among causes of consistent facial nerve conduction defects, the most common is iatrogenic injury during extensive surgical interventions for removal of tumors of the parotid gland. Various surgery interventions are used for correction of such disorders. The article objective is to present results of performed static plastic surgeries using polypropylene thread in patients with facial nerve damage caused by radical parotidectomy.

Materials and methods. From 2014 to 2016 in the Department of Microsurgery of the P.A. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Center, 14 patients underwent static correction using polypropylene thread to treat iatrogenic injury of the facial nerve after radical surgery for malignant and benign tumors.

Results. In all patients, optimal results of repair of the esthetic component of the facial nerve were achieved. Postoperative period didn»t exceed 3 days. Effect duration is longer than 3 years.

Conclusions. Use of polypropylene thread in static plastic surgery allows to perform cosmetic facial correction, eliminate gravitational ptosis and lymphostasis in patients with consistent syndrome of complete damage of facial nerve conductance.

Introduction. Thyroid surgeries are one of the most common surgical interventions. Duration of hospital stay depends on the risk of postoperative complications, primarily, transient or permanent hypocalcemia, recurrent laryngeal nerve paralysis, bleeding.

Objective: presentation of first-hand results of using a protocol of enhanced recovery after thyroid surgery by us.

Materials and Methods. In the study, results of treatment of 162 patients who underwent surgery in the period from January 2014 to January 2016 are analyzed. In 22 (13.5 %) patients the surgery was performed endoscopically using bilateral axillo-breast approach (ВАВА). Results. No deaths were registered. In 2 patients, intraoperative complications were observed: In one case the recurrent laryngeal nerve was transected in a patient with retrosternal giant (larger than 15 cm) nodular goiter; in the 2nd case, the cricoid cartilage of a female patient was damaged by a harmonic scalpel during endoscopic intervention. Mean surgery duration in the studied group was 69.5 ± 15.7 min. Postoperative complications were observed in 5 (3 %) patients: In 1 it was subcutaneous emphysema after endoscopic surgery, in 2 patients – laryngospasm, in another two – transient hypocalcemia. Mean duration of hospital stay was 2.1 ± 0.5 days.

Conclusions. Based on literature data analysis and results of our study, we can conclude that the use of enhanced recovery protocols after thyroid surgeries is safe with low rate of complications and earlier hospital discharge.

Objective: in paper direct results of investigation the products of tumor makers – CEA (carcino-embryonic antigen), CYFRA 21-1 and SCC and heat shock proteins hsp27, hsp70, hsp90. reflacting the possibility of malignization epithelial cells in chronic hyperpiastic laryngitis.

Materials and methods. There were investigated 36 patients with chronic hyperplastic laryngitis. It was investigated the production of CEA (carcino-embryonic antigen), CYFRA 21-1, SCC and heat shock proteins hsp27, hsp70 in immune-enzyme method. The variation of serum concentration oncomarkers was investigated in dependent on the maximum production of heat shock proteins reflactihg the value of cell stress in chronic hyperplastic laryngitis. Statistics analysis was convey in programs Statistica (version 6,0) and “Biostat 4.03”.

Results. It was shown more prognostic informative in chronic hyperplastic laryngitis the level of CEA, CYFRA 21-1 and SCC on the background of maximum production of heat shock proteins hsp27, hsp70, hsp90. The serum level of CEA was higher in comparison with control. On the maximum of production hsp27, hsp70, hsp90 the concentration of CEA was 2–3 ng/ml, Cyfra 21-1 – 0–1,2 ng/ml and SCC 1–2 ng/ml. Conclusions. Variation of serum oncomarkers level of CEA – 2–3 ng/ml, CYFRA 21-1 – 0–1,2  ng/ml and SCC – 1–2 ng/ml are the prognostic value in the possibility of malignization epithelial cells in chronic hyperpiastic laryngitis. This results is important in clinical practice.

Multiple approaches are currently available for treatment of oropharyngeal cancer. Particular attention is usually paid to preservation of the normal shape of the organ and maintenance of the quality of life in patients. Early-stage oropharyngeal cancer can be treated by both radiotherapy and surgery, including transoral laser microsurgery and robot-assisted surgery.

Early diagnosis and the use of modern technological approaches allow to conduct adequate surgical treatment without significant injury of the surrounding soft tissues and bone structures, which in turn promotes both aesthetic and functional rehabilitation of the patient. The case of robot-assisted surgical treatment of the oropharyngeal tumor described in this article is a good example of this rehabilitation.