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P46 Reconstruction surgery after oropharyngeal resections
Poster abstracts, Friday 18 May
P45 Osteonecrosis of the mandible and maxilla associated to bisphosphonates. Report of six cases B.R.I. Zarco *, M. Frias-Mendevil, F.L. Medina. Instituto Nacional de Cancerologia, Mexico Background: Bisphosphonates are used for the treatment of bone metastases; their therapeutic potential is unquestionable. However, case series have been published recently describing an association between these drugs and necrosis and bone exposure in the mandible and maxilla. Objective: To describe the clinical, stomatological, and radiological characteristics of a series of cases with cancer that developed osteonecrosis of the mandible and maxilla. Methodology: Clinical, stomatological, and radiological variables, as well as information on the type, dose, and intensity of the used biphosphonates, were obtained from the clinical records of the patients. Results: All patients were women, four with breast cancer, one with cancer of the parotid gland, and another with multiple myeloma. Median age was 62 years. The six patients received zoledronic acid (4 mg), and two of them received also pamidronate (90 mg), every four weeks, for a median of 26 months (range, 12 45 months). Osteonecrosis appeared in a median time of 8.5 months, in two cases the lesion was detected before 9 months; only in two cases did the lesion develop spontaneously. The most frequent site of appearance was in the mandible (four cases). Necrosis and bone exposure of the mandible and/or maxilla was associated with chronic infection and did not respond to antibiotic therapy. Conclusion: Bisphosphonates are effectiveness for the treatment of bone metastases, being renal failure the only indication to stop its administration; however, necrosis and bone exposure of the mandible and maxilla are events that merit suspending their administration, since there is still no treatment capable of reverting the injury. Keywords: Biphosphonates, bone necrosis, jaws, bone metastases
P46 Reconstruction surgery after oropharyngeal resections A. Klochihin, A. Chistjakov, M. Klochihin *. Yaroslavl Regional Oncological Hospital, Russia Actuality: Unified tactic of treatment of oropharyngeal carcinoma is not yet determined, many authors give a priority to the surgery as the first stage of combined or complex treatment, others consider chemoradiotherapy to be the basic method. The task: to estimate functional and oncological results of reconstruction of extensive defects of oral cavity and mandible. Material and Methods: 27 patients undergone expanded resections of oral cavity and mandible with simultaneous titan implantation and (or) myo-cutaneous pectoralis major island flap. Localizations were distributed as follows: cancer of mandible 9 patients; floor of oral cavity 7; oropharyx, spreading in oral cavity 6; mucosa of a cheek 3; tongue 2. TNM system distribution: T1N0M0, relapse after radiation therapy with spreading to the mandible 1 patient; T2N0 2M0 7; T3N0 2M0 8; T4N0 2 M0 11. Thus, 20 (74.1%) from 27 patients with initial tumors, 7 (25.9%) from 27 with residual or recurrent cancer after radiation or chemoradiotherapy. For the purpose of repairing of the defect of mandible and oropharynx, pectoralis major island flap was used at 17 patients. At 8 patients reconstruction of mandible was carried out by titan implant. In 2 cases, in connection with the expanded volume of operation, the reconstruction was performed using combination of pectoralis major island flap and titan implant. Results: The described above methods of reconstruction of defects after expanded resections of oropharyngeal region provide good functional and cosmetic effect. The best results of healing were marked in the group of patients, where pectoralis major flap was applied. The percent of primary healing was 76.5. In the group with application of titan implants the percent of primary and secondary healing appeared identical. From 27 patients of researched group 23 are alive within one year after operation (year survival rate of 85.2%). P47 Survey of radiation oncologists’ knowledge level and practice patterns for prevention of dental complications P.L. Sandow *, R.C. Philip, D. Chang, L. Baccaglini, G.S. Mitchell. University of Florida, USA Introduction: Dental problems secondary to radiotherapy are common and can result in significant pain, expense, and deterioration of quality of life. Many head and neck radiotherapy patients do not regularly visit a dentist. Therefore, it is imperative that radiation oncologists are familiar with basic preventive measures to reduce the risk of radiation-induced dental complications. The purpose of this study was to determine the practice patterns and knowledge level of radiation oncologists, as it pertains to the prevention and treatment of radiation-induced dental problems. Methods: A web-based survey was answered, via e-mail, by radiation oncologists (n = 116). The survey included questions pertaining to the incidence of referral for pre-therapy dental examinations, indications for pre-therapy extractions, fluoride use, and hyperbaric oxygen therapy. Results: Most respondents (86.3%) referred head and neck radiotherapy patients to a dentist for pre-therapy evaluations, however, only 56.7% initiated a direct conversation with the dentist. There was a disparity in answers when asked the minimum length of time necessary for healing after an extraction, before initiating radiotherapy. The majority of respondents (94.9%) recommended fluoride for their head and neck radiotherapy patients however, only 68.2% knew the proper method of fluoride application (in custom trays)
Poster abstracts
OPC mortality rates in Mexico along time, considering gender and site of lesion. Methods: All OPC deaths registered by the General Board of Health Information of the Mexican Health Ministry (SSA) from 1979 to 2003 were included in the present analysis, in accordance with the ICD-9(140 149) and 10(C00-C14) codes. Linear Poisson regression analysis was performed using calendar years as a regressor variable. Results: During the study period, 15576 OPC deaths occurred (67% males). The mean OPC crude mortality rate was 0.73/100,000 (0.5 and 1.0/100 000 for women and men, respectively). Crude mortality rate of OPC varied from 0.84 (1979) to 1.07 (2003) in men, and from 0.39 (1979) to 0.55 (2003) in women, per 100,000. Oral cancer deaths represented 41.5% of all OPC deaths, being tongue the most frequent site, followed by other sites of the mouth and gingiva. Pharyngeal and salivary glands cancer deaths accounted for 17.1% and 13.4%, respectively. The Poisson regression analysis indicated stability in rates during the study period (b1 = 0.00084 p > 0.99). In addition, the regression model applied to the annual percentage change showed non significant increase or decrease in OPC mortality during the 25 years studied (b1 = 0.00078, p > 0.62]. Discussion: Our findings showed that the mortality rates of OPC remained stable from 1979 to 2003. Regardless of the low rates and the stable pattern in OPC mortality found in the present study, it is important to strengthen the value of the early diagnoses of pre-malignant and malignant lesions of oral and pharyngeal tissues. Keywords: oral cancer, mortality, trends
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P45 Osteonecrosis of the mandible and maxilla associated to bisphosphonates. Report of six cases B.R.I. Zarco *, M. Frias-Mendevil, F.L. Medina. Instituto Nacional de Cancerologia, Mexico Background: Bisphosphonates are used for the treatment of bone metastases; their therapeutic potential is unquestionable. However, case series have been published recently describing an association between these drugs and necrosis and bone exposure in the mandible and maxilla. Objective: To describe the clinical, stomatological, and radiological characteristics of a series of cases with cancer that developed osteonecrosis of the mandible and maxilla. Methodology: Clinical, stomatological, and radiological variables, as well as information on the type, dose, and intensity of the used biphosphonates, were obtained from the clinical records of the patients. Results: All patients were women, four with breast cancer, one with cancer of the parotid gland, and another with multiple myeloma. Median age was 62 years. The six patients received zoledronic acid (4 mg), and two of them received also pamidronate (90 mg), every four weeks, for a median of 26 months (range, 12 45 months). Osteonecrosis appeared in a median time of 8.5 months, in two cases the lesion was detected before 9 months; only in two cases did the lesion develop spontaneously. The most frequent site of appearance was in the mandible (four cases). Necrosis and bone exposure of the mandible and/or maxilla was associated with chronic infection and did not respond to antibiotic therapy. Conclusion: Bisphosphonates are effectiveness for the treatment of bone metastases, being renal failure the only indication to stop its administration; however, necrosis and bone exposure of the mandible and maxilla are events that merit suspending their administration, since there is still no treatment capable of reverting the injury. Keywords: Biphosphonates, bone necrosis, jaws, bone metastases
P46 Reconstruction surgery after oropharyngeal resections A. Klochihin, A. Chistjakov, M. Klochihin *. Yaroslavl Regional Oncological Hospital, Russia Actuality: Unified tactic of treatment of oropharyngeal carcinoma is not yet determined, many authors give a priority to the surgery as the first stage of combined or complex treatment, others consider chemoradiotherapy to be the basic method. The task: to estimate functional and oncological results of reconstruction of extensive defects of oral cavity and mandible. Material and Methods: 27 patients undergone expanded resections of oral cavity and mandible with simultaneous titan implantation and (or) myo-cutaneous pectoralis major island flap. Localizations were distributed as follows: cancer of mandible 9 patients; floor of oral cavity 7; oropharyx, spreading in oral cavity 6; mucosa of a cheek 3; tongue 2. TNM system distribution: T1N0M0, relapse after radiation therapy with spreading to the mandible 1 patient; T2N0 2M0 7; T3N0 2M0 8; T4N0 2 M0 11. Thus, 20 (74.1%) from 27 patients with initial tumors, 7 (25.9%) from 27 with residual or recurrent cancer after radiation or chemoradiotherapy. For the purpose of repairing of the defect of mandible and oropharynx, pectoralis major island flap was used at 17 patients. At 8 patients reconstruction of mandible was carried out by titan implant. In 2 cases, in connection with the expanded volume of operation, the reconstruction was performed using combination of pectoralis major island flap and titan implant. Results: The described above methods of reconstruction of defects after expanded resections of oropharyngeal region provide good functional and cosmetic effect. The best results of healing were marked in the group of patients, where pectoralis major flap was applied. The percent of primary healing was 76.5. In the group with application of titan implants the percent of primary and secondary healing appeared identical. From 27 patients of researched group 23 are alive within one year after operation (year survival rate of 85.2%). P47 Survey of radiation oncologists’ knowledge level and practice patterns for prevention of dental complications P.L. Sandow *, R.C. Philip, D. Chang, L. Baccaglini, G.S. Mitchell. University of Florida, USA Introduction: Dental problems secondary to radiotherapy are common and can result in significant pain, expense, and deterioration of quality of life. Many head and neck radiotherapy patients do not regularly visit a dentist. Therefore, it is imperative that radiation oncologists are familiar with basic preventive measures to reduce the risk of radiation-induced dental complications. The purpose of this study was to determine the practice patterns and knowledge level of radiation oncologists, as it pertains to the prevention and treatment of radiation-induced dental problems. Methods: A web-based survey was answered, via e-mail, by radiation oncologists (n = 116). The survey included questions pertaining to the incidence of referral for pre-therapy dental examinations, indications for pre-therapy extractions, fluoride use, and hyperbaric oxygen therapy. Results: Most respondents (86.3%) referred head and neck radiotherapy patients to a dentist for pre-therapy evaluations, however, only 56.7% initiated a direct conversation with the dentist. There was a disparity in answers when asked the minimum length of time necessary for healing after an extraction, before initiating radiotherapy. The majority of respondents (94.9%) recommended fluoride for their head and neck radiotherapy patients however, only 68.2% knew the proper method of fluoride application (in custom trays)
Poster abstracts
OPC mortality rates in Mexico along time, considering gender and site of lesion. Methods: All OPC deaths registered by the General Board of Health Information of the Mexican Health Ministry (SSA) from 1979 to 2003 were included in the present analysis, in accordance with the ICD-9(140 149) and 10(C00-C14) codes. Linear Poisson regression analysis was performed using calendar years as a regressor variable. Results: During the study period, 15576 OPC deaths occurred (67% males). The mean OPC crude mortality rate was 0.73/100,000 (0.5 and 1.0/100 000 for women and men, respectively). Crude mortality rate of OPC varied from 0.84 (1979) to 1.07 (2003) in men, and from 0.39 (1979) to 0.55 (2003) in women, per 100,000. Oral cancer deaths represented 41.5% of all OPC deaths, being tongue the most frequent site, followed by other sites of the mouth and gingiva. Pharyngeal and salivary glands cancer deaths accounted for 17.1% and 13.4%, respectively. The Poisson regression analysis indicated stability in rates during the study period (b1 = 0.00084 p > 0.99). In addition, the regression model applied to the annual percentage change showed non significant increase or decrease in OPC mortality during the 25 years studied (b1 = 0.00078, p > 0.62]. Discussion: Our findings showed that the mortality rates of OPC remained stable from 1979 to 2003. Regardless of the low rates and the stable pattern in OPC mortality found in the present study, it is important to strengthen the value of the early diagnoses of pre-malignant and malignant lesions of oral and pharyngeal tissues. Keywords: oral cancer, mortality, trends
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