Stanisław Zyłka

Not only primary malignancies but also metastatic tumors may be found within the parotid gland. Epidemiological and clinical characteristic, and preliminary assessment of treatment results. The retrospective analysis of 95 cases with metastatic tumors to the parotid gland, selected from the material of H&N Surg. Dept of Holy Cross Cancer Center in Kielce – Poland (2001–2011), with the analysis of age, sex, localization and histopathology of primary tumor, stage according to O’Brien classification, diagnostic methods and treatment modalities, and analysis of 3 and 5 years survival. Studied group consits of 95 patients (56 M, 39 F), in the age ranging from 31 to 97 years (mean 74.6). The most common primary localization of metastatic tumor was skin of the head and neck (Squamous Cell Ca – 53.7%; Malignant Melanoma 28.4%). 81% of patients underwent radical therapy intentionally – mostly combined surgery and radiotherapy. 19.0% of patients received symptomatic and palliative treatment only. In the group with 3 and 5 years of observation accordingly, 51.7% and 34.0% total survival was achieved.

Although laryngeal malignancies of mesenchymal origin (laryngeal sarcomas, LS) are extremely rare (1% of all laryngeal malignancies), the histological manifestations are very diverse. LS sign as a solid tumor covered with an intact mucosa.

Is to demonstrate epidemiological and clinical parameters of the group of patients with sinonasal malignancies and to analyze its impact on development of recurrences after primary surgical treatment conducted in Head and Neck Surgery Department of Holly Cross Cancer Center Kielce during 7-years period 2001-2007. The retrospective analysis of the group of 42 patients with sinonasal malignancies was made, based on medical record and outpatient follow-up, considering: age, sex, primary focus, histological outcome, local and clinical stage and methods of the therapy. In the group of patients with at least 3-years period of follow-up (n=42) the dependence the rate of oncological failures such as local recurrence, nodal metastases, distant metastases or the second primary focus on clinical and epidemiological factors was analyzed. The probability of survival rate was also estimated. The studied group consists of 42 patients (27M, 15K, M:K = 1.8:1). Age ranged from 28 to 87. The most common localization was maxillary sinus--59.5%. Patients with high local (T3, T4) and clinical (III, IV) stage constitute 77.5% of the studied group. In 66.7% cases the radiation therapy had to follow the surgery. In the group of 42 patients with at least 3-years period of follow-up the oncological failure appeared in 17 cases (40.5%): local recurrence (8), nodal metastases (7), distant metastases (1) and all of them in 1 case. The treatment was performed through: local recurrence (surgery in 2 cases, CHTH--3, symptomatic treatment--3), nodal metastases (RND--3, SND--4, supplementary radiotherapy--7), distant metastases--CHTH--2 cases. Thanks to these procedures the 5-year survival rate is 23.1% and the 3-year survival rate is 29.4%. (1) The oncological failure after primary surgical treatment in the group of patients with sinonasal malignancies developed in 40.5% cases, mainly as local recurrence or nodal metastases. (2) Primary localization and sex have no impact on the rate of the recurrence. (3) The oncological failures significantly more often relate to young patients with high local, clinical stage and low grade of malignancies. (4) The recurrence after primary surgical treatment in the group of patients with sinonasal malignancies substantially reduces 3- and 5-year survival rate (29.4%; 23.1%) compared with the entire studied group--54.8%; 40.0%.

The 280 cases (29.8%) of treatment failures after surgical and combined (surgery + rtg-therapy) treatment in 940 cases of carcinoma of larynx and hypopharynx has been taken into analysis. The recurrence within regional lymph nodes (11.9%), followed by local recurrences (11.5%) has dominated in this group. The distant metastases had been registered only in 2.6% of the whole treated group and the second primary tumours (included to the analysis of treatment failures) has been registered in 3.8%. The failures distribution has not been related to the sex and age of the patients, but significant dependence of failures rate to the general condition of the patient, the local and nodal advancement of the disease, and histological grade of tumour has been found. The highest rate of treatment failures was in hypopharynx localisation of primary tumour and the lowest in glottic region of the larynx. The results obtained in salvage treatment after failure of primary treatment has been unfavourable. In general, only 22.1% of patient with primary treatment failure has achieved 3-years survival, and 13.6% 5-years survival rate. In should be pointed out, that salvage treatment has been applied only to 40.8% of this group. The remaining patients received only symptomatic and palliative treatment.

Pharyngotonsillitis (PT) caused by group A beta hemolytic streptococci (GABHS) is one of the most common infections of childhood. Two antibiotic suspensions, cefaclor (CEF) and amoxicillin/clavulanate (AMC), are commonly used in Poland for the treatment of PT caused by GABHS in children. This multi-center, randomized, single-blinded study was undertaken in order to compare the efficacy and safety of CEF (20 mg/kg/d) and AMC (25 mg/kg/d) in 10 days treatment of GABHS-related PT. 100 children (mean age 6 years) were enrolled into the study. Clinical and bacteriological assessments were done on the 14-18 th, and 38-45 th days after randomization. No GABHS strain isolated from throat smears was resistant in vitro to both antibiotics. Both antibiotics had almost 98% effectiveness at the post therapy visit. On follow-up, significantly more relapses and recurrences were observed in the AMC-treated group than in the CEF-treated group (relapse rate 21.28% vs 15.56%, p<0.02, recurrence 10.64% vs 6.66%, p<0.002). The relapse odds ratio in the AMC group was 1.7 times greater than in the CEF group, and recurrence was 1.5 times higher. There were significantly higher rates of gastrointestinal adverse events in children treated by AMC (p<0.02). CEF provides a clinically and bacteriologically effective treatment for children with PT caused by GABHS, comparable to AMC but significantly safer in terms of gastrointestinal side effects. AMC shows a greater risk of relapse and recurrence than CEF.

The epidemiological characteristic of 940 patients with carcinoma of larynx and hypopharynx, treated from 1978 to 1997 was presented, as well as the results obtained in this group with surgical and combined (surgery + rtg-therapy) treatment. There was a prevalence--75.2% of highly advanced cases (III degrees + IV degrees). The 65.6% of patients had been treated by surgery alone, and the remaining had received additional rtg-therapy after surgery. The 3-years survival rate had been achieved in 77.8%, and 5-years survival in 61.7% of the whole group. The analysis of the survival rates had proved the significant differences depending mainly to localisation of primary tumour, and clinical advancement stage of the disease.