Combination of radiotherapy and surgery in the treatment of head and neck cancers.
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Biomedical subjects
Publications and source records attributed to Y Cachin.
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A total of 218 non-Hodgkin's malignant lymphomata of the upper digestive and respiratory tract are reported. 72% had Waldeyer's ring involvement and 22% had paranasal sinus involvement. Ilio-lumbar lymphography was performed in 98 cases: 33 lymphograms were abnormal. In 152 Stage I and II patients, loco-regional irradiation gave 129 remissions. Among these patients, 66 suffered a relapse, most of them during the first year after treatment. Primary relapse analysis revealed 18 true recurrences, 10 nodal extensions and 38 extranodal disseminations. The median survival is 14 months for all stages; the survival rate at 5 years is 38% for Stages I and II for patients treated by 60Co alone. No statistical significance in prognosis has been found for age, sex, size of primary tumour, involvement of upper or lower nodes in the neck, histological type nor between Stage I and Stage II. Lymphography and x-ray gastrointestinal examination must be performed routinely before treatment in order to stage patients correctly.
The author considers successively: 1--The theoretical justifications for horizontal partial laryngectomy (anatomical considerations, indications as to the modalities of extension of supraglottic tumors, results concerning the cancer itself, functional results). 2--The indications of and contraindications for this type of surgery, with special reference to two types of cancers: median supraglottic carcinomas and antero-lateral epilarynx carcinomas. 3--Some specific problems, namely that of large supraglottic laryngectomy, of combined nodal surgery, and of preoperative radiotherapy. The limits of horizontal partial laryngectomy are specified on the basis of two criteria: its value as far as cancer is concerned (five-year survival rate), the quality of functional results.
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