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ECCO 12
- the European Cancer Conference Copenhagen, Denmark, 21-25 September 2003.
Abstract No. 137
(Clinical Study)
European Journal of
Cancer Supplements; Vol. 1, No. 5, September 2003, page S45
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Advanced
tumors of the skull base. Diagnostic, clinical and therapeutic features
A.M. Mudunov1,
E.G. Matyakin1, O.M. Meluzova2
1Blokhins Cancer Research Centre, Upper Aerodigestive
Tract Tumors, Moscow, Russian Federation; 2Blokhins Cancer Research
Centre, X-Ray Diagnostic Methods, Moscow, Russian Federation
Introduction.
Tumors of the skull base are one of the most difficult nosological forms among
others in head and neck due to the complex topography, absence of clear clinical
picture and therapeutic tactic, difficulties of surgical intervention owing to
the combined lesion of several anatomic zones and consequently low survival rate
and disease-free follow-up.
Material
and methods. 320 patients with various tumors of the skull base were treated
at our clinic for the period within 1980-2003.
146 (45.6%) pts out of them with various malignant tumors of paranasal sinuses
and nose cavity (including 12 (3.7%) with esthesioneuroblastoma), 167 (52.2%)
with the soft-tissue tumors of parapharyngeal localization, 4 (1/2%) primary
tumors of the orbit, 3 (1%) advanced skin cancer spreading into the skull
base.
Cure tactic depended on histologic type, tumor spreading and localization.
Main diagnostic procedures were CT, MRI scanning, ultrasound, in some cases
angyography, endoscopy, aspiration biopsy and postoperative histology.
Results.
18 (5.6%) pts mainly with mesenchymal tumors and primary skull base cancer had
chemoradiotherapy as the first step procedure with subsequent surgery.
36 (11.2%) pts had palliative chemoradiotherapy with 27.7% complete clinical
response.
Combined treatment modality (radiotherapy + surgery) performed in 48 (15%) cases
of epithelial cancers.
44 (13.7%) pts had palliative radiotherapy with 6.8% complete clinical
response.
223 patients had an operation.
Extended surgery performed in 71 (31.8%) cases with combined resections of
maxilla at one or both sites, orbit, ethmoidal cells, walls of frontal and
sphenoid sinuses, dura mater.
27 (8.4%) pts had intracranial tumor spreading into anterior, middle and/or
posterior cranial fossa.
In these cases combined craniofacial approach performed for radical surgery with
subsequent plastic reconstruction of the dura defect by pericranial or
myofascial flap.
Liquorrhea developed in 2 (7.4%) cases.
An external neck approach was quiet enough for total removal of parapharyngeal
tumors (160 pts) located basically in the limits of infratemporal fossa.
27 (8.4%) pts with advanced primary tumors had different treatment failures such
as local recurrence or distant metastasis.
Conclusions.
Preoperative chemoradiotherapy in advanced non-epithelial tumors of the skull
base allows to achieve significant regress of the primary site and to increase
resectability.
Application of CT and MRI allows in most cases detect correct diagnosis,
especially in benign tumors, estimate tumor spreading and connections to the
main anatomic formations of the head and neck (blood vessels, nervous branches,
brain and spinal cord), plane further surgery volume and adequate cure.
Intracranial tumor spreading required combined craniofacial approach with the
purpose for radical surgery.
©
2003 Elsevier Ltd. All rights reserved.
Source: http://ex2.excerptamedica.com/ciw-03ecco/abstracts/index.cfm?fuseaction=abs.prn&abstractID=137
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