In this paper the Authors, after a description of the prognostic factors in patients with differe... more In this paper the Authors, after a description of the prognostic factors in patients with differentiated thyroid carcinoma, propose a rationale for the therapy. The role of surgery, radioiodine treatment, endocrine therapy, radiotherapy and chemotherapy is described. The follow-up for the disease is briefly outlined. The authors suggest that treatment and follow-up protocols should be in accordance with the prognostic factors.
Background: Chemohyperthermic peritoneal perfusion (CHPP) after extensive cytoreductive surgery i... more Background: Chemohyperthermic peritoneal perfusion (CHPP) after extensive cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinomatosis (PC). The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with colon peritoneal carcinomatosis subjected to conventional surgical and/or chemotherapeutic treatment was 5.2 months. Historically, mitomycin C is the drug of choice in the treatment of intraperitoneal carcinomatosis from colon cancer. Methods: Twenty-five patients affected by stage IV colon cancer with only peritoneal involvement and a prior completion of at least a partial first cycle of systemic chemotherapeutic and/or surgical treatment (24 patients) were enrolled. Immediately following extensive cytoreductive surgery, early postoperative closed abdomen CHPP was performed. Results: Complete surgical cytoreduction (CC0-CC1) was obtained in 22 patients. Postoperative mortality was 1 out of 25 (4%). Major postoperative morbidity was 6 out of 25 (24%). Median overall survival estimated by Kaplan-Meier curve was 30.3 months. Locoregional progressionfree survival was 17.3 months. Of all the patients 64% and 40% were alive after 1 and 2 years respectively. Conclusions: In referral centers CHPP after optimal surgical debulking is a safe procedure for peritoneal carcinomatosis from colonic cancer. Locoregional control was obtained in the majority of the pretreated patients and 1-year survival was statistically improved. A closed abdomen CHPP procedure lasting 1 hour and standard mitomycin C at a dosage of 15 mg/m 2 is probably as efficacious as other hyperthermic procedures, using higher mitomycin C dosages, with a comparable or lower number of cases of side effects. These results, as in other published phase II studies, justify future randomized trials to assess definitively the role of CHPP in the treatment of locally advanced colon neoplasms in western countries. C hemohyperthermic peritoneal perfusion (CHPP) after extended cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinoma-tosis (PC). The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with peritoneal carcinomatosis from gastric and colonic cancers subjected to conventional surgical and/or chemotherapeutic treatment was 3.1 and 5.2 months
Background: Recurrent undifferentiated nasopharyngeal carcinoma is a chemosensitive disease. Few ... more Background: Recurrent undifferentiated nasopharyngeal carcinoma is a chemosensitive disease. Few third-line treatments have been reported. Methods: Twelve patients (9 males, 3 females; median age 50 years, range, 20-62) with recurrent undifferentiated nasopharyngeal carcinoma were treated with carboplatin AUC 5.5 + paclitaxel (175 mg/m 2 , 3-hr infusion) on day 1 every 3 weeks. All patients had been previously treated for recurrent disease with a first-line cisplatin-based chemotherapy and a second-line therapy with low-dose continous infusion 5-fluorouracil. Results: Overall, 54 courses were given (median, 5; range, 2-6). Three patients (25%) obtained a partial response lasting 6, 10 and 26+ months, 1 (8.3%) a minimal response lasting 6 months, and 3 (25%) no change with a median duration of 5 months. The median survival time was 14 months for patients who had a partial or minimal response or no change, and 5 months for non responders. Median overall survival was 9.5 months (3-30+). The treatment was well tolerated, and toxicity was manageable. Conclusions: The combination has a good pallitive role as thirdline chemotherapy in recurrent undifferentiated nasopharyngeal cancer.
The authors have evaluated general immunocompetence after cryosurgical treatment of 33 patients a... more The authors have evaluated general immunocompetence after cryosurgical treatment of 33 patients affected by oral squamous carcinoma. Patients have been divided into two groups: 17 of them were classifiable in 1st and 2nd stage and 16 of them in 3rd and 4th stages. Serum immunoglobulin levels, C3 - C4, peripheral lymphocytes, E-rosette forming cells, lymphocyte response to PHA were analyzed before a single cryotreatment 7 and 14 days after. The results indicate that immunological parameters vary in a significant way and can be constantly observed in 1st and 2nd stages, while the 3rd and 4th stages undergo no variations. Cryosurgery in the 1st and 2nd stages is able to modify, in particular, the parameters concerning cell - mediate immunity, although the phenomenon seems transitory, showing itself most on the seventh day.
Background SAFE trial (NCT2236806) is a phase 3 study comparing the effect on subclinical heart d... more Background SAFE trial (NCT2236806) is a phase 3 study comparing the effect on subclinical heart damage of bisoprolol (B), ramipril (R), or both drugs (R+B), as compared to placebo (P), in breast cancer treated with (neo)adjuvant anthracyclines +/- trastuzumab. Methods Primary endpoint is subclinical cardiotoxicity measured with echocardiography and global linear strain (GLS). This interim analysis was pre-specified on the first 120 patients who had completed cardiological assessments at 12-mos. Stopping rules per arm were: dose reduction >15%, study withdraw rate >5%, and no significant impact on 3D-left ventricular ejection fraction (3D-LVEF) as compared to T0 at 12-mos assessment. Results A total of 191 out of 480 patients have been enrolled; overall 123 patients were available for the analysis (P = 34; R = 28; B = 31; R+B=30). 3D-LVEF decreased at 3-mos (-3.3%; p
Critical Reviews in Oncology Hematology, Jun 1, 2019
Table of contents 1. Introduction: the multidimensional importance of assessing pain in head and ... more Table of contents 1. Introduction: the multidimensional importance of assessing pain in head and neck cancer 2. Material and Methods 3. Which instruments should be employed for evaluation and monitoring of pain in head and neck cancer patients? 4. Perioperative pain in head and neck cancer 5. Breakthrough cancer pain during (chemo-)radiotherapy 6. Correlation between pain and compliance to oncologic treatment and other clinical issues
Nine patients (5 males, 4 females; median age, 62 years) with recurrent high-grade malignancies o... more Nine patients (5 males, 4 females; median age, 62 years) with recurrent high-grade malignancies of major (7 cases) and minor (2 cases) salivary gland origin (4 adenoid cystic carcinomas, 2 adenocarcinomas, 2 poorly differentiated carcinomas, 1 mixed malignant tumor) were treated with clsplatin (60 mg/m2), eplrublcin (50 mg/m2) and 5-fluorouracil (600 mg/m2) (CEF) by Intravenous Injections on the first day of a 21-day regimen. Previous therapy Included surgery (1 case), radiotherapy (1 case), and surgery+radiotherapy (7 cases). There
e17559Background: SDC is a rare and highly aggressive disease. AR+ metastatic SDC can be successf... more e17559Background: SDC is a rare and highly aggressive disease. AR+ metastatic SDC can be successfully treated with a complete anti-androgen blockade (CAB) approach . In case of progression a second...
2084 Background: Aim of this study is to describe clinical characteristics and outcome of CRC pat... more 2084 Background: Aim of this study is to describe clinical characteristics and outcome of CRC patients with CNS metastases undergone to surgical resection, and report preliminary data on the comparison between molecular aspects of primary tumor and metastasis. Methods: Thirty-two pts (17 males, 15 females) with a median age of 65 yrs (range 38-80 yrs) with brain metastases from colon (23 pts, 72%) or rectum (9 pts; 28% ) adenocarcinoma (G1 in 3 pts, 9%; G2 in 12 pts, 37%; G3 in 17 pts, 53%) underwent total surgical resection. Primary tumor TNM was: T2 in 1 pt (3%), T3 in 22 pts (69%) and T4 in 9 pts (28 %); no patient had N0 status , 10 pts had N1 lesions (31%) and 22 pts had N2 (69%) lesions; 25 pts were M0 (78%) while 7 (22%) were M1. Results: One patient had neurological symptoms as first manifestation of CRC; the other cases had metachronous metastases in the SNC after a median of 35.5 months (range 4-96). The CNS location was cerebellum in 15 pts (47 %), frontal lobe in 9 pts (28 %), spinal cord in 5 pts (16% ), parietal lobe in 2 pts (6%) and occipital lobe in 1 pt (3%). Perioperative mortality was 3%. Ten pts (31%) received post-operative whole-brain radiotherapy. Six patient (19%) had local recurrence. Primary cancers harbored a K-RAS mutation in 13 cases (41%) and a BRAF mutation in 1 case (3%). Preliminary data in 20 pts indicate a 100% mutation concordance between primary tumor and CNS metastases. Conclusions: Resectable CNS metastases from CRC adenocarcinoma were seen after a median of 3 yrs originating from T3-4 N1-2 M0-1 lesions. The preferential locations in the CNS were cerebellum and frontal lobe, being spinal metastases relatively frequent. The total resection was feasible with a good long-term local control ; the whole-brain irradiation given to one third of cases could have contributed to local control. Almost all pts died of extranervous metastases. There was a concordance of KRAS and BRAF mutation in primary and CNS lesions.
Contexte― Le processus de cancerogenese laryngee se developpe souvent par etapes assez longues (l... more Contexte― Le processus de cancerogenese laryngee se developpe souvent par etapes assez longues (lesions precancereuses) et est influence par differents facteurs de risque, les plus important etant la fumee de tabac et la consommation d'alcool. Methodes ― Dans cette etude (comportant 216 hommes), nous avons voulu explorer si la continuation ou l'interruption de I'exposition a la fumee de tabac modifieraient l'histoire naturelle de telles lesions chez des malades traites par la seule decortication des cordes vocales pour lesions precancereuses, classee selon l'echelle recommandee par Hellquist: classe 1 (dysplasie moyenne), classe 2 (dysplasie moderee), classe 3 (dysplasie severe-carcinome in situ)
Using an immunoperoxidase method the Authors have demonstrated carcinoembryonic antigen (CEA) in ... more Using an immunoperoxidase method the Authors have demonstrated carcinoembryonic antigen (CEA) in 4/7 patients with benign oral lesion and in 9/10 patients with oral cancer. All 4 oral leukoplakias were positive for CEA. The histologic presence of CEA in oral cancer was related mainly to the formation of well differentiated tissue. The anaplastic carcinoma was negative. These findings indicate that CEA is a product of differentiated cells and should not be considered exclusively an oncofetal antigen or a marker of undifferentiated cells.
Thirty patients with recurrent squamous cell carcinoma of the head and neck were treated with an ... more Thirty patients with recurrent squamous cell carcinoma of the head and neck were treated with an outpatient schedule: cisplatin (100 mg/m2) day 1 and an 8-hour infusion of 5-fluorouracil (1000 mg/m2) on days 1-4 every 28 days. Twenty-eight patients were evaluable for response and toxicity: there were 5 complete responses (17.8%), 12 partial responses (42.8%), 6 stable disease (21.6%) and 5 progressions (17.8%). Patients with good performance status had a better response; patients who received prior chemotherapy had less positive responses. Median remission duration was 30+ weeks in patients who had a complete response, 25+ weeks in patients with a partial response. Median overall survival was 28+ weeks: 36+ weeks for responders and 14 weeks for non-responders. The major toxic effect was nausea/vomiting, while myelosuppression and stomatitis were less frequent and never severe.
Recurrence is a tumor renewal in a previously treated field or surgical wound after a disease-fre... more Recurrence is a tumor renewal in a previously treated field or surgical wound after a disease-free period. The present work investigates loco-regional recurrences. In the first part of the work the most frequent recurrence sites, types and their characteristics (i.e. infiltrating, exophytic, ulcerating) are studied along with the problems in clinical and pathological diagnosis, new diagnostic imaging (CT and MR) and the UICC classification system. The second part of the work is dedicated to examining classical treatments (surgery, radiotherapy, chemotherapy and radiochemotherapy associations) as well new therapies (i.e. cryosurgery, hyperthermia, immunotherapy, photodynamic therapy). A review of the literature is made for indications, results and complications. An extensive study of the cases of the Head and Neck Group of the University of Turin during the 1983-1990 period is also reported. This experience is based on 312 cases: 68 (oropharynx and larynx) treated by surgery, 51 (neck nodes and stomal recurrences) treated by radiotherapy and hyperthermia, 35 (neck nodes) by hyperthermia alone, 168 (all sites) by chemotherapy and 20 by immunotherapy. In the third part of this work supportive therapies and practical problems are reported. In conclusion a therapeutic approach is proposed in relation to the site of the recurrence and previous treatments.
In this paper the Authors, after a description of the prognostic factors in patients with differe... more In this paper the Authors, after a description of the prognostic factors in patients with differentiated thyroid carcinoma, propose a rationale for the therapy. The role of surgery, radioiodine treatment, endocrine therapy, radiotherapy and chemotherapy is described. The follow-up for the disease is briefly outlined. The authors suggest that treatment and follow-up protocols should be in accordance with the prognostic factors.
Background: Chemohyperthermic peritoneal perfusion (CHPP) after extensive cytoreductive surgery i... more Background: Chemohyperthermic peritoneal perfusion (CHPP) after extensive cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinomatosis (PC). The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with colon peritoneal carcinomatosis subjected to conventional surgical and/or chemotherapeutic treatment was 5.2 months. Historically, mitomycin C is the drug of choice in the treatment of intraperitoneal carcinomatosis from colon cancer. Methods: Twenty-five patients affected by stage IV colon cancer with only peritoneal involvement and a prior completion of at least a partial first cycle of systemic chemotherapeutic and/or surgical treatment (24 patients) were enrolled. Immediately following extensive cytoreductive surgery, early postoperative closed abdomen CHPP was performed. Results: Complete surgical cytoreduction (CC0-CC1) was obtained in 22 patients. Postoperative mortality was 1 out of 25 (4%). Major postoperative morbidity was 6 out of 25 (24%). Median overall survival estimated by Kaplan-Meier curve was 30.3 months. Locoregional progressionfree survival was 17.3 months. Of all the patients 64% and 40% were alive after 1 and 2 years respectively. Conclusions: In referral centers CHPP after optimal surgical debulking is a safe procedure for peritoneal carcinomatosis from colonic cancer. Locoregional control was obtained in the majority of the pretreated patients and 1-year survival was statistically improved. A closed abdomen CHPP procedure lasting 1 hour and standard mitomycin C at a dosage of 15 mg/m 2 is probably as efficacious as other hyperthermic procedures, using higher mitomycin C dosages, with a comparable or lower number of cases of side effects. These results, as in other published phase II studies, justify future randomized trials to assess definitively the role of CHPP in the treatment of locally advanced colon neoplasms in western countries. C hemohyperthermic peritoneal perfusion (CHPP) after extended cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinoma-tosis (PC). The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with peritoneal carcinomatosis from gastric and colonic cancers subjected to conventional surgical and/or chemotherapeutic treatment was 3.1 and 5.2 months
Background: Recurrent undifferentiated nasopharyngeal carcinoma is a chemosensitive disease. Few ... more Background: Recurrent undifferentiated nasopharyngeal carcinoma is a chemosensitive disease. Few third-line treatments have been reported. Methods: Twelve patients (9 males, 3 females; median age 50 years, range, 20-62) with recurrent undifferentiated nasopharyngeal carcinoma were treated with carboplatin AUC 5.5 + paclitaxel (175 mg/m 2 , 3-hr infusion) on day 1 every 3 weeks. All patients had been previously treated for recurrent disease with a first-line cisplatin-based chemotherapy and a second-line therapy with low-dose continous infusion 5-fluorouracil. Results: Overall, 54 courses were given (median, 5; range, 2-6). Three patients (25%) obtained a partial response lasting 6, 10 and 26+ months, 1 (8.3%) a minimal response lasting 6 months, and 3 (25%) no change with a median duration of 5 months. The median survival time was 14 months for patients who had a partial or minimal response or no change, and 5 months for non responders. Median overall survival was 9.5 months (3-30+). The treatment was well tolerated, and toxicity was manageable. Conclusions: The combination has a good pallitive role as thirdline chemotherapy in recurrent undifferentiated nasopharyngeal cancer.
The authors have evaluated general immunocompetence after cryosurgical treatment of 33 patients a... more The authors have evaluated general immunocompetence after cryosurgical treatment of 33 patients affected by oral squamous carcinoma. Patients have been divided into two groups: 17 of them were classifiable in 1st and 2nd stage and 16 of them in 3rd and 4th stages. Serum immunoglobulin levels, C3 - C4, peripheral lymphocytes, E-rosette forming cells, lymphocyte response to PHA were analyzed before a single cryotreatment 7 and 14 days after. The results indicate that immunological parameters vary in a significant way and can be constantly observed in 1st and 2nd stages, while the 3rd and 4th stages undergo no variations. Cryosurgery in the 1st and 2nd stages is able to modify, in particular, the parameters concerning cell - mediate immunity, although the phenomenon seems transitory, showing itself most on the seventh day.
Background SAFE trial (NCT2236806) is a phase 3 study comparing the effect on subclinical heart d... more Background SAFE trial (NCT2236806) is a phase 3 study comparing the effect on subclinical heart damage of bisoprolol (B), ramipril (R), or both drugs (R+B), as compared to placebo (P), in breast cancer treated with (neo)adjuvant anthracyclines +/- trastuzumab. Methods Primary endpoint is subclinical cardiotoxicity measured with echocardiography and global linear strain (GLS). This interim analysis was pre-specified on the first 120 patients who had completed cardiological assessments at 12-mos. Stopping rules per arm were: dose reduction >15%, study withdraw rate >5%, and no significant impact on 3D-left ventricular ejection fraction (3D-LVEF) as compared to T0 at 12-mos assessment. Results A total of 191 out of 480 patients have been enrolled; overall 123 patients were available for the analysis (P = 34; R = 28; B = 31; R+B=30). 3D-LVEF decreased at 3-mos (-3.3%; p
Critical Reviews in Oncology Hematology, Jun 1, 2019
Table of contents 1. Introduction: the multidimensional importance of assessing pain in head and ... more Table of contents 1. Introduction: the multidimensional importance of assessing pain in head and neck cancer 2. Material and Methods 3. Which instruments should be employed for evaluation and monitoring of pain in head and neck cancer patients? 4. Perioperative pain in head and neck cancer 5. Breakthrough cancer pain during (chemo-)radiotherapy 6. Correlation between pain and compliance to oncologic treatment and other clinical issues
Nine patients (5 males, 4 females; median age, 62 years) with recurrent high-grade malignancies o... more Nine patients (5 males, 4 females; median age, 62 years) with recurrent high-grade malignancies of major (7 cases) and minor (2 cases) salivary gland origin (4 adenoid cystic carcinomas, 2 adenocarcinomas, 2 poorly differentiated carcinomas, 1 mixed malignant tumor) were treated with clsplatin (60 mg/m2), eplrublcin (50 mg/m2) and 5-fluorouracil (600 mg/m2) (CEF) by Intravenous Injections on the first day of a 21-day regimen. Previous therapy Included surgery (1 case), radiotherapy (1 case), and surgery+radiotherapy (7 cases). There
e17559Background: SDC is a rare and highly aggressive disease. AR+ metastatic SDC can be successf... more e17559Background: SDC is a rare and highly aggressive disease. AR+ metastatic SDC can be successfully treated with a complete anti-androgen blockade (CAB) approach . In case of progression a second...
2084 Background: Aim of this study is to describe clinical characteristics and outcome of CRC pat... more 2084 Background: Aim of this study is to describe clinical characteristics and outcome of CRC patients with CNS metastases undergone to surgical resection, and report preliminary data on the comparison between molecular aspects of primary tumor and metastasis. Methods: Thirty-two pts (17 males, 15 females) with a median age of 65 yrs (range 38-80 yrs) with brain metastases from colon (23 pts, 72%) or rectum (9 pts; 28% ) adenocarcinoma (G1 in 3 pts, 9%; G2 in 12 pts, 37%; G3 in 17 pts, 53%) underwent total surgical resection. Primary tumor TNM was: T2 in 1 pt (3%), T3 in 22 pts (69%) and T4 in 9 pts (28 %); no patient had N0 status , 10 pts had N1 lesions (31%) and 22 pts had N2 (69%) lesions; 25 pts were M0 (78%) while 7 (22%) were M1. Results: One patient had neurological symptoms as first manifestation of CRC; the other cases had metachronous metastases in the SNC after a median of 35.5 months (range 4-96). The CNS location was cerebellum in 15 pts (47 %), frontal lobe in 9 pts (28 %), spinal cord in 5 pts (16% ), parietal lobe in 2 pts (6%) and occipital lobe in 1 pt (3%). Perioperative mortality was 3%. Ten pts (31%) received post-operative whole-brain radiotherapy. Six patient (19%) had local recurrence. Primary cancers harbored a K-RAS mutation in 13 cases (41%) and a BRAF mutation in 1 case (3%). Preliminary data in 20 pts indicate a 100% mutation concordance between primary tumor and CNS metastases. Conclusions: Resectable CNS metastases from CRC adenocarcinoma were seen after a median of 3 yrs originating from T3-4 N1-2 M0-1 lesions. The preferential locations in the CNS were cerebellum and frontal lobe, being spinal metastases relatively frequent. The total resection was feasible with a good long-term local control ; the whole-brain irradiation given to one third of cases could have contributed to local control. Almost all pts died of extranervous metastases. There was a concordance of KRAS and BRAF mutation in primary and CNS lesions.
Contexte― Le processus de cancerogenese laryngee se developpe souvent par etapes assez longues (l... more Contexte― Le processus de cancerogenese laryngee se developpe souvent par etapes assez longues (lesions precancereuses) et est influence par differents facteurs de risque, les plus important etant la fumee de tabac et la consommation d'alcool. Methodes ― Dans cette etude (comportant 216 hommes), nous avons voulu explorer si la continuation ou l'interruption de I'exposition a la fumee de tabac modifieraient l'histoire naturelle de telles lesions chez des malades traites par la seule decortication des cordes vocales pour lesions precancereuses, classee selon l'echelle recommandee par Hellquist: classe 1 (dysplasie moyenne), classe 2 (dysplasie moderee), classe 3 (dysplasie severe-carcinome in situ)
Using an immunoperoxidase method the Authors have demonstrated carcinoembryonic antigen (CEA) in ... more Using an immunoperoxidase method the Authors have demonstrated carcinoembryonic antigen (CEA) in 4/7 patients with benign oral lesion and in 9/10 patients with oral cancer. All 4 oral leukoplakias were positive for CEA. The histologic presence of CEA in oral cancer was related mainly to the formation of well differentiated tissue. The anaplastic carcinoma was negative. These findings indicate that CEA is a product of differentiated cells and should not be considered exclusively an oncofetal antigen or a marker of undifferentiated cells.
Thirty patients with recurrent squamous cell carcinoma of the head and neck were treated with an ... more Thirty patients with recurrent squamous cell carcinoma of the head and neck were treated with an outpatient schedule: cisplatin (100 mg/m2) day 1 and an 8-hour infusion of 5-fluorouracil (1000 mg/m2) on days 1-4 every 28 days. Twenty-eight patients were evaluable for response and toxicity: there were 5 complete responses (17.8%), 12 partial responses (42.8%), 6 stable disease (21.6%) and 5 progressions (17.8%). Patients with good performance status had a better response; patients who received prior chemotherapy had less positive responses. Median remission duration was 30+ weeks in patients who had a complete response, 25+ weeks in patients with a partial response. Median overall survival was 28+ weeks: 36+ weeks for responders and 14 weeks for non-responders. The major toxic effect was nausea/vomiting, while myelosuppression and stomatitis were less frequent and never severe.
Recurrence is a tumor renewal in a previously treated field or surgical wound after a disease-fre... more Recurrence is a tumor renewal in a previously treated field or surgical wound after a disease-free period. The present work investigates loco-regional recurrences. In the first part of the work the most frequent recurrence sites, types and their characteristics (i.e. infiltrating, exophytic, ulcerating) are studied along with the problems in clinical and pathological diagnosis, new diagnostic imaging (CT and MR) and the UICC classification system. The second part of the work is dedicated to examining classical treatments (surgery, radiotherapy, chemotherapy and radiochemotherapy associations) as well new therapies (i.e. cryosurgery, hyperthermia, immunotherapy, photodynamic therapy). A review of the literature is made for indications, results and complications. An extensive study of the cases of the Head and Neck Group of the University of Turin during the 1983-1990 period is also reported. This experience is based on 312 cases: 68 (oropharynx and larynx) treated by surgery, 51 (neck nodes and stomal recurrences) treated by radiotherapy and hyperthermia, 35 (neck nodes) by hyperthermia alone, 168 (all sites) by chemotherapy and 20 by immunotherapy. In the third part of this work supportive therapies and practical problems are reported. In conclusion a therapeutic approach is proposed in relation to the site of the recurrence and previous treatments.
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