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Kang YJ, Park G, Park SY, Kim T, Kim E, Heo Y, Lee C, Jeong HS. Extra-Capsular Spread of Lymph Node Metastasis in Oral, Oropharyngeal and Hypopharyngeal Cancer: A Comparative Subsite Analysis. Cancers (Basel) 2024; 16:659. [PMID: 38339410 PMCID: PMC10854589 DOI: 10.3390/cancers16030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The extra-capsular spread (ECS) of lymph node metastasis (LNM) is a hallmark of aggressive primary tumor phenotype in head and neck cancer (HNC); however, the factors influencing ECS are poorly understood. PATIENTS AND METHODS This was a retrospective study, including 190 cases of oral tongue cancer (OTC), 148 cases of oropharyngeal cancer (OPC) (118 HPV-positive and 30 HPV-negative), and 100 cases of hypopharyngeal cancer (HPC). Tumor dimension, tumor biological variables (lymphovascular/perineural invasion and histologic grade), and LNM variables (LNM number and size) were analyzed according to the presence of ECS using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS LNM variables were significant factors for ECS in all subsites of HNC (p < 0.05), except HPV-positive OPC. In OTC, tumor dimensional variables were significantly related to ECS (p < 0.01). Meanwhile, in OPC and HPC, neither the primary tumor dimension nor the T status were significant factors for ECS occurrence. The predictability of ECS by ROC curve using multiple variables was 0.819 [95% confidence interval: 0.759-0.878] in OTC, 0.687 [0.559-0.815] in HPV-positive OPC, 0.823 [0.642-1.000] in HPV-negative OPC, and 0.907 [0.841-0.973] in HPC. CONCLUSION LNM variables were correlated with ECS occurrence for most HNC subsites, and site-dependent primary tumor characteristics might contribute differentially to the ECS development of LNM in HNC.
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Affiliation(s)
- Yung Jee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Goeun Park
- Center for Biomedical Statistics, Samsung Medical Center, Seoul 06351, Republic of Korea;
| | - Sung Yool Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Taehwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Eunhye Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Yujin Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Changhee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
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Subash A, Rao VUS, Bylapudi BP, Sinha P, Thakur S, Tazeen S. The Impact and Prognostic Significance of Extra-Nodal Extension in Clinically N0 Oral Cancer: A Prospective Clinical Study. Indian J Otolaryngol Head Neck Surg 2023; 75:3786-3791. [PMID: 37974687 PMCID: PMC10645682 DOI: 10.1007/s12070-023-03761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/30/2023] [Indexed: 11/19/2023] Open
Abstract
Oral cavity squamous cell carcinoma (OCSCC) demonstrates a high propensity to metastasize to regional lymph nodes. Despite technological and scientific advances, identification of pathological adverse features preoperatively remains elusive. This study intended to identify the true occurrence of extra-nodal extension (ENE) in clinically and radiologically N0 OCSCC patients and to investigate its impact and prognostic significance. A prospective, single-centre, non-randomized study was conducted at a tertiary cancer centre in South India to include all untreated operable patients of OCSCC without clinical, radiological, or cytological evidence of nodal metastasis (cN0). All the patients underwent tumor resection surgery with neck dissection and received adjuvant therapy when indicated. Patients were followed up and neck dissection specimens were histopathologically analyzed. The primary outcome was to assess the presence of ENE in cN0 OCSCC patients and its extent. The secondary outcomes were 2-year disease-free survival (DFS) and tumor characteristics. A total of 237 patients with operable OCSCC were evaluated. Out of these, 80 patients who were clinically and radiologically N0 were included in the study and they underwent tumor resection surgery and neck dissection. The final histopathological evaluation revealed that 21.25% of patients (n = 17) had metastatic neck disease and 7.5% of patients (n = 6) had ENE, and all were reported as microscopic ENE. Within the node-positive group, the 2-year DFS for patients with and without ENE were 50% and 90.9%, respectively (p = 0.0362). The results suggest that ENE remains a strong predictor of adverse outcomes, recurrence, and survival in oral cancer patients.
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Affiliation(s)
- Anand Subash
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka 560020 India
| | - Vishal U. S. Rao
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka 560020 India
| | - Bhanu Prakash Bylapudi
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka 560020 India
| | - Piyush Sinha
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka 560020 India
| | - Shalini Thakur
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka 560020 India
| | - Sanah Tazeen
- Department of Head and Neck Surgical Oncology and Robotic Surgery, HealthCare Global (HCG) Cancer Centre, Bangalore, Karnataka 560020 India
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Henson CE, Abou-Foul AK, Morton DJ, McDowell L, Baliga S, Bates J, Lee A, Bonomo P, Szturz P, Nankivell P, Huang SH, Lydiatt WM, O’Sullivan B, Mehanna H. Diagnostic challenges and prognostic implications of extranodal extension in head and neck cancer: a state of the art review and gap analysis. Front Oncol 2023; 13:1263347. [PMID: 37799466 PMCID: PMC10548228 DOI: 10.3389/fonc.2023.1263347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) TNM classification. Although ENE was first described almost a century ago, several issues remain unresolved, including lack of consensus on definitions, terminology, and widely accepted assessment criteria and grading systems for both pENE and ENE detected on radiological imaging (imaging-detected ENE; iENE). Moreover, there is conflicting data on the prognostic significance of iENE and pENE, particularly in the context of HPV-associated HNSCC. Herein, we review the existing literature on ENE in HNSCC, highlighting areas of controversy and identifying critical gaps requiring concerted research efforts.
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Affiliation(s)
- Christina E. Henson
- Department of Radiation Oncology and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ahmad K. Abou-Foul
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniel J. Morton
- Department of Pediatrics and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - James Bates
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Anna Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - William M. Lydiatt
- Department of Surgery, Creighton University, and Nebraska Methodist Health System, Omaha, NE, United States
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
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Kaur V, Rooney A, Horton B. Prognostic significance of extra-nodal extension and positive surgical margins in HPV positive oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2023; 44:103877. [PMID: 37030131 DOI: 10.1016/j.amjoto.2023.103877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/25/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Whether extra-nodal extension (ENE+) and surgical margin positivity (margin+) are poor prognostic factors in HPV-associated (HPV+) oropharyngeal carcinoma (OPC) remains uncertain. RESULTS Our study evaluated if microscopic ENE+ and/or margin+ are associated poorer recurrence free survival (RFS) and overall survival (OS) in HPV+ OPC. Patients were classified as high risk (ENE+ and/or margin+) or low risk (ENE- and margins-). Of a total of 176 patients HPV+ OPC, 81 underwent primary surgery and dad data on ENE and margin status. There was no statistically significant difference in RFS (p = 0.35) or OS (p = 0.13) for high-risk versus low-risk groups. Ongoing smoking (p = 0.023), alcohol use (p = 0.044) and advanced stage (p = 0.019) were associated with higher risk of recurrence. Only advanced stage (p-value <0.0001) was associated poorer overall survival. CONCLUSIONS The presence of ENE+ and/or margin+ was not an independent predictor of poor RFS or OS in HPV+ OPC.
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Rao V, Subash A, Sinha P, Shetty S, Thakur S, Merchant Y, Kudpaje A, Arakeri G. Role of Adjuvant Radiotherapy in Early Stage Tongue Cancer: Need for Establishing Stringent Guidelines. Indian J Surg Oncol 2021; 12:549-553. [PMID: 34658584 DOI: 10.1007/s13193-021-01379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
The primary objective of this study was to determine, using population-based data, whether the addition of postoperative radiotherapy (RT) provides an overall survival benefit in patients with early primary squamous cell carcinoma (SCC) of tongue. The study included the data of tongue cancer patients treated between January 2016 and July 2019 retrieved from our hospital database. Tumours limited to pathologic T1 and T2 category managed with primary surgery with or without postoperative external beam RT were included. Overall survival (OS) and disease-free survival (DFS) were the main outcomes of interest. A total of 211 cases of oral cancer were evaluated and all the patients had clear surgical and pathological margins. Postoperative adjuvant therapy (PORT) was received by 16 patients. Comparison of DFS and OS at 2-year follow-up depicted a similar outcome (p = 0.582 and p = 0.312 respectively). Findings from our study suggest that in the absence of any absolute advantage on quantifiable survival and disease control, it is necessary to define stringent criteria when advocating PORT in early tongue cancer.
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Affiliation(s)
- Vishal Rao
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Anand Subash
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Piyush Sinha
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Sameep Shetty
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Shalini Thakur
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Yash Merchant
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Akshay Kudpaje
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Gururaj Arakeri
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
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Fan KH, Yeh CH, Hung SP, Kang CJ, Huang SF, Chang KP, Wang HM, Chia-Hsun Hsieh J, Lin CY, Cheng AJ, Ng SH, Tung-Chieh Chang J. Prognostic value of radiologic extranodal extension in patients with hypopharyngeal cancer treated with primary chemoradiation. Radiother Oncol 2020; 156:217-222. [PMID: 33385465 DOI: 10.1016/j.radonc.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the prognostic value of radiologic extranodal extension (rENE) in patients with hypopharyngeal cancer (HPC) treated with primary chemoradiation. MATERIALS AND METHODS Cancer registry data were reviewed from 2005 to 2014. Inclusion criteria included HPC, clinical N1-3 disease (AJCC staging system, 7th edition), and receiving radiotherapy. Patients with M1 diseaseor with synchronous/metachronous cancer were excluded. Staging images were reviewed by two radiologists. rENE was defined as infiltration of adjacent fat/muscles, irregular nodal surface, or irregular capsular enhancement. Clinical stage, rENE status, and clinical outcome were analyzed. RESULTS Overall, 355 patients were included. Patients with rENE had lower 3-year overall survival (OS) and recurrence-free survival (RFS) rates. Univariate analysis showed that clinical T4 or N3 stage, overall stage IV, and rENE correlated with OS and RFS. In multivariate analysis, clinical T4 or N3 stage correlated with poor OS, while clinical T4 or N3 stage and rENE were independent predictors of poor RFS. N1/2 without rENE was designated as Group 1, N1/2 with rENE as Group 2, and N3 with/without rENE as Group 3. The 3-year RFS rates in Groups 1, 2, and 3 were 55.8%, 41.0%, and 29.3%, respectively. The 3-year RFS rate in Group 1 was significantly higher than that in the other two groups. CONCLUSIONS rENE is an adverse prognostic factor for survival in patients with HPC treated with primary chemoradiation. It correlated with inferior RFS regardless of N stage. rENE may be used as a criterion for clinical ENE in future staging systems.
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Affiliation(s)
- Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, Taiwan; Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Ping Hung
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ann-Joy Cheng
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital at Xiamen, China.
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Dhouib F, Bertaut A, Maingon P, Siala W, Daoud J, Aubignac L, Lestrade L, Crehange G, Vulquin N. Patterns of Failure in Patients With Head and Neck Squamous Cell Carcinomas of Unknown Primary Treated With Chemoradiotherapy. Technol Cancer Res Treat 2020; 19:1533033820905826. [PMID: 32484037 PMCID: PMC7268107 DOI: 10.1177/1533033820905826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: To evaluate the patterns of failure in patients treated for head and neck carcinoma of unknown primary and to discuss treatment practices concerning radiotherapy target volumes definition and dose prescription. Methods: Eleven patients presenting a locoregional recurrence after head and neck carcinoma of unknown primary treatment with curative-intent radiochemotherapy performed between 2007 and 2017 in the departments of radiation oncology of 2 French cancer institutes. Images of the computed tomography scan or the magnetic resonance imaging performed at the time of the recurrence were fused with those of the simulation computed tomography scan to delimit a volume corresponding to the recurrence and to define the area of relapse compared to the volumes treated. Results: Irradiation was unilateral in 6 cases and bilateral in 5 cases. The median time to onset of recurrence was 7.24 months (extreme 3-67.7 months). Six patients had only a neck node recurrence, 3 had a neck node and subsequent primary recurrence, and 1 had only a median subsequent primary recurrence. Only 1 patient had synchronous distance progression to local recurrence. All neck node recurrences were solitary and ipsilateral. The subsequent primary recurrences were in the oropharynx in 3 cases and in the contralateral oral cavity in one case. All neck node recurrences were into the irradiated volume. The subsequent primary recurrences were either within or in border of the irradiated volumes. The median of the mean dose, received by neck node recurrences, was 69.9 Gy and that of the mean dose, minimum dose, maximum dose, and dose received by 95% of the volume of recurrence was 66.7 Gy. For the primary relapses, the median of the mean dose was 52.1 Gy and that of the mean dose, minimum dose, maximum dose, and dose received by 95% of the volume of recurrence was 39.9 Gy. Conclusions: All local nodal recurrences occurred at sites that received high radiotherapy doses and doses received by sites of eventual failure did not vary significantly from sites that remain in control.
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Affiliation(s)
- Fatma Dhouib
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France.,Department of Oncology Radiotherapy, Habib Bourguiba Central University Hospital, Sfax, Tunisia
| | - Aurélie Bertaut
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Philippe Maingon
- Department of Oncology Radiotherapy, Central University Hospital La Pitié Salpêtrière, Paris, France
| | - Wicem Siala
- Department of Oncology Radiotherapy, Habib Bourguiba Central University Hospital, Sfax, Tunisia
| | - Jamel Daoud
- Department of Oncology Radiotherapy, Habib Bourguiba Central University Hospital, Sfax, Tunisia
| | - Léone Aubignac
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Laetitia Lestrade
- Department of Oncology Radiotherapy, Central University Hospital, Besançon, France
| | - Gilles Crehange
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Noemie Vulquin
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
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Subash A, Singh A, Sinha P. The omission of level IIB in early oral cancers: A word of caution. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:224-226. [PMID: 32535254 DOI: 10.1016/j.jormas.2020.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Affiliation(s)
- A Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bangalore, India.
| | - A Singh
- Department of Surgical Oncology, AIIMS, Rishikesh, India
| | - P Sinha
- Department of Head and Neck Surgical Oncology, Medanta Hospital, Lucknow, India
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Tumor Budding and Cell Nest Size Are Highly Prognostic in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: Further Evidence for a Unified Histopathologic Grading System for Squamous Cell Carcinomas of the Upper Aerodigestive Tract. Am J Surg Pathol 2020; 43:303-313. [PMID: 30475254 DOI: 10.1097/pas.0000000000001178] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Squamous cell carcinoma (SCC) is the most common cancer of the head and neck region including-among others-laryngeal (LSCC) and hypopharyngeal (HSCC) subsites. LSCC/HSCC are heterogenous diseases with respect to patient outcome. Currently, tumor stage-based patient stratification is essential to predict prognosis and thus selection of the appropriate treatment modalities. In contrast, the prognostic impact of the current HSCC/LSCC grading system according to the WHO classification is limited. Recently, a novel grading system based on tumor budding activity (BA) and cell nest size (CNS) has been introduced for SCC in different anatomic regions of the upper aerodigestive tract. To test and transvalidate this grading scheme in LSCC and HSCC, we retrospectively correlated BA, CNS, and additional histomorphologic parameters with clinicopathologic data of 157 treatment-naive patients. In doing so, we demonstrate that a 3-tiered novel grading system (well-differentiated [nG1], intermediately [nG2], and poorly differentiated [nG3]) based on a sum score for BA and CNS is highly and independently prognostic for patient survival in LSCC/HSCC, strongly outperforming the current WHO grading scheme with a hazard ratio for disease-specific survival of 6.6 for nG2 and 13.4 for nG3 cases (P<0.001). This finding contributes to a growing body of evidence that a CNS and BA-based pan-entity grading system in SCC might be useful and seems to capture differences in underlying SCC biology crucial for survival.
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Rajappa S, Maheshwari U, Ram D, Koyyala V, Mandal G, Kumar R, Dewan A, Vishwakarma G. Extracapsular extension in oral cavity cancers—predictive factors and impact on recurrence pattern and survival. Int J Oral Maxillofac Surg 2019; 48:989-994. [DOI: 10.1016/j.ijom.2019.03.900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
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11
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Gong Y, Ju H, Ren G, Wu Y. Cisplatin based induction chemotherapy modified by ERCC1 improved the outcome of young adults with locally advanced oral squamous cell carcinoma. J Cancer 2019; 10:2083-2090. [PMID: 31205569 PMCID: PMC6548157 DOI: 10.7150/jca.28959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/07/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To evaluate the efficacy of induction chemotherapy in young adults with locally advanced oral squamous cell carcinoma (OSCC) and the usefulness of ERCC1 as a prognostic indicator. Methods: A total of 156 young adults with locally advanced OSCC were retrospectively analyzed from May 2007 to May 2017. Cisplatin based induction chemotherapy followed by surgery and upfront surgery were the primary treatment options for locally advanced OSCC. ERCC1 was evaluated by immunohistochemistry. Multivariate analysis was performed to identify significant prognostic factors for the overall survival (OS) in young adults with locally advanced OSCC. Results: Extracapsular spread (ECS) (p<0.0001) and UICC staging (p<0.0001) were critical prognostic factors for OS in young adults with locally advanced OSCC. The 5-year OS was 83.2% in N0 patients received induction chemotherapy and 61.7% in N0 patients received upfront surgery (p<0.05). Patients with a low ERCC1 expression were more likely to benefit from induction chemotherapy, as the 5-year OS was 22.4% in patients with a high ERCC1 expression and 84.7% in patients with a low ERCC1 expression, respectively (p<0.0001). However, induction chemotherapy resulted in a higher 5-year OS (84.7%) than upfront surgery (59.1%) in patients with a low ERCC1 expression (p=0.03). Conclusions: Induction chemotherapy can improve the outcome of N0 patients. However, the ERCC1 expression should be determined in young patients with locally advanced OSCC prior to induction chemotherapy, as it is a useful biomarker for predicting the outcome after induction chemotherapy.
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Affiliation(s)
- Yin Gong
- Dept. of of stomatology, First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Houyu Ju
- Dept. of Oral & Maxillofacial -head and neck Oncology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Guoxin Ren
- Dept. of Oral & Maxillofacial -head and neck Oncology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Yunteng Wu
- Dept. of Oral & Maxillofacial -head and neck Oncology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
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12
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Noor A, Mintz J, Patel S, Bajic N, Boase S, Sethi N, Foreman A, Krishnan S, Hodge J. Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol 2019; 63:500-509. [DOI: 10.1111/1754-9485.12888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony Noor
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Jack Mintz
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Sandy Patel
- Department of Radiology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Nicholas Bajic
- Department of Radiology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Sam Boase
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Neeraj Sethi
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Andrew Foreman
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Suren Krishnan
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - John‐Charles Hodge
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
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13
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Lop J, Rigó A, Codina A, de Juan J, Quer M, León X. Significado pronóstico de la extensión extranodal en pacientes con carcinomas escamosos de cabeza y cuello cN0 con metástasis ganglionares ocultas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:156-164. [DOI: 10.1016/j.otorri.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
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14
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Prognostic Significance of Extranodal Extension in Head and Neck Squamous Cell Carcinoma cN0 Patients With Occult Metastatic Neck Nodes. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Matos LL, Dedivitis RA, Kulcsar MAV, de Mello ES, Alves VAF, Cernea CR. External validation of the AJCC Cancer Staging Manual, 8th edition, in an independent cohort of oral cancer patients. Oral Oncol 2017; 71:47-53. [DOI: 10.1016/j.oraloncology.2017.05.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/22/2017] [Accepted: 05/27/2017] [Indexed: 02/07/2023]
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16
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Prognostic significance of extracapsular spread of lymph node metastasis from oral squamous cell carcinoma in the clinically negative neck. Int J Oral Maxillofac Surg 2017; 46:669-675. [DOI: 10.1016/j.ijom.2017.02.1277] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022]
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17
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Mermod M, Tolstonog G, Simon C, Monnier Y. Extracapsular spread in head and neck squamous cell carcinoma: A systematic review and meta-analysis. Oral Oncol 2016; 62:60-71. [PMID: 27865373 DOI: 10.1016/j.oraloncology.2016.10.003] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/06/2016] [Accepted: 10/08/2016] [Indexed: 11/24/2022]
Abstract
Extracapsular spread (ECS) is one of the most important prognostic factors in head and neck squamous cell carcinoma (HNSCC). However, despite its major clinical relevance, there are still a number of important remaining issues regarding this condition. Indeed, standardized diagnostic and grading criteria of ECS are still lacking. The imaging modality of choice for its diagnosis is a matter of debate. Current research looking at the identification of specific biomarkers is ongoing. Recent findings demonstrate a direct correlation between the level of extension of ECS and a poor prognosis. Accumulating data show that ECS does not carry the same adverse features in human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). New treatment strategies based on these factors are currently considered to investigate the possibility of diminishing the toxicity of chemo-radiotherapy while maintaining similar outcomes. The goal of this article was to provide a systematic review of the literature covering all the issues related to ECS. As an additional component of the review, meta-analyses were performed on relevant aspects of ECS for which previous quantitative data were outdated or not available. The results of these meta-analyses confirm the negative impact of ECS on loco-regional recurrence and distant metastasis. They also demonstrate the absence of a negative impact of ECS in HPV-positive OPSCC.
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Affiliation(s)
- Maxime Mermod
- Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland
| | - Genrich Tolstonog
- Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland
| | - Christian Simon
- Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland
| | - Yan Monnier
- Department of Otolaryngology, Head & Neck Surgery, Head & Neck Tumor Laboratory, CHUV, University Hospital, Lausanne, Switzerland.
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18
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Huhn JL, Regine WF, Valentino JP, Meigooni AS, Kudrimoti M, Mohiuddin M. Spatially Fractionated GRID Radiation Treatment of Advanced Neck Disease Associated with Head and Neck Cancer. Technol Cancer Res Treat 2016; 5:607-12. [PMID: 17121437 DOI: 10.1177/153303460600500608] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Advanced nodal disease associated with head and neck cancer warrants aggressive, often multi-modality therapy to maximize local-regional control. The expansion of a novel treatment paradigm developed by our institution includes the addition of a single-fraction of high dose spatially-fractionated radiation (GRID) to a conventional course of treatment. Between 1995 and 2002 a series of 27 patients (median age 65) with bulky N2-3 disease were treated. Median nodal tumor size was 7 cm. Two groups of patients were evaluated. Group 1 (N=14) patients received a median neck dose 69 Gy (range 54–79 Gy) plus GRID treatment. Group 2 (N=13) patients received a median neck dose of 59 Gy (range 54–72 Gy) plus GRID treatment followed by planned neck dissection. Patients were evaluated for local-regional control, pathological response, survival, and morbidity. Median time to follow-up for Group 1 was 10 months (range 3–44 months). Neck control was 93%. Disease specific survival was 50%. Morbidity was limited to soft-tissue related damage and was mild. Median time to follow-up for Group 2 was 38 months (range 5–116 months). Pathologic complete response rate was 85%. Overall neck control rate was 92%. Disease specific survival was 85%. Surgical morbidity was limited to three wound healing complications. GRID treatment may be safely added to conventional treatment management of locally advanced neck disease related to cancer with acceptable morbidity. It may improve pathologic complete response rates in those patients who undergo planned neck dissection, possibly leading to improved survival. In patients with inoperable bulky disease, addition of GRID enhances local-regional control.
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Affiliation(s)
- Jeniffer L Huhn
- University of Kentucky, 800 Rose St. N15, Lexington, KY 40536, USA.
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19
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Soft tissue metastasis in p16-positive oropharynx carcinoma: Prevalence and association with distant metastasis. Oral Oncol 2015; 51:778-86. [DOI: 10.1016/j.oraloncology.2015.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 11/18/2022]
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20
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Sinha P, Lewis JS, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer 2011; 118:3519-30. [DOI: 10.1002/cncr.26671] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 09/28/2011] [Accepted: 10/05/2011] [Indexed: 11/11/2022]
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21
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Marioni G, Staffieri A, Giacomelli L, Lionello M, Guzzardo V, Busnardo A, Blandamura S. Mammalian target of rapamycin expression and laryngeal squamous cell carcinoma prognosis: novel preliminary evidence. Histopathology 2011; 58:1148-56. [PMID: 21707714 DOI: 10.1111/j.1365-2559.2011.03864.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The mammalian target of rapamycin (mTOR) has a key role in regulating cancer cell proliferation, apoptosis, cell migration, and angiogenesis. The aim of this study was to assess the relationships between mTOR and clinicopathological and prognostic parameters in laryngeal squamous cell carcinoma (SCC). METHODS AND RESULTS Mammalian target of rapamycin expression was determined in 103 consecutive operable laryngeal SCCs. Among the mTOR-positive cases, the locoregional recurrence rate was higher (P=0.048) and the disease-free survival (DFS) rate was shorter (P=0.031) in patients with mTOR expression >50.7%. In the N(0) subgroup, the disease recurrence rate was higher (P=0.034) and the DFS was shorter (P=0.009) in patients with mTOR expression >50.7%. In mTOR-positive patients, multivariate analysis showed that N stage (P=0.0001) and mTOR status (P=0.042) were independent indicators of a poor prognosis. CONCLUSIONS mTOR appeared to be a significant predictor of DFS in univariate and multivariate models. mTOR expression in laryngeal SCC may be useful for the detection of patients at higher risk for recurrence, and N(0) patients at higher risk for early locoregional recurrence who might benefit from more aggressive therapy. The role of mTOR inhibitors in multimodality or multitarget strategies against laryngeal SCC warrants investigation.
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Affiliation(s)
- Gino Marioni
- Department of Medical and Surgical Specialties, Otolaryngology Section, University of Padova, Padova, Italy.
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22
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Sumi M, Nakamura T. Extranodal spread in the neck: MRI detection on the basis of pixel-based time-signal intensity curve analysis. J Magn Reson Imaging 2011; 33:830-8. [PMID: 21448947 DOI: 10.1002/jmri.22454] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We evaluated dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for the preoperative detection of extranodal spread (ENS) in metastatic nodes in the neck. MATERIALS AND METHODS The time-signal intensity curve (TIC) profiles of 54 histologically proven metastatic nodes (26 ENS-positive and 28 ENS-negative) from 43 patients with head and neck squamous cell carcinoma (SCC) were retrospectively analyzed to determine the effective TIC criteria for ENS-positive nodes. The TICs were semiautomatically classified into four distinctive patterns (flat, slow uptake, rapid uptake with low washout ratio, and rapid uptake with high washout ratio) on a pixel-by-pixel basis. RESULTS A number of the MRI findings were significantly correlated with ENS. However, multivariate logistic regression analysis revealed that only a short-axis diameter and an area with slow uptake TIC patterns were significantly and independently indicative of the presence of ENS. The combined MRI criteria of nodal size (>25 mm) or TIC profile (>44% nodal areas with slow-uptake TIC patterns) yielded the best results for differentiation between ENS-positive and ENS-negative nodes, providing 96% sensitivity, 100% specificity, 98% accuracy, and 100% positive, and 97% negative predictive values. CONCLUSION When combined with size criteria, pixel-based MR factor analysis may be a promising tool for detecting ENS.
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Affiliation(s)
- Misa Sumi
- Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan
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23
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Méndez E, Lohavanichbutr P, Fan W, Houck JR, Rue TC, Doody DR, Futran ND, Upton MP, Yueh B, Zhao LP, Schwartz SM, Chen C. Can a metastatic gene expression profile outperform tumor size as a predictor of occult lymph node metastasis in oral cancer patients? Clin Cancer Res 2011; 17:2466-73. [PMID: 21300763 DOI: 10.1158/1078-0432.ccr-10-0175] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the differential gene expression between oral squamous cell carcinoma (OSCC) with and without metastasis to cervical lymph nodes and to assess prediction of nodal metastasis by using molecular features. EXPERIMENTAL DESIGN We used Affymetrix U133 2.0 plus arrays to compare the tumor genome-wide gene expression of 73 node-positive OSCCs with 40 node-negative OSCCs (≥ 18 months). Multivariate linear regression was used to estimate the association between gene expression and nodal metastasis. Stepwise logistic regression and receiver operating characteristics (ROC) analysis were used to generate predictive models and to compare these with models by using tumor size alone. RESULTS We identified five genes differentially expressed between node-positive and node-negative OSCCs after adjusting for tumor size and human papillomavirus status: REEP1, RNF145, CTONG2002744, MYO5A, and FBXO32. Stepwise regression identified a four-gene model (MYO5A, RFN145, FBXO32, and CTONG2002744) as the most predictive of nodal metastasis. A leave-one-out ROC analysis revealed that our model had a higher area under the curve (AUC) for identifying occult nodal metastasis compared with that of a model by tumor size alone (respective AUC: 0.85 and 0.61; P = 0.011). A model combining tumor size and gene expression did not further improve the prediction of occult metastasis. Independent validation using 31 metastatic and 13 nonmetastatic cases revealed a significant underexpression of CTONG2002744 (P = 0.0004). CONCLUSIONS These results suggest that our gene expression markers of OSCC metastasis hold promise for improving current clinical practice. Confirmation by others and functional studies of CTONG2002744 is warranted.
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Affiliation(s)
- Eduardo Méndez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Antonio JK, Menezes MB, Kavabata NK, Bertelli AAT, Kikuchi W, Gonçalves AJ. Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract. SAO PAULO MED J 2008; 126:112-8. [PMID: 18553034 DOI: 10.1590/s1516-31802008000200009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 03/12/2008] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. DESIGN AND SETTING Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). METHODS We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). RESULTS Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. CONCLUSIONS SND may be a good option for treating node-positive necks in selected cases.
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Affiliation(s)
- Jamile Karina Antonio
- Division of Head and Neck Surgery, Department of Surgery, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
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25
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Mochiki M, Sugasawa M, Nibu KI, Asai M, Nakao K, Asakage T. Prognostic factors for hypopharyngeal cancer: a univariate and multivariate study of 142 cases. Acta Otolaryngol 2007:136-44. [PMID: 18340585 DOI: 10.1080/03655230701600095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS Reduction of distant metastases is essential for better survival. Effective adjuvant chemotherapy should be developed for patients with advanced primary disease (T>2) as well as for patients with advanced nodal status (N>0 or PLN>2). OBJECTIVES The aim of this study was to identify prognostic factors for hypopharyngeal cancer. PATIENTS AND METHODS In all, 142 previously untreated patients were analyzed retrospectively; 75% of the cases were stage III or IV. Surgical resection was administered as primary treatment to 116 of the patients (82%), while 26 patients (18%) underwent primary radiotherapy. RESULTS The cause-specific 5-year actuarial survival was 46.3%. Distant metastases were the most frequent (23%) cause of failure, followed by local recurrence (15%), and regional recurrence (13%). Cox's regression analysis showed that the significant factors affecting cause-specific survival were N classification, T classification, number of pathological lymph node metastases (PLN), lymphatic invasion, and positive surgical margin. Similarly, T classification and PLN affected distant metastases.
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Abstract
Squamous cell carcinoma of the oral tongue (SCCOT) is one of the most prevalent tumors of the head and neck region. Despite advances in treatment, the survival of patients with SCCOT has not significantly improved over the past several decades. Most frequently, treatment failure takes the form of local and regional recurrences, but as disease control in these areas improves, SCCOT treatment failures are occurring more often as distant metastasis. The presence of cervical lymph node metastasis is the most reliable adverse prognostic factor in patients with SCCOT, and extracapsular spread (ECS) of cervical lymph nodes metastasis is a particularly reliable predictor of regional and distant recurrence and death from disease. Decisions regarding the elective and therapeutic management of cervical lymph node metastases are made mainly on clinical grounds as we cannot always predict cervical lymph node metastasis from the size and extent of invasion of the primary tumors. Therefore, the treatment of these metastases in the management of SCCOT remains controversial. The promise of basing treatment decisions on biomarkers has yet to be fully realized because of our poor understanding of the mechanisms of regional and distant metastases of SCCOT. Here we summarize the current status of investigations of SCCOT metastases and the potential of these studies to have a positive impact on the clinical management of SCCOT in the future.
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Affiliation(s)
- Daisuke Sano
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Unit 441, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA.
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Woolgar JA. The topography of cervical lymph node metastases revisited: the histological findings in 526 sides of neck dissection from 439 previously untreated patients. Int J Oral Maxillofac Surg 2007; 36:219-25. [PMID: 17239562 DOI: 10.1016/j.ijom.2006.10.014] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 07/27/2006] [Accepted: 10/06/2006] [Indexed: 11/18/2022]
Abstract
The pathological reports, minimum datasets and topographical plots of the neck dissections from 439 cases of oral and oropharyngeal cancer reported by a single pathologist following a standard protocol were analysed. Metastasis was evident in 47% of patients including bilateral metastases in 6%, extracapsular spread in 29% and matting in 7%. The extent of metastasis (both volume and distribution) was greatest in tumours of the oropharynx followed by lateral tongue, ventral tongue and floor of mouth. The typical 'inverted-cone pattern' was seen in 67% of patients with metastasis. A single micrometastasis was seen in 14%, skip lesions in 10% and involvement of 'other' nodal groups in 4%. Contralateral neck metastases (0.4%), peppering (2%), flushing of lymph node sinuses (1%) and all nodes positive (0.4%) accounted for the remaining 'aberrant' patterns. Skip lesions were seen in tumours at all sites other than retromolar.
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Affiliation(s)
- J A Woolgar
- Oral Pathology, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK.
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28
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Marioni G, Marchese-Ragona R, Cartei G, Marchese F, Staffieri A. Current opinion in diagnosis and treatment of laryngeal carcinoma. Cancer Treat Rev 2006; 32:504-15. [PMID: 16920269 DOI: 10.1016/j.ctrv.2006.07.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 06/28/2006] [Accepted: 07/03/2006] [Indexed: 11/28/2022]
Abstract
Laryngeal carcinoma is the 11th commonest form of cancer in men world-wide, with 121,000 new cases in 1985. More than 95% of all laryngeal malignancies are squamous cell carcinomas. Treatment indications in cancer of the larynx are often controversial, since there are few comparative studies of different available therapeutic approaches. Surgery and radiotherapy are both widely used, and the choice between these two procedures is the most common therapeutic decision which has to be taken. Laryngeal function preservation has gained more and more weight in the last decades and chemotherapy is also a significant component of several curative approaches. In the last decades, several organ-preserving surgical techniques have become available and consequently total laryngectomy results less applied. Regardless of the treatment modality, Tis, T1, T2 laryngeal carcinomas have an 80-90% probability of cure, whereas for more advanced tumours this is approximately 60%. The most effective approach to laryngeal cancer remains prevention and early diagnosis when this cancer is curable with function preserving treatments.
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Affiliation(s)
- Gino Marioni
- Department of Medical and Surgical Specialties, Section of Otolaryngology, University of Padova, Via Giustiniani 2, 35100 Padua, Italy.
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29
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Dünne AA, Müller HH, Eisele DW, Kessel K, Moll R, Werner JA. Meta-analysis of the prognostic significance of perinodal spread in head and neck squamous cell carcinomas (HNSCC) patients. Eur J Cancer 2006; 42:1863-8. [PMID: 16831543 DOI: 10.1016/j.ejca.2006.01.062] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Revised: 11/22/2005] [Accepted: 01/26/2006] [Indexed: 11/26/2022]
Abstract
To assess the risk factor of capsular rupture for individual prognosis and potential therapeutic decision making, the present meta-analysis elaborated the prognostic significance of perinodal spread in a large group of patients suffering from head and neck squamous cell carcinomas (HNSCC). A review of the published literature was conducted, and fixed and random effects models were applied for estimation of the summarised odds ratio and 95% confidence intervals, including a test for homogeneity of the odds ratios. Study methodology allowed the enrollment of only nine studies of 115 published papers. Excluded studies lacked regarding primary tumour location, number and location of lymph node metastases, values on five-year survival, or adequate follow-up data. A summarised odds ratio of 2.7 leads to the conclusion that perinodal spread negatively impacts the five-year survival. The lower confidence limit of more than 2 also supports the concept that perinodal spread significantly reduces (doubled risk) the five-year-survival. These results support the conclusion that perinodal spread is a significant adverse risk factor for survival in patients with HNSCC.
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Affiliation(s)
- A A Dünne
- Department of Otolaryngology, Head and Neck Surgery, Philipps University Marburg, Deutschhausstrasse 3, 35037 Marburg, Germany.
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Yamazaki Y, Chiba I, Hirai A, Satoh C, Sakakibara N, Notani KI, Iizuka T, Totsuka Y. Clinical value of genetically diagnosed lymph node micrometastasis for patients with oral squamous cell carcinoma. Head Neck 2006; 27:676-81. [PMID: 15957194 DOI: 10.1002/hed.20200] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the incidence and clinical significance of genetically diagnosed lymph node micrometastasis for patients with oral squamous cell carcinoma (SCC). METHODS A total of 495 lymph nodes obtained from 21 patients with primary oral SCCs that had p53 mutations were examined for corresponding p53 mutations in lymph nodes using mutant allele-specific amplification (MASA). RESULTS Among 476 histologically negative nodes, 44 were scored as positive for metastasis by MASA. All 19 histologically positive lymph nodes were genetically positive. Four of the 10 pN0 cases and nine of the 11 pN-positive cases had genetically positive micrometastases. Four patients who had five or more genetically positive lymph nodes located in three or more levels, three with disease staged as pN0 or pN1, died of cancer. CONCLUSIONS These results indicate that a high rate of micrometastasis in cervical lymph nodes of oral SCCs and patients with multiple or lower neck spread of micrometastases have a poor prognosis; they should be treated with postoperative adjuvant therapy.
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Affiliation(s)
- Yutaka Yamazaki
- Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Kita-13 Nishi-7, Sapporo, 060-8586, Japan.
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Abstract
Sentinel lymph node biopsy (SLNB) is a minimally invasive method that was developed to stage the regional lymphatics of patients with cutaneous melanoma. Many studies performed worldwide have shown that SLNB is a feasible method to stage the cervical lymphatics in patients with head and neck squamous cell carcinoma (HNSCC). The accuracy of SLNB in patients with HNSCC is currently under investigation in a multicenter study sponsored by the American College of Surgeons Oncology Group that compares the results of SLNB with standard elective neck dissection. Research to date has also shown that multiple SLNs and individualized drainage patterns characterize head and neck mucosal sites. These findings suggest that lymphoscintigraphy alone may be useful to delineate the lymphatic basins that require treatment in patients with HNSCC and in patients whose head and neck lymphatics are disrupted because of prior surgery or irradiation.
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Affiliation(s)
- Karen T Pitman
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS 30216, USA.
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32
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Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2005; 42:229-39. [PMID: 16150633 DOI: 10.1016/j.oraloncology.2005.05.008] [Citation(s) in RCA: 287] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 05/24/2005] [Indexed: 11/20/2022]
Abstract
Histopathological assessment of the surgical resection specimen continues to provide information that is central to determining the post-operative treatment needs and prognosis for an individual patient with oral/oropharyngeal squamous cell carcinoma. This review describes the prognostic value of histopathological features related to the primary tumour and the cervical lymph nodes, and considers their relative merits. In addition, a brief overview of more general patient factors is included. Throughout the review, guidance is offered on practical aspects of the histopathological assessment together with brief mention of potential inaccuracies. Emphasis is given also to the importance of the partnership between the surgeon and the pathologist, the need for standardisation during all stages of the histopathological assessment, and the value of accurate documentation of the findings.
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Affiliation(s)
- Julia A Woolgar
- Oral Pathology, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, United Kingdom.
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Rabbels J, Wyzisk M, Siessegger M, Klesper B, Reuther T, Kübler AC. [Quality of life of patients with squamous cell carcinoma of the oral cavity]. ACTA ACUST UNITED AC 2005; 9:300-5. [PMID: 16041616 DOI: 10.1007/s10006-005-0628-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the changes in quality of life during and after treatment in patients with cancer of the oral cavity. PATIENTS AND METHODS In the period between October 1999 and September 2000, 57 patients of the Department of Craniomaxillofacial Surgery, University of Cologne, underwent surgery, radiation therapy or the combination of both for the treatment of cancer of the oral cavity. Before, during and after the therapy their quality of life was measured with two psychometric scales. RESULTS The average loss of quality of life in the female group was less than in the male group. Younger patients suffered more than older ones did. All patients had a loss of quality of life 3 months after the beginning of the therapy. The biggest decrease was in the group of patients treated with combined therapy, and the lowest loss in the radiated group. During the assessment period of 9 months, there were significant differences between all three groups. The size of the tumor did not show any influence on the reduction of quality of life. Patients with cancer of the tongue or maxilla showed more loss of quality of life than patients with tumors located in other regions of the oral cavity. CONCLUSION Location of the tumor, age, gender of the patient, and type of therapy influenced the quality of life, while the size of the tumor did not.
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Affiliation(s)
- J Rabbels
- Klinik und Poliklinik für Zahnärztliche Chirurgie und für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universität zu Köln.
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Chandu A, Adams G, Smith ACH. Factors affecting survival in patients with oral cancer: an Australian perspective. Int J Oral Maxillofac Surg 2005; 34:514-20. [PMID: 16053871 DOI: 10.1016/j.ijom.2004.10.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Revised: 06/01/2004] [Accepted: 10/18/2004] [Indexed: 11/25/2022]
Abstract
Little is known regarding disease-specific cumulative survival and factors affecting survival in Australian populations with oral squamous cell carcinoma. Kaplan Meier and Cox proportional hazards models were used to determine survival factors in 116 consecutive patients treated surgically at a single institution. Overall 5-year disease-specific survival rate was 83.3%. Five-year disease-specific survival probability was 88.7%, 83.8%, 83.3% and 76.5% for stage I, II, III and IV, respectively. Univariate analysis revealed that local and regional recurrence, distant metastases, N stage, margin status, radiotherapy, perivascular spread and extra-capsular spread (ECS) significantly influenced survival. Significant multivariate factors included local and regional recurrence, positive margins, and ECS. Better survival rates were found than in previous, older Australian reports. Close observation for early recurrence and aggressive management of patients with recurrence, positive margins and ECS, is advised.
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Affiliation(s)
- A Chandu
- Oral and Maxillofacial Surgery, Austin Health, Burgundy St., Heidelberg 3084, Vic., Australia
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Wenzel S, Koch U. [Squamous cell carcinomas of the upper aerodigestive tract. Prognostic significance of the capsular rupture and extracapsular spread of lymph node metastases]. HNO 2004; 52:783-9. [PMID: 15249966 DOI: 10.1007/s00106-004-1119-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The capsular rupture and subsequent extranodal spread of lymph node metastases is of crucial and well established prognostic value in patients with squamous cell carcinomas of the upper aerodigestive tract. Besides the basic histologic definition of the extranodal spread (i.e. contact of the metastasis with perinodal fatty tissue), there is no agreement on the morphologic extent of transcapsular spread. As a measure of improvement, a histologic evaluation differentiating between seven gradual types of metastatic nodal affection was applied. The histologic scheme considers intranodal growth, infiltration of the capsule, the presence of desmoplasia and especially the rupture of the capsule and the subsequent extranodal spread of the metastasis. As extranodal spread is an easily reproducible and reliably significant prognostic criterion, it should be included in the current TNM classification, e.g., by an addition of the index R+ (lymph node metastasis with capsular rupture) or R- (lymph node metastasis without capsular rupture) to the N category.
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Affiliation(s)
- S Wenzel
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde des Universitätsklinikums Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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Ferrer Ramírez MJ, Guallart Doménech F, Brotons Durban S, Carrasco Llatas M, Estellés Ferriol E, López Martínez R. [Hypopharyngeal cancer: analysis of the evolution and surgical results]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2004; 55:67-72. [PMID: 15195522 DOI: 10.1016/s0001-6519(04)78485-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.
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Affiliation(s)
- M J Ferrer Ramírez
- Servicio de Otorrinolaringología, Hospital Universitario Dr. Peset, Valencia.
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Greenberg JS, El Naggar AK, Mo V, Roberts D, Myers JN. Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma. Implication for therapeutic decision making. Cancer 2003; 98:508-15. [PMID: 12879467 DOI: 10.1002/cncr.11526] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Regional lymph node metastasis is the most reliable predictor of treatment outcomes for patients with squamous cell carcinoma of the oral tongue (SCCOT). A recent American Joint Committee on Cancer staging update of malignant melanoma has incorporated pathologic lymph node staging. The authors hypothesized that pathologic lymph node staging (pN) would be a more reliable predictor of treatment outcomes than clinical lymph node staging (cN). METHODS The authors retrospectively reviewed 266 patients who received primary surgical treatment for SCCOT, including a neck dissection, from January 1980 to December 1995. Overall and disease-specific survival and disease-free interval were compared with respect to clinical and pathologic lymph node stages. RESULTS Statistically significant survival differences were identified for both clinical (cN0-cN2) and pathologic lymph node stages (pN0-pN2). However, survival and disease-free interval differences for pathologic lymph node staging reached higher statistical significance (P < 0.0001) than for clinical lymph node staging (P < 0.002). This disparity can be explained by stage migration (i.e., patients with cN0-1 disease have a more advanced lymph node stage at the time of pathologic review compared with patients without cN0-1 disease). The authors found a 34% rate of occult lymph node disease in the cN0 group (19% of occult lymph nodes had extracapsular spread [ECS]). Similarly, 43% of cN1 patients had a higher stage than pN2b disease and 50% had ECS. CONCLUSIONS Pathologic lymph node staging, based on a staging or therapeutic neck dissection, should be considered for patients treated for SCCOT to identify high-risk patients who may benefit from additional adjuvant therapy. Prospective studies are essential to validate these findings before pathologic lymph node staging is included in standard staging criteria.
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Affiliation(s)
- Jayson S Greenberg
- The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas 77030-4009, USA.
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Jose J, Coatesworth AP, Johnston C, MacLennan K. Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract: the significance of extracapsular spread and soft tissue deposits. Head Neck 2003; 25:451-6. [PMID: 12784236 DOI: 10.1002/hed.10214] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Literature regarding the prognostic significance of extracapsular spread and soft tissue deposits in cervical lymph node metastases of squamous cell carcinoma of the upper aerodigestive tract shows variable results. METHODS We analyzed 215 prospectively collected neck dissections from 155 patients with upper aerodigestive tract squamous cell carcinoma to assess the prevalence of extracapsular spread and soft tissue deposits and to assess their effect on survival. RESULTS Both extracapsular spread and soft tissue deposits significantly reduced survival (actuarial and recurrence free) compared with pN0 necks (p <.001) and pN+ve necks without extracapsular spread (p <.0025). There was no statistically significant difference between pN+ve necks without soft tissue deposits or extracapsular spread compared with those with pN0 necks (p =.24). Multivariate analysis revealed comparable results. CONCLUSIONS Microscopic and macroscopic extracapsular spread and soft tissue deposits are of prognostic significance for survival and recurrence-free survival in patients with upper aerodigestive tract squamous cell carcinoma.
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Affiliation(s)
- Jemy Jose
- Department of Otolaryngology, Head and Neck Surgery, Leeds General Infirmary, Great George Street, Leeds, United Kingdom
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Jose J, Coatesworth AP, MacLennan K. Cervical metastases in upper aerodigestive tract squamous cell carcinoma: histopathologic analysis and reporting. Head Neck 2003; 25:194-7. [PMID: 12599286 DOI: 10.1002/hed.10194] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate histopathologic assessment of neck dissections is of paramount importance. Retrospective analyses of the distribution of lymph node metastases have formed the rationale for elective neck dissection. However, standard techniques for examination of neck dissection specimens may have difficulty in correctly recognizing node levels and may also miss micrometastases, microscopic extracapsular spread, and soft tissue deposits. METHODS Two hundred thirty-seven neck dissections were performed in 173 patients with squamous cell carcinoma of the upper aerodigestive tract between August 1995 and November 2000. The neck dissections were separated into node levels peroperatively, sectioned at 6 microm thickness, and stained with hematoxylin and eosin. RESULTS Eleven thousand three hundred forty-nine lymph nodes were identified and examined. The mean yield per neck dissection was 50.4 (range, 12-131); 21.4% had extracapsular spread, 11.0% had soft tissue deposits, and 13.3% had both. A third of the metastatic nodes were 3 mm or less in diameter. CONCLUSIONS The accurate pathologic staging of the neck in patients with upper aerodigestive tract squamous cell cancer is important for providing prognostic information and optimizing the treatment plan for the patient. Accurate staging also allows the changing patterns of disease to be monitored and allows equitable comparison of patients in clinical trials and among surgical units.
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Affiliation(s)
- Jemy Jose
- Department of Otolaryngology Head and Neck Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
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Ferlito A, Rinaldo A, Devaney KO, MacLennan K, Myers JN, Petruzzelli GJ, Shaha AR, Genden EM, Johnson JT, de Carvalho MB, Myers EN. Prognostic significance of microscopic and macroscopic extracapsular spread from metastatic tumor in the cervical lymph nodes. Oral Oncol 2002; 38:747-51. [PMID: 12570052 DOI: 10.1016/s1368-8375(02)00052-0] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
It has been established that the presence or absence of cervical node metastases in patients with head and neck squamous cell carcinoma (HNSCC) is a powerful prognostic indicator. This report reviews the evolution of thinking over the past 70 years with regard to the import and detection of cervical nodal metastases which exhibit spread of tumor beyond the confines of the original encompassing nodal capsule. In the process, this discussion touches upon clinical examination, gross and microscopic pathologic examination, and radiographic imaging studies. In particular, the distinction between gross nodal extracapsular spread of tumor and microscopic nodal extracapsular spread of tumor has been drawn in recent reports; this raises the possibility that identification of microscopic breaching of the nodc capsule by tumor might provide clinically significant information which is not provided by the gross observation of an intact lymph node capsule. While it remains to be seen whether microscopic extracapsular spread alone will prove to be an important prognostic factor, it is recommended that selective neck dissection continue to be offered even in those patients with clinically negative necks; further studies should aid in defining the import of microscopic extracapsular tumor spread in patients with positive cervical nodes.
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Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 1-33100 Udine, Italy.
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Gooris PJJ, Vermey A, de Visscher JGAM, Burlage FR, Roodenburg JLN. Supraomohyoid neck dissection in the management of cervical lymph node metastases of squamous cell carcinoma of the lower lip. Head Neck 2002; 24:678-83. [PMID: 12112542 DOI: 10.1002/hed.10079] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Supraomohyoid neck dissection (SOHND) is generally considered an adequate staging procedure in selected patients with squamous cell carcinoma (SCC) of the lip and oral cavity, with clinically negative nodes in the neck that are at increased risk for occult metastatic disease. The potential role of SOHND as a therapeutic surgical procedure for cervical metastasis limited to level I is controversial. METHODS A series of 44 patients with clinical cervical lymph node metastases at level I from SCC of the lower lip is reported to evaluate the results of a treatment protocol consisting of therapeutic SOHND on indication followed by radiotherapy. RESULTS Regional recurrences were observed in four (9%) patients. All recurrences developed within the SOHND dissected area only. CONCLUSIONS A therapeutic SOHND, on indication followed by radiotherapy, can be an oncologically sound and effective procedure in the management of regional lymph node metastases at level I from SCC of the lower lip.
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Affiliation(s)
- Peter J J Gooris
- Department of Oral and Maxillofacial Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands.
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Suoglu Y, Erdamar B, Katircioglu OS, Karatay MC, Sunay T. Extracapsular spread in ipsilateral neck and contralateral neck metastases in laryngeal cancer. Ann Otol Rhinol Laryngol 2002; 111:447-54. [PMID: 12018330 DOI: 10.1177/000348940211100510] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the incidence of extracapsular spread (ECS) and the impact of ECS on contralateral neck metastasis in 67 patients with ipsilateral nodal metastasis (IpN+) whose records were extracted retrospectively from those of 155 laryngeal cancer patients. The incidence of ECS in association with variables was determined: T stage, N stage, tumor location, tumor extension, number of positive nodes, and contralateral neck status. The variables were evaluated to identify their impact on the rates of contralateral neck metastasis (CNM) and 3-year survival. Of the 67 patients, 30 (44.7%) had ECS. A significant relationship was found between ECS positivity and increased N stage, tumor extension up to the midline, number of positive nodes, and CNM (p = .04, p = .0001, p = .018, p = .0001, respectively). Multivariate analysis revealed that N stage (p = .002; odds ratio, 3.5517) and the presence of ECS (p = .0036; odds ratio, 7.7840) in IpN+ were associated with the greatest risk of CNM. The 3-year survival rate of patients with ipsilateral ECS was significantly lower than that of patients without ECS (43% versus 81%, p = .0002). Both CNM and presence of ECS in IpN+ emerged as significant independent predictors for survival with Cox multivariate analysis (p = .0086 and p = .0234, respectively). This result indicates the necessity of treating the contralateral N0 neck in cases of IpN+ with ECS.
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Affiliation(s)
- Yusufhan Suoglu
- Department of Otorhinolaryngology, Istanbul School of Medicine, Istanbul University, Turkey
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Su CK, Bhattacharya J, Wang CC. Role of neck surgery in conjunction with radiation in regional control of node-positive cancer of the oropharynx. Am J Clin Oncol 2002; 25:109-16. [PMID: 11943885 DOI: 10.1097/00000421-200204000-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For patients with clinically node-positive oropharynx cancer treated with radiotherapy, planned neck dissection is controversial. We investigated whether neck surgery after radiation reduces nodal recurrence. Between 1970 and 1995, 263 patients at Massachusetts General Hospital received radiotherapy for clinically node-positive base of tongue or tonsil carcinomas. Patients received three different types of treatment: neck surgery followed by radiation (SR)-50 patients; radiation alone (RT)-160 patients; and radiation followed by surgery (RS)-53 patients. Median patient follow-up was 28 months. SR patients have an 84% complete response (CR) rate, RT patients 76%, and RS patients 13%. In multivariate analysis, among patients with a CR, the three treatment groups have the same regional control rates. Among patients with an incomplete response, the RS treatment group is 67% (p < 0.01) and 86% (p < 0.01) less likely to have recurrence than the RT and SR groups, respectively. Neck dissection after radiation therapy improves regional control for patients without a complete clinical response to radiation therapy but not for those with a CR. Despite higher CR rates, neck dissection before radiation confers no regional control benefit. We therefore recommend that primary radiotherapy with neck dissection be reserved for those without a complete clinical response.
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Affiliation(s)
- Catherine K Su
- East Bay Regional Cancer Center, Hayward, California 94541, USA
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Vaidya AM, Petruzzelli GJ, Clark J, Emami B. Patterns of spread in recurrent head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2001; 125:393-6. [PMID: 11593178 DOI: 10.1067/mhn.2001.117715] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the pattern of spread regarding recurrent disease in primary head and neck squamous cell carcinoma. STUDY DESIGN AND SETTING A retrospective study reviewed 128 patients who underwent primary tumor resection and postoperative radiation and/or chemoradiation for squamous cell carcinoma at Loyola University Medical Center from July 1993 to August 1998. Patterns of spread of recurrent disease were grouped according to site of recurrence and compared with the histopathology. RESULTS Of 128 patients, 40 (32%) had recurrent disease, 22 (17%) died without disease, and 66 (51%) are disease free. Although the recurrences in patients who were N0 were primarily local-regional (8/11), the majority of recurrences in patients that were N+ with extracapsular nodal spread involved distant sites (18/24); 17/18 involved metastasis to the lung. SIGNIFICANCE This study gives the first report at our institution of patterns of spread in recurrent head and neck squamous cell cancer and compares these patterns within subgroups of patients based on the extent of neck disease at the time of primary surgical resection. CONCLUSION Not only was there a higher rate of recurrent disease in patients with extracapsular nodal spread, there was a much higher involvement of distant metastatic sites as opposed to local-regional recurrence more often seen with the N0 neck. The most common site of distant metastasis was the lung.
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Affiliation(s)
- A M Vaidya
- Department of Otolaryngology, Loyola University Medical Center, 2160 South First Ave., Maywood, IL 60153, USA
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Tomik J, Składzien J, Modrzejewski M. Evaluation of cervical lymph node metastasis of 1400 patients with cancer of the larynx. Auris Nasus Larynx 2001; 28:233-40. [PMID: 11489367 DOI: 10.1016/s0385-8146(00)00116-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The main goal of the paper was to evaluate the results of surgical treatment of patients with laryngeal carcinoma, among whom cervical lymph node metastases were observed. The results of treatment were assessed after prior analysis of the following factors localization of laryngeal carcinoma, local and regional advancement, number of lymph nodes affected by metastases, the incidence of 'occult metastases', the presence of metastases in the pre-laryngeal node, the regions of the neck which were most frequently affected by metastases and supplementary irradiation treatment. METHODS An analysis of a group of 1400 patients who underwent surgery for laryngeal carcinoma in the period 1948-1992, was carried out. In all of the cases, a partial or total laryngectomy accompanied by a unilateral or bilateral surgery of the cervical lymph node system was performed. The results of the above treatment were assessed over a 5-year survival period. RESULTS In patients among whom metastases to the lymph nodes were observed, it is the following factors that exert an influence on survival chances: supraglottic and glottic localization of the tumor, an increase of regional and organ advancement of the tumor, number of lymph nodes affected by metastases, the presence of metastases in the 'pre-laryngeal' node and the level of the neck affected by metastases. CONCLUSION The incidence of metastases in regional lymph nodes is a prognostic factor in the treatment of patients suffering from laryngeal carcinoma.
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Affiliation(s)
- J Tomik
- Otolaryngological Clinic Collegium Medicum, Jagiellonian University, Cracow, Poland.
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Newkirk KA, Cullen KJ, Harter KW, Picken CA, Sessions RB, Davidson BJ. Planned neck dissection for advanced primary head and neck malignancy treated with organ preservation therapy: disease control and survival outcomes. Head Neck 2001; 23:73-9. [PMID: 11303636 DOI: 10.1002/1097-0347(200102)23:2<73::aid-hed1001>3.0.co;2-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The role of planned neck dissection after organ preservation therapy with radiotherapy or chemotherapy/radiotherapy for advanced head and neck cancers presenting with clinically positive neck disease is still being elucidated. The aim of this study is to review the outcomes of such patients treated by organ preservation therapy at our institution. METHODS A retrospective chart review of 33 patients who underwent planned neck dissections after organ preservation therapy for advanced primary head and neck malignancy. Endpoints measured were disease-free survival and local, regional, and distant control. SETTING Tertiary metropolitan medical center. RESULTS Two-year actuarial disease-free survival was 61%, and neck control was 92%, with only two failures in the neck. The use of neoadjuvant chemotherapy and total dose of radiotherapy did not correlate with neck control or disease-free survival. The presence of pathologically positive nodal disease at the time of neck dissection did not correlate with recurrent neck disease, but was a predictor of local recurrence (p = .0086). CONCLUSIONS Our data suggest that for patients undergoing planned neck dissection after organ preservation therapy, neck control is obtained in almost all cases. The presence of pathologically positive nodal disease at the time of surgery may have implications for the incidence of local recurrence.
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Affiliation(s)
- K A Newkirk
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
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Steuer-Vogt MK, Bonkowsky V, Ambrosch P, Scholz M, Neiss A, Strutz J, Hennig M, Lenarz T, Arnold W. The effect of an adjuvant mistletoe treatment programme in resected head and neck cancer patients: a randomised controlled clinical trial. Eur J Cancer 2001; 37:23-31. [PMID: 11165126 DOI: 10.1016/s0959-8049(00)00360-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The effect of an adjuvant mistletoe extract treatment was tested in a prospective, randomised controlled clinical trial involving 477 patients with head and neck squamous cell carcinoma. The patients were stratified into two treatment groups that underwent surgery or surgery followed by radiotherapy and both groups were randomised for additional treatment with mistletoe extract. Patients treated with a mistletoe lectin-1 (ML-1) standardised mistletoe preparation had no lower risk of local/locoregional recurrences, distant metastases or second primaries. In the main analysis based on 202 patients treated with surgery and 275 patients treated with surgery and radiotherapy the adjusted hazard ratio for the disease-free survival (DFS) was 0.959 (95% confidence interval (CI) 0.725-1.268). The 5-year survival rates of patients from the mistletoe group were no better than the survival rates of patients from the control group. Furthermore, no significant changes in the cellular immune reaction or in quality of life could be detected. We conclude that the used mistletoe preparation has no indication in the adjuvant treatment of patients with head and neck cancer.
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Affiliation(s)
- M K Steuer-Vogt
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Germany.
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Klotch DW, Muro-Cacho C, Gal TJ. Factors affecting survival for floor-of-mouth carcinoma. Otolaryngol Head Neck Surg 2000; 122:495-8. [PMID: 10740167 DOI: 10.1067/mhn.2000.102185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The treatment of extensive floor-of-mouth carcinoma has remained a challenging problem for head and neck surgeons. We have reviewed our experience in the surgical management of floor-of-mouth cancer in an attempt to identify factors influencing survival. METHODS A total of 144 patients with cancer involving the floor of the mouth were treated between March 1988 and November 1995. A retrospective chart review was conducted that captured information including clinical staging, therapeutic modalities, pathologic findings, and patient follow-up. Factors affecting survival were assessed by nonparametric analysis and analysis of variance. RESULTS There was no statistical significance for the effects of vascular invasion (P = 0.4019), lymphatic invasion (P = 0.3430), bone invasion (P = 0.1548), or positive margins (P = 0.1113) on survival. Extranodal extension and recurrent disease were strongly suggestive of influencing survival but were not statistically significant (P = 0.0650 and P = 0.0504, respectively). Nodal disease significantly affected survival (P = 0.0138) but did not affect recurrence (P = 0.451). CONCLUSION Mean survival for this cohort was 30.6 months. Positive node status significantly affected mean overall survival in this series, whereas extracapsular disease did not. These data suggest that aggressive surgical management of neck disease is mandated to maximize survival.
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Affiliation(s)
- D W Klotch
- Department of Otolaryngology-Head and Neck Surgery, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
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Greenman J, Homer JJ, Stafford ND. Markers in cancer of the larynx and pharynx. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2000; 25:9-18. [PMID: 10764231 DOI: 10.1046/j.1365-2273.2000.00339.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- J Greenman
- Academic Surgical Unit, University of Hull, Hull Royal Infirmary, UK
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Affiliation(s)
- K T Pitman
- Naval Medical Center Portsmouth, Department of Otolaryngology-Head and Neck Surgery, VA 23708, USA
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