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Tirelli G, Costariol L, Gardenal N, Tofanelli M, Sia E, Polesel J, Giudici F, Boscolo-Rizzo P, Marcuzzo AV. MRI and frozen section evaluation of mylohyoid muscle in determining surgical approach for T2-T3 floor of the mouth cancer. Eur Arch Otorhinolaryngol 2024; 281:4325-4331. [PMID: 38691154 DOI: 10.1007/s00405-024-08665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The choice of surgical approach for floor of the mouth (FOM) cancer, particularly for intermediate-stage tumors (cT2-cT3), remains controversial. This study aims to evaluate a method considering mylohyoid muscle (MM) invasion as a determinant for surgical approach selection, utilizing magnetic resonance imaging (MRI) preoperatively and frozen section (FS) analysis intraoperatively. METHODS This observational retrospective cohort study analyzed patients undergoing surgical resection of cT2 and cT3 FOM squamous cell carcinoma (SCC) between January 2013 and June 2023. MM infiltration assessed by preoperative MRI determined the surgical approach: clear infiltration led to compartmental surgery (CS), while doubtful or absent infiltration led to transoral surgery (TOS). Conversion from TOS to CS occurred intraoperatively based on macroscopic evidence or positive FS. Data collected included demographic, clinical, surgical, and pathological variables. Survival analysis was conducted using Kaplan-Meier method. RESULTS Among 44 patients included, majority had cT2 tumors (59.1%). MM resection was necessary in 22.7% of cases. Overall survival (OS) and progression-free survival (PFS) did not significantly differ between TOS and CS groups. Radiological depth of invasion (rDOI) < 10 mm is correlated with MM preservation in 89% of cases, while rDOI > 10 mm is correlated with MM resection only in 23.8% of cases. Pathological depth of invasion (pDOI) discrepancies were observed in the two groups: in CS group is shown a higher pDOI (> 10 mm) confirmation (90%). Surgical complications and functional outcomes differed between TOS and CS groups. CONCLUSION Considering MM invasion for surgical approach selection in cT2-cT3 FOM tumors appears oncologically safe, with better functional outcomes in muscle preservation. Preoperative MRI for MM assessment combined with intraoperative FS analysis provides reliable guidance for surgical decision-making.
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Affiliation(s)
- Giancarlo Tirelli
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Ludovica Costariol
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Nicoletta Gardenal
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Margherita Tofanelli
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Egidio Sia
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Fabiola Giudici
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy.
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Asarkar AA, Chang BA, de Bree R, Kowalski LP, Guntinas-Lichius O, Bradley PJ, de Graaf P, Strojan P, Rao KN, Mäkitie AA, López F, Rinaldo A, Palme C, Genden EM, Sanabria A, Rodrigo JP, Ferlito A. Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies. Adv Ther 2024; 41:2133-2150. [PMID: 38642199 DOI: 10.1007/s12325-024-02861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. METHODS A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. RESULTS Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. CONCLUSION The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.
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Affiliation(s)
- Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, Louisiana Health Sciences Center, Shreveport, LA, 71103, USA.
| | - Brent A Chang
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Patrick J Bradley
- Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Pim de Graaf
- Amsterdam UMC Location Vrije Universiteit, Radiology and Nuclear Medicine, de Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000, Ljubljana, Slovenia
| | - Karthik N Rao
- Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Center, Bangalore, India
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fernando López
- ENT and Head and Neck Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Carsten Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY, 10029, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Universidad de Antioquia, Medellin, Colombia
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, 33011, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35030, Padua, Italy
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Ji Z, Jiang YL, Sun HT, Qiu B, Li M, Fan JH, Wang JJ. Three-Dimensional-Printed Template-Guided Radioactive Seed Brachytherapy via a Submental Approach for Recurrent Base of Tongue and Floor of Mouth Cancer. World J Oncol 2024; 15:414-422. [PMID: 38751702 PMCID: PMC11092411 DOI: 10.14740/wjon1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/30/2024] [Indexed: 05/18/2024] Open
Abstract
Background This study assessed clinical outcomes of three-dimensional-printed template (3DPT)-guided radioactive seed brachytherapy (RSBT) via a submental approach for recurrent base of tongue and floor of mouth cancer. Methods Thirty-one patients with recurrent lingual and floor of mouth squamous cell carcinoma after surgery and radiotherapy were treated with 3DPT-guided RSBT from 2015 to 2022. Seeds were implanted through a submental approach guided by 3DPTs. Local control (LC), overall survival (OS), disease control (DC) and quality of life (QOL) were evaluated. Results The median follow-up was 13.7 months. The 1-, 3- and 5-year LC rates were 66.1%, 66.1%, and 55.1% respectively. The 1-, 3- and 5-year OS rates were 63.4%, 33.4%, and 8.3%. The 1-, 3- and 5-year DC rates were 37.8%, 26.5%, and 21.2%. Univariate analysis showed tumor size significantly affected LC (P = 0.031). The presence of extraterritorial lesions affected DC and OS on multivariate analysis (P < 0.01). QOL improved significantly in domains of pain, swallowing, chewing, taste, and emotion after treatment compared to baseline. Four patients (13%) developed necrosis and osteoradionecrosis. Conclusions 3DPT-guided submental RSBT provided favorable LC and QOL for recurrent tongue/floor of mouth cancer with minimal toxicity; moreover, severe toxicity should be noted.
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Affiliation(s)
- Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Yu Liang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Hai Tao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Mao Li
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Jing Hong Fan
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Jun Jie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
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Mattavelli D, Montenegro C, Piazza C. Compartmental surgery for T4b oral squamous cell carcinoma involving the masticatory space. Curr Opin Otolaryngol Head Neck Surg 2024; 32:55-61. [PMID: 38193497 PMCID: PMC10919272 DOI: 10.1097/moo.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW This review aims to describe the oncological outcomes of T4b oral squamous cell carcinomas (OSCC) with masticatory space involvement as well as the surgical approaches that are able to achieve compartmental 'en bloc' resection of these lesions. RECENT FINDINGS The masticatory space is subdivided into infra-notch and supra-notch spaces according to the axial plane passing through the mandibular notch between the coronoid process and the condyle neck. Compartmental resection for T4b OSCC with masticatory space invasion can be successfully achieved via purely external approaches or combining external and transnasal endoscopic routes. Infra-notch T4b OSCC showed survival outcomes comparable to T4a OSCC, thus prompting treatment with curative intent. SUMMARY Compartmental resection of the masticatory space is technically feasible with comprehensive control of tumour margins. Use of a transnasal endoscopic anterior route within a multiportal approach may provide better control of margins at the level of the pterygo-maxillary fissure. Equivalent survival outcomes between T4a and infra-notch T4b OSCC are reported. Thus, a downstaging of the latter to T4a is advisable and compartmental surgery of such advanced lesions could be considered as a first-line treatment option in selected patients.
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Affiliation(s)
- Davide Mattavelli
- Department of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, School of Medicine, Brescia, Italy
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Irawan H, Bharata MBS. Sternocleidomastoid flap for reconstruction of tongue small cell carcinoma: A case report. World J Surg Proced 2024; 14:8-14. [DOI: 10.5412/wjsp.v14.i2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/06/2024] [Accepted: 02/01/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND The management of tongue carcinoma is excision and radical neck dissection followed with reconstruction. This is a case report of a patient with tongue squamous cell carcinoma (SCC) who underwent the procedure with sternocleidomastoid (SCM) flap reconstruction.
CASE SUMMARY A 52-year-old woman without smoking history complained tongue ulcer since 3 years ago. Based on the histopathological examination, the patient was diagnosed with T2N2M0 right tongue SCC and underwent wide excision of tumor; right mandibular; neck dissection and were reconstructed with SCM flap.
CONCLUSION SCC of the tongue requires wide excision and dissection of the neck and mandible if infiltration into the surrounding lymph nodes has been found. The SCM flap reconstruction could be used post-surgery.
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Affiliation(s)
- Hendry Irawan
- Surgical Oncology Division, Department of Surgery, Medical Faculty Universitas Udayana, Denpasar 80113, Bali, Indonesia
| | - Made Bagus Sastrapramaya Bharata
- General Surgery Resident, Department of Surgery, Medical Faculty Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar 80113, Bali, Indonesia
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Calabrese L, Tagliabue M, Grammatica A, De Berardinis R, Corso F, Gazzini L, Abousiam M, Fazio E, Mattavelli D, Fontanella W, Giannini L, Bresciani L, Bruschini R, Gandini S, Piazza C, Ansarin M. Compartmental tongue surgery for intermediate-advanced squamous cell carcinoma: A multicentric study. Head Neck 2023; 45:2862-2873. [PMID: 37727894 DOI: 10.1002/hed.27517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A multicentric study was conducted on technical reproducibility of compartmental tongue surgery (CTS) in advanced tongue cancers (OTSCC) and comparison to standard wide margin surgery (SWMS). METHODS We studied 551 patients with OTSCC treated by CTS and 50 by SWMS. Oncological outcomes were analyzed. A propensity score was performed to compare survival endpoints for the two cohorts. RESULTS In the CTS group, survival and prognosis were significantly associated with positive lymph-nodes, extranodal extension, depth of invasion and involvement of the soft tissue connecting the tongue primary tumor to neck lymph nodes (T-N tract), independently from the center performing the surgery. SWMS versus CTS showed a HR Cause-Specific Survival (CSS) of 3.24 (95% CI: 1.71-6.11; p < 0.001); HR Loco-Regional Recurrence Free Survival (LRRFS) of 2.54 (95% CI: 1.47-4.40; p < 0.001); HR Overall Survival (OS) of 0.11 (95% CI: 0.01-0.77; p = 0.03). CONCLUSION Performing the CTS could provide better CSS and LRRFS than SWMS regardless of the center performing the surgery, in advanced OTSSC.
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Affiliation(s)
- Luca Calabrese
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Marta Tagliabue
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Alberto Grammatica
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Rita De Berardinis
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Corso
- Department of Mathematics (DMAT), Politecnico di Milano, Milan, Italy
- Centre for Health Data Science (CHDS), Human Techonopole, Milan, Italy
| | - Luca Gazzini
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Monir Abousiam
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Enrico Fazio
- Department of Otolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Walter Fontanella
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Lorenzo Giannini
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Lorenzo Bresciani
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, Milan, Italy
| | - Roberto Bruschini
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Experimental Oncology IRCCS, Milan, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Mohssen Ansarin
- Department of Otorhinolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Ozawa T, Oze I, Matsuzuka T, Sasaki E, Yokoyama J, Sano Y, Tomifuji M, Araki K, Kogashiwa Y, Tateya I, Agena S, Sakashita T, Tsuzuki H, Terada H, Suzuki H, Nishikawa D, Beppu S, Matoba T, Mukoyama N, Oguri K, Hasegawa Y. Indications for sentinel lymph node biopsy in node-negative oral cancers. Head Neck 2023; 45:2533-2543. [PMID: 37552157 DOI: 10.1002/hed.27477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/24/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND We aimed to define the indications for sentinel lymph node biopsy (SLNB), the third option for cervical treatment in oral cancer with negative cervical lymph nodes. METHODS The greatest depth of invasion (DOI) and long diameter (LD) of the primary site were used as exposures. SLN metastasis was considered the outcome. RESULTS In three trials conducted between 2009 and 2016, 158 patients were eligible and reassigned to this study group. The scatterplot based on the respective values of DOI and LD would eventually be divided into three sections. In cases of sections T1, T2, and T3, the proportions of SLN metastasis positivity were 21.3%, 35.3%, and 51.2%, respectively. In certain cases of T1 with 2 mm < DOI ≤ 5 mm and 8 mm < LD ≤ 20 mm, the proportion of SLN metastasis positivity was 40.9%. CONCLUSIONS SLNB-navigated or assisted neck dissection can be added as an effective procedure for N0 neck control.
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Affiliation(s)
- Taijiro Ozawa
- Department of Otolaryngology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Takashi Matsuzuka
- Department of Head and Neck Surgery - Otolaryngology, Asahi University Hospital, Gifu, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Junkichi Yokoyama
- Department of Otolaryngology - Head and Neck Surgery, Nadogaya Hospital, Kashiwa, Japan
| | - Yoshie Sano
- Department of Oral and Maxillofacial Surgery, Saitama Medical University, Saitama, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical Collage, Tokorozawa, Japan
| | - Koji Araki
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical Collage, Tokorozawa, Japan
| | - Yasunao Kogashiwa
- Department of Otorhinolaryngology, Head and Neck Surgery, Kamifukuoka General Hospital, Saitama, Japan
| | - Ichiro Tateya
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shinya Agena
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomohiro Sakashita
- Department of Otorhinolaryngology / Head and Neck Surgery, Kushiro City General Hospital, Kushiro, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Okazaki City Hospital, Okazaki, Japan
| | - Hoshino Terada
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shintarou Beppu
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takuma Matoba
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Oguri
- Department of Otorhinolaryngology, Konan Kosei Hospital, Konan, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery - Otolaryngology, Asahi University Hospital, Gifu, Japan
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Gazzini L, Fazio E, Dallari V, Spirito L, Abousiam M, Nocini R, Nebiaj A, Giorgetti G, Calabrese L. Beyond the boundaries of compartmental hemiglossectomy: a proposal for an anatomically based classification of surgical approaches to advanced oral tongue squamous cell carcinoma. Eur Arch Otorhinolaryngol 2023; 280:3015-3022. [PMID: 36897364 DOI: 10.1007/s00405-023-07915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION In the last decade, compartmental surgery (CTS) has been the surgical approach of choice for advanced tumors of the tongue and oral floor. METHODS Advanced tumors (cT3-T4) oral tongue squamous cell carcinoma (OTSCC) may extend beyond the lingual septum and involve the contralateral hemitongue, developing along the intrinsic transverse muscle. The disease may then involve the genioglossus muscle and, more laterally, the hyoglossus muscle. RESULTS The surgical approach to the contralateral tongue must be guided by anatomic and anatomopathological principles to achieve a safe oncological resection based on the principles of CTS. CONCLUSION We propose a schematic classification of glossectomies that extend to the contralateral hemitongue based on the anatomy and pathways of tumor spread.
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Affiliation(s)
- Luca Gazzini
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Enrico Fazio
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Virginia Dallari
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy.
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Luca Spirito
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Varese Insubria, Varese, Italy
| | - Monir Abousiam
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Riccardo Nocini
- Otolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Verona, Italy
| | - Aurel Nebiaj
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Giovanni Giorgetti
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Luca Calabrese
- Division of Otorhinolaryngology Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
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Karpenko A V, Sibgatullin R R, Boyko A A, Nikolayeva OM. Comparison of transoral and combined approach for surgical treatment of moderately advanced tongue and floor of the mouth cancer. HEAD AND NECK TUMORS (HNT) 2023. [DOI: 10.17650/2222-1468-2022-12-4-25-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Introduction. Surgical approach for oral cancer treatment is one of the key factors that determines oncologic effectiveness, risk of postoperative complications, need for reconstructive methods etc. Currently, there exists lack of strict criteria for using one or another approaches based on the sound scientific evidence for a primary tumor of given depth of invasion.Aim. The aim of the study is a retrospective comparative analysis of oncologic efficiency of transoral and combined approaches for surgical treatment of tongue and floor of the mouth moderately advanced carcinoma.Materials and methods. 75 patients aged between 30 and 80 years with tongue and floor of the mouth squamous cell carcinoma with depth of invasion from 10 to 20 mm were included into the study. In 29 cases the tumor was resected transorally (Group 1), in 45 – via combined approach (Group 2). Group 2 patients had more advanced tumors both locally and regionally. 13 patients of Group 1 and 27 patients of Group 2 underwent adjuvant radiotherapy. The following parameters were used for comparative analysis: the rate of local and regional recurrence, locoregional control, the rate of distant metastasis and Kaplan–Meyer overall survival.Results. Mean follow up was 33.77 ± 27.72 months (range 14–115 months). The rate of local and regional recurrence was higher in Group 2 (20 % vs 10.3 % and 22.2 % vs 17.2 % respectively). Locoregional control was better in Group 1 (72.4 % vs 62.2 %). The difference for neither of the above-mentioned parameters did not reach statistical significance. Median survival was statistically significantly better in Group 1: 66 ± 17.42 months vs 23 ± 3.85 months (p = 0.030). Poorer treatment results in Group 2 can be explained by a higher proportion of patients with more advanced tumors in this group.Conclusion. The results of the present study do not allow to conclude that combined approach has oncologic advantage over less aggressive transoral approach for tumors with depth of invasion from 10 to 20 mm. It is questionable to recommend the combined approach as a universal one for lesions with such a stage of local invasiveness.
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Affiliation(s)
| | | | - A. A. Boyko
- Leningrad Regional Clinical Oncologic Dispensary
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10
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Paderno A, Bossi P, Piazza C. Editorial: Advances in the Multidisciplinary Management of Oral Cancer. Front Oncol 2021; 11:817756. [PMID: 34976848 PMCID: PMC8714657 DOI: 10.3389/fonc.2021.817756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alberto Paderno
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
- *Correspondence: Alberto Paderno,
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
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11
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He Y, Liu Z, Sheng S, Gao W, Tang X, Li X, Ma C. Salvage surgery for patients with residual/persistent diseases after improper or insufficient treatment of oral squamous cell carcinoma: can we rectify these mistakes? BMC Cancer 2021; 21:878. [PMID: 34332566 PMCID: PMC8325844 DOI: 10.1186/s12885-021-08600-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patterns of failure after treatment of oral and squamous cell carcinomas (OSCC) are diversified, with recurrences being one of the common causes. A special group of patients are sometimes encountered in the outpatient clinic for improper or insufficient initial treatment with reports of positive margins, implying residual/persistent diseases. The question of whether these patients can be surgically salvaged remain unanswered. METHODS A retrospective study was performed between January 2013 and December 2017 for patients with residual or rapid recurrent (within 3 months) OSCCs, who received salvage surgeries in our institution. The patients with residual/persistent OSCCs were those with microscopic or macroscopic positive surgical margins, while those with rapid recurrent OSCCs were those with close or negative margins, but unabated painful symptoms right after treatment. Both clinicopathological and prognostic variables were analyzed. The focus was also directed towards lessons for possible initial mistakes, resulting in these residual/persistent diseases. RESULTS Of 103 patients, 68 (66%) were men, with mean age of 56.3 years. The overall survival reached 60.2%. Regarding the primary OSCC status, most of our patients (n = 75, 72.8%) were diagnosed with ycT2-3 stages. Besides, most patients were found with macroscopic residual diseases (52.4%) before our salvage surgery. The sizes of the residual/persistent OSCCs were generally under 4 cm (87.3%) with minimally residual in 21 (20.4%). Among all the variables, primary T stage (p = 0.003), and residual lesion size (p < 0.001) were significantly associated with the prognosis in multivariate analysis. Though the causes for the initial surgical failure were multifactorial, most were stemmed from poor planning and unstandardized execution. CONCLUSIONS Cases with residual/persistent OSCCs were mostly due to mistakes which could have been avoided under well-round treatment plans and careful surgical practice. Salvage surgery for cases with smaller residual/persistent OSCCs is still feasible with acceptable outcomes.
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Affiliation(s)
- Yue He
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China.
| | - Zhonglong Liu
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China
| | - Surui Sheng
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China
| | - Weijin Gao
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiao Tang
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China
| | - Xiaoguang Li
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China.
| | - Chunyue Ma
- Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai, 200011, Shanghai, China.
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12
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Alterio D, Augugliaro M, Tagliabue M, Bruschini R, Gandini S, Calabrese L, Belloni P, Preda L, Maffini FA, Marvaso G, Ferrari A, Volpe S, Zerella MA, Oneta O, Turturici I, Alessandro O, Ruju F, Ansarin M, Orecchia R, Jereczek-Fossa BA. The T-N tract involvement as a new prognostic factor for PORT in locally advanced oral cavity tumors. Oral Dis 2021; 29:128-137. [PMID: 33893695 DOI: 10.1111/odi.13885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/24/2021] [Accepted: 04/15/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The space comprised between tumor and neck lymph nodes (T-N tract) is one of the main routes of tumor spread in oral cavity tumors. Aim of the study was to investigate the impact of T-N tract involvement on the postoperative radiotherapy (PORT) outcomes. MATERIALS AND METHODS Patients (pts) treated between 2000 and 2016 with indication to PORT were retrospectively retrieved. Inclusion criteria were: (a) locally advanced tumors of the oral cavity, (b) who received with indication to PORT (c) with a minimum follow-up of six months. RESULTS One hundred and fifty-seven pts met the inclusion criteria (136 pts treated with PORT and 21 pts not treated with PORT). In the PORT cohort, the T-N tract involvement had no impact on both OS (p = .09) and LRFS (p = .2). Among the non-PORT cohort, both OS (p = .007) and LRFS (p = .017) were worse for pts with positive T-N tract compared to those with negative T-N tract. PORT improved both OS (p = .008) and LRFS (p = .003) in pts with positive T-N tract but not in those with negative T-N tract (p = .36 and p = .37, respectively). CONCLUSIONS Our results suggest that involvement of T-N tract should be considered as prognostic factors informing the indication to PORT.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Luca Calabrese
- Division of Otorhinolaryngology, San Maurizio" Hospital, Bolzano, Italy
| | - Pietro Belloni
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Statistical Sciences, University of Padua, Italy
| | - Lorenzo Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Alessia Zerella
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Olga Oneta
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Irene Turturici
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Ombretta Alessandro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Francesca Ruju
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Italy
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13
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Galli A, Bondi S, Canevari C, Tulli M, Giordano L, Di Santo D, Gianolli L, Bussi M. High-risk early-stage oral tongue squamous cell carcinoma, when free margins are not enough: Critical review. Head Neck 2021; 43:2510-2522. [PMID: 33893752 DOI: 10.1002/hed.26718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022] Open
Abstract
Oral tongue squamous cell carcinoma (OTSCC) is a quite peculiar disease from an anatomical and biological standpoint. An increasing amount of literature highlights the existence of a small subset of T1-T2N0 OTSCC, properly resected on a margin-dependent basis, which conversely proved higher than expected rates of loco-regional/distant failure and disease-specific mortality. These specific high-risk tumors might not have a margin-dependent disease and could possibly benefit from a more aggressive upfront loco-regional treatment, especially addressing the so-called T-N tract. Widespread adoption of a histopathological risk model would allow early recognition of these high-risk diseases and, consequently, intensification of the traditional treatment strategies in that specific niche. We reviewed the available knowledge trying to shed light on the potential determinants of the dismal prognosis of these high-risk OTSCC, with special reference to the role of overlooked T-N tract involvement and possible alternatives in terms of elective neck management and risk stratification.
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Affiliation(s)
- Andrea Galli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Bondi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Carla Canevari
- Unit of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Michele Tulli
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Leone Giordano
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Di Santo
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Unit of Nuclear Medicine, San Raffaele Scientific Institute, Milan, Italy
| | - Mario Bussi
- Department of Otorhinolaryngology, San Raffaele Scientific Institute, Milan, Italy
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14
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Grammatica A, Piazza C, Ferrari M, Verzeletti V, Paderno A, Mattavelli D, Schreiber A, Lombardi D, Fazio E, Gazzini L, Giorgetti G, Buffoli B, Rodella LF, Nicolai P, Calabrese L. Step-by-Step Cadaver Dissection and Surgical Technique for Compartmental Tongue and Floor of Mouth Resection. Front Oncol 2021; 11:613945. [PMID: 33968719 PMCID: PMC8104033 DOI: 10.3389/fonc.2021.613945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background The aim of oral cancer surgery is tumor removal within clear margins of healthy tissue: the latter definition in the literature, however, may vary between 1 and 2 cm, and should be intended in the three dimensions, which further complicates its precise measurement. Moreover, the biological behavior of tongue and floor of mouth cancer can be unpredictable and often eludes the previously mentioned safe surgical margins concept due to the complexity of tongue anatomy, the intricated arrangements of its intrinsic and extrinsic muscle fibers, and the presence of rich neurovascular and lymphatic networks within it. These structures may act as specific pathways of loco-regional tumor spread, allowing the neoplasm to escape beyond its visible macroscopic boundaries. Based on this concept, in the past two decades, compartmental surgery (CS) for treatment of oral tongue and floor of mouth cancer was proposed as an alternative to more traditional transoral resections. Methods The authors performed three anatomical dissections on fresh-frozen cadaver heads that were injected with red and blue-stained silicon. All procedures were documented by photographs taken with a professional reflex digital camera. Results One of these step-by-step cadaver dissections is herein reported, detailing the pivotal points of CS with the aim to share this procedure at benefit of the youngest surgeons. Conclusions We herein present the CS step-by-step technique to highlight its potential in improving loco-regional control by checking all possible routes of tumor spread. Correct identification of the anatomical space between tumor and nodes (T-N tract), spatial relationships of extrinsic tongue muscles, as well as neurovascular bundles of the floor of mouth, are depicted to improve knowledge of this complex anatomical area.
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Affiliation(s)
- Alberto Grammatica
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Padua, Padua, Italy
| | - Vincenzo Verzeletti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Enrico Fazio
- Department of Otorhinolaryngology - Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Luca Gazzini
- Department of Otorhinolaryngology - Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Giovanni Giorgetti
- Department of Otorhinolaryngology - Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
| | - Barbara Buffoli
- Department of Clinical and Experimental Sciences, Section of Anatomy and Physiopathology, University of Brescia, Brescia, Italy
| | - Luigi Fabrizio Rodella
- Department of Clinical and Experimental Sciences, Section of Anatomy and Physiopathology, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Padua, Padua, Italy
| | - Luca Calabrese
- Department of Otorhinolaryngology - Head and Neck Surgery, "San Maurizio" Hospital, Bolzano, Italy
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15
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Ansarin M, De Berardinis R, Corso F, Giugliano G, Bruschini R, De Benedetto L, Zorzi S, Maffini F, Sovardi F, Pigni C, Scaglione D, Alterio D, Cossu Rocca M, Chiocca S, Gandini S, Tagliabue M. Survival Outcomes in Oral Tongue Cancer: A Mono-Institutional Experience Focusing on Age. Front Oncol 2021; 11:616653. [PMID: 33912446 PMCID: PMC8075362 DOI: 10.3389/fonc.2021.616653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The prognostic role of age among patients affected by Oral Tongue Squamous Cell Carcinoma (OTSCC) is a topic of debate. Recent cohort studies have found that patients diagnosed at 40 years of age or younger have a better prognosis. The aim of this cohort study was to clarify whether age is an independent prognostic factor and discuss heterogeneity of outcomes by stage and treatments in different age groups. Methods We performed a study on 577 consecutive patients affected by primary tongue cancer and treated with surgery and adjuvant therapy according to stage, at European Institute of Oncology, IRCCS. Patients with age at diagnosis below 40 years totaled 109 (19%). Overall survival (OS), disease-free survival (DFS), tongue specific free survival (TSFS) and cause-specific survival (CSS) were compared by age groups. Multivariate Cox proportional hazards models were used to assess the independent role of age. Results The median follow-up time was 5.01 years (range 0–18.68) years with follow-up recorded up to February 2020. After adjustment for all the significant confounding and prognostic factors, age remained independently associated with OS and DSF (respectively, p = 0.002 and p = 0.02). In CSS and TSFS curves, the role of age seems less evident (respectively, p = 0.14 and p = 0.0.37). In the advanced stage sub-group (stages III–IV), age was significantly associated with OS and CSS with almost double increased risk of dying (OS) and dying from tongue cancer (CSS) in elderly compared to younger groups (OS: HR = 2.16 95%, CI: 1.33–3.51, p= 0.001; CSS: HR = 1.76 95%, CI: 1.03–3.01, p = 0.02, respectively). In our study, young patients were more likely to be treated with intensified therapies (glossectomies types III–V and adjuvant radio-chemotherapy). Age was found as a prognostic factor, independently of other significant factors and treatment. Also the T–N tract involved by disease and neutrophil-to-lymphocyte ratio ≥3 were independent prognostic factors. Conclusions Young age at diagnosis is associated with a better overall survival. Fewer younger people than older people died from tongue cancer in advanced stages.
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Affiliation(s)
- Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Corso
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Mathematics, DMAT, Politecnico di Milano, Milan, Italy.,Center for Analysis Decisions and Society, CADS, Human Technopole, Milan, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi De Benedetto
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Sovardi
- Department of Otorhinolaryngology, Policlinico San Matteo, IRCCS, Pavia, Italy
| | - Carolina Pigni
- Department of Otorhinolaryngology, ASST Ovest Milanese, Legnano, Italy
| | - Donatella Scaglione
- Division of Data Manager, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Department of Medical Oncology, Urogenital and Head and Neck Tumors Medical Treatment, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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16
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Berrone M, Lajolo C, De Corso E, Settimi S, Rupe C, Crosetti E, Succo G. Cooperation between ENT surgeon and dentist in head and neck oncology. ACTA ACUST UNITED AC 2021; 41:S124-S137. [PMID: 34060528 PMCID: PMC8172104 DOI: 10.14639/0392-100x-suppl.1-41-2021-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/08/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Mattia Berrone
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Turin, Italy
| | - Carlo Lajolo
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy.,School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio De Corso
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Stefano Settimi
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Cosimo Rupe
- Head and Neck Department, "Fondazione Policlinico Universitario A. Gemelli - IRCCS" Rome, Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute - FPO, IRCCS, Candiolo, Italy.,Department of Oncology, University of Turin, Turin, Italy
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17
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Yang CC, Kang BH, Liu WS, Yin CH, Lee CC. Postoperative radiotherapy is associated with improved survival in pT1-2N1 oral and oropharyngeal cancer without adequate neck dissection. Radiat Oncol 2021; 16:6. [PMID: 33407647 PMCID: PMC7788971 DOI: 10.1186/s13014-020-01736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background To assess the benefit of postoperative radiotherapy in patients with pT1-2N1M0 oral and oropharyngeal cancer by the quality of neck dissection. Methods In the Surveillance, Epidemiology, and End Results database, pT1-2N1M0 oral and oropharyngeal cancer patients treated by primary tumor resection and neck dissection with or without radiotherapy were included between 2004 and 2015. Univariate and multivariate analysis were used to explore the effect of adjuvant radiotherapy on 5-year overall survival (OS) and disease-specific survival (DSS) among different quality of neck dissection. Results Of the 1765 patients identified, 1108 (62.8%) had oral cancer, 1141 (64.6%) were men, and 1067 (60.5%) underwent adjuvant radiotherapy. After adjusting for confounding factors, postoperative radiotherapy reduced the adjusted hazard ratio (aHR) of 5-year OS to 0.64 (95% confidence interval [CI] 0.49–0.84) in those with < 18 lymph nodes (LNs) removed, but not in those with 19–24 LNs removed (aHR 0.78; 95% CI 0.73–1.13), and in those with ≥ 25 LNs removed (aHR 0.96; 95% CI 0.75–1.24). For 5-year DSS, similar effect was observed. The adjusted hazard ratio was 0.66 (95% confidence interval, 0.45–0.97) in those with < 18 LNs. The protective effect was not seen in those with 18–24 LNs (aHR 1.07; 95% CI 0.59–1.96), and in those with ≥ 25 LNs (aHR 1.12; 95% CI 0.81–1.56). Sensitivity testing also showed a robust protective effect of postoperative radiotherapy in patients with < 18 LNs removed. Conclusion Radiotherapy was associated with improved survival in pT1-2N1M0 oral and oropharyngeal cancer patients without adequate neck dissection.
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Affiliation(s)
- Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Bor-Hwang Kang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Pharmacy, Tajen University, Pingtung, Taiwan
| | - Wen-Shan Liu
- Department of Radiaton Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,School of Medicine, National Defense Medical Center, Taipei, Taiwan. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
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18
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Romani C, Salviato E, Paderno A, Zanotti L, Ravaggi A, Deganello A, Berretti G, Gualtieri T, Marchini S, D'Incalci M, Mattavelli D, Piazza C, Bossi P, Romualdi C, Nicolai P, Bignotti E. Genome-wide study of salivary miRNAs identifies miR-423-5p as promising diagnostic and prognostic biomarker in oral squamous cell carcinoma. Am J Cancer Res 2021; 11:2987-2999. [PMID: 33456584 PMCID: PMC7806472 DOI: 10.7150/thno.45157] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022] Open
Abstract
Survival rates of oral squamous cell carcinoma (OSCC) remained substantially unchanged over the last decades; thus, additional prognostic tools are strongly needed. Salivary miRNAs have emerged as excellent non-invasive cancer biomarker candidates, but their association with OSCC prognosis has not been investigated yet. In this study, we analyzed global salivary miRNA expression in OSCC patients and healthy controls, with the aim to define its diagnostic and prognostic potential. Methods: Saliva was collected from patients with newly diagnosed untreated primary OSCC and healthy controls. Global profiling of salivary miRNAs was carried out through a microarray approach, while signature validation was performed by quantitative real-time PCR (RT-qPCR). A stringent statistical approach for microarray and RT-qPCR data normalization was applied. The diagnostic performance of miRNAs and their correlation with OSCC prognosis were comprehensively analyzed. Results: In total, 25 miRNAs emerged as differentially expressed between OSCC patients and healthy controls and, among them, seven were significantly associated with disease-free survival (DFS). miR-106b-5p, miR-423-5p and miR-193b-3p were expressed at high levels in saliva of OSCC patients and their combination displays the best diagnostic performance (ROC - AUC = 0.98). Moreover, high expression of miR-423-5p was an independent predictor of poor DFS, when included in multivariate survival analysis with the number of positive lymph nodes - the only significant clinical prognosticator. Finally, we observed a significant decrease in miR-423-5p expression in matched post-operative saliva samples, suggesting its potential cancer-specific origin. Conclusion: Salivary miRNAs identified in our cohort of patients show to be accurate in OSCC detection and to effectively stratify patients according to their likelihood of relapse. These results, if validated in an independent set of patients, could be particularly promising for screening/follow-up of high-risk populations and useful for preoperative prognostic assessment.
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19
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Filauro M, Missale F, Marchi F, Iandelli A, Carobbio ALC, Mazzola F, Parrinello G, Barabino E, Cittadini G, Farina D, Piazza C, Peretti G. Intraoral ultrasonography in the assessment of DOI in oral cavity squamous cell carcinoma: a comparison with magnetic resonance and histopathology. Eur Arch Otorhinolaryngol 2020; 278:2943-2952. [PMID: 33084951 PMCID: PMC8266699 DOI: 10.1007/s00405-020-06421-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
Objective The first-line therapeutic approach for oral cavity squamous cell carcinoma (OCSCC) is complete surgical resection. Preoperative assessment of depth of invasion (cDOI) is crucial to plan the surgery. Magnetic resonance (MR) and intraoral ultrasonography (IOUS) have been shown to be useful tools for assessment of DOI. The present analysis investigates the accuracy of MR and IOUS in evaluating DOI in OCSCC compared to histological evaluation (pDOI). Materials and methods Forty-nine previously untreated patients with cT1-T3 OCSCC were reviewed. Nine patients were staged with MR alone, 10 with IOUS alone, and 30 with both MR and IOUS. Results Mean difference between cDOIMR and pDOI values of 0.2 mm (95% CI − 1.0–1.3 mm) and between cDOIIOUS and pDOI of 0.3 mm (95% CI − 1.0–1.6 mm). Spearman R between cDOIMR and pDOI was R = 0.83 and between cDOIIOUS and pDOI was R = 0.76. Both radiological techniques showed high performance for the correct identification, with the optimum cut-off of 5 mm, of patients with a pDOI ≥ 4 mm and amenable to a neck dissection, with an AUC of 0.92 and 0.82 for MR and IOUS, respectively. Conclusion Both examinations were valid approaches for preoperative determination of DOI in OCSCC, although with different cost-effectiveness profiles and indications. Electronic supplementary material The online version of this article (10.1007/s00405-020-06421-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marta Filauro
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Francesco Missale
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Filippo Marchi
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Andrea Iandelli
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - Andrea Luigi Camillo Carobbio
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy. .,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy.
| | - Francesco Mazzola
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | | | - Emanuele Barabino
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Diagnostic Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Giuseppe Cittadini
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Department of Diagnostic Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- IRCCS Policlinico San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
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20
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Morand GB, Broglie MA, Schumann P, Huellner MW, Rupp NJ. Histometabolic Tumor Imaging of Hypoxia in Oral Cancer: Clinicopathological Correlation for Prediction of an Aggressive Phenotype. Front Oncol 2020; 10:1670. [PMID: 32984043 PMCID: PMC7481376 DOI: 10.3389/fonc.2020.01670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a widely used imaging tool for oral squamous cell carcinoma (OSCC). Preliminary studies indicate that quantification of tumor metabolic uptake may correlate with tumor hypoxia and aggressive phenotypes. Methods Retrospective review of a consecutive cohort of OSCC (n = 98) with available pretherapeutic FDG-PET/CT, treated at the University Hospital Zurich. Clinico-pathologico-radiological correlation between maximum standard uptake value (SUVmax) of the primary tumor, immunohistochemical staining for hypoxia-related proteins glucose transporter 1 (GLUT1) and hypoxia-inducible factor 1-alpha (HIF1a), depth of invasion (DOI), lymph node metastasis, and outcome was examined. Results Positive staining for GLUT1 and HIF1a on immunohistopathological analysis correlated with increased SUVmax on pretherapeutic imaging and with increased DOI (Kruskal–Wallis, P = 0.037, and P = 0.008, respectively). SUVmax and DOI showed a strong positive correlation (Spearman Rho, correlation coefficient = 0.451, P = 0.0003). An increase in SUVmax predicted nodal metastasis (Kruskal–Wallis, P = 0.017) and poor local control (log rank, P = 0.047). Conclusion In OSCC, FDG-PET-derived metabolic tumor parameter SUVmax serves as a surrogate marker for hypoxia and can be used to predict tumor aggressiveness, with more invasive phenotypes and poorer local control.
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Affiliation(s)
- Grégoire B Morand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Paul Schumann
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Niels J Rupp
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
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21
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Carta F, Quartu D, Mariani C, Tatti M, Marrosu V, Gioia E, Gerosa C, Zanda JSA, Chuchueva N, Figus A, Puxeddu R. Compartmental Surgery With Microvascular Free Flap Reconstruction in Patients With T1-T4 Squamous Cell Carcinoma of the Tongue: Analysis of Risk Factors, and Prognostic Value of the 8th Edition AJCC TNM Staging System. Front Oncol 2020; 10:984. [PMID: 32760667 PMCID: PMC7372302 DOI: 10.3389/fonc.2020.00984] [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] [Received: 02/22/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
Compartmental surgery and primary reconstruction with microvascular free flaps represent the gold-standard in the treatment of oral tongue squamous cell carcinoma (OTSCC). However, there are still unclear clinical features that negatively affect the outcomes. This retrospective study included 80 consecutive patients with OTSCC who underwent compartmental surgery and primary reconstruction by free flap. The oncologic outcomes, the reliability of the 8th edition American Joint Committee on Cancer (AJCC) staging system and the prognostic factors were evaluated. Fifty-nine males and 21 females (mean age 57.8 years, range 27-81 years) were treated between November 2010 and March 2018 (one patient had two metachronous primaries). Seventy-one patients (88.75%, 52 males, 19 females, mean age of 57.9 years, range of 27-81 years) had no clinical history of previous head and neck radiotherapy and were considered as naive. Histology showed radical surgery on 80/81 lesions (98.8%), with excision margins >0.5 cm, while in 1 case (1.2%), a close posterior margin was found. According to the 8th AJCC classification, 37 patients (45.7%) were upstaged shifting from the clinical to the pathological stage, and 39 (48.1%) showed an upstaging while shifting from the 7th to the 8th AJCC staging system (no tumors were downstaged). Nodal involvement was confirmed in 33 patients (40.7%). Perineural and lymphovascular invasion were present in 9 (11.1%) and 11 (13.6%) cases, respectively. Twenty-two patients (27.1%) underwent adjuvant therapy. The 5-years disease-specific, overall, overall relapse-free, locoregional relapse-free and distant metastasis-free survival rates were 73.2, 66.8, 62.6, 67.4, and 86%, respectively. Patients with a lymph node ratio >0.09 experienced significantly worse outcomes. Univariate analysis showed that patients with previous radiotherapy, stage IV disease, nodal involvement, and lymphovascular invasion had significantly worse outcomes. Multivariate analysis focused naive patients and showed that lymphovascular invasion, advanced stage of disease, and node involvement resulted reliable prognostic factors, and patients with the same tumor stage and histological risk factors who did not undergo adjuvant therapy experienced significantly worse outcomes. In our series, surgery played a major role in the treatment of local extension; adjuvant therapy resulted strictly indicated in patients with advanced-stage disease associated with risk factors.
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Affiliation(s)
- Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Daniela Quartu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Edoardo Gioia
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Jacopo S A Zanda
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Natalia Chuchueva
- ENT Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrea Figus
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
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22
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Surgical resection of oral cancer: en-bloc versus discontinuous approach. Eur Arch Otorhinolaryngol 2020; 277:3127-3135. [PMID: 32367148 DOI: 10.1007/s00405-020-06016-5] [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: 01/07/2020] [Accepted: 04/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In the past literature agreed on treating oral carcinomas, using an "en-bloc" resection (EBR) but recently minimally invasive transoral surgery has spread as the preferable treatment for selected cases. This latter technique, which is performed with a discontinuous resection (DR), allows for a satisfactory postoperative quality of life (QoL) maintaining good survival rates. MATERIALS AND METHODS In this study, we analyzed data about 147 surgically treated patients with oral cancer involving tongue and floor of the mouth. The sample was divided according to the surgical approach: EBR and DR group which were compared in terms of recurrence, overall survival, disease-free survival, and QoL. RESULTS In the DR group, survival analysis showed better results in term of survival, locoregional control, and postoperative anxiety, while the other QoL scores were similar in the two groups. CONCLUSION The more invasive approach does not correlate to a better outcome. In selected cases, DR is an oncologically safe technique; EBR is still a valid option to treat advanced oral cancers.
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23
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Grammatica A, Piazza C, Montalto N, Del Bon F, Frittoli B, Mazza M, Paderno A, Lancini D, Fior M, Deganello A, Lombardi D, Nicolai P. Compartmental Surgery for Oral Tongue Cancer: Objective and Subjective Functional Evaluation. Laryngoscope 2020; 131:E176-E183. [PMID: 32239760 DOI: 10.1002/lary.28627] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/16/2020] [Accepted: 02/28/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess functional outcomes in patients treated by compartmental tongue surgery (CTS) and reconstruction for advanced oral tongue/floor-of-mouth cancer. STUDY DESIGN Retrospective case series. METHODS A retrospective cohort of patients (n = 48) treated by CTS and free flap reconstruction was prospectively evaluated concerning postoperative functional outcomes at different time points (6 months and 1 year). Swallowing was studied by videonasal endoscopic evaluation (VEES) and videofluoroscopy (VFS), testing various food consistencies and grading the results with the Donzelli scale. Speech articulation, lingual strength, and endurance were studied by phone call and Iowa Oral Performance Instrument (IOPI). Subjective tests (EORTC H&N35 and UWQOL) were administered. RESULTS After 1 year, VEES showed a Donzelli scale of 67% level 1, 23% level 2, and 10% level 3. Vallecular pouch was present in 81% of patients. VFS showed levels 1, 2, and 3 in 42%, 25%, and 33%, respectively, with liquids (L); 48%, 19%, and 33%, with semi-liquids (SL); and 54%, 33%, and 13%, with semi-solids (SS). Vallecular pouch residue was present in 69% with L, 73% with SL, and 87% with SS. The mean number of words recognized at phone call was 56 of 75 (range, 27-74). IOPI showed a mean tongue strength of 19.2 kPa (range, 0-40), and a mean endurance of 16.2 seconds (range, 0-60). CONCLUSION CTS does not significantly affect speech. Sub-clinical food aspiration and vallecular pouch are present in a significant proportion of patients, especially when adjuvant treatments are administered. Residual tongue strength is not affected when proper reconstruction is performed. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E176-E183, 2021.
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Affiliation(s)
- Alberto Grammatica
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, Milan, Italy.,Department of Oncology and Oncohaematology, University of Milan, Milan, Italy
| | - Nausica Montalto
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | | | - Monica Mazza
- Department of Physical Medicine and Rehabilitation, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Milena Fior
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
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24
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Marchi F, Filauro M, Iandelli A, Carobbio ALC, Mazzola F, Santori G, Parrinello G, Canevari FRM, Piazza C, Peretti G. Magnetic Resonance vs. Intraoral Ultrasonography in the Preoperative Assessment of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2020; 9:1571. [PMID: 32117789 PMCID: PMC7010633 DOI: 10.3389/fonc.2019.01571] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Preoperative assessment is critical to decide the most adequate surgical strategy for oral squamous cell carcinoma (SCC). Magnetic resonance (MR) and intraoral ultrasonography (US) have been reported to be of great value for preoperative estimation of depth of invasion (DOI) and/or tumor thickness (TT). This review aims to analyze the accuracy of MR and intraoral US in determining DOI/TT in oral SCC, by assuming histological evaluation as the reference method. Methods: The procedure was conducted following the modified 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We performed a systematic search of papers on PubMed, Scopus, Web of Science, and Cochrane Library databases until July 31st, 2019. For quantitative synthesis, we included nine studies (487 patients) focused on MR, and 12 (520 patients) focused on intraoral US. The Pearson correlation coefficient (r) between DOI/TT evaluated with MR or intraoral US was assumed as effect size. A meta-analysis (MA) for each study group (MR and US) was performed by using the random-effects models with the DerSimonian–Laird estimator and r-to-z transformation. Results: In the MA for MR studies, a high heterogeneity was found (I2 = 94.84%; Q = 154.915, P < 0.001). No significant risk of bias occurred by evaluating funnel plot asymmetry (P = 0.563). The pooled (overall) r of the MR studies was 0.87 (95% CI from 0.82 to 0.92), whereas the pooled r-to-z transformed was 1.44 (95% CI from 1.02 to 1.85). In the MA for US studies a high heterogeneity was found (I2 = 93.56%; Q = 170.884, P < 0.001). However, no significant risk of bias occurred (P = 0.779). The pooled r of the US studies was 0.96 (95% CI from 0.94 to 0.97), whereas the pooled r-to-z transformed was 1.76 (95% CI from 1.39 to 2.13). These outputs were confirmed in additional MA performed by enrolling only MR (n = 8) and US (n = 11) studies that evaluated TT. Conclusions: MR and intraoral US seem to be promising approaches for preoperative assessment of DOI/TT in oral SCC. Remarkably, a higher pooled r and r-to-z transformed were observed in the intraoral US studies, suggesting that this approach could be more closely related to histopathological findings.
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Affiliation(s)
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | | | | | | | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | | | - Frank Rikky Mauritz Canevari
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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25
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Tagliabue M, Gandini S, Maffini F, Navach V, Bruschini R, Giugliano G, Lombardi F, Chiocca S, Rebecchi E, Sica E, Tommasino M, Calabrese L, Ansarin M. The role of the T-N tract in advanced stage tongue cancer. Head Neck 2019; 41:2756-2767. [PMID: 30942940 DOI: 10.1002/hed.25761] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We investigated the role of the soft tissue tract between the primary tumor and the neck lymph nodes, the "T-N tract," in patients with tongue squamous cell carcinoma at an advanced stage. METHODS We performed a compartmental tongue surgery in 233 patients. Cumulative incidence of relapses and overall survival curves were compared by T-N tract involvement. Multivariate Cox proportional hazards models were used to assess the independent role of T-N tract. RESULTS At 4 years of follow-up, patients with disease in the T-N tract experienced a significantly more distant recurrence (40%) than did patients without T-N tract involvement (22%; P = .02). Multivariate Cox models indicate a significant almost triple risk of distant metastases (hazard ratio [HR], 2.70; 95% CI, 1.01-7.19; P = .05) and double risk of death (HR, 2.09; 95%CI, 1.13-3.85; P = .02) in patients with "T-N tract involvement." CONCLUSIONS Our data show that the T-N tract plays an important role in prognosis and survival in patients with tongue cancer.
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Affiliation(s)
- Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Navach
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Lombardi
- Division of Data Manager, European Institute of Oncology IRCCS, Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisabetta Rebecchi
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Eleonora Sica
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Course Albert Thomas 150, Lyon, France
| | - Luca Calabrese
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
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26
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Piazza C, Bresciani L, Giannini L. Depth of invasion for prognostic stratification in oral cavity cancer: do we need further validation? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S84. [PMID: 31576293 DOI: 10.21037/atm.2019.04.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Lorenzo Bresciani
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology, Head and Neck Surgery, Fondazione IRCCS, Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Giannini
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Milan, Italy.,Department of Otorhinolaryngology, Head and Neck Surgery, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
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