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Kansara S, Oral E, Sarkar I, Sandulache V, Mualla R, Walvekar RR, Ryan W, Ha P. Rate of occult metastasis in lip squamous cell carcinoma: A systematic review and meta-analysis. Head Neck 2024. [PMID: 38497534 DOI: 10.1002/hed.27747] [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: 12/05/2023] [Revised: 02/12/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES The rate of occult metastasis in lip cancer is poorly studied. Management of the regional nodal basin in lip cancer is thus controversial. This study sought to understand the true rate of micrometastasis in lip cancer. MATERIALS AND METHODS Systematic review and meta-analysis was conducted of English language studies reporting lip cancer sentinel node biopsy results. Studies were obtained from the PubMed database between the years 2000 and 2023 using the search terms "sentinel node biopsy" and "squamous cell carcinoma." Random effect and fixed effect meta-analyses were performed. RESULTS Thirteen studies met inclusion criteria. Low heterogeneity was noted among the studies, as indicated by the I2 inconsistency test (I2 = 0%). The rate of occult metastasis ranged between 0 and 33% (mean 9%). A total of 189 lip sentinel node biopsies had been performed. Of these, 21 revealed occult nodal metastasis (11.1%, 95% CI 7.36%-16.44%). One step, generalized linear mixed modeling revealed the true rate of occult nodal metastasis to be 10% (95% CI (0.0504, 0.1746), p < 0.0001). CONCLUSION The rate of occult metastasis in lip cancer approaches the threshold for elective management of the regional nodal basin. Sentinel node biopsy is optimally suited for management of high-risk early T stage lip cancer.
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Affiliation(s)
- Sagar Kansara
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Evrim Oral
- School of Public Health, Biostatistics and Data Science Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Indrani Sarkar
- School of Public Health, Biostatistics and Data Science Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Vlad Sandulache
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Rula Mualla
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rohan R Walvekar
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - William Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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Inan CH, Yanasma HO, Aslier M, Saraydaroglu O, Sahin I, Basut O, Kasapoglu F, Ozmen AO, Demir UL, Coskun H. Role of the neck dissection in early-stage lower lip cancers. Niger J Clin Pract 2023; 26:1303-1308. [PMID: 37794543 DOI: 10.4103/njcp.njcp_36_23] [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] [Indexed: 10/06/2023]
Abstract
Background In early-stage lip cancer, spread to cervical lymph nodes is extremely rare. Elective neck treatment options include suprahyoid or supraomohyoid neck dissection, sentinel lymph node biopsy, or close follow-up. Aim: In this study, our aim was to investigate the effect of elective surgery on survival in patients operated for early-stage lip cancer. Methods Patients who underwent surgical treatment for lower lip squamous cell carcinoma between 2005 and 2020 were retrospectively analyzed. Age, gender, neck dissection status (yes/no), clinical and pathological T stage of the tumor, grade, and perineural invasion were recorded and 3-year and 5-year overall (OS) and disease-free survival (DFS) rates were estimated. Results Thirty patients were included: 20 patients had pT1 and 10 patients had pT2 tumors. Neck dissection was performed in 13 patients. The 5-year OS rate was 90.9% and 87.8% with and without dissection, respectively. Neck dissection did not appear to affect OS (P = 0.534) in these patients. The 5-year DFS rate was 96.4% in the overall group, while it was 91.7% and 100% in patients who did or did not undergo neck dissection, respectively (P = 0.756). Discussion Patients with or without neck dissection did not differ significantly in terms of OS and DFS. Watchful waiting with regular ultrasound imaging of the neck in patients with T1 and T2 lip tumors may be an appropriate therapeutic option.
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Affiliation(s)
- C H Inan
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - H O Yanasma
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - M Aslier
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - O Saraydaroglu
- Department of Pathology, Bursa Uludağ University, Bursa, Turkey
| | - I Sahin
- Department of Biostatistics, Bursa Uludağ University, Bursa, Turkey
| | - O Basut
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - F Kasapoglu
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - A O Ozmen
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - U L Demir
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
| | - H Coskun
- Department of Otorhinolaryngology, Bursa Uludağ University, Bursa, Turkey
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Matsuura D, Yuan A, Harris V, Shaha AR, Tuttle RM, Patel SG, Shah JP, Ganly I. Surgical Management of Low-/Intermediate-Risk Node Negative Thyroid Cancer: A Single-Institution Study Using Propensity Matching Analysis to Compare Thyroid Lobectomy and Total Thyroidectomy. Thyroid 2022; 32:28-36. [PMID: 34861772 PMCID: PMC8792497 DOI: 10.1089/thy.2021.0356] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: The approach for surgical treatment of patients with low-/intermediate-risk T1T2N0/Nx well-differentiated thyroid cancer (WDTC)-total thyroidectomy (TT) versus thyroid lobectomy (TL)-remains a controversial topic. Conducting a randomized controlled trial (RCT) would be the gold standard to address this issue. However, this is challenging due to excellent survival outcomes, and therefore, high number of patients and long-term follow-up would be required. As an alternative to RCT, we have used propensity score (PS) matching to determine if T1T2N0/Nx patients selected to have TL had equivalent outcomes to a similar group treated with TT. Methods: After institutional review board approval, a database of 6259 patients with WDTC treated with primary surgery at our institution between 1985 and 2016 was analyzed to identify patients with T1T2N0/Nx cancers. Of 3756 patients identified, 943 were managed by TL and 2813 by TT. To control for possible confounders and reduce potential bias, we selected age, sex, histology, 131I therapy, American Thyroid Association risk, and American Joint Committee Cancer stage as our PS matching criteria. Subsequently, 918 TL patients were successfully matched with 918 TT patients. The Pearson χ2 test or Fisher's exact test was used to compare categorical covariates, and Student's t-test was used for comparison of continuous variables between the two groups. Disease-specific survival (DSS), overall survival (OS), and recurrence-free survival (RFS) were calculated using the Kaplan-Meier method and compared using the log-rank test. Results: After PS matching, there were no significant differences between TL and TT patients for OS (10-year OS: 92.2% vs. 91.3%, p = 0.9668), DSS (10-year DSS: 100% vs. 99.1%, p = 0.1967), or RFS (10-year RFS: 99.5% vs. 98.3%, p = 0.079). Conclusions: For low-/intermediate-risk patients with intrathyroidal thyroid cancer <4 cm, patients selected for TL have similar survival outcomes to a comparable group treated by TT.
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Affiliation(s)
- Danielli Matsuura
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Avery Yuan
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Victoria Harris
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashok R. Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R. Michael Tuttle
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal G. Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin P. Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Address correspondence to: Ian Ganly, MD, PhD, Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Copelli C, Manfuso A, Cassano L, Pederneschi N, Tewfik K, Pansini A, Cocchi R. Recurrent squamous cell carcinoma of the lower lip: salvage surgery outcome. Br J Oral Maxillofac Surg 2021; 59:921-927. [PMID: 34456078 DOI: 10.1016/j.bjoms.2020.10.019] [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: 04/27/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022]
Abstract
Squamous cell carcinoma (SCC) of the lip is one of the most commonly occurring oral cancers, mainly involving the lower lip. Despite a good prognosis in cases of early detection, survival rates drop dramatically in the presence of recurrence. While there are many studies in the literature regarding the management of primary tumours, the rate of recurrence in lower lip SCC is low and therefore there are few data and articles about them. We retrospectively reviewed patients affected by recurrent SCC of the lower lip treated surgically from 2011 to 2019 in a single centre. Data and results were compared with those in the literature. A total of 16 patients (mean [range] age: 78.1 [62-93] years) were eligible for inclusion. The disease-free survival rate at 2 and 5 years was 29.6% and the overall survival rate at 2 and 5 years was 14.4%. A significantly higher rate of failure and a worse prognosis was observed in patients with neck involvement. The prognosis of recurrent lower lip SCC is unfavourable with extremely low survival rates. This issue is probably linked to the oncological pathology but also to the advanced age of most patients, the presence of several comorbidities and, consequently, the high risk of perioperative mortality. For this reason, the analysis of data sets reported in the literature may help the surgeon in the management of recurrences and selection of patients.
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Affiliation(s)
- C Copelli
- Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy.
| | - A Manfuso
- Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - L Cassano
- Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - N Pederneschi
- Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - K Tewfik
- Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| | - A Pansini
- Operative Unit of Maxillo-Facial Surgery, Federico II University, Naples, Italy
| | - R Cocchi
- Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
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Toledo LM, de Oliveira AS, Pinheiro RA, Leite AKN, de Mello ES, Moyses RA, Kulcsar MAV, Dedivitis RA, Kowalski LP, Matos LL. Implication of the New AJCC pT Classification of SCC of the Lip Comparing With Other Oral Subsites. Laryngoscope 2021; 131:E2770-E2776. [PMID: 33949686 DOI: 10.1002/lary.29596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the implication of the new AJCC staging system for pT classification in a cohort of patients with SCC of the lip mucosa and compare it to other oral cavity sites. METHODS Retrospective cohort of 744 patients treated between 2002 and 2017, by the Head and Neck Surgery Department of the University of Sao Paulo. RESULTS Of 95 lip patients, 42 had pT upstage (58.1% of pT1 to pT2-3 and 50% of pT2 to pT3). Similar DFS/OS observed for those pT1 maintained or upstaged to pT2-3, pT2 patients upstaged to pT3 presented worse OS (49.4% versus 92.3%, P = .032). The comparison between lip and other mouth topographies, denoted better prognosis for pT1-2, but not for pT3-4a. Lip tumors had lower DOI, rates of perineural/angiolymphatic invasion, nodal metastasis, recurrence, and death. CONCLUSION The inclusion of DOI to the new pT classification better stratifies patients with SCC of the lip mucosa upstaged to pT3 by assessing inferior OS. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Loic Monginet Toledo
- Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Renan Aguera Pinheiro
- Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Raquel Ajub Moyses
- Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Luongo Matos
- Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
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El Ayachy R, Sun R, Ka K, Laville A, Duhamel AS, Tailleur A, Dumas I, Bockel S, Espenel S, Blanchard P, Tao Y, Temam S, Moya-Plana A, Haie-Meder C, Chargari C. Pulsed Dose Rate Brachytherapy of Lip Carcinoma: Clinical Outcome and Quality of Life Analysis. Cancers (Basel) 2021; 13:cancers13061387. [PMID: 33808535 PMCID: PMC8003123 DOI: 10.3390/cancers13061387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary Lip cancer accounts for 25–30% of all oral cancers, with 23,000 new cases per year in the world. Carcinomas of the lip can be successfully treated with different methods: surgery, external beam radiotherapy (EBRT) and brachytherapy. The choice of the treatment depends on the tumor size, location and expected functional and esthetic results with each option, but also depends on treatment type accessibility. There are no randomized studies comparing these different treatment strategies. In this article, we investigated the complications and outcomes of patients treated with interstitial pulsed dose rate brachytherapy in our institution. Abstract Purpose: Lip carcinoma represents one of the most common types of head and neck cancer. Brachytherapy is a highly effective therapeutic option for all stages of lip cancers. We report our experience of pulsed dose rate brachytherapy (PDR) as treatment of lip carcinoma. Methods and Materials: this retrospective single center study included all consecutive patients treated for a lip PDR brachytherapy in our institution from 2010 to 2019. The toxicities and outcomes of the patients were reported, and a retrospective quality of life assessment was conducted by phone interviews (FACT H&N). Results: From October 2010 to December 2019, 38 patients were treated in our institution for a lip carcinoma by PDR brachytherapy. The median age was 73, and the majority of patients presented T1-T2 tumors (79%). The median total dose was 70.14 Gy (range: 60–85 Gy). With a mean follow-up of 35.4 months, two patients (5.6%) presented local failure, and seven patients (19%) had lymph node progression. The Kaplan–Meier estimated probability of local failure was 7.2% (95% CI: 0.84–1) at two and four years. All patients encountered radiomucitis grade II or higher. The rate of late toxicities was low: three patients (8.3%) had grade II fibrosis, and one patient had grade II chronic pain. All patients would highly recommend the treatment. The median FACT H&N total score was 127 out of 148, and the median FACT H&N Trial Outcome Index was 84. Conclusions: This study confirms that an excellent local control rate is achieved with PDR brachytherapy as treatment of lip carcinoma, with very limited late side effects and satisfactory functional outcomes. A multimodal approach should help to improve regional control.
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Affiliation(s)
- Radouane El Ayachy
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Roger Sun
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Kanta Ka
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Adrien Laville
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Anne-Sophie Duhamel
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Anne Tailleur
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Isabelle Dumas
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Sophie Bockel
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Sophie Espenel
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Pierre Blanchard
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Yungan Tao
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
| | - Stéphane Temam
- Head and Neck Surgery Department, Gustave Roussy, 94800 Villejuif, France; (S.T.); (A.M.-P.)
| | - Antoine Moya-Plana
- Head and Neck Surgery Department, Gustave Roussy, 94800 Villejuif, France; (S.T.); (A.M.-P.)
| | - Christine Haie-Meder
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
- Centre de Cancérologie, Département d’Oncologie Radiothérapie, Charlebourg la Défense, 92250 La Garenne Colombes, France
| | - Cyrus Chargari
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France; (R.E.A.); (R.S.); (K.K.); (A.L.); (A.-S.D.); (A.T.); (I.D.); (S.B.); (S.E.); (P.B.); (Y.T.); (C.H.-M.)
- INSERM1030 Radiothérapie Moléculaire et Innovations Thérapeutiques, Université Paris-Saclay, 94800 Villejuif, France
- Correspondence:
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Yücel A, Ömeroğlu E, Güllüev M, İnan İ, Yücel H. Predictive factors of late neck metastasis in early stage lip cancer followed by "wait and see" policy. Am J Otolaryngol 2020; 41:102556. [PMID: 32526529 DOI: 10.1016/j.amjoto.2020.102556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
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