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Scorziello C, Borcea MC, Biffoni M, Pernazza A, Arienzo F, Melcarne R, Ventrone L, Laca A, Grani G, Durante C, Consorti F, Giacomelli L. Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report. Clin Case Rep 2023; 11:e7417. [PMID: 37484755 PMCID: PMC10362120 DOI: 10.1002/ccr3.7417] [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: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/25/2023] Open
Abstract
Incidental sonographic discovery of thyroid nodules is an increasingly common event in clinical practice. Less frequently, patients with cytological benign thyroid nodules have suspicious cervical lymph nodes detected by ultrasound examination or by cytological exam. Here, we discuss an intriguing case of cervical lymph node metastasis with a probable thyroid origin in a 65-year-old asymptomatic male smoker. He underwent thyroidectomy and unilateral cervical lymphadenectomy. Despite a negative chest X-ray, the postoperative histological examination revealed that the lymph node metastasis was actually from a lung carcinoma. Metastatic lesions in cervical lymph nodes from non-thyroidal origins must be excluded when evaluating lesions in the region, especially when thyroid nodules subjected to fine needle aspiration biopsy yield negative results, or lymph node cytological evaluations are inconsistent with thyroid cytological findings and sonographic features. Thyroid and lung adenocarcinomas share some epithelial and mesenchymal markers. Thyroglobulin helps differentiate primary thyroid tumors from lung ones, but in cases of poor differentiation, distinguishing metastatic lesions in the thyroid gland can be challenging. Lung cancer (LC) is the leading cause of cancer mortality worldwide, and survival rates have only marginally improved over the last several decades. The ongoing clinical challenge is detecting LC at earlier stages of the disease.
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Affiliation(s)
| | | | - Marco Biffoni
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Angelina Pernazza
- Department of Medico‐Surgical Sciences and BiotechnologySapienza University of RomeRomeItaly
| | - Francesca Arienzo
- Department of Radiological, Oncological and Pathological SciencesSapienza University of RomeRomeItaly
| | | | - Luca Ventrone
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Angelo Laca
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Giorgio Grani
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Cosimo Durante
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | | | - Laura Giacomelli
- Department of Surgical SciencesSapienza University of RomeRomeItaly
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Dhouib F, Bertaut A, Maingon P, Siala W, Daoud J, Aubignac L, Lestrade L, Crehange G, Vulquin N. Patterns of Failure in Patients With Head and Neck Squamous Cell Carcinomas of Unknown Primary Treated With Chemoradiotherapy. Technol Cancer Res Treat 2020; 19:1533033820905826. [PMID: 32484037 PMCID: PMC7268107 DOI: 10.1177/1533033820905826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: To evaluate the patterns of failure in patients treated for head and neck carcinoma of unknown primary and to discuss treatment practices concerning radiotherapy target volumes definition and dose prescription. Methods: Eleven patients presenting a locoregional recurrence after head and neck carcinoma of unknown primary treatment with curative-intent radiochemotherapy performed between 2007 and 2017 in the departments of radiation oncology of 2 French cancer institutes. Images of the computed tomography scan or the magnetic resonance imaging performed at the time of the recurrence were fused with those of the simulation computed tomography scan to delimit a volume corresponding to the recurrence and to define the area of relapse compared to the volumes treated. Results: Irradiation was unilateral in 6 cases and bilateral in 5 cases. The median time to onset of recurrence was 7.24 months (extreme 3-67.7 months). Six patients had only a neck node recurrence, 3 had a neck node and subsequent primary recurrence, and 1 had only a median subsequent primary recurrence. Only 1 patient had synchronous distance progression to local recurrence. All neck node recurrences were solitary and ipsilateral. The subsequent primary recurrences were in the oropharynx in 3 cases and in the contralateral oral cavity in one case. All neck node recurrences were into the irradiated volume. The subsequent primary recurrences were either within or in border of the irradiated volumes. The median of the mean dose, received by neck node recurrences, was 69.9 Gy and that of the mean dose, minimum dose, maximum dose, and dose received by 95% of the volume of recurrence was 66.7 Gy. For the primary relapses, the median of the mean dose was 52.1 Gy and that of the mean dose, minimum dose, maximum dose, and dose received by 95% of the volume of recurrence was 39.9 Gy. Conclusions: All local nodal recurrences occurred at sites that received high radiotherapy doses and doses received by sites of eventual failure did not vary significantly from sites that remain in control.
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Affiliation(s)
- Fatma Dhouib
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France.,Department of Oncology Radiotherapy, Habib Bourguiba Central University Hospital, Sfax, Tunisia
| | - Aurélie Bertaut
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Philippe Maingon
- Department of Oncology Radiotherapy, Central University Hospital La Pitié Salpêtrière, Paris, France
| | - Wicem Siala
- Department of Oncology Radiotherapy, Habib Bourguiba Central University Hospital, Sfax, Tunisia
| | - Jamel Daoud
- Department of Oncology Radiotherapy, Habib Bourguiba Central University Hospital, Sfax, Tunisia
| | - Léone Aubignac
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Laetitia Lestrade
- Department of Oncology Radiotherapy, Central University Hospital, Besançon, France
| | - Gilles Crehange
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
| | - Noemie Vulquin
- Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France
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Carsuzaa F, Dufour X, Gorphe P, Righini C, Cosmidis A, Rogé M, De Mones E, Servagi Vernat S, Tonnerre D, Morinière S, Dugas A, Malard O, Pasquier F, Vergez S, Schick U, Gérard M, Salleron J, Thariat J. Locoregional control, progression-free survival and morbidity rates in N3 head and neck cancer patients with low primary tumour burden: A 301-patient study. Clin Otolaryngol 2020; 45:877-884. [PMID: 32729227 DOI: 10.1111/coa.13615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/26/2020] [Accepted: 07/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In patients with N3 head and neck squamous cell carcinoma (HNSCC), N3 disease is associated with high regional relapse and metastatic risks. Patients with resectable N3 disease have better prognosis although their metastatic risk may be similar as in patients with unresectable disease. Neoadjuvant chemotherapy has been associated with lower metastatic rates, but N3 patients may die of rapid locoregional progression. We assessed outcomes with the three modalities in patients with low primary burden to better assess the specific prognosis of N3 disease. METHODS This retrospective multicentric study included T0-2 N3 HNSCC patients. Outcomes and morbidity in upfront neck dissection (uND) vs non-surgical groups were analysed and oncological outcomes and morbidity compared between patients undergoing chemoradiation or neoadjuvant chemotherapy in patients with initially unresectable N3 nodes. RESULTS Of 301 patients, 142 (47%) underwent uND, 68 (23%) neoadjuvant chemotherapy and 91 (30%) chemoradiation. The 24- and 60-month incidence of locoregional relapse was 23.2% [18.3%; 28.4%] and 27.4% [21.8%; 33.3%]; it was lower in patients undergoing uND (P = .006). In patients with non-surgical treatments, success rates were 57.8% [49.4%; 66.3%] after chemoradiation and 38.1% [29.6%; 46.7%] after neoadjuvant chemotherapy (P = .001). Overall morbidity was more frequent in patients undergoing uND (68.8%) (P < .001). CONCLUSION uND improved locoregional control but increased morbidity and showed no survival benefit. Success rates were better after chemoradiation versus neoadjuvant chemotherapy. Neoadjuvant chemotherapy did not reduce metastatic rates but non-responders to chemoradiation had poor PFS and survival rate, suggesting that predictive criteria are warranted.
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Affiliation(s)
- Florent Carsuzaa
- Head and neck surgery, University Hospital of Poitiers, Poitiers, France
| | - Xavier Dufour
- Head and neck surgery, University Hospital of Poitiers, Poitiers, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Christian Righini
- Head and neck surgery, University Hospital of Grenoble, Grenoble, France
| | - Alain Cosmidis
- Head and neck surgery, University Hospital of Lyon, Lyon, France
| | | | - Erwan De Mones
- Head and neck surgery, University Hospital of Bordeaux, Bordeaux, France
| | | | - Denis Tonnerre
- Head and neck surgery, University Hospital of Poitiers, Poitiers, France
| | | | - Amaury Dugas
- Head and neck surgery, University Hospital of Caen, Caen, France
| | - Olivier Malard
- Head and neck surgery, University Hospital of Nantes, Nantes, France
| | - François Pasquier
- Head and neck surgery, University Hospital of Nantes, Nantes, France
| | - Sébastien Vergez
- Head and neck surgery, Institut Universitaire du Cancer de Toulouse Oncopole / University Hospital of Toulouse, Toulouse, France
| | - Ulrike Schick
- Radiation oncology, University Hospital of Brest, Brest, France
| | - Michael Gérard
- Radiation oncology, Centre François Baclesse / ARCHADE, Caen, France
| | - Julia Salleron
- Cellule Data Biostatistique, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Juliette Thariat
- Radiation oncology, Centre François Baclesse / ARCHADE, Caen, France
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Pflumio C, Troussier I, Sun XS, Salleron J, Petit C, Caubet M, Beddok A, Calugaru V, Servagi-Vernat S, Castelli J, Miroir J, Krengli M, Giraud P, Romano E, Khalifa J, Doré M, Blanchard N, Coutte A, Dupin C, Sumodhee S, Pointreau Y, Patel S, Rehailia-Blanchard A, Catteau L, Bensadoun RJ, Tao Y, Roth V, Geoffrois L, Faivre JC, Thariat J. Unilateral or bilateral irradiation in cervical lymph node metastases of unknown primary? A retrospective cohort study. Eur J Cancer 2019; 111:69-81. [PMID: 30826659 DOI: 10.1016/j.ejca.2019.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Patients with cervical lymphadenopathy of unknown primary carcinoma (CUP) usually undergo neck dissection and irradiation. There is an ongoing controversy regarding the extent of nodal and mucosal volumes to be irradiated. We assessed outcomes after bilateral or unilateral nodal irradiation. METHODS This retrospective multicentre study included patients with CUP and squamous cellular carcinoma who underwent radiotherapy (RT) between 2000 and 2015. RESULTS Of 350 patients, 74.5% had unilateral disease and 25.5% had bilateral disease. Of 297 patients with available data on disease and irradiation sides, 61 (20.5%) patients had unilateral disease and unilateral irradiation, 155 (52.2%), unilateral disease and bilateral irradiation and 81 (27.3%), bilateral disease and bilateral irradiation. Thirty-four (9.7%) and 217 (62.0%) patients received neoadjuvant and/or concomitant chemotherapy, respectively. Median follow-up was 37 months. Three-year local, regional, locoregional failure rates and CUP-specific survival were 5.6%, 11.7%, 15.0% and 84.7%, respectively. In patients with unilateral disease, the 3-year cumulative incidence of regional/local relapse was 7.7%/4.3% after bilateral irradiation versus 16.9%/11.1% after unilateral irradiation (hazard ratio = 0.56/0.61, p = 0.17/0.32). The cumulative incidence of CUP-specific deaths was 9.2% after bilateral irradiation and 15.5% after unilateral irradiation (p = 0.92). In multivariate analysis, mucosal irradiation was associated with better local control, whereas no neck dissection, ≥N2b and interruption of RT for more than 4 days were associated with poorer regional control. Toxicity was higher after bilateral irradiation (p < 0.05). No positron-emission tomography-computed tomography, largest node diameter, ≥N2b, neoadjuvant chemotherapy and interruption of RT were associated with poorer cause-specific survival. CONCLUSION Bilateral nodal irradiation yielded non-significant better nodal and mucosal control rates but was associated with higher rates of severe toxicity.
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Affiliation(s)
- Carole Pflumio
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Idriss Troussier
- Department of Radiation Therapy, CHU Pitié Salpêtrière, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Xu Shan Sun
- Department of Radiation Therapy, Hôpital de Montbéliard, Montbéliard, France
| | - Julia Salleron
- Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Claire Petit
- Department of Radiation Therapy, Institut Gustave Roussy, Villejuif, France
| | - Matthieu Caubet
- Department of Radiation Therapy, CHU de Besançon, Besançon, France
| | - Arnaud Beddok
- Department of Radiation Therapy, Institut Curie, Paris, France
| | | | | | - Joël Castelli
- Department of Radiation Therapy, Institut Eugène Marquis, Rennes, France
| | - Jessica Miroir
- Department of Radiation Therapy, Institut Jean Perrin, Clermont-Ferrand, France
| | - Marco Krengli
- Department of Radiation Therapy, University of Piemonte Orientale, Pavia, Italy
| | - Paul Giraud
- Department of Radiation Therapy, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Edouard Romano
- Department of Radiation Therapy, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Jonathan Khalifa
- Department of Radiation Therapy, Institut Universitaire du Cancer, Toulouse, France
| | - Mélanie Doré
- Department of Radiation Therapy, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Nicolas Blanchard
- Department of Radiation Therapy, Clinique les Dentellières, Valenciennes, France
| | | | - Charles Dupin
- Department of Radiation Therapy, Centre Antoine Lacassagne, Nice, France
| | - Shakeel Sumodhee
- Department of Radiation Therapy, Centre Antoine Lacassagne, Nice, France
| | - Yoann Pointreau
- Department of Radiation Therapy, Clinique Victor Hugo, Le Mans, France
| | - Samir Patel
- Department of Radiation Therapy, Mayo Clinic, Arizona, USA
| | | | - Ludivine Catteau
- Department of Radiation Therapy, CHU de Poitiers, Poitiers, France
| | | | - Yungan Tao
- Department of Radiation Therapy, Institut Gustave Roussy, Villejuif, France
| | | | - Lionnel Geoffrois
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Jean-Christophe Faivre
- Academic Department of Radiation Therapy, Lorraine Institute of Cancerology, Vandoeuvre-lès-Nancy, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre Francois Baclesse, Advanced Resource Center for Hadrontherapy in Europe, Caen, France, Unicaen-Normandie Universite.
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