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Zhang Y, Su X, Qiao Y, Huang S, Kou Y. Occult lymph node metastasis in the contralateral neck of oropharyngeal squamous cell carcinoma: a meta-analysis and literature review. Eur Arch Otorhinolaryngol 2022; 279:2157-2166. [PMID: 35041065 DOI: 10.1007/s00405-021-07230-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine whether contralateral cervical lymph node dissection is needed in patients with oropharyngeal squamous cell carcinoma (OPSCC) with contralateral cervical cN0. METHODS We searched the PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM) and Cochrane Library databases up to August 14, 2021 for studies examining the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-negative (cN0) OPSCC and the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-positive (cN1, cN2a, cN2b) OPSCC. This rate is used to determine whether patients with contralateral cN0 OPSCC need contralateral cervical lymph node dissection. RESULTS A total of 14 articles, including 532 cases, were included in the analysis. When studying the rate of ipsilateral cervical occult metastasis in patients with ipsilateral cN0, 163 cases were included in 11 studies. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN0 was 0.6816% (95% CI 0.0000-4.4880 (P = 0.3005)). In the study of ipsilateral cN+ (cN1, cN2a, cN2b), a total of 369 cases of 10 articles were included in the analysis. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN+ was 11.4920% [95% CI 7.8944-15.5223 (P = 0.0000)]. CONCLUSION For cancer treatment, the ultimate goal is to achieve the best control of cancer and the lowest complications. It seems unnecessary to intervene in the contralateral neck of patients with OPSCC with ipsilateral cN0. For OPSCC with ipsilateral cN+ , this index is a factor that cannot be ignored when making clinical decisions.
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Affiliation(s)
- Ying Zhang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Xingzhou Su
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Yumeng Qiao
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Shaohui Huang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China. .,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China.
| | - Yurong Kou
- Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, No. 117 Nanjing North Street, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
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2
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Gupta T, Maheshwari G, Kannan S, Nair S, Chaturvedi P, Agarwal JP. Systematic review and meta-analysis of randomized controlled trials comparing elective neck dissection versus sentinel lymph node biopsy in early-stage clinically node-negative oral and/or oropharyngeal squamous cell carcinoma: Evidence-base for practice and implications for research. Oral Oncol 2021; 124:105642. [PMID: 34861565 DOI: 10.1016/j.oraloncology.2021.105642] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Management of clinically node-negative (N0) neck in early-stage (T1-T2) oral and/or oropharyngeal squamous cell carcinoma (OOSCC) has been controversial. The purpose of this systematic review and meta-analysis was to compare sentinel lymph node biopsy (SLNB) with elective neck dissection (END) in early-stage OOSCC. METHODS Studies comparing SLNB versus END in early-stage clinically node-negative OOSCC were identified using validated search strategy. To be considered eligible, trials had to include patients with early-stage, clinically node-negative OOSCC who had been randomly assigned to either SLNB or END. Primary outcome of interest was overall survival (OS), while secondary outcomes included isolated neck nodal recurrence (NNR), loco-regional recurrence (LRR), and neck-shoulder function. Outcome data was pooled using random-effects model and reported as hazard ratio (HR) or risk ratio (RR) with 95% confidence interval (CI). Any p-value < 0.05 was considered statistically significant. RESULTS A total of 608 patients from three trials comparing SLNB versus END in early-stage clinically node-negative OOSCC were included. The pooled HR of death for SLNB versus END was 1.18 (95% CI: 0.79-1.78, p = 0.41) which was not statistically significant. The rates of isolated NNR (pooled RR = 1.11, 95% CI: 0.69-1.80, p = 0.66) and LRR (pooled RR = 1.18, 95% CI: 0.81-1.72, p = 0.39) were also similar. Pooled analysis of the neck-shoulder function significantly favoured SLNB arm (pooled RR = 1.21, 95% CI: 1.12-1.32, p < 0.00001). CONCLUSION There is low-certainty evidence that SLNB is oncologically non-inferior to END and is associated with potentially lesser functional morbidity making it an emerging alternative standard of care in patients with early-stage clinically node-negative OOSCC.
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Affiliation(s)
- Tejpal Gupta
- Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, INDIA.
| | - Guncha Maheshwari
- Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, INDIA
| | - Sadhana Kannan
- Department of Clinical Research Secretariat, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, INDIA
| | - Sudhir Nair
- Department of Head & Neck Surgery, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, INDIA
| | - Pankaj Chaturvedi
- Department of Head & Neck Surgery, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, INDIA
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, INDIA
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3
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Zeng X, Peng L, Wen W, Sun W. Comparison of Survival of Patients With T 1 -2 cN 0 Oropharyngeal Cancer Treated With or Without Elective Neck Dissection. Laryngoscope 2021; 132:1205-1212. [PMID: 34797566 DOI: 10.1002/lary.29951] [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: 08/01/2021] [Revised: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to examine the prognostic value of elective neck dissection (END) in T1-2 clinical negative cervical lymph node (cN0 ) oropharyngeal cancer (OPC) patients. STUDY DESIGN An observational retrospective study. METHODS This retrospective study included 845 patients diagnosed with T1-2 cN0 OPC during 2010-2015 from Surveillance, Epidemiology, and End Results database. Univariable and multivariable Cox regression models were used to evaluate the prognostic roles of END. Furthermore, propensity score matching was used to balance the covariates between the END and observation (OBS) groups, and subgroup analyses were conducted in the matched cohorts. The primary endpoint was overall survival (OS). RESULTS Our study showed that END was an independent prognostic factor associated with a better 3-year OS compared with OBS in human papillomavirus (HPV)-positive cohort (adjusted hazard ratio [HR], 0.464; 95% confidence interval [CI], 0.235-0.916; P = .027). However, we found no prognostic value of END in HPV-negative cohort (adjusted HR, 0.837; 95% CI, 0.535-1.310; P = .435). In the subgroup analyses, we found that younger patients (≤65 years old) and patients with nontonsillar tumors in HPV-positive cohort were more likely to benefit from END, while patients with tonsillar tumors in HPV-negative cohort may benefit from END. CONCLUSIONS We found that patients with HPV-positive T1-2 cN0 OPC could benefit from END in terms of OS, especially younger patients and those with nontonsillar tumors. Patients with HPV-negative T1-2 cN0 OPC could not benefit from END in terms of OS, while those with tonsillar tumors may benefit from END. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Xuelan Zeng
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
| | - Liang Peng
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
| | - Weiping Wen
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China.,Department of Otolaryngology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Sun
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
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4
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De Virgilio A, Costantino A, Sebastiani D, Russo E, Franzese C, Mercante G, Scorsetti M, Spriano G. Elective neck irradiation in the management of esthesioneuroblastoma: a systematic review and meta-analysis. Rhinology 2021; 59:433-440. [PMID: 34254061 DOI: 10.4193/rhin21.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is no consensus about the optimal management of the neck in clinically node negative esthesioneuroblastoma (ENB). The aim of this study is to assess the impact of elective neck irradiation (ENI) in terms of regional disease control and survival. METHODS The study was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, and Google Scholar databases. The primary outcome was the regional recurrence rate (RRR), that was reported as odds ratio (OR) and 95% confidence interval (CI). Secondary outcomes were the overall survival (OS), and the distant-metastases free survival (DMFS), that were reported as logarithm of the hazard ratios (logHRs) and 95% confidence intervals (CIs). RESULTS A total of 489 clinically node negative patients were included from 9 retrospective studies. ENI significantly reduced the risk of regional recurrence compared to no treatment. No difference was measured between ENI and observation, according to both OS and DMFS. No stratified analysis could be performed based on Kadish stage and Hyams grade. CONCLUSIONS ENI should be recommended to improve the regional disease control. No advantage was measured in terms of survival or distant metastases with a low quality of evidence. Further prospective studies should be designed to understand if ENI could be avoided in early stage and low-grade tumors.
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Affiliation(s)
- A De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - D Sebastiani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - E Russo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - C Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Radiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Radiotherapy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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5
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Nuyts S, Bollen H, Eisbruch A, Corry J, Strojan P, Mäkitie AA, Langendijk JA, Mendenhall WM, Smee R, DeBree R, Lee AWM, Rinaldo A, Ferlito A. Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck. Head Neck 2021; 43:2807-2821. [PMID: 33871090 DOI: 10.1002/hed.26713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/21/2022] Open
Abstract
Cancers of the head and neck region often present with nodal involvement. There is a long-standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, small metastases that used to remain undetected and were thus in the past included in the elective nodal volume, will now be included in high-dose volumes. Furthermore, the elective nodal areas are situated close to the parotid glands, the submandibular glands and the swallowing muscles. Therefore, irradiation of a smaller, more selected volume of the elective nodes could reduce treatment-related toxicity. Several researchers consider the current bilateral elective neck irradiation strategies an overtreatment and show growing interest in a unilateral nodal irradiation in selected patients. The aim of this article is to give an overview of the current evidence about the indications and benefits of unilateral nodal irradiation and the use of SPECT/CT-guided nodal irradiation in squamous cell carcinomas of the head and neck.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Avrahram Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - June Corry
- Division of Medicine, Department of Radiation Oncology, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - William M Mendenhall
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Remco DeBree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Udine, Italy
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6
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Huopainen P, Jouhi L, Hagstrom J, Apajalahti S. MRI correlates to histopathological data in oral tongue squamous cell carcinoma diagnostics. Acta Odontol Scand 2021; 79:161-166. [PMID: 32654567 DOI: 10.1080/00016357.2020.1789736] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study was to compare magnetic resonance imaging (MRI) maximum tumor diameter and depth of invasion with histopathology in oral tongue squamous cell carcinoma (OTSCC) patients in our Institute. Another objective was to compare recorded nodal status between MRI and histology. MATERIAL AND METHODS MRI and pathological records of 45 patients diagnosed with T1-T3 OTSCC were reviewed retrospectively. Maximum tumor diameter and depth of invasion were measured and rechecked by oral radiologist and pathologist. Nodal status was recorded from both MRI and histopathology. Correlation analyses were performed using Pearson's correlation. RESULTS Both maximum tumor diameter and depth of invasion correlated significantly between MRI and histology (ρ = 0.874, p < .001; ρ = 0.898, p < .001). Significant correlation was found between MRI and pathological dimensions in the MRI-based T-staged subgroups of T2 and T3 but not in T1. MRI sensitivity for detecting pathologically positive nodes was 60%. MRI specificity for detecting pathologically negative nodes was 83%. Moderate correlation was found between MRI and histological nodal status (ρ = 0.44, p = .003). CONCLUSIONS MRI tumor dimensions correlate with histopathological data in OTSCC. Based on our Finnish patient material and results, MRI serves as an accurate tool in supporting OTSCC patient treatment in our Institute.
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Affiliation(s)
- Piia Huopainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagstrom
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
- Department of Oral Pathology and Radiology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Satu Apajalahti
- HUS Medical Imaging Center, Department of Radiology, Helsinki University Hospital, Helsinki, Finland
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7
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De Virgilio A, Costantino A, Canzano F, Accorona R, Mercante G, Ferreli F, Malvezzi L, Colombo G, Pellini R, Spriano G. Regional disease control in sinonasal mucosal melanoma: Systematic review and meta‐analysis. Head Neck 2020; 43:705-715. [DOI: 10.1002/hed.26537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 02/03/2023] Open
Affiliation(s)
- Armando De Virgilio
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
- Department of Biomedical Sciences Humanitas University Via Rita Levi Montalcini 4 Pieve Emanuele (MI) Italy
| | - Andrea Costantino
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
- Department of Biomedical Sciences Humanitas University Via Rita Levi Montalcini 4 Pieve Emanuele (MI) Italy
| | - Federica Canzano
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
| | - Remo Accorona
- Department of Otorhinolaryngology ‐ Head and Neck Surgery Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Milan Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
- Department of Biomedical Sciences Humanitas University Via Rita Levi Montalcini 4 Pieve Emanuele (MI) Italy
| | - Fabio Ferreli
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
| | - Luca Malvezzi
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
| | - Giovanni Colombo
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
| | - Raul Pellini
- Department of Otolaryngology ‐ Head and Neck Surgery IRCCS Regina Elena National Cancer Institute Rome Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit IRCCS Humanitas Clinical and Research Center Via Manzoni 56 Rozzano (MI) Italy
- Department of Biomedical Sciences Humanitas University Via Rita Levi Montalcini 4 Pieve Emanuele (MI) Italy
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8
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Vassiliou LV, Acero J, Gulati A, Hölzle F, Hutchison IL, Prabhu S, Testelin S, Wolff KD, Kalavrezos N. Management of the clinically N 0 neck in early-stage oral squamous cell carcinoma (OSCC). An EACMFS position paper. J Craniomaxillofac Surg 2020; 48:711-718. [PMID: 32718880 DOI: 10.1016/j.jcms.2020.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/20/2020] [Indexed: 12/12/2022] Open
Abstract
Metastasis of oral squamous cell carcinoma (OSCC) to the cervical lymph nodes has a significant impact on prognosis. Accurate staging of the neck is important in order to deliver appropriate treatment for locoregional control of the disease and for prognosis. The management of the neck in early, low volume disease (clinically T1/T2 oral cavity tumours) has long been debated. The risk of occult nodal involvement in cT1/T2 OSCC is estimated around 20-30%. We describe the natural evolutionary history of OSCC and its patterns of spread and metastasis to the local lymphatic basins. We discuss most published literature and studies on management of the clinically negative neck (cN0). Particular focus is given to prospective randomized trials comparing the outcomes of upfront elective neck dissection against the observational stance, and we summarize the results of the sentinel node biopsy studies. The paper discusses the significance of the primary tumour histological characteristics and specifically the tumour's depth of invasion (DOI) and its impact on predicting nodal metastasis. The DOI has been incorporated in the TNM staging highlighting its significance in aiding the treatment decision making and this is reflected in world-wide oncological guidelines. The critical analysis of all available literature amalgamates the existing evidence in early OSCC and provides recommendations in the management of the clinically N0 neck.
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Affiliation(s)
- Leandros V Vassiliou
- Department of Oral and Maxillofacial Surgery, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK
| | - Julio Acero
- Department of Oral and Maxillofacial Surgery, Ramon y Cajal University Hospital, Alcala University, Madrid, Spain
| | - Aakshay Gulati
- Maxillofacial Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, UK
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, Aachen University Hospital, Aachen, Germany
| | - Iain L Hutchison
- Department of Oral & Maxillofacial Surgery, Barts Health NHS Trust, Saving Faces-The Facial Surgery Research Foundation, London, UK
| | - Satheesh Prabhu
- Division of Oral & Maxillofacial Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sylvie Testelin
- Department of Maxillo-Facial Surgery, University Hospital of Amiens, Amiens, France
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, University Hospital Rechts der Isar, Munich, Germany
| | - Nicholas Kalavrezos
- Department of Head & Neck Surgery, University College London Hospital, London, UK.
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9
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Jouhi L, Atula T, Mäkitie A, Keski-Säntti H. Management of clinically N0 neck in oropharyngeal carcinoma. Eur Arch Otorhinolaryngol 2019; 276:1205-1210. [PMID: 30729294 PMCID: PMC6426801 DOI: 10.1007/s00405-019-05314-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/23/2019] [Indexed: 02/05/2023]
Abstract
Purpose Only a minority of patients with oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed without regional metastasis (cN0). Studies focusing on the management of cN0 neck in OPSCC are scarce. Methods We reviewed all OPSCC patients treated at our institution with cN0 neck between 2000 and 2009. The treatment of neck and pattern of regional control was analyzed. Median follow-up was 5 years (range 3.5–9.0) or until death. Results Of the total 313 OPSCC patients treated within the period, 56 (18%) presented with cN0 neck. Of them, 51 (91%) received completed treatment with curative intent: 46 (90%) underwent elective neck treatment with either neck dissection ± (chemo)radiotherapy (C)RT (n = 23) or (C)RT (n = 23). A regional recurrence occurred in three patients (6%) and they all had a p16-negative soft palate midline primary tumor. Two of these patients had received RT on the neck. Conclusions While the overall prognosis of OPSCC is generally favorable and regional recurrences are infrequent, soft palate tumors, that are usually p16 negative, may form an subgroup warranting more aggressive treatment despite the clinical appearance of early stage.
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Affiliation(s)
- Lauri Jouhi
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland.
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland
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10
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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11
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Amit M, Tam S, Abdelmeguid AS, Roberts DB, Raza SM, Su SY, Kupferman ME, DeMonte F, Hanna EY. Approaches to regional lymph node metastasis in patients with head and neck mucosal melanoma. Cancer 2017; 124:514-520. [PMID: 29044491 DOI: 10.1002/cncr.31083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/23/2017] [Accepted: 09/13/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mucosal melanomas in the head and neck region are most often located in the nasal cavity and paranasal sinuses. To the authors' knowledge, the prognostic effects of lymph node metastasis in patients with sinonasal mucosal melanoma (SNMM) have not been established. Therefore, the objective of the current study was to determine the effects of lymph node metastasis on survival. METHODS The current study included 198 patients with SNMM who had been treated between 1985 and 2016 at The University of Texas MD Anderson Cancer Center in Houston. Patients' clinical and pathologic lymph node statuses were evaluated and characterized. A multivariate analysis was used to assess the associations between regional spread and survival outcomes. RESULTS Therapeutic neck dissection was performed in 23 patients with SNMM (11.6%). Regional disease recurrence occurred in 7 of the patients who had lymph node metastasis at the time of presentation (30.4%) and in 30 of those who had N0 disease at the time of presentation (17.1%) (P = .15). Metastasis to the contralateral lymph nodes was present in 7 patients (3.5%). The 5-year disease-specific survival rate was 66% in patients with lymph node spread compared with 45% in patients with N0 status (P = .04, log-rank test). A multivariate analysis demonstrated that distant metastasis was the only variable found to be independently associated with both overall survival (hazard ratio, 2.96; 95% confidence interval, 1.54-6.95 [P = .01]) and disease-specific survival (hazard ratio, 3.32; 95% confidence interval, 1.79-7.14 [P = 0.01]). CONCLUSIONS The results of the current study demonstrated that lymph node status in patients with SNMM was not a significant predictor of outcome. This finding, together with the low incidence of lymph node metastases in patients with SNMM, suggests that elective treatment of the neck should be highly selective in this patient population. Cancer 2018;124:514-20. © 2017 American Cancer Society.
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Affiliation(s)
- Moran Amit
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samantha Tam
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed S Abdelmeguid
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura City, Egypt
| | - Dianna B Roberts
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shaan M Raza
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shirley Y Su
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Kupferman
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Franco DeMonte
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Al-Mamgani A, van Werkhoven E, Navran A, Karakullukcu B, Hamming-Vrieze O, Machiels M, van der Velden LA, Vogel WV, Klop WM. Contralateral regional recurrence after elective unilateral neck irradiation in oropharyngeal carcinoma: A literature-based critical review. Cancer Treat Rev 2017; 59:102-108. [DOI: 10.1016/j.ctrv.2017.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/28/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
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13
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Frequency of bilateral cervical metastases in hypopharyngeal squamous cell carcinoma: a retrospective analysis of 203 cases after bilateral neck dissection. Eur Arch Otorhinolaryngol 2017; 274:3965-3970. [DOI: 10.1007/s00405-017-4724-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/19/2017] [Indexed: 12/28/2022]
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14
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Ahmed SQ, Junaid M, Awan S, Kazi M, Khan HU, Halim S. Frequency of Cervical Nodal Metastasis in Early-Stage Squamous Cell Carcinoma of the Tongue. Int Arch Otorhinolaryngol 2017; 22:136-140. [PMID: 29619101 PMCID: PMC5882373 DOI: 10.1055/s-0037-1603626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/01/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction
Oral cavity carcinoma is an aggressive tumor, with the tongue being one of the most common subsites of involvement. Surgery is a gold standard method of dealing with advanced-stage tumors. However, for early-stage carcinomas of the tongue, the management remains controversial. Several studies have indicated that early-stage cancers have a high chance of occult cervical node metastasis, which, if left untreated, can greatly affect the prognosis. Certain parameters can help identify patients with occult cervical node metastases, and can avoid unnecessary neck dissection in node negative patients. Tumor thickness is one such objective parameter.
Objective
To estimate the frequency of cervical lymph node metastasis in patients with early-stage, node-negative (N
0
) squamous cell carcinoma of the tongue.
Methods
In-patient hospital data was reviewed from January 2013 until March 2014, and 78 patients who underwent primary resection of the tumor and neck dissection for biopsy-proven, early stage squamous cell carcinoma of the tongue were included. Data such as tumor thickness, tumor differentiation and presence of occult nodal metastasis in the surgical specimen were gathered from the histopathology reports. The frequency of subclinical cervical lymph node metastasis in patients with early-stage squamous cell carcinoma of the tongue was estimated.
Results
A total of 69% of the patients with tumor thicknesses > 5 mm had tumor metastases in the neck nodes, while 100% of the patients with tumor thicknesses < 5 mm had no neck nodal metastasis.
Conclusion
A tumor thickness > 5 mm is significantly associated with subclinical metastasis, and prophylactic neck dissection is warranted in such cases.
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Affiliation(s)
- Sadaf Qadeer Ahmed
- Department of Otorhinolaryngology, Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan
| | - Montasir Junaid
- Department of Otorhinolaryngology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Sohail Awan
- Department of Otorhinolaryngology, Aga Khan University, Karachi, Pakistan
| | - Maliha Kazi
- Department of Otorhinolaryngology, Manchester Royal Infirmary, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Hareem Usman Khan
- Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Sohail Halim
- Department of Pathology, Aga Khan University, Karachi, Pakistan
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15
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Raj R, Lotwala V, Anajwala P. Minimally invasive supraomohyoid neck dissection by total endoscopic technique for oral squamous carcinoma. Surg Endosc 2015; 30:2315-20. [PMID: 26715016 DOI: 10.1007/s00464-015-4427-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/07/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE To study the feasibility of a total endoscopic technique for selective neck dissection in oral cancers and to compare the technique with conventional open technique with a long cervical scar. METHODS We included patients with early intraorally resectable squamous carcinomas and excluded patients whose primary lesion required reconstruction with microvascular flaps. We compared the following intraoperative parameters: cumulative length of the incision(s), duration of surgery, estimated blood loss, and intraoperative complications. The postoperative parameters included hospital stay, shoulder function, duration of analgesic use, and early postoperative complications. We used Shoulder Pain And Disability Index scores to assess shoulder function and assessed the oncologic outcome histopathologically by the number of nodes dissected. RESULTS The mean operative time for minimally invasive supraomohyoid neck dissection (MISOND) was 53.7 ± 29.8 min, which was significantly longer than 39.4 ± 5.0 min for the open technique. The estimated blood loss in the MISOND group was significantly lower compared with the open technique (p < 0.001), and there were no major intraoperative complications in either group. Postoperative recovery assessed by hospital stay and time to resume routine work was slightly shorter in the MISOND group but not statistically significant. There were no reported early postoperative complications such as haemorrhage, wound dehiscence, or chyle leakage in either group. The mean Shoulder Pain And Disability Index score assessed 2 weeks postoperatively for the MISOND group was 14.35 ± 0.71 %, which was significantly better than 44.14 ± 1.18 % for the open technique (p < 0.001). The number of nodes dissected showed no significant difference between groups. CONCLUSIONS MISOND is a feasible and safe procedure with immediate oncologic outcomes comparable with those of conventional open SOND and provides better cosmetic and functional outcomes.
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Affiliation(s)
- Ravindrasinh Raj
- Department of Surgical Oncology, Bharat Cancer Hospital and Research Institute, Saroli, Kadodara Road, Surat, 395010, Gujarat, India.
| | - Vikram Lotwala
- Department of Minimal Access Surgery, Bharat Cancer Hospital and Research Institute, Surat, India
| | - Piyush Anajwala
- Department of Minimal Access Surgery, Bharat Cancer Hospital and Research Institute, Surat, India
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16
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Kaya İ, Göde S, Öztürk K, Turhal G, Aliyev A, Akyıldız S, Duygun ÜY, Uluöz Ü, Yavuzer A. The Value of Sentinel Lymph Node Biopsy in Oral Cavity Cancers. Turk Arch Otorhinolaryngol 2015; 53:62-66. [PMID: 29391982 DOI: 10.5152/tao.2015.1178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/11/2015] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to establish the effectiveness of sentinel lymph node biopsy in the detection of metastasis in N0 necks of T1-T2 early-stage oral cavity cancers. Materials and Methods Twenty neck dissections were performed in 18 patients diagnosed with T1 and T2 oral cavity cancer, with an indication for elective neck dissection between November 2007 and January 2011. The male to female ratio was 12:8, with a mean age of 54.5 years (range 28-76). Eight of the dissections were performed for lower lip cancer, 7 for tongue cancer, and 5 for floor of the mouth cancer. Sentinel lymph node biopsy was used to detect metastatic lymph nodes. Tc99m radionuclide injection was administered to the periphery of the tumor 24 h before the operation, and a lymphoscintigraphy image was obtained 30 min after the injection. Sentinel lymph nodes were localized and excised on the day of surgery using static lymphoscintigraphy images and a gamma probe. Sentinel lymph nodes were sent for a frozen section examination, and either a selective or a comprehensive neck dissection was performed for each neck according to the results. Results After the final histopathological examination of the specimens, the negative predictive value, the positive predictive value, the accuracy of the sentinel lymph node biopsy, and frozen section accuracy were found to be 100%. Conclusion Sentinel lymph node biopsy was found to be an efficient method in the pathological staging and management of the N0 neck in early T-stage oral cavity cancers.
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Affiliation(s)
- İsa Kaya
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sercan Göde
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Kerem Öztürk
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Göksel Turhal
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Araz Aliyev
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Serdar Akyıldız
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | | | - Ümit Uluöz
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Atilla Yavuzer
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir, Turkey
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17
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de Carvalho AC, Scapulatempo-Neto C, Maia DCC, Evangelista AF, Morini MA, Carvalho AL, Vettore AL. Accuracy of microRNAs as markers for the detection of neck lymph node metastases in patients with head and neck squamous cell carcinoma. BMC Med 2015; 13:108. [PMID: 25956054 PMCID: PMC4493814 DOI: 10.1186/s12916-015-0350-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/20/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The presence of metastatic disease in cervical lymph nodes of head and neck squamous cell carcinoma (HNSCC) patients is a very important determinant in therapy choice and prognosis, with great impact in overall survival. Frequently, routine lymph node staging cannot detect occult metastases and the post-surgical histologic evaluation of resected lymph nodes is not sensitive in detecting small metastatic deposits. Molecular markers based on tissue-specific microRNA expression are alternative accurate diagnostic markers. Herein, we evaluated the feasibility of using the expression of microRNAs to detect metastatic cells in formalin-fixed paraffin-embedded (FFPE) lymph nodes and in fine-needle aspiration (FNA) biopsies of HNSCC patients. METHODS An initial screening compared the expression of 667 microRNAs in a discovery set comprised by metastatic and non-metastatic lymph nodes from HNSCC patients. The most differentially expressed microRNAs were validated by qRT-PCR in two independent cohorts: i) 48 FFPE lymph node samples, and ii) 113 FNA lymph node biopsies. The accuracy of the markers in identifying metastatic samples was assessed through the analysis of sensitivity, specificity, accuracy, negative predictive value, positive predictive value, and area under the curve values. RESULTS Seven microRNAs highly expressed in metastatic lymph nodes from the discovery set were validated in FFPE lymph node samples. MiR-203 and miR-205 identified all metastatic samples, regardless of the size of the metastatic deposit. Additionally, these markers also showed high accuracy when FNA samples were examined. CONCLUSIONS The high accuracy of miR-203 and miR-205 warrant these microRNAs as diagnostic markers of neck metastases in HNSCC. These can be evaluated in entire lymph nodes and in FNA biopsies collected at different time-points such as pre-treatment samples, intraoperative sentinel node biopsy, and during patient follow-up. These markers can be useful in a clinical setting in the management of HNSCC patients from initial disease staging and therapy planning to patient surveillance.
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Affiliation(s)
- Ana Carolina de Carvalho
- Laboratory of Cancer Molecular Biology, Department of Biological Sciences, Diadema Campus, Federal University of São Paulo, Rua Pedro de Toledo, 669, São Paulo, SP, 04039-032, Brazil. .,Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, Barretos, SP, 14784-400, Brazil.
| | - Cristovam Scapulatempo-Neto
- Department of Pathology, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, Barretos, SP, 14784-400, Brazil.
| | - Danielle Calheiros Campelo Maia
- Laboratory of Cancer Molecular Biology, Department of Biological Sciences, Diadema Campus, Federal University of São Paulo, Rua Pedro de Toledo, 669, São Paulo, SP, 04039-032, Brazil.
| | - Adriane Feijó Evangelista
- Molecular Oncology Research Center, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, Barretos, SP, 14784-400, Brazil.
| | - Mariana Andozia Morini
- Department of Pathology, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, Barretos, SP, 14784-400, Brazil.
| | - André Lopes Carvalho
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, Barretos, SP, 14784-400, Brazil.
| | - André Luiz Vettore
- Laboratory of Cancer Molecular Biology, Department of Biological Sciences, Diadema Campus, Federal University of São Paulo, Rua Pedro de Toledo, 669, São Paulo, SP, 04039-032, Brazil. .,Cancer Stem Cell Biology Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
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18
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Amit M, Na'ara S, Sharma K, Ramer N, Ramer I, Agbetoba A, Glick J, Yang X, Lei D, Bjoerndal K, Godballe C, Mücke T, Klaus-Dietrich W, Eckardt AM, Copelli C, Sesenna E, Palmer F, Ganly I, Gil Z. Elective neck dissection in patients with head and neck adenoid cystic carcinoma: an international collaborative study. Ann Surg Oncol 2014; 22:1353-9. [PMID: 25249259 DOI: 10.1245/s10434-014-4106-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adenoid cystic carcinoma (ACC) accounts for 3-5 % of all head and neck malignancies. Investigations of outcomes from elective neck dissection (END) for patients with ACC are sparse. This study aimed to assess the impact of END on the survival of patients with ACC. METHODS This retrospective multicentered study investigated 270 patients who underwent neck dissection. A multivariate analysis assessed associations of clinical and histopathologic characteristics with survival outcomes. RESULTS The primary tumor sites included the oral cavity in 250 patients (55 %), the major salivary glands in 133 patients (29 %), the sinonasal mucosa in 68 patients (15 %), and the larynx in six patients (1 %). The overall rate of occult nodal metastases among the patients who underwent END was 17 % (38/226). The highest incidence of occult nodal metastases was with the oral cavity (66 %). The 5-year overall survival (72 and 79 % for patients with or without END, respectively) and disease-specific survival (74 and 81 % for patients with or without END, respectively) were similar in the two groups. The subgroup analysis of patients according to the primary site showed no significant impact of END on outcome. In the multivariate analysis, primary site, T classification, and N classification were the only variables associated with outcome. CONCLUSIONS The incidence of occult neck metastases among patients with ACC is 17 %. The highest incidence of occult metastases is with the oral cavity. Statistical analysis showed no survival advantage for patients who underwent END compared with those who did not.
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Affiliation(s)
- Moran Amit
- Department of Otolaryngology Head and Neck Surgery, Clinical Research Institute at Rambam (CRIR), Rambam Medical Center, The Technion, Israel Institute of Technology, Haifa, Israel
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19
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Amit M, Binenbaum Y, Sharma K, Ramer N, Ramer I, Agbetoba A, Glick J, Yang X, Lei D, Bjørndal K, Godballe C, Mücke T, Wolff KD, Fliss D, Eckardt AM, Copelli C, Sesenna E, Palmer F, Ganly I, Patel S, Gil Z. Incidence of cervical lymph node metastasis and its association with outcomes in patients with adenoid cystic carcinoma. An international collaborative study. Head Neck 2014; 37:1032-7. [PMID: 25060927 DOI: 10.1002/hed.23711] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 01/19/2014] [Accepted: 04/04/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The patterns of regional metastasis in adenoid cystic carcinoma (ACC) of the head and neck and its association with outcome is not established. METHODS We conducted a retrospective multicentered multivariate analysis of 270 patients who underwent neck dissection. RESULTS The incidence rate of neck metastases was 29%. The rate observed in the oral cavity is 37%, and in the major salivary glands is 19% (p = .001). The rate of occult nodal metastases was 17%. Overall 5-year survival rates were 44% in patients undergoing therapeutic neck dissections, and 65% and 73% among those undergoing elective neck dissections, with and without nodal metastases, respectively (p = .017). Multivariate analysis revealed that the primary site, nodal classification, and margin status were independent predictors of survival. CONCLUSION Our findings support the consideration of elective neck treatment in patients with ACC of the oral cavity.
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Affiliation(s)
- Moran Amit
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Yoav Binenbaum
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Kanika Sharma
- The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel
| | - Naomi Ramer
- Department of Radiotherapy and Oncology, Max Cancer Center, New Delhi, India
| | - Ilana Ramer
- Department of Radiotherapy and Oncology, Max Cancer Center, New Delhi, India
| | - Abib Agbetoba
- Mount Sinai Medical Center, Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Joelle Glick
- Mount Sinai Medical Center, Department of Pathology, The Mount Sinai School of Medicine, New York, New York
| | - Xinjie Yang
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Delin Lei
- Department of Otolaryngology, The Mount Sinai School of Medicine, New York, New York
| | - Kristine Bjørndal
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Christian Godballe
- Department of Oral and Maxillofacial Surgery, School of Stomatology, the Fourth Military Medical University, People's Republic of China
| | - Thomas Mücke
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Klaus-Dietrich Wolff
- Department of Otolaryngology Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Dan Fliss
- Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - André M Eckardt
- Department of Otolaryngology Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Chiara Copelli
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Enrico Sesenna
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - Frank Palmer
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Ian Ganly
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Snehal Patel
- Maxillo-Facial Surgery, University-Hospital of Parma, Italy
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.,The Laboratory for Applied Cancer Research, the Clinical Research Center at Rambam Rambam Medical Center, the Technion, Israel Institute of Technology, Israel.,Head and Neck Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Sentinel lymph node biopsy versus elective neck dissection in patients with cT1-2N0 oral tongue squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:186-90. [DOI: 10.1016/j.oooo.2013.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/03/2013] [Accepted: 09/19/2013] [Indexed: 11/17/2022]
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Szyfter W, Leszczyńska M, Wierzbicka M, Kopeć T, Bartochowska A. Value of open horizontal glottectomy in the treatment for T1b glottic cancer with anterior commissure involvement. Head Neck 2013; 35:1738-44. [DOI: 10.1002/hed.23264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 07/16/2012] [Accepted: 01/21/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Witold Szyfter
- Department of Otolaryngology; Head and Neck Surgery; Poznań University of Medical Sciences; Poland
| | - Małgorzata Leszczyńska
- Department of Otolaryngology; Head and Neck Surgery; Poznań University of Medical Sciences; Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology; Head and Neck Surgery; Poznań University of Medical Sciences; Poland
| | - Tomasz Kopeć
- Department of Otolaryngology; Head and Neck Surgery; Poznań University of Medical Sciences; Poland
| | - Anna Bartochowska
- Department of Otolaryngology; Head and Neck Surgery; Poznań University of Medical Sciences; Poland
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Böscke R, Cakir BD, Hoffmann AS, Wiegand S, Quetz J, Meyer JE. Outcome after elective neck dissection and observation for the treatment of the clinically node-negative neck (cN0) in squamous cell carcinoma of the oropharynx. Eur Arch Otorhinolaryngol 2013; 271:567-74. [DOI: 10.1007/s00405-013-2545-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
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Psychogios G, Mantsopoulos K, Koch M, Klintworth N, Kapsreiter M, Zenk J, Iro H. Elective neck dissection vs observation in transorally treated early head and neck carcinomas with cN0 neck. Acta Otolaryngol 2013; 133:313-7. [PMID: 23294240 DOI: 10.3109/00016489.2012.743032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION This study showed that elective neck dissection (ND) resulted in reduced regional recurrences in a selected group of surgically treated patients with pT1-2 carcinomas but did not show any benefit for disease-specific survival (DSS). Furthermore, the importance of pN classification was also verified for this patient group. OBJECTIVES The aim of this study was to determine whether the use of elective ND in patients with early head and neck carcinomas and cN0 neck that have undergone a transoral removal of the primary tumor can reduce the incidence of regional recurrence and improve survival. METHODS Between 1980 and 2010, 224 patients that underwent transoral resection of a pT1-2 carcinoma and had a cN0 neck were included in the study; 101 patients received an elective ND and 123 did not. RESULTS The group that underwent elective ND showed a tendency toward better regional control (RC) (96.0% vs 90.3%, p = 0.07) but similar DSS (85.7% vs 85.4%, p = 0.984). Cases with pN0 classification had a better overall survival (74.6% vs 46.9%, p = 0.07), DSS (88.4% vs 53.6%, p = 0.44), and RC (98.6% vs 62.5%, p < 0.001) compared with pN+ patients.
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Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
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Park YM, Holsinger FC, Kim WS, Park SC, Lee EJ, Choi EC, Koh YW. Robot-Assisted Selective Neck Dissection of Levels II to V via a Modified Facelift or Retroauricular Approach. Otolaryngol Head Neck Surg 2013; 148:778-85. [DOI: 10.1177/0194599813478934] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives We performed robot-assisted selective neck dissection via a modified facelift or retroauricular approach without creating an apparent scar around the neck to remove neck node of levels II to V after transoral robotic surgery of a primary lesion in patients with laryngopharyngeal carcinoma. Patient data were prospectively analyzed to verify the feasibility and efficacy of robot-assisted neck dissection in the treatment of cN0 laryngopharyngeal carcinoma. Study Design Prospective case series. Setting University tertiary care facility. Subjects and Methods Between March 2011 and March 2012, 7 patients were enrolled in the study. Before study initiation, the Institutional Review Board of Yonsei University approved the protocol, and informed consent was obtained from all patients. Results Robot-assisted neck dissection was successfully performed in all patients. Five patients underwent selective neck dissection including levels II to IV, and 2 patients underwent selective neck dissection including levels II to V. The average number of lymph nodes retrieved was 25.1. Occult nodal metastasis was found in 1 (14%) neck specimen. During the follow-up period (mean of 13.5 months), all patients were alive without locoregional recurrence. All patients were extremely satisfied with their cosmetic results. Conclusion Robot-assisted selective neck dissection is a feasible and safe technique to manage the neck in cN0 laryngopharyngeal carcinoma patients. It may be especially helpful for patients undergoing transoral robotic surgery since no apparent scar around the neck remains. Long-term results with respect to oncologic safety and functional outcomes are required to establish the validity of robot-assisted neck dissection.
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Affiliation(s)
- Young Min Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - F. Christopher Holsinger
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Park
- Department of Otorhinolaryngology–Head and Neck Surgery, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea
| | - Eun Jung Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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The role of positron emission tomography with 18F-fluorodeoxyglucose in nodal staging of clinical and radiological N0 head and neck cancers. Eur Arch Otorhinolaryngol 2013; 270:2307-13. [DOI: 10.1007/s00405-012-2337-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
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26
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Psychogios G, Mantsopoulos K, Bohr C, Koch M, Zenk J, Iro H. Incidence of occult cervical metastasis in head and neck carcinomas: development over time. J Surg Oncol 2012; 107:384-7. [PMID: 22833224 DOI: 10.1002/jso.23221] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/25/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND With the development of imaging techniques in diagnostics of head and neck carcinomas, especially computed tomography and ultrasonogaphy, one might expect that the incidence of occult metastases would be reduced. The aim of this study was to determine the rate of occult metastases in a large population cohort and explore its changes with improvement of imaging techniques over the last 30 years. METHODS All patients between 1980 and 2010 with head and neck carcinoma and cN0 neck status were retrospectively evaluated. Six hundred thirty-six patients with cN0 neck who received an elective neck dissection as part of a definitive surgical treatment were included. RESULTS The overall rate of occult metastases was 24.8% (158/636). The rate was 26.5% (80/302) between 1980 and 1995 and 23.4% (78/334) between 1995 and 2010. Only pT1-2 glottic carcinomas had an occult metastases rate of less than 10%. All other pT1-2 carcinomas had an incidence of occult metastases between 19.1% and 42.5%. pT3-4 tumors showed an occult metastases rate of 24.5-53.3%. CONCLUSION The occult metastases rate showed only a marginal improvement over the last 30 years and is still above the 20% margin. All but pT1-2 glottic carcinomas should be considered for elective treatment of the neck.
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Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Germany.
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Meng FY, Ko JY, Lou PJ, Wang CP, Yang TL, Chang CH, Chang YL, Chen TC. The determining risk factors for treatment outcomes in patients with squamous cell carcinoma of the hard palate. Ann Surg Oncol 2012; 19:2003-10. [PMID: 22271207 DOI: 10.1245/s10434-011-2214-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The determining risk factors for patients with squamous cell carcinoma of the hard palate are not well verified. METHODS Medical records from our facility of all patients with squamous cell carcinoma of the hard palate receiving curative surgery between March 2003 and May 2009 were reviewed. RESULTS Seventy-eight patients were enrolled in the study. The 5 year disease-free and overall survival rates were 49.8 and 49.7%, respectively. The 5 year disease-free and overall survival rates were statistically different between positive/close margins and negative margins (24.6% vs. 65.4%, P = 0.02; 20.1% vs. 63.1%, P = 0.001, respectively), with and without soft palate invasion (38.8% vs. 68.9%, P = 0.02; 27.4% vs. 77.5%, P = 0.001, respectively), and soft palate invasion patients with and without perineural invasion (10.4% vs. 52.8%, P = 0.02; 0% vs. 38.1%, P = 0.008, respectively). The rate of positive nodal metastasis for T3 and T4 tumors was 44%. For the tumor with soft palate invasion, the rate of positive nodal metastasis was 29%. After multivariate analyses, soft palate invasion and positive/close margins were the determining risk factors for disease-free and overall survival. CONCLUSIONS Soft palate invasion and positive/close margins were the determining risk factors for disease-free and overall survival in patients with squamous cell carcinoma of the hard palate. Elective neck dissection is suggested for advanced primary tumors (T3 or T4) or tumors with soft palate invasion.
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Affiliation(s)
- Fan-Yu Meng
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Lee HS, Kim WS, Hong HJ, Ban MJ, Lee D, Koh YW, Choi EC. Robot-assisted Supraomohyoid Neck Dissection via a Modified Face-lift or Retroauricular Approach in Early-stage cN0 Squamous Cell Carcinoma of the Oral Cavity: A Comparative Study with Conventional Technique. Ann Surg Oncol 2012; 19:3871-8. [DOI: 10.1245/s10434-012-2423-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Indexed: 11/18/2022]
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de Souza Figueiredo PT, Leite AF, Barra FR, Dos Anjos RF, Freitas AC, Nascimento LA, Melo NS, Guerra ENS. Contrast-enhanced CT and MRI for detecting neck metastasis of oral cancer: comparison between analyses performed by oral and medical radiologists. Dentomaxillofac Radiol 2012; 41:396-404. [PMID: 22241874 DOI: 10.1259/dmfr/57281042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of the study was to verify the concordance of contrast-enhanced CT (CECT) and MRI evaluation among four radiologists in detecting metastatic cervical lymph nodes of oral cancer patients. METHODS Ten patients underwent clinical and imaging examinations (CECT and MRI). Four radiologists, two oral and maxillofacial radiologists (OMRs) and two medical radiologists (MRs), independently analysed the images twice. Cohen's kappa index and Wilcoxon signed-rank test were used to verify the concordance between all analyses. RESULTS Regarding the interobserver agreement, the OMRs presented excellent kappa values for determining the regional lymph nodes (N-stage) in both CECT and MRI. The MRs presented moderate agreement for CECT evaluation at the first reading, but no concordance was found for the other analyses. When each imaging modality was analysed separately, kappa values were higher between all examiners. Greater variability was demonstrated between N-stage evaluation using different examinations. All radiologists were able to identify a greater number of metastatic lymph nodes in CECT than in MRI, except one MR, but no significant difference was found for all readers. The differences between the number of metastatic lymph nodes among all radiologists were not statistically significant. Moderate intraobserver agreement was observed for CECT and MRI evaluation, except for one MR. CONCLUSIONS The differences found between the N-stage performed by OMRs and MRs support the necessity of a multidisciplinary approach in the imaging evaluation of metastatic nodes. Further studies are necessary to confirm which imaging modality should be employed when evaluating neck areas.
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Value of18F-Fluorodeoxyglucose Position Emission Tomography/Computed Tomography in Diagnosis of Cervical Lymph Node Metastasis of Head and Neck Squamous Cell Carcinoma: Comparison with Computed Tomography and Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2012. [DOI: 10.3342/kjorl-hns.2012.55.6.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Koh YW, Chung WY, Hong HJ, Lee SY, Kim WS, Lee HS, Choi EC. Robot-Assisted Selective Neck Dissection via Modified Face-lift Approach for Early Oral Tongue Cancer: A Video Demonstration. Ann Surg Oncol 2011; 19:1334-5. [DOI: 10.1245/s10434-011-2155-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Indexed: 11/18/2022]
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Kim WS, Lee HS, Kang SM, Hong HJ, Koh YW, Lee HY, Choi HS, Choi EC. Feasibility of Robot-Assisted Neck Dissections via a Transaxillary and Retroauricular (“TARA”) Approach in Head and Neck Cancer: Preliminary Results. Ann Surg Oncol 2011; 19:1009-17. [DOI: 10.1245/s10434-011-2116-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Indexed: 12/15/2022]
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Parikh S, Tedman BM, Scott B, Lowe D, Rogers SN. A double blind randomised trial of IIb or not IIb neck dissections on electromyography, clinical examination, and questionnaire-based outcomes: a feasibility study. Br J Oral Maxillofac Surg 2011; 50:394-403. [PMID: 21996573 DOI: 10.1016/j.bjoms.2011.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/07/2011] [Indexed: 10/16/2022]
Abstract
The aim of this double-blind randomised controlled trial was to evaluate the feasibility of a study to compare differences using electromyographic (EMG) or nerve conduction studies (NCS), questionnaires completed by patients, and range of movement, after selective supraomohyoid neck dissection in patients with and without level IIb for node-negative oral cancer. Between January 2006 and July 2008 we recruited 57 previously untreated consecutive patients with node-negative T1 or T2 squamous cell carcinomas (SCC) of the anterior two-thirds of the tongue and floor of the mouth. Thirty-eight patients were randomised (32 unilateral and 6 bilateral dissections) into two groups. Preoperatively and at 6 weeks postoperatively we collected EMG or NCS data on trapezius muscle activity (primary outcome), the University of Washington quality of life scale (UWQoLv4), the neck dissection impairment index (NDII), and range of movement. At 6 months data on range of movement and data from the questionnaires were obtained. There was a greater mean fall in trapezius M-response amplitude for those who had IIb dissected, which suggested that inclusion of this level caused additional morbidity. However, it was not significant for patients who had unilateral dissections or for all necks combined. Changes in M-amplitude from baseline to 6 weeks, and from baseline to 6 months were strongly associated with changes in the shoulder domain of the UWQoL and the NDII, but were less strong for change in range of movement. This feasibility study has shown that a randomised controlled trial (RCT) is achievable. The combination of EMG or NCS with questionnaire data preoperatively and to 6 weeks would suffice and would simplify a new study design.
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Affiliation(s)
- S Parikh
- Regional Maxillofacial Unit, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7LN, UK.
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Olzowy B, Tsalemchuk Y, Schotten KJ, Reichel O, Harréus U. Frequency of bilateral cervical metastases in oropharyngeal squamous cell carcinoma: a retrospective analysis of 352 cases after bilateral neck dissection. Head Neck 2011; 33:239-43. [PMID: 20848445 DOI: 10.1002/hed.21436] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The decision whether to perform an elective neck dissection in patients with head and neck squamous cell carcinoma (HNSCC) and clinically negative lymph nodes (cN0) is made based on the probability of micrometastases in the neck for the given subsite and size of the primary. To date there is limited information about contralateral and bilateral cervical lymph node metastases of oropharyngeal carcinoma. METHODS A retrospective chart review was performed of 352 patients with oropharyngeal SCC who received a bilateral neck dissection. The frequency of histologically unveiled bilateral neck metastases was determined. RESULTS Carcinomas of the tonsillar fossa starting with a T2 classification and carcinomas of the soft palate, base of tongue, and pharyngeal wall at any stage showed a high frequency of bilateral metastases. CONCLUSIONS Bilateral neck dissection should be recommended for all but T1 and selected cases of T2 carcinomas of the tonsillar fossa.
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Affiliation(s)
- Bernhard Olzowy
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University of Munich Medical Center, Munich, Germany.
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Rodrigo JP, Shah JP, Silver CE, Medina JE, Takes RP, Robbins KT, Rinaldo A, Werner JA, Ferlito A. Management of the clinically negative neck in early-stage head and neck cancers after transoral resection. Head Neck 2010; 33:1210-9. [PMID: 21755564 DOI: 10.1002/hed.21505] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 04/14/2010] [Accepted: 05/03/2010] [Indexed: 11/11/2022] Open
Abstract
The decision regarding treatment of the clinically negative neck has been debated extensively. This is particularly true with early-stage tumors for which surgery is the treatment of choice, and the tumor has been resected transorally without a cervical incision. Elective neck dissection in this situation is an additional procedure with potential associated morbidity. The alternative strategy for the clinically negative neck is to "wait and watch." Both an elective neck dissection policy and a "watchful waiting" policy have their proponents. The purpose of this article was for us to review the literature about this subject to try to answer the following question: if the tumor has been resected transorally, should an elective treatment of the neck be performed or is a "watchful waiting" policy safe and adequate? We conclude that, currently, the best available evidence suggests that elective neck dissection does not seem to be superior to the policy of observation without neck surgery, with regard to survival and control of neck disease. This review highlights the need for further well-designed prospective studies that will provide more reliable answers to the debatable issue of the management of the clinically negative neck in such cases.
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Affiliation(s)
- Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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36
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Management of the clinically N0 neck in oral and oropharyngeal carcinoma in Scotland. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0416-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bussu F, Almadori G, De Corso E, Rizzo D, Rigante M, Parrilla C, Valentini V, Paludetti G. Endoscopic horizontal partial laryngectomy by CO(2) laser in the management of supraglottic squamous cell carcinoma. Head Neck 2009; 31:1196-206. [PMID: 19360749 DOI: 10.1002/hed.21085] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the results of endoscopic horizontal supraglottic laryngectomy (EHSL) by CO(2) laser. METHODS Between 1996 and 2005, 78 patients underwent a horizontal supraglottic laryngectomy operation (HSL) with an external approach and 70 underwent laser EHSL, as treatment for supraglottic laryngeal squamous cell carcinoma (LSCC). We evaluated oncological endpoints, comparing the external and the endoscopic approach. RESULTS Among patients primarily treated by EHSL, the 5-year disease-specific survival (DSS) was 89% (vs 80% in the external approach group). Statistical analysis did not reveal significant differences between the 2 groups as for survival nor for organ preservation. The most significant clinical predictor for DSS is neck relapse (p < .0001). CONCLUSIONS This study confirms the effectiveness of laser EHSL in which oncological outcome is similar to the external approach and functional results are probably better. Neck management in this setting is fundamental to warrant the best survival.
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Affiliation(s)
- Francesco Bussu
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Okura M, Aikawa T, Sawai NY, Iida S, Kogo M. Decision analysis and treatment threshold in a management for the N0 neck of the oral cavity carcinoma. Oral Oncol 2009; 45:908-11. [PMID: 19457712 DOI: 10.1016/j.oraloncology.2009.03.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 03/26/2009] [Accepted: 03/26/2009] [Indexed: 11/28/2022]
Abstract
The optimal method of management of clinical N0 neck in squamous cell carcinoma of the oral cavity remains controversial. We used decision analysis to determine the current optimal strategy in comparison with observation of the neck and elective neck dissection. A total of 165 previously untreated patients with N0 classification were investigated. Probabilities of each recurrence were calculated and probabilities of being cured in each event were substituted with the 5-year overall survival calculation with Kaplan-Meier method. A sensitivity analysis was performed to determine the optimal threshold for treatment of the N0 neck. The threshold of N0 neck was calculated using the formula with putting the three probabilities of being cured. In this study the threshold was estimated at 44.4%. N0 neck of squamous cell carcinoma of the oral cavity should be observed if the probability of occult metastasis is less than 44.4%. Proper calculation of three probabilities of being cured in each institution will make a decision of the optimal method of clinical N0 neck by using the threshold formula.
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Affiliation(s)
- Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Panizza B. Prognostic factors and the treatment of the negative neck in oral carcinoma. ANZ J Surg 2009; 79:7-8. [PMID: 19183369 DOI: 10.1111/j.1445-2197.2008.04785.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ben Panizza
- Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Factors related to regional recurrence in early stage squamous cell carcinoma of the oral tongue. Clin Exp Otorhinolaryngol 2008; 1:166-70. [PMID: 19434251 PMCID: PMC2671749 DOI: 10.3342/ceo.2008.1.3.166] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 01/08/2008] [Indexed: 11/08/2022] Open
Abstract
Objectives This study analyzed various clinical and histopathologic factors for patients with early stage squamous cell carcinoma (SCC) of the oral tongue to define a high risk group for regional recurrence and finally to find out the indication of elective neck dissection (END). Methods Retrospective chart review was performed for 63 patients with T1-T2N0 SCC of the oral tongue who underwent partial glossectomy with/without END. Clinical and histopathologic factors assessed were age, gender, clinical T stage, tumor cell differentiation, depth of invasion, pathologic nodal status, and intrinsic muscle involvement, perineural invasion, lymphovascular emboli and resection margin involvement. Results Five year overall survival rate was 97.1% in stage I and 76.2% in stage II, and 5-yr disease free survival rate was 76.7% in stage I and 43.5% in stage II. Rates of occult nodal metastasis in stage I and II were 15.4% and 42.9%, respectively. Overall regional recurrence rate was 15.9%, which consisted of 10.2% in stage I and 35.7% in stage II. The success rate of salvage treatment was 100% in stage I and 40% in stage II. Higher T stage, higher histologic grade, depth of invasion ≥3 mm, presence of intrinsic muscle involvement were significantly related to regional recurrence (P=0.035, P=0.011, P=0.016, P=0.009, respectively). In stage I, the non-END group (n=36) showed 13.9% of regional recurrence rate, while END group (n=13) did not have any regional recurrence (P=0.198). Five year disease free survival rate of END group was significantly higher than non-END group (100% and 68.7%, respectively, P=0.045). Conclusion We recommend to perform END in early stage SCC of the oral tongue if the primary tumor has T2 stage, and T1 stage with higher histologic grade, depth of invasion more than 3 mm, or presence of intrinsic muscle involvement.
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Jang WI, Wu HG, Park CI, Kim KH, Sung MW, Kim MJ, Choung PH, Lee JH, Choi JY. Treatment of Patients with Clinically Lymph Node-negative Squamous Cell Carcinoma of the Oral Cavity. Jpn J Clin Oncol 2008; 38:395-401. [DOI: 10.1093/jjco/hyn048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kyzas PA, Evangelou E, Denaxa-Kyza D, Ioannidis JPA. 18F-fluorodeoxyglucose positron emission tomography to evaluate cervical node metastases in patients with head and neck squamous cell carcinoma: a meta-analysis. J Natl Cancer Inst 2008; 100:712-20. [PMID: 18477804 DOI: 10.1093/jnci/djn125] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Positron emission tomography using 18F-fluorodeoxyglucose (18F-FDG PET) has been proposed to enhance preoperative assessment of cervical lymph node status in patients with head and neck squamous cell carcinoma (HNSCC). Management is most controversial for patients with a clinically negative (cN0) neck. We aimed to assess the diagnostic accuracy of 18F-FDG PET in detecting lymph node metastases in patients with HNSCC. METHODS We performed a meta-analysis of all available studies of the diagnostic performance of 18F-FDG PET in patients with HNSCC. We determined sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves using hierarchical regression models. We also compared the performance of 18F-FDG PET with that of conventional diagnostic methods (ie, computed tomography, magnetic resonance imaging, and ultrasound with fine-needle aspiration) by analyzing studies that had also used these diagnostic methods on the same patients. RESULTS Across 32 studies (1236 patients), 18F-FDG PET sensitivity was 79% (95% confidence interval [CI] = 72% to 85%) and specificity was 86% (95% CI = 83% to 89%). For cN0 patients, sensitivity of 18F-FDG PET was only 50% (95% CI = 37% to 63%), whereas specificity was 87% (95% CI = 76% to 93%). Overall, LR+ was 5.84 (95% CI = 4.59 to 7.42) and LR- was 0.24 (95% CI = 0.17 to 0.33). In studies in which both 18F-FDG PET and conventional diagnostic tests were performed, sensitivity and specificity of 18F-FDG PET were 80% and 86%, respectively, and of conventional diagnostic tests were 75% and 79%, respectively. CONCLUSION 18F-FDG PET has good diagnostic performance in the overall pretreatment evaluation of patients with HNSCC but still does not detect disease in half of the patients with metastasis and cN0.
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Affiliation(s)
- Panayiotis A Kyzas
- Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece
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Selective Neck Dissection (IIA, III): A Rational Replacement for Complete Functional Neck Dissection in Patients With N0 Supraglottic and Glottic Squamous Carcinoma. Laryngoscope 2008; 118:676-9. [DOI: 10.1097/mlg.0b013e31815f6f25] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Should there be more molecular staging of head and neck cancer to improve the choice of treatments and thereby improve survival? Curr Opin Otolaryngol Head Neck Surg 2008; 16:117-26. [PMID: 18327030 DOI: 10.1097/moo.0b013e3282f6a4b0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Overall survival of head and neck squamous cell carcinoma patients on the whole has not dramatically improved in the last 30 years. One of the reasons is that tumour, node, metastasis classification is probably in some cases inadequate, since similar cases under a clinico-pathological point of view, may differ widely in prognosis. The most important reason for this is probably the extreme biological heterogeneity, which leads to a lack of consistency in treatment planning. The aim of the present review is to delineate the advances and the perspectives of clinical use of molecular characterization, which is an attempt to break through such molecular heterogeneity and to define, together with tumour, node, metastasis classification, homogeneous groups of patients for prognostic stratification and treatment selection. RECENT FINDINGS Among the markers evaluated in the last years, some have revealed particular promise. Epidermal growth factor receptor is probably the most reliable molecular marker at present, retaining its prognostic value independently from primary treatment. The p53 gene, the p53 protein being the main effector of DNA damage induced apoptosis, is probably the best predictor of radio/chemosensitivity. SUMMARY Even if clinical tumour, node, metastasis classification will probably retain its significance, it is now becoming possible, by molecular markers, to acquire biological information about host and tumour, to break through the above-cited molecular heterogeneity and eventually to optimize the choice of treatment.
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Soft tissue deposits from head and neck cancer: an under-recognised prognostic factor? The Journal of Laryngology & Otology 2008; 121:1115-7. [PMID: 18329971 DOI: 10.1017/s002221510700028x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Takes RP, Rinaldo A, Pablo Rodrigo J, Devaney KO, Fagan JJ, Ferlito A. Can biomarkers play a role in the decision about treatment of the clinically negative neck in patients with head and neck cancer? Head Neck 2008; 30:525-38. [DOI: 10.1002/hed.20759] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Richards PS, Peacock TE. The role of ultrasound in the detection of cervical lymph node metastases in clinically N0 squamous cell carcinoma of the head and neck. Cancer Imaging 2007; 7:167-78. [PMID: 18055290 PMCID: PMC2151323 DOI: 10.1102/1470-7330.2007.0024] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nodal involvement is the most important prognostic factor in head and neck squamous cell carcinoma (HNSCC) of mucosal origin. The presence of a single ipsilateral or contralateral metastatic node reduces survival by 50% and bilateral disease by a further 50%. The management of N+ HNSCC is relatively clear-cut. By contrast, the investigation and treatment of patients with clinically N0 disease is controversial. Most institutions electively treat the neck with surgery or radiotherapy because the risk of occult metastases is over 20%, even though it will be unnecessary in the majority of cases. In this situation the main purpose of staging would be to assess those nodes that are not going to be removed. However, the optimal management of the clinically N0 neck remains controversial and there is growing interest in a more conservative approach. Research is now directed toward finding a method of staging sensitive enough to bring the risk of occult metastases below 20%. High spatial resolution, ease of multiplanar scanning, power Doppler and the ability to perform guided fine-needle aspiration for cytology give ultrasound (US) an advantage over other imaging techniques.
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Affiliation(s)
- P S Richards
- Barts and the London NHS Trust, Department of Diagnostic Imaging, Queen Elizabeth II Wing, St Bartholomew's Hospital, West Smithfield, London, EC1A 7EB, UK.
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Keski-Säntti H, Kontio R, Törnwall J, Leivo I, Mätzke S, Suominen S, Leppänen E, Atula T. Sentinel lymph node biopsy or elective neck dissection for patients with oral squamous cell carcinoma? Eur Arch Otorhinolaryngol 2007; 265 Suppl 1:S13-7. [PMID: 17909828 DOI: 10.1007/s00405-007-0465-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
Sentinel lymph node biopsy (SNB) seems to be a promising method for staging clinically N0 neck in patients with oral squamous cell carcinoma (OSCC). In the present study, SNB was performed on 46 patients having elective neck dissection (END; six bilateral dissections) for T1-T3N0 OSCC. Sentinel lymph nodes (SLN) were first examined according to only slightly modified standard histopathologic protocol including sections at 1-2 mm intervals and H&E staining. SLN that appeared false negative (i.e. metastatic non-SLN without metastasis in a SLN) after the initial histopathologic examination were further assessed by step sectioning at 150 microm intervals and immunohistochemistry. Of the 47 neck sides with at least one SLN identified, nine contained metastasis in nine patients. After the initial histopathologic examination, SLNs were negative for malignant cells in four out of the nine metastatic neck sides. In one neck side, two metastatic SLNs were detected after the additional meticulous histopathologic work-up of the initially false negative SLNs. Therefore, in three neck sides the SLN did not contain metastasis although there was a metastasis in a non-SLN. In all these three cases with a false negative SLN, only one SLN had been identified. The sensitivity of the method (employing extensive histopathologic work-up) for detection of occult cervical metastasis was 67% (6/9 neck sides). The sensitivity of SNB for detection of occult metastasis seems to be poor in cases where only one SLN can be identified. The results of this study do not entitle us to entirely replace END by SNB in patients with OSCC.
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Affiliation(s)
- Harri Keski-Säntti
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital, P. O. Box 220, 00029 HUCH Helsinki, Finland.
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Keski-Säntti H, Atula T, Tikka J, Hollmén J, Mäkitie AA, Leivo I. Predictive value of histopathologic parameters in early squamous cell carcinoma of oral tongue. Oral Oncol 2007; 43:1007-13. [PMID: 17306608 DOI: 10.1016/j.oraloncology.2006.11.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 11/17/2006] [Accepted: 11/20/2006] [Indexed: 11/17/2022]
Abstract
The clinical course of early squamous cell carcinoma of oral tongue (OTSCC) is unpredictable and various histopathologic parameters of the primary tumour have been suggested as prognostic factors to be used in clinical decision-making. We reviewed clinicopathologic data of 73 patients diagnosed with Stage I-II OTSCC. Predictive value of pathological T-stage, depth of infiltration, grade, and mode of invasion with respect to local recurrences, occult cervical metastases, and disease specific survival (DSS) was analysed. Depth of infiltration and pT-stage significantly predicted occult nodal disease, while only pT-stage predicted local recurrence. Specific cut-off value for depth of infiltration separating high-risk and low-risk patients was not found. Significant correlations between the histopathologic parameters and DSS were not found. We conclude that depth of infiltration predicted occult nodal disease but its value in clinical decision-making is limited because of poor specificity when using a cut-off value that offers reasonable sensitivity for finding the patients with occult nodal disease. The risk for occult metastases and local recurrence was high in patients with pT2 tumours.
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Affiliation(s)
- Harri Keski-Säntti
- Department of Otorhinolaryngology Head and Neck Surgery, Helsinki University Central Hospital, P.O. Box 220, FIN - 00029 HUCH, Helsinki, Finland.
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Abstract
This paper reviews the main papers related to oral squamous cell carcinoma published in 2006 in oral oncology - an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, and all other scientific articles relating to the aetiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck, and orofacial disease in patients with malignant disease.
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Affiliation(s)
- Crispian Scully
- Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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