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Wichmann G, Wald T, Pirlich M, Stoehr M, Zebralla V, Kuhnt T, Nicolay NH, Hambsch P, Krücken I, Hoffmann KT, Lordick F, Kluge R, Wiegand S, Dietz A. Improved survival of locoregional-advanced larynx and hypopharynx cancer patients treated according to the DeLOS-II protocol. Front Oncol 2024; 14:1394691. [PMID: 38919522 PMCID: PMC11198870 DOI: 10.3389/fonc.2024.1394691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction Larynx organ preservation (LOP) in locoregional-advanced laryngeal and hypopharyngeal squamous cell carcinoma (LA-LHSCC) being only R0-resectable (clear margins > 5 mm) by total laryngectomy (TL) is desirable. Based on tumor-specific survival (TSS) and overall survival (OS) data from the RTOG 91-11 trial and meta-analyses of randomized clinical trials (RCTs), cisplatin-based concurrent radiochemotherapy (CRT) is discussed being superior to cisplatin-based induction chemotherapy followed by radiotherapy (IC+RT) and TL followed by postoperative RT (TL+PORT) or radiochemotherapy (TL+PORCT). Outside of RCTs, T4 LHSCC treated with TL+PORCT demonstrated improved OS and TSS compared to CRT alone; comparisons with docetaxel plus cisplatin (TP)-based IC+RT are unpublished. Head-to-head comparisons in RCTs of these four alternatives are missing. Materials and methods We utilized monocentric registry data to compare the outcome in the LOP trial DeLOS-II (NCT00508664) and propensity score (PS)-matched LHSCC patients. DeLOS-II utilized endoscopic tumor staging after one cycle of TP-based IC for selecting TL+R(C)T for non-responders versus IC+RT for responders. Main risk factors for survival (localization hypopharynx, T4, N+, tobacco smoking >30 pack years, alcohol consumption >60 g/day, age, sex) were used to calculate the individual PS for each DeLOS-II patient and 330 LHSCC patients suitable for DeLOS-II according to eligibility criteria in Leipzig by CRT (78), TL+PORT (148), and TL+PORCT (104). We performed PS matching with caliper width 0.2. Results The 52 DeLOS-II patients (whole intent-to-treat cohort) and three PS-matched cohorts (52 LHSCC patients each) had equal distribution regarding risk factors including Charlson comorbidity score (CS; all p > 0.05) but differed in outcome. During 12,498.6 months of follow-up, 162 deaths (36/41/43/42 in DeLOS-II/TL+PORCT/TL+PORT/CRT, p = 0.356) occurred; DeLOS-II patients had superior OS and TSS. Compared to DeLOS-II, the HR (95% CI) observed in TL+PORCT, TL+PORT, and CRT for OS and TSS were 1.49 (0.92-2.43), 1.49 (1.15-3.18), and 1.81 (1.11-2.96) for OS; and 2.07 (0.944-4.58), 3.02 (1.32-6.89), and 3.40 (1.58-7.31) for TSS. Conclusion In addition potential LOP, LA-LHSCC suitable for LOP according the DeLOS-II protocol may achieve improved survival.
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Affiliation(s)
- Gunnar Wichmann
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Theresa Wald
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Markus Pirlich
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Matthaeus Stoehr
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Veit Zebralla
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Clinic for Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Nils Henrik Nicolay
- Clinic for Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Peter Hambsch
- Clinic for Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Irene Krücken
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | | | - Florian Lordick
- Department of Medicine, Division of Oncology, University Cancer Center (UCCL), University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Clinic for Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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Thariat J, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, Merlotti A, Dejean C, Devauchelle B. Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy. Front Oncol 2024; 14:1379861. [PMID: 38665951 PMCID: PMC11043495 DOI: 10.3389/fonc.2024.1379861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Background Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy. Methods A systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT. Results Despite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap-tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications. Conclusion Flap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.
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Affiliation(s)
- Juliette Thariat
- Department of Radiotherapy, Centre François-Baclesse, Caen, France
- Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Caen, France
- Faculté de Médecine de Caen, Université de Normandie, Caen, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Orsay, France
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Deneuve
- Surgical Oncology Department, Centre Léon Bérard, UNICANCER, Lyon, France
- Inserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon Bérard, Lyon, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Ollioules, France
| | - Anna Merlotti
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, University Hospital of Amiens Picardy, Research Unit, UR7516 CHIMERE, University of Picardy Jules Verne, Institut Faire Faces, Amiens, France
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Matos LL, Guimarães YLM, Leite AK, Cernea CR. Management of Stage III Oral Cavity Squamous Cell Carcinoma in Light of the New Staging System: a Critical Review. Curr Oncol Rep 2023; 25:107-113. [PMID: 36585962 DOI: 10.1007/s11912-022-01353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Oral squamous cell carcinoma (OSCC) patients have a poor prognosis, especially in advanced stages. AJCC/UICC staging system 8th edition (TNM8) included depth of invasion (DOI) as part of T staging and stage III has become a heterogeneous group of lesions, composed of patients with larger DOI and/or width. Additionally, stage III includes N1, regardless of the primary tumor width or DOI. The real prognostic value of each of these characteristics and the need for adjuvant treatment for stage III patients is not well established. RECENT FINDINGS TNM8 stratified OSCC into prognostic groups based on overall survival. Extranodal extension, positive or close margins, pT3 or pT4 tumors, pN2 or pN3 nodal disease, nodal disease in levels IV or V, perineural invasion, vascular invasion, and lymphatic invasion are the main adverse features for OSCC, and adjuvant treatment is largely recommended for these patients. Stage III patients should be addressed with caution. So far, there is no significant evidence for recommending or excluding adjuvant treatment for stage III OSCC without adverse features. The authors largely recommend adjuvant radiotherapy for these cases, especially because pT3 without adverse features is rare. Further studies on this topic are necessary.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto Do Câncer Do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Icesp, HCFMUSP), Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil. .,Surgical Clinic, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil.
| | - Yasmin Laryssa Moura Guimarães
- Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, Brazil
| | - Ana Kober Leite
- Head and Neck Surgery, Instituto Do Câncer Do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Icesp, HCFMUSP), Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.,Surgical Clinic, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | - Claudio Roberto Cernea
- Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 255, 8Th Floor, Room 8174, São Paulo, SP, Brazil
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Adjuvant therapy improves survival in pT4aN0 oral cavity squamous cell carcinoma with bone invasion. Am J Otolaryngol 2022; 43:103303. [PMID: 34894450 DOI: 10.1016/j.amjoto.2021.103303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The prognostic significance of bone invasion in oral cavity squamous cell carcinoma (OCSCC) after accounting for tumor size, nodal spread, and surgical margins is controversial. The aim of this study is to determine whether patients with pT4aN0 oral cavity squamous cell carcinoma with bone invasion have improved overall and disease-free survival with adjuvant treatment. METHODS We conducted a retrospective review of medical records from 64 patients with stage pT4aN0 due to mandibular involvement who underwent surgery from 2000 to 2020. Kaplan-Meier analysis compared disease-free survival and overall survival between groups who underwent surgery only versus surgery and adjuvant therapy. The prognostic impact of adjuvant therapy was assessed using multivariate analysis and reported as hazard ratios. RESULTS There were no statistically significant differences in clinicopathologic features or mean follow-up between patients who received surgery only and patients who received surgery with RT/CCRT (radiotherapy/concurrent chemoradiation therapy). 5-year disease-free (42.5% versus 65.9%, p = 0.02) and overall survival (43.6% versus 69.0%, p = 0.014) were improved in groups who received surgery and RT/CCRT. Regression analysis controlling for clinicopathologic characteristics, including tumor size, identified radiation as an independent predictor of improved disease-free survival (HR: 0.04, p < 0.001) and overall survival (HR: 0.10, p < 0.001). CONCLUSION Adjuvant RT/CCRT in patients with pT4N0 OCSCC with mandibular bone involvement is associated with improved disease-free and overall survival. This association was significant regardless of tumor pathologic features such as size or margin status. These findings may help guide physicians in counseling patients regarding risks and benefits of adjuvant RT/CCRT and inform practice guidelines.
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Marhic A, Guerlain J, Benmoussa N, Breuskin I, Honart JF, Janot F, Moya-Plana A, Temam S, Gorphe P. Replacement of lip-split mandibulotomy by pull-through approach for T3-4 oral carcinomas. Int J Oral Maxillofac Surg 2021; 50:1123-1130. [PMID: 33414034 DOI: 10.1016/j.ijom.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/06/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022]
Abstract
At the study hospital, the lip-split mandibulotomy (LSM) has progressively been replaced by a pull-through (PT) approach. This study compared the outcomes of the LSM and PT approaches in a series of 192 patients with T3-T4a oral tongue and floor of the mouth squamous cell carcinoma treated over the two last decades. No difference in margin status (P = 0.254), rate of early complications (local infections) (P = 0.867), haematoma/haemorrhage (P = 0.221), delayed wound healing (P = 0.438), re-operation (P = 0.083), or Clavien-Dindo classification (P= 0.5281) was found. The LSM approach was associated with a higher rate of late complications such as pseudarthrosis (14.5% vs 0.9%; OR 17.89, P = 0.0005) and trismus (35% vs 13.8%; OR 3.32, P = 0.025), and a trend towards a higher rate of fistulas (24.6% vs 13.1%; OR 2.16, P = 0.088). The quality of life of long-term survivors (median 132 months) was similar in the two groups, with a mean QLQC30 score of 59.7 (P = 0.099) and mean MDADI score of 57.4 (P = 0.213). The 5-year local control rate was 86.4% in the PT group and 86.2% in the LSM group (P = 0.878), while the 5-year overall survival rates were 50.0% and 48.3%, respectively (P = 0.68). In our experience, replacement of LSM by a PT approach in oral carcinoma was associated with decreased rates of late complications such as pseudarthrosis, fistula, and trismus, without any difference in oncological outcomes.
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Affiliation(s)
- A Marhic
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - J Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - N Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - I Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - J-F Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - F Janot
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - A Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - S Temam
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - P Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France.
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Margalit DN, Sacco AG, Cooper JS, Ridge JA, Bakst RL, Beadle BM, Beitler JJ, Chang SS, Chen AM, Galloway TJ, Koyfman SA, Mita C, Robbins JR, Tsai CJ, Truong MT, Yom SS, Siddiqui F. Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria. Head Neck 2021; 43:367-391. [PMID: 33098180 PMCID: PMC7756212 DOI: 10.1002/hed.26490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios. METHODS An analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodology-based systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings [MeSH], EMTREE). Study screening and selection was performed with Covidence software and full-text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus. RESULTS A total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC-8). CONCLUSIONS Prospective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.
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Affiliation(s)
- Danielle N. Margalit
- Dana‐Farber/Brigham & Women's Cancer Center, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | | | - Beth M. Beadle
- Stanford University School of MedicineStanfordCaliforniaUSA
| | | | | | | | | | | | - Carol Mita
- Countway Library, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | - Minh T. Truong
- Boston University School of MedicineBostonMassachusettsUSA
| | - Sue S. Yom
- University of CaliforniaSan FranciscoCaliforniaUSA
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Zhu X, Zhao M, Zhou L, Zhang M, Cao P, Tao L. Significance of examined lymph nodes number and metastatic lymph nodes ratio in overall survival and adjuvant treatment decision in resected laryngeal carcinoma. Cancer Med 2020; 9:3006-3014. [PMID: 32112627 PMCID: PMC7196060 DOI: 10.1002/cam4.2902] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/17/2019] [Accepted: 01/21/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The value of adjuvant therapy in resected laryngeal cancer remains controversial. This large SEER-based cohort study aimed to investigate the existing parameters of lymph node status that could predict survival outcomes and the prognostic value of adjuvant treatment in resected laryngeal carcinoma. METHODS Population-based data from the US Surveillance, Epidemiology, and End Results (SEER-18) Program on patients after laryngectomy and lymphadenectomy (2004-2015) were analyzed. The optimal cut-off values for examined lymph nodes number (ELNs) and metastatic lymph nodes ratio (MLNR) were determined using the X-tile program. Associations of ELNs and MLNR with overall survival were investigated through Cox regression analysis. A survival-predicting model was then constructed to stratified patients. The prognostic value of adjuvant therapy was evaluated in different subgroups. RESULTS A total of 2122 patients with resected laryngeal cancer were analyzed. A novel survival-predicting model was proposed based on ELNs, MLNR, and other clinicopathological characteristics. Patients were stratified into three subgroups with the increasing risk of death. Only patients in the high-risk group who receiving adjuvant treatment had a significantly better survival outcome than those receiving surgery alone. CONCLUSION A new survival-predicting model was established in this study, which was superior in assessing the survival outcomes of patients with resected laryngeal cancer. Notably, this model was also able to assist in the decision making of adjuvant therapy for patients and physicians.
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Affiliation(s)
- Xiaoke Zhu
- Department of OtolaryngologyShanghai Key Clinical Disciplines of otorhinolaryngologyEye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Min Zhao
- School of NursingFudan UniversityShanghaiChina
| | - Liang Zhou
- Department of OtolaryngologyShanghai Key Clinical Disciplines of otorhinolaryngologyEye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Ming Zhang
- Department of OtolaryngologyShanghai Key Clinical Disciplines of otorhinolaryngologyEye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Pengyu Cao
- Department of OtolaryngologyShanghai Key Clinical Disciplines of otorhinolaryngologyEye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Lei Tao
- Department of OtolaryngologyShanghai Key Clinical Disciplines of otorhinolaryngologyEye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
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Evaluation of Locoregional Recurrence Patterns Following Adjuvant (Chemo)Radiotherapy for Oral Cavity Carcinoma. Clin Oncol (R Coll Radiol) 2020; 32:228-237. [DOI: 10.1016/j.clon.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022]
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9
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Huang SH, Hahn E, Chiosea SI, Xu ZY, Li JS, Shen L, O'Sullivan B. The role of adjuvant (chemo-)radiotherapy in oral cancers in the contemporary era. Oral Oncol 2020; 102:104563. [PMID: 31918174 DOI: 10.1016/j.oraloncology.2019.104563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 12/28/2022]
Abstract
Squamous cell carcinoma of oral cavity (OSCC) is predominantly managed with surgery. Post-operative radiotherapy (PORT) and chemoradiotherapy (POCRT) enhance disease control in OSCC patients with adverse anatomic and pathologic primary and nodal features. Knowledge about disease behavior, surgery and radiotherapy advances, and the emergence of new systemic agents prompt refinement of PORT volumes and POCRT regimens. Traditional and emerging prognostic models that include adverse histopathological features underpin such approaches. This review summarizes research over recent decades with emphasis on the 2015 to Feb 2019 period describing: (1) Indications for PORT and/or POCRT, addressing surgical "margin status" including the definition of a "clear" margin to permit withholding PORT/POCRT; these concepts include characterizing the specimen yielding these measurements, the optimal time point to assess these findings, and the putative value of a "revised margin" performed during the same operative procedure, (2) Emerging prognostic factors including nodal burden (total number of involved lymph nodes) and perineural invasion, (3) PORT volume design, dose/fractionation and optimal surgery-to-PORT interval, (4) Chemotherapy dose, schedule, and agents, and (5) On-going clinical trials involving systemic agents and combinations of chemotherapy with immunotherapy.
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Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, PA, USA
| | - Zhi-Yuan Xu
- Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China
| | - Ji-Shi Li
- Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China
| | - Lin Shen
- Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada; Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China.
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Abstract
Cervical esophageal carcinoma (CEC) is rare, accounting for 2-10% of esophageal cancers and is mostly squamous cell carcinoma. Because of the anatomical proximity of CEC to larynx, surgical treatment would involve pharyngo-laryngo-esophagectomy (PLE) with inherent high mortality and morbidity. Laryngeal preservation is an important consideration, and definitive chemoradiotherapy is the recommended treatment. Treatment strategy of CEC can be more akin to treatment for head and neck cancers than to thoracic esophageal cancers. Since the exact location, extent of primary and nodal metastasis varies between patients, radiotherapy treatment needs to be individualized. The optimal radiation dose for CEC is uncertain, but retrospective data suggests that higher radiation dose of at least 60 Gy is associated with better local control and survival. Advanced radiotherapy technique, like intensity modulated radiotherapy, is usually required to achieve high dose to tumor while protecting normal tissues from excessive radiation.
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Zhu J, Zhou R, Wang Y, Yu M. Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis. Acta Otolaryngol 2019; 139:1038-1043. [PMID: 31464544 DOI: 10.1080/00016489.2019.1655167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Squamous cell carcinoma (SCC) is the most common type of head and neck cancer, and head and neck squamous cell carcinoma (HNSCC) was proved to having a high prevalence of perineural invasion (PNI). Although some reports have revealed a relationship between PNI and the prognosis in HNSCC patients, the contribution of PNI to the prognosis remains unclear. Objectives: This study was aimed to comprehensively and quantitatively summarize the prognostic value of PNI for the survival of patients with HNSCC. Material and methods: We conducted PubMed and EMBASE to identify all relevant studies. A meta-analysis and subgroup analysis were performed to clarify the prognostic role of PNI. Results: A total of 18 studies (n = 3894) were included. 989 (25.4%) of the 3894 patients exhibited positive PNI, PNI was shown to be significantly associated with overall survival (OS) [hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.88-4.16], disease-free survival (DFS) (HR = 2.42, 95% CI: 1.92-3.05) and disease-specific survival (DSS) (HR = 2.60, 95% CI: 1.86-3.63). Conclusions: The presence of PNI significantly affected OS, DFS and DSS in patients with HNSCC.
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Affiliation(s)
- Jing Zhu
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Zhou
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yihan Wang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Yu
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Perineural Invasion and Perineural Tumor Spread in Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2019; 103:1109-1124. [DOI: 10.1016/j.ijrobp.2018.12.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/18/2018] [Accepted: 12/01/2018] [Indexed: 01/03/2023]
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Li M, Zhang T, Tan B, Yu M, Zhang B. Role of postoperative adjuvant radiotherapy for locally advanced laryngeal cancer: a meta-analysis. Acta Otolaryngol 2019; 139:172-177. [PMID: 30734627 DOI: 10.1080/00016489.2018.1542159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Studies have shown mixed results on the role of postoperative adjuvant radiotherapy (PORT) in surgically managed locally advanced laryngeal cancer. OBJECTIVES The aim of this study is to review and investigate the role of PORT in patients with locally advanced laryngeal cancer using meta-analysis. MATERIALS AND METHODS Relevant studies were searched using PubMed and eligible information has been extracted. Then, meta-analysis of hazard ratio (HR) was performed to evaluate the role of PORT in locally advanced laryngeal cancer. RESULTS This meta-analysis included 7 published studies containing 2007 patients. For overall survival (OS), patients of locally advanced laryngeal cancer who were treated with PORT have a combined hazard ratio (HR) of 0.67 with 95%CI (0.56, 0.79), compared to those who were not treated with PORT, which was significantly associated with better survival. PORT was also associated with a better disease-free survival (DFS) and local control rate (LCR) in patients with locally advanced laryngeal cancer. The pooled HR and 95%CI for DFS and LCR were 0.72 (0.53, 0.99) and 0.29 (0.09, 0.99), respectively. CONCLUSIONS AND SIGNIFICANCE This study suggested that PORT could improve the survival of patients with surgically managed locally advanced laryngeal cancer.
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Affiliation(s)
- Minmin Li
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Zhang
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Benxu Tan
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Yu
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Binglan Zhang
- Department of gastroenterology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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14
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Ghanem AI, Schymick M, Bachiri S, Mannari A, Sheqwara J, Burmeister C, Chang S, Ghanem T, Siddiqui F. The effect of treatment package time in head and neck cancer patients treated with adjuvant radiotherapy and concurrent systemic therapy. World J Otorhinolaryngol Head Neck Surg 2019; 5:160-167. [PMID: 31750429 PMCID: PMC6849356 DOI: 10.1016/j.wjorl.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 01/13/2023] Open
Abstract
Objectives In patients with head and neck carcinoma, “treatment package time” (TPT) was proven to impact outcomes in cases receiving adjuvant radiotherapy alone. Its impact in patients receiving radiotherapy with concurrent systemic therapy has not been studied previously. The TPT influence on survival endpoints for patients treated with surgery followed by radiation and concurrent systemic therapy was analyzed. Methods Institutional database to identify head and neck carcinoma cases treated with definitive surgery followed by concomitant chemo(bio) radiotherapy (CRT) was used. TPT was the number of days elapsed between surgery and the last day of radiation. %FINDCUT SAS macro tool was used to search for the cutoff TPT that was associated with significant survival benefit. Kaplan–Meier curves, log-rank tests as well as univariate and multivariate analyses were used to assess overall survival (OS) and recurrence free survival (RFS). Results One hundred and three cases with a median follow up of 37 months were included in the study. Oropharyngeal tumors were 43%, oral cavity 40% and laryngeal 17% of cases. Concurrent systemic therapy included platinum and cetuximab in 72% and 28%, respectively. Optimal TPT was found to be < 100 days with significantly better OS (P = 0.002) and RFS (P = 0.043) compared to TPT ≥100 days. On multivariate analysis; TPT<100 days, extracapsular nodal extension, high-risk score, lymphovascular space and perineural invasion were independent predictors for worse OS (P < 0.05). T4, extracapsular nodal extension and high-risk score were all significantly detrimental to RFS (P < 0.05). Conclusions Addition of concomitant systemic therapy to adjuvant radiotherapy did not compensate for longer TPT in head and neck squamous cell carcinoma. Multidisciplinary coordinated care must be provided to ensure the early start of CRT with minimal treatment breaks.
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Affiliation(s)
- Ahmed I Ghanem
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA.,Alexandria Clinical Oncology Department, Alexandria University, Qasm Bab Sharqi, Alexandria Governate, 00302, Egypt
| | - Matthew Schymick
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Souheyla Bachiri
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Aniruddh Mannari
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Jawad Sheqwara
- Department of Medical Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Charlotte Burmeister
- Department of Public Health Science, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Steven Chang
- Department of Otolaryngology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Tamer Ghanem
- Department of Otolaryngology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
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Vonk J, Smit KA, Roodenburg JLN, van der Vegt B, Halmos GB, Vemer-van den Hoek JGM, Dijkstra PU, Witjes MJH. Effect of adjuvant radiotherapy on the local recurrence of oral squamous cell carcinoma with perineural invasion: A systematic review. Clin Otolaryngol 2018; 44:131-137. [PMID: 30295408 PMCID: PMC7379253 DOI: 10.1111/coa.13239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/13/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022]
Abstract
Objectives of the Review The decision whether to include postoperative radiotherapy on patients with oral squamous cell carcinoma depends on the risk of local recurrence. The objectives of this study were to systematically review literature on whether perineural invasion in oral squamous cell carcinoma patients is associated with higher local recurrence rates and whether local recurrence is influenced by the administration of postoperative radiotherapy in patients presenting with perineural invasion. Type of Review Systematic review. Search Strategy Embase, PubMed, Web Of Science. Evaluation Method The databases above were searched for studies that analysed: the treatment of oral squamous cell carcinoma patients with perineural invasion, local recurrence and postoperative radiotherapy. The data of seven studies were analysed qualitatively. Results The overall quality of the studies was moderate to low. There was no evidence of the effect of postoperative radiotherapy on local recurrence rates in patients presenting with perineural invasion. Some evidence suggests that local recurrence rates may increase in cases of multifocal perineural invasion, especially if nerves >1 mm are involved but these data should be interpreted with caution due to the low‐quality evidence. Conclusions High‐quality evidence regarding the prognostic value of perineural invasion and the impact of postoperative radiotherapy in patients presenting with perineural invasion is lacking in the literature, making it difficult to select a postoperative strategy for early‐stage tumours.
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Affiliation(s)
- Jasper Vonk
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kim A Smit
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hararah MK, Stokes WA, Jones BL, Oweida A, Ding D, McDermott J, Goddard J, Karam SD. Nomogram for preoperative prediction of nodal extracapsular extension or positive surgical margins in oropharyngeal squamous cell carcinoma. Oral Oncol 2018; 83:73-80. [PMID: 30098782 DOI: 10.1016/j.oraloncology.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Extracapsular extension (ECE) in regional lymph nodes and positive surgical margins (PSM) are considered high-risk adverse pathologic features in patients with oropharyngeal squamous cell carcinoma (OPSCC) that each constitute an indication for postoperative adjuvant chemoradiation. We identify pre-operative clinical factors that can predict post-operative ECE and/or PSM and create a nomogram to help clinical decision making. METHODS Adult patients with non-metastatic OPSCC with initial surgical treatment and confirmed HPV status diagnosed between 2010 and 2014 were selected from the National Cancer Database. Clinical staging was modified to American Joint Committee on Cancer 8th edition parameters. Logistic regression was used for multivariate analysis to identify predictors of pathologic ECE and/or PSM. RESULTS 5065 patients were included. 47.5% of the 3336 HPV-positive (HPV+) patients had ECE/PSM. 40.4% of the 1729 HPV-negative (HPV-) patients with had ECE/PSM. A model was built that included age, clinical ECE, tumor grade, and clinical T and N staging for HPV+ patients. Increasing N-classification was highly predictive of pathologic ECE and/or PSM (N1 OR = 3.6, N2 OR = 7.0, N3 OR = 11.2, p < 0.01). Clinical ECE (OR = 4.1, p < 0.01), tumor grade (ORs 2.2-4.4 with p < 0.05), and increasing clinical T-classification (ORs 1.2-1.8, p < 0.05) were also associated with ECE and/or PSM. A similar model was built for HPV- with similar predictive capability. Two internally validated nomograms were designed that demonstrated good discrimination (HPV+ AUC = 0.66, 95% CI: 0.64-0.68, and HPV- AUC = 0.70, 95% CI: 0.67-0.72) and good calibration (goodness-of-fit statistic of HPV+ 6.32, p = 0.61 and HPV- 11.66, p = 0.17). CONCLUSIONS These are the first nomograms designed to help predict ECE or PSM for both HPV+ and HPV- OPSCC. The nomograms can facilitate shared decision-making between clinicians and patients as they consider upfront treatment selection for OPSCC.
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Affiliation(s)
- Mohammad K Hararah
- Departments of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, United States
| | - William A Stokes
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Bernard L Jones
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ayman Oweida
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ding Ding
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jessica McDermott
- Medical Oncology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Julie Goddard
- Departments of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Sana D Karam
- Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
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Spiotto MT, Jefferson GD, Wenig B, Markiewicz MR, Weichselbaum RR, Koshy M. Survival outcomes for postoperative chemoradiation in intermediate-risk oral tongue cancers. Head Neck 2017; 39:2537-2548. [DOI: 10.1002/hed.24932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/13/2017] [Accepted: 07/20/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael T. Spiotto
- Department of Radiation and Cellular Oncology; University of Chicago Medical Center; Chicago Illinois
- Department of Radiation Oncology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Gina D. Jefferson
- Department of Otolaryngology - Head and Neck Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Barry Wenig
- Department of Otolaryngology - Head and Neck Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Michael R. Markiewicz
- Department of Oral and Maxillofacial Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Ralph R. Weichselbaum
- Department of Radiation and Cellular Oncology; University of Chicago Medical Center; Chicago Illinois
- Department of Radiation Oncology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology; University of Chicago Medical Center; Chicago Illinois
- Department of Radiation Oncology; University of Illinois Hospital and Health Sciences System; Chicago Illinois
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18
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Woody NM, Ward MC, Koyfman SA, Reddy CA, Geiger J, Joshi N, Burkey B, Scharpf J, Lamarre E, Prendes B, Adelstein DJ. Adjuvant Chemoradiation After Surgical Resection in Elderly Patients With High-Risk Squamous Cell Carcinoma of the Head and Neck: A National Cancer Database Analysis. Int J Radiat Oncol Biol Phys 2017; 98:784-792. [DOI: 10.1016/j.ijrobp.2017.03.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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Graboyes EM, Zhan KY, Garrett-Mayer E, Lentsch EJ, Sharma AK, Day TA. Effect of postoperative radiotherapy on survival for surgically managed pT3N0 and pT4aN0 laryngeal cancer: Analysis of the National Cancer Data Base. Cancer 2017; 123:2248-2257. [PMID: 28182267 DOI: 10.1002/cncr.30586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The current study was conducted to determine the effect of postoperative radiotherapy (PORT) on overall survival in patients with surgically managed pT3-T4aN0 laryngeal squamous cell carcinoma (SCC). METHODS A review of the National Cancer Data Base from 2004 through 2013 was performed. Patients with surgically managed pT3-4aN0 laryngeal SCC with negative surgical margins were included. Univariable and multivariable Cox regression analyses were used to determine factors associated with survival. RESULTS A total of 1460 patients were included, 46.2% of whom had pT3N0 disease (674 patients) and 53.8% of whom had pT4aN0 disease (786 patients). Approximately 72.0% of the patients with pT3N0 disease (485 patients) and 50.1% of the patients with pT4aN0 disease (394 patients) received PORT. PORT was not found to be associated with improved overall survival on univariable analysis for patients with pT3N0 disease (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.62-1.14), but was for patients with pT4aN0 disease (HR, 0.57; 95% CI, 0.45-0.71). For patients with pT3N0 SCC of the larynx, in a multivariable Cox regression analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, extent of laryngectomy, and number of lymph nodes removed, PORT was not found to be associated with improved survival (adjusted HR, 0.88; 95% CI, 0.64-1.21). For patients with pT4aN0 disease, the administration of PORT was associated with improved survival on multivariable analysis adjusting for age >65 years, severity of comorbidities, larynx subsite, number of lymph nodes removed, and type of hospital (adjusted HR, 0.58; 95% CI, 0.46-0.73). CONCLUSIONS For patients with surgically managed pT3N0 laryngeal SCC with negative margins, PORT does not appear to be associated with improved survival. Despite a survival benefit, nearly 50% of patients with pT4aN0 laryngeal SCC and negative surgical margins do not receive standard-of-care PORT. Cancer 2017;123:2248-2257. © 2017 American Cancer Society.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Elizabeth Garrett-Mayer
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Eric J Lentsch
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Sailer V, Holmes EE, Gevensleben H, Goltz D, Dröge F, de Vos L, Franzen A, Schröck F, Bootz F, Kristiansen G, Schröck A, Dietrich D. PITX2 and PANCR DNA methylation predicts overall survival in patients with head and neck squamous cell carcinoma. Oncotarget 2016; 7:75827-75838. [PMID: 27716615 PMCID: PMC5342781 DOI: 10.18632/oncotarget.12417] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/20/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma of the head and neck region (HNSCC) is a common malignant disease accompanied by a high risk of local or distant recurrence after curative-intent treatment. Biomarkers that allow for the prediction of disease outcome can guide clinicians with respect to treatment and surveillance strategies. Here, the methylation status of PITX2 and an adjacent lncRNA (PANCR) were evaluated for their ability to predict overall survival in HNSCC patients. RESULTS PITX2 hypermethylation was associated with a better overall survival (hazard ratio, HR = 0.51, 95%CI: 0.35-0.74, p<0.001), while PANCR hypermethylation was significantly associated with an increased risk of death (HR = 1.64, 95%CI: 1.12-2.39, p=0.010). METHODS Quantitative, methylation-specific real-time PCR assays for PITX2 and PANCR were employed to measure bisulfite-converted DNA from formalin-fixed, paraffin-embedded (FFPE) tissues in a cohort of 399 patients with localized or locally advanced HNSCC who received curative-intent treatment (surgery with optional adjuvant radiochemotherapy or definite radiochemotherapy). CONCLUSIONS PITX2 and PANCR methylation status were shown to be independent predictors for overall survival in HNSCC patients. Tissue-based methylation testing could therefore potentially be employed to identify patients with a high risk for death who might benefit from a more radical or alternative treatment.
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Affiliation(s)
- Verena Sailer
- Weill Medical College of Cornell University and New York Presbyterian Hospital, Department of Pathology and Laboratory Medicine, New York, NY, USA
- Weill Medical College of Cornell University and New York Presbyterian Hospital, Englander Institute for Precision Medicine, New York, NY, USA
| | - Emily Eva Holmes
- Institute of Pathology, University Hospital of Bonn, Bonn, Germany
| | | | - Diane Goltz
- Institute of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Freya Dröge
- Department of Otorhinolaryngology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Luka de Vos
- University Hospital Bonn, Department of Otolaryngology, Head and Neck Surgery, Bonn, Germany
| | - Alina Franzen
- University Hospital Bonn, Department of Otolaryngology, Head and Neck Surgery, Bonn, Germany
| | - Friederike Schröck
- Department of Addictive Disorders and Addiction Medicine, LVR Hospital Bonn, Bonn, Germany
| | - Friedrich Bootz
- University Hospital Bonn, Department of Otolaryngology, Head and Neck Surgery, Bonn, Germany
| | - Glen Kristiansen
- Institute of Pathology, University Hospital of Bonn, Bonn, Germany
| | - Andreas Schröck
- University Hospital Bonn, Department of Otolaryngology, Head and Neck Surgery, Bonn, Germany
| | - Dimo Dietrich
- Institute of Pathology, University Hospital of Bonn, Bonn, Germany
- University Hospital Bonn, Department of Otolaryngology, Head and Neck Surgery, Bonn, Germany
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Junn JC, Baugnon KL, Lacayo EA, Hudgins PA, Patel MR, Magliocca KR, Corey AS, El-Deiry M, Wadsworth JT, Beitler JJ, Saba NF, Liu Y, Aiken AH. CT Accuracy of Extrinsic Tongue Muscle Invasion in Oral Cavity Cancer. AJNR Am J Neuroradiol 2016; 38:364-370. [PMID: 28059707 DOI: 10.3174/ajnr.a4993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/30/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Extrinsic tongue muscle invasion in oral cavity cancer upstages the primary tumor to a T4a. Despite this American Joint Committee on Cancer staging criterion, no studies have investigated the accuracy or prognostic importance of radiologic extrinsic tongue muscle invasion, the feasibility of standardizing extrinsic tongue muscle invasion reporting, or the degree of agreement across different disciplines: radiology, surgery, and pathology. The purpose of this study was to assess the agreement among radiology, surgery, and pathology for extrinsic tongue muscle invasion and to determine the imaging features most predictive of extrinsic tongue muscle invasion with surgical/pathologic confirmation. MATERIALS AND METHODS Thirty-three patients with untreated primary oral cavity cancer were included. Two head and neck radiologists, 3 otolaryngologists, and 1 pathologist prospectively evaluated extrinsic tongue muscle invasion. RESULTS Fourteen of 33 patients had radiologic extrinsic tongue muscle invasion; however, only 8 extrinsic tongue muscle invasions were confirmed intraoperatively. Pathologists were unable to determine extrinsic tongue muscle invasion in post-formalin-fixed samples. Radiologic extrinsic tongue muscle invasion had 100% sensitivity, 76% specificity, 57% positive predictive value, and 100% negative predictive value with concurrent surgical-pathologic evaluation of extrinsic tongue muscle invasion as the criterion standard. On further evaluation, the imaging characteristic most consistent with surgical-pathologic evaluation positive for extrinsic tongue muscle invasion was masslike enhancement. CONCLUSIONS Evaluation of extrinsic tongue muscle invasion is a subjective finding for all 3 disciplines. For radiology, masslike enhancement of extrinsic tongue muscle invasion most consistently corresponded to concurrent surgery/pathology evaluation positive for extrinsic tongue muscle invasion. Intraoperative surgical and pathologic evaluation should be encouraged to verify radiologic extrinsic tongue muscle invasion to minimize unnecessary upstaging. Because this process is not routine, imaging can add value by identifying those cases most suspicious for extrinsic tongue muscle invasion, thereby prompting this more detailed evaluation by surgeons and pathologists.
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Affiliation(s)
- J C Junn
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - K L Baugnon
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - E A Lacayo
- Department of Radiology (E.A.L.), Georgetown University, Washington, DC
| | - P A Hudgins
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - M R Patel
- Otolaryngology (M.R.P., M.E.-D., J.T.W.)
| | | | - A S Corey
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - M El-Deiry
- Otolaryngology (M.R.P., M.E.-D., J.T.W.)
| | | | | | | | - Y Liu
- Statistics (Y.L.), Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
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Kim SH, Lee YS, Kwon M, Kim JW, Roh JL, Choi SH, Kim SY, Lee SW, Nam SY. Adjuvant role of radiation therapy for locally advanced laryngeal cancer without pathological lymph node metastasis. Acta Otolaryngol 2016; 136:703-10. [PMID: 26924463 DOI: 10.3109/00016489.2016.1146827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Conclusion The application of adjuvant RT to reduce recurrence should be tailored in cases of pathologically negative node metastasis. Objectives The treatment modality following surgical resection of advanced laryngeal cancer is determined by adverse factors. Aside from lymph node metastasis (LNM) or positive margins, definite risk factors supporting adjuvant radiation therapy (RT) have not been clearly suggested. The aim of this study was to analyze the risk factors for advanced laryngeal cancer without LNM and the role of RT. Materials and methods Pathologically T3 and T4-staged laryngeal squamous cell carcinoma without LNM were reviewed. The patients were classified into RT (+) (n = 22) and RT (-) (n = 38) groups. Results Five-year overall survival (OS) of the RT (+) and RT (-) groups was 84.4% and 83.8%, respectively. Five-year disease-specific survival of the RT (+) and RT (-) groups was 88.4% and 93.9%. Five-year local control rate of the RT (+) and RT (-) groups was 94.7% and 91.3%. The factors affecting OS were smoking history and recurrence history (p = 0.02). By multivariate analysis, smoking history and recurrence history were determining factors for 5-year OS (p = 0.024 and p = 0.047, respectively).
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Affiliation(s)
- Sung Hee Kim
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Yoon Se Lee
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Minsu Kwon
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Ji Won Kim
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jong-Lyel Roh
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Seung-Ho Choi
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Sang Yoon Kim
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Sang-Wook Lee
- b Department of Radiation Oncology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Soon Yuhl Nam
- a Department of Otolaryngology, Asan Medical Center , University of Ulsan College of Medicine , Seoul , Republic of Korea
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Gorphe P, Matias M, Moya-Plana A, Tabarino F, Blanchard P, Tao Y, Janot F, Temam S. Results and Survival of Locally Advanced AJCC 7th Edition T4a Laryngeal Squamous Cell Carcinoma Treated with Primary Total Laryngectomy and Postoperative Radiotherapy. Ann Surg Oncol 2016; 23:2596-601. [DOI: 10.1245/s10434-016-5217-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Indexed: 11/18/2022]
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Raslan OA, Muzaffar R, Shetty V, Osman MM. Image findings of cranial nerve pathology on [18F]-2- deoxy-D-glucose (FDG) positron emission tomography with computerized tomography (PET/CT): a pictorial essay. Cancer Imaging 2015; 15:20. [PMID: 26634826 PMCID: PMC4668699 DOI: 10.1186/s40644-015-0054-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/04/2015] [Indexed: 12/26/2022] Open
Abstract
This article aims to increase awareness about the utility of (18)F -FDG-PET/CT in the evaluation of cranial nerve (CN) pathology. We discuss the clinical implication of detecting perineural tumor spread, emphasize the primary and secondary (18)F -FDG-PET/CT findings of CN pathology, and illustrate the individual (18)F -FDG-PET/CT CN anatomy and pathology of 11 of the 12 CNs.
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Affiliation(s)
- Osama A Raslan
- Department of Radiology, Division of Nuclear Medicine, St Louis University, 3635 Vista Avenue, Saint Louis, MO, 63110, USA.
| | - Razi Muzaffar
- Department of Radiology, Division of Nuclear Medicine, St Louis University, 3635 Vista Avenue, Saint Louis, MO, 63110, USA
| | - Vilaas Shetty
- Department of Radiology, Division of Neuroradiology, St Louis University, 3635 Vista Avenue, Saint Louis, MO, 63110, USA
| | - Medhat M Osman
- Department of Radiology, Division of Nuclear Medicine, St Louis University, 3635 Vista Avenue, Saint Louis, MO, 63110, USA
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Bur AM, Lin A, Weinstein GS. Adjuvant radiotherapy for early head and neck squamous cell carcinoma with perineural invasion: A systematic review. Head Neck 2015; 38 Suppl 1:E2350-7. [DOI: 10.1002/hed.24295] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/09/2015] [Accepted: 09/12/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Andrés M. Bur
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Gregory S. Weinstein
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania
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Mücke T, Kanatas A, Ritschl LM, Koerdt S, Tannapfel A, Wolff KD, Loeffelbein D, Kesting M. Tumor thickness and risk of lymph node metastasis in patients with squamous cell carcinoma of the tongue. Oral Oncol 2015; 53:80-4. [PMID: 26625728 DOI: 10.1016/j.oraloncology.2015.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Oral squamous cell carcinomas, and tongue malignancies in particular, are among the most common tumors of the oral cavity. Classification for therapeutic and prognostic purposes is routinely made using the tumor, node, metastasis (TNM) system; however, current definitions do not include tumor thickness. We therefore aimed to identify variables associated with survival, and to evaluate the correlation between tumor thickness and the occurrence of lymph node metastasis. PATIENTS AND METHODS All patients undergoing radical tumor resection for squamous cell carcinomas of the tongue between 2000 and 2012 were included. Specimens were analyzed histopathologically and co-variables were interpreted. Follow-up was performed clinically and radiologically for at least 3years according to current guidelines. RESULTS We included 492 patients who had a median follow-up of 70months. Variables associated with survival (p<0.05) were age, tumor stage, N stage, UICC (Union for International Cancer Control) stage, tumor grade, and recurrence. In the receiver operating characteristic curve and Youden-Index analyses, the optimal tumor thickness cut-off was 8mm to detect significant differences in overall survival. CONCLUSION We highlight the importance of tumor thickness as a predictive variable in tongue cancer. Specifically, a cut-off point of 8mm allowed for a more accurate and statistically precise prediction of lymph node metastasis. These findings could supplement the current classification of tongue cancers and form the basis for treatment.
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Affiliation(s)
- Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany.
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds General Infirmary, LS1 3EX, UK
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | | | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | - Denys Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, Germany
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Abstract
Oral cavity squamous cell carcinoma (OC-SCC) is the most common malignancy of the head and neck (excluding nonmelanoma skin cancer). Recent trends have shown a dramatic rise in the incidence of oropharyngeal squamous cell carcinoma (OP-SCC), with a marked increase in lesions related to human papillomavirus infection. This update presents the latest evidence regarding OC-SCC and OP-SCC. In particular, the authors compare and contrast tumors at these two sites with respect to epidemiology, etiopathogenesis, clinicopathologic presentation, clinical assessment, imaging, management, and prognosis. It is important for clinicians to be aware of differences between OC-SCC and OP-SCC so that appropriate patient education and multidisciplinary care can be provided to optimize outcomes.
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Affiliation(s)
- Angela C Chi
- Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
| | - Terry A Day
- Professor, Wendy and Keith Wellin Endowed Chair for Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Brad W Neville
- Distinguished University Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
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Gorphe P, Ben Lakhdar A, Tao Y, Breuskin I, Janot F, Temam S. Evidence‐based management of the thyroid gland during a total laryngectomy. Laryngoscope 2015; 125:2317-22. [DOI: 10.1002/lary.25417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/10/2022]
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Gupta A, Veness M, De'Ambrosis B, Selva D, Huilgol SC. Management of squamous cell and basal cell carcinomas of the head and neck with perineural invasion. Australas J Dermatol 2015; 57:3-13. [PMID: 25759949 DOI: 10.1111/ajd.12314] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 12/16/2014] [Indexed: 01/01/2023]
Abstract
Perineural invasion (PNI) occurring in non-melanoma skin cancers (NMSC) is associated with an increased risk of locoregional recurrence and reduced disease-free survival. This necessitates early and accurate diagnosis, appropriate risk-stratification and a clear management strategy. The diagnosis of PNI is based on careful clinical assessment, imaging and histopathology. Surgery, preferably with margin control, and definitive or adjuvant radiotherapy (ART) are established treatment strategies for PNI. Clinical uncertainty remains over the role of ART in incidental PNI. This review synthesises current literature to ascertain which clinicopathological features impart a higher risk to individuals with PNI in NMSC, in order to provide treatment algorithms, including the identification of patient subsets that are most likely to benefit from ART. This includes those with extratumoural PNI, involvement of larger-calibre nerves, tumour invasion beyond dermis, recurrent tumour or diffuse intratumoural spread. Patients with clinical PNI may be optimally managed by a multidisciplinary head and neck cancer service that is best placed to offer skull base surgery and intensity-modulated radiation therapy (IMRT). The management options presented are stratified by histological subtype and a new classification of PNI into low-risk, medium-risk and high-risk groups.
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Affiliation(s)
- Aakriti Gupta
- Department of Dermatology, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Veness
- Westmead Cancer Care Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Brian De'Ambrosis
- University of Queensland and South East Dermatology, Brisbane, Queensland, Australia
| | - Dinesh Selva
- Department of Ophthalmology & Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, South Australia, Australia.,Adelaide Skin and Eye Centre, Adelaide, South Australia, Australia
| | - Shyamala C Huilgol
- Department of Dermatology, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Adelaide Skin and Eye Centre, Adelaide, South Australia, Australia
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Mücke T, Mitchell DA, Ritschl LM, Tannapfel A, Wolff KD, Kesting MR, Loeffelbein DJ, Kanatas A. Influence of tumor volume on survival in patients with oral squamous cell carcinoma. J Cancer Res Clin Oncol 2014; 141:1007-11. [PMID: 25423880 DOI: 10.1007/s00432-014-1881-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/18/2014] [Indexed: 01/16/2023]
Abstract
PURPOSE The TNM classification is used to assess cancers of the oral cavity, and advancements in imaging techniques have revealed clear variations in tumor volume at presentation. This study therefore aimed to clarify whether preoperative imaging, with exact measurements of the tumor, could affect post-surgery survival after controlling for demographic, clinical, and tumor characteristics. METHODS We included 437 patients with histologically confirmed, stage T1-4, N1-3, M0, invasive squamous cell carcinoma of the tongue. Participants were assessed for recurrence every 3 months for the first 2 years, every 6 months for another 2 years, and annually thereafter; routine computed tomography was performed annually. Associations were determined using the Kaplan-Meier estimator, univariate log-rank test, and Cox proportional hazards regression models. RESULTS The mean survival of all patients was 68.1 ± 48.2 months. The 2- and 5-year overall survival rates were 82.2 and 66.7 %, respectively. The mean primary tumor volume was 7.14 cm(3) with a range of 1.3-24.21 cm(3). The ROC curve and Youden Index analysis revealed that the optimal cutoff volume was between ≤5.9 and ≤18.3 cm(3) for three different volume groups (p < 0.0001). Large tumor volume was associated with a significantly poorer overall survival (p < 0.0001). CONCLUSIONS Tumor volume was significantly associated with the overall survival of patients. This has both prognostic and reconstructive implications that will affect health-related quality of life. In addition, this will inform surgical planning and the allocation of resources.
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Affiliation(s)
- Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany,
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Approche anatomopathologique de l’extension microscopique des carcinomes épidermoïdes ORL : implications pour la définition du volume cible anatomoclinique. Cancer Radiother 2014; 18:666-71. [DOI: 10.1016/j.canrad.2014.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 04/11/2014] [Accepted: 04/18/2014] [Indexed: 11/23/2022]
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Paes FM, Singer AD, Checkver AN, Palmquist RA, De La Vega G, Sidani C. Perineural spread in head and neck malignancies: clinical significance and evaluation with 18F-FDG PET/CT. Radiographics 2014; 33:1717-36. [PMID: 24108559 DOI: 10.1148/rg.336135501] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Certain tumors of the head and neck use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread. Perineural spread is associated with decreased survival and a higher risk of local recurrence and metastasis. Radiologists play an important role in the assessment and management of head and neck cancer, and positron emission tomography/computed tomography (PET/CT) with 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) is part of the work-up and follow-up of many affected patients. Awareness of abnormal FDG uptake patterns within the head and neck is fundamental for diagnosing perineural spread. The cranial nerves most commonly affected by perineural spread are the trigeminal and facial nerves. Risk of perineural spread increases with a midface location of the tumor, male gender, increasing tumor size, recurrence after treatment, and poor histologic differentiation. Focal or linear increased FDG uptake along the V2 division of the trigeminal nerve or along the medial surface of the mandible, or asymmetric activity in the masticator space, foramen ovale, or Meckel cave should raise suspicion for perineural spread. If FDG PET/CT findings suggest perineural spread, the radiologist should look at available results of other imaging studies, especially magnetic resonance imaging, to confirm the diagnosis. Knowledge of common FDG PET/CT patterns of neoplastic involvement along the cranial nerves and potential diagnostic pitfalls is of the utmost importance for adequate staging and treatment planning.
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Affiliation(s)
- Fabio M Paes
- Department of Radiology, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, West Wing-279, 1611 NW 12th Ave, Miami, FL 33136
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Eldeeb H, Macmillan C, Elwell C, Hammod A. The effect of the surgical margins on the outcome of patients with head and neck squamous cell carcinoma: single institution experience. Cancer Biol Med 2013; 9:29-33. [PMID: 23691451 PMCID: PMC3643636 DOI: 10.3969/j.issn.2095-3941.2012.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 02/29/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the impact of close or positive surgical margins on the outcome, and to determine whether margin status influence the recurrence rate and the overall survival for patients with head and neck cancers. Methods Records from 1996 to 2001 of 413 patients with primary head and neck squamous cell carcinoma (SCC) treated with surgery as the first line treatment were analysed. Of these patients, 82 were eligible for the study. Patients were followed up for 5 years. Results Patients with margins between 5-10 mm had 50% recurrence rate (RR), those with surgical margins between 1-5 mm had RR of 59% and those with positive surgical margins had RR of 90% (P=0.004). The 5-year survival rates were 54%, 39% and 10%, respectively (P=0.002). Conclusions Unsatisfactory surgical margin is an independent risk factor for recurrence free survival as well as overall survival regardless of the other tumor and patient characteristics.
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Affiliation(s)
- Hany Eldeeb
- Northamptonshire Centre for Oncology, Northampton, Northamptonshire NN1 5BD, UK
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