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Nicholson OA, Van Lanschot CGF, van den Besselaar BN, Aaboubout Y, Iseli T, Hardillo JAU, Mast H, McDowell L, Koljenović S, Kranz S, Baatenburg de Jong RJ, Keereweer S, Wiesenfeld D. Management of the neck in T1 and T2 buccal squamous cell carcinoma. Int J Oral Maxillofac Surg 2024; 53:259-267. [PMID: 37640565 DOI: 10.1016/j.ijom.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
Buccal squamous cell carcinoma (SCC) appears to behave more aggressively than other oral subsites, in particular with regards to regional disease at presentation and regional recurrence. Adequate management of the neck is of the utmost importance but is still the subject of debate. An international multicentre retrospective review of 101 patients treated for T1-T2 buccal SCC was performed. Twenty-four were staged clinical node positive (cN+) and underwent therapeutic neck dissection, while 77 were node negative (cN0), with 32 undergoing elective neck dissection (END), with an occult nodal metastasis rate of 28.1%. Depth of invasion (DOI) < 4 mm was associated with a significantly lower rate of cervical nodal metastasis (87.5% versus 12.5%; P = 0.033). END demonstrated a non-significantly lower regional recurrence rate compared to observation (6.3% versus 8.9%, P = 0.670). Regional recurrence was more common in pN+ (24%) and undissected cases (8.9%) than in pN0 patients (0%) (P = 0.011) and was associated with DOI > 5 mm (P = 0.002). Regional recurrence resulted in a reduction in survival (24 versus 93 months, P < 0.001). In the pT2cN0 group, END improved survival (123 versus 26 months, P = 0.009). It is suggested that END be performed in cT2N0 buccal SCC, particularly for tumours with DOI > 4 mm.
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Affiliation(s)
- O A Nicholson
- Head and Neck Tumour Stream, Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - C G F Van Lanschot
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - B N van den Besselaar
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Y Aaboubout
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Pathology, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - T Iseli
- Head and Neck Tumour Stream, Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - J A U Hardillo
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - H Mast
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - L McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - S Koljenović
- Department of Pathology, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Pathology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - S Kranz
- Department of Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - S Keereweer
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - D Wiesenfeld
- Head and Neck Tumour Stream, Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Singh A, Roy S, Tuljapurkar V, Nair D, Chaturvedi P. Critical Review of the Current Evidence on Sentinel Node Biopsy in Oral Cancer. Curr Oncol Rep 2022; 24:783-791. [PMID: 35298797 DOI: 10.1007/s11912-021-01171-2] [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] [Accepted: 08/19/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW With contemporary surgery of the cN0 neck in early oral cancer becoming more selective, sentinel node biopsy (SNB) is gaining popularity as a possible alternate option to elective neck dissection (END). This review attempts to critically appraise the current evidence and highlight pertinent arguments for the use of SNB in early oral cancers. RECENT FINDINGS Based on the recent randomized trials, it is imperative to perform an END at the time of primary resection in cN0 oral cancers. The much criticized false negative rate of SNB can be argued to be equal to the regional failure rate after END for pN0 necks, possibly making a case for SNB due to the reduction in number of neck dissections. There still lies ambiguity on the technique, protocols, and benefit of SNB over END. The role of extended histopathological techniques and the implications of micrometastasis and isolated tumor cells for treatment intensification remain questionable. Currently, SNB is an intermediary between routine imaging and END that needs to evolve before it can become a practice changing alternative to END itself. More efforts are needed in standardizing the protocols for SNB.
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Affiliation(s)
- Arjun Singh
- Head and Neck Oncology Department, Tata Memorial Hospital and HBNI, Mumbai, India
| | - Satadru Roy
- Head and Neck Oncology Department, Tata Memorial Centre and HBNI, Mumbai, India
| | - Vidisha Tuljapurkar
- Head and Neck Oncology Department, Tata Memorial Centre and HBNI, Mumbai, India
| | - Deepa Nair
- Head and Neck Oncology Department, Tata Memorial Centre and HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Head and Neck Oncology Department, Tata Memorial Hospital and HBNI, Mumbai, India.
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Mahmood S, Mair M, Fagiry R, Ahmed MM, Menon I, Ibrahim N, Baker A, Vaidhyanath R. Diagnostic efficacy of combined CT and MRI in detecting nodal metastasis in patients with oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:343-348. [PMID: 34625385 DOI: 10.1016/j.oooo.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/23/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to assess the diagnostic efficacy of combined computed tomography (CT) and magnetic resonance imaging (MRI) in detecting metastases of oral cancers to lymph nodes in the neck. STUDY DESIGN In total, 105 patients with previously untreated oral squamous cell carcinoma underwent both CT and MRI within 6 weeks before tumor excision and selective neck dissection. The diagnostic efficacy of combined CT and MRI was compared with published data on the efficacy of CT and MRI alone. RESULTS The sensitivity, specificity, positive and negative predictive values, and accuracy of diagnosis based on CT and MRI were 80%, 90%, 80%, 90%, and 87%, respectively. These values were similar to or higher than those reported in a meta-analysis for CT or MRI alone. The highest and lowest sensitivities were found for metastatic nodes at levels I (75%) and III (33%). The highest and lowest specificities were discovered for nodes at levels IV (99%) and I (88%). CONCLUSIONS Combined CT and MRI may be superior to a single modality alone in detecting metastatic neck nodes. This may have an advantage in both preoperative planning and neck surveillance in superficial oral cancers.
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Affiliation(s)
- Sara Mahmood
- Senior House Officer, Department of Oral & MaxilloFacial Surgery, University Hospital of Leicester, Leicester, United Kingdom
| | - Manish Mair
- Consultant, Head and Neck Surgery, University Hospital of Leicester, Leicester, United Kingdom.
| | - Rihab Fagiry
- Senior House Officer, Department of Oral & MaxilloFacial Surgery, University Hospital of Leicester, Leicester, United Kingdom
| | - Mandy Mohamed Ahmed
- Department of Oral & MaxilloFacial Surgery, University Hospital of Leicester, Leicester, United Kingdom
| | - Ipsit Menon
- Consultant, Department of Radiology, University Hospital of Leicester, Leicester, United Kingdom
| | - Niyaz Ibrahim
- Consultant, Department of Radiology, University Hospital of Leicester, Leicester, United Kingdom
| | - Andrew Baker
- Consultant, Department of Oral & Maxillo Facial Surgery, University Hospital of Leicester, Leicester, United Kingdom
| | - Ram Vaidhyanath
- Consultant, Department of Radiology, University Hospital of Leicester, Leicester, United Kingdom
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Panda S, Kumar R, Chandran C A, Thakar A, Sharma SC, Bhasker S, Sharma A. Impact of skin invasion on long-term survival outcomes in gingivobuccal complex carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:205-211. [PMID: 34294218 DOI: 10.1016/j.otoeng.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/09/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Gingivo-buccal complex cancers (GBCC) have an aggressive clinical course in the presence of skin and bone involvement. OBJECTIVE This study intends to analyze the clinico-pathological factors affecting local control and survival outcomes in GBCC. METHODS This is a retrospective study conducted on 125 GBCC cases from January 2011 to April 2016. RESULT Univariate analysis revealed lymphovascular invasion (LVI) and skin involvement as predictors of poor overall survival (OS) and disease- free survival (DFS). Multivariate analysis showed skin involvement and LVI to be independent prognostic factors towards poor OS. Corresponding results in case of DFS showed skin involvement to be the single most important prognostic factor. With a median follow up of 24 months, the median survival of patients with skin involvement, skin and mandible invasion and isolated mandible invasion, respectively, were 18 months, 12 months and 22 months. CONCLUSION GBCC with skin involvement portends poor outcome in terms of survival. In the presence of skin invasion, treatment entails liberal soft tissue and bone margin followed by adjuvant treatment.
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Affiliation(s)
- Smriti Panda
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashwin Chandran C
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh C Sharma
- Department of Otolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Panda S, Kumar R, Chandran C A, Thakar A, Sharma SC, Bhasker S, Sharma A. Impact of skin invasion on long-term survival outcomes in gingivobuccal complex carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rocchetti F, Tenore G, Montori A, Cassoni A, Cantisani V, Di Segni M, Di Gioia CRT, Carletti R, Valentini V, Polimeni A, Romeo U. Preoperative evaluation of tumor depth of invasion in oral squamous cell carcinoma with intraoral ultrasonography: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:130-138. [PMID: 32792295 DOI: 10.1016/j.oooo.2020.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/10/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of preoperative intraoral ultrasonography (US) in the assessment of tumor depth of invasion (DOI) in oral squamous cell carcinoma (OSCC). STUDY DESIGN Records of 32 patients with biopsy-proven OSCC who underwent preoperative intraoral US were retrospectively reviewed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy as indicated by receiver operating characteristic (ROC) analysis were measured for US in the assessment of the infiltration of the tumor beyond the lamina propria into the submucosa. The correlations between US and histologic DOI, and between US DOI and US diameter of the lesion, were assessed. RESULTS US sensitivity, specificity, PPV, and NPV in the assessment of the infiltration of the tumor beyond the lamina propria into the submucosa were 93.1%, 100%, 100%, and 60%, respectively. The area under the ROC curve was 0.96. A significant correlation was found between the measurements of US DOI and histological DOI (r = 0.907). A moderate correlation was found between US DOI and US diameter (r = 0.591). CONCLUSIONS Intraoral US has potential in preoperatively determining tumor DOI and may provide additional guidance for optimal planning of therapy for OSCC patients .
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Affiliation(s)
- Federica Rocchetti
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Gianluca Tenore
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Alessandra Montori
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - Andrea Cassoni
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Mattia Di Segni
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Raffaella Carletti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentino Valentini
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
| | - Umberto Romeo
- Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy
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Pantvaidya G, Rao K, D'Cruz A. Management of the neck in oral cancers. Oral Oncol 2020; 100:104476. [DOI: 10.1016/j.oraloncology.2019.104476] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
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Parikh AS, Puram SV, Faquin WC, Richmon JD, Emerick KS, Deschler DG, Varvares MA, Tirosh I, Bernstein BE, Lin DT. Immunohistochemical quantification of partial-EMT in oral cavity squamous cell carcinoma primary tumors is associated with nodal metastasis. Oral Oncol 2019; 99:104458. [PMID: 31704557 DOI: 10.1016/j.oraloncology.2019.104458] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/19/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Quantify by immunohistochemistry (IHC) a partial epithelial-to-mesenchymal transition (p-EMT) population in oral cavity squamous cell carcinoma (OCSCC) and determine its predictive value for lymph node metastasis. METHODS Tissue microarrays (TMA) were created using 2 mm cores from 99 OCSCC patients (47 with low volume T2 disease, 52 with high volume T4 disease, and ∼50% in each group with nodal metastasis). IHC staining was performed for three validated p-EMT markers (PDPN, LAMB3, LAMC2) and one marker of well-differentiated epithelial cells (SPRR1B). Staining was quantified in a blinded manner by two reviewers. Tumors were classified as malignant basal subtype based on staining for the four markers. In this subset, the p-EMT score was computed as the average of p-EMT markers. RESULTS 84 tumors were classified as malignant basal. There was 87% inter-rater consistency in marker quantification. There were associations of p-EMT scores with higher grade (2.15 vs. 1.92, p = 0.04), PNI (2.13 vs. 1.83, p = 0.003), and node positivity (2.09 vs. 1.87, p = 0.02), including occult node positivity (56% vs. 19%, p = 0.005). P-EMT was independently associated with nodal metastasis in a multivariate analysis (OR 3.12, p = 0.039). Overall and disease free survival showed trends towards being diminished in the p-EMT high group. CONCLUSIONS IHC quantification of p-EMT in OCSCC primary tumors is reliably associated with nodal metastasis, PNI, and high grade. With prospective validation, p-EMT biomarkers may aid in decision-making over whether to perform a neck dissection in the N0 neck and/or for adjuvant therapy planning.
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Affiliation(s)
- Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
| | - William C Faquin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Kevin S Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Itay Tirosh
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Bradley E Bernstein
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
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Garg M, Tudor-Green B, Bisase B. Current thinking in management of the neck (including contralateral neck) in ipsilateral recurrent or second primary oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2019; 57:711-715. [PMID: 31378403 DOI: 10.1016/j.bjoms.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
Metastasis to the neck in patients with oral squamous cell carcinoma (SCC) has a huge impact on long-term survival and prognosis, and its incidence varies. Due consideration therefore should be given to management of the neck in each individual case. The pathways in patients with primary oral SCC are well-established, but there is a paucity of published papers on management of the neck in those with ipsilateral recurrent or second primary oral SCC whose necks have previously been operated on with or without radiotherapy or chemoradiotherapy, or treated with radiotherapy or chemoradiotherapy alone. These patients may be under treated because of failure to stage the most likely drainage site, and are likely to have a worse outcome if there is macroscopic recurrence in the neck after independent treatment of the recurrent or second primary tumour. Based on the current review, we think there is a need for a multicentre, collaborative, retrospective review of the outcomes of patients with ipsilateral second primaries or recurrent oral SCC in the previously treated neck. Our recommendations include consideration of positron emission tomography-computed tomography in all patients with recurrent or second primary oral SCC (if "hot" - neck dissection, if "cold" - sentinel node biopsy); consideration of sentinel node biopsy in all patients with recurrent or second primary oral SCC who have previously had treatment to the neck; and finally, consideration of definitive management of the sentinel biopsy zone or region if the node is invaded.
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Affiliation(s)
- Montey Garg
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, RH19 3DZ.
| | - Ben Tudor-Green
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, RH19 3DZ.
| | - Brian Bisase
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, RH19 3DZ.
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De Silva RK, Siriwardena BSMS, Samaranayaka A, Abeyasinghe WAMUL, Tilakaratne WM. A model to predict nodal metastasis in patients with oral squamous cell carcinoma. PLoS One 2018; 13:e0201755. [PMID: 30091996 PMCID: PMC6084951 DOI: 10.1371/journal.pone.0201755] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022] Open
Abstract
Difficulty in precise decision making on necessity of surgery is a major problem when managing oral squamous cell carcinomas (OSCCs) with clinically negative neck. Therefore, use of clinical and histopathological parameters in combination would be important to improve patient management. The main objective is to develop a model that predicts the presence of nodal metastasis in patients with OSCC.623 patients faced neck dissections with buccal mucosal or tongue squamous cell carcinoma (SCC) were selected from patients’ records. Demographic data, clinical information, nodal status, Depth of invasion (DOI) and pattern of invasion (POI) were recorded. The parameters which showed a significant association with nodal metastasis were used to develop a multivariable predictive model (PM). Univariate logistic regression was used to estimate the strengths of those associations in terms of odds ratios (OR). This showed statistically significant associations between status of the nodal metastasis and each of the following 4 histopathological parameters individually: size of the tumour (T), site, POI, and DOI. Specifically, OR of nodal metastasis for tongue cancers relative to buccal mucosal cancers was 1.89, P-value < 0.001. Similarly, ORs for POI type 3 and 4 relative to type 2 were 1.99 and 5.83 respectively. A similar relationship was found with tumour size; ORs for T2, T3, and T4 compared to T1 were 2.79, 8.27 and 8.75 respectively. These four histopathological parameters were then used to develop a predictive model for nodal metastasis. This model showed that probability of nodal metastasis is higher among tongue cancers with increasing POI, with increasing T, and with larger depths while other characteristics remained unchanged. The proposed model provides a way of using combinations of histopathological parameters to identify patients with higher risks of nodal metastasis for surgical management.
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Affiliation(s)
- R. K. De Silva
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- * E-mail: (RKDeS); (WMT)
| | - B. S. M. S. Siriwardena
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - A. Samaranayaka
- Department of Preventive and Social Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand
| | - W. A. M. U. L. Abeyasinghe
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - W. M. Tilakaratne
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- * E-mail: (RKDeS); (WMT)
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Gad ZS, El-Malt OA, El-Sakkary MAT, Abdal Aziz MM. Elective Neck Dissection for Management of Early- Stage Oral Tongue Cancer. Asian Pac J Cancer Prev 2018; 19:1797-1803. [PMID: 30049190 PMCID: PMC6165647 DOI: 10.22034/apjcp.2018.19.7.1797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The occult neck metastasis rate is very high with tongue cancers. The aim of this study was to assess the current role of elective neck dissection (END) in management of early-stage oral tongue cancer with a focus on lymph node metastasis. In addition, effects of END on regional or systemic disease recurrence and survival were investigated. Methods This retrospective study included patients with stage I and II tongue cancer recruited from our National Cancer Institute (NCI) over a time period of six years (2007-2013). The collected data were analyzed for disease free survival (DFS) and recurrence rate. Results A total of 144 patients presented to our NCI with oral tongue cancer but only 88 were staged clinically and radiologically as early stage (stage I, stage II). Some 53% were smokers. Most lesions were dealt with by surgery, either by wide local excision (22%) or hemiglossectomy (78%). Treatment of neck lesions was either by neck dissection (85.2%) or “wait and see” (14.8%). The rates for local and nodal recurrence were 7.9% and 20.4%, respectively. Analysis of associations between DFS and different factors revealed significance for adoption of adjuvant therapy and the dissected lymph node status. Conclusion Controversy still exists regarding neck management.
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Affiliation(s)
- Zeiad S Gad
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt.
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Mair M, Nair D, Nair S, Malik A, Mishra A, Kannan S, Bobdey S, Singhvi H, Chaturvedi P. Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue. Head Neck 2018; 40:1667-1675. [PMID: 29734474 DOI: 10.1002/hed.25161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 09/13/2017] [Accepted: 02/05/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. METHODS This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. RESULTS Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metastasis as compared to tumor volume and T classification. CONCLUSION Concordance between the tumor thickness and volume proves that tumor thickness can be taken as a surrogate and reliable predictor of outcomes instead of calculating the tumor volume.
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Affiliation(s)
- Manish Mair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Akshat Malik
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Aseem Mishra
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Sadhana Kannan
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, India
| | - Hitesh Singhvi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
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Faisal M, Adeel M, Riaz S, Anwar A, Rashid A, Usman S, Jamshed A, Hussain R. The Submental Island Flap in Head and Neck Cancer. Ann Maxillofac Surg 2018; 8:287-291. [PMID: 30693247 PMCID: PMC6327798 DOI: 10.4103/ams.ams_225_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives The submental flap provides an alternative technique in orofacial reconstruction, especially in situations where free flap services are not available. The objective of this study is to demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction in a tertiary care cancer hospital. Materials and Methods A total of 27 patients with oral cavity cancers, which underwent submental flap reconstruction from 2015 to 2017 at Shaukat Khanum Cancer Memorial Hospital, were included in the study. We have retrospectively reviewed records of these patients. Results There were 25 male and 2 female patients with age ranging from 21 to 73 years. Most common primary tumor sites were buccal mucosa (13), tongue (7), and lower alveolus (7). All patients underwent ipsilateral selective neck dissection after flap was harvested. Complete flap loss was observed in three, whereas one patient had flap dehiscence that subsequently healed. Mean follow-up was 11 months. There were four regional recurrences but no local recurrence. On the last follow-up (minimum 6 months), 15 patients were alive without any disease, 4 were alive with disease, and 3 had died. Conclusion Submental flap is a satisfactory option for oral cavity reconstruction. However, preoperative selection of clinically neck node-negative patient is extremely important as it has potential risk of occult metastasis.
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Affiliation(s)
- Muhammad Faisal
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Mohammad Adeel
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Sheryar Riaz
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Abdullah Anwar
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Asma Rashid
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Sadaf Usman
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Arif Jamshed
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
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Sung KW, Kim SM, Myoung H, Kim MJ, Lee JH. The effectiveness of elective neck dissection on early (stage I, II) squamous cell carcinoma of the oral tongue. J Korean Assoc Oral Maxillofac Surg 2017; 43:147-151. [PMID: 28770154 PMCID: PMC5529187 DOI: 10.5125/jkaoms.2017.43.3.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/23/2016] [Accepted: 12/04/2016] [Indexed: 12/28/2022] Open
Abstract
Objectives The purpose of this study was to evaluate and compare the treatment outcomes of partial glossectomy with or without elective neck dissection in patients with tongue squamous cell carcinoma (SCCa). Materials and Methods A total of 98 patients who were diagnosed with tongue SCCa and underwent partial glossectomy between 2005 and 2014 were evaluated. Only 14 patients received elective neck dissection, and 84 patients received only partial glossectomy. Results There were 56 men and 42 women with a mean age of 57 years and mean follow-up period of 33.7 months. There were 70 patients graded as T1 and 28 as T2. The total occult metastasis rate was 17.3%. The 5-year overall survival rate was 83.3% with elective neck dissection and 92.4% with observation. The 5-year disease-free survival rate was in 70.7% in the elective neck dissection group and 65.3% in the observation group. Conclusion We retrospectively reviewed the records of 98 patients with tongue SCCa. These patients were divided into two groups, those who underwent elective neck dissection and those who did not. There was no statistically significant difference between the groups undergoing partial glossectomy with or without elective neck dissection.
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Affiliation(s)
- Ki-Woong Sung
- Oral Cancer Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soung Min Kim
- Oral Cancer Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hoon Myoung
- Oral Cancer Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Myung-Jin Kim
- Oral Cancer Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Oral Cancer Center, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
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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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Oncological Safety of Submental Artery Island Flap in Oral Reconstruction - Analysis of 229 Cases. Indian J Surg Oncol 2016; 7:420-424. [PMID: 27872529 DOI: 10.1007/s13193-016-0532-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 05/31/2016] [Indexed: 10/21/2022] Open
Abstract
Submental artery island flap (SMIF) is gaining popularity as a viable alternative to free flaps in carefully selected oral cavity defects after surgical extirpation of cancers.The current paper looks into the overall efficacy and oncological safety of the flap based on a prospective audit of 229 cases done at a high volume cancer center from october 2004 to september 2012 and concludes that SMIF is a oncologically safe,reliable reconstructive option in carefully selected oral cancers undergoing surgical resections.
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Dhawan I, Sandhu SV, Bhandari R, Sood N, Bhullar RK, Sethi N. Detection of cervical lymph node micrometastasis and isolated tumor cells in oral squamous cell carcinoma using immunohistochemistry and serial sectioning. J Oral Maxillofac Pathol 2016; 20:436-444. [PMID: 27721609 PMCID: PMC5051292 DOI: 10.4103/0973-029x.190946] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/16/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Oral squamous cell carcinoma (OSCC) comprises one of the largest subsets of cancers with a tendency for regional metastasis. Nodal status is a key prognostic indicator in patients with OSCC, particularly with N0 neck. Occult metastasis in the form of micrometastasis (MM) and isolated tumor cells (ITCs), often goes undetected by routine hematoxylin and eosin (H&E) examination using 1-2 sections for analysis. This limitation could be overcome by combining serial sectioning (SS) with immunohistochemistry (IHC) for the detection of MM and ITC. Pan-cytokeratin (pan-CK) (AE1/AE3) is particularly a useful marker to detect these deposits as their presence has resulted in varied interpretations and different applications of the tumor-node-metastasis system. OBJECTIVES The objective of the study was to identify a suitable method for detecting MM and ITC in lymph nodes (LNs) of OSCC by combining SS and IHC and to compare it with conventional H&E staining. MATERIALS AND METHODS This laboratory-based, prospective study was conducted on 133 LNs harnessed from ten patients treated with radical neck dissection for primary OSCC. The LNs were subjected to SS at 100 μm intervals. The sections were stained with routine H&E staining, pan-CK and analyzed for MM and ITC according to criteria laid by Hermanek et al. STATISTICAL ANALYSIS The obtained data were subjected to statistical analysis using Chi-square test. RESULTS The application of combination of SS and IHC using pan-CK (AE1/AE3) in our study revealed the presence of MM and ITC in 2.25% of the LNs diagnosed as negative on routine H&E examination. The detection of these occult metastatic deposits resulted in upstaging of 33.33% of the patients. CONCLUSION In the view of crucial role of occult LN metastasis in prognosis and survival of OSCC patients with N0 neck, diagnostic tools such as IHC staining, particularly with pan-CK (AE1/AE3), combined with SS should be preferred over conventional methods as they result in upstaging, thus sparing the low-risk patients the morbidity of unnecessary treatment.
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Affiliation(s)
- Isha Dhawan
- Department of Oral and Maxillofacial Pathology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Simarpreet V Sandhu
- Department of Oral and Maxillofacial Pathology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Rajat Bhandari
- Department of Oral and Maxillofacial Pathology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramanpreet Kaur Bhullar
- Department of Oral and Maxillofacial Pathology, Desh Bhagat Dental College and Hospital, Muktsar, Punjab, India
| | - Neerja Sethi
- Department of Oral and Maxillofacial Pathology, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India
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Patel TD, Vázquez A, Marchiano E, Sanghvi S, Eloy JA, Baredes S, Park RCW. Efficacy of Elective Neck Dissection in T1/T2N0M0 Oral Tongue Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2016; 155:588-97. [DOI: 10.1177/0194599816643695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/18/2016] [Indexed: 11/17/2022]
Abstract
Objective/Hypothesis The aim of this population-based study is to analyze the survival benefits of elective neck dissection (END) over neck observation in T1/T2N0M0 oral tongue squamous cell carcinoma (OT-SCC) cases. Study Design Retrospective administrative database analysis. Subjects and Methods The SEER database (Surveillance, Epidemiology, and End Results) was queried for patients diagnosed with T1/T2N0M0 OT-SCC from 1998 to 2011. Data included patient demographics, initial treatment, and survival outcomes. The Kaplan-Meier model and the Cox proportional hazards model were utilized for survival analysis. Results Out of 7010 T1/T2N0M0 cases, END was performed in 1770 T1 and 950 T2 cases, and the neck was observed in 3278 T1 and 1001 T2 cases. Significantly poorer 5-year disease-specific survival (DSS) rates were noted for the neck observation group when compared with the END group for tumors with moderately differentiated (72.1% vs 86%, P < .0001) and poorly differentiated or undifferentiated (55.6% vs 71.5%, P = .0001) histologic grades. No significant survival benefit was seen between the END group and the neck observation group when tumor size was <1 cm, regardless of histology grade. However, those with tumors >1 cm had a significantly better 5-year DSS with END, except for the well-differentiated tumor cohort, which showed improved survival only when the tumors were >2 cm (5-year DSS: END vs neck observation, 83.5% vs 65.7%, P = .0002). Conclusion END improves DSS versus neck observation in T1/T2N0M0 OT-SCC patients with moderately differentiated, poorly differentiated, or undifferentiated histologic grade tumors >1 cm. Those with well-differentiated tumors benefited from END only when tumor size was >2 cm.
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Affiliation(s)
- Tapan D. Patel
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alejandro Vázquez
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Emily Marchiano
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Saurin Sanghvi
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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19
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Low THH, Gao K, Gupta R, Clifford A, Elliott M, Ch'ng S, Milross C, Clark JR. Factors predicting poor outcomes in T1N0 oral squamous cell carcinoma: indicators for treatment intensification. ANZ J Surg 2016; 86:366-71. [DOI: 10.1111/ans.13504] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 11/16/2015] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
- Department of Otolaryngology Head and Neck; Victoria Hospital; London Ontario Canada
| | - Kan Gao
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Anthony Clifford
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
- Institute of Academic Surgery at Royal Prince Alfred Hospital; The University of Sydney; Sydney New South Wales Australia
| | - Chris Milross
- Department of Radiation Oncology; Chris O'Brien Lifehouse; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Sydney Head and Neck Cancer Institute; Chris O'Brien Lifehouse; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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20
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Rani P, Bhardwaj Y, Dass PK, Gupta M, Malhotra D, Ghezta NK. Neck dissection for oral squamous cell carcinoma: our experience and a review of the literature. J Korean Assoc Oral Maxillofac Surg 2015; 41:299-305. [PMID: 26734556 PMCID: PMC4699930 DOI: 10.5125/jkaoms.2015.41.6.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives This article describes our experience with neck dissection in 10 patients with oral squamous cell carcinoma. Materials and Methods Between January 2007 and October 2009, 10 patients underwent primary surgery for the treatment of squamous cell carcinoma of the oral cavity. For patients with N0 disease on clinical exam, selective neck dissection (SND [I-III]) was performed. In patients with palpable cervical metastases (N+), modified radical neck dissections were performed, except in one patient in whom SND (I-III) was performed. The histopathologic reports were reviewed to assess the surgical margins, the presence of extra-capsular spread, perineural invasion, and lymphatic invasion. Results On histopathologic examination, positive soft tissue margins were found in three patients, and regional lymph node metastases were present in five of the ten patients. Perineural invasion was noted in five patients, and extra nodal spread was found in four patients. Regional recurrence was seen in two patients and loco-regional recurrence plus distant metastasis to the tibia was observed in one patient. During the study period, three patients died. Seven patients remain free of disease to date. Conclusion Histopathological evaluation provides important and reliable information for disease staging, treatment planning, and prognosis. The philosophy of neck dissection is evolving rapidly with regard to the selectivity with which at-risk lymph node groups are removed. The sample size in the present study is small, thus, caution should be employed when interpreting these results.
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Affiliation(s)
- Pooja Rani
- Department of Oral and Maxillofacial Surgery, Himachal Dental College and Hospital, Sunder Nagar, India
| | - Yogesh Bhardwaj
- Department of Oral and Maxillofacial Surgery, HP Govt. Dental College and Hospital, Shimla, India
| | - Praveen Kumar Dass
- Department of Anatomy, Lady Hardinge Medical College and Hospital, New Delhi, India
| | - Manoj Gupta
- Department of Radiotherapy, Regional Cancer Centre, Shimla, India
| | - Divye Malhotra
- Department of Oral and Maxillofacial Surgery, Himachal Dental College and Hospital, Sunder Nagar, India
| | - Narottam Kumar Ghezta
- Department of Oral and Maxillofacial Surgery, HP Govt. Dental College and Hospital, Shimla, India
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Habib M, Murgasen J, Gao K, Ashford B, Shannon K, Ebrahimi A, Clark JR. Contralateral neck failure in lateralized oral squamous cell carcinoma. ANZ J Surg 2015; 86:188-92. [PMID: 26138827 DOI: 10.1111/ans.13206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elective treatment of the contralateral clinically node-negative (cN0) neck is not routinely recommended for lateralized oral cavity squamous cell carcinoma (SCC). We sought to determine the failure rate in the untreated contralateral neck in patients with lateralized oral SCC undergoing treatment of the primary and ipsilateral neck and to identify any features placing patients at sufficient risk of contralateral regional failure to justify elective treatment. METHODS We identified 688 patients with oral SCC undergoing curative surgery ± adjuvant therapy between 1985 and 2012 from a prospectively collected database. Patients with midline primaries and those undergoing bilateral neck treatment were excluded. The primary endpoint was isolated contralateral neck failure. RESULTS Of 481 patients, 14 (2.9%) developed isolated contralateral neck recurrence, with median time to recurrence of 8 months. Patients with poorly differentiated tumours or pathologically proven ipsilateral nodal metastases were at significantly higher risk of contralateral failure (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.1-11.9, P = 0.037 and HR 4.6, 95% CI 1.5-13.8, P = 0.006 respectively). Presence of both of these factors conferred a 10% risk of contralateral failure. CONCLUSION Patients with lateralized oral SCC undergoing treatment of the primary tumour and ipsilateral neck have a low rate of isolated contralateral neck failure. Although poorly differentiated primaries and ipsilateral nodal metastases were predictors of contralateral recurrence, the risk remains relatively modest in this subset of patients suggesting close observation may be more appropriate than elective treatment. Our results support current recommendations for observation of the cN0 contralateral neck in lateralized oral SCC.
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Affiliation(s)
- Miriam Habib
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jothi Murgasen
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Bruce Ashford
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Kerwin Shannon
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ardalan Ebrahimi
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.,Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Abstract
Although there is ample literature reporting on the identification of molecular biomarkers for head and neck squamous cell carcinoma, none is currently recommended for routine clinical use. A major reason for this lack of progress is the difficulty in designing studies in head and neck cancer to clearly establish the clinical utility of biomarkers. Consequently, biomarker studies frequently stall at the initial discovery phase. In this article, we focus on biomarkers for use in clinical management, including selection of therapy. Using several contemporary examples, we identify some of the common deficiencies in study design that hinder success in biomarker development for this disease area, and we suggest some potential solutions. The purpose of this article is to provide guidance that can assist investigators to more efficiently move promising biomarkers in head and neck cancer from discovery to clinical practice
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Dabirmoghaddam P, Sharifkashany S, Mashali L. Ultrasound-guided fine needle aspiration cytology in the assessment of cervical metastasis in patients undergoing elective neck dissection. IRANIAN JOURNAL OF RADIOLOGY 2014; 11:e7928. [PMID: 25763085 PMCID: PMC4341177 DOI: 10.5812/iranjradiol.7928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 08/11/2013] [Accepted: 09/10/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients' survival. OBJECTIVES To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis. PATIENTS AND METHODS Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique. RESULTS Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests. CONCLUSIONS In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection.
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Affiliation(s)
- Payman Dabirmoghaddam
- Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Payman Dabirmoghaddam, Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, North Saadi Ave., P.O. Box: 1145765111, Tehran, Iran. Tel: +98-2166703037, Fax: +98-2166760245, E-mail:
| | - Shervin Sharifkashany
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Mashali
- Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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24
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Carlson ER, Miller I. Surgical management of the neck in oral cancer. Oral Maxillofac Surg Clin North Am 2012; 18:533-46. [PMID: 18088851 DOI: 10.1016/j.coms.2006.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, University of Tennessee Cancer Institute, 1930 Alcoa Highway, Suite 335, Knoxville, TN 37920, USA
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25
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Are We Over-treating Neck in Buccal & Alveolo-buccal Cancers: Experience from a Tertiary Cancer Care Center. Indian J Surg Oncol 2012; 3:272-5. [PMID: 24293960 DOI: 10.1007/s13193-012-0173-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 07/09/2012] [Indexed: 10/28/2022] Open
Abstract
Oral cancer is one of the most common types of cancer seen in India with buccal and alveolo buccal regions being the most frequent subsites. A retrospective analysis of buccal and alveolo buccal cancer patients undergoing neck dissection from 1995 to 2009 was performed to analyze the profile of neck dissections and patterns of nodal involvement in these patients. Total 310 neck dissections were done for buccal and alveolo-buccal cancer including 41 (13.2 %) RND, 231(74.5 %) MND and 38 (12.2 %) Supraomohyoid neck dissection (SOHND). Clinically palpable nodes were present in 75.9 % patients but only 117 (38 %) were pathologically node positive. 20 % had occult positive nodes in N0 group. Level I was most commonly involved with 35 % having positive nodes in more than one level. There were no patients with isolated involvement of level IV or V with only 3.9 % patients with involvement of level III. Current guidelines recommend neck dissection in all clinically node positive patients. However, our experience shows that neck is over treated in majority of patients and there is a need to optimize surgical management of neck in these patients.
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Wang W, Han S, Yao Z, Li X, Huang P, Zhang M, Chen Y, He J. A study of epidemiologic and recurrence factors of oral cancer. J Oral Maxillofac Surg 2011; 70:2205-10. [PMID: 22209101 DOI: 10.1016/j.joms.2011.09.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/21/2011] [Accepted: 09/24/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the epidemiologic characteristics and recurrence factors of oral squamous cell carcinoma (OSCC) in northwest China. PATIENTS AND METHODS Patients with OSCC whose first visits to the Stomatology Hospital of the Fourth Military Medical University from January 2007 through December 2008 were investigated. The epidemiologic risk factors and recurrence of OSCC were studied with logistic regression and a Cox regression model. RESULTS The mean age of all 414 patients with OSCC was 58.16 ± 9.92 years; 67.15% were men, 43.24% were cigarette smokers, and 26.09% came from rural areas. In addition, 49.03% of these patients were diagnosed at an early stage. One hundred forty-seven patients developed recurrence of the disease, and the median progression-free survival was 7.3 months (range, 1.1 to 32.5 mo). The recurrence rate was approximately 35.5%. CONCLUSION The study indicated that smoking habit, older age, and living in rural areas were the high-risk epidemiologic factors for OSCC. Smoking habit and late clinical stage were the high-risk factors for the recurrence of OSCC.
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Affiliation(s)
- Wei Wang
- Administration of Clinical Research and Teaching, School of Stomatology, Fourth Military Medical University, Xi'an, China
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Ebrahimi A, Clark JR, Zhang WJ, Elliott MS, Gao K, Milross CG, Shannon KF. Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma. Head Neck 2010; 33:1245-51. [PMID: 20967874 DOI: 10.1002/hed.21600] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 07/11/2010] [Accepted: 07/29/2010] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We aimed to validate the lymph node ratio (LNR) as an independent prognostic factor in oral squamous cell carcinoma (OSCC) and compare its utility with the current nodal staging system. METHODS We conducted a retrospective analysis of 313 patients with OSCC undergoing neck dissection. The LNR was adjusted by relevant covariates in a multivariable Cox regression model. RESULTS LNR displaced conventional nodal staging and was shown to be an independent predictor of regional failure (p = .020), disease-specific (p = .003) and overall survival (p = .001). Patients with an LNR of 2.5% to 7.5%, 7.5% to 20%, and >20% had 2.6, 3.7, and 4.4 times the risk of death from OSCC, respectively, when compared with patients with an LNR <2.5%. CONCLUSIONS The LNR is an independent prognostic factor in OSCC and may be used in conjunction with the current TNM staging to enable better risk stratification and selection for adjuvant therapy.
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Affiliation(s)
- Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute and The Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia.
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Sklenicka S, Gardiner S, Dierks EJ, Potter BE, Bell RB. Survival Analysis and Risk Factors for Recurrence in Oral Squamous Cell Carcinoma: Does Surgical Salvage Affect Outcome? J Oral Maxillofac Surg 2010; 68:1270-5. [DOI: 10.1016/j.joms.2009.11.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 11/18/2009] [Accepted: 11/18/2009] [Indexed: 10/19/2022]
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Kademani D, Bell RB, Schmidt BL, Blanchaert R, Fernandes R, Lambert P, Tucker WM. Oral and maxillofacial surgeons treating oral cancer: a preliminary report from the American Association of Oral and Maxillofacial Surgeons Task Force on Oral Cancer. J Oral Maxillofac Surg 2008; 66:2151-7. [PMID: 18848117 DOI: 10.1016/j.joms.2008.06.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 02/29/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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Misra S, Chaturvedi A, Misra NC. Management of gingivobuccal complex cancer. Ann R Coll Surg Engl 2008; 90:546-53. [PMID: 18701010 DOI: 10.1308/003588408x301136] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Squamous cell carcinoma of the oral cavity ranks as the 12th most common cancer in the world and the 8th most frequent in males. It accounts for up to one-third of all tobacco-related cancers in India. Cancer of the gingivobuccal complex is especially common in Indians due to their tobacco habits. This review focuses on the management of lower gingivobuccal complex cancers. PATIENTS AND METHODS References for this review were identified by search of Medline and other bibliographic information available in the PubMed database. The search terms carcinoma oral cavity, and cancer oral cavity, buccal mucosa, gingiva, gingivobuccal complex, and alveolus cancer/carcinoma were used. References from relevant articles and abstracts from international conferences were also included. Only articles published in the English language were used. RESULTS Treatment of gingivobuccal complex cancer is primarily surgical. Radical neck dissection, or its modification, is the standard treatment for the node-positive neck. Supraomohyoid neck dissection is the accepted treatment for the node-negative neck. Radiotherapy is usually not the preferred modality of treatment for early gingivobuccal complex cancer. It is used either as postoperative adjuvant treatment or as definitive treatment for advanced cancer with or without chemotherapy. Chemotherapy has been used as neo-adjuvant, adjuvant or palliative treatment. Advanced cancers are common and continue to pose a challenge to the multidisciplinary team. CONCLUSIONS Gingivobuccal complex cancer remains a major public health problem despite being highly preventable and easily detectable. Advanced cancers constitute a major proportion of patients presenting for treatment. These patients are difficult to treat and have a poor outcome.
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Affiliation(s)
- Sanjeev Misra
- Department of Surgical Oncology, King George's Medical University, Lucknow, India.
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Abstract
The oral cavity is anterioly located and unique in the variety of tissues contained in this area. Although oral cancer screening may be done on clinical examination, imaging plays a critical role in staging and determination of deep margins for either tumor resectability or radiation planning. This article discusses the relevant anatomy on magnetic resonance imaging (MRI), including the lips and gingiva, floor of mouth, and oral tongue. This is followed by a discussion of standard MRI techniques, American Joint Committee on Cancer (AJCC) classification, and relevant MRI findings with discussion and imaging examples of carcinoma in major sites, including floor of mouth, oral tongue, buccal mucosa, bony upper alveolus, hard palate, and retromolar trigone. A brief summary of newer imaging techniques for evaluation of oral cancer is also presented.
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Affiliation(s)
- Claudia Kirsch
- Neuroradiology and Head and Neck Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1721, USA.
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Abstract
Oral cavity cancers represent an area of head and neck oncology with some unique and interesting management themes. In spite of a significant paradigm shift in the treatment of many head and neck cancers toward us-ing primary chemoradiation, this treatment is not frequently applied to the oral cavity. Small cancers of the oral cavity are usually managed by surgery alone. Larger cancers are usually treated with primary surgery followed by chemoradiation. Neck treatment is offered to patients who have a greater than 20% chance of having lymph node metastasis or who have neck disease at the time of presentation. Neck treatment may involve surgery, radiation therapy, or both. Reconstruction of surgical defects of the oral cavity runs the gamut of techniques from the most simple to the most complex three-dimensional microvascular composite flaps. A multidisciplinary setting with a tumor board and multiple supportive services provides the best care for patients who have advanced-stage cancers.
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Affiliation(s)
- John P Campana
- Department of Otolaryngology, B-205, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, CO 80262, USA.
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Carlson ER, Cheung A, Smith B, Pfohl C. Neck Dissections for Oral/Head and Neck Cancer: 1906–2006. J Oral Maxillofac Surg 2006; 64:4-11. [PMID: 16360851 DOI: 10.1016/j.joms.2005.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Cancer Institute, Knoxville, TN, USA.
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