Upper aerodigestive tract cancer: summary of the National Institute for Health and Care Excellence guidelines for England and Wales

Survival Outcomes and Patterns of Failure in Maxillary Alveolus Squamous Cell Carcinoma

Introduction  Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives  To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods  We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results  More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion  Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.

Squamous Cell Carcinoma of the Oral Cavity, Oropharynx, and Larynx: A Scoping Review of Treatment Guidelines Worldwide

Head and neck cancer (HNC) treatments have been based on single or multimodal therapies with surgery, radiotherapy (RT), chemotherapy, and immunotherapy. However, treatment recommendations among countries may differ due to technological/human resources and usual local practices. This scoping review aims to identify, compare, and map the clinical practice guidelines (CPGs) for treating squamous cell carcinoma (SCC) of the oral cavity, oropharynx, and larynx worldwide. A search strategy on global CPGs for HNC was performed by using five electronic databases and grey literature. CPGs were selected for inclusion using EndNote-20 and Rayyan online software. No language or publication date restrictions were applied. The results were analyzed descriptively considering the most updated CPG version. In total, 25 CPGs covering the head and neck region (10), the larynx (7), the oral cavity (5), and the oropharynx (3), were found in 13 geographical regions, and 19 were developed by medical societies from 1996 to 2023. Surgery and RT remain the main modalities for early-stage HNC, with surgery preferred in low-resource countries, and RT in selected cases, especially in the larynx/oropharynx aiming to achieve a cure with organ preservation. Human papillomavirus infection for oropharyngeal SCC is not tested in some Asian countries and there is still no consensus to treat p16-positive cases differently from p16-negative. Recommendations for larynx preservation vary according to facilities in each country, however, individualized choice is emphasized. Inequality across countries/continents is evident, with a similar pattern of recommendations among developed as well as developing ones. No CPGs were found in Latin America as well as Oceania countries, where the incidence of HNC is high and limitations of access to treatment may be encountered.

Clinical course and survival in patients with squamous cell carcinoma of the maxillary alveolus and hard palate: Results from a single-center prospective cohort

OBJECTIVES

Operative management of squamous cell carcinoma of the maxillary alveolus and hard palate (MHSCC) is still a controversial issue, especially for cN0 cases. We report the survival outcomes in patients with MHSCC, including the rate of cervical occult metastasis for UICC stages I/II and survival after elective neck dissection (END).

METHODS

77 patients with primary MHSCC were followed-up from 2 months to 14.6 years within a prospectively obtained patient cohort. Factors influencing overall survival (OS), oral cancer-specific survival (OCSS) and disease-free survival (DFS) were assessed. We estimated survival probabilities using Kaplan-Meier survival analysis by histology and stage. We used Cox's proportional hazard regression model to estimate adjusted hazard ratios for OS, OCSS and DFS.

RESULTS

Initially, 22 patients presented with stage I, 13 with stage 2, 11 patients with stage 3 and 31 with stage 4 tumors. The presence of nodal disease rose with increased tumor size. 66.2% were treated with surgery only, 26.0% received adjuvant radiotherapy, and 7.8% received primary radiotherapy. Median overall survival was 10.9 years, and survival probabilities at 2, 5 and 10 years were 68.2%, 61.1% and 61.1%, respectively. Five-year overall survival was 72.4% in the END group and 88.9% in the non-END group. Factors influencing OS, OCSS and DFS were tumor size, the presence of metastatic disease and positive resection margins.

CONCLUSIONS

MHSCC seems to show a better overall survival compared to OSCC of other locations and is less likely to develop regional and distant metastasis; END might not be necessary in early stage tumors.