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Hintze JM, O'Riordan I, Jones H, McHugh A, Gendre A, Timon C, Kinsella J, Lennon P, Walsh RM, Shine N, O'Neill JP. Pattern of nodal metastasis of cutaneous squamous cell carcinoma involving the temporal bone. Laryngoscope Investig Otolaryngol 2022; 8:120-124. [PMID: 36846411 PMCID: PMC9948558 DOI: 10.1002/lio2.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/31/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The objective of this study was to explore the pattern of lymph-node spread of SCCs involving the temporal bone. Methods We retrospectively reviewed all cutaneous SCCs involving the temporal bone over a 20-year time-period. Forty-one patients were eligible. Results Mean age was 72.8 years. The diagnosis was cutaneous SCC in all cases.All patients underwent a temporal bone resection, 70.7% had a neck-dissection and 78.0% a parotidectomy.Level 2 was the most common area of neck metastasis, and occurred in 12.2%. The parotid had disease in 34.1%. 51.2% of patients underwent free-flap reconstruction.Mean overall survival of the cohort was 4.2 years. Conclusions Overall, the rate of cervical nodal metastasis was 22.0% and 13.5% in the occult setting. The parotid was involved in 34.1% and 10.0% in the occult setting. Results from the present study support consideration for performing a parotidectomy at the time of temporal bone resection, while a neck dissection can be performed for adequate staging of the nodal basin. Level of Evidence 3.
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Affiliation(s)
- Justin M. Hintze
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland,Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Isobel O'Riordan
- Royal College of Surgeons in IrelandDublinIreland,Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Holly Jones
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Alison McHugh
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Adrien Gendre
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Conrad Timon
- Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - John Kinsella
- Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Paul Lennon
- Department of Otolaryngology—Head and Neck SurgerySt. James HospitalDublinIreland
| | - Rory McConn Walsh
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - Neville Shine
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
| | - James P. O'Neill
- Department of Otolaryngology—Head and Neck SurgeryBeaumont HospitalDublinIreland,Royal College of Surgeons in IrelandDublinIreland
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2
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Ferini G, Palmisciano P, Forte S, Viola A, Martorana E, Parisi S, Valenti V, Fichera C, Umana GE, Pergolizzi S. Advanced or Metastatic Cutaneous Squamous Cell Carcinoma: The Current and Future Role of Radiation Therapy in the Era of Immunotherapy. Cancers (Basel) 2022; 14:1871. [PMID: 35454779 PMCID: PMC9032290 DOI: 10.3390/cancers14081871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
Radiation therapy (RT) is an effective therapeutic option for small localized cutaneous squamous cell carcinoma (cSCC) among patients who are not eligible for or refuse surgery. RT also has a defined role as an adjuvant treatment in cases of adverse features that predispose to tumor recurrence after local excision. Since the development of cSCC is often a late consequence of chronic sun exposure, its occurrence is more common among elderly patients whose comorbidities may contraindicate surgical procedures. These could be impeded not only by frail medical conditions but also by technical issues. Indeed, an aggressive locoregional behavior of cSCC may culminate in unresectability due to widespread invasion of neighboring tissues. Moreover, cSCC could develop distant metastases. Both locally advanced and metastatic cSCCs carry a poor prognosis. In these scenarios, recent discoveries of tumor molecular targets are promoting the use of promising systemic therapies, especially immunotherapy, over RT. However, the results from using immunotherapy and, even more so, of chemotherapy are still not optimal. By contrast, advances in radiation delivery equipment can safely treat even large and complex-shaped cSCC targets in challenging body sites. In addition, RT could also have a role in metastatic cSCC settings by enhancing the effectiveness of concomitant immunotherapy. The aim of this review is to summarize and comment on the body of literature about the use of radiotherapy for operable and inoperable locally advanced cSCCs and for metastatic ones in an attempt to define its current and future role.
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Affiliation(s)
- Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy;
| | | | - Stefano Forte
- IOM Ricerca srl, Via Penninazzo 11, 95029 Viagrande, Italy; (S.F.); (E.M.)
| | - Anna Viola
- Fondazione Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy;
| | - Emanuele Martorana
- IOM Ricerca srl, Via Penninazzo 11, 95029 Viagrande, Italy; (S.F.); (E.M.)
| | - Silvana Parisi
- Radiation Oncology Unit—Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98100 Messina, Italy; (S.P.); (S.P.)
| | - Vito Valenti
- Department of Radiation Oncology, REM Radioterapia srl, Via Penninazzo 11, 95029 Viagrande, Italy;
| | - Corrado Fichera
- Department of Plastic Surgery, Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy;
| | - Giuseppe Emmanuele Umana
- Trauma and Gamma-Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Stefano Pergolizzi
- Radiation Oncology Unit—Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, 98100 Messina, Italy; (S.P.); (S.P.)
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Indications and limits of postoperative radiotherapy for skin malignancies. Curr Opin Otolaryngol Head Neck Surg 2021; 29:100-106. [PMID: 33664195 DOI: 10.1097/moo.0000000000000696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide a summary of the current evidence, with a focus on recent publications, pertaining to indications for postoperative radiation therapy for cutaneous squamous-cell carcinoma (cSCC), basal-cell carcinoma, Merkel-cell carcinoma and melanoma of the head and neck. RECENT FINDINGS Meta-analyses in cSCC and Merkel-cell carcinoma have shown an association between postoperative radiation therapy and overall survival. Prospective phase III data in head and neck cSCC has shown excellent locoregional control following surgery and postoperative radiation therapy. The addition of concurrent cytotoxic chemotherapy to postoperative radiation therapy has not improved outcomes in either of these two entities. Postoperative immune checkpoint inhibition or combined BRAF and MEK blockade in stage-III melanoma improves progression-free survival whereas postoperative radiation therapy does not. SUMMARY Further improvement in outcomes with high-risk cSCC and Merkel-cell carcinoma might be achieved with concurrent or sequential immune checkpoint inhibition and postoperative radiation therapy. Postoperative radiation therapy for cutaneous melanoma should be reserved for patients in whom novel systemic therapies are not a treatment option.
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Flukes S, Long S, Lohia S, Barker CA, Dunn LA, Cracchiolo J, Ganly I, Patel S, Cohen MA. Metastatic Cutaneous Squamous Cell Carcinoma Involving the Parotid Gland: Experience Outside of the Sun Belt. OTO Open 2021; 5:2473974X20984720. [PMID: 33474523 PMCID: PMC7797591 DOI: 10.1177/2473974x20984720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To characterize a subset of patients with metastatic head and neck cutaneous squamous cell carcinoma in a tertiary North American center and describe oncologic outcomes following definitive treatment. STUDY DESIGN Retrospective chart review. SETTING National Cancer Institute-designated Comprehensive Cancer Center. METHODS We conducted a retrospective chart review of patients with cutaneous squamous cell carcinoma with metastases to intraparotid lymph nodes who underwent parotidectomy between 1993 and 2020. Baseline patient and tumor characteristics were assessed. Regional control, disease-specific survival, and overall survival were estimated using Kaplan-Meier method. Multivariate analysis was used to determine the relationship between adverse pathological features and survival. RESULTS A total of 122 patients were included. The median age was 76, 84.4% of patients were male, and 17.2% were immunosuppressed. Regional control, disease-specific survival, and overall survival were 68.5%, 70.7%, and 59.4% at 5 years, respectively. Perineural and lymphovascular invasion were predictive of worse disease-specific survival. Extracapsular spread was observed in 90.2% of patients and was not a significant predictor of outcome. CONCLUSIONS We found the demographics and oncologic outcomes of our cohort in the Northeast United States to be comparable with those previously reported in Australia and the Sun Belt of the United States. We noted a high rate of extracapsular spread but did not find it to be a significant predictor of recurrence or survival. Future efforts should address the impact of extracapsular spread on prognosis and adjuvant treatment decisions.
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Affiliation(s)
- Stephanie Flukes
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sallie Long
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Otolaryngology–Head and Neck Surgery, New York-Presbyterian Hospital Weill Cornell Medicine, New York, New York, USA
| | - Shivangi Lohia
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christopher A. Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lara A. Dunn
- Head and Neck Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A. Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Porceddu SV, Daniels C, Yom SS, Liu H, Waldron J, Gregoire V, Moore A, Veness M, Yao M, Johansen J, Mehanna H, Rischin D, Le QT. Head and Neck Cancer International Group (HNCIG) Consensus Guidelines for the Delivery of Postoperative Radiation Therapy in Complex Cutaneous Squamous Cell Carcinoma of the Head and Neck (cSCCHN). Int J Radiat Oncol Biol Phys 2020; 107:641-651. [PMID: 32289475 DOI: 10.1016/j.ijrobp.2020.03.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 11/17/2022]
Abstract
Radiation therapy (RT) consensus contouring guidelines in the postoperative setting for complex cutaneous squamous cell carcinoma of the head and neck have been developed by expert clinicians in the field of head and neck and dermato-oncology and members of the Head and Neck Cancer International Group to assist radiation oncologists involved in the management of this disease. These guidelines present a set of principles used to define postoperative RT volumes and corresponding minimum doses after resection of all macroscopic tumor with or without microscopic residual disease. It is anticipated they will promote the harmonization of postoperative RT globally and contribute to a reduction in treatment variation among clinicians, allowing for RT quality and outcomes assessment across institutions.
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Affiliation(s)
- Sandro V Porceddu
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Queensland, Australia.
| | | | - Sue S Yom
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Howard Liu
- Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Queensland, Australia
| | - John Waldron
- Princess Margaret Cancer Centre, Toronto, Canada; University of Toronto, Toronto, Canada
| | | | - Alisha Moore
- Trans Tasman Radiation Oncology Group, Newcastle, Australia; University of Newcastle, Newcastle, Australia
| | - Michael Veness
- Westmead Hospital, Westmead, Australia; University of Sydney, Sydney, Australia
| | - Min Yao
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | - Danny Rischin
- Peter MacCallum Cancer Center, Melbourne, Australia; University of Melbourne, Melbourne, Australia
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Likhacheva A, Awan M, Barker CA, Bhatnagar A, Bradfield L, Brady MS, Buzurovic I, Geiger JL, Parvathaneni U, Zaky S, Devlin PM. Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin: Executive Summary of an American Society for Radiation Oncology Clinical Practice Guideline. Pract Radiat Oncol 2019; 10:8-20. [PMID: 31831330 DOI: 10.1016/j.prro.2019.10.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE This guideline reviews the evidence for the use of definitive and postoperative radiation therapy (RT) in patients with basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). METHODS The American Society for Radiation Oncology convened a task force to address 5 key questions focused on indications for RT in the definitive and postoperative setting for BCC and cSCC, as well as dose-fractionation schemes, target volumes, basic aspects of treatment planning, choice of radiation modality, and the role of systemic therapy in combination with radiation. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS The guideline recommends definitive RT as primary treatment for patients with BCC and cSCC who are not surgical candidates while conditionally recommending RT with an emphasis on shared decision-making in those situations in which adequate resection can lead to a less than satisfactory cosmetic or functional outcome. In the postoperative setting, a number of indications for RT after an adequate resection are provided while distinguishing the strength of the recommendations between BCC and cSCC. One key question is dedicated to defining indications for regional nodal irradiation. The task force suggests a range of appropriate dose-fractionation schemes for treatment of primary and nodal volumes in definitive and postoperative scenarios. The guideline also recommends against the use of carboplatin concurrently with adjuvant RT and conditionally recommends the use of systemic therapies for unresectable primaries where treatment may need escalation. CONCLUSIONS Defining the role of RT in the management of BCC and cSCC has been hindered by a lack of high-quality evidence. This document synthesizes available evidence to define practice guidelines for the most common clinical situations. We encourage practitioners to enroll patients in prospective trials and to approach care in a multidisciplinary fashion whenever possible.
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Affiliation(s)
- Anna Likhacheva
- Department of Radiation Oncology, Sutter Medical Center, Sacramento, California.
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ajay Bhatnagar
- Department of Radiation Oncology, Alliance Oncology, Casa Grande, Arizona
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Mary Sue Brady
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ivan Buzurovic
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | | | - Sandra Zaky
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Phillip M Devlin
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
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7
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Rotman A, Kerr SJ, Giddings CEB. Elective neck dissection in metastatic cutaneous squamous cell carcinoma to the parotid gland: A systematic review and meta‐analysis. Head Neck 2018; 41:1131-1139. [DOI: 10.1002/hed.25561] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/15/2018] [Accepted: 11/15/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Anthony Rotman
- Department of Otolaryngology, Head & Neck SurgeryMonash Health Melbourne Australia
| | - Stephen J Kerr
- The Kirby Institute, The University of New South Wales Sydney New South Wales Australia
| | - Charles E B Giddings
- Department of Otolaryngology, Head & Neck SurgeryMonash Health Melbourne Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health SciencesMonash University Clayton Victoria Australia
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8
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Role of neck dissection in metastatic squamous cell carcinoma to the parotid gland. The Journal of Laryngology & Otology 2017; 130 Suppl 4:S54-9. [PMID: 27488339 DOI: 10.1017/s0022215116008343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the rate of occult neck disease in patients with metastatic squamous cell carcinoma to the parotid gland following parotidectomy and neck dissection. METHODS A consecutive series of patients treated between 2000 and 2014 for metastatic squamous cell carcinoma to the parotid were analysed. Patients were included if they had no clinical or radiological evidence of neck disease. Pathology of parotidectomy and neck dissection specimens was reviewed. Other variables analysed included patient immune status, surgery type, complications, use of positron emission tomography scanning and treatment with radiotherapy. RESULTS Sixty-five patients had no clinical or radiological evidence of neck disease initially. Forty-six patients (70.8 per cent) underwent neck dissection. Occult neck disease was only found in 8 of the 46 patients (17.3 per cent). Occult neck disease was found more often in those with immunocompromise (5.7 vs 38.5 per cent, p = 0.003). Patients who were immunocompromised had a significantly worse disease-specific survival rate at five years (0 vs 92 per cent, p = 0.0001). CONCLUSION Occult neck disease was seen in 17.3 per cent of patients and immunosuppression was a significant predictor for this.
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Skulsky SL, O'Sullivan B, McArdle O, Leader M, Roche M, Conlon PJ, O'Neill JP. Review of high‐risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology. Head Neck 2016; 39:578-594. [DOI: 10.1002/hed.24580] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/13/2016] [Accepted: 08/02/2016] [Indexed: 01/23/2023] Open
Affiliation(s)
| | - Barry O'Sullivan
- Department of Plastic and Reconstructive SurgeryBeaumont HospitalDublin Ireland
| | - Orla McArdle
- St. Luke's Radiation Oncology Network, Beaumont HospitalDublin Ireland
| | - Mary Leader
- Department of PathologyRoyal College of Surgeons in IrelandDublin Ireland
| | - Muireann Roche
- Department of DermatologyBeaumont Hospital and Royal College of Surgeons in IrelandDublin Ireland
| | - Peter J. Conlon
- Department of Nephrology and Renal TransplantationBeaumont Hospital and Royal College of Surgeons in IrelandDublin Ireland
| | - James Paul O'Neill
- Department of Neurosciences, Otolaryngology and Cochlear ImplantRoyal College of Surgeons in Ireland, Beaumont HospitalDublin Ireland
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10
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Stathopoulos P, Igoumenakis D, Shuttleworth J, Frawley T, Ennis C, Battista E, Ameerally P. Head and neck nonmelanoma cutaneous malignancy treatment in a skin cancer referral center. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:183-187. [PMID: 27989709 DOI: 10.1016/j.oooo.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/31/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the level of accuracy provided by clinical diagnosis in head and neck cutaneous malignancy as confirmed by histopathologic examination of the specimen in a skin cancer referral center. Positive predictive value was selected as a reliable measure of diagnostic accuracy. We also aimed to audit our surgical outcomes and record and present the completeness of excision, the rates of recurrence and metastasis, and the reconstructive method. STUDY DESIGN We reviewed the electronic charts of 867 consecutive patients with skin tumors and calculated the positive and negative predictive values of clinical diagnosis. RESULTS The positive predictive value was 91% for basal cell carcinoma and 78.8% for squamous cell carcinoma. Of the 178 histologically diagnosed squamous cell carcinomas, 15 were metastatic. CONCLUSIONS In a skin cancer referral center, expert clinical diagnosis may safely overcome the need for preoperative biopsy. Relying on clinical diagnosis to formalize a treatment plan for head and neck nonmelanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma compared with suspected squamous cell carcinomas.
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Affiliation(s)
| | | | - James Shuttleworth
- Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK
| | - Tom Frawley
- Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK
| | - Ciara Ennis
- Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK
| | - Eric Battista
- Core Dental Trainee, Oral and Maxillofacial Surgery Department, Kettering General Hospital, UK
| | - Phillip Ameerally
- Consultant Oral and Maxillofacial Surgeon, Northampton General Hospital, UK
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11
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Porceddu SV. Prognostic factors and the role of adjuvant radiation therapy in non-melanoma skin cancer of the head and neck. Am Soc Clin Oncol Educ Book 2016:e513-8. [PMID: 25993217 DOI: 10.14694/edbook_am.2015.35.e513] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-melanoma skin cancer (NMSC) is the most common cancer worldwide. Among the two types of NMSC, basal cell carcinoma (BCC) accounts for approximately 75% to 80% of cases and cutaneous squamous cell carcinoma (cSCC) accounts for 20% to 25% of cases. The majority of lesions are low risk and treated with simple surgical excision, which provides histopathologic information and is associated with high cure rates and acceptable cosmetic and functional outcomes. cSCCs are generally more aggressive than BCCs. NMSC commonly occurs in the sun-exposed head and neck region (80% to 90%). Approximately 5% of patients with NMSC (mainly cSCC) will have clinicopathologic features that predict for an increased risk for local and regional recurrence and, rarely, distant relapse. These features include locally advanced primary disease (stage T3-T4), regional nodal involvement, clinical perineural invasion, recurrent disease following treatment, and immunosuppression. Patients who have these features may warrant review by a multidisciplinary tumor board and might require combined modality treatment involving surgery and adjuvant radiation therapy (RT). This article focuses on our current understanding of the prognostic factors and role of adjuvant RT in high-risk NMSC of the head and neck.
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Affiliation(s)
- Sandro V Porceddu
- From the Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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12
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Porceddu SV, Veness MJ, Guminski A. Nonmelanoma Cutaneous Head and Neck Cancer and Merkel Cell Carcinoma: Current Concepts, Advances, and Controversies. J Clin Oncol 2015; 33:3338-45. [PMID: 26351348 DOI: 10.1200/jco.2014.60.7333] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Nonmelanoma skin cancer (NMSC) is the most common cancer worldwide and the most frequently observed malignancy in whites. Approximately 75% to 80% are basal cell carcinomas and 20% to 25% are squamous cell carcinomas. Incidence is increasing, partly reflecting an ageing population, and NMSC is more commonly seen in men. The predominant causative agent is ultraviolet solar radiation exposure, with the majority of cases occurring on the head and neck. Surgical excision is typically the treatment of choice, providing histopathologic information, high cure rates, and acceptable cosmetic and functional outcomes. Radiation therapy is reserved for cases where surgery is not the preferred choice or for high-risk cases where adjuvant therapy is recommended. Although overall mortality rates are low, patients with complex cases such as those with immunosuppression should be considered for management within multidisciplinary tumor boards. In contrast, Merkel cell carcinoma is a rare and aggressive malignancy, frequently arising on the head and neck in older whites, with a poorer prognosis. This article focuses on the current evidence guiding practice, recent advances, and areas of controversy in NMSC and Merkel cell carcinoma of the head and neck.
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Affiliation(s)
- Sandro V Porceddu
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Michael J Veness
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alexander Guminski
- Sandro V. Porceddu, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland; Michael J. Veness, Westmead Cancer Cancer Centre; Michael J. Veness and Alexander Guminski, University of Sydney; and Alexander Guminski, Royal North Shore Hospital, Sydney, New South Wales, Australia
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13
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Schmidt C, Martin JM, Khoo E, Plank A, Grigg R. Outcomes of nodal metastatic cutaneous squamous cell carcinoma of the head and neck treated in a regional center. Head Neck 2015; 37:1808-15. [PMID: 24995842 DOI: 10.1002/hed.23843] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Given its metastatic potential and high incidence, cutaneous squamous cell carcinoma of the head and neck (SCCHN) has significant morbidity and mortality. METHODS We conducted a retrospective review of prospectively collected data for 113 consecutive patients with nodal metastatic cutaneous SCCHN treated surgically with curative intent in a regional center. Survival curves were generated by the Kaplan-Meier method. RESULTS Five-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 80%, 83%, and 75%, respectively. Twenty-six patients (23%) relapsed, with 92% of relapses occurring within 2 years of surgery. Immunosuppression (p = .008) and N classification (p = .043) predicted decreased DFS on univariate analysis. On multivariate analysis, only immunosuppression independently predicted DFS (p = .034). CONCLUSION This study validates the current N classification system, supports the adverse effect of immunosuppression, and suggests that intense follow-up for 2 years postsurgery is warranted. Survival at this regional center is comparable to that achieved at metropolitan tertiary cancer centers.
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Affiliation(s)
- Campbell Schmidt
- School of Medicine, University of Queensland, Queensland, Australia
| | - Jarad M Martin
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, Australia
| | - Eric Khoo
- Radiation Oncology Queensland, St Andrew's Cancer Care Center, St Andrew's Hospital, Toowoomba, Queensland, Australia
| | | | - Roger Grigg
- Department of Otolaryngology Head and Neck Surgery, Toowoomba Rural Clinical School, University of Queensland, Queensland, Australia
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14
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Head and Neck Cutaneous Squamous Cell Carcinoma Requiring Parotidectomy. Otolaryngol Head Neck Surg 2014; 150:610-7. [DOI: 10.1177/0194599814520686] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective Evaluate characteristics and risk factors for patients with advanced cutaneous squamous cell carcinoma (cSCC). Study Design Retrospective case series. Setting Tertiary care center. Patients and Methods Chart review of patients with cSCC undergoing a parotidectomy (2003-2012). Results Of 218 patients identified, 49% presented with a new primary lesion (n = 107) and 51% with a recurrence (n = 111). Parotid lymph nodes were positive in 52% of patients; 81% had a concurrent neck dissection, and 28% had cervical lymph node metastases. In 18% of patients, both parotid and cervical nodes were positive, while 44% were both parotid and cervical node negative; 33% had positive parotid and negative cervical nodes, and only 5% had negative parotid and positive cervical nodes. The overall 2- and 5-year survival rates were 0.71 and 0.58. Overall 5-year survival was lower for patients presenting with recurrent (0.49) versus new primary disease (0.69; P = .04). In addition, decreased overall 5-year survival rates were associated with cervical lymph node involvement (0.47 vs. 0.62; P = .01). There was no difference in overall survival when stratified by parotid lymph node involvement ( P = .85), margin status ( P = .67), perineural invasion ( P = .42), facial nerve sacrifice ( P = .92), or type of parotid operation performed ( P = .51). Conclusions In this study, cervical, but not parotid, lymph node involvement was associated with poor outcomes in patients with advanced cSCC requiring a parotidectomy. In patients without evidence of cervical or parotid lymph node involvement, a neck dissection may be spared, given there is a 5% chance of occult disease.
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Yilmaz M, Eskiizmir G, Friedman O. Cutaneous Squamous Cell Carcinoma of the Head and Neck. Facial Plast Surg Clin North Am 2012; 20:473-81. [DOI: 10.1016/j.fsc.2012.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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