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Lopez J, Reategui ML, Rooper L, Koch W, Fakhry C, Mydlarz W, Tan M, Eisele DW, Mandal R, Vosler P, Gourin CG. Node Count as a Quality Indicator in Surgically Treated Mucosal Head and Neck Squamous Cell Cancer. Laryngoscope 2023; 133:2160-2165. [PMID: 36197005 DOI: 10.1002/lary.30429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION A yield of ≥18 nodes from neck dissection has been shown to be associated with improved locoregional recurrence rates and survival. We sought to determine factors associated with lymph node yields below this threshold. MATERIALS AND METHODS A retrospective review of patients who underwent neck dissection as part of definitive surgical treatment for mucosal head and neck squamous cell carcinoma (SCC) between January 2015 and December 2018 at an academic tertiary referral center was performed. Patients with a history of prior radiation or neck dissection were excluded. RESULTS There were 412 neck dissections performed in 323 patients. Specimens containing <18 nodes decreased from 16.2% in 2015-2016 to 7.4% of neck dissections in 2017-2018. The proportion of neck dissections removing <3 levels decreased from 9.1% of neck dissections in 2015-2016 to 4.0% in 2017-2018. Multivariable regression analysis demonstrated that dissection of ≥3 levels (OR = 0.2 [0.1-0.4]) and neck dissection in 2017-2018 compared to 2015-2016 (OR = 0.4 [0.2-0.8]) were significantly associated with a lower odds of <18 nodes. Stage, site, race, sex, human papillomavirus status, positive nodes, surgeon volume, and pathologist volume were not associated with neck dissection specimens with <18 nodes, after controlling for all other variables. CONCLUSIONS Increased recognition of the importance of node count as a quality indicator, and the extent of neck dissection is associated with increased nodal yield from neck dissection. These data suggest that node count can be used as a quality measure of neck dissection for mucosal SCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2160-2165, 2023.
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Affiliation(s)
- Joseph Lopez
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Maria Laura Reategui
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Lisa Rooper
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Wojtech Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Marietta Tan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Rajarsi Mandal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Peter Vosler
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Moratin J, Horn D, Semmelmayer K, Ristow O, Engel M, Hoffmann J, Bleymehl M, Held T, Zittel S, Freudlsperger C. Surgical Treatment of Carcinomas of the Oral Minor Salivary Glands-Oncological Outcome in Dependence of Tumor Entity and Therapeutic Strategies. Cancers (Basel) 2023; 15:3895. [PMID: 37568711 PMCID: PMC10417329 DOI: 10.3390/cancers15153895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this study was to analyze the clinical outcomes of three types of minor salivary gland carcinomas (adenoid-cystic carcinomas (ACC), adeno carcinomas not otherwise specified (AC-NOS), and mucoepidermoid carcinomas (MEC)) after primary surgical therapy. A retrospective cohort study was designed and patients with cancer of the minor oral salivary glands treated in our department in the years 2011 to 2022 were included. Clinicopathological data were evaluated to compare overall survival and progression-free survival between the entities. Eighty-one patients were included. The rates of cervical metastases were 38.9% for ACC, 25% for MEC, and 9.1% for AC-NOS. ACC exhibited significantly higher rates of local and systemic disease recurrence (p = 0.02), and the presence of neck node metastases was confirmed as an independent prognostic factor for progression-free survival (p = 0.014). Treatment success in terms of oncological outcome varied significantly between the different entities and implies different treatment regimens for each tumor entity.
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Affiliation(s)
- Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Dominik Horn
- Department of Oral and Cranio-Maxillofacial Surgery, Saarland University Medical Center, Kirrberger Straße, D-66424 Homburg, Germany;
| | - Karl Semmelmayer
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Oliver Ristow
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Michael Engel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Moritz Bleymehl
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Thomas Held
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany;
- National Center for Tumor Diseases, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
- Heidelberg Ion Beam Therapy Center, Im Neuenheimer Feld 460, D-69120 Heidelberg, Germany
| | - Sven Zittel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (K.S.); (O.R.); (M.E.); (J.H.); (M.B.); (S.Z.); (C.F.)
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de la Fuente C, Prat-Valero N, Alberola-Ferranti M, Mis-Castell D, Sáez-Barba M, Pujol-Pina R, Pamias-Romero J, Bescós-Atín C. Occult metastases of oral maxillary squamous cell carcinoma: Systematic review and meta-analysis. Head Neck 2023; 45:733-744. [PMID: 36515647 DOI: 10.1002/hed.27276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/30/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. The performance of END (elective neck dissection) in cases of maxillary SCC is controversial because the literature traditionally classified maxillary tumors as having low metastatic potential. The aim of this systematic review and meta-analysis was to determine the percentage of occult cervical metastases in maxillary SCC to identify in which cases there is the need to perform an END. We searched the PubMed database to select articles dated from 2000 to 2020 that fulfilled our inclusion criteria; finally, we reviewed 27 manuscripts. We show that the overall cervical and occult metastases rate was 35% and 19%, respectively. For T1, the percentage of occult metastasis rate was 11%; for T2, it was 16%; for T3, it was 20%; and for T4, it was 32%. We suggest END (levels I-II-III) as treatment to T3/T4 cN0 patients.
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Affiliation(s)
- Carlos de la Fuente
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Nil Prat-Valero
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Margarita Alberola-Ferranti
- Servei d'Anatomia Patològica, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Mis-Castell
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Sáez-Barba
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Pujol-Pina
- CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jorge Pamias-Romero
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Coro Bescós-Atín
- Servei de Cirurgia Oral i Maxil·lofacial, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBBIM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Bond MR, Versteeg AL, Sahgal A, Rhines LD, Sciubba DM, Schuster JM, Weber MH, Fehlings MG, Lazary A, Clarke MJ, Boriani S, Bettegowda C, Arnold PM, Gokaslan ZL, Fisher CG. Surgical or Radiation Therapy for the Treatment of Cervical Spine Metastases: Results From the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) Cohort. Global Spine J 2020; 10:21-29. [PMID: 32002346 PMCID: PMC6963359 DOI: 10.1177/2192568219839407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Ambispective cohort study design. OBJECTIVES Cervical spine metastases have distinct clinical considerations. The aim of this study was to determine the impact of surgical intervention (± radiotherapy) or radiotherapy alone on health-related quality of life (HRQOL) outcomes in patients treated for cervical metastatic spine tumours. METHODS Patients treated with surgery and/or radiotherapy for cervical spine metastases were identified from the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) international multicentre prospective observational study. Demographic, diagnostic, treatment, and HRQOL (numerical rating scale [NRS] pain, EQ-5D (3L), SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months postintervention. RESULTS Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery ± radiation and 17 received radiation alone. Surgically treated patients had higher mean spinal instability neoplastic scores compared with the radiation-alone group (13.0 vs 8.0, P < .001) and higher NRS pain scores and lower HRQOL scores compared to the radiation alone group (P < .05). From baseline to 6 months posttreatment, surgically treated patients demonstrated statistically significant improvements in NRS pain, EQ-5D (5L), and SOSGOQ2.0 scores compared with nonsignificant improvements in the radiotherapy alone group. CONCLUSIONS Surgically treated cervical metastases patients presented with higher levels of instability, worse baseline pain and HRQOL scores compared with patients who underwent radiotherapy alone. Significant improvements in pain and HRQOL were noted for those patients who received surgical intervention. Limited or no improvements were found in those treated with radiotherapy alone.
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Affiliation(s)
- Michael R. Bond
- University of British Columbia, Vancouver, British Columbia, Canada
- Michael R. Bond, Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
| | | | - Arjun Sahgal
- Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Michael H. Weber
- McGill University and Montreal General Hospital, Montreal, Quebec, Canada
| | - Michael G. Fehlings
- University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Aron Lazary
- National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | | | | | | | - Paul M. Arnold
- The University of Kansas Hospital, Kansas City, Kansas, USA
| | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
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Persichetti A, Bizzarri G, Guglielmi R, Barnabei A, Bianchini A, Coccaro C, Appetecchia M, Papini E. Ultrasound-guided laser ablation for local control of neck recurrences of medullary thyroid cancer. A feasibility study. Int J Hyperthermia 2018; 35:480-492. [PMID: 30204004 DOI: 10.1080/02656736.2018.1508759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Surgery is the standard treatment for cervical metastases of medullary thyroid cancer (MTC) diagnosed after initial surgical treatment. Repeated neck dissections, however, carry an elevated risk of complications, have an adverse impact on the quality of life, and sometimes do not achieve cure of the disease Clinical case: In a patient who had undergone two cervical neck dissections complicated by accessory nerve injury, an US-guided laser ablation (LA) of a lymph node metastasis of MTC was performed. LA was performed with two treatments during a five month period. The procedure was carried out with one optical fiber and an energy delivery of 3300 and 360 Joules. Treatments were well tolerated and resulted in complete structural and biochemical cure during a 12 month follow-up. No major complication was registered. CONCLUSIONS LA is a promising tool for the management of relapsing cervical metastases that are localized in non- critical areas and are characterized by low progression rate. Advantages of LA are the outpatient setting, the absence of general anesthesia, the tolerability and the safety of the procedure. Thus, LA may be considered as an alternative approach to surgery or active surveillance for the management of local recurrences of MTC in selected patients.
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Affiliation(s)
- Agnese Persichetti
- a Department of Molecular Medicine , University La Sapienza , Rome , Italy
| | - Giancarlo Bizzarri
- b Department of Diagnostic Imaging , Regina Apostolorum Hospital , Rome , Italy
| | - Rinaldo Guglielmi
- c Department of Endocrinology & Metabolic Diseases , Regina Apostolorum Hospital , Rome , Italy
| | - Agnese Barnabei
- d Regina Elena, Endocrinology Unit , National Cancer Institute of Rome , Rome , Italy
| | - Antonio Bianchini
- b Department of Diagnostic Imaging , Regina Apostolorum Hospital , Rome , Italy
| | - Carmela Coccaro
- c Department of Endocrinology & Metabolic Diseases , Regina Apostolorum Hospital , Rome , Italy
| | | | - Enrico Papini
- c Department of Endocrinology & Metabolic Diseases , Regina Apostolorum Hospital , Rome , Italy
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Abstract
Objective To provide an anatomic description of submandibular nodes at risk of being left undissected during neck dissection (ND) and to assess whether the Hayes Martin maneuver is a safe procedure in oncologic surgery of level IB nodes. Study Design Prospective study. Setting Academic medical center. Subjects and Methods We recruited 62 patients who were candidates for level IB ND. Perifacial nodes (PFNs) were identified and their characteristics noted. The Hayes Martin maneuver was simulated, and its oncologic safety was tested. Results The study included 63 NDs. PFNs were identified in 84% of cases: their number ranged from 0 to 5, and their mean greatest diameter was 12.45 mm. Anterior PFNs were found to be in direct contact with the marginal mandibular nerve. In 59% of NDs, the Hayes Martin maneuver would have failed to remove all PFNs. Conclusions The PFNs were identified in 84% of cases and ranged in number from 0 to 5. In some cases, the distinction between retro- and preglandular nodes and PFNs is not useful. The Hayes Martin maneuver may not be oncologically sound for complete treatment of level IB nodes.
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Affiliation(s)
- Giancarlo Tirelli
- 1 Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Alberto Vito Marcuzzo
- 1 Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
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De la Garza-Ramos R, Benvenutti-Regato M, Caro-Osorio E. Vertebroplasty and kyphoplasty for cervical spine metastases: a systematic review and meta-analysis. Int J Spine Surg 2016; 10:7. [PMID: 26913227 DOI: 10.14444/3007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Vertebroplasty (VP) and kyphoplasty (KP) are two minimally invasive techniques used to relieve pain and restore stability in metastatic spinal disease. However, most of these procedures are performed in the thoracolumbar spine, and there is limited data on outcomes after VP/KP for cervical metastases. The purpose of this article is to evaluate the safety and efficacy of VP and KP for treating pain in patients with cervical spine metastases. METHODS A systematic review of the literature was conducted using the PubMed and Medline databases. Only studies that reported five or more patients treated with VP/KP in the cervical spine were included. Levels of evidence and grades of recommendation were established based on the Oxford Centre for Evidence-Based Medicine guidelines. Data was pooled to perform a meta-analysis for pain relief and complication rates. RESULTS Six studies (all level 4 studies) met the inclusion criteria, representing 120 patients undergoing VP/KP at 135 vertebrae; the most common addressed level was C2 in 83 cases. The average volume of injected cement was 2.5 ± 0.5 milliliters at each vertebra. There were 22 asymptomatic cement leaks (16%; 95% CI, 9.8% - 22.2%) most commonly occurring in the paraspinal soft tissue. There were 5 complications (4%; 95% CI, 0.5% - 7.5%): 3 cases of mild odynophagia, 1 case of occipital neuralgia secondary to leak, and 1 case of stroke secondary to cement embolism. Pain relief was achieved in 89% of cases (range: 80 - 100%). The calculated average pain score decreased significantly from 7.6 ± 0.9 before surgery to 1.9 ± 0.8 at last evaluation (p=0.006). CONCLUSION Although the calculated complication rate after VP/KP in the cervical spine is low (4%) and the reported pain relief rate is approximately 89%, there is lack of high-quality evidence supporting this. Future randomized controlled trials are needed.
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Affiliation(s)
- Rafael De la Garza-Ramos
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México; Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion Tecnológico de Monterrey, Monterrey, México
| | - Mario Benvenutti-Regato
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México; Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion Tecnológico de Monterrey, Monterrey, México; Department of Neurosurgery, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Enrique Caro-Osorio
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, México; Institute of Neurology and Neurosurgery, Hospital Zambrano Hellion Tecnológico de Monterrey, Monterrey, México
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Sagheb K, Sagheb K, Rahimi-Nedjat R, Taylor K, Al-Nawas B, Walter C. Sentinel lymph node biopsy in T1/T2 squamous cell carcinomas of the tongue: A prospective study. Oncol Lett 2015; 11:600-604. [PMID: 26870253 PMCID: PMC4727194 DOI: 10.3892/ol.2015.3933] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 09/25/2015] [Indexed: 02/06/2023] Open
Abstract
Commonly used staging procedures often cannot predict the absence of cervical metastases (CM) in squamous cell carcinomas (SCCs) of the oral cavity. Due to the high incidence of occult CM in numerous N0 cases in the clinic, an elective neck dissection (ND) is performed. The sentinel lymph node biopsy (SNB) is a common concept in the modern surgical therapy of malignancies. The present study evaluates the applicability of this concept for T1/T2-SCC of the tongue. In a prospective clinical study, 10 consecutive patients with T1/T2-SCC of the tongue and cN0 necks, were enrolled. Following sentinel lymph node (SLN) scintigraphy, all patients underwent SNB with a γ-probe and a subsequent ND. SNB specimens were compared with histopathological assessments of surgical specimens from the ND. A total of 5 female and 5 male patients (mean age, 52 years; women, 62 years; men, 42 years), with a median follow-up time of 33.5 months (range, 10–40 months), were treated. All patients presented with detectable SLNs. In 7 cases, the SLN(s) and the residual ND were negative for CM. In 3 cases, the SLN(s) were positive without further CM in the other neck nodes. Furthermore, 1 patient showed additional CMs after 10 months in the contralateral neck and lung metastasis after 18 months, but none at the time of the initial treatment. The concept of an SNB appears to be applicable to the management of the cN0 neck in small SCC of the tongue. The role of SNB in the management of SCC requires further investigation by prospective trials with larger patient numbers.
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Affiliation(s)
- Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Centre, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
| | - Kawe Sagheb
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Centre, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
| | - Roman Rahimi-Nedjat
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Centre, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
| | - Kathy Taylor
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Centre, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial Surgery-Plastic Surgery, University Medical Centre, Johannes Gutenberg-University of Mainz, Mainz 55131, Germany
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Davis KS, Byrd JK, Mehta V, Chiosea SI, Kim S, Ferris RL, Johnson JT, Duvvuri U. Occult Primary Head and Neck Squamous Cell Carcinoma: Utility of Discovering Primary Lesions. Otolaryngol Head Neck Surg 2014; 151:272-8. [PMID: 24812081 DOI: 10.1177/0194599814533494] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 04/08/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Cancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status. STUDY DESIGN Retrospective, matched-pairs analysis contrasting 2 cohorts based upon discovery of primary lesion. SETTING Tertiary teaching hospital. SUBJECTS AND METHODS Records of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980-2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan-Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age. RESULTS Discovered lesions were more likely to exhibit HPV positivity (P < .001). Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95% confidence interval [CI], 0.019-0.822; P = .030). Discovery of the primary was associated with improved cause-specific survival (HR = 0.142; 95% CI, 0.021-0.93; P = .0418) and disease-free survival (HR = 0.25; 95% CI, 0.069-0.91; P = .03). CONCLUSION HPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause-specific survival, and disease-free survival in patients initially presenting as CUP in matched-pair and cohort comparison analyses.
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Affiliation(s)
- Kara S Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - J Kenneth Byrd
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vikas Mehta
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Simon I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonas T Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA VA Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
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