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PubMed2001

Organ preservation with radiotherapy for T1-T2 carcinoma of the pyriform sinus.

PURPOSE: To report long-term results using radiotherapy with or without a planned neck dissection for T1-T2 carcinoma of the pyriform sinus. METHODS: An analysis of 101 patients treated at the University of Florida with RT with or without a planned neck dissection for organ preservation. RESULTS: The 5-year local control rates after RT were 90% for T1 cancers and 80% for T2 lesions. The only parameter that significantly influenced local control in univariate analyses was apex involvement for T1 tumors. Multivariate analysis revealed no parameter that significantly affected local control. Cause-specific survival rates at 5 years were as follows: stage I-II, 96%; stage III, 62%; stage IVA, 49%; and stage IVB, 33%. The absolute survival rates were as follows: stage I, 57%; stage II, 61%; stage III, 41%; stage IVA, 29%; and stage IVB, 25%. Moderate to severe long-term complications developed in 12% of patients. CONCLUSIONS: RT alone or combined with a planned neck dissection resulted in local control with larynx preservation in a high proportion of patients. The chance of cure is comparable to that observed after conservation surgery, and the risk of major complications is lower. The addition of adjuvant chemotherapy is unlikely to improve the probability of organ preservation, but might improve locoregional control for patients with advanced nodal disease.

Adult↗
PubMed2004

Quality of life of well-differentiated thyroid carcinoma patients.

The thyroid gland is the second most common site for malignancy in the head and neck region. Quality of life (QOL) of thyroid cancer patients has not been studied directly. The QOL of long-term thyroid carcinoma patients was investigated. A standardized set of questions based on the University of Washington QOL questionnaire for head and neck cancer with specific domains associated with thyroid disease was created. This questionnaire was mailed to patients who underwent total thyroidectomy for well-differentiated cancer in the department of Otolaryngology--Head and Neck surgery at the Chaim Sheba Medical Centre in Israel between the years 1994-2000. Seventy-eight patients undergoing total thyroidectomy were identified. Forty-eight patients were excluded and 20 out of the 30 remaining patients responded to the questionnaires. Six were male and 14 female, 12 were under the age of 45 (these 12 patients were staged as stage 1). Eleven patients underwent neck dissection. General health and QOL were significantly better for the younger age group and so was the calcium balance score. General health and QOL were significantly better for patients undergoing neck dissection. The overall QOL score was 3.8 conforming with 'good' in the questionnaire. Surgery and initial radioiodine treatment scored 6.75 and 6.9 respectively in the distressing scale (0-10 range: 10 = most distressing). The highest distress was encountered during withdrawal from thyroid hormone. Women rated the importance of proper replacement therapy significantly higher than men. Global low scores were found for employment and for effective L-thyroxine replacement therapy. Overall, QOL in these patients was good although lower than expected when compared with other forms of cancer. Age and gender-related differences were noted. Better QOL in neck dissection patients is probably associated with age under 45 years. High distress scores for hormone withdrawal during periodical imaging correspond with former reports and supports use of Thyrogen. Better hormone balance is warranted for this group.

Adolescent↗
PubMed2005

Familial nonmedullary thyroid cancer.

Familial nonmedullary thyroid cancer (FNMTC) is a syndrome of familial clustering of thyroid cancers of follicular cell origin. It is characterized by multifocality, early onset, more recurrences, and a higher degree of aggressiveness than nonfamilial thyroid cancers of follicular cell origin. An autosomal dominant inheritance pattern with reduced penetrance appears likely in most pedigrees. Although several candidate genes responsible for isolated clinical variants of FNMTC have been identified in single families, the gene(s) responsible for the vast majority of FNMTC cases has yet to be identified. Members of FNMTC cohorts should be followed longitudinally with physical examination and ultrasonography, and aggressively treated when cancer is diagnosed. When cancer is diagnosed, total thyroidectomy should be performed, and most patients should have a prophylactic central neck dissection and a therapeutic lateral functional neck dissection, postoperative radioiodine ablation and thyroid-stimulating hormone (TSH) suppressive therapy. Close follow-up with stimulated thyroglobulin levels, neck ultrasounds, and radioiodine scans are also central to the management strategy.

Humans↗
PubMed2003

[Relevant factors and management for patients with squamous carcinoma in tongue without clinical cervical lymphatic node metastasis].

OBJECTIVE: To discuss the treatment of cN(0) tongue carcinoma patients. METHODS: 185 cases of the mobile tongue carcinoma patients (male 102, female 83, aged 28 to 88) treated with surgery from 1988.5 to 1995.6 had been followed up and retrospectively analyzed. Extensive resection of the primary tumors and neck dissections were performed, and all the samples were pathological positive. RESULTS: The cervical lymphatic node metastasis rates for stage I-II, III-IV disease, grade I, II disease were 16.66%, 38.05%, 17.42% and 37.50% respectively. And the rates were 9.00%, 31.37% and 55.55% for submucous infiltration, muscle infiltration and perineural infiltration, respectively. The overall 5 year survival was 72.43%, and the 5 year specific survival rate was 44.44% and 83.96% for those having or not having cervical node metastasis. The levels of 29 patients with positive node metastasis for 148 cN(0) patients were submandibular and submental lymphatic nodes (22.64%), superior deep cervical lymphatic nodes (35.84%), middle deep cervical lymphatic nodes (26.41%), inferior deep cervical lymphatic nodes (15.09%), posterior neck lymphatic nodes (0.00%). The over all 5 year survival rates for selective neck dissection were 85.13% and 21.62% in therapeutic dissection (chi(2) = 29.73, P < 0.01). Patients performed selective neck dissection the rates were 68.96% and 89.07% respectively with or without lymphatic node metastasis. Comparably the 5-year rate was only 20.00% for the patients performed the therapeutic dissection with lymphatic node metastasis. CONCLUSIONS: (1) cN(0) patients should be observed carefully in stage I, and the selective dissection must be performed in stage II-IV. (2) Supraomohyoid ND is essential for T(2) patients, and functional ND is essential for T(3 - 4) patients. (3) There is correlation between cervical metastasis and the stage, grade or infiltration of tongue cancer (P < 0.05). The prognosis could be expected from these factors.

Adult↗
PubMed2002

Predictors of nodal metastasis in salivary gland cancer.

OBJECTIVES: This study was conducted to determine clinical and histologic factors that would predict nodal metastasis in patients with major salivary gland cancer. METHODS: A retrospective study of 40 patients who underwent surgery, including neck dissection, for major salivary gland cancer between 1975 and 1997 was performed. Patient charts were reviewed, and clinical and pathologic data were extracted along with outcome. Predictive factors were identified and survival curves were obtained. RESULTS: Neck dissections were performed in 40 patients, which revealed histologic evidence of tumor in lymph nodes in 15 cases. Histologically proven metastasis was found in 16% of specimens from elective and 73% of specimens from therapeutic neck dissection. Five-year overall and locoregional disease-free survival rates for histologically positive and negative groups were 40% versus 63% (P < 0.05) and 67% versus 69% (P = 0.59), respectively. Univariate analysis of the factors revealed that clinical evidence of nodal metastasis (P < 0.001) and high-grade cancer (P < 0.033) predicted histologic nodal involvement. Multivariate analysis revealed that only a positive neck examination was a significant predictive factor (OR = 31, 95%CI = 2.99-312). CONCLUSIONS: Our results suggest that clinical neck examination is a reliable predictor of regional metastasis in patients with major salivary gland cancer. In view of the low frequency of occult metastases, routine elective treatment of the neck is not recommended.

Adolescent↗
PubMed1986

[Malignant melanoma in the area of the head and neck].

The incidence of malignant melanoma is rising worldwide. Recognition of the biological types of malignant melanoma (nodular melanoma, superficial spreading melanoma, lentigo maligna melanoma, and acrolentiginous melanoma) have greatly helped to improve the prognosis in recent years. Determination of the depth of invasion in histological serial sections has proved to be of great prognostic value. Melanomas with minimal invasion have an excellent prognosis. Wide excision of the primary tumour is of utmost importance. The excisional margins should be 3-5 cm, but in superficial melanomas the width of excision may be less. Prophylactic neck dissection is unnecessary for superficial melanomas, it is necessary for lesions between 1 and 3.9 mm in thickness, whereas in tumours with a depth of invasion greater than 4 mm the outcome of the disease is not improved by prophylactic neck dissection. In metastasizing malignant melanoma the tumour mass should be reduced by surgical intervention. Survival is sometimes prolonged by several months or even longer when lymph nodes and metastases are excised. A radical neck dissection is indicated therefore when lymph nodes are clinically involved.

Combined Modality Therapy↗
PubMed2005

Recurrent nodal metastases in the posterior triangle: implications for treatment of the atypical tumour.

We studied the incidence of recurrent nodal metastases in level V (posterior triangle) in patients who had previously had a staging or therapeutic dissection of the neck, with or without postoperative radiotherapy. Of 160 patients studied (177 neck dissections), 41 (26%) developed recurrent metastases in the neck. Four patients (3%) developed ipsilateral recurrent disease in level V. In these four patients, level III or IV lymph nodes were shown histologically to have extracapsular spread at the time of the original dissection. All four metastases were located at or just beyond the anatomical boundaries of the posterior triangle. None of the metastases at level V were from oral or oropharyngeal primary tumours.

Adult↗
PubMed1978

Significance of site and nodal metastases in squamous cell carcinoma of the epiglottis.

One hundred twelve patients treated by surgery alone for squamous cell carcinoma of the epiglottis were retrospectively reviewed. The results showed: (1) 27 per cent of patients with N0 disease had microscopic nodal metastases; (2) 35 to 47 per cent of patients with N0 and N1 disease and histologically positive nodes (micrometastases) in the initial neck dissection developed contralateral nodal metastases; (3) 36.9 per cent of the patients who had nodal micrometastases (histologically positive) survived five years, as contrasted with 94.5 per cent of those who did not have node involvement; (4) 53.2 per cent of the patients who had nodal metastases in one neck and 16 per cent of those who had metastases in both necks survived five years; (5) when the primary tumor in the epiglottis was located in the midline or there was bilateral supraglottic involvement, 18 to 50 per cent of patients developed contralateral ("second") neck nodal metastases; (6) performing early elective contralateral ("second") neck dissection shortly after recovery from the initial surgery may improve survival of patients in whom either the "first" neck dissection showed microscopic nodal metastases and/or the primary tumor was located either in midline or there was bilateral supraglottic involvement.

Adult↗
PubMed2003

[The incidence of level I metastasis in laryngopharyngeal squamous cell carcinoma].

OBJECTIVES: We investigated the incidence of level I metastasis in patients with laryngeal and hypopharyngeal squamous cell carcinoma (SCC). PATIENTS AND METHODS: The records of 126 patients who underwent primary tumor excision with radical neck dissection (RND) or its modifications for laryngeal or hypopharyngeal SCC were retrospectively reviewed. Preoperative tumor and neck stages, the sites and the number of metastatic lymph nodes were recorded. Patients treated with selective neck dissection (SND) or preoperative chemotherapy and/or radiation therapy were excluded. RESULTS: Of 155 RND or modified RND performed for 113 laryngeal and 13 hypopharyngeal SCC, lymph node metastases were detected in 51 specimens, all of which spared level I. The most frequently involved levels were II and III. CONCLUSION: Selective neck dissection sparing level I may be appropriate for clinically and radiologically N0 patients with laryngopharyngeal carcinoma.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Carcinoma of the laryngeal margin.

The laryngeal margin constitutes an anatomic and clinical entity that differs from what is commonly referred to as supraglottic. The present retrospective study reviews 189 cases of carcinomas occurring in this specifically defined region. Local, nodal, and distant metastatic spread of these tumors varied depending on whether the initial tumor site was located in the anterior or lateral margin. Treatment regimens were planned according to the tumor's origin. Primary tumor site surgery associated with a modified or radical neck dissection according to N staging, followed by postoperative radiation is advocated for treatment of these tumors. Cervical nodal metastases are frequent and often bilateral (36%) in cases of anterior margin carcinoma suggesting that bilateral neck dissection sparing two jugular veins for N0 staged carcinoma and one jugular vein when there is evidence of a palpable node, be routinely used. Nodal involvement in cases of lateral margin carcinoma is also frequent but is almost exclusively confined to the ipsilateral nodes. It is suggested that homolateral neck dissection therefore be systematically associated with primary tumor site surgery for these tumors. The various anatomical aspects and pathways of extension of laryngeal margin carcinoma are discussed and a modified TNM classification is proposed.

Carcinoma↗
PubMed2006

[Current trends in diagnosis and treatment head and neck cancer].

Prognosis of head and neck squamous cell carcinomas (HNSCC) is partly determined by lymph nodes metastases. Contemporary imaging provides detection of adenopathies but remains unable to detect infracentimetric micrometastatic nodes. Topographical classification according to Robbins allows for better treatment through proper definition of impaired neck areas. The high rate of node metastases in HNSCC indicates systematic treatment of the neck in most localizations. Several neck dissection techniques are available with wide acceptation of elective functional neck dissections. Improvement of detection of node metastases and better selection of neck sites for treatment are eventual direction of progress. In neck carcinoma with unknown primary, search of primary should address first head and neck area and upper aero-digestive tract. Differential diagnosis are glomic tumour, congenital cyst and other causes of lymph node disease

Carcinoma, Squamous Cell↗
PubMed1991

[10 years' experience on infrahyoid myocutaneous flap].

From May 1979 to December 1989, 260 infrahyoid myocutaneous flaps (IHMCFs) were used for reconstruction after resection of head and neck cancer in one stage. It has been certified that the IHMCF is a reliable versatile and convenient island myocutaneous flap, suitable for repairing the defect in the oral cavity, parotid region, oro- or hypopharynx particularly the tongue after hemi-excision of oral tongue to radical total glossectomy. The success rate of the IHMCF may be increased to 97% if the following points are noticed. 1. The sternal head of the sternocleidomastoid (SCM) muscle below the hyoid bone is included in the flap for protecting the platysma and the SCM branches of the superior thyroid artery to the IHMCF. 2. During cutting the tributaries of the internal jugular vein (IJV) below the level of the hyoid bone for increasing movability of the IHMCF, the cutting points must be near the anterior edge of IJV for preserving the communicating veins between the anterior jugular vein and IJV. 3. For reconstructing the oral tongue, the medial edge of the IHMCF must be designed 1 cm beyond that of the defect after partial excision of the oral tongue. Since the application of the IHMCF, the incidence of the tongue carcinoma patient (TCP) with T4 has increased from zero to 53%. The 5-year cure rate of the TCP with stage IV has raised from 11% to 42%. For N0 and N1 cases, the pure neck failure after modified neck dissection with preservation of lower 2/3 or whole length of the IJV was similar to that of the radical neck dissection.

Adolescent↗
PubMed1980

Surgical treatment of cervical lymph nodes in carcinoma of the tongue.

A series of 56 cases of carcinoma of the anterior two-thirds of the tongue treated surgically was reviewed. Lymph node metastasis occurred in 50% of cases. There was 22% false-negative clinical assessments of lymph node status for the ipsilateral side of the neck. Because of these and the difficulty in ensuring early treatment of subsequent node metastasis, concurrent ipsilateral radical neck dissection is recommended. When the ipsilateral side of the neck was involved the contralateral side has 22% false-negative assessments. Elective radical neck dissection for the contralateral side is recommended in this situation. The overall five-year survival was 50.6%, and was greatly affected by the status of the neck lymph nodes.

Carcinoma, Squamous Cell↗
PubMed2000

A clinical study of oral tongue cancer.

Thirty-nine previously untreated patients with squamous cell carcinoma of the oral tongue treated with curative intent in our hospital from 1993 through 1998 are reviewed. Of these patients, those in the early stage (stages I and II) constituted 64%. The over all 5-year survival rate of all the patients was 60%. The 5-year survival rate of the patients with early stage cancers was unsatisfactory (stage I: 73%; II: 56%). This was thought to be related to the absence of elective neck dissection and the administration of chemotherapy in the patients with early stage cancer. We concluded that elective neck dissection for levels I, II and III is the first choice of treatment strategy for patients with stage II cancer. Our data indicate that chemotherapy in patients with early stage cancer was not beneficial and might have increased the risk of late lymph node metastasis in the clinically NO patients without neck dissection. There were 9 patients younger than 40 years of age and their survival rate at 5 years was 80%, which was better than that of the older patients. The treatment strategy for patients younger than 40 years of age was similar to that of older patients.

Adult↗
PubMed2005

Effectiveness of lymphoscintigraphic sentinel node detection for cervical staging of patients with squamous cell carcinoma of the head and neck.

PURPOSE: To evaluate the feasibility and staging ability of the sentinel node (SN) technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. This prospective study compares the histopathologic status of the SN with that of the remaining neck dissection tissues. PATIENTS AND METHODS: Thirty previously untreated patients with T1 to T4 squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks (N0) were included in the study. Injection of 99m Tic-radiolabeled sulfur colloid around the primary tumor and lymphoscintigraphy were performed the day before surgery. Intraoperatively, the SN(s) was localized with a gamma probe and removed during neck dissection. The tumor was resected at the same time. RESULTS: For 1 patient, lymphoscintigraphy revealed no SN. SN were identified in 29 patients/37 necks. In 29 necks, there were no positive SN. In 5 patients, the SN was the only histopathologically positive node. In 1 patient, SN and other nodes in the remaining neck tissue were positive. There was 1 false negative case; the first case of the study, indicating the need for a learning curve for the technique. CONCLUSION: This prospective study shows that the SN is useful for the staging of N0 necks. The SN technique has the potential to decrease the need for neck dissections, which are usually performed in clinically negative necks, thus reducing both associated morbidity for patients and cost.

Carcinoma, Squamous Cell↗
PubMed2005

[Postoperative radiotherapy in N0 laryngeal cancer].

PURPOSE: A retrospective study to re-assess the indications for postoperative radiation therapy in squamous cell carcinoma of the larynx staged N0 after gross resection. PATIENTS AND METHODS: Between January 1975 and December 2000, 166 patients with squamous cell carcinoma of the larynx were treated by total laryngectomy with or without neck dissection. Surgery was completed by external radiotherapy delivering 45 to 65 Gy to the tumour bed and 45 to 50 Gy to cervical lymphatic chains. Minimal follow-up was 36 months and median follow-up was 98 months. RESULTS: The rate of nodal recurrence was 6% (median time for relapse was 9 months). The survival rates at 1, 2, 3 and 5 years were 93.5, 84, 80 and 69% respectively, with a 8 year 3 month median survival. The univariate analysis showed 4 parameters, which significantly increased the risk of local recurrence: the medical necessity for immediate tracheotomy, the subglottic involvement, the involvement of the whole larynx and the presence of lymphatic embols in the neck dissection. There was no statistically significant difference between the patients with or without a neck dissection. Fifty-nine secondary cancers were observed, 15 of them occurring in the head and neck area. The late complications consisted of cervical subcutaneous fibrosis (7%), oesophageal stricture (4%), oeso-tracheal fistula (l%), hypothyroidism (3%), bone necrosis (1%). CONCLUSION: Prophylactic cervical radiotherapy in laryngeal cancers resulted in 6% cervical node recurrence rate. This value may represent the maximal rate to accept if one would favour new therapeutic strategies based on restricted indications for radiotherapy.

Adult↗
PubMed2003

Concurrent chemoradiotherapy for N2 or N3 squamous cell carcinoma of the head and neck from an occult primary.

BACKGROUND: Our aim was to explore the use of concurrent chemoradiotherapy in the management of patients with squamous cell carcinoma of the head and neck from an occult primary (HNCOP). PATIENTS AND METHODS: From 1991 to 2000, 25 patients with T0N2M0 or T0N3M0 HNCOP were entered into five sequential phase II clinical trials. Chemoradiotherapy consisted of a split course of radiotherapy with concurrent 5-fluorouracil and hydroxyurea either alone or with cisplatin, or paclitaxel. Two of the five protocols incorporated induction chemotherapy. RESULTS: Nodal stage was N2a in five patients (20%), N2b in 13 (52%), N2c in one (4%) and N3 in six (24%). Twenty-two patients (88%) underwent neck dissection; 14 of 22 patients underwent neck dissection before initiating protocol therapy. Total radiation doses of 55-75 Gy (median 60 Gy) were delivered; radiation fields included the potential sites of mucosal primaries and the neck bilaterally. Selected patients received a radiation boost to the involved neck. With a median follow-up of 3.9 years, three patients have progressed (one local, two distant) and seven patients have died. Deaths were due to disease progression (three) or unrelated causes (four). No metachronous primaries developed. The 5-year progression-free and overall survival was 87% and 75%, respectively. CONCLUSION: Combined-modality treatment with intensive chemoradiotherapy results in excellent disease control and long-term survival for patients with N2-N3 HNCOP and compares favorably with traditional therapy.

Adolescent↗
PubMed2004

[Occult metastases of oral cavity cancers].

Despite new approaches to treatment and lower mortality, malignant tumors of the head and neck, including the malignant tumors of the oral cavity, still represent significant oncological problem because long-term survival has not been significantly prolonged. The growth of tumors of this localization is fast and infiltrative, while early metastases of regional lymph nodes are rather frequent. Malignant tumors of the oral cavity account for 1.1% of population in our community (Dimitrijvic, 2001). The objective of the study was to analyze regional metastases of the cancers of the tongue and the floor of mouth in 101 patients with planocellular cancers treated in the period 1991 to 1995. Clinically positive regional lymph nodes were found in 67.3% of patients, while the most commonly involved regions were submandibular (47.4%) and upper jugular region (46.1%). They were more frequent in localization of the floor of mouth than in case of tongue cancer. Three types of neck dissections were used for surgical treatment of patients. In the group of patients with clinically negative results of the neck (N0) who underwent neck dissection, occult metastases of regional lymph nodes were verified pathohistologically in 19.2% of the time. Malignant tumors of the oral cavity are always the indication for neck dissection, even in N0 category, on account of high proportion of occult metastases.

Carcinoma, Squamous Cell↗