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PubMed2006

[Parathyroid carcinoma].

Parathyroid carcinoma is a rare disease accounting for 1 to 5% of parathyroid neoplasms. This malignant tumour must be suspected when a severe primary hyperparathyroidism occurs with high hypercalcemia and elevated parathormon levels. At this time, a cervical mass is often palpable. Both head and neck ultrasonography and 99mTc-sestamibi scintigraphy are the best preoperative imaging tests to suspect and localize the tumour. Surgical approach with simultaneous tumorectomy and hemithyroidectomy, completed by selective neck dissection (level VI) is the treatment of choice. An elective lateral neck dissection should be performed if necessary. Tumour control should be monitored by regular measurement of calcium and parathormon levels. Local recurrence or metastasis risk is 30 to 70% and the 5 year overall survival about 50 to 80%. In case of recurrence, aggressive surgical management should be applied and adjuvant radiation therapy may be discussed.

Humans↗
PubMed1998

Management of malignant tumors of the salivary glands.

Results of treatment for patients with salivary gland carcinoma have improved in recent years, most likely due to earlier diagnosis and the use of more effective locoregional therapy. Salivary gland tumors are treated surgically, often in conjunction with postoperative radiation therapy when the tumor is malignant. Good results rest strongly on the performance of an adequate, en bloc initial resection. Radical neck dissection in indicated in patients with obvious cervical metastasis, and limited neck dissection may be appropriate in patients with clinically negative nodes in whom occult nodal involvement is likely. Postoperative radiation therapy should be administered when the tumor is high stage or high grade, the adequacy of the resection is in question, or the tumor has ominous pathologic features. Neutron beam therapy shows promise in controlling locoregional disease but requires further study. No single chemotherapeutic agent or combination regimen has produced consistent results. At present, chemotherapy is clearly indicated only for palliation in symptomatic patients with recurrent and/or unresectable cancers. Patients with salivary gland carcinomas must be followed for long periods, as recurrence may occur a decade or more following therapy. Distant metastasis appears to occur in approximately 20% of patients.

Humans↗
PubMed1996

[Therapeutic concepts and long-term outcome in thyroid gland carcinoma].

UNLABELLED: Data of all (n = 131) patients carrying thyroid carcinoma and operated on between January 1st, 1979, and September 30th, 1994 in our center were analyzed retrospectively. Patient's files were reviewed concerning histological diagnosis, TNM-classification, operation procedure and complications. Follow-up data were obtained in all cases from local cancer registry as well as from personal records. Statistical analysis was performed using PCS-software (TopSoft, Hannover). RESULTS: Follow-up data from 3-191 months (mean: 50.4 mo.) postoperatively were obtained from 72 patients with papillary thyroid carcinoma (PTC) including 27 cases of occult papillary thyroid carcinoma (oPTC, < 1.5 cm), 30 patients with follicular thyroid carcinoma (FTC), 10 patients with medullary thyroid carcinoma (MTC) and 19 patients carrying anaplastic tumor (ATC). In case of oPTC 51.8% of the patients received total thyroidectomy or lobectomy and contralateral near-total resection. In PTC, both procedures were performed in 68.9% combined with neck dissection in 31%. Radioiodine treatment was given to 59.7%. Treatment of FTC consisted mainly of thyroidectomy (60%) followed by radioiodine therapy (76.7%). In patients with MTC preference was given to thyroidectomy and bilateral neck dissection, more recently completed by mediastinal lymph node dissection. 90% of the patients with ATC were inoperable. No patient received chemotherapy pre- or postoperatively, respectively. Five-and 10-year survival of patients with PTC (oPTC) was 91.6% (93.7%) and 80.2% (93.7%), respectively. Corresponding data for FTC were 70.5% and 50.3%, and 71.6 % and 47.9%, for MTC respectively. ATC showed 10.3% 3-year survival. CONCLUSIONS: Despite therapy of choice was not performed in all patients, our long-term results generally confirm those reported by others. Despite of this, limited radical therapy should be restricted to oPTC in our opinion. In case of MTC presenting rising or elevated tumor markers postoperatively, early mediastinal lymph node dissection should be considered.

Adenocarcinoma, Follicular↗
PubMed1981

The pattern of lymph node metastases in intra-oral squamous cell carcinoma.

Histological study of all radical neck dissection specimens from 98 patients with clinically operable intra-oral squamous cell carcinoma has been carried out since 1973 to establish not only the presence of positive nodes but their site in the neck. All cases treated primarily by other methods such as radiotherapy or chemotherapy were excluded. Positive lymph nodes, found in 73 specimens, were grouped according to the site of the primary lesion. In no patient were nodal metastases found in the posterior triangle or in the submental region. No tumour deposits were found in the salivary glands nor were any found either in or superficial to the sternomastoid muscle. Obviously several factors must be taken into account in deciding the place of "functional" as distinct from radical neck dissection in the treatment of intra-oral malignancy, but the findings in this survey provide evidence in favour of the simpler less radical approach.

Carcinoma, Squamous Cell↗
PubMed2005

Intraoperative lymphatic mapping in cases of midline squamous cell carcinoma.

OBJECTIVE: To analyze the value of intraoperative lymphatic mapping in cases of midline primary head and neck squamous cell carcinoma (HNSCC) in clinically staged N0 necks. MATERIAL AND METHODS: Eleven patients with HNSCC of the epiglottis (2 T1, 6 T2, 3 T3), all of whom were staged with a neck status of N0 using sonography and CT, underwent intraoperative peritumoral (99m)Tc-nanocoll injection (4 sites; 45 MBq), radiolabeled detection and analysis of up to 3 hot sentinel nodes (SNs) during elective neck dissection. RESULTS: Gamma probe use revealed bi- and unilateral intranodal tracer uptake in 6/11 and 5/11 patients, respectively. In 2/6 patients with bilateral intranodal tracer uptake an SN with an isolated metastasis was found at one neck site while the other four patients were tumor-free in the SNs. Of the five patients with unilateral intranodal tracer uptake, three had radiolabeled SNs containing isolated metastases whereas two had no cancer detected, giving a total occult cancer rate of 45% (5/11). No cancer was found in non-labeled nodes. CONCLUSIONS: Intraoperative lymphatic mapping correctly identified the stage of metastatic disease. Unilateral tracer uptake represented the pathway of occult metastatic spread in 3/5 patients and the disease-free neck status of both neck sites in 2/5 patients. No patient had occult bilateral cancer. Future investigations should be done to determine whether intraoperative lymphoscintigraphy can guide the indication for unilateral only or bilateral neck dissection in these patients.

Aged↗
PubMed1989

[Primary melanoma of the oral cavity].

Melanoma most often develops in the skin; usually at the site of a preexisting nevus. It is quite rare in the oral cavity and the maxilla is the most common location there. It appears that males between 60 and 70 years old are affected more often than females. The etiology is unknown. However the melachromatic nevus and the color of the skin are considered predisposing factors. Based on clinical and histologic criteria it is classified in three categories. Unfortunately the frequency of the occurrence of each category into the mouth separately, is inversely proportional to the prognosis. The 5 year survival rate of intraoral melanoma does not exceed 5-9%. The treatment of melanoma is surgical and comprises radical excision of the lesion and radical neck dissection. Radiotherapy and chemotherapy do not seem to contribute to the treatment. We present our experience of two patients with melanoma of the maxilla. In one case submandibular lymphadenopathy had already been established and a radical neck dissection was performed. In the other case subtotal maxillectomy was performed with intraoral approach.

Female↗
PubMed1990

A retrospective study on the efficacy of cervical lymph node dissection in well-differentiated carcinoma of the thyroid.

The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid is controversial. In our department, from 1963 to 1972, node plucking was performed only in patients with cervical lymphadenopathy whereas, from 1973 to 1983, modified radical neck dissection was therapeutically or electively performed. In order to determine whether the more extensive dissection is adequate, a retrospective analysis was performed using two groups of patients who were managed differently with regard to the treatment of cervical lymph node metastases. From this series of 206 patients with more than five years follow-up, it was found that the rates of survival and lymph node recurrence did not differ between the two groups. However, since the well-differentiated carcinoma of the thyroid has relatively indolent biological behaviour, further long-term follow-up seems to be necessary for demonstrating the efficacy of neck dissection.

Adolescent↗
PubMed2004

Prognosis after reoperation for local recurrence of papillary thyroid carcinoma.

PURPOSE: To investigate the factors associated with a favorable prognosis after reoperation for local recurrent papillary thyroid carcinoma (PTC), we reviewed 45 patients who underwent surgery for first local recurrence of PTC. METHODS: We divided the patients into two groups. Group A (n = 28) had no second recurrence, and group B (n = 17) had second local recurrence after surgery for recurrence. RESULTS: The mean follow-up period after reoperation was 56.9 months. The mean age at the time of reoperation in group A was significantly lower than that in group B, at 48.1 years versus 62.3 years, respectively (P = 0.0007). The mean age at the time of the initial operation in group A was also significantly lower than that in group B, at 40.1 years versus 55.1 years, respectively (P = 0.0006). Patients with recurrent tumors only outside the area dissected at the initial operation (n = 27) had a better outcome than those with recurrence within the dissected area (n = 18; P = 0.0127). Patients who underwent systematic partial or modified neck dissection (n = 36) had a better outcome than those who underwent only simple local resection (n = 9; P = 0.0169). CONCLUSION: For local recurrent PTC, systematic neck dissection is recommended over local resection of recurrent tumors.

Adult↗
PubMed2003

Paratracheal lymph node involvement in advanced cancer of the larynx, hypopharynx, and cervical esophagus.

OBJECTIVES/HYPOTHESIS: The presence of nodal metastatic disease in head and neck cancer is the foremost prognostic factor. Although neck dissection is the surgical gold standard for the treatment of cervical lymphatic spread, the paratracheal nodal group is not routinely included in the dissection. The study determined the nodal yield, presence of metastases, and prognostic importance of paratracheal nodes in patients with advanced carcinoma of the upper aerodigestive tract. STUDY DESIGN: Prospective histological and survival analysis. METHODS: Over a 4-year period (October 1994-June 1998), consecutive patients undergoing laryngectomy with or without pharyngectomy or cervical esophagectomy underwent paratracheal node dissection on a prospective basis. Nodal tissue was examined for the presence of metastases. Statistical comparison of survival probability was determined by use of log-rank/chi2 test. RESULTS: Fifty patients have been included in the study to date, with a minimal follow-up of 3 years. The average number of paratracheal nodes dissected was three per side (range, 1-5). Thirteen (26%) patients demonstrated histological evidence of paratracheal nodal metastases (larynx, 20%; postcricoid/cervical esophageal region, 43%). Five patients (10%) had positive paratracheal nodes alone in a histologically negative cervical neck dissection. The majority of positive paratracheal nodes were less than 1 cm in diameter and appeared negative preoperatively. The absence of positive paratracheal nodes may have a survival benefit. CONCLUSION: The study highlighted the propensity of advanced carcinoma of the upper aerodigestive tract to involve the paratracheal nodes. This area should be routinely dissected in the surgical management of these tumors.

Aged↗
PubMed1996

Cervical lymph node metastatic patterns of squamous carcinomas in the upper aerodigestive tract.

The radical neck dissection specimens of 384 ethnically Chinese patients with different primary squamous carcinomas in the head and neck region were studied. Over 50 per cent of the specimens showed metastatic disease at one level in the neck. For oral cavity carcinoma, the levels of metastasis frequently involved were I, II and III while for carcinoma of the oropharynx, hypopharynx and larynx the levels were II, III and IV. Extracapsular spread was present in 112/384 of patients (29 per cent) and this increased with advancing N-stages. Based on these findings, different selective neck dissections could be used for patients harbouring different primary head and neck carcinomas with limited neck disease.

Carcinoma, Squamous Cell↗
PubMed2005

FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma.

PURPOSE: Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck. METHODS AND MATERIALS: Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85%) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings. RESULTS: FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96% (26 of 27) and 98.5% (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (kappa 0.95, 95% confidence interval 0.82-0.99) than for CT alone (kappa 0.81, 95% confidence interval 0.63-0.91; p = 0.06 by two-sided McNemar's testing). CONCLUSION: These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.

Adult↗
PubMed2006

Contralateral cervical lymph node metastases in pyriform sinus carcinoma.

OBJECTIVE: We designed a retrospective study to evaluate the incidence of contralateral neck metastases in squamous cell carcinoma of the pyriform sinus. STUDY DESIGN AND SETTING: Sixty-three patients with strictly unilateral squamous cell carcinoma of the pyriform sinus who underwent bilateral neck dissection at the time of primary surgery were included in this study. The medical records of all patients were reviewed. A multivariate statistical analysis was performed, considering some clinical and histologic parameters of T stage and N stage in relation to contralateral neck metastases. RESULTS: Contralateral neck metastases were histopathologically confirmed in more than 20% of the cases examined (13 out of 63 patients), of whom 3 were clinically staged as N2c, 2 N2b, 5 N2a, 2 N1 and 1 N0. The percentage of occult contralateral neck metastases was 77% (10/13 cases). Poorly differentiated tumors (P= .02) and the involvement of the lateral wall (P= .036) showed a statistically significant correlation with stage pN2c. Also T size and ipsilateral N stage were associated with the presence of contralateral neck metastases. CONCLUSIONS: Our data suggest that elective bilateral neck dissection is recommended in patients with locally advanced squamous cell carcinoma of the pyriform sinus. EBM RATING: C-4.

Adult↗
PubMed2003

Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?

Pharyngocutaneous fistula is the most common complication (8.7 to 22%) in the immediate postoperative period following total laryngectomy. The study's objective was to determine the incidence of post-laryngectomy fistulas in patients operated on in our department to establish whether specific factors predispose to fistula formation and to determine whether fistulas and tumor recurrence are related. Between 1992 and 2001, 377 cases of laryngeal carcinoma were diagnosed, and the patients underwent total laryngectomy in our department. Of these patients, 291 had total laryngectomy as the primary management of their disease, while in 86 patients the operation treated recurrence of the disease. In 92 patients, total laryngectomy was combined with radical or eclectic neck dissection. The presence of early postoperative fistula was established in 49 of the 377 patients (13%) studied. The cancerous stage, exact localization of the tumor, degree of differentiation, previous irradiation, patient's age, performance or not of neck dissection or emergency tracheostomy and fitting of voice prostheses were all factors that, after statistical analysis, did not appear to significantly influence the incidence of postoperative fistulas. Factors that did show statistical significance were the histological infiltration of the tumor's surgical margins (11% negative vs. 38% with positive margins) and coexisting early complications. Fistula management was conservative in the majority of cases. The necessary closure period for a fistula varied between 5 and 81 days (mean: 29 days). Postoperative follow-up of all patients revealed that fistulas did not influence the incidence of tumor recurrence. The incidence of postoperative fistulas in our study was 13%. Incomplete excision of the tumor and coexisting complications were related, among other things, to a higher rate of fistula formation. The rate of tumor recurrence after total laryngectomy was not related to the presence of a fistula during the postoperative period.

Adult↗
PubMed2001

Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy.

BACKGROUND: After treatment of locally advanced laryngeal carcinomas with induction chemotherapy and radiotherapy, some patients suffer a local or regional failure of the tumor, and salvage surgery is required. The aim of this study was to review the results of such salvage surgery in this group of patients. METHODS: A retrospective study of a cohort of 110 patients diagnosed between 1989 and 1996 with a locally advanced laryngeal carcinoma (T3-T4) treated with induction chemotherapy and radiotherapy was performed. The results of salvage surgery in patients with a local and/or regional failure of the treatment were analyzed. RESULTS: Forty-two patients presented a local and/or a regional recurrence of the tumor: 26 patients in the larynx, eight in the neck, and a further eight in both in the larynx and the neck. Salvage surgery was carried out in 28 patients (67%), consisting of total laryngectomies with neck dissections (24 cases), endoscopic resection of the tumor (one case), and radical neck dissections (three cases). Five-year adjusted survival for the 42 patients was 38%. Five-year survival for the 28 patients treated with salvage surgery was 57%. Five patients had postoperative complications: four had pharyngo-cutaneous fistulas and one had wound infection. CONCLUSIONS: After a local and/or regional recurrence, 67% of patients with advanced laryngeal carcinoma treated with induction chemotherapy and radiotherapy were candidates to salvage surgery. Five-year adjusted survival for this group of patients was 57%.

Cohort Studies↗
PubMed1984

Minimal thyroid carcinoma: a report of nine cases discovered by cervical lymph node metastases.

From 1962 to 1983, nine patients with minimal carcinoma of the thyroid were referred to Aichi Cancer Center Hospital and to Aichi Medical University Hospital for evaluation of enlarged lymph nodes in the neck. The radiographic study and scintigraphy of the thyroid were useful in detection of small thyroid lesions. In two cases, a lymph node biopsy was required for confirmation of the diagnosis. The thyroid lesions were histologically papillary carcinoma, in all the cases. A modified neck dissection with total thyroidectomy was carried out in five patients and modified neck dissection with thyroid lobectomy was done in four cases. Nine patients were followed for 6 months to 20 years and all the patients except one are alive.

Adult↗
PubMed2005

[Sentinel lymphonodectomy as a staging method for head and neck cancer. Analysis of 70 patients].

BACKGROUND: The excision of sentinel lymph nodes has a growing relevance in the diagnosis of oral and oropharyngeal cancer in cases of N0 necks. The validity of sentinel node biopsy (SNB) was examined as a single surgical staging tool. PATIENTS AND METHODS: Within the framework of a multi-modal treatment scheme, SNB without elective neck dissection was carried out on 70 previously untreated patients in the same session as the surgery for the primary cancer. Control of accuracy was via observation of the manifestation of neck node metastases in 45 patients who were postoperatively irradiated. RESULTS: A total of 94% of sentinel nodes could be excised; 9 patients (13%) had positive nodes and were treated with a therapeutic neck dissection (ND). There were 2 neck node metastases as second primaries, all other patients remained regionally inconspicuous (median observation time 26 months). CONCLUSION: As a staging tool for N0 necks and T1-3 tumors, SNB could lead to a considerable reduction in the number of elective NDs. It could be well integrated into a multi-modal treatment scheme.

Adult↗
PubMed1982

Planned preoperative radiation therapy for advanced laryngeal carcinoma.

One hundred ten patients with predominantly advanced laryngeal carcinoma were treated in the period 1969-1978 with planned preoperative radiation therapy followed by surgery. Site distribution was: 63 supraglottic, 26 glottic, 15 transglottic and 6 subglottic. There were 4 Stage II patients, 66 Stage III and 40 Stage IV. Preoperative radiation therapy consisted of Telecobalt irradiation to a total dose of 25 Gy given to a target volume encompassing the larynx and regional neck nodes, given in 5 equal daily fractions of 5 Gy in 5 consecutive days. Surgery was performed 2 days later. Total laryngectomy was performed on 48 patients, total laryngectomy with neck dissection on 55 patients, supraglottic laryngectomy on 5 and supraglottic laryngectomy with neck dissection on 2 patients. Crude actuarial 5 and 10 year survival probability for the whole group is 71 and 61%, respectively. The corrected 5 and 10 year survival is 75%. For patients with T3-T4-N0 tumors 5 and 10 year survival probability is: crude 65 and 58%, and corrected 70% respectively. For T3-T4-N+ crude: 75 and 60% and corrected: 78%. Of 110 patients, one died postoperative, three died of intercurrent disease, five died as a result of second malignancy, and 23 died of their larynx carcinoma: 12/23 because of locoregional failure, and 11/23 because of distant metastasis. We concluded that short intensive preoperative radiation therapy and surgery offer a high cure rate in the treatment of advanced resectable laryngeal carcinoma. The merits of this technique are outlined in the text.

Humans↗