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PubMed2006

Very early prophylactic thyroid surgery for infants with a mutation of the RET proto-oncogene at codon 634: evaluation of the implementation of international guidelines for MEN type 2 in a single centre.

OBJECTIVE: Genetic diagnosis available since 1993 established germinal mutations of the RET proto-oncogene at codon 634 as the main cause of inherited medullary thyroid carcinoma (MTC). International guidelines established in 1999 recommend that children with such mutations undergo a total thyroidectomy before age 5, with unspecified cervical neck dissection. Since 1993, only 41 of 275 thyroidectomies reported in RET 634 children were performed before age 5 (15%). The aim of this study was to evaluate the implementation of these guidelines in a single centre. DESIGN AND PATIENTS: Genetic diagnosis was proposed to the parents of all eight children born after 1992 from two RET 634 families. Total thyroidectomy was proposed before age 5 if the child carried a mutation. RESULTS: Genetic diagnosis was performed in all the children (aged 1-3) and thyroidectomy in the five who carried a mutation (aged 2-5). Cervical lymph node dissection varied from lymphadenectomy of central and lateral compartments in the eldest child to pickings in the youngest. There was no permanent hypoparathyroidism or recurrent nerve paralysis. C-cell hyperplasia, medullary thyroid carcinoma and lymph node metastasis were present in 5/5, 3/5 and 0/5, respectively. Undetectable pentagastrin-stimulated CT levels were achieved and maintained postoperatively in all five children (average follow-up 3.6 years). CONCLUSIONS: MEN 2 guidelines on thyroidectomy can be efficiently and safely implemented by a multidisciplinary team operating in a single centre. The lack of guidelines on cervical neck dissection remains a problem; this could be solved by determining an age under which this procedure would be deemed unnecessary.

Biomarkers, Tumor↗
PubMed2005

[Contralateral cervical lymph node metastasis in piriform sinus carcinoma].

OBJECTIVE: To evaluate relative factors affecting contralateral cervical lymph node metastasis in piriform sinus carcinoma. METHODS: Ninety-six cases of piriform sinus carcinoma with no preoperative treatments were selected. The contralateral cervical lymph node metastasis and relative factors were analyzed during operation or postoperative follow-up. The contralateral cervical metastasis was defined as followed: 1 contralateral cervical metastasis was confirmed pathologically after bilateral neck dissection (pN2c) or 2 contralateral cervical metastasis was found firstly during postoperative follow-up and the recurrence of primary lesion was excluded. RESULTS: The incidence of contralateral cervical metastasis was 32% (31/96). According to the T stage, the incidence of contralateral cervical metastasis was T1: 0% ,T2: 18%, T3: 37%, T4: 32% and to the N stage N0: 12%, N1: 13%, N2a: 17%, N2b: 39%, N2c: 100%, and N3: 75%. For primary lesions beyond midline the incidence of contralateral cervical metastasis was 52% but for those remaining on ipsilateral side it was 18%. CONCLUSIONS: Contralateral cervical lymph node showed higher metastatic incidence with higher T and N stage. When the primary lesions invaded beyond midline, the contralateral cervical metastasis increased greatly and neck dissection should be selected positively.

Adult↗
PubMed1997

[Histopathological study of local invasion and cervical lymph node metastasis in transglottic carcinoma].

To study the histopathological characteristics of local invasion and cervical lymph node metastasis in transglottic carcinoma and provide theoretical guide to clinical practice, 30 laryngectomy and 35 neck dissection specimens were studied by serial section, HE staining and observation under light microscope. The results showed that transglottic carcinomas originated from the ventricle invaded supraglottic and glottic areas equally. The metastatic rate of cervical lymph nodes was 43.3%; the latent metastatic rate was 30%. The metastatic and extracapsular perforation rates as well as the number of the aggregated fusion lymphnodes increased with the increase in the size of the lymphonodes. It was concluded that the transglottic carcinoma should be defined as one with the main lesion locates in the ventricle, or the ventricle being the center with transglottic spread. Since the barrier of ventricle was weak, partial laryngectomy should be performed with care, and ipsilateral neck dissection shoud be included during operation.

Adult↗
PubMed1998

[The parotid gland as a filtering station of metastatic head-neck melanoma. Retrospective study of 884 patients].

Formation of metastases was observed in 246 cases (27.8%) out of a group of 884 patients with melanoma of the head and neck region treated in the years 1967-1991. In the group of patients with metastases, regional metastases were found in the cervical lymph nodes in 136 cases (55.3%). In 74 patients (30.1%) the first metastasis was a distant metastasis, i.e., the tumor had spread by hematogenic dissemination. In 53 patients (21.5%) the first metastasis was located in the parotid gland. Evaluation of the clinical data of the patients led to interesting results regarding prognosis following the different types of surgical treatment. The 5-year survival rates were established by means of multivariant analysis using the Cox model, taking into account sex and tumor thickness: Following radical tumor removal, including neck dissection and parotidectomy, the 5-year survival rate amounted to 61.8%. If the parotid gland was not removed and only tumor and cervical lymph nodes were resected, 66.2% of the patients were still alive 5 years following surgery. The difference between these two groups was statistically not significant (P = 0.07). In those cases where only the primary tumor was removed, the 5-year survival rate was 85.8% and thus significantly better than in the two other groups (P < or = 0.0001). Two conclusions can be drawn: In metastasizing melanoma of the head and neck the parotid glands are affected in 20% of the cases and thus more frequently than expected. The retrospective analysis of groups of patients differing with regard to the prognosis of their disease cannot be used to provide information on which therapy is the best. This is particularly true for the question whether or not the parotid gland should be removed in addition to a neck dissection. It will be necessary to perform a prospective randomized study in order to find answers to these questions. Such a study could be performed within DOSAK (Deutsch-Osterreich-Schweizerischer Arbeitskreis für Tumoren im Mund-Kiefer-Gesichtsbereich = German, Austrian, Swiss Working Group on Tumors in the Maxillo-Facial Region) in cooperation with different hospitals.

Adolescent↗
PubMed2006

Sentinel lymph node biopsy in parotid gland carcinoma.

Indications for elective neck dissection (ELND) and its extent in N0-staged patients with parotid gland carcinoma are inconsistent. Therefore, a pilot study was performed to test the feasibility and efficacy of radioguided sentinel lymph node biopsy (SLNB) in these tumors. A total of 6 patients underwent lymphoscintigraphy, SLNB, and level II-IV ELND. In 2 patients, the latter was extended to level V because the scans had revealed an additional sentinel lymph node (SLN) in this atypical nodal region. In all cases, the SLNs were detected intraoperatively. The SLNB exactly reflected the positive and negative histopathologic status of the remaining lymphatic basin in patients 1 and 4, respectively. One case of false negativity of SLNB could be explained by distortion of the lymphatic outflow resulting from intraparotid localization of lymphatic metastasis. The authors believe that the SLNB could provide reliable information on the status of regional lymph nodes, making it possible to base the neck dissection on the actual presence of the micrometastases and to detect metastatic tumors at unusual nodal levels.

Humans↗
PubMed2003

[Treatment strategy for T4N1 thyroid papillary carcinoma based upon our clinical experience].

We retrospectively evaluated clinical profiles and prognoses in 152 patients with thyroid papillary carcinoma treated at Fukui Medical University between 1986 and 2000. As standard treatment, 106 (70%) underwent hemithyroidectomy to preserve the normal thyroid lobe. Subtotal thyroidectomy or total thyroidectomy was conducted on 40 cases (23%). Regional lymphnodes were extirpated in 104 (68%) with pathological N0, and radical or conservative neck dissection for 46 cases (30%) with pathological N1. Overall survival for 10 years, estimated using the Kaplan-Meier method, was 100% in both stage I and II, and 95% in stage III. Of 152 thyroid papillary cases, 22 (14%) had tumor recurrence. Of 51 in stage III, 14 (27%) had tumor recurrence. The 14 recurrent in stage III showed local extrathyroidal invasion. Note that 5 of 10 (50%) T4N1 treated with hemithyroidectomy had tumor recurrence in the residual thyroid lobe. Of 11 T4N0 cases who underwent hemithyroidectomy, none had tumor recurrence in the residual thyroid lobe. Results suggest that patients with T4N1 should be treated by total thyroidectomy and neck dissection at initial treatment. Tumor size, cervical lymphnodal metastasis, and distant metastasis may be prognostic factors for thyroid papillary carcinoma.

Adolescent↗
PubMed1996

Small carcinomas of the thyroid. A long-term follow-up of 867 patients.

OBJECTIVE: To determine the adequate extent of surgery for small carcinomas of the thyroid. DESIGN: Retrospective cohort study of 867 consecutive patients with small carcinomas of the thyroid (lesions < 10 mm in diameter) who were operated on at the Noguchi Thyroid Clinic, Oita, Japan, between 1965 and 1987. Mean follow-up was 12.8 years. SETTINGS: A center for treatment of thyroid disease, where about 1400 thyroid operations are performed per year. PATIENTS: Thyroidectomy was performed in patients with a preoperative diagnosis of Graves' disease, Graves' disease with nodules, solitary thyroid nodules, multinodular goiters, cysts, chronic thyroiditis and small carcinomas of the thyroid, in 394, 22, 136, 193, 18, 28, and 76 patients, respectively. RESULTS: Operations were conservative. Three patients who had adenomatous nodular goiters underwent total thyroidectomy. Modified radical neck dissection was performed in 66 patients. Of these 66 patients, 30 had grossly noticeable nodal metastases and 17 had microscopic metastases. Another 50 patients underwent selective lymph node excision, and 28 patients had nodal metastases. Recurrence from remnants of thyroid was seen in five patients. They were treated by surgery. Recurrence in lymph nodes was observed in five patients, and four of them were successfully treated. Recurrence in bone was observed in two patients; one with recurrence in the femur was successfully treated. Two patients died with recurrent cancer. CONCLUSIONS: Small carcinomas of the thyroid can be fatal. Total thyroidectomy is unnecessary. Modified radical neck dissection is unnecessary unless gross nodal metastases are present. Long-term follow-up is mandatory. A

Adolescent↗
PubMed1999

[Surgical management of subglottic carcinoma].

OBJECTIVE: To explore the clinical features and the methods of surgery and functional restoration of subglottic carcinoma. METHODS: Thirteen cases with primary subglottic carcinoma were treated surgically in this department from 1981 to 1997. Among them, six had T1-2N0 lesions, one had T3N0 lesion and six had T3-4N1-2 lesions. Four cases underwent total laryngectomy and nine had subglottic partial laryngectomy. The extensive subglottic partial laryngectomy was performed on patients with tracheal invasion. The defects of larynx were reconstructed by using unilateral or bilateral pedicled musculocutaneous flap, myofascial flap accordingly. T-shape silastic tube was placed in to the reconstructed cavity of larynx during the operation and the patients were decannulated in 2 to 6 months. Unilateral radical neck dissection was performed on 4 patients and bilateral on 2. RESULTS: All cases had restored the function of phonation except for 4 who underwent total laryngectomy. Five out of 9 (55.6%) were decannulated. The swallowing function was restored in all patients. The 3-year and 5-year survival rates were 100% and 66.7% in the cases with total laryngectomy, 88.9% and 75.0% with subglottic partial laryngectomy, respectively. CONCLUSION: It is possible to detect early subglottic carcinoma by using fiberoptic laryngoscopy routinely with the combination of stroboscopy, CT, MRI in male patients over 40 with hoarseness. It is practical that the whole or partial function of larynx could be restored in most cases with subglottic carcinoma after partial laryngectomy or subtotal laryngectomy. Unilateral or bilateral neck dissection should be performed on patients with T3 or T4 lesion. Postoperative radiotherapy is necessary.

Adult↗
PubMed2006

Lip-splitting in transmandibular resections: is it really necessary?

Mandibular resection approach (Commando or Composite resection) is one of the fundamental techniques for oral and oropharyngeal large tumour resection. We reviewed the charts of patients who underwent a transmandibular resection for an oral and/or oropharyngeal cancer between 1980 and 2002. Of 700 patients who underwent a mandibular resection for cancer, 332 had been operated without lower lip splitting. A mono or bilateral en-block neck dissection was always performed, except in cases of relapses after a prior surgical treatment with neck dissection. We repaired 307 patients with flaps (pedicled or free flaps, with or without bone). Unsplitting of the lip never complicated resection and reconstruction. Furthermore the procedure was time sparing, as we avoided haemostasis and suture of the lip. The cosmetic results were better than those obtained by traditional technique. We used a non-lip-splitting technique also for pull-through, marginal mandibulectomy and, sometimes, for mandibular-swing approaches. In the latter case, the technique has some advantages and disadvantages and must be applied according to circumstances. We can conclude that lip-splitting in transmandibular resection for oral and oropharyngeal tumours is not necessary.

Humans↗
PubMed1977

Carcinoma of the tonsil: results of radical irradiation with surgery reserved for radiation failure.

This analysis reviews the treatment results of 58 patients with squamous cell carcinoma of the tonsil who were treated by radical irradiation to the primary, with operation reserved for radiation failures. Postirradiation radical neck dissection was sometimes added as part of the initial treatment plan. The local control and absolute survival rates for T1-T2 lesions were quite good, and complications were minimal. On the other hand, the local control and absolute survival for T3-T4 lesions were only fair, and complications generally more severe, although mandibulectomy for osteonecrosis was not required in this small series. There appears to be no justification for combining operation with radiation in the initial attack for T1-T2 lesions. Although the T1-T2 lesions might as well be cured by operation alone, it would entail the loss of part of the mandible, pharyngeal wall, possibly some tongue and soft palate, and at least one radical neck dissection. At attempt at combining operation and irradiation for some T3 (T4) lesions appears justified by the high failure rate of radical irradiation alone. However, therapeutic zeal should be tempered by the realization that many of these patients are elderly or in poor general health, and an aggressive combined treatment approach may be unrealistic .

Carcinoma, Squamous Cell↗
PubMed2004

Parotidectomy for primary nonparotid diseases.

OBJECTIVE: To analyze the indications and results of parotid gland resections for patients with primary nonparotid diseases. STUDY DESIGN AND SETTING: Retrospective analysis of 442 consecutive parotidectomies (76 for primary nonparotid disease) in a referral head and neck surgery service, tertiary care university hospital. RESULTS: Skin cancer (mainly squamous cell and basal cell carcinomas) was the most common indication for parotidectomy. Superficial parotidectomy with preservation of the facial nerve was the most commonly performed operation (61.8%), with some form of nerve sacrifice necessary in 31.6%. Parotid gland parenchyma and/or lymph nodes were pathologically positive in 46 cases. Neck dissections were carried out in conjunction with parotidectomy in 42 patients (1 patient had had previous neck dissection), of which 16 turned out to be pN+. CONCLUSION: Parotidectomy should be considered as part of the surgical treatment of tumors whenever oncologically necessary for appropriate margins, lymph node dissection, and for proper identification and preservation of the facial nerve.

Adolescent↗
PubMed1993

Bilateral intraocular pressure elevation and decrease of facility of aqueous humour outflow as a consequence of regional lymphoedema of head and neck.

Aqueous humour drainage to the deep cervical lymphatics has been proven in animal experiments, but there have been no observations of changes in intraocular pressure (IOP) or aqueous humour drainage as a consequence of lymph drainage dysfunction. The history of a patient with non-Hodgkin's lymphoma, who underwent a left-sided radical neck dissection in January 1991, is reported. From the end of 1991 lymphoedema of the head and neck, predominantly on the right side, developed without venous stasis but with significant bilateral IOP elevation and aqueous humour outflow reduction, refract to conventional treatment. Two days after cytostatic treatment the lymphoedema disappeared, and IOP and aqueous humour outflow became normal. Four days later the patient died because of an acute bronchopneumonia. The pathological examination revealed an intact internal jugular venous system, enlarged lymph nodes and, as a consequence of previous irradiation, cicatrization in the right side of the neck. On the left side, there was absence of the internal jugular vein and jugular lymphatic trunk due to previous radical neck dissection. Our case suggests that regional lymphatic stasis and the absence of the collateral drainage to the contralateral side significantly reduces the aqueous humour outflow and leads to a bilateral, secondary IOP elevation.

Aqueous Humor↗
PubMed2002

Lymphatic mapping and sentinel lymph node biopsy in squamous cell carcinoma of the lower lip.

AIMS: The risk of metastases to the submandibular and submental lymph nodes in squamous cell carcinoma (SCC) of the lower lip is closely related to the primary tumour size and the differentiation of the tumour. In order to determine the feasibility of the technique and the possible metastatic lymph nodes in SCC of the lower lip, intraoperative lymphatic mapping and sentinel lymph node biopsy was performed in patients with tumour size greater than 2 cm (T2) and clinically non-palpable regional lymph nodes (N0). METHODS: Intraoperative lymphatic mapping with patent blue dye was performed in 20 patients with SCC of the lower lip. The stained lymph node (sentinel) was identified in each patient and sent for frozen section analysis in order to verify tumour metastasis. All patients had undergone bilateral suprahyoid neck dissection at the same stage. RESULTS: Three of the patients were female and 17 were male. The median age was 66. Sentinel lymph nodes were identified in 18 of the patients (90%). Intraoperative or post-operative histopathologic examination of the sentinel lymph node showed tumour metastasis in three of the patients (16.6%). The histopathologic examination of the remaining 15 patients whose sentinel lymph nodes were free of metastasis, showed no metastasis in the non-sentinel lymph nodes. In two of the three patients with metastatic sentinel lymph nodes, non-sentinel lymph nodes were free of metastases. There were no false negative results and no local or systemic complications of the technique were seen among the patients. CONCLUSIONS: Intraoperative lymphatic mapping and sentinel lymph node biopsy is feasible in patients with SCC of the lower lip who have large tumour size and non-palpable regional lymph nodes. The technique may help to avoid neck dissection when the patient has negative sentinel lymph node and when positive provides useful information for more effective radical treatment.

Adult↗
PubMed2006

Desmoplastic stromal reaction in medullary thyroid cancer-an intraoperative "marker" for lymph node metastases.

BACKGROUND: Medullary thyroid cancer (MTC) disseminates early to lymph nodes (LN). There is no pre- or intraoperative marker to exclude LN involvement and thereby avoid lateral neck dissection in LN-negative patients. MATERIALS AND METHODS: This study was intended to verify the observation that patients with MTC lacking desmoplastic stromal reaction (DSR) never have LN metastases. In 120 patients undergoing primary operation for sporadic MTC the prognostic value of DSR with respect to LN involvement was evaluated. RESULTS: Thirty-two (27%) of 120 tumors were DSR negative, and 88 (73%) were DSR positive. All 32 (100%) DSR-negative tumors were LN negative (N0), and all patients were biochemically cured. Of 88 DSR-positive tumors, 57 (65%) were staged N0, and 31 (36%) were staged N1(LN positive; Fisher's exact test: P = 0.0001). In a comparison of the LN involvement to the DSR characteristics, 32 (36%) of the 89 N0 patients and none of the 31 N1 patients were DSR negative. The sensitivity of DSR in predicting N0 is 38% (95% confidence interval: CI 95% = 27 %-55%), the specificity is 100% (CI 95% = 88%-100%). The sensitivity and specificity for the parameter DSR to differentiate between N0 or N1 were 100% and 36%, respectively. CONCLUSIONS: The desmoplastic stromal reaction appears to be an excellent intraoperative marker to predict LN involvement with a high specificity but low sensitivity. We therefore propose to avoid initial lateral neck dissection in MTC patients without DSR.

Adult↗
PubMed2001

[Lymph node metastasis in head-neck tumors].

BACKGROUND: One of the most important criteria of malignancy of head and neck cancer are the cervical lymph metastases. Being significant for the therapeutical plan is how tumor depending parameters like T-stage, degree of differentiation and tumor localisation will influence the N-stage and therefore the extension of neck dissection. METHOD: To evaluate the pattern of formations of metastases and the success of therapy a retrospective study was performed on 405 patients with carcinoma of the oral cavity (n = 47), the oropharynx (n = 117), the hypopharynx (n = 47) and the larynx (n = 193). RESULTS: By the time of surgery carcinoma of the hypopharynx were most frequently accompanied by cervical metastases (80%), followed by carcinoma of the oropharynx (70%), the oral cavity (52%) and the larynx (26%). Occurrence and extension of regional lymph node metastases correlated well with T-stages and degree of differentiation. After surgical therapy locoregional recurrence could be observed in 5.2% of the patients. Five-year-survival rate was reduced to 50% on patients with positive lymph nodes. The different tumour sites showed preferred patterns of metastatic spread, without complete avoidance of certain levels. CONCLUSION: For the decision on indication and extent of neck dissection the preoperative diagnostic (ultrasound, CT-scan, MRI), localisation of tumour, T-stage, degree of differentiation and the knowledge of typical metastatic spread must be considered.

Carcinoma, Squamous Cell↗
PubMed2002

Neodymium YAG contact laser in the treatment of cancer of the mobile tongue.

The aim of this study was to evaluate the usefulness of a contact neodymium YAG laser for the treatment of squamous cell carcinoma (SCC) of the mobile tongue in 35 patients. The TNM stage and histologic grade were as follows: T1, n = 20; T2, n = 11; T3, n = 4; and N0, n = 33; N1, n = 2; G1, n = 20; G2, n = 10; and G3, n = 5. The surgical treatment consisted of a hemiglossectomy or resection with adequate margins in 28 cases, and an ipsilateral neck dissection was also performed in 7 patients. Radiotherapy to a mean tumor dose of 62-64 Gy and an elective dose of 50 Gy to the cervical lymph nodes was given to 14 patients. The radiotherapy was preoperative in 12 patients and postoperative in 2. Tongue resection was easily performed using the contact neodymium YAG laser, with a mean operation time of 31 min and intraoperative bleeding varying from negligible to 100 cm3. During postoperative follow-up no major complications occurred: cases with minor hemorrhage were easily controlled on the ward and 1 patient had a bleed on the 14th postoperative day necessitating hospitalization. The resection was histologically radical in all cases. During follow-up one patient had a local recurrence (T2N0, G3) and four failed in the neck (T1N0 G2, T1N0 G2, T1N0 G2, T2N0 G2), three of whom were successfully salvaged with a neck dissection and radiotherapy. One patient with osteoradionecrosis was diagnosed and treated curatively. Two patients died of their tongue cancer (T2N0 G3, T2N0 G2), 1 died from a second primary tumor (T2N0 G1) and 2 of intercurrent disease with no evidence of cancer; 30 patients (86%) are still alive with no evidence of disease. The function of the tongue in all patients in this sample was good to satisfactory. The major complaint was xerostomia in the irradiated patients. In conclusion, the contact neodymium YAG laser appears to be suitable for resection of T1-T2 SCCs of the oral tongue. In this limited patient sample T stage or grade did not predict failures in the neck. Biologic predictive markers need to be evaluated.

Carcinoma, Squamous Cell↗
PubMed2003

Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma. Implication for therapeutic decision making.

BACKGROUND: Regional lymph node metastasis is the most reliable predictor of treatment outcomes for patients with squamous cell carcinoma of the oral tongue (SCCOT). A recent American Joint Committee on Cancer staging update of malignant melanoma has incorporated pathologic lymph node staging. The authors hypothesized that pathologic lymph node staging (pN) would be a more reliable predictor of treatment outcomes than clinical lymph node staging (cN). METHODS: The authors retrospectively reviewed 266 patients who received primary surgical treatment for SCCOT, including a neck dissection, from January 1980 to December 1995. Overall and disease-specific survival and disease-free interval were compared with respect to clinical and pathologic lymph node stages. RESULTS: Statistically significant survival differences were identified for both clinical (cN0-cN2) and pathologic lymph node stages (pN0-pN2). However, survival and disease-free interval differences for pathologic lymph node staging reached higher statistical significance (P < 0.0001) than for clinical lymph node staging (P < 0.002). This disparity can be explained by stage migration (i.e., patients with cN0-1 disease have a more advanced lymph node stage at the time of pathologic review compared with patients without cN0-1 disease). The authors found a 34% rate of occult lymph node disease in the cN0 group (19% of occult lymph nodes had extracapsular spread [ECS]). Similarly, 43% of cN1 patients had a higher stage than pN2b disease and 50% had ECS. CONCLUSIONS: Pathologic lymph node staging, based on a staging or therapeutic neck dissection, should be considered for patients treated for SCCOT to identify high-risk patients who may benefit from additional adjuvant therapy. Prospective studies are essential to validate these findings before pathologic lymph node staging is included in standard staging criteria.

Carcinoma, Squamous Cell↗
PubMed1991

Larynx preservation with combined chemotherapy and radiation therapy in advanced but resectable head and neck cancer.

Forty patients with advanced, resectable squamous cell carcinoma of the larynx, oropharynx, or hypopharynx whose surgery would have required total laryngectomy (TL), were treated with one to three cycles of cisplatin-based chemotherapy before local therapy with the goal of larynx preservation. Clinical complete responses (CRs) or partial responses (PRs) to chemotherapy were seen in 26 of 40 patients (65%). Three patients with primary-site disease unresponsive to chemotherapy underwent resection of the primary lesion and neck dissection followed by radiation therapy (RT). Thirty-seven patients were referred after chemotherapy for RT +/- neck dissection. Thirty-one of 40 patient (78%) were rendered disease-free (no evidence of disease [NED]). With a median follow-up of 49 months (range, 31 to 76), the overall actuarial survival rate for the group was 58% at 2 years and 33% at 5 years. The failure-free survival rate was 42% and 33% at 2 and 5 years, respectively. Seven patients refused recommended TL throughout their course. This may have adversely affected survival results. A greater proportion of patients who achieved a CR or PR to chemotherapy remained disease-free compared with those who achieved less than a PR (P less than .001). Sixteen patients relapsed, 10 with locoregional disease. Six patients underwent TL, either for initial induction failure or at relapse, for an actual larynx-preservation rate of 34 of 40 patients (85%). If the seven patients who refused TL are included, the anticipated preservation rate is 27 of 40 patients (68%). Larynx preservation with combined chemotherapy and radiation is feasible and effective in patients with advanced, resectable squamous cell carcinoma of the head and neck (SCHN). This treatment approach requires a motivated patient, careful patient monitoring, and close interdisciplinary cooperation among oncologists.

Adult↗