Recurrence of oropharyngeal carcinoma after radiotherapy

Two-hundred-and-twenty-one patients with squamous carcinoma of the oropharynx treated by irradiation are presented. The primary recurrence rate at five years in the previously untreated patients was 27%, but was dictated by neither host factors (age, sex and general condition) nor tumour factors (site, T-stage and histological grade). Pre-operative histological diagnosis had a very high sensitivity but a low specificity, indicating that false positives are common but false negatives unusual. Twenty per cent of patients with a recurrent primary tumour were untreatable. The five year survival after a primary recurrence was 31 per cent. Sixty-eight per cent of patients undergoing major surgery recovered without a major complication, and the hospital mortality rate was three per cent, due entirely to major medical catastrophes. The major complication rate in those undergoing flap repair after major resection was seven per cent. The metastatic rate in lymph nodes was 44 per cent at five years, and again this did not depend on any host or tumour factors. The survival at five years after node recurrence was a mere 19 per cent, and the length of survival was related to the primary site of the original tumour and the presence of extranodal disease. Two-thirds of patients had advanced disease (N2 and N3) when node recurrence was diagnosed and about 15 per cent were unsuitable for surgery.     

Surgery and postoperative radiotherapy a valid treatment for advanced oropharyngeal carcinoma

Since 1992 we have prospectively included all head and neck cancer patients in our health region in a departmental based register. Our hospital takes care of all head and neck cancer patients in our health region consisting of approximately 1 million people. In 1997, we evaluated the results of the treatment of oropharyngeal cancer in the 1992?C1997 period. On the basis of this evaluation, we changed our treatment policy for tonsillar and base of tongue carcinoma. We first changed the treatment for the lesions with worst prognosis, i.e., those with T3?CT4 carcinomas, from radiotherapy only, to radical surgery and postoperative radiotherapy. We have since that time increasingly also operated the smaller oropharyngeal carcinomas. The 2?years?? overall survival and disease-specific survival for all patients diagnosed in the 1992?C1997 period was 56 and 63%, respectively. The results from a similar group of patients in the 6?years?? period from 2000 to 2005, after the change in treatment, have increased to 83 and 88%. When we looked at the subgroup of patients in the 2000?C2005 period treated with surgery and postoperative radiotherapy, 45 out of 69 patients (65%) presenting with an oropharyngeal cancer were fit for operation. With radical surgery and postoperative radiation therapy, the 2?years overall survival is now 91%. The 2-year disease-specific survival is 96% and the locoregional control is 98%. This is a marked improvement as compared to radiotherapy alone and definitely competitive with modern radiochemotherapy.     

Advanced oropharyngeal carcinoma treated with surgery and radiotherapy: oncologic outcome and functional assessment

INTRODUCTION/PURPOSE: Surgery and postoperative radiotherapy (XRT) is a standard therapy for locally advanced resectable oropharyngeal carcinoma. This maximizes local-regional control, but does not address the potential for occult distant metastases. Additionally, some patients may suffer poor functional outcome after this intensive local therapy. This report reviews our institutional experience with modern radical surgery and XRT for this disease. METHODS: A retrospective chart review was performed on 51 consecutive patients treated from 1991 to 1997 at the University of Pennsylvania with radical surgery and postoperative XRT. This study included patients with locally advanced, stage III/IV (exclusive of T1-2N1) squamous carcinoma of the oropharynx. All patients had a good performance status (ECOG 0-1). Patients who received adjuvant chemotherapy were excluded. No patient had gross residual disease after surgery; the median XRT dose was 63.7 Gy. Survival, local-regional control (LRC), and freedom from distant metastases (DM) were calculated actuarially. In patients who remained free of disease, functional status was determined using the List Performance Status Scale (PSS). RESULTS: With a median follow-up in surviving patients of 34 months, the 3-year actuarial overall survival was 51%. The 3-year LRC was 73%, and the freedom from DM was 69%. The most significant factor predicting for failure was the number of pathologically positive nodes (P <.001 for survival and DM; P =.003 for LRC). In 29 patients who were evaluable for the List PSS, the mean normalcy-of-diet score was 48; the mean eating-in-public score was 53; and the mean understandability-of-speech score was 75. There was a trend toward better PSS scores in patients with T1-2 tumors versus T3-4 tumors, although this did not reach statistical significance. CONCLUSIONS: Surgery and postoperative XRT offer relatively good LRC and moderate overall survival rates. Results, however, remain suboptimal, particularly with respect to the risk of DM and the functional outcome. These data provide a baseline for comparison with maturing results from multimodality trials in which radical surgery is not used in all patients with locally advanced oropharyngeal carcinoma.     

Tumor volume as a prognostic factor in oropharyngeal squamous cell carcinoma treated with primary radiotherapy

Objectives/Hypothesis: Tumor volume has been demonstrated to play a prognostic role in many head and neck cancers. The purpose of this study was to conduct an institutional review analyzing the correlation between tumor volume and locoregional control of oropharyngeal squamous cell cancer treated with primary radiotherapy. Study Design: Retrospective institutional chart analysis. Methods: Seventy‐nine patients from 1991 to 2005 with primary T1 to T4 oropharyngeal squamous cell carcinoma (base of tongue, n = 31; soft palate, n = 1; tonsils, n = 47) were treated with primary radiotherapy. Tumor volumes were measured from pretreatment computerized tomography scans by two observers. Three‐dimensional tumor volumes were calculated using a computer digitizer for each computed tomography slice showing the primary lesion. Survival analysis, using the methods of Kaplan and Meier, was performed to assess whether tumor volume, Tumor, Node, Metastasis classification, tumor stage, or location were associated with locoregional failure. Results: Tumor volume did not significantly correlate with locoregional failure (observer 1, P = .6244; observer 2, P = .5612). There was a high interobserver correlation (r = 0.98970). Univariate analysis did, however, demonstrate a significant difference in locoregional failure between T4 tumors and all other T stages (T1 vs. T4, P = .0107; T2 vs. T4, P = .0004; T3 vs. T4, P = .0155). Nodal status, tumor stage, and location did not significantly correlate with locoregional failure rate. Conclusions: Tumor volume does not appear to play a significant role in predicting locoregional recurrence for patients with primary squamous cell cancer of the oropharynx treated with primary radiotherapy. However, T4 status was predictive of poor locoregional control.     

口咽癌的外科治疗

目的：探讨口咽癌扩大切除一期再建的手术方法,观察并发症及术后语言、吞咽功能恢复情况。方法：30例口咽癌中软腭癌2例,扁桃体癌3例,咽侧壁癌16例,舌根癌9例;Ⅲ、Ⅳ期患者占63．3％（19／30）,颈淋巴结转移53．3％（16／30）。22例用下颌骨切开外旋或切除升支入路进行了肿块根治性切除,同期行颌下清扫术1例,肩胛舌骨肌上清扫术3例,根治性颈清扫术26例。咽部缺损用带蒂胸大肌皮瓣整复17例,胸锁乳突肌皮瓣4例,额顶部岛状皮瓣3例,斜方肌皮瓣和颈阔肌皮瓣各1例,游离前臂皮瓣＋带蒂复合瓣4例。手术＋放疗25例,单纯手术5例。结果：3年生存率为66．7％（14／21）。术后局部感染7例,涎瘘5例,皮瓣远端部分坏死4例,语言、吞咽功能基本恢复。结论：局部缺损范围和选择适宜的肌皮瓣是恢复腭咽闭合及舌可动性的主要因素,带蒂胸大肌皮瓣修复软腭、口咽侧壁及舌根大面积缺损效果良好。     

Major surgery of oral and oropharyngeal carcinoma.

Thirty-two composite resections were carried out in the Department of Otolaryngology at Groote Schuur Hospital for oral and oro-pharyngeal squamous carcinoma over the 10-year period, 1977-1986. Three patients were lost to review but all others were followed up to death or to five years. Twenty-seven patients underwent surgery as their primary procedure and five for recurrence after primary radiotherapy. The overall survival was 16 patients at three years and eight at five years. Only one of the five patients who underwent salvage surgery after failed radiotherapy was alive at five years and all five experienced serious postoperative complications. All those surviving over five years had had either N0 or N1 disease at the time of presentation for surgery.     

经舌骨入路口咽前壁癌的综合治疗

目的 探讨对口咽前壁癌患者施行以经舌骨入路切除为主的综合治疗效果.方法 回顾性分析2005年5月至2010年10月24例口咽前壁即舌根会厌区癌患者的临床资料.24例患者中T27例,T3 2例,T4 15例;N0 7例,N1 4例,N2 12例,N3 1例.均经舌骨入路,行全舌根和(或)半舌切除+喉部分切除9例,舌部分切除+喉全切除7例,舌全切除+喉部分切除7例,舌部分切除(全舌根+半舌)1例.胸大肌岛状肌皮瓣修复全舌(7例)或部分舌(9例)及咽侧壁缺损(16例),修复颈部皮肤缺损1例;游离前臂皮瓣+胸骨舌骨肌瓣修复半舌、咽侧及部分咽后缺损1例;胸骨舌骨肌瓣修复舌根2例;直接拉拢缝合4例.20例行双侧颈清扫术,4例行单侧颈清扫术.术前放疗5例,术后放疗16例.结果 24例患者原发灶切缘均阴性,17例(70.8％)患者淋巴转移阳性.术后咽瘘3例,其中2例舌部分切除+喉全切除胸大肌皮瓣一期修复术后4d出现咽瘘者,经清创换药后拉拢缝合;1例舌根全切除+喉部分切除术后放疗后咽瘘者以胸大肌皮瓣修复.17例保留喉功能患者中16例于术后1～6个月内拔管,恢复正常饮食,构音尚可,另1例发音、吞咽尚好,但堵管后通气不足,未能拔管.随访3年以上21例,Kaplan-Meier法计算3年总生存率72.6％.结论 经舌骨入路口咽前壁癌切除是较为理想的术式之一,手术缺损较大,多需一期修复,综合治疗尚能取得较满意结果.     

Squamous carcinoma of the posterior oropharyngeal wall

We treated 9 patients with squamous cell carcinoma of the posterior oropharyngeal wall at the Cancer Institute Hospital, Tokyo. All were men averaging 64.1 years of age. One patient each was stage I, stage II or stage III, and 6 were stage IV. Cervical lymph node metastasis was seen in 6 at initial diagnosis. Retropharyngeal lymph nodes were involved in 4, while 5 had second primary cancer such as esophageal, gastric, head and neck cancer. Radical radiotherapy was done for 3 and surgery as initial treatment in 6. Five-year local control was 50% and 5-year disease-free survival was 22%. Total laryngectomy was done for 4 patients. Six died of oropharyngeal cancer and 1 of second primary cancer. Cancer of posterior pharyngeal wall is relatively rare and the prognosis is considered poorer than other types of oropharyngeal cancer for necessitating study to determine which modality may improve treatment results.     

Adenosquamous carcinoma of the lateral oropharyngeal wall

Adenosquamous carcinoma of the head and neck is a rare and aggressive tumor, with fewer than 100 cases reported in the world literature to date. We report a case of adenosquamous carcinoma of the oral pharynx arising as a second primary malignancy in a patient being treated for primary gastric MALT (mucosa-associated lymphoid tissue) lymphoma. We also review the literature to assess current treatment and long-term prognosis of this rare tumor.     

人类乳头状病毒相关性口咽癌的研究进展

近年来,人类乳头状病毒(human papillomavirus,HPV)感染与口咽鳞状细胞癌(oropharyngeal squamous cell carcinomas,OPSCCs)发病率的关联性已得到证实。最新发布的美国癌症联合委员会(American Joint Committee on Cancer,AJCC)第8版癌症分期手册中建议将HPV的表达情况作为OPSCCs分级分期的重要指标之一。与HPV阴性的OPSCCs相比,HPV阳性的OPSCCs在病因学特征、流行病学表现及病理发展等方面存在明显差异,并且2种OPSCCs对标准放化疗治疗的反应不同,HPV阳性的OPSCCs患者预后更佳。同时,亚洲地区HPV相关的OPSCCs的发病情况、相关疾病预后因素与欧美地区存在区别。     

Mutagen sensitivity of patients with laryngeal and oropharyngeal carcinoma

BACKGROUND: Carcinogenesis in the larynx and oropharynx is often associated with excessive exposure to tobacco smoke and alcohol. However, attention is increasingly being focused on genetically determined mutagen sensitivities and on the mutagenic impact of xenobiotics. The purpose of this study was to evaluate the genotoxicity of phthalates (plasticizers widely used in synthetic materials), as well as nitrosamines and polycyclic aromatic carbohydrates, on laryngeal and oropharyngeal epithelia and peripheral lymphocytes of patients with laryngeal and oropharyngeal carcinomas. METHODS: The comet assay was used to detect induced DNA strand breaks. Macroscopically healthy supraglottic and oropharyngeal epithelia of patients with laryngeal and oropharyngeal tumors, respectively, and lymphocytes were investigated with dibutyl phthalate (DBP), diisobutylphthalate (DiBP). N'nitrosodiethylamine (NDELA), and benzo[a]pyrene (BaP). The Olive Tail Moment (OTM) was used to quantify genotoxicity. RESULTS: For the first time, the genotoxicity of DBP and DiBP was demonstrated in laryngeal and oropharyngeal epithelia, as well as in peripheral lymphocytes, of patients suffering from laryngeal and oropharyngeal carcinomas. OTM levels for NDELA were higher than for phthalates; levels for BaP were lower. Testing of lymphocytes and mucosa showed no significant differences among the various substances. CONCLUSIONS: Phthalates show a genotoxic impact on epithelia of tumor patients. OTM levels were higher than in nasal and oropharyngeal mucosa of healthy donors in results reported earlier. Thus, specific susceptibilities to these xenobiotics need to be discussed. No such effect was demonstrated for NDELA and BaP. In tumor patients, no significant differences could be shown in mutagenic sensitivities in mucosal cells and lymphocytes.     

One-stage reconstruction following resection of oropharyngeal carcinoma]

Fifty-nine cases undergone one-stage reconstruction following radical resection for oropharyngeal carcinoma were reviewed. Pectoralis major myocutaneous flap has been our first choice for reconstruction of surgical defects. A composite repair with forehead island flap and mucosal flap of the posterior pharyngeal wall for defect of the total soft palate was recommended. Preoperative radiation had some influence on wound healing. The 3 and 5 year survival rates were 58.1% and 41.7% respectively, and the cosmetic and functional restorations were satisfactory in most patients operated.