Influential factors on tumor recurrence in head and neck cancer patients

Alcohol consumption and cigarette smoking play a key role in the development and progression of head and neck cancer. Additionally, epidemiologic studies have given evidence that other environmental and genetic factors are relevant. We present a prospective study including 465 head and neck cancer patients. All patients were recruited between 1994 and 1998 during the initial tumor diagnosis. Three hundred twelve patients could be followed over 5 years after histologically proven curative surgical treatment. All clinical data were recorded (i.e., age, gender, TNM stage, histological grading, smoking and drinking habits) and genetic variations at loci encoding detoxifying enzymes (glutathione S-transferase and cytochrome P450); immune modulating cytokines (tumor necrosis factor) and cell cycle regulating proteins (cyclin D1) were determined. Parameters with an impact on recurrence-free survival were analyzed. A strong influence could be attributed to the tumor size at the time of presentation. Additionally, the grading of the tumor showed a strong influence (5 years recurrence free: G1: 87% and G1: 61%). Furthermore, it could be shown that the recurrence-free survival was significantly influenced by cyclin D1 genotypes ( CCND1GG: P =0.01; HR=3.72) and TNF microsatellite haplotypes ( TNFB1D5: P =0.043; HR=2.05). These findings are compatible with the view that genetic predisposition is important in determining recurrence-free survival after surgical treatment of head and neck cancer.     

The impact of virus in N3 node dissection for head and neck cancer

This study is to determine the impact of virus in surgical outcomes among patients of head and neck cancer with N3 lymph node metastasis. A retrospective analysis was conducted for 32 patients with operable N3 neck metastasis undergoing surgical treatment between January 1987 and October 2006. The nuclei of the tumor cells were investigated for the presence of human papillomavirus (HPV) and Epstein–Barr virus (EBV) DNAs and were taken into account as the variable for survival analysis. The primary sites were oropharynx in 11 patients, tongue in 3, buccal mucosa in 1, hypopharynx in 8 and unknown primary in 9. The five-year cumulative overall survival rate was 40.7% and 5-year cumulative regional control rate was 55.8%. The 5-year cumulative overall survival rate of patients with unknown primary site (72.9%) and HPV or EBV positive in the tumor (77.8%) were significantly higher than those patients with known primary site (31.3%) and HPV or EBV negative in the tumor (27.4%), respectively (P = 0.0335 and P = 0.0348, log rank test). In conclusion, surgery with adjuvant therapy offers reasonable outcomes for operable N3 node in head and neck cancer in our cohort. In addition, patients with HPV or EBV positive in the tumor have a better survival.     

Therapeutic effect of Nivolumab for advanced / recurrent temporal bone squamous cell carcinoma

ObjectiveThe immune checkpoint inhibitor Nivolumab was approved for the treatment of platinum-refractory head and neck squamous cell carcinoma (SCC), expanding the treatment options for recurrent or advanced head and neck SCC. However, since temporal bone squamous cell carcinoma (TB-SCC) is very rare cancer, the effectiveness of Nivolumab remains unclear. We investigated the effects of Nivolumab for TB-SCC.MethodChart information was collected for all patients who underwent the first administration of Nivolumab for recurrent or residual TB-SCC in our hospital between September 2017 and December 2019. Tumor staging followed the modified Pittsburgh classification. Changes in the tumor burden and survival outcome were examined.ResultsWe examined 9 patients with recurrent or residual TB-SCC who started administration of Nivolumab. In these cases, recurrent or residual SCC was observed after chemotherapy and/or chemoradiotherapy including platinum. The duration of Nivolumab was 2–54 weeks (median 20.0 weeks). The evaluation of the therapeutic effect according to the RECIST method showed partial response in 1 case, stable disease in 2 cases, progressive disease in 4 cases, and size unevaluated in 2 case. Although the number of cases was small, comparing with 5 cases without Nivolumab, these cases showed longer overall survival (1-year OS 33.3% vs 20.0%).ConclusionWe used Nivolumab as palliative chemotherapy in 9 patients with recurrent/residual TB-SCC, and we were able to obtain a certain therapeutic effect on TB-SCC as well as other head and neck SCC.     

Long-term follow-up in patients treated with curative electrochemotherapy for cancer in the oral cavity and oropharynx

Conclusion: ECT can be a safe curative mono modality treatment, especially in tongue cancer. The future role for ECT in head and neck cancer needs to be further investigated. Introduction: Electrochemotherapy (ECT) is a cancer treatment modality that uses electroporation to increase the intracellular accumulation of hydrophilic chemotherapeutic drugs, especially bleomycin. Objectives: To report the 5-year local tumor control, safety of treatment and survival after ECT, and the 1-year quality-of-life (QoL) data. Materials and methods: Nineteen patients with primary head and neck cancer were included and treated with ECT with curative intent. All except one patient had squamous cell carcinoma (SCC). Radiotherapy (RT) was performed in all patients with SCC and tumor infiltration ≥5 mm. The EORTC H&N 35 questionnaire was used at baseline and 12 months after treatment. The Wilcoxon signed rank test and McNemar’s test were used for paired data and Mann Whitney U-test and Fishers exact test were used for independent data (sub-group comparison). Results: There were no local recurrences in the follow-up period. Thirteen patients were treated with adjuvant RT. The six patients that were treated with ECT alone were tumor-free and alive 5 years after treatment. There was one serious adverse event reported; aspiration after treatment of a tongue base tumor. The tumor-specific 5-year survival was 75%. The QoL outcome 1 year after ECT showed a significant increase in problems with senses (taste, smell), speech, mouth opening and xerostomia. The QoL outcome also showed worse outcome in the smoking patients regarding speech, in the patients receiving adjuvant RT regarding mouth dryness and swallowing and in the patients with non-tongue oral cavity cancer regarding need for painkillers.     

Better outcome for parotid versus neck metastasis of head and neck cutaneous squamous cell carcinoma: a new report on reemerging data

IntroductionRegional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival, currently with no distinction between parotid and neck metastasis.ObjectiveThe purpose of this study was to evaluate the prognostic features among patients with head and neck cutaneous squamous cell carcinoma exhibiting regional metastasis.MethodsA retrospective analysis of patients with cutaneous squamous cell carcinoma who underwent parotidectomy and/or neck dissection from 2011 to 2018 at a single institution tertiary center was performed. Patient demographics, clinical, surgical and pathological information, adjuvant treatments, and outcome at last follow-up were collected. Outcomes included disease recurrence and death due to the disease. Prognostic value of clinic pathological features associated with disease-specific survival was obtained.ResultsThirty-eight cases of head and neck cutaneous squamous cell carcinoma with parotid and/or neck metastasis were identified. Overall, 18 (47.3 %) patients showed parotid metastasis alone, 12 (31.5 %) exhibited neck metastasis alone and 8 (21.0 %) had both. A primary tumor in the parotid zone (Hazard Ratio ? HR = 5.53; p = 0.02) was associated with improved disease-specific survival. Poorer disease-specific survival was observed in patients with higher primary tumor diameter (HR = 1.54; p = 0.002), higher depth of invasion (HR = 2.89; p = 0.02), invasion beyond the subcutaneous fat (HR = 5.05; p = 0.002), neck metastasis at first presentation (HR = 8.74; p < 0.001), number of positive lymph nodes (HR = 1.25; p = 0.004), and higher TNM stages (HR = 7.13; p = 0.009). Patients presenting with isolated parotid metastasis during all follow-ups had better disease-specific survival than those with neck metastasis or both (HR = 3.12; p = 0.02).ConclusionHead and neck cutaneous squamous cell carcinoma with parotid lymph node metastasis demonstrated better outcomes than cases with neck metastasis.     

Neoangiogenesis and squamous cell carcinoma of the tongue

A tumour can only successfully propagate if it develops its own blood supply. Human cancers show a great propensity for stimulating neoangiogenesis through a variety of mechanisms. The present study investigates the relationship between neoangiogenesis, metastasis and survival in 51 patients with tongue cancer resected surgically, 26 of whom had lymph node metastases treated by radical neck dissection. The vessels were immunolabelled for CD34. Two parameters were studied: the vessel count/mm-₂ (VC) and the vessel count corrected for the relative proportions of carcinoma and stroma (VV). The data were analysed by uni variate and multivariate methods. The median VC was 35 and the VV was 103. Patients with neck node metastases tended to have a lower VV (93) than those with no metastases (114) (P = 0.0489). The tumour specific survival of the whole groups of patients was 59% (95% confidence intervals, 37–74%) and not surprisingly the patients with neck node metastases had a poorer survival than those without neck node metastases (,P = 0.0083). Cox’s proportional hazards model demon strated that patients with a low VC index tended to have a good prognosis (P = 0.0234). Previous studies of neoangiogenesis in head and neck squamous carcinoma have been limited and the present investigation suggests that VV is associated with metastases, and that VC may be an indicator of prognosis.     

Paradoxical spread of renal cell carcinoma to the head and neck

Objectives: To present cases of renal cell carcinoma presenting with only head and neck metastases, to review theories of physiology and anatomy describing this phenomenon, and to discuss the role of the otolaryngologist in the treatment of these lesions. Study Design: Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases over the 3-year period from 1992 to 1995. Methods: Retrospective review of the records of three patients who presented with renal cell carcinoma with head and neck metastases. In addition, English-language literature was reviewed with special focus on the anatomic and physiologic pathways possible to allow for such a phenomenon. Conclusions: Renal cell carcinoma has an occasional presentation as a head and neck mass without evidence of disease elsewhere. Various routes of spread have been postulated. Batson's venous plexus, as postulated by Nahum and Bailey, ² is an anatomic route through which emboli could navigate to the head and neck and avoid pulmonary vascular filtration. Interactions on the cellular level may also be responsible for the seemingly paradoxical spread. We recommend local excision of head and neck metastases of renal cell carcinoma without sacrifice of vital structures as a sound treatment regimen.     

Patterns of recurrence and survival of head and neck adenoid cystic carcinoma after definitive resection

Objectives/Hypothesis:

To determine factors impacting recurrence and long‐term survival of adenoid cystic carcinoma (ACC) of the head and neck after definitive resection.

Study Design:

Retrospective cohort study at an academic tertiary care hospital.

Methods:

Patients with ACC of the head and neck treated at our institution were reviewed. Those not receiving surgery, or with metastatic disease were excluded. Clinicopathological data on each patient was collected.

Results:

Of 113 patients identified with ACC, 99 were studied. The overall median survival for the cohort was 71 months (mean ± standard deviation, 94 ± 79 months). American Joint Committee on Cancer (AJCC) tumor stage and N stage were independent predictors of survival on multivariate analysis. Mean overall survival (P = .001) and time to recurrence (P = .006) were lower for patients with cervical lymph node positive disease (N+). Tumors in major salivary glands were associated with longer survival (P = .027). The overall recurrence rate was 53%, with a mean time to recurrence of 63 ± 64 months. The presence of lymphovascular invasion predicted recurrence on multivariate analysis (P = .002), with advanced tumor stage predicting early (≤36 months) recurrence (P = .013). Among the 57 patients who received adjuvant radiation therapy, there was no difference in survival, rate of recurrence, or time to recurrence, when compared to patients treated with surgery alone.

Conclusions:

Clinicopathological variables including AJCC tumor stage, tumor site, presence of N+ disease, and lymphovascular invasion may be used as prognostic factors in predicting survival and recurrence after a definitive resection of ACC of the head and neck. Laryngoscope, 2010     

A comparison of radiotherapy or radiochemotherapy with symptomatic treatment alone in patients with advanced head and neck carcinomas

The choice of palliative treatment and the prognostic factors in unresectable head and neck cancer cases continue to be controversial. In the present study we compared the survival rates of untreated stage IV head and neck cancer patients with cases managed prospectively at A.C. Camargo Hospital for Cancer with neoadjuvant chemotherapy, concomitant chemotherapy or radiotherapy alone. Previous results had shown that while the type of treatment did not influence survival rates (P = 0.706), tumor response to treatment (whether complete, partial or none) significantly influenced survival (P = 0.00002). In the present study we compared the survival rates in the groups with untreated patients (who remained untreated until death) with the same demographic and clinical characteristics of patients receiving treatment. We found that there was a significant difference between the survival rates of the untreated group and those of the treated groups that was independent of the type of treatment performed (P < 0.00001) or the tumor response to treatment (P < 0.0001). Received: 19 October 1998 / Accepted: 15 April 1999     

The effects of age on survival and other parameters in squamous cell carcinoma of the oral cavity,pharynx and larynx

Many papers have been written on the effect of age on survival from cancer and a number of these papers have concentrated on cancer of the head and neck. The literature is fairly evenly split between those studies that claim that the young patient has a better chance of survival and those that suggest the older patient has a better chance of survival. The present study investigates 2647 patients with histologically proven squamous cell carcinoma of the oral cavity, oropharynx, larynx and hypopharynx. The tumour-specific 5-year survival of patients with head and neck cancer from the third decade through to the seventh decade at presentation was 54%, whereas this figure dropped to 44% for the eighth, ninth and tenth decades. This difference was statistically significant (P = 0.0001). When the patients in the third to seventh decades of presentation were compared with those from the eighth to tenth decades, it was found that older patients tended to have significantly more advanced disease at the primary site and fewer neck node metastases when compared with younger patients at presentation. These differences were confirmed by multiple logistic regression. Multivariate analysis of survival confirmed that advanced age was associated with poor survival (P = 0.0001). Whilst patients with head and neck cancer in their eighth, ninth and tenth decades fared worse than younger patients, their mean tumour specific survival at 5 years was in the region of 44%, which makes treatment worthwhile, certainly in selected cases.     

Presentation,course, and outcome of head and neck skin cancer in african americans: A case-control study

Background: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset data from these studies suggest that the course of head and neck skin cancer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African-American patients. Methods: Retrospective case-control study including 215 patients with skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanoma, and adnexal tumors) presenting to a tertiary care institution over a 9.5-year period. Cases were defined as African Americans with skin cancer, and the control group included white and Latin-American patients with skin cancer. Results: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was less common in African-American patients (44%) than the control group (76%; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often involved. In the head and neck region, the ratio of BCC to SCC (4:1) was similar among all groups. In contrast, in non–sun-exposed regions, the ratio was 1:8.5 for African-American patients compared with 1:1 for the control group (P < .001). The overall distribution of malignant melanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modality, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < .001), their disease-free interval was similar to the control group. Only the margin status was a significant predictor of disease-free survival by multivariate analysis, with a relative risk of 1.68 (95% CI: 1.58–18.24) Conclusions: Head and neck skin cancer is similar with regard to presentation and distribution in patients of all skin types. Moreover, in contrast to previous reports, the course of head and neck skin cancer may be less aggressive in African Americans, if appropriate treatment is provided. This report suggests that differences in skin cancer in African Americans reported in the literature reflect cancer occurring in non–sun-exposed regions.     

Second primary tumors in head and neck cancer

IntroductionThe development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions.PurposeTo define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer.Material and methodRecords of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT.ResultsThe overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group).ConclusionBecause of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.     

Management of the N0 neck in patients with laryngeal squamous cell carcinoma

Abstract

Background: Neck lymph node status is the chief prognostic index in patients with head and neck squamous cell carcinoma (SCC), yet the management of a clinically negative neck in this setting is still controversial, especially in patients with laryngeal SCC (LSCC).

Objectives: To evaluate the efficacy of selective neck dissection (SND) to control occult disease in patients with LSCC and clinically negative (cN0) necks.

Materials and methods: Medical records of 1476 patients with cN0 LSCC were analyzed. In conjunction with primary treatment, 126 (8.5%) underwent at least unilateral elective neck dissection, whereas most 1350 (91.5%) followed a wait-and-see protocol. Prognostic significance was indicated by the Kaplan–Meier survival estimates.

Results: The rate of occult neck disease was 15%. Five-year overall and disease-free survival rates were 74.4% and 66.7%, respectively. Prognosis was closely related to T stage, preoperative tracheotomy, and postoperative recurrence. There was no significant correlation with age, sex, or preoperative neck dissection; but in patients with supraglottic LSCC, the relation between prognosis and preoperative neck dissection was significant, with fewer neck and local recurrences than the wait-and-see group (p?<?.05).

Conclusions and significance: Selective neck dissection is serving as an accurate prognostic tool in patients with supraglottic laryngeal cancers.     

Presence of malignant tumor cells in persistent neck disease after radiotherapy for advanced squamous cell carcinoma of the oropharynx is associated with poor survival

Non-surgical therapy consisting of external beam radiation with or without chemotherapy is an effective treatment for patients with squamous cell carcinoma (SCC) of the oropharynx with advanced neck disease (N2a or greater). However, many of these patients have to undergo a neck dissection for clinically persistent regional disease. It is reported that nearly 50% of the neck dissection specimens contain residual viable tumor cells that may indicate partial radiation failure and as a consequence poor survival. In order to address the significance of this finding, we conducted a nonrandomized retrospective study, including 35 patients who underwent definitive radiation therapy followed by either a radical or modified radical (RND/MRND) or a selective neck dissection (SND) for clinically persistent neck disease 6 weeks after completing therapy for stage III/IV SCC of the oropharynx (base of the tongue =15, tonsil =12, soft palate =7 and pharyngeal wall =1). All neck dissection specimens were reviewed according to histological criteria indicating viable residual tumor. We observed an increased relative risk (RR) for local and regional failures in the patient population with viable cancer cells in the post-irradiation neck specimens (RR=6.7 and 4.1, respectively). The presence of malignant tumor cells in residual disease in the neck correlated with poor disease-specific and overall survival ( P =0.03 and P =0.01, respectively). Of note, the extent of neck dissection did not improve the disease-free or overall survival in this patient population ( P =0.5 and P =0.6, respectively). In conclusion, the presence of viable cancer cells in radiated neck nodes is a novel prognostic marker for disease-specific survival in patients treated for SCCs of the oropharynx with advanced neck disease and may serve as an identifier for patients who will benefit from post-treatment chemoprevention.     

Definitive re-irradiation using intensity-modulated radiation therapy in cancers of the head and neck,focusing on rare tumors

Purpose: To analyze the outcomes following re-irradiation for local recurrence of rare head and neck tumors.

Material and methods: We retrospectively analyzed 11 patients who had received intensity-modulated radiation therapy (IMRT) for recurrent tumors in the head and neck except for laryngopharynx.

Results: Primary tumor sites included the maxillary sinus, nasal cavity, and external ear canal in six, three, and two patients, respectively. The median follow-up times were 13 (range, 3–54) months. The median survival time was 17 months with 1- and 2-year survival rates of 63.64 and 39.77%, respectively. Among 11 patients, five experienced local failure in the follow-up period. The 1- and 2-year local control rates were 58 and 47%, respectively. Patients who had received a radiation dose of ≥3?Gy per fraction showed significantly better local control than those receiving less (p?=?.0419). One patient experienced Grade 3 facial pain as acute toxicity. Late toxicities included radiographic findings of partial central nervous system necrosis in three patients and Grade 3 osteonecrosis and Grade 3 facial nerve disorder in one patient.

Conclusions: Re-irradiation of rare head and neck tumors using IMRT for loco-regional recurrence may be an acceptable treatment option.     

Minor salivary gland tumors of the palate: Clinical and pathologic correlates of outcome

Minor salivary gland tumors of the palate are rare and may pose a diagnostic and therapeutic dilemma for the head and neck surgeon. The authors reviewed their 46 years of experience with minor salivary gland tumors of the palate to determine the factors that influence outcome and their implications for treatment. Malignant tumors were seen in 116 patients (78%) and benign tumors were found in 33 patients (22%). Adenoid cystic carcinoma was the most common malignant tumor, occurring in 43 patients, and pleomorphic adenoma was the most common benign tumor, occurring in 30 patients. Univariate analysis on the malignant lesions showed that grade 3 tumor histology (P<.001), tumor size greater than 3 cm (P<.001), perineural invasion (P=.031), bone invasion (P=.012), positive surgical margins (P<.001), and positive initial but negative final margins (P=.004) were all associated with decreased survival. With multivariate analysis, tumor size, margin status, and grade were shown to be independently associated with decreased survival (P<.05). The recurrence rate at the primary site was significantly higher for adenoid cystic carcinoma than for other histologies (P=.0059). The 2-, 5-, and 10-year disease-specific survival rates for patients with malignant disease were 96%, 87%, and 80%, respectively. Wide surgical excision with adequate margins is essential for a favorable outcome in patients with malignant minor salivary gland tumors. Postoperative radiotherapy is reserved for patients with grade 3 tumor histology, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins, although a clear-cut survival advantage has not been proven. Recurrence, especially regional and distant metastasis, portends an extremely poor prognosis. Laryngoscope, 105:1155-1160, 1995     

Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Abstract

Background: Squamous cell carcinoma (SCC) is the most common type of head and neck cancer, and head and neck squamous cell carcinoma (HNSCC) was proved to having a high prevalence of perineural invasion (PNI). Although some reports have revealed a relationship between PNI and the prognosis in HNSCC patients, the contribution of PNI to the prognosis remains unclear.

Objectives: This study was aimed to comprehensively and quantitatively summarize the prognostic value of PNI for the survival of patients with HNSCC.

Material and methods: We conducted PubMed and EMBASE to identify all relevant studies. A meta-analysis and subgroup analysis were performed to clarify the prognostic role of PNI.

Results: A total of 18 studies (n?=?3894) were included. 989 (25.4%) of the 3894 patients exhibited positive PNI, PNI was shown to be significantly associated with overall survival (OS) [hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.88–4.16], disease-free survival (DFS) (HR = 2.42, 95% CI: 1.92–3.05) and disease-specific survival (DSS) (HR = 2.60, 95% CI: 1.86–3.63).

Conclusions: The presence of PNI significantly affected OS, DFS and DSS in patients with HNSCC.     

Interleukin-13 gene polymorphisms at −1055 C/T and +2044 G/A positions in patients with squamous cell carcinoma of head and neck

Squamous cell carcinoma (SCC) is the most common malignancy that involves the upper aerodigestive tract. Interleukin-13 (IL-13) is an immunoregulatory cytokine that has been reported to have some polymorphisms in it gene associated with same disease especially asthma and allergy. The present study aimed to investigate whether the polymorphisms of IL-13 gene (at positions of 1055C/T in the promoter of 1L-13 gene and +2044G/T exon-4) differ in patients with head and neck SCC from healthy controls.MethodsThis study was investigated in patient with head and neck SCC (n = 137) and age- and sex-matched healthy controls (n = 127). Genotyping of IL-13 gene polymorphism was performed using polymerase chain reaction-based restriction fragment length polymorphism method.ResultsNo statistically significant differences were found in the frequencies of genotypes and alleles between patients and control group at both sites (p = 0.16). In addition, no association was observed between investigated genotypes and other potential prognostic factors such as age, sex, primary tumor site, tumor size and smoking.ConclusionThis study suggests that there is no association between IL-13 gene polymorphisms (at position ?1055C/T and +2044GI A) and susceptibility of the patients to SCC of head and neck.     

The impact of paratracheal lymph node metastasis in squamous cell carcinoma of the hypopharynx

The aim of this study was to analyze the prevalence and prognostic importance of paratracheal lymph nodes in squamous cell carcinoma of the hypopharynx. A retrospective review of 64 previously untreated patients with squamous cell carcinoma (SCC) of the hypopharynx that underwent surgery was performed. Ipsilateral paratracheal lymph node metastases occurred in 22% (14 out of 64) and the mean number of paratracheal lymph nodes dissected per side was 2.3 (range 1–6). Contralateral paratracheal lymph node metastases were present in 2% (1 out of 42). Sixty-seven percent with postcricoid SCC and 22% with pyriform sinus SCC developed clinical node-positive ipsilateral paratracheal lymph node metastases, whereas 11% with posterior pharyngeal wall SCC developed paratracheal metastases. There was a significant correlation between paratracheal lymph node metastasis and cervical metastasis (p = 0.005), and the primary tumor site (postcricoid, 57.1%; pyriform sinus, 20.0%; posterior pharyngeal wall, 8.3%) (p = 0.039). Patients with no evidence of paratracheal lymph node metastasis may have a survival benefit (5-year disease-specific survival rate, 60 vs. 29%). However, this result did not reach statistical significance (p = 0.071). The patients with SCC of the postcricoid and/or pyriform sinus were at risk for ipsilateral paratracheal lymph node metastasis; furthermore, patients with paratracheal node metastasis had a high frequency of cervical metastasis and a poorer prognosis. Therefore, routine ipsilateral paratracheal node dissection is recommended during the surgical treatment of patients with SCC of the postcricoid and/or pyriform sinus with clinical node metastases.     

Sentinel node mapping in head and neck squamous cell carcinoma

BACKGROUND: Commonly used staging procedures often cannot predict the absence of lymphatic micro- metastases in squamous cell carcinoma (SCC) of the head and neck. Therefore in many cases an elective neck dissection (ND) is necessary. In the surgical therapy of melanoma or breast cancer the presence of metastases can be evaluated securely by identification and examination of the sentinel lymph node (SLN). The type of surgical procedure is usually chosen in regard to the histopathological result. The present study evaluates the applicability of this concept for SCC of the head and neck. METHODS: Radioactive labeled micro-albumin particles were injected preoperatively around the tumor in 38 patients without proven metastases. Following the excision of the primary tumor the sentinel lymph node/s were detected and dissected and ND was completed. Histological examination of the tissue was performed to evaluate whether the SLN reflected the lymphatic status. RESULTS: In two cases (5.1 %) no SLN were detected. ND was completed in 32 cases. In nine cases (28.1 %) the SLN were infiltrated by the primary tumor. In 22 cases (68.8 %) SLN and ND revealed a N(0) stage. In one case (3.1 %) we could not identify a metastasis because of the anatomical closeness of the SLN to the primary. The negative predictive value was 96 %. CONCLUSION: Predictive value regarding metastases to the neck was higher with the detection of SLN than with conventional staging procedures. Whether the detection of a tumor-free SLN is an indication not to perform an elective neck dissection is a matter of discussion, especially under the aspect of the effective reduction of postoperative morbidity.