Synchronous squamous cell carcinomas of the esophagus and renal pelvis

A 55-year-old man was incidentally diagnosed with a superficial squamous cell carcinoma of esophagus. However, the systemic survey with FDG PET/CT revealed a picture of more advanced disease because of the regional lymph node metastases and a suspected distal metastasis in the left renal pelvis, which was somewhat strange for a small superficial esophageal cancer. Subsequently, the renal pelvic lesion was confirmed as squamous cell carcinoma. However, a primary tumor rather than metastasis in the renal pelvis was considered according to the histologic characteristics and radiologic findings.     

多层螺旋CT评价口腔鳞癌p53蛋白表达

目的：评价口腔鳞癌MSCT征象与p53蛋白表达的关系。方法：39例口腔鳞癌术前行多层螺旋CT扫描。采用免疫组化方法，对病理标本行p53蛋白测定，统计学分析p53蛋白与MSCT征象的相关性。结果：口腔鳞癌的MSCT征象如肿瘤边界、大小、增强情况及有无淋巴结转移与p53蛋白明显相关，而肿瘤密度与p53蛋白则无明显关系。结论：MSCT征象与口腔鳞掰p53蛋白表达有明显相关性，有助于对其预后进行评价。     

Superselective intra-arterial infusion chemotherapy for stage III/IV squamous cell carcinomas of the oral cavity: midterm results

PURPOSE: We performed superselective intra-arterial infusion chemotherapy (SIC) according to a protocol in which drug distribution is evaluated by the use of interventional radiology (IVR)-computed tomography (CT) system, and the chemotherapy is combined with medium-dose conformal radiation therapy (CRT). We analyzed retrospectively the factors that affect the midterm survival ratio, including local response, for stage III and IV squamous cell carcinomas of the oral cavity. MATERIALS AND METHODS: Forty consecutive patients with stage III and IV squamous cell carcinomas of the oral cavity and who had undergone both SIC and CRT were enrolled. A microcatheter was placed in the appropriate feeding artery of the tumor and cisplatin (50mg/body) was infused twice. CRT was administered with a dual-energy (4 and 10 MV) linear accelerator. The total and daily doses delivered were 30 and 2.0 Gy, respectively. Histopathologic effects were classified into five grades: grade 0 or 1 was defined as a poor response, and grade II or higher as a good response. Age, sex, stage, local response to treatment, mode of invasion and lymph node metastasis were analyzed, and differences in the midterm survival ratio were assessed. RESULTS: The 3-year survival ratio of the 40 cases was 67%. A good local response (III or IV) was achieved in 75% of the cases. The survival ratio of the good local response group was significantly better than that of the poor response group (p=0.04). Mode of invasion (p=0.03) and lymph node metastasis (p=0.01) were also predictive of survival. In the multivariable analysis of survival, however, no variables including good local response (p=0.12), were predictive. CONCLUSION: Our new protocol improved local response, but it did not contribute to the survival ratio.     

Lymphoscintigraphic details of sentinel lymph node detection in 82 patients with squamous cell carcinoma of the oral cavity and oropharynx

Lymphoscintigraphy for sentinel node (SN) detection has been studied extensively in melanoma and breast cancer. In head and neck squamous cell carcinoma (HNSCC), however, experience in this field is relatively meagre. The purpose of this study was to document and evaluate lymphoscintigraphic findings in HNSCC patients. Eighty-two patients with clinical T1-T4 N0 SCC of the oral cavity or oropharynx received peritumoral injections of 25-75 MBq 99mTc-colloidal albumin (CA). Dynamic lymphoscintigraphy was performed in lateral projection for 20 min, followed by 2 min static imaging in anterior projection. In 26 patients, additional static images were obtained 2-6 h after injection of the tracer. In four of 82 patients, both early and late imaging revealed no tracer transport. In 78 of 82 patients, one (60), two (14) or three (4) SNs could be visualized, either by dynamic scintigraphy (73) or delayed static imaging (5). In 48 of 78 (62%) patients, the SN was visualized within the first minute of dynamic imaging. In particular, SNs of tumours of the mobile tongue were visualized within the first minute. No effect of T-stage or 99mTc-CA dose on the transport time of the tracer towards the SN was seen. The distribution of the SNs in the various levels of the neck relative to the primary tumour sites within the oral cavity was in concordance with the patterns of lymph node metastases reported traditionally for patients with SCC in the oral cavity. This study demonstrates the different variables affecting SN identification with lymphoscintigraphy using 99mTc-CA in HNSCC patients.     

CT detection of mandibular invasion by squamous cell carcinoma of the oral cavity.

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of CT in detecting mandibular invasion by squamous cell carcinoma of the oral cavity. MATERIALS AND METHODS: Forty-nine patients who had squamous cell carcinoma of the oral cavity that was clinically fixed to the mandible were treated with mandibulectomy. All patients underwent contrast-enhanced CT (contiguous 3-mm-thick sections) through the primary site before surgery. All studies were reconstructed with bone algorithm. These studies were retrospectively reviewed by a neuroradiologist for evidence of mandibular invasion. The imaging results were compared with the histologic findings in all cases. RESULTS: CT correctly revealed 25 of 26 cases with mandibular invasion. CT correctly excluded mandibular invasion in 20 of 23 cases without invasion. The diagnostic accuracy of CT for detecting mandibular invasion was as follows: sensitivity, 96%; specificity, 87%; positive predictive value, 89%; and negative predictive value, 95%. CONCLUSION: Thin-section (3-mm) CT reconstructed with bone algorithm is an accurate technique to detect mandibular involvement by squamous cell carcinoma of the oral cavity.     

Iodine-125 brachytherapy in the management of squamous cell carcinoma of the oral cavity and oropharynx

PurposeBrachytherapy is an acknowledged modality for treating head and neck cancers and has moved from low-dose-rate (LDR) to high-dose-rate remote afterloading to reduce staff exposure. Iodine-125 (¹²⁵I) is a low-energy source and can be used for LDR brachytherapy with minimal staff exposure. The results of treating with this isotope at Groote Schuur Hospital, Cape Town, are reported here.Methods and Materials¹²⁵I brachytherapy was used to treat 114 tumors from 1994 to 2010. Brachytherapy alone was used for 72 tumors, 39 postsurgery and 33 de novo. A brachytherapy boost together with external beam radiotherapy was used for 42 tumors, eight postsurgery and 34 de novo. Tumors were in the tongue, floor of mouth, soft palate, and tonsil, and mainly T1 or T2 classification. Brachytherapy was administered via an applicator or in plastic tubes implanted into the soft tissues or through the submandibular region.ResultsLocal control rates of 80.7% at 5 years and 80% at 10 years were comparable to LDR, pulsed-dose-rate, and high-dose-rate results with iridium-192, likewise the 5- and 10-year disease-specific survival rate of 74.3%. Complications of soft tissue ulceration occurred in 21 patients (18.4%) and healed spontaneously in 20 patients. There was no mandibular necrosis.Conclusions¹²⁵I can be used as the sole treatment or as a boost to external beam radiotherapy, with or without surgery for early mouth cancer. It combines the radiobiological advantages of LDR brachytherapy with minimum staff exposure. It is a flexible system. Local control is excellent with acceptable morbidity, and the treatment time is short.     

Local recurrences in keratoid squamous cell carcinomas of the oral cavity: incidence, causes and therapy after a curative primary treatment (author's transl)]

The frequency of local recurrences in keratoid squamous cell carcinomas of the oral cavity is analyzed in view of the following criteria: Irradiation technique, volume of the primary tumor, irradiation parameters considering the factor of dose and time. The values of the dose, measured by ret, were calculated using the Ellis-formula modified by Gabriel-Jürgens et al. A focal dose of 1,700 ret is recommended for Stage T1 carcinomas of the tongue, a dose of 1,900 ret for the stages T2 and T3. The importance of the concept of nominal standard dose is emphasized with regard to its clinical application. Surgery seems to be superior to the renewal of radiation therapy in the treatment of recurrences.     

Pre-irradiation and surgery of patients with squamous cell carcinoma of the oral cavity and oropharynx: the results of a 1973-1984 study

In collaboration with the Radiotherapeutic Hospital, 87 patients with squamous cell carcinomas of the oral cavity and the oropharynx were treated by combined pre-irradiation and surgical intervention at the University ORL Hospital of Cologne. The study was supposed to improve the five-year survival of patients suffering from advanced carcinomas of the head and neck area. The male and female patient's ratio was 4.5 to 1. Half of the patients had squamous cell carcinomas of the oropharynx, 21 patients had tumors of the floor of the mouth, and another 21 had tumors of the anterior two thirds of the tongue. The tumor and lymph node status was classified according to the UICC regulations (1979). In the pre-irradiation, 40 to 50 Gy were applied to the primary tumor and the regional lymph nodes. Surgery was executed generally four weeks after pre-irradiation. The tumor remission following to pre-irradiation was very good. 27% of the patients showed little or moderate post-operative disturbances in wound healing. An osteoradionecrosis was found in 4.6%. Almost 25% of the patients developed local recurrences. The cumulated five-year survival of all patients is 32%. In dependence on TNM stages, the three-year survival rates are as follows: stage I and II 80%, stage III 44%, and stage IV 40%.     

Comparison of 16-slice MSCT and MRI in the assessment of squamous cell carcinoma of the oral cavity

The goal of this retrospective study was to assess the accuracy of 16-slice multislice CT (MSCT) and MRI in staging of patients with primary squamous cell carcinoma (SCC) of the oral cavity. Fifty-two patients with histologically proven primary SCC were examined with contrast enhanced MSCT and MRI at 1.5 T with a combined head and surface neck coil. Image modalities were evaluated in a blinded fashion by two radiologists and an oral-maxillofacial surgeon in consensus concerning tumour depiction, local tumour infiltration and cervical lymph node metastases. Results of the radiological assessment were correlated with the intraoperative and histopathological findings in all patients. 36 of 52 primary tumours (69.2%) were depicted by MSCT while 44 were localized by MRI (84.6%). Regarding muscle infiltration MRI versus MSCT had a sensitivity of 81.8% versus 72.7%, but a low specificity and an accuracy of 63.4% versus 61% and 67.3% versus 63.5%, respectively, were found. There was a trend towards a better detection of bony infiltration by MRI than MSCT with a sensitivity of 100% versus 71.4%, a specificity of 93.3% versus 95.5% and an accuracy 94.2% versus 92.3%, respectively. Detection of cervical lymph node involvement was similar for MRI and MSCT with a sensitivity of 84.2% and 78.9%, a specificity of 63.6% and 75.7% and an accuracy of 71.1% and 76.9%, respectively. For N-staging both methods failed to detect small metastasis. For T-staging MRI was superior to MSCT, because there was a tendency to underestimate the tumour size by MSCT more often (19.4% versus 6.8% by MRI). Therefore, pre-operative MRI is recommended as the basic imaging modality of choice for treatment planning of oral SCC. MSCT is a valid alternative imaging method especially in cases with low patient compliance.     

18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation.

Accurate evaluation of primary tumors and cervical lymph node status of squamous cell carcinoma (SCC) of the oral cavity is important to treatment planning and prognosis prediction. In this prospective study, we evaluated the use of 18F-FDG PET, CT/MRI, and their visual correlation for the identification of primary tumors and cervical nodal metastases of SCC of the oral cavity with histologic correlation. METHODS: One hundred twenty-four patients with pathologically proven diagnoses of oral cavity SCC underwent 18F-FDG PET and CT/MRI within 2 wk before surgery. We interpreted 18F-FDG PET, CT/MRI, and visually correlated 18F-FDG PET and CT/MRI separately to assess the primary tumors and their regional lymph node status. We recorded lymph node metastases according to the neck level system of imaging-based nodal classification. Histopathologic analysis was used as the gold standard for assessment of the primary tumors and lymph node involvement. We analyzed differences in sensitivity and specificity among the imaging modalities using the McNemar test. The receiver-operating-characteristic (ROC) curve and calculation of the area under the curve were used to evaluate their discriminative power. RESULTS: The accuracy of 18F-FDG PET, CT/MRI, and their visual correlation for the identification of primary tumors was 98.4%, 87.1%, and 99.2%, respectively. The sensitivity of 18F-FDG PET for the identification of nodal metastases on a level-by-level basis was 22.1% higher than that of CT/MRI (74.7% vs. 52.6%, P < 0.001), whereas the specificity of 18F-FDG PET was 1.5% lower than that of CT/MRI (93.0% vs. 94.5%, P = 0.345). The sensitivity and specificity of the visual correlation of 18F-FDG PET and CT/MRI were 3.2% and 1.5% higher than those of 18F-FDG PET alone (77.9% vs. 74.7%, P = 0.25; 94.5% vs. 93.0%, P = 0.18, respectively). The area under the curve obtained from the ROC curve showed that 18F-FDG PET was significantly superior to CT/MRI for total nodal detection (0.896 vs. 0.801, P = 0.002), whereas the visual correlation of 18F-FDG PET and CT/MRI was modestly superior to 18F-FDG PET alone (0.913 vs. 0.896, P = 0.28). CONCLUSION: 18F-FDG PET is superior to CT/MRI in the detection of cervical status of oral cavity SCC. The sensitivity of 18F-FDG PET for the detection of cervical nodal metastasis on a level-by-level basis was significantly higher than that of CT/MRI, whereas their specificities appeared to be similar. Visual correlation of 18F-FDG PET and CT/MRI showed a trend of increased diagnostic accuracy over 18F-FDG PET alone but without a statistically significant difference, and its sensitivity was still not high enough to replace pathologic lymph node staging based on neck dissection.     

A potential pitfall of MR imaging for assessing mandibular invasion of squamous cell carcinoma in the oral cavity

BACKGROUND AND PURPOSE: Whether MR imaging is superior to CT in evaluating the presence and extent of mandibular invasion by squamous cell carcinoma remains controversial. The purpose of this study was to directly compare the diagnostic accuracy of MR imaging and that of CT. METHODS: MR and CT images in 51 patients with squamous cell carcinoma of the oral cavity were evaluated for the presence and extent of mandibular invasion. The results were correlated with histopathologic findings. RESULTS: Twenty-five of 51 patients had histopathologic evidence of mandibular cortical invasion. The tumor involved both the cortex and the bone marrow in all 25 patients and involved the inferior alveolar canal in 5 patients. The sensitivity and specificity for mandibular cortical invasion were 96% and 54% for MR imaging and 100% and 88% for CT, respectively. Those for inferior alveolar canal involvement were 100% and 70% for MR imaging and 100% and 96% for CT, respectively. In both evaluations, the specificity of MR imaging was significantly lower than that of CT (McNemar test, P = .004 in the former and P = .002 in the latter). Chemical shift artifact by bone marrow fat was postulated to be the source of most false-positive cases on MR imaging findings for mandibular cortical invasion. Those for inferior alveolar canal involvement were due to MR imaging visualization of the tumor and surrounding inflammation with similar signal intensity. CONCLUSION: In assessing the presence and extent of mandibular invasion by squamous cell carcinoma, the specificity of MR imaging was significantly lower than that of CT.     

平阳霉素术前诱导化疗72例老年口腔鳞癌临床分析

目的探讨平阳霉素术前诱导化疗老年口腔鳞癌患者的临床特点及疗效。方法对我科2006年1月至2014年1月收治的72例老年口腔鳞癌患者采用平阳霉素进行术前诱导化疗,每次8 mg,1次/d,总剂量80~200 mg。对72例患者的临床资料进行回顾性分析,观察近期疗效及不良反应并分析相关因素与疗效的关系。结果老年口腔鳞癌行平阳霉素单药术前诱导性化疗的总有效率为66.67%。化疗效果与肿瘤病理分级及临床分期无显著相关性。有效组与无效组的最低显效剂量比较有统计学差异(P<0.05),两组的总剂量比较无统计学差异(P>0.05)。化疗期间副作用较轻,主要为发热、消化道反应及皮肤症状等。结论平阳霉素适合老年口腔鳞癌患者的术前诱导化疗。120~160 mg的总剂量可作为其术前诱导性化疗的推荐剂量,高龄或有肺部疾患的患者应酌情减量。