Surgery alone for squamous cell carcinoma of the oral cavity: survival rates,recurrence patterns,and salvage treatment

Conclusion. Surgery alone may be a reliable and feasible treatment of choice in selected patients with squamous cell carcinoma (SCC) of the oral cavity, given the proper indications. Objective. To evaluate the results of treatment of oral cavity SCC patients with surgery alone in a single institution. Patients and methods. Between 1992 and 2004, 76 patients with previously untreated SCC of the oral cavity who had surgery alone without any other adjuvant treatment modalities were included in our study. Results. The 5-year overall rate, disease-specific survival rates, and locoregional control rate of all 76 patients were 69%, 83%, and 73%, respectively. A total of 16 patients (21%) presented with recurrences (8 with regional recurrences, 5 with local, 2 with locoregional, and 1 with distant metastasis). Four (6%) of the patients with primary T1 or T2 stage and one (50%) of those with T4 stage had recurrence at the primary site. The regional recurrence rate of patients with ≤N1 and ≥N2b was 10% (6 of 59) and 67% (2 of 3), respectively. Three of four patients who had recurrence at the primary site and attempted salvage treatment have been cured. However, only one of five patients with nodal recurrence and salvage treatment has recovered.     

Marital status as a predictor of survival in patients with human papilloma virus-positive oropharyngeal cancer

Purpose

Determine whether marital status is a significant predictor of survival in human papillomavirus-positive oropharyngeal cancer.

Chemoradiation for patients with advanced oral cavity cancer

Objectives/Hypothesis:

Patients with advanced oral cavity cancer (OCC) typically have not been enrolled in clinical trials utilizing contemporary multimodality strategies. There exist dogmatic expectations of inferior outcome in OCC patients secondary to ineffectiveness of treatment and unacceptable toxicity. The purpose of this study was to analyze survival, swallowing function, and incidence of osteoradionecrosis (ORN) of patients with stage III/IV OCC who have undergone primary concomitant chemoradiotherapy (CRT).

Methods:

All advanced OCC patients who were enrolled in University of Chicago concomitant CRT protocols from 1994 to 2008 were reviewed. One hundred eleven newly diagnosed advanced OCC patients were evaluated. We performed a subset analysis of 27 additional advanced OCC patients who underwent surgery followed by postoperative CRT. Swallowing function was assessed via oropharyngeal motility study, and a Swallowing Performance Status Scale score was assigned. Presence of clinically significant ORN was documented.

Results:

Median follow‐up was 3.25 years. Five‐year overall and progression‐free survival was 66.9% and 65.9%, respectively. There was no difference in overall or progression‐free survival when the surgery‐first group was compared with the primary CRT group (P = .88 and P = .86 respectively). Function, without gastric tube requirement, was excellent, with 92.2% of patients able to maintain weight via oral route. Incidence of ORN was 18.4%, occurring in nine of 49 patients evaluated.

Conclusions:

Our data support the use of primary CRT as a viable treatment option for patients with advanced OCC. Survival is high, and overall function for the majority of patients is satisfactory. Patients with T4 oral tongue cancer may be spared total glossectomy. The incidence of ORN may be considered acceptable, in light of the benefits of enduring life and function. Laryngoscope, 2010     

Results of free flap reconstruction for patients aged 80 years or older with head and neck cancer

ObjectiveFree flap reconstruction in elderly patients is one of the most challenging surgeries in the treatment of head and neck cancers. The aim of this study was to examine the oncological and functional outcomes of free flap reconstruction for elderly patients with head and neck cancer.MethodsWe retrospectively reviewed elderly patients who underwent free flap reconstruction for the treatment of head and neck cancers. All patients were 80 years or older. Clinicopathologic features, surgical procedures, oncological and functional outcomes were obtained from medical records.ResultsFree flap reconstructions were performed in 13 patients (3 female, 10 male). The mean age was 82.6 ± 3.4 years (range: 80–91). The mean follow-up period was 23.3 months (range 4–41 months). The mean disease-free survival was 49 ± 6 months (range 4–60 months). All patients had been alive more than one year after surgery. Reconstruction was performed using free jejunum in 10 patients and radial forearm flap in 3 patients. Graft necrosis occurred in 2 patients. Other two patients experienced major postoperative medical complications.ConclusionFree flap reconstruction in well-selected older adults is safe and effective. Advanced age should not preclude consideration of free flap reconstruction in those patients.     

Elective neck dissection and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx

OBJECTIVE/HYPOTHESIS: The utility of elective neck dissection in the management of patients with oral cavity and oropharyngeal cancer who present without neck metastases remains controversial. The study addressed the question of whether elective neck dissection improves regional control and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx presenting with T1/T2 node-negative disease. STUDY DESIGN: A nonrandomized, uncontrolled retrospective chart review. METHODS: A nonrandomized, uncontrolled retrospective chart review was performed. Resection of the primary tumor was performed in all patients. The neck was observed in one group, and elective neck dissection was performed for patients in another group. RESULTS: The study data indicated that elective neck dissection significantly improves regional control and regional recurrence-free survival. Elective neck dissection when compared with observation of the neck did not improve overall survival. CONCLUSION: Elective neck dissection reduces regional recurrence and may extend disease-free survival.     

Prognostic factors in oral cavity cancer with skull base recurrence

Objective

Recurred oral cavity cancer at the skull base is complicated to treat due to difficult surgical approach and possible dural invasion. Therefore, initial curative treatment is of most importance and it would be helpful to know cases that would likely recur before treatment. We tried to identify prognostic factors that can predict skull base recurrence after initial treatment, to find out cases that need more aggressive initial treatment.

Methods

This retrospective study was performed on 51 patients diagnosed as squamous cell carcinoma in the oral cavity, and they underwent surgery and adjuvant radiotherapy. Variables associated with clinical findings, imaging studies, and pathologic results were analyzed to identify factors related to skull base recurrence.

Results

Recurrences occurred in 21% (11) cases, and skull base invasion in 5 of these recurred cases. Tumor location, clinical T stage, retromolar trigone (RMT) invasion, bone invasion, perineural invasion, positive resection margin, endolymphatic tumor emboli, and medial and lateral pterygoid muscle invasion were found to be significant prognostic factors by univariate analyses. Among those factors, medial pterygoid muscle invasion and positive resection margin remained independent predictors of skull base recurrence with multivariate analyses by Cox regression.

Conclusion

Patients with medial pterygoid muscle invasion or a positive resection margin have a high risk of skull base invasion during tumor recurrence. Therefore, careful evaluation and aggressive management are needed to prevent skull base invasion in cases that recur.     

The association of smoking, alcoholic consumption, betel quid chewing and oral cavity cancer: a cohort study

We aimed to analyze the relationship between smoking, alcoholic consumption and betel quid chewing with oral cavity cancer. All male patients age ≥18 years who visited our clinic received an oral mucosal inspection. Basic data including personal habits were also obtained. A multivariate logistic regression model was utilized to determine relevant risk factors for developing oral cavity cancer. A total of 8,356 patients were enrolled in this study. Abnormal findings were found in 382 patients (4.6%). Two hundred and ninety-seven patients received biopsy and 191 patients were proven to have oral cavity cancer. The results of multivariate logistic regression showed that those who smoked, consumed alcohol and chewed betel quid on a regular basis were most likely to contract oral cancer (odds ratio: 39.66, 95% confidence interval: 26.04–60.38). Therefore, habitual cigarette smokers, alcohol consumers, and betel quid chewers have a higher risk of contracting oral cavity cancer and should receive oral mucosal screening regularly so potential oral cavity cancer can be detected as early as possible, which may result in better and improved survival of oral cancer patients.     

Analysis of treatment results for oral tongue cancer

OBJECTIVE: The study reports the results of treatment of oral tongue cancer with five different treatment modalities with long-term follow-up. STUDY DESIGN: Retrospective study of 332 patients with oral tongue cancer treated in the Departments of Otolaryngology-Head and Neck Surgery and Radiation Therapy at Washington University School of Medicine (St. Louis, MO) from 1957 to 1996. METHODS: Patients with biopsy-proven squamous cell carcinoma of the oral tongue who were previously untreated and were treated with curative intent by one of five modalities and who were eligible for 5-year follow-up were included. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine statistical significance. RESULTS: The overall 5-year disease-specific survival rate (DSS) was 57% with death due to tumor in 43%. The 5-year cumulative disease-specific survival probability (CDSS) was 0.61 (Kaplan-Meier) with a mean of 17.5 years and a median of 30.1 years. The DSS by treatment modality included local resection (73%), composite resection (61%), radiation therapy (46%), local resection and radiation therapy (65%), and composite resection with radiation therapy (CR/RT) (44%). Overall, local resection had a significantly improved DSS and CR/RT had a decreased DSS that was related to the stage of disease being treated. In treating stage IV disease, CR/RT produced a more significantly improved CDSS than the other treatment modalities. Recurrence at the primary site was as common as recurrence in the neck. Eighty-nine percent of recurrences occurred within the first 60 months. Recurrence significantly decreased survival. DSS was significantly improved in patients with clear margins of resection. Metastasis to a distant site occurred in 9.6% of patients. Twenty-one percent of patients had second primary cancers, and 54% of these patients died of their second primary cancer. CONCLUSIONS: Significant improvement in DSS was seen in patients with clear margins, early stage grouping and clinical (pretreatment) tumor stage, and negative nodes. Significant decrease in DSS was seen in patients with close or involved margins, advanced stage grouping and clinical (pretreatment) tumor staging, positive clinical (pretreatment) node staging, and tumor recurrence. Obtaining clear margins of resection is crucial because it significantly affects survival. A minimum of 5 years of close monitoring is recommended because of the high incidence of second primary cancers.     

The expression of epidermal growth factor receptors in the oral mucosa of patients with oral cancer

Summary Representative tumor samples and mucosal samples were taken from three different groups of patients and were stained immunohistochemically for their expressions of epidermal growth factor receptors (EGFR). Patients in group 1 had oral squamous carcinoma, with specimens taken from the tumor as well as from the mucosa without tumor invasion. Patients in group 2 had no evidence of tumor but had heavy drinking and smoking habits. Tumor-free patients who do not drink or smoke served as the control group. The findings in the present study showed that the tumor and mucosal samples from groups 1 and 2 had increased EGFR expression while the control group showed significantly less EGFR. These results suggest that EGFR may play a role in the development of premalignant tissue changes, which are probably influenced by chronic toxic irritation.Presented at the XXI Pan American Congress of Otolaryngology, Head and Neck Surgery, Bahia-Salvador, Brazil, 2 November 1988