Abstract
BackgroundThe incidence rate has been increasing for superficial head and neck squamous cell carcinoma (HNSCC) discovered through surveillance endoscopic study using narrow band imaging (NBI), a procedure mainly used for high-risk patients with esophageal squamous cell carcinoma (ESCC). However, there are few reports on the natural history of superficial HNSCC. The aim of this retrospective study was to investigate the natural history of superficial HNSCC.MethodsFrom January 2007 to December 2012, 535 consecutive histologically confirmed superficial HNSCCs at the oropharynx, hypopharynx, or larynx in 319 patients were detected by endoscopic surveillance examination by using NBI. Of those, 20 untreated and observed lesions fulfilled the eligibility criteria and were analyzed in this study.ResultsTwenty lesions from 17 patients were analyzed. All patients were men ranging from 52 to 86 years of age, with a median age of 69 years. The median endoscopic follow-up period was 20 months (range, 6–71); 17 lesions progressed in size. In this study, four patients died; the causes of death were synchronous ESCC, synchronous HNSCC, acute myocardial infarction, and unknown causes. No patient died from progression of superficial HNSCC.ConclusionsMost superficial HNSCC has the potential to change progressively. Therefore, superficial HNSCC should be detected at an early stage and be treated less invasively, such as with endoscopic resection or partial resection.
Highlights
The incidence rate has been increasing for superficial head and neck squamous cell carcinoma (HNSCC) discovered through surveillance endoscopic study using narrow band imaging (NBI), a procedure mainly used for high-risk patients with esophageal squamous cell carcinoma (ESCC)
Patients From January 2007 to December 2012, consecutive superficial HNSCCs were detected by oral endoscopic examination using NBI in high-risk patients who had prior or present HNSCC and ESCC
We analyzed the cohort that met the following eligibility criteria: 1) the lesion was the primary, 2) the lesion diameter was 20 mm or less, 3) the lesion was supposed to be clinically localized in the superficial mucosal region, 4) there was no lymph node or distant metastasis, 5) the initial treatment plan for HNSCC was observation, or planned endoscopic resection (ER) if concomitant cancers, such as ESCC or HNSCC, had achieved a cure, 6) at least one follow-up endoscopic observation was performed after detection and the follow-up period was longer than 6 months, 7) there was no systemic chemotherapy for any cancer, and 8) there was no prior radiotherapy that involved the head and neck region
Summary
The incidence rate has been increasing for superficial head and neck squamous cell carcinoma (HNSCC) discovered through surveillance endoscopic study using narrow band imaging (NBI), a procedure mainly used for high-risk patients with esophageal squamous cell carcinoma (ESCC). Several prospective randomized studies using this imaging technique have shown that the detection rate of superficial squamous cell carcinoma of the larynx and pharynx is enhanced [1,2,3]. Almost all superficial head and neck squamous cell carcinoma (HNSCC) can be cured with favorable prognosis by endoscopic resection (ER) or partial resection [4]. The synchronous or metachronous occurrence of esophageal squamous cell carcinoma (ESCC) and other HNSCCs is observed frequently; the former and latter rates are reported to be 14–83 % and 28 %, respectively [5, 6]. Treatment for more advanced cancer takes precedence over that for other cancers when multiple synchronous cancers are detected at once
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