Aerodigestive Tract Squamous Cell Carcinoma Research Articles

The use of tobacco-free betel-quid in conjunction with alcohol/tobacco impacts early-onset age and carcinoma distribution for upper aerodigestive tract cancer

Recognition of how risk factors affect the age when cancers are first diagnosed may help to establish more appropriate cancer screening and preventive strategies. To investigate the independent and synergistic effects of alcohol, tobacco-free betel-quid (TF-BQ), and cigarette use on diagnosis age and dissemination of upper aerodigestive tract squamous cell carcinoma (UADT-SCC), we recruited pathology-proven 1522 patients with UADT-SCC for study. A 49-, 53-, 57-, and 62-year-old stepwise older median age at carcinoma diagnosis was, respectively, found among patients with oral, pharyngeal, esophageal, and laryngeal cancer. Oral cavity (53.2%) and larynx (11.6%) were separately the dominant and recessive sites where the UADT-SCC occurred. Although alcohol and tobacco bestowed increased risks of earlier tumor occurrence only for oral/pharyngeal and oral cancers, respectively, TF-BQ was consistently observed to confer elevated age-associated risks for each UADT-SCC [adjusted hazard ratio (aHR) = 1.6-2.3]. Alcohol and TF-BQ joint consumers experienced a stepwise increased cumulative risk (CR) of contracting carcinomas of the larynx (46.2%), esophagus (47.5%), pharynx (53.5%), and oral cavity (60.5-71.0%), with >68% of CRs found among drinkers who started chewing before age 20. Alcohol + Betel + Cigarette and Alcohol + Betel users exhibited earlier diagnosis ages than non-users: 10 years ahead for oral cancer, 7, 17, and 12 years earlier for pharyngeal, esophageal, and laryngeal cancers. Noticeably, higher cumulative cancer risks regarding earlier tumor occurrence were correspondingly identified for these users aged 43, 49, 43, and 44 upward. Tobacco-free betel-quid, in conjunction with alcohol and/or tobacco consumption, impacts early cancer occurrence for specific UADT-SCC and influences tumor site incidence pattern of these neoplasms.

Tobacco and alcohol use after head and neck cancer treatment: influence of the type of oncological treatment employed

To assess the cigarette smoking and alcohol intake maintenance rate in patients treated for head and neck squamous cell carcinoma and to compare the observed outcome with the type of oncological treatment employed. One hundred and ten patients treated for high aero-digestive tract squamous cell carcinoma were included and divided into a surgical group, treated with a surgery, and a medical group, treated with chemotherapy and/or radiation. The patients were interviewed to determine whether or not they had persisted with the smoking and drinking behavior after treatment. The habit maintenance rate was compared with the treatment modality employed. The relationship between the oncological status of the patients and the cigarette smoking and alcohol intake rates found was also tested. Among smokers, 35% maintained the habit after treatment. The medical group had a significantly higher percentage of patients maintaining smoking compared with the surgical group (58.3% vs 25.0%; p = 0.004). Among alcohol users, 16.6% kept drinking alcoholic beverages, with a percentage also shown higher for the medical group (23.8% vs 13,3%), but with no statistically significant difference. The oncological status of patients was not related to the maintenance of the habits studied. Smoking and alcoholism maintenance rates are high after head and neck squamous cell carcinoma is treated, especially if we consider smoking in patients treated with chemotherapy and/or radiation. A more effective multidisciplinary approach is required in order to obtain better rates of tobacco and alcohol quitting, especially in patients undergoing non-surgical treatments.

Evidence for mesenchymal-like sub-populations within squamous cell carcinomas possessing chemoresistance and phenotypic plasticity

Variable drug responses among malignant cells within individual tumors may represent a barrier to their eradication using chemotherapy. Carcinoma cells expressing mesenchymal markers resist conventional and epidermal growth factor receptor (EGFR)-targeted chemotherapy. Here we evaluated whether mesenchymal-like subpopulations within human squamous cell carcinomas (SCCs) with predominantly epithelial features contribute to overall therapy resistance. We identified a mesenchymal-like subset expressing low E-cadherin (Ecad-lo) and high vimentin (Vim-hi) within upper aerodigestive tract SCCs. This subset was both isolated from cell lines and identified in xenografts and primary clinical specimens. The Ecad-lo subset contained more low-turnover cells, correlating with resistance to the conventional chemotherapeutic paclitaxel in vitro. Epidermal growth factor (EGF) induced less stimulation of the MAP kinase and PI3-kinase pathways in Ecad-lo cells, which was likely due to lower EGFR expression in this subset and correlated with in vivo resistance to the EGFR-targeted antibody cetuximab. The Ecad-lo and high E-cadherin (Ecad-hi) subsets were dynamic in phenotype, showing the capacity to repopulate each other from single cell clones. Taken together, these results provide evidence for a low-turnover, mesenchymal-like subpopulation in SCCs with diminished EGFR pathway function and intrinsic resistance to conventional and EGFR-targeted chemotherapies.

Is there a role for flexible oesophagogastroscopy in upper aerodigestive tract squamous cell carcinoma?

There is growing evidence to suggest that reflux (both laryngopharyngeal and gastroesophageal) has a role in the development of upper aerodigestive tract squamous cell carcinoma. This study discusses the role of identifying reflux in this patient group, and its prevalence. Prospective review of patients with head and neck cancer undergoing flexible oesophagogastroscopy as part of their diagnostic investigation. Forty-five consecutive patients were identified. All patients were found to have evidence of oesophagitis, with 28 having oesophageal erosions and two Barrett's oesophagitis. Flexible oesophagogastroscopy is a useful test in patients with upper aerodigestive tract squamous cell carcinoma.

Cytology of head and neck squamous cell carcinoma variants

The most common diagnosis rendered with head and neck fine needle aspiration (FNA) biopsy is metastatic squamous cell carcinoma (SCC). While most cases of metastatic SCC pose little diagnostic difficulty, the diagnosis of metastatic histologic variants of SCC, often coupled with less common etiologies, can be more problematic. This manuscript reviews the clinicopathologic features of the histologic variants of upper aerodigestive tract SCC (verrucous, papillary, spindle cell, undifferentiated, acantholytic, and basaloid) and uncommon etiologies of head and neck SCC (human papillomavirus, Epstein-Barr Virus, and NUT midline carcinomas). Particular attention is paid to the cytologic features of these lesions. Differential diagnoses and the use of ancillary testing are discussed.

HPV-16 E6 L83V variant in squamous cell carcinomas of the upper aerodigestive tract

The aim of this prospective case series study was to determine the prevalence of HPV-DNA, analyze the E6 mRNA expression, identify intra-type variation in the E6 oncogene in upper aerodigestive tract (UADT) squamous cell carcinoma (SCC), and correlate the presence of HPV-DNA with several clinical parameters and outcome. Frozen samples of UADT-SCC were analyzed for the presence and characterization of HPV-DNA and RNA sequences by means of polymerase chain reaction (PCR), reverse transcriptase-PCR, and direct sequencing of amplified products. HPV-DNA sequences were detected in 10% of the tumors, all of which were typed as HPV-16. Positivity for HPV-16 E6/E7 mRNA was observed in five of the eight HPV-positive tumors (62.5%). The HPV-16 E6 L83V variant was present in five cases. Multivariate analysis identified a history of absence of smoking (P = 0.009) as a predictor of HPV-positive tumor. No significant differences in overall and disease free survival curves were observed between patients with HPV-positive tumors and patients with tumors without detectable HPV-DNA. Our findings support the etiological participation of HPV-16 in a subset of UADT-SCCs from patients lacking traditional risk factors. The potential prognostic significance of HPV-16 E6 L83V variant in HPV-16 positive UADT-SCCs should be more extensively investigated.

Incidence and Significance of Myocardial Injury After Surgical Treatment of Head and Neck Cancer

AbstractObjective/Hypothesis: To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies.Study Design: Observational cohort study.Methods: Records of 65 patients surgically treated for upper aerodigestive tract squamous cell carcinoma between 2005 and 2006 were reviewed. Information about cardiovascular history, tumor characteristics, details of surgery, and postoperative complications were recorded. Patients had troponin assays on the third postoperative day. Logistic regression was used to identify risk factors for postoperative myocardial injury.Results: The average age at presentation was 62 ± 12 years. There were 46 (71%) males and 19 (29%) females. Troponin‐positive and ‐negative groups were matched for age, sex, cardiovascular risks, comorbidity, site, tumor‐node‐metastasis status, and duration of the operations. Sixteen (25%) patients had postoperative myocardial injury including five clinical myocardial infarctions. Factors identified as independent predictors of postoperative myocardial injury were blood pressure level (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04–1.31; P < .02), intraoperative heart rate variability (OR 1.33; 95% CI 1.04–1.71; P < .02), and the degree of postoperative inflammatory response (OR 1.07; 95% CI 1.02–1.13; P < .001).Conclusions: Postoperative myocardial injury is a known independent predictor of cardiovascular prognosis. Its incidence in head and neck patients could potentially be reduced through stringent blood pressure management, tight intraoperative heart rate control, and dampening of the postoperative inflammatory response. Troponin testing is a valuable screening tool, and patients who have elevated levels postoperatively should be closely monitored and referred to a cardiologist for optimization of cardiovascular care.

This Month in Laryngoscope

To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies. Observational cohort study. Records of 65 patients surgically treated for upper aerodigestive tract squamous cell carcinoma between 2005 and 2006 were reviewed. Information about cardiovascular history, tumor characteristics, details of surgery, and postoperative complications were recorded. Patients had troponin assays on the third postoperative day. Logistic regression was used to identify risk factors for postoperative myocardial injury. The average age at presentation was 62+/-12 years. There were 46 (71%) males and 19 (29%) females. Troponin-positive and -negative groups were matched for age, sex, cardiovascular risks, comorbidity, site, tumor-node-metastasis status, and duration of the operations. Sixteen (25%) patients had postoperative myocardial injury including five clinical myocardial infarctions. Factors identified as independent predictors of postoperative myocardial injury were blood pressure level (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04-1.31; P<.02), intraoperative heart rate variability (OR 1.33; 95% CI 1.04-1.71; P<.02), and the degree of postoperative inflammatory response (OR 1.07; 95% CI 1.02-1.13; P<.001). Postoperative myocardial injury is a known independent predictor of cardiovascular prognosis. Its incidence in head and neck patients could potentially be reduced through stringent blood pressure management, tight intraoperative heart rate control, and dampening of the postoperative inflammatory response. Troponin testing is a valuable screening tool, and patients who have elevated levels postoperatively should be closely monitored and referred to a cardiologist for optimization of cardiovascular care.

Dissection of the submuscular recess (sublevel IIb) in squamous cell cancer of the upper aerodigestive tract: Prospective study and systematic review of the literature

Selective neck dissection is commonly used to clear occult neck metastases in the N0 neck. The aim of this study was to identify the incidence of occult metastases in lymph nodes of sublevel IIb (submuscular recess; SMR) in upper aerodigestive tract squamous cell carcinoma in the setting of clinically and radiologically staged N0 necks and to perform a systematic review of the literature on the incidence of metastases in this setting. We conducted a prospective study of 50 neck dissections and systematic review of the literature. (A) Prospective study: Tissue dissected out from the SMR was sent separately for histopathologic analysis. Between 0 and 7 nodes were harvested from sublevel IIb. One patient had a metastatic node in sublevel IIb with extracapsular spread in the ipsilateral neck. No other positive nodes were detected. Sixteen necks showed occult metastases at other levels. (B) Systematic review: The review identified 14 articles with 903 necks suitable for inclusion. The overall incidence of metastatic disease at this sublevel in the context of an N0 neck from any site is 2.0% (18 of 903). The incidence of occult metastatic disease in sublevel IIb for oral cavity, oropharyngeal, and laryngeal cancer is 3.9% (11 of 279), 5.2% (5 of 96), and 0.4% (1 of 230) patients, respectively. Contralateral positive nodes (0.9%) and isolated metastases (0.3%) at this sublevel were rare. Nodal metastases are uncommon in the SMR even in the presence of positive nodes in adjacent sublevel IIa. There appears to be no advantage in performing contralateral SMR dissection in N0 necks and in laryngeal primaries.

Dissection of level IIb in squamous cell cancer of the upper aerodigestive tract: prospective study and systematic review of the literature

Objectives. Selective neck dissection is commonly used to clear occult metastases in the N0 neck. The aim of this study is to identify the incidence of micrometastases in level IIb nodes in patients with upper aerodigestive tract squamous cell carcinoma with clinically and radiologically staged N0 necks and to perform a systematic review of the literature on the incidence of metastases in this setting.Methods. Thirty‐eight patients were selected and 50 neck dissection (ND) specimens were examined prospectively. Tissue dissected from level IIb was sent separately for histo‐pathological analysis. All the relevant literature in the English language was systematically reviewed.Results. On average, 2.9 ± 0.4 nodes (range 0–10) were harvested. One patient had a metastatic node in level IIb with extracapsular spread in the ipsilateral neck. No other positive nodes were detected. There was an incidental finding of a deposit of papillary thyroid carcinoma. Sixteen of the 50 NDs showed micrometastases at other levels, predominantly in level IIa (75%). The systematic review identified 11 papers with 704 patients suitable for inclusion. The overall incidence of metastatic disease at level IIb in the context of an N0 neck from any site is 2.3% (16/704). 3.5% (11/312) of oral cavity cancer metastasise to level IIb and none of the 244 patients with laryngeal cancer had level IIb metastatic nodes.Conclusions. Nodal metastasis is rare in the level IIb even in the presence of positive nodes in adjacent level IIa. There appears to be no advantage in performing contralateral level IIb dissection in N0 necks.

Novel Techniques to Guide the Neodymium-Doped Yttrium Aluminum Garnet Laser Fiber for Laser Surgery of Upper Aerodigestive Tract Squamous Cell Carcinoma

The LaryngoscopeVolume 115, Issue 5 p. 912-914 Article Novel Techniques to Guide the Neodymium-Doped Yttrium Aluminum Garnet Laser Fiber for Laser Surgery of Upper Aerodigestive Tract Squamous Cell Carcinoma Vinidh Paleri MS FRCS(ORL-HNS), Corresponding Author Vinidh Paleri MS FRCS(ORL-HNS) [email protected] Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Mr. V. Paleri, 21 Greenlee Drive, Little Benton, Newcastle upon Tyne, NE7 7GA, UK.Search for more papers by this authorLouise Nelson CN MACORN, Louise Nelson CN MACORN Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Search for more papers by this authorGuy Rees FRCS(ORL-HNS), FRACS, Guy Rees FRCS(ORL-HNS), FRACS Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Search for more papers by this authorSuren Krishnan FRACS, Suren Krishnan FRACS Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Search for more papers by this author Vinidh Paleri MS FRCS(ORL-HNS), Corresponding Author Vinidh Paleri MS FRCS(ORL-HNS) [email protected] Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Mr. V. Paleri, 21 Greenlee Drive, Little Benton, Newcastle upon Tyne, NE7 7GA, UK.Search for more papers by this authorLouise Nelson CN MACORN, Louise Nelson CN MACORN Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Search for more papers by this authorGuy Rees FRCS(ORL-HNS), FRACS, Guy Rees FRCS(ORL-HNS), FRACS Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Search for more papers by this authorSuren Krishnan FRACS, Suren Krishnan FRACS Department of Otolaryngology—Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia.Search for more papers by this author First published: 03 January 2009 https://doi.org/10.1097/01.MLG.0000157329.09688.D2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume115, Issue5May 2005Pages 912-914 RelatedInformation

Recidivas locais após tratamento cirúrgico do carcinoma epidermóide de cabeça e pescoço em estágio avançado

OBJETIVO: Avaliar os resultados do tratamento de resgate das recidivas locais nos pacientes com carcinoma epidermóide das vias aerodigestivas superiores submetidos a tratamento cirúrgico. MÉTODO: Foram revisados os prontuários de 943 pacientes submetidos à ressecção do tumor primário e esvaziamento cervical entre 1977 e 1996, e selecionados 107 pacientes com recidiva no sítio primário. Foram avaliados os resultados do tratamento de resgate, bem como os motivos para a não realização do mesmo. RESULTADOS: A principal queixa no diagnóstico da recidiva foi dor. O tratamento de resgate foi realizado em 45% dos pacientes e o principal motivo para a não realização do mesmo foi a extensão da recidiva. Foram resgatados 54% dos pacientes com recidiva no estádio rT1T2 em comparação com 31% dos pacientes rT3T4 (p = 0,04). Apenas quatro (8%) dos pacientes resgatados estavam assintomáticos por período superior a 12 meses após o re-tratamento, todos resgatados com cirurgia. O intervalo de tempo entre o tratamento inicial e a recidiva apresentou mediana de oito meses e as novas recidivas ocorreram na mediana de cinco meses. CONCLUSÃO: As recidivas locais após tratamento cirúrgico extenso apresentam prognóstico reservado.

Upper aerodigestive tract squamous cell carcinoma: Distribution of extracapsular spread and soft tissue deposits in the neck

ObjectiveExtracapsular spread (ECS) and soft tissue deposits (STD) of squamous cell carcinoma (SCC) in the neck of patients with metastatic SCC of the upper aerodigestive tract have been shown to adversely affect actuarial and disease-free survival. No studies to date have detailed the distribution of ECS and STD within the neck.Material and MethodsA total of 215 neck dissections from 155 patients were prospectively collected and analysed for the presence of both STD and ECS. As no classification for STD exists, their distribution was classified according to the nodal levels used for classification of cervical lymph nodes as described by the Memorial Sloan–Kettering Cancer Center.ResultsA total of 81 neck dissections from 59 patients were found to have either metastatic lymph nodes with ECS, STD or both. The distribution of lymph node metastasis, ECS and STD was very similar. Level II was most frequently affected, with Levels III and IV being affected less frequently. There were very few lymph node metastases to Level V, and this level contained no evidence of either ECS or STD.ConclusionThe method of pathological assessment of neck dissection specimens and reporting on the presence of ECS and STD has not been formalized. By analysing neck dissection specimens in the manner described we can report on the presence or absence of ECS and STD with increased accuracy. This has considerable implications for patient management.

CAROTID ARTERY INVASION BY SQUAMOUS CELL CARCINOMA OF THE UPPER AERODIGESTIVE TRACT: THE PREDICTIVE VALUE OF CT IMAGING

SUMMARYCarotid artery invasion by squamous cell carcinoma of the upper aerodigestive tract is a poor prognostic indicator and a relative indicator of tumour inoperability. A number of imaging modalities are available for detecting such invasion, but, because of its availability, computerised tomography (CT) is the usual modality We have analysed the CT scans of 196 patients referred to the department with an upper aerodigestive tract squamous cell carcinoma. Comparing the scans with the operative findings indicates that CT scans significantly overestimate carotid artery invasion.

Cervical node metastases in squamous cell carcinoma of the upper aerodigestive tract: the significance of extracapsular spread and soft tissue deposits.

Literature regarding the prognostic significance of extracapsular spread and soft tissue deposits in cervical lymph node metastases of squamous cell carcinoma of the upper aerodigestive tract shows variable results. We analyzed 215 prospectively collected neck dissections from 155 patients with upper aerodigestive tract squamous cell carcinoma to assess the prevalence of extracapsular spread and soft tissue deposits and to assess their effect on survival. Both extracapsular spread and soft tissue deposits significantly reduced survival (actuarial and recurrence free) compared with pN0 necks (p <.001) and pN+ve necks without extracapsular spread (p <.0025). There was no statistically significant difference between pN+ve necks without soft tissue deposits or extracapsular spread compared with those with pN0 necks (p =.24). Multivariate analysis revealed comparable results. Microscopic and macroscopic extracapsular spread and soft tissue deposits are of prognostic significance for survival and recurrence-free survival in patients with upper aerodigestive tract squamous cell carcinoma.

Widespread subcutaneous distant metastases from a head and neck squamous cell carcinoma

During the past 30 years, the incidence of squamous cell carcinoma (SCC) arising in the upper aerodigestive tract has generally increased worldwide.1 The development of SCC within the head and neck (HN) results from a series of genetic transformations producing a malignant phenotype.2 The essential nature of this malignant phenotype is its ability to act autonomously, initially invading local tissues and subsequently being capable of metastasizing to regional and distant sites. The cervical lymph nodes are the most common sites for regional metastases of oral and oropharyngeal SCC.3 The distribution of regional nodal deposits of metastatic SCC from various mucosal primary sites within the HN has been well documented in the literature.4,5 Distant metastases from primary cancers of the HN occur most commonly in the lungs, liver, and bone (Table 1). Other less common sites have been reported in the literature (Table 2). Historically the incidence of distant metastases (DMs) among patients with HN cancer has been very low. However, as local and regional control has improved, DMs may be seen as an increasingly important source of morbidity and mortality. There is a paucity of antemortem case reports of DM in the literature and none documenting subcutaneous deposits below the clavicles. In view of this, we report an unusual presentation of DM relating to widespread subcutaneous metastatic deposits. We also review the literature related to the presentation of DM arising from upper aerodigestive tract SCC.

Squamous cell carcinoma of the upper aerodigestive tract: the prevalence of microscopic extracapsular spread and soft tissue deposits in the clinically N0 neck.

With squamous cell carcinoma of the upper aerodigestive tract the presence or absence of neck metastases is the most important prognostic factor. This makes the histopathologic assessment of neck dissections of paramount importance. With the clinically N0 neck the prevalence of microscopic extracapsular spread and soft tissue deposits has not previously been described. We have prospectively analyzed 96 elective neck dissections in 63 patients with upper aerodigestive tract squamous cell carcinoma and clinically N0 necks to assess the prevalence of microscopic extracapsular spread and soft tissue deposits. The dissections were separated peroperatively into nodal levels; these were sectioned at 6-microm sections and stained with H & E. Nineteen patients (30.2%) were upstaged to pN+ve. Twelve of these had microscopic extracapsular spread, which was 19.0% of the clinically N0 necks and 63.2% of the pN+ve. Five had soft tissue deposits, which was 7.9% of the clinically N0 necks. Fourteen patients had microscopic extracapsular spread and/or soft tissue deposits, which represented 22.2% of all necks examined and 73.7% of the pN+ve necks. Microscopic extracapsular spread and soft tissue deposits have a high prevalence in patients with clinically N0 necks. Extracapsular spread can occur at an early stage in metastasis from upper aerodigestive tract squamous cell carcinoma. Soft tissue deposits can also occur at an early stage. Soft tissue deposits may occur by the same process as lymph node metastasis with total effacement of the lymph node or may occur by some other process such as lymphatic tumor embolization.

Electroporation therapy for head and neck cancer including carotid artery involvement.

Electroporation therapy with intralesional bleomycin (EPT) is a novel, technically simple outpatient technique in which high-voltage electric impulses delivered into a neoplasm transiently increase cell membrane permeability to large molecules, including cytotoxic agents, causing localized progressive necrosis. Unlike many laser ablation methods, EPT can treat bulky tumors (>2 cm) with complete penetration. Our recent publication confirms an excellent response rate in the use of EPT in a clinical trial. Following our initial prospective study report in 1998, we have followed our entire initial cohort (10 patients) of patients with head and neck cancer beyond 24-months follow-up. Additionally, we have used this approach to treat four additional patients (total: 9 males/5 females) with upper aerodigestive tract squamous cell carcinoma, including three with internal carotid artery (ICA) involvement up to or within the skull base. Two patients underwent preoperative balloon test occlusion with cerebral perfusion studies followed by carotid embolization. EPT was then done safely at least 2 weeks later to avoid the temporary hypercoagulable state. Within the overall cohort (14 patients) 6 patients had a complete response, 6 had a partial response, and 2 did not respond (overall 85.7% response rate). Both patients with ICA involvement had a partial or complete response to treatment; neither patient had a hemorrhagic or neurologic complication. Overall, 13 of the 14 patients were treated for persistent or recurrent head and neck cancer. Two of the four patients with early recurrent stage tumors had no evidence of recurrence after EPT with an average follow-up of 31.5 months. The overall early stage tumor group had four complete responders out of five (80%). On the contrary, only 2 of 9 patients with advanced recurrent stage tumors were disease-free at 18 months. Morbidity was low for early stage tumors, but higher for advanced tumors with complications, including poor wound healing, dysphagia, and osteomyelitis. There were no treatment-related deaths. We found EPT to be safe and efficacious in patients with head and neck cancer, even with internal carotid artery involvement. Patients with early stage recurrences have the potential for prolonged survival beyond 2 years without the morbidity of surgery and radiation or toxicity of systemic chemotherapy. Because of its superb access qualities even for bulky tumors, EPT is a potential method of delivery for other tumoricidal agents such as in genetic-altering schemes.

Cyclin D1 and p53 overexpression predicts multiple primary malignant neoplasms of the hypopharynx and esophagus.

Multiple primary upper aerodigestive tract carcinomas can occur in up to 15% of patients. We have shown previously that half of the patients with multiple upper aerodigestive tract squamous cell carcinomas are initially seen with synchronous tumors. Most metachronous squamous cell carcinomas become manifest within 3 years. To examine the expression of 2 proteins-cyclin D1 and p53--in an attempt to predict the occurrence of multiple primary malignant neoplasms (MPs). Monoclonal antibodies to cyclin D1 (DCS-6 [dilution, 1:50]. Novocastra Laboratories Ltd, Newcastle, England) and p53 (DO-7 [dilution, 1-100], Dako Corp, Carpinteria, Calif) proteins were used. Resection specimens from a total of 47 patients, 12 patients with MP and 35 patients with nonmultiple primary malignant neoplasms, were analyzed. Those in the nonmultiple primary malignant neoplasm group had longer than 3 years' follow-up to ascertain the absence of MP. Tumor overexpression of cyclin D1 was significantly associated with the development of MP (P<.01). Tumor overexpression of p53 was also frequent in patients with MP although statistical significance was not achieved. The combination of these 2 parameters was an even greater predictor of MP (P<.001). Overexpression of cyclin D1 and p53 proteins was highly correlated with the development of MP. Additional studies are necessary to confirm this finding. Immunohistochemical evaluation of primary squamous cell carcinomas for cyclin D1 and p53 overexpression may become an important fact of surgical pathologic reporting for primary upper aerodigestive tract squamous cell carcinomas.

Isolated submandibular gland metastasis from oral cavity squamous cell carcinoma

Malignant neoplasms of the major salivary glands are rare, with an estimated incidence of 1% to 4% of all head and neck malignant tumors.’ Although only 20% to 30% of parotid tumors are malignant, approximately 40% to 50% of submandibular gland neoplasms are malignant.2-6 Even more rare than a primary malignant salivary gland neoplasm is a malignancy metastatic to the salivary glands. The Armed Forces Institute of Pathology (AFIP) estimates 3% of all malignant salivary gland tumors are metastatic.6p7 This report describes an isolated metastatic lesion to the ipsilateral submandibular gland in two patients. From July 1993 to January 1998,260 neck dissections were performed by the senior author in patients with upper aerodigestive tract squamous cell carcinoma (SCCA). On review of the histopathological material, two patients (0.7%) were found to have metastatic SCCA to the submandibular gland.