Early Squamous Cell Cancer Research Articles

Retromolar trigone squamous cell cancers: A reappraisal of 16 section MDCT for assessing mandibular invasion

To reinvestigate the accuracy of 16 section multidetector computed tomography (MDCT) in assessing mandibular invasion in retromolar trigone (RMT) squamous cell cancers (SCC). A search for diagnosed cases of early RMT SCC that were both imaged and treated at Tata Memorial Centre, Mumbai, India, between 2007 and 2010, was undertaken and yielded 37 patients. The average tumour size was 2.6 cm. All patients had undergone segmental, marginal, or hemimandibulectomy within 2 weeks of imaging. Imaging records archived on the picture archiving and communication system (PACS) were analysed. Contrast-enhanced CT had been performed using a 16 section MDCT system using the puffed-cheek technique. Image acquisition was at 2.5 mm section thickness, but axial images and isotropic coronal and sagittal multiplanar reformations were generated ad hoc from 0.625 mm retro-reconstructed images. Optimal oblique reformations were generated at will by the radiologist to depict the RMT in its entirety. The soft-tissue algorithm and bone window or bone algorithm reformations and axial images were analysed on a volume viewer integrated within the PACS using triangulation. Two investigators independently studied the images and these were compared with the findings at histopathology. The sensitivity, specificity, and accuracy of 16 section MDCT for mandibular cortical and marrow invasion was 94, 90, and 91.8% and 83, 92, and 89%, respectively. Use of ad hoc generated oblique reformation contributed to the enhanced sensitivity and specificity. The accuracy for inferior alveolar canal invasion was 100%. There was excellent agreement between the two observers. Sixteen-section MDCT used to its full potential has high accuracy for the detection of mandibular invasion in RMT SCC.

Transoral Resection Technique and Resected Tissue Volume in Patients with Oropharyngeal Squamous Cell Carcinoma

Objectives: Elucidate the relationship between transoral resection technique and resected tissue volume in patients with early stage oropharyngeal squamous cell cancer (OPSCC) and determine if resection volume affects functional outcome. Methods: Forty-six patients with previously untreated early T-stage OPSCC underwent transoral laser microsurgery (TLMS) and transoral robotic surgery (TORS) between 2008 and 2013 at academic referral center were studied retrospectively. The resected tissue volume, the location of resection, and MD Anderson Dysphagia Inventory (MDADI) were described. Results: Mean resected tissue volume for T1 tumors with TORS was 11.44 cm3 and was 7.90 cm3 with TLMS, ( P = 0.44). Mean resected tissue volume for T2 tumors with TORS was 19.45 cm3 and 10.73 cm3 for TLMS ( P = 0.194). With a median follow-up of 11 months, the average of MDADI score was 77.9 for TORS and 74.2 for TLMS for T1 tumors, ( P = 1) and 67.9 for TORS and 50.1 for TLMS, ( P = 0.052) for T2 tumors. MDADI score for T1 with TLMS and TORS combined was 76.7 and for T2 was 63.45 ( P = 0.0048). Conclusions: TLMS and TORS are minimally invasive surgical approaches used to treat OPSCC. Both techniques employ different resection techniques; TLMS removes smaller, tumor specific volumes while TORS has anatomy-based predefined resection limits. Our study shows that despite these differences in surgical technique, there is no statistical difference in resected tissue volumes and swallowing function for T1 and T2 tumors removed by both techniques. However, functional outcome of both techniques combined for T1 tumors were superior to T2 tumors.

Diagnosing early Barrett's neoplasia and oesophageal squamous cell neoplasia by bioimpedance spectroscopy in human tissue.

Detection of early oesophageal cancer in surrounding normal tissue can be challenging, but detection is essential to determine the subsequent treatment. Dysplastic tissue can be detected by using electrical impedance spectroscopy (EIS). The aim of the present study was to evaluate the feasibility and value of EIS in the diagnosis of oesophageal neoplasia. This prospective ex-vivo study included 23 patients with early oesophageal cancer (17 with Barrett's cancer and six with early squamous cell cancer). Immediately after endoscopic resection, the electrical properties of the resected specimens were investigated using a pencil probe (5 mm in diameter, frequency range from 100 Hz to 1 MHz). Punch biopsies were taken from the measured site in order to compare the results of EIS with histology. EIS was able to detect dysplastic oesophageal mucosa with a high rate of accuracy (82% in Barrett's oesophagus and 100% in squamous oesophagus) A total of 54 different sites in 26 tumours were evaluated. EIS was able to differentiate reliably between non-neoplastic and neoplastic oesophageal mucosa. Using EIS, it might be possible to use it for targeted biopsies and to avoid unnecessary biopsies during cancer surveillance in future.

Management of the N0 neck in early stage oral squamous cell cancer: A modeling study of the cost-effectiveness

To assess the cost-effectiveness of five strategies for diagnosing and treating cT1-2N0 oral squamous cell cancer. A Markov decision analytic model was used to evaluate the cost-effectiveness of (1) elective neck dissection (END), (2) watchful waiting (WW), (3) gene expression profiling (GEP) followed by neck dissection (ND) or WW, (4) sentinel lymph node (SLN) procedure followed by ND or WW, and (5) GEP and SLN (for positive GEP) followed by ND or WW. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Base-case analysis showed that SLN procedure followed by ND or WW was the most effective and most cost effective strategy. Compared with direct END the incremental cost effectiveness ratio was €3356 per QALY gained. Uncertainty analysis showed that the model was sensitive to changes in assumed occult metastases incidence and utility values. SLN was found to have the highest probability (66%) of being cost-effective of the five strategies, at a willingness to pay of €80,000 per QALY. Given the current evidence and costs the SLN procedure followed by ND or WW appears to be the most cost effective strategy for diagnosing and treating oral squamous cell cancer patients. Our model provides the foundation for future diagnostic and therapeutic research in this field and shows that further information on quality of life in this population is highly valuable.

Sp608 Successful Mucosal Transplantation from Stomach to Esophagus for Stricture Prevention after Widespread Circular Endoscopic Submucosal Dissection (ESD) For Early Esophageal Squamous Cell Carcinoma - Report of a First Case in Man with 1 1/2 Year Transplant Survival

Secondary stricture formation is the major drawback for resections >3 cm or more than 75% of the esophageal circumference at esophageal ESD. In March 2011 we embarked on animal experiments regarding esophageal resection and re-transplantation of esophageal and gastric mucosal patches in pigs under an approved protocol (NLVL No: 33-42502-06/1151) for stricture prevention. CASE REPORT: A 72 y old man with swallowing difficulty (DG1); tabacco use of 20 py until >15 y ago. Prior rectal resection with sigma anus praeter for a T2 distal rectal cancer. EGD: Suspicion of early squamous cell cancer (Paris IIa; EUS UT1a, m, N0), >75% circum-ferential tumor spread within the cervical esophagus and upper sphincter area (17-25 cm aborally). Biopsy: SC HG-IEN. On April 13, 2011 we performed an EGD under general anesthesia with tracheal intubation with first tubular ESD over 10 cm from the lower hypopharynx through the UES from 17-27 cm followed by a 9x4 cm ESD in the gastric antrum. The healthy gastric specimen retrieved was cut longitudinally into 3 mucosal stripes that were attached to the denuded esophageal muscular layer by means of hemoclips. The stripes were gently pressed against the wall by a non-covered self-expanding metal stent with the intent to allow also a luminal nutrition of the specimen. The sphincter area of 1.5 cm length had to be spared. The esophageal specimen showed a non-invasive low horny early squamous cell cancer (pT1a G2 L-, V-) and curative resection (R0; invasion depth of lamina propria max. 150 microns). Stent removal was performed at day 20 and was cumbersome due to local mucosal hyperplasia. However, multiple islets of gastric mucosa had successfully grown at the esophageal resection site. The patient was discharged on day 24 and regularly seen as outpatient. We observed a stepwise circular spread out of the reddish layer over an area of 5-6 cm within the next 6 months. Stenosis was successfully prevented. Biopsy proved antral HP-negative mucosa. 1 1/2 years later the patient is free of complaints. This first case of a successful gastro-esophageal endoscopic mucosal transplant with one year follow-up after wide- spread ESD in the esophagus for an early squamous cell cancer opens a new perspective for systematic research in this field.

Significance of anterior commissure involvement in early glottic squamous cell carcinoma treated with trans‐oral CO2 laser microsurgery

To study and compare the outcome of trans-oral CO2 laser microsurgery for early glottic squamous cell cancer with and without the involvement of anterior commissure (AC). This is a retrospective analysis of 296 cases of early glottic squamous cancer treated by trans-oral CO2 laser microsurgery. The patients were divided into two groups depending on whether AC was involved or not. The impact of AC involvement on rates of local recurrence, laryngeal preservation, overall survival, and disease-specific survival was compared in both the groups. Out of the 296 cases, 61 cases had AC involvement, while in 235 cases AC was free of disease. Local recurrence rate was significantly higher at 29.51% in the group with AC involvement, while only 18.3% cases had local recurrence in the group without AC involvement with P value of 0.0001. On T stage-wise analysis, 34.8% cases of T2 lesions with AC involvement developed local recurrence, as compared to only 10.26% cases of T2 without AC involvement with significant P value of 0.007. Larynx preservation rate was 95.8% versus 93.26% in the AC-involved and AC not-involved cases, respectively, without any statistical significance (P=0.287). The overall survival was 90.16% versus 86.38% in the cases with and without AC involvement, respectively, without significant P value 0.642. Trans-oral laser surgery is an excellent treatment option in patients with early glottic cancer irrespective of whether or not the AC is involved. Trans-oral laser microsurgery for early glottic cancer involving AC requires adequate exposure, proper assessment, good experience, and advanced surgical skills.

Early-Stage Esophageal Squamous Cell Carcinoma Treated with Californium-252 Neutron Brachytherapy: Clinical Report on 16 Cases

Californium-252 (²⁵²Cf) neutron brachytherapy is a form of high linear energy transfer radiotherapy, which has proven effective when used in combination with external beam radiotherapy to treat intracavitary cancers of the cervix, colon/rectum and esophagus. No study has been reported for treatment of intracavitary cancers with neutron brachytherapy alone. The aim of the study was to observe and analyze the long-term curative effects and complications for early stage thoracic esophageal cancer patients treated with neutron brachytherapy alone. From December 2001 to August 2006, 16 patients of early stage squamous cell carcinoma underwent neutron brachytherapy. The total radiation dose to the reference point was 20-28 Gy-eq in 5 to 7 fractions with 4 Gy-eq/fraction. The 1-, 3-, and 5-year follow-up rates were 100%. The 2-, 3-, 4-, and 5-year survival rates were 100%, 87.5%, 87.5%, and 75%, respectively. The early complication rates for grades 1 and 2 radiation esophagitis were 75% and 25%, respectively. The late complication rates for grades 0 and 1 (according to the RTOG/EORTC standard) were 87.5% and 12.5%, respectively. Barium esophagography after treatments confirmed that the complete response rate was 100%. Fourteen patients were confirmed by endoscopy to have either normal mucosa or inflammation change. Neutron brachytherapy alone was an effective and safe treatment for early stage esophageal squamous cell cancer.

Long‐term regional control and survival in patients with “low‐risk,” early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation

The objectives of this study were to determine the incidence of locoregional failure in patients with low-risk, early stage oral tongue squamous cell cancer (OTSCC) who undergo partial glossectomy and ipsilateral elective neck dissection without receiving postoperative radiation. A combined database of patients with OTSCC who received treatment at Memorial Sloan-Kettering Cancer Center and Princess Margaret Cancer Center from 1985 to 2005 was established. In total, 164 patients with pathologic T1-T2N0 OTSCC who underwent partial glossectomy and ipsilateral elective neck dissection without postoperative radiation were identified. Patient-related, tumor-related, and treatment-related characteristics were recorded. Local recurrence-free survival, regional recurrence-free survival, and disease-specific survival were calculated by the Kaplan-Meier method. Predictors of outcome were analyzed by univariate and multivariate analysis. At a median follow-up of 66 months (range 1-171 months), the 5-year rates of local recurrence-free survival, regional recurrence-free survival, and disease-specific survival were 89%, 79.9%, and 85.6%, respectively. Regional recurrence was ipsilateral in 61% of patients and contralateral in 39% of patients. The regional recurrence rate was 5.7% for tumors <4 mm and 24% for tumors ≥ 4 mm. Multivariate analysis indicated that tumor thickness was the only independent predictor of neck failure (regional recurrence-free survival, 94% vs 72% [P = .02] for tumors <4 mm vs ≥ 4 mm, respectively). Patients who developed recurrence in the neck had a significantly poorer disease-specific survival compared with those who did not (33% vs 97%; P < .0001). Patients with low-risk, pathologic T1-T2N0 OTSCC had a greater than expected rate of neck failure, with contralateral recurrence accounting for close to 40% of recurrences. Failure occurred predominantly in patients who had primary tumors that were ≥ 4 mm thick.

Outcome of per oral wide excision of T1‐2 N0 localized squamous cell cancer of the buccal mucosa—analysis of 156 cases

The purpose of the study was to study the outcomes of per oral wide excision of early T1-2 N0 squamous cell cancer of buccal mucosa. This is a retrospective study of early and localized squamous cell cancer of the buccal mucosa treated with peroral wide excision at a tertiary-care hospital. A total of 156 patients were analyzed. One hundred ten patients (70.5%) had no recurrence, whereas 15 (9.6%) had a local recurrence, 24 (15.4%) had regional metastasis, three (1.9%) had locoregional recurrence, and four (2.6%) developed second primary tumors over a median follow-up of 48 months. Most patients with local recurrences (14 patients, 93.3%) and regional metastases (24 patients, 100%) could be salvaged with treatment. In contrast, all three cases with locoregional could not be salvaged. Most of the cases with recurrences, 36 (78%) in this study group, occurred within 2 years of primary treatment. Out of 143 cases with a habit of tobacco/beetel quid chewing, premalignancy was seen in 62 (43.4%) cases, showing a statistically significant association with P-value of 0.012. Fifteen (21.4%) cases with stage T2 developed regional neck nodes, while only 9 (10.5%) cases with stage T1 developed regional neck nodes with P-value of 0.032. Three-year overall survival rate and disease-free survival rates were 91.7% and 70.5%, respectively. Peroral wide excision seems to be an adequate procedure for T1-2N0 localized squamous cancer of buccal mucosa. Prophylactic selective neck dissection should be considered in only T2 N0 cases as only T stage of the disease could be significantly correlated with the development of the metastatic neck nodes.

Successful mucosal transplantation from stomach to esophagus for stricture prevention after widespread circular endoscopic submucosal dissection (ESD) for early esophageal squamous cell carcinoma – report of a first case in man with 1 year transplant survival after preliminary animal experiments in the pig

ESD in the esophagus is an expert technique for ‘en bloc’ resection of mucosal cancers >2cm in size. I can provide a quasi-surgical specimen and significantly reduces the risk of local recurrence compared to piecemeal EMR. However, secondary stricture formation is the major drawback for resections >3cm and of more than 75% of the esophageal circumference. Multiple bouginage sessions or temporary stent placement may be required limiting the QoL. Experimental approches include transplantation of buccal or dermal cell grafts as well as systemic and local steroid applications. However, clinical experience is very limited so far. Since march 2011 be had been performing animal experiments concerning esophageal resection and re-transplantation of esophageal and gastric mucosal patches in pigs under an approved protocol (NLVL No: 33–42502–06/1151) with first preliminary but encouraging results when the following clinical presented. Case report: A 72 y male pat. with swallowing difficulty; tabacco use of 20 py until >15y ago. Prior rectal resection with sigma anus praeter for a T2 distal rectal cancer. EGD: Suspicion of early squamous cell cancer (Paris IIa; EUS UT1a, m, N0), >75% circum-ferential superficial tumor spread within the cervical esophagus and upper sphincter area (17–25cm aborally). Biopsy: SC HG-IEN. Discussion of the different treatment options in our interdisciplinary tumor board and with the patient: tubular endoscopic resection alone with 80–100% stricture probability, thermal ablation, radical surgery, primary chemoradiation or an experimental approach as compassionate use with primary ESD in the esophagus and secondary gastro-esophageal mucosal patch transplantation. On April 13, 2011 we performed an EGD under general anesthesia with tracheal intubation with first tubular ESD over 10cm from the lower hypopharynx through the UES from 17–27cm followed by a 9×4cm ESD in the gastric antrum. The healthy gastric specimen prelieved was cut longitudinally into 3 mucosal stripes which were attached to the denuded esophageal muscular layer by means of hemoclips. The specimen were gently pressed against the wall by a non-covered self-expanding metal stent to allow luminal and vascular nutrition of the specimen. The sphincter area of 1.5cm length had to be spared in order to not compress the lower larynx with the stent and to avoid unsupportable pain for the patient. After a control the following day the patient could be extubated. The esophageal specimen showed a non-invasive low horny early squamous cell cancer (pT1a G2 L-, V-) and and curative resection (R0; invasion depth of lamina propria max. 150 microns). Stent removal was performed at day 20 pp and was cumbersome due to local mucosal hyperplasia. However, multiple islets of gastric mucosa had successfully grown at the esophageal resection site. The patient was discharged on day 24 and regulary seen as outpatient. We observed a stepwise circular spread out of the reddish layer over an area of 5–6cm within the next 6 month and successful prevention of stenosis. Biopsy proved antral HP-negative mucosa. Unfortunately a 1–1.5cm non-transplant covered segment in the sphincter area showed a repetive tendency to stricture formation serving quasi as ‘natural’ control and requiring multiple ambulatory bouginage treatments but allowing a (semi-) solid diet without restrictions for most food products (DG1). Conclusions: The so far unique case of a gastro-esophageal endoscopic mucosal transplant with one year follow-up after wide-spread ESD in the esophagus for an early squamous cell cancer opens a new perspective for systematic research in this field.

A matched cohort comparison of mTHPC-mediated photodynamic therapy and trans-oral surgery of early stage oral cavity squamous cell cancer

Photodynamic therapy (PDT) of early stage oral cavity tumors have been thoroughly reported. However, statistical comparison of PDT to the surgical treatment is not available in published literature. We have identified and matched cohorts of patients with early stage oral cavity cancers undergoing surgery (n = 43) and PDT (n = 55) from a single institute experience. The groups are matched demographically and had the same pre-treatment screening and follow-up schedule. Both groups consisted only of tumors thinner than 5 mm to ensure comparability. The endpoints were local disease free survival, disease free survival, overall survival and response to initial treatment. Local disease free survival at 5 years were 67 and 74 % for PDT and surgery groups, respectively [univariate HR = 1.9 (p = 0.26), multivariable HR = 2.7 (p = 0.13)]. Disease free survival at 5 years are 47 and 53 % for PDT and surgery groups, respectively [univariate HR = 0.8 (p = 0.52), multivariable HR = 0.75 (p = 0.45)]. Overall survival was 83 and 75 % for PDT and surgery groups, respectively [(univariate HR = 0.5 (p = 0.19), multivariable HR = 0.5 (p = 0.17)]. In the PDT group, six patients (11 %) and in the surgery group 11 patients (26 %) had to receive additional treatments after the initial. All of the tested parameters did not have statistical significant difference. Although there is probably a selection bias due to the non-randomized design, this study shows that PDT of early stage oral cavity cancer is comparable in terms of disease control and survival to trans-oral resection and can be offered as an alternative to surgical treatment.

SOX2 and FGFR1 gene copy number in surgically resected non-small cell lung cancer (NSCLC).

7061 Background: SOX2 is a member of the SRY-related HMG-box family of transcription factors and has been shown to be frequently amplified and overexpressed in squamous cell lung cancer, with conflicting results regarding its prognostic relevance. Similarly, FGFR1, a transmembrane tyrosine kinase receptor belonging to the fibroblast growth factor receptor family, has been recently reported to be amplified in squamous cell lung carcinomas, suggesting a potential role for FGFR1 as a therapeutic target in NSCLC. Aim of the present study is to evaluate SOX2 and FGFR1 gene copy number in surgically resected NSCLCs, to investigate their prognostic relevance and their association with clinico-pathological characteristics. Methods: SOX2 and FGFR1 gene copy number was assessed by fluorescence in situ hybridization (FISH) in tissue microarray cores from 447 surgically resected NSCLCs. Each patient was given a score ranging from 1 to 6 according to increasing mean copy number per cell of each gene, with 6 indicating true gene amplification. Results: SOX2 and FGFR1 FISH was successfully performed in 445 patients (pts), which were grouped as + (score 5-6) and - (score 1-4). Using this scoring system 105 (23.6%) pts tested SOX2+, while 74 (16.6%) pts resulted FGFR1+. True gene amplification for SOX2 and FGFR1 was observed in 19 (4.3%) and 37 (8.3%) cases, respectively. SOX2+ and FGFR1+ status was significantly associated with squamous histology (p&lt;.001). Additionally, SOX2+ pts had a significantly higher chance of being former/current smokers, male and FGFR1+. FGFR1 gene status had no prognostic impact in the whole population and in the squamous cell carcinoma subgroup. Conversely, SOX2+ pts had significantly longer overall survival compared with SOX2- pts (HR 0.68, p=.020). When restricting survival analysis to squamous cell histology, stage I-II SOX2+ pts had a significant survival advantage compared with SOX2- group (HR 0.38, p=.006), while no difference was observed in stage III-IV pts. Conclusions: Increased SOX2 and FGFR1 gene copy number is a common event in lung cancer pts with squamous cell histology. SOX2 gene gain is a favorable prognostic factor in surgically resected pts, particularly in early stage squamous cell cancers.

Early stage squamous cell cancer of the oral tongue—clinicopathologic features affecting outcome

The objective of this study was to report the authors' experience in the management of patients with early stage squamous cell cancer (SCC) of the oral tongue and determine clinicopathologic factors predictive of outcome. Two hundred sixteen patients with early stage (cT1T2N0) SCC of the oral tongue were identified from a pre-existing database of patients with oral cancer who were treated at Memorial Sloan-Kettering Cancer Center from 1985 to 2005. Patient, tumor, and treatment characteristics were recorded. Overall survival (OS), disease-specific survival (DSS), and recurrence free survival (RFS) were calculated using the Kaplan-Meier method. Predictors of outcome were identified using multivariate analysis. With a median follow-up of 80 months (range, 1-186 months), the 5-year DSS, OS, and RFS rates were 86%, 79%,and 70%, respectively. Local, neck, and distant recurrences occurred in 24 patients (11%), 40 patients (18%), and 5 patients (2%), respectively. Multivariate analysis identified occult neck metastases as the main independent predictor of OS, DSS, and RFS; patients who had occult metastases had a 5-fold increased risk of dying of disease compared with patients who did not have occult metastases (5-year DSS, 85.5% vs 48.5%; P = .001). A positive surgical margin was the main independent predictor for local RFS (91% vs 66% for a negative surgical margin; P = .0004), and depth of invasion was the main predictor for neck RFS (91% vs 73% for depth of invasion <2 mm and >2 mm, respectively; P = .02). In the authors' experience, patients with early stage oral tongue cancer have excellent outcomes. In the current study, the presence of occult metastases was the main predictor of survival outcome.

1038 Lesser Sensitivity and Positive Predictive Value of Fecal Immunochemical Test (FIT) in Right Advanced Colonic Neoplasia Than Left Lesions

Background: Screening for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) with an EGD remains controversial, especially with regards to its cost-effectiveness. Prior models have not considered the added benefits of identifying early gastric cancer (GCA) or esophageal squamous cell cancer (SCC). In addition, screening costs can be reduced by performing screening EGD at the same time as screening colonoscopy. Aim: To evaluate the cost effectiveness of screening the general population for UGI cancers (EAC, esophageal SCC, GCA) by performing an EGD at the time of screening colonoscopy. Methods: A Markov Model was created using a hypothetical cohort of 50 year old patients with no gastrointestinal symptoms who are already undergoing screening colonoscopy. The primary decision compared two strategies: adding and not adding a screening EGD. Options for surveillance for non-dysplastic BE (NDBE) and low grade dysplasia (LGD), non-compliance with surveillance, endoscopic eradication therapy (EET) for BE with high grade dysplasia (HGD) and mucosal EAC, and endoscopic misdiagnosis were included in the model. Transition rates and utility values were taken from the published literature and expert consensus. Costs were viewed from the perspective of a third party payor and were obtained from the Centers for Medicare and Medicaid Services. The time horizon was from age 50 to age 80 or death. The primary outcome was the incremental cost-effectiveness ratio (ICER). Results: Screening the general population at the age of 50 for UGI cancers with surveillance of NDBE and LGD required $113,500 per quality-adjusted life-year (QALY) compared to no screening or surveillance. A screening only strategy (no BE surveillance) was dominated by the screening and surveillance strategy. If all patients were compliant with surveillance guidelines and all patients with HGD and mucosal EAC underwent EET (base case: 55% compliant, 50% choose EET while remaining undergo surgery), the ICER for screening and surveillance decreased to $92,300 per QALY compared to no screening or surveillance. In one-way sensitivity analyses, the prevalence of EAC, esophageal SCC, or GCA would have to increase by a factor of 10.3, 28.7, or 5.8, respectively to generate an ICER of less than $50,000 per QALY. Conclusion: The ICE ratio for screening the general population for UGI cancers with endoscopy remains high, despite accounting for reduced endoscopy costs and the combined benefits of detecting early EAC, esophageal SCC, and GCA. However, the ICER compares favorably to commonly performed screening strategies for other cancers.

S1506: High Success Rate of EMR in Early Barrett's and Squamous Cell Cancer

S1506: High Success Rate of EMR in Early Barrett's and Squamous Cell Cancer

587d: First Prospective Study on Endoscopic Radiofrequency Ablation of Moderate and High-Grade Intraepithelial Squamous Neoplasia and Early Squamous Cell Cancer of the Esophagus

587d: First Prospective Study on Endoscopic Radiofrequency Ablation of Moderate and High-Grade Intraepithelial Squamous Neoplasia and Early Squamous Cell Cancer of the Esophagus

Cryotherapy for Barrettʼs Esophagus and Early Esophageal Cancer: A Pooled Analysis of Cases from 1999-May 2009

Purpose: Endoscopic spray cryotherapy is increasingly recognized to be effective in ablating Barrett's esophagus (BE) and early esophageal cancer (EEC). To summarize the current practice and efficacy of cryotherapy for BE and EEC, we conducted a systematic literature review. Methods: We individually searched the literature (PubMed, EMBase, Web of Science, Cochrane, DDW and ACG meeting abstracts from 1999 to May 2009, bibliographies of selected articles). The search was limited to English publications, pilot studies and clinical trials with human participants. We excluded studies on advanced esophageal cancer, cryotherapy combined with other ablative modalities and studies not reporting complete resolution (CR), defined as no histological evidence of BE or neoplasia after treatment. We used the following search terms: cryotherapy, cryoablation, Barrett's esophagus and esophageal cancer. Data from earlier reports by the same authors and study were pooled with their updated reports. Three independent reviewers determined eligibility for inclusion and extracted data. Results: We identified no randomized clinical trials. Our search yielded 46 papers of which 8 met the inclusion criteria. These were published from 2006 to April 2009 with a total of 222 enrolled patients (mean age 68.5 yrs; 50-87% male). All studies were prospective case series, with cryotherapy as either primary or rescue treatment for BE and EEC. Six abstracts reported aggregated data while two abstracts published individual patient data. All used spray cryotherapy with either liquid nitrogen (N2, n=7 studies) or carbon dioxide (CO2, n=1). Four studies noted failed treatments before cryotherapy with endoscopic mucosal resection being the most common (n=34 cases). All verified histology by biopsy before treatment. There were 8 cases of early squamous cell cancer combined with the majority of cases reporting BE, high grade dysplasia and intramucosal carcinoma. Studies that reported BE length had a mean of 4.4 cm. Cryotherapy was administered over 2-8 cycles for 10-20 seconds per area, with a mean of 4.3 sessions per patient. Overall, 63% of enrolled patients completed treatment. The mean CR was 74% (range: 48-94%). The case series with CO2 cryogen had the highest CR rate (94%). Transient abdominal discomfort was the most common side effect (n=28 cases). Strictures were the most common serious events (n=9 cases), requiring dilation in 4 patients. Conclusion: The current literature suggests that cryotherapy is a safe and effective modality for BE and EEC. Further research using randomized trials is needed to establish efficacy, comparison with other modalities, optimal dosimetry and choice of cryogen (CO2 vs. N2) for better CR rates.

Consensus statement on management in the UK: Transoral laser assisted microsurgical resection of early glottic cancer

Transoral laser assisted microsurgical resection of early glottic laryngeal cancer is a relatively new treatment modality that is practised in many centres across the UK. In the absence of the results from randomised clinical trials, clinicians may be guided by an expert panel consensus statement on transoral laser assisted microsurgical resection of early squamous cell cancer of the larynx. To provide consensus recommendations on the various aspects of transoral laser assisted microsurgical resection for early glottic cancer. Nine centres across the UK were invited to describe current practice and outcomes for transoral laser assisted microsurgical resection of early glottic cancer. Four working groups were created to draw consensus on standard of care, surgical procedures, outcomes measures and training/certification. The feedback from these groups was integrated into the consensus statement. The consensus meeting confirmed the stablished and widespread use of transoral laser assisted microsurgical resection for early glottic cancer throughout the UK. The common experience gained allowed a full discussion of all aspects of the management with consensus achieved in key areas of standards of care, surgery, histopathologic reporting, outcomes assessment and training. This consensus statement will result in closer auditing of management and dissemination of results.

Incidence and patterns of regional metastasis in early oral squamous cell cancers: Feasibility of submandibular gland preservation

We aimed to study the incidence of metastasis to the submandibular gland (SMG) and to establish the oncologic basis of SMG preservation in early-stage cancer of the oral cavity (OSCC). This was a retrospective study of 261 patients with OSCC treated primarily with surgery at a tertiary medical center. One hundred thirty-two early-stage (T1-2, N0) OSCCs were further analyzed. The mean age was 59 years with male-to-female sex ratio of 1.4:1. Two hundred sixty-one neck dissections were performed with SMG removal in 253 patients. One patient with an advanced floor of mouth cancer had obvious infiltration of the SMG. Only 2.5% (3 of 116) patients with early-stage OSCC had level I metastasis; none had SMG metastases. SMG preservation in early cancers (T1-2, N0) of the oral cavity should be feasible unless there is evidence of direct invasion of the gland or close proximity of the cancer to it.

Evaluation of PET imaging in treatment decision making for early stage head and neck squamous cell cancer

e17017 Background: Positron emission tomography (PET) scanning is widely used in staging of patients (pts.) with head and neck squamous cell cancers (HNSCC). However, the role of PET scan in pts. with early stage disease and clinically negative nodes remains controversial. The purpose of our study was to correlate preoperative PET scan findings in early stage disease with operative pathological findings of neck dissection. Methods: A retrospective review of medical records of all pts. treated at Long Island Jewish Medical Center with T1N0 HNSCC from 2002 to 2008 was undertaken. Institutional Review Board approval was obtained for this study. Eligibility criteria included: clinically staged T1N0, documented pre-operative PET scans and primary surgical management including a neck lymph node dissection as part of initial treatment. Data collected included age, gender, physical examination findings, PET scan results, operative pathology and modalities of treatment. Results: Sixty six pts with early stage T1N0 HNSCC were identified. Twelve of sixty six pts met eligibility criteria for this study. Median age was 61 years (range: 27 to 84 yrs), M:F ratio was 1:1. Primary sites of tumor were: tongue (n = 8) 67%; oral cavity (n = 3) 25%; larynx (n = 1) 8%. Preoperative PET scan was positive at primary sites in all pts (n = 12). Additionally, PET positivity was noted in regional lymph node sites in six of twelve pts. Operative pathology confirmed tumor presence in all primary sites. However, nodal involvement was not found in any pt. Median numbers of lymph nodes dissected were 25 (range:13–34). Based on these clinical data, the calculated statistical parameters for preoperative PET scan in detecting occult neck lymph node metastases were: negative predictive value: 100%; positive predictive value: 50%: specificity: 50%; sensitivity: 0%. Conclusions: The clinical application of PET scans in early stage (T1N0) HNSCC may be limited by its high false positive rate. A high negative predictive value suggests that a negative result can exclude metastatic lymph nodes involvement in this group of pts. with early stage disease. Correlation with SUV values of the PET scans and comparisons between the relative PET avidity of the primary tumors and the nodal uptake are ongoing. No significant financial relationships to disclose.