Squamous Cell Carcinoma Of Hard Palate Research Articles

Postoperative Radiotherapy in Advanced Stage Squamous Cell Carcinoma Requiring Maxillectomy.

To evaluate whether postoperative radiotherapy (PORT) improves survival among patients who received maxillectomy for pT4aN0 maxillary gingival or hard palate squamous cell carcinoma (SCC) with respect to tumor size. Retrospective analysis. National Cancer Database from 2004 to 2019. Included adult patients who received maxillectomy (partial, subtotal, or total) and neck dissection for treatment-naive margin negative pT4aN0 SCC of the maxillary gingiva or hard palate. Adjusted for age, gender, race, insurance status, income, education, urban/rural, facility type, region, comorbidity index, tumor grade, and tumor extension. Inverse probability weights were incorporated into a multivariable Cox proportional hazards model. A priori post hoc subgroup analysis was performed according to tumor size. We included 416 patients who underwent maxillectomy for pT4aN0 SCC of the maxillary gingiva or hard palate (mean [standard deviation] age, 71.5 [11.3] years; male, 190 [45.7%]; tumor size 2 cm, 362 [87%]). Overall, 49.3% of patients received PORT (205 patients). PORT was associated with a 50% improvement in survival compared to surgery alone (adjusted hazard ratio [aHR], 0.50; 95% confidence interval [95% CI], 0.32-0.81). On subgroup analysis, PORT was associated with improved survival for tumors 2 cm (aHR, 0.47; 95% CI, 0.29-0.77), but not for tumors < 2 cm (aHR, 1.15; 95% CI, 0.33-4.08). The vast majority of patients with pT4aN0 bone-invading SCC of the maxillary gingiva and hard palate benefit from PORT. Patients with tumors < 2 cm did not demonstrate a survival benefit from adjuvant treatment, suggesting that bony invasion alone may not be sufficient criteria for treatment escalation.

Neck dissection of cN0 maxillary oral squamous cell carcinoma: A study based on SEER database

ObjectiveFor patients with clinical nodal-negative (cN0) maxillary oral squamous cell carcinoma (MOSCC), neck dissection (ND) and clinical observation are the main two management strategies for the neck. However, the indications corresponding to these two options remain controversial. This study aimed to elucidate the clinical factors affecting ND treatment and to identify clinical characteristics of the population that may benefit from ND based on a retrospective analysis of cN0 MOSCC patient data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods8846 MOSCC patients were identified in the SEER database from 2000 to 2020. The Kaplan-Meier method was utilized to examine overall survival (OS) and disease-specific survival (DSS), while the hazard ratio (HR) was estimated using the stepwise multivariate Cox regression model. Furthermore, multi-subgroup analyses of DSS and OS were performed to compare ND and No ND. ResultsWe included 2,512 cN0 MOSCC patients. Basic survival analysis and Cox regression modeling showed that ND was an independent prognostic factor that promoted DSS and OS. Additional subgroup analyses revealed that the primary site and T-stage might influence the efficacy of ND modality. Moreover, patients with T3/T4 stage of upper gingival squamous cell carcinoma (UGSCC) (DSS p = 0.009, OS p = 0.004), hard palate squamous cell carcinoma (HPSCC) (DSS p = 0.001, OS p < 0.001), and soft palate squamous cell carcinoma (SPSCC) (p = 0.029) showed a better survival benefit with ND in OS and DSS. Nonetheless, no differences were observed in OS and DSS between ND and No ND at the T1/T2 stage of the abovementioned primary tumor sites. Additionally, the DSS outcomes for T1/T2 stage upper lip squamous cell carcinoma (ULSCC) patients were significantly worse in the ND group than in the No ND group (p = 0.018). However, no significant differences were noted in OS (p = 0.140) as well as OS (p = 0.248) and DSS (p = 0.627) for T1/T2 and T3/T4 patients, respectively. ConclusionActive surveillance might be a feasible strategy for managing all T-staged ULSCC as well as early-stage (T1/T2) UGSCC, SPSCC, and HPSCC, provided regular and meticulous follow-up is performed. Hence, concurrent ND is recommended for patients with intermediate to advanced (T3/T4) stage UGSCC, SPSCC, and HPSCC.

Maxillary sinus and hard palate squamous cell carcinoma: Multi-institutional experience

Maxillary sinus and hard palate squamous cell carcinoma: Multi-institutional experience

What is the role of elective neck dissection in patients with squamous cell carcinoma of the upper jaw?

BackgroundSurgical treatment of clinically negative neck in maxillary squamous cell carcinoma (SCC) of the upper jaw is controversial. The purpose of this study was to define the incidence of cervical metastasis and to assess if elective neck dissection is justified when the neck is not primarily affected. MethodsWe retrospectively reviewed 20 patients treated of SCC of the maxillary alveolus and hard palate between 2005 and 2012. ResultsSix (30%) patients presented with cervical lymph metastasis at initial diagnosis. Two of the14 patients who initially had no signs of metastasis in the neck developed cervical metastasis during follow-up and another patient with cervical metastasis at diagnosis developed contralateral cervical metastasis. All the patients with cervical metastasis (45%) were pT3/T4 SCC. Cervical metastasis developed at a mean of 11.6 months. ConclusionsDespite this study being limited by its retrospective nature and the sample size, based on our findings and on an extensive review of the literature, we may conclude that cervical metastasis from maxillary alveolus and hard palate SCC appears most frequently in pT3/T4 tumors. Therefore, we find elective neck dissection appropriate for patients with pT3/T4 SCC of the upper jaw.

Immediate Endosseous Dental Implant Placement in Osteocutaneous Radial Forearm Free Flap

Objectives: (1) Analyze the advantages and disadvantages of immediate endosseous dental reconstruction using osteocutaneous radial forearm free flap (OCRFFF). (2) Describe the “double barrel” technique for dental reconstruction following OCRFFF. Methods: A 61-year-old man with previous hard palate squamous cell carcinoma (SCC) and fibula flap reconstruction complicated by osteoradionecrosis then underwent OCRFFF for secondary reconstruction of the maxilla using the “double barrel” technique. The Straumann system was used to immediately place 3 endosseus implants in the radial bone graft and one in the previously bone-grafted site. The purpose of this case report is to evaluate the methodology and outcome of immediate dental reconstruction with endosseous implants into an OCRFFF, which is traditionally thought to be an unsuitable graft for dental implants because of inadequate bone thickness. Outcome measures include hardware stability, aesthetics, and function. Aesthetics and function were subjectively measured through patient and surgeon satisfaction. Additionally, hardware stability was measured through follow-up imaging studies and functionality. Results: Both patients and physicians concluded positive functional and aesthetic outcomes using this reconstruction technique. Conclusions: Use of a double-barrel technique harvest of an OCRFFF provides adequate bone for immediate endosseus dental implants with improved aesthetic and functional outcomes over other reconstructive techniques.

Oral cavity squamous cell carcinoma: Role of pretreatment imaging and its influence on management

Squamous cell carcinoma (SCC) is the commonest malignancy in the oral cavity. The oral cavity has several subsites. Knowledge of the patterns of disease spread at each subsite with the impact on treatment and prognosis provides a deeper understanding of the role of imaging. Information from imaging helps accurate staging, assess resectability, and plan multimodality treatment. Mandibular erosion, posterior soft tissue extent, and perineural spread influence treatment and prognosis in gingival, buccal, and retromolar trigone (RMT) cancers. Multidetector computed tomography (MDCT) with multiplanar reformations and bone and soft tissue algorithms provides the highest specificity for bone erosion. Hard palate SCC is optimally imaged with contrast-enhanced magnetic resonance imaging (MRI) to detect perineural spread. In oral tongue and floor of the mouth (FOM) SCC, extrinsic muscle invasion, extension across the midline, extent of posterior and inferior spread, and proximity to the hyoid are issues that impact therapeutic options. Contrast-enhanced MRI is the optimal imaging method for staging the primary due to its superior soft tissue resolution. In oral tongue SCCs with tumour thickness ≤4mm, elective neck dissection can be avoided. For nodal staging (N-staging), all imaging methods are comparable, but fall short of surgical staging. Sentinel lymph node biopsy has a promising role in N-staging. Positron emission tomography (PET)/integrated PET/CT has no role in evaluating the clinically negative neck. PET/CT has a role in pretreatment evaluation of advanced oral cavity SCC for depicting distant metastases and for mapping nodal extent in the clinically positive neck. Diffusion-weighted MRI, dynamic contrast-enhanced MRI, and CT perfusion have a potential role as baseline pretreatment studies for response assessment to chemoradiation in advanced oral cavity SCC.

OP132: Cervical metastasis of maxillary squamous cell carcinoma

The cervical treatment of squamous cell carcinoma (SCC) of maxilla is still in controversy. The purpose of this study was to determine the incidence of cervical metastasis of SCC of maxilla and evaluate the predictive factors of cervical metastasis. 133 consecutive patients with SCC of hard palate and maxillary alveolus from 2000 to 2009 in the department of Oral and Maxillofacial Surgery, Peking University School of Stomatology were reviewed. There were 65 patients underwent neck dissection. The clinical data of primary site, T-stage, histological grade and cervical lymph nodal metastasis were collected and analyzed. Among the 65 cases underwent neck dissection, maxillary alveolus was the primary subsite in 42 cases and hard palate in 23 cases. 22 patients were clinically examined nodal metastasis at present and 13 patients were confirmed as late metastasis. The overall incidence of cervical metastasis was 53.8%. Among all 35 N+ patients, positive lymph nodes were likely to be examined in level I (77.1%), II (60%) and III (11.4%), and level IV was involved only in one case, none was found in level V. The incidence of metastasis of maxillary alveolus (57.1%) was higher than that of hard palate (47.8%), but there is no significant difference ( p = 0.791). There are seven T1, 26 T2, nine T3 and 23 T4 tumors, the incidence of metastasis were 40%, 53.8%, 55.6%, and 60.9% respectively ( p = 0.228). The prevalence of metastasis of histological Grade1, Grade 2 and Grade3 tumors were 33.3%, 72% and 77.8% respectively ( p = 0.003). SCC of maxilla exhibits aggressive regional metastasis behavior. Levels I–III are most likely to be involved. There is significant relevance between histological grade and cervical lymph nodal metastasis of SCC of maxilla.

The Impact of Cervical Metastasis on the Prognosis of Squamous Cell Carcinoma of the Hard Palate

Objective: To evaluate the impact of cervical metastasis on the prognosis of patients with squamous cell carcinoma of the hard palate. Methods: We reviewed the data of 127 cases of squamous cell carcinoma of the hard palate treated in our hospital between 1964 and 2004. Kaplan-Meier method and the log-rank test were used to analyze the impact of cervical lymph node metastasis and N-stage on patient survival. Results: The 5-year disease-specific survival rate of patients with cervical lymph node metastasis (49 cases) was 17.59% and that of patients without cervical lymph node metatasis (78 cases) was 39.55% (P=0.043). The 5-year disease-specific survival rates were 39.55%, 22.79%, 10.48%, and 0 for N_0, N_1, N_2 and N_3 lesions, respectively (P=0.037). Cervical lymph node metastasis was found in 38.58% (49 cases) of patients with hard palate squamous cell carcinoma at first diagnosis. Of those who were not found with cervical lymph node metastasis at diagnosis, 11 cases (8.66%) were detected with cervical lymph node metastasis after therapy. Conclusion: Cervical lymph node metastasis is associated with low survival rate in patients with squamous cell carcinoma of the hard palate. Advanced N-stage is correlated with poor prognosis. Squamous cell carcinoma of the hard palate should be treated aggressively, and elective neck dissection should be considered because of the high rate of cervical metastasis.