T1 Squamous Cell Carcinoma Research Articles

The Mushroom-Shaped Anterolateral Thigh Perforator Flap for Subtotal Tongue Reconstruction

Reconstruction of a functional tongue with proper motility and sensation after subtotal resection is a demanding procedure. The authors describe the reinnervated mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. Thirteen patients (mean age, 54.8 years; range, 49 to 71 years) diagnosed with T3 and T4 squamous cell carcinomas were allocated prospectively to anterior total mobile (n = 7) or subtotal tongue resection (n = 6). All patients received the mushroom-shaped anterolateral thigh perforator flap. A Likert scale ranging from 1 to 4 was used to assess speech intelligibility, swallowing function, and cosmetic results. Epicritic and proprioceptive sensitivity testing was performed with the Pressure-Specified Sensory Device on the tip of the tongue preoperatively, on the neotongue at the donor site preoperatively, and at the recipient site 12 months postoperatively; protopathic thermoreceptor and nociceptors were clinically investigated. Outcomes were analyzed, and values of p < 0.05 were considered significant. All flaps healed uneventfully (mean follow-up, 18 months). Six patients (46.2 percent) recovered a nearly natural deglutition, whereas seven (53.8 percent) had mild impairment (p = 0.274). Normal intelligible speech was achieved in seven cases (53.8 percent), and acceptable intelligible speech was achieved in six (46.2 percent) (p = 0.286). Aesthetic results were excellent in eight patients (61.5 percent) and good in five (38.5 percent) (p = 0.592). All patients recovered epicritic, proprioceptive, and protopathic sensitivity; cortical upgrading phenomena of the recipient nerve were observed. The reinnervated mushroom-shaped anterolateral thigh perforator flap was found to be an innovative and effective option for subtotal tongue reconstruction.

Incidence of Synchronous Bilateral Tonsillar Carcinoma in a Cohort of T1/T2 Primary Tonsil Cancer

Objectives: The most recent review of bilateral synchronous tonsillar carcinoma published in 2012 identified 12 previously described cases in the literature. It has been estimated that there is a 10% incidence of contralateral nodal metastasis from tonsillar carcinoma. However, the true incidence of bilateral synchronous occult disease is unknown. This study aims to describe the incidence of bilateral tonsillar carcinoma in early stage disease. Methods: The study design consisted of a retrospective cohort study of 120 patients with T1 or T2 primary tonsillar squamous cell carcinoma treated between 1995 to 2012. All patients were treated with primary radical surgical therapy and had the contralateral tonsil removed at the time of surgery. Data was extracted from an institutional review board approved department database. All cases were reviewed for evidence of an occult tumor in the contralateral tonsil. Results: Out of 120 patients, 3 patients were identified to have an occult primary cancer in the contralateral tonsil. This resulted in a 2.5% incidence of disease in this cohort of patients. Compared to the incidence of tonsillar carcinoma in the general population 2.1 x 10-5, (95% CI: 2 x 10-5, 2.2 x 10-5) this is significantly elevated. Conclusions: This is the first study attempting to establish the incidence of bilateral tonsillar carcinoma in a large cohort of early stage tonsillar carcinoma patients. Given the increasing use of transoral robotic surgery to treat these patients, it is important to be aware that there is likely a small but slightly elevated risk of contralateral occult disease.

Introducing the Tibial‐Dorsalis Pedis Osteocutaneous Shin Flap: A New Option for Oromandibular Reconstruction

Objectives: The authors investigate the possibility of incorporating a well vascularized, partial corticotomy of the anterolateral aspect of the tibia in-series with a dorsalis pedis fasciocutaneous free flap for oromandibular reconstruction. Methods: The study consisted of three components. A cadaveric perfusion study was performed to characterize the vascular territory of the anterior tibial artery in regard to the surrounding osseous and soft tissue. A two-point breaking strength of the tibia was examined with fracture strain gauge analysis to determine the threshold of tibia corticotomy that would lead to a pathological fracture. Finally, the authors performed an in-vivo prospective clinical examination of the tibial-dorsalis pedis osteocutaneous shin flap. Results: The perfusion study revealed that the anterior tibial artery provided a rich matrix of myofascial periosteal blood supply to the anterolateral cortex of the tibia that could support free osseous tibial transfer. Two-point osteotomy fracture strain gauge analysis demonstrated that the threshold of tibia corticotomy that would lead to fracture of the remaining tibia was 30%. The osteocutaneous shin flap was performed in eight patients for recurrent, radiation failure, oral cavity T4 squamous cell carcinomas. The mean follow-up was 61 months. There were no cases of flap loss, salivary fistula, nonunion, or tibia pathologic fracture. All patients achieved ambulation. Conclusions: The authors introduce the osteocutaneous tibial-dorsalis pedis free vascularized flap as a viable option for oromandibular reconstruction. Its most notable advantage is the independent mobility of the skin paddle, in combination with an osseous reconstruction of the mandibular arch that facilitates primary osseointegration or denture rehabilitation.

Pharyngolaryngoesophagectomy with Gastric Transposition Reconstruction: Comparison of Single Institution Outcomes from 1965 to Today

Objectives: 1) Comparison of our current operative and functional outcomes with those published previously from our institution for pharyngolaryngoesophagectomy (PLO) with gastric transposition reconstruction. 2) Analysis of the role of this reconstructive option in contemporary head and neck surgery. Methods: Retrospective review of patients who underwent PLO with gastric transposition and feeding jejunostomy from 2010 to 2013. Comparison was made with previously published data from our institution dating back to 1965 for the same procedure, and with more recent literature reports. Results: Nine patients were identified: 3 had primary T4 squamous cell carcinoma, 3 had local recurrence from radical radiotherapy, and 3 had previously treated metastatic tumor. There was no in-hospital mortality. Early complications occurred in 44% including salivary fistula (n = 1). Average length of stay was 36.4 days. 1 patient had local recurrence at 6 months. Disease free survival was 89% at last follow up (range 1-28 months). Method of communication at 12 months included esophageal speech, electrolarynx and voice prosthesis. Time to jejunostomy removal was 2-16 months. Conclusions: The in-hospital mortality rate of zero in this series compares with rates of 7-12% previously in our institution. However our contemporary morbidity rates are higher than the 8% and 29% previously reported, which may reflect our 67% rate of salvage surgery and exclusively T4 or metastatic caseload. Our complication rates are comparable with those published in the last decade for both gastric transposition and free tissue transfer reconstruction and highlights that gastric transposition is an effective reconstruction option in these advanced tumors.

Flexible CO2 Laser in the Head and Neck: Single Institution Outcomes for First 4 years

Objectives:Determine the surgical, oncological, and functional outcomes of patients treated with the flexible CO2 laser for head and neck lesions without robotic assistance.Methods:Retrospective case review of patients treated with the Omniguide® Flexible CO2 laser in the head and neck unit of a university teaching hospital.Results:21 patients underwent 24 procedures from January 2009 to January 2013. 15 procedures involved confirmed invasive carcinoma (T1 to T3). 5 patients underwent further surgery due to involved margins/early local recurrence. 6 month disease free survival was 77%. Other pathology included squamous papilloma, lymphoid hyperplasia, vascular lesions and severe dysplasia. Anatomic sites included larynx (n = 15), base of tongue (n = 8), and postnasal space (n = 1). One case required semi‐elective intraoperative tracheostomy, nasogastric tube and a 21 day stay. All other patients returned to oral intake prior to discharge (mean length of stay 1.5 days). No other airway complications were reported.Conclusions:Our experience using a CO2 phototonic bandgap laser fiber in head and neck disease without robotic assistance provides the first published oncological and functional outcomes for this new modality. Our data is representative of the diverse cases selected for this technique in our unit. Our 3 cases of T3 squamous cell carcinoma represent patients who declined laryngectomy. All other patients had anatomy which precluded accessing the lesions with a straight‐line CO2 laser. The cost per case is a significant factor (approximately GBP £500), but may be offset by reduced length of stay and improved morbidity compared with open resection.

Transoral robotic surgery for the treatment of T1–T2 carcinoma of the larynx: Preliminary study

To determine the feasibility and the preliminary oncological results of transoral robotic surgery (TORS) for the treatment of early stage laryngeal tumors. Retrospective single center study. We reviewed the medical records of 23 patients who underwent TORS for the treatment of T1 or T2 laryngeal squamous cell carcinoma between August 2009 and March 2012. Laryngeal tumors were involving the glottis (13 cases) and the supraglottis (10 cases). They were classified T1 N0 in 16 cases, T2 N0 in four cases, and T2 N+ in three cases. The median TORS operative time was 60 minutes (ranging from 30 to 118 minutes). The median hospitalization time was 7.5 days. Histopathological examination of the resected tumors confirmed 14 cases in which the margins were clear, four cases in which the surgical margins were close (less than 1 mm), one case in which the margins were microscopically positive, and in four cases margins status were not able to be recorded. A tracheostomy was carried out for three patients, and 11 patients got a nasogastric feeding tube postoperatively. The local recurrence rate was 8.7% (2/ 23 cases), and in both cases the recurrence occurred in the anterior commissure area only. The overall larynx preservation rate was 95,7% (22/ 23 cases). In this preliminary study, we demonstrated that laryngeal TORS is feasible and may result in oncological results comparable with other treatment strategies, including laser CO2 surgery. This innovative approach needs to be evaluated through randomized multi-institutional trial. 4.

Lateral pharyngotomy for selected invasive squamous cell carcinoma of the lateral oropharynx—part I: How

To revisit the surgical technique of lateral pharyngotomy in patients with selected, isolated, and untreated invasive squamous cell carcinoma of the lateral oropharynx. To describe postoperative management, complications, and functional outcomes. Retrospective review from a French university teaching hospital. Ninety-one patients consecutively underwent lateral pharyngotomy for selected T1–T4 squamous cell carcinoma of the lateral oropharynx. Of the patients, 73.6% and 98.9% experienced an uncomplicated surgical and medical postoperative course, respectively. There were no intraoperative deaths, but a single patient died in the immediate postoperative period from carotid rupture following salivary oropharyngeal fistula. The most common significant complications were severe postoperative swallowing impairment, pneumonia from aspiration, and salivary oropharyngeal fistula noted in 6.5%, 4.3%, and 4.3% of cases, respectively. In univariate analysis, none of the variables under analysis was related to the various significant complications noted and/or to immediate postoperative death. No patient had a permanent tracheotomy, whereas one had a permanent gastrostomy. Of the patients in whom a full course of radiation therapy was delivered postoperatively, 13.6% developed a major complication. From a functional point of view, lateral pharyngotomy is a safe, reliable surgery with few major complications and might be considered a valuable alternative to chemoradiation and/or mandibulotomy for selected tumors of the lateral oropharynx.

A Strategy for Supraclavicular Lymph Node Dissection Using Recurrent Laryngeal Nerve Lymph Node Status in Thoracic Esophageal Squamous Cell Carcinoma

The desirability of supraclavicular lymph node (LN) dissection, which is the cervical part of three-field LN dissection, has been discussed for a long time. In this study, we examine the pattern of supraclavicular LN metastasis in esophageal cancer, with a particular focus on the correlation between recurrent laryngeal nerve (RLN) LN and supraclavicular LN metastasis. In all, 220 cases of R0 resected T1 to T3 squamous cell carcinomas were retrospectively examined. All of these patients underwent bilateral RLN LNs dissection; none received cancer treatment before surgery. Of 21 upper esophageal cancer cases, 33.3% of the patients had metastasis in the supraclavicular LN. Every patient in whom supraclavicular LN metastasis developed had metastasis in the RLN LN. Of 141 cases of middle esophageal cancer, 19.1% had metastasis in the supraclavicular LN. Among the patients whose RLN LN metastasized, 38.3% had metastasis in the supraclavicular LN. A similar correlation between RLN LN and supraclavicular LN metastasis was observed in lower esophageal cancer cases, especially in T3 cases. When considering cancers of the esophagus and patients who had metastasis in the supraclavicular LN, our data demonstrated that RLN LN metastasis did not always lead to metastasis on the same side of the supraclavicular LN. The status of the RLN LN can be an indicator of supraclavicular LN dissection in upper esophageal cancer patients and advanced cases of middle and lower esophageal cancer patients. Bilateral supraclavicular LN dissection should be recommended even when only unilateral RLN LN metastasis occurs.

Tumor budding as a useful prognostic marker in T1‐stage squamous cell carcinoma of the esophagus

Background: Establishing a new prognostic factor for early-stage cancer may seem difficult due to the small number of disease-specific deaths. Tumor budding has been recognized as a useful microscopic finding reflecting biological activity of the tumor.Methods: Tumor budding stand for isolated single cancer cells and cell clusters scattered beyond the tumor margin at the invasive front. It was searched for in the resected esophagus with T1 squamous cell carcinoma (SCC), and the correlation between the tumor budding, patient survival, and various pathologic factors were analyzed to verify whether tumor budding is a prognostic factor in superficial esophageal cancer.Results: Seventy-nine patients undergoing curative esophagectomy were assigned to frequent (n = 29) and rare (n = 50) groups according to the microscopically observed frequency of tumor budding in the tumor. Three-year survival rates after esophagectomy were 48.8% for the frequent group and 94.5% for the rare group. Multivariate analysis using the Cox proportional hazards model identified this morphological variable as a significant independent prognostic factor.Conclusions: Tumor budding reflects the biological activity of the tumor and may be a useful prognostic indicator even in early-stage SCC of esophagus.

Squamous cell carcinoma of the uvula: An analysis of factors affecting survival

Uvular squamous cell carcinoma (SCC) is usually considered with soft palate tumors as an oropharyngeal cancer subsite. This investigation aims to determine whether the uvula itself is a high-risk subsite in the oropharynx for primary squamous cell carcinomas. Retrospective analysis of a large population database. Using the Surveillance, Epidemiology, and End Results database, we identified patients with T1 and T2 SCC of the oropharynx. Patients were categorized into two groups based on primary site: 1) uvula; and 2) oropharynx not otherwise specified. Clinicopathologic characteristics and disease-specific survival (DSS) were compared between the two groups. Of the 9,833 patients we identified, 129 (1.3%) had primary uvular tumors. Primary tumors of the uvula were more likely to be smaller lesions at diagnosis (P < .001) and to present at a lower anatomical stage (P < .001). They also presented with less concurrent nodal metastasis (P < .001) and lower histological grade (P < .001). There was no evidence that size of uvular SCC lesion had any effect on nodal disease (P = .54), and survival was the same for T1 and T2 uvular SCC patients (P = .14). DSS was similar between the two groups as well (P = .7629). Our data indicate that primary SCC of the uvula does not have a worse prognosis, and tends to be recognized earlier and treated more definitively than SCC found in other oropharyngeal regions. However, survival being equivalent between two distinctive groups is perplexing, and may indicate an underlying aggressiveness to uvular cancers.

Treatment outcome of Photofrin-based photodynamic therapy for T1 and T2 oral squamous cell carcinoma and dysplasia

Photodynamic therapy (PDT) is a minimally invasive treatment modality for early and superficial malignancy or premalignancy in the head and neck regions. However, few studies have examined the use of Photofrin-mediated PDT to manage early carcinoma and dysplasia in the oral cavity. Between January 2004 and November 2008, 25 T1 to T2 patients with N0 oral squamous cell carcinoma and mucosal dysplasia in the oral cavity were treated by Porfimer sodium (Photofrin(®))-mediated PDT at Nagasaki University Hospital. Clinical responses were evaluated according to the guidelines of the Response Evaluation Criteria in Solid Tumors (RECIST). After the PDT and a 2-year follow-up period, disease specific survival rates were then calculated. A total of 30 regions in 25 patients (18 with squamous cell carcinoma and 7 with epithelial dysplasia with hyperkeratosis in the oral cavity) were treated by PDT. Complete response was achieved in 24 of the 25 patients (96%), with a partial response found in the remaining patient. For the three patients who exhibited recurrence at 4, 5, and 15 months after PDT, salvage surgery or a second PDT was performed. Of these three patients, one died due to another disease, while one died due to local lymphatic metastasis that occurred during the follow-up period. Overall, the disease specific survival rate was 95.8%. Treatment-related edema and pain emerged within 24h after irradiation. Pain control using non-steroid anti-inflammatory drugs and opiates was required for 3-4 weeks in all patients. Complete healing was attained at 4-6 weeks after the treatment. No persistent problems related to functional or esthetic outcomes were noted.

One stage reconstruction of large lower lip carcinoma, with local flaps

Squamous cell carcinoma (SCC) of the lower lip is a frequently diagnosed malignant pathology in the maxillofacial region. It is a slow-growing cancer, and can be diagnosed and treated easily and effectively; however, early treatment is important because its mortality rate is 10%-30%. Reconstruction for a large lower lip defect is surgically challenging, especially reconstruction with local flaps. Here, we present a 52-year-old male with a large T3 SCC, which started 13 years before this treatment and involved nearly all of his lower lip, oral commissure and upper lip. It was reconstructed by local flaps with good aesthetic and functional results. The lip was reconstructed with a combination of a Karapandzic flap on one side and a contralateral Webster cheek advancement, using a functional neck dissection on the tumor side and supraomohyoid neck dissection contralaterally. Histopathology results of the neck were negative for metastasis. We were satisfied with the aesthetic and functional results of the neck.

Significant Invasion of the Pharyngeal Constrictor Muscle in Early Squamous Cell Carcinoma of the Tonsil

To determine whether invasion of the pharyngeal constrictor muscle in early squamous cell carcinoma of the tonsil is correlated with lymph node metastasis. Retrospective analysis of medical records and pathology specimens. Tertiary care referral center. Forty-eight patients who were diagnosed as having T2 squamous cell carcinoma of the tonsil and who underwent surgery. They were divided into 2 groups: an invasive group with invasion of the pharyngeal constrictor muscle and a noninvasive group without invasion of the pharyngeal constrictor muscle. Comparison of regional metastasis, 5-year locoregional recurrence, and 5-year disease-specific survival between the 2 groups. Invasion of the pharyngeal constrictor muscle was found in 36 patients (75%) with T2 squamous cell carcinoma of the tonsil. The rate of lymph node metastasis, the mean (SD) number of positive nodes, and the mean (SD) lymph node density were 81%, 5.47 (9.27), and 0.15 (0.22) in the invasive group, respectively, and 50%, 1.33 (1.72), and 0.04 (0.04) in the noninvasive group, respectively (P = .04, P = .02, and P = .01, respectively). Five-year locoregional recurrence was significantly correlated with invasion of the pharyngeal constrictor muscle (P = .05) and with multiple lymph node metastasis (≥5 nodes) (P = .04) in the univariate analyses. No factor was correlated with 5-year locoregional recurrence in the multivariate analysis. Five-year disease-specific survival was significantly correlated with multiple lymph node metastasis (≥5 nodes) in the univariate analyses (P = .009). Five-year disease-specific survival was not significantly correlated with any clinicopathological factor in the multivariate analysis. Higher risk for multiple lymph node metastasis and 5-year locoregional recurrence seems to be predicted in patients with extratonsillar invasion of the pharyngeal constrictor muscle, even in early squamous cell carcinoma of the tonsil.

Neoadjuvant Concurrent Chemoradiation Therapy Followed by Definitive High-dose Radiation Therapy or Surgery for Operable T3 Squamous Cell Carcinoma of Thoracic Esophagus

Neoadjuvant Concurrent Chemoradiation Therapy Followed by Definitive High-dose Radiation Therapy or Surgery for Operable T3 Squamous Cell Carcinoma of Thoracic Esophagus

Competing‐risks analysis in patients with T1 squamous cell carcinoma of the penis

To quantify and compare cancer-specific mortality (CSM) and other-cause mortality (OCM) in individuals with stage T1G1-3 clinically node-negative (cN0) squamous cell carcinoma of the penis (SCCP) since there is no consensus regarding the need for an inguinal lymph node dissection (ILND) in patients with T1G2-3 cN0 SCCP. Relying on the Surveillance, Epidemiology and End Results database, we identified 655 patients diagnosed with primary SCCP between 1988 and 2006. Cumulative incidence plots were used to graphically depict the effect of CSM relative to OCM. Competing-risks regression analyses were used to quantify the risk of CSM or OCM after adjusting for age, race, tumour grade and surgery type. The 5-year CSM rates after a primary tumour excision without ILND were 2.6%, 10.0% and 15.9% in patients with respectively T1G1, T1G2 and T1G3 cN0 SCCP. The 5-year OCM rates were 29.5%, 27.3% and 29.3% in patients with respectively T1G1, T1G2 and T1G3. Age failed to provide additional stratification. The CSM rate was highest in T1G3 patients and appears to justify ILND. Conversely, the CSM rate was lowest in T1G1 patients, which justifies active surveillance in this patient subset. A moderate CSM rate at 5 years was recorded for T1G2 patients, which brings into question the benefits of ILND.

Analysis of multicentricity in supraglottic laryngeal carcinoma treated with partial laryngeal surgery

A clinicopathological analysis of multicentricity in patients treated with either supraglottic horizontal laryngectomy or supracricoid partial laryngectomy for supraglottic squamous cell carcinoma of the larynx was conducted. This study included 63 patients who underwent supracricoid partial laryngectomy or supraglottic horizontal laryngectomy for T2 or T3 supraglottic laryngeal squamous cell carcinoma. The patients were divided into two groups: Group 1 included patients with one focus of the tumor (monocentric), and Group 2 included patients who had more than one focus of the tumor (multicentric) diagnosed after pathology examination. Forty-eight (76.2 %) of the patients had one focus of the tumor (Group 1) and 15 (23.8 %) of the patients had more than one focus of the tumor (Group 2). The rates of lymph node metastasis in Group 1 and Group 2 were 12.5 and 60 %, respectively. The second focus was invasive in seven (46.6 %) of the patients, carcinoma in situ in six (40 %) of the patients, and both invasive and carcinoma in situ in two (13.3 %) patients. The overall 3- and 5-year survival rates of Groups 1 and 2 were 77.1-66.7 % and 56.2-46.7 %, respectively. With regard to survival rates, no statistically significant difference was observed between Group 1 and Group 2 (p = 0.576). The lack of statistical significance might have been associated with the low sample size. Although multicentric tumors of the supraglottic larynx have high incidence of nodal metastasis, no significant increase in the rate of recurrence was determined.

Early‐stage squamous cell carcinoma of the lip: The Australian experience and the benefits of radiotherapy in improving outcome in high‐risk patients after resection

The purpose of this study was to analyze the outcome of Australian patients treated for early lip cancer. Data on 217 patients with T1 to T2 squamous cell carcinoma (SCC) of the lip and treated with radical intent were analyzed. The addition of local adjuvant radiotherapy in patients with a close/positive margin was associated with a significant improvement in relapse-free survival (RFS; p = .008). Tumor thickness (≤4 mm vs >4 mm) was also significantly associated with RFS (p = .01). The 5-year RFS was 51% after surgery, 87% after radiotherapy, and 92% after adjuvant radiotherapy. Patients with a tumor thickness >4 mm experienced an increased risk of recurrence, especially nodal. Compared with patients having any radiotherapy, those undergoing surgery experienced a higher rate of locoregional recurrence. The addition of adjuvant radiotherapy in patients with inadequate excision significantly decreased the risk of recurrence.

Factors leading to the use of alternate treatment modalities following transoral laser excision of T1 and T2 glottic squamous cell carcinoma

CO(2) transoral laser surgery and radiotherapy are both recognized as acceptable treatments for early glottic squamous cell carcinoma (SCC) with similar rates of cure. The reasons why some of the patients in our series undergoing laser resection as their primary modality of treatment subsequently underwent radiotherapy or chemoradiotherapy will be discussed. Retrospective study between January 2003 and August 2010 of all T1 and T2 glottic SCCs treated with laser resection at a major tertiary centre. Tis lesions were excluded. A review of the cases in which primary control with laser resection was not achieved was undertaken. Failure was defined as patients treated initially with laser resection who subsequently received radiotherapy, combined chemoradiotherapy or open surgery for the same tumour. Factors leading to failure were analysed, including tumour location, histology, stage and patient factors. Thirty-one patients were identified, with the majority (27) having T1 disease. Mean number of laser excisions per patient was 1.7. Local control rate was 71% with laser alone. One patient had nodal recurrence with no primary recurrence. Mean follow-up was 32 months. Of the nine patients in whom local control was not achieved with laser alone, all had tumour at or crossing the anterior commissure. Four patients were deemed potentially curable with further excision but chose radiotherapy. Two patients were deemed appropriate for radiotherapy and chemoradiotherapy. Three patients had loco-regional recurrence and underwent laryngectomy. All had anterior commissure involvement. Transoral laser excision is a safe, function-preserving treatment of early glottic SCC. Anterior commissure involvement was the major factor for potential failure with laser resection in T1 and T2 glottic tumours.

Lack of Prognostic Effect of Carbonic Anhydrase-9, Hypoxia Inducible Factor-1α and Bcl-2 in 286 Patients with Early Squamous Cell Carcinoma of the Glottic Larynx Treated with Radiotherapy

AimsTo evaluate the prognostic significance of potential tumour markers of hypoxia and apoptosis in early squamous cell carcinoma of the glottic larynx managed with radiotherapy. Materials and methodsIn total, 382 patients with T1 and T2 squamous cell carcinoma of the glottic larynx (vocal cords) received radical radiotherapy (50–55 Gy, in 16 fractions in 98% of cases). Pre-treatment haemoglobin was available for 328 patients; biopsy samples were available for 286. Immunohistochemistry was carried out for carbonic anhydrase-9 (CA-9), hypoxia inducible factor-1α (HIF-1α) and Bcl-2. ResultsAt 5 years, locoregional control was achieved in 88.2%, cancer-specific survival in 95.0% and overall survival in 78.7%. Adverse prognostic factors for locoregional tumour recurrence were pre-treatment haemoglobin <13.0 g/dl (P = 0.035, Log rank test; sensitivity 0.28, specificity 0.84) and stage T2 rather than T1 (P = 0.002). The effect of haemoglobin level on locoregional control was not significant when stratified by the median of 14.2 g/dl (P = 0.43) or as a continuous variable (P = 0.59). High CA-9 (P = 0.11), HIF-1α (P = 0.67) and Bcl-2 (P = 0.77) expression had no prognostic significance. ConclusionsHigh CA-9, HIF-1α and Bcl-2 do not add to the prognostic significance of tumour stage and lower haemoglobin in predicting failure of local control in early glottic larynx squamous cell carcinoma managed with radiotherapy. The effect of haemoglobin was not strong enough to be useful as a prognostic biomarker.

Outcome of patients with early T1 and T2 squamous cell carcinoma of the base of tongue managed by conventional surgery with adjuvant postoperative radiation

Existing treatment regimens for squamous cell carcinoma (SCC) of the base of tongue (BOT) favor chemoradiation. However, there is a shifting paradigm toward minimally invasive surgery with adjuvant radiotherapy for select tumors. The aim was to report our experience in conventional surgical management with particular focus on T1/T2 tumors, which may be candidates for minimally invasive techniques. Between 1985 and 2005, 128 patients were treated with primary surgery. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) rates were calculated using Kaplan-Meier method, and predictive factors analyzed by univariate and multivariate analyses. Five-year OS, DSS, and RFS rates were 60%, 70%, and 61%, respectively. Multivariate analysis showed pathologic T classification and extracapsular extension (ECE) were significant predictors for DSS, whereas T classification remained significant for local recurrence. DSS for T1/T2 tumors ranged from 77% (node-positive) to 84% (node-negative). T classification and ECE are independent predictors of outcome for BOT SCC. Patients with cT1/T2 tumors had excellent outcome and may be suitable for transoral robotic or endoscopic surgical procedures.