Jochen A. Werner R. Kim Davis (Eds.) Metastases in Head and Neck Cancer

Transcription

1 Jochen A. Werner R. Kim Davis (Eds.) Metastases in Head and Neck Cancer

2 Jochen A. Werner R. Kim Davis (Eds.) Metastases in Head and Neck Cancer With 106 Figures and 21 Tables 123

3 ISBN Springer Berlin Heidelberg NewYork Jochen A. Werner M.D. Professor and Chairman Department of Otolaryngology, Philipps University of Marburg Deutschhausstrasse Marburg Germany R. Kim Davis M.D. Grant H. and Mildred Burrows Beckstrand Professor of Surgical Oncology Chief, Division of Otolaryngology, University of Utah, School of Medicine 3C 120 University Health Sciences Center Salt Lake City, Utah, USA Library of Congress Control Number: This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable for prosecution under the German Copyright Law. Springer is a part of Springer Science+Business Media springeronline.com Springer-Verlag Berlin Heidelberg 2004 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Editor: Ute Heilmann, Heidelberg Desk editor: Dörthe Mennecke-Bühler, Heidelberg Production editor: Bernd Wieland, Heidelberg Illustrations: R. Henkel, Heidelberg Cover design: F. Steinen, e Studio Calamar, Spain Typesetting: AM-productions, Wiesloch Printing and bookbinding: Stürtz AG, Würzburg 21/ Printed on acid-free paper

4 Preface Our intent in writing the book Metastases in Head and Neck Cancer is to provide the reader with a comprehensive and cohesive presentation of this very important topic. As we have shared a common treatment philosophy over many years, it has been a pleasure to relate our experiences with this important topic. This book is unique in that it supplies an in-depth discussion of lymphology and pathology that provides a strong basic science background to help the reader understand this disease process. The intent of the book is not to be a how to do it manual. Rather, it is to develop the necessary basic science background blended with our experiences in order to provide a framework of thinking about why metastasis occurs, where it occurs, and what the treatment options are. While neck dissection is covered in great detail, the chapters on diagnosis and radiation therapy provide in-depth discussions of modern techniques at the cutting edge. In this regard the descriptions of IMRT elaborate a treatment technique that has the potential to significantly change how radiation therapy is delivered to head and neck cancer. The diagnosis chapter provides a detailed discussion of ultrasonography, something which American head and neck surgeons use less frequently than their colleagues in Europe and elsewhere, who have significant experience with this technique from which all can benefit. The authors wish to give special thanks to Dr. Anja Dünne for the vast amount of work she has performed in helping to compile this book.we also want to especially thank our secretaries, Susanne Zapf and Leora Loy, for their patience in transcribing and revising these chapters on numerous occasions. We finally express our love and thanks to our families for their constant understanding, support, love, and patience in helping such a project to proceed. Jochen A.Werner R. Kim Davis

5 Contents 1 Basics of Lymphology Embryology and Anatomy Lymph Vessels History Embryology Morphology Distribution Lymph Nodes Embryology Morphology Topography and Classification of Cervicofacial Lymph Nodes Fascial System of the Neck Physiology and Pathophysiology Lymph Vessels Lymph Nodes References Lymphogenic Metastatic Spread Squamous Cell Carcinomas Nasal Cavity and Paranasal Sinuses Lip and Oral Cavity Nasopharynx Oropharynx Hypopharynx and Cervical Esophagus Larynx and Trachea Skin Malignant Melanoma Merkel Cell Carcinoma Carcinomas of the Salivary Glands Carcinomas of the Thyroid Gland References The Pathology of Lymphogenic Metastatic Spread Examination Methods Squamous Cell Carcinomas of the Head and Neck Conventional Squamous Cell Carcinoma Cytologic Diagnosis Variants of Squamous Cell Carcinomas of the Head and Neck Basaloid Squamous Cell Carcinoma Adenoid Squamous Cell Carcinoma Undifferentiated (Lymphoepithelial) Carcinoma (Schmincke Tumor) Adenosquamous Carcinoma Spindle Cell Carcinoma Micrometastases of Squamous Cell Carcinomas Extracapsular Extension of Lymph Node Metastases Cystic Cervical Lymph Node Metastases Changes of Cervical Lymph Node Metastases After Radiation and Chemotherapy Metastases of Salivary Gland Tumors and Thyroid Gland Carcinomas Uncommon Cervical Lymph Node Metastases Non-Neoplastic Reactive Lymph Node Alterations. 77 References Diagnostic Techniques Introduction Inspection and Palpation Inspection Palpation

6 VIII Contents 4.3 B-Mode Sonography Benign Lymphadenitis Malignant Lymphomas Lymph Node Metastases Sonographic Criteria Extracapsular Growth Lymph Node Metastases of Non-Squamous Origin Follow-Up Sonographic Differential Diagnosis of Enlarged Cervical Lymph Nodes Sonographically Controlled Fine Needle Aspiration Cytology Future Technical Developments Color-Coded Duplex Sonography Signal Amplification Digital Sonographic Procedures Computed Tomography and Magnetic Resonance Imaging Computed Tomography Magnetic Resonance Imaging CT/MRI for Benign Cervical Masses CT/MRI for Lymph Node Metastases Lymphoscintigraphy Dynamic Scintigraphy of Lymphatic Drainage Thallium-201 Scintigraphy Sentinel Lymphadenectomy Radioimmunoscintigraphy Positron Emission Tomography Lymphography Lymph Node Biopsy Lymph Node Extirpation Scalene Node Biopsy Mediastinoscopy Conclusion References Principles of Surgery History and Classification of the Surgical Treatment of Cervicofacial Lymph Node Metastases History Neck Dissection Classification Decision Points in Neck Dissection Pre- and Perioperative Care Facets of Preoperative Lymph Node Biopsy Diagnostics of Therapeutic Carotid Occlusion Timing of Neck Dissection Patient Age and Neck Dissection Infectious Prophylaxis Operative Approaches Radical Neck Dissection Modified Radical Neck Dissection Selective Neck Dissection References Radiation Therapy: Principles and Treatment Elective Neck Irradiation Postoperative Radiation of the Node Positive Neck Intensity-Modulated Radiation Therapy IMRT in Nasopharynx Cancer IMRT of Oropharynx Cancer IMRT of Paranasal Sinus Cancers IMRT in Other Situations Future Potential Applications References Surgical Treatment Concepts The Role of Neck Dissection in the Treatment of Squamous Cell Carcinomas of the Upper Aerodigestive Tract Clinical N0 Neck Contralateral N0 Neck in the Case of an Ipsilateral N+ Neck Anterior Oral Cavity Oropharynx Supraglottis Glottis Hypopharynx Verified Lymph Node Metastases (N+ Neck) N1 and N2 Neck

7 Contents IX Fixed Lymph Node Metastases Neck Dissection Following Primary Radio(Chemo)Therapy Peristomal Recurrence Retropharyngeal Lymph Nodes in Metastases from Head and Neck Cancers Neck Dissection for Lymphoepithelial Carcinomas Neck Dissection for Skin Malignancies Squamous Cell Carcinomas Malignant Melanoma Merkel Cell Carcinoma Neck Dissection for Carcinomas of the Salivary Glands Neck Dissection for Carcinomas of the Thyroid Gland Sentinel Node Biopsy Marking of the Sentinel Node Intraoperative Detection of Activity Limits and Sources of Errors Conclusion References Complications Surgical Complications General Considerations Preoperative Informed Consent Wound Healing Impairment Vascular System Neural Impairment Vasovagal Response Chylus Fistula and Chylothorax Increased Intracranial Pressure Visual Loss and Blindness Lymphedema Clavicular Fracture Postoperative Care Complications from Radiation Therapy Clinically Evident Acute Toxicities Delayed Radiation Effects References Cancer of Unknown Primary Sites General Considerations Topography of Lymph Node Metastases in Cancer of Unknown Primary Diagnostics Prognosis in Patients with Cancer of Unknown Primary Site Metastases in Squamous Cell Carcinoma of Unknown Primary Metastases in Adenocarcinoma of Unknown Primary Metastases in Malignant Melanoma of Unknown Primary Treatment Concepts of Lymph Node Metastases in Sqamous Cell Carcinoma of Unknown Primary Site Primary Radio(chemo)therapy Combined Radiotherapy and Surgery Treatment Concept of Cervical N1 Lymph Node Metastasis in Squamous Cell Carcinomas of the Head and Neck Treatment Concept of the Contralateral Neck Side (N0) Treatment Concepts of Lymph Node Metastases in Adenocarcinoma Treatment Concepts of Lymph Node Metastases in Occult Malignant Melanoma Value of Post-Therapeutic Appearance of the Primary Cancer Branchiogenic Carcinoma References Distant Metastases Nasopharynx Lips and Anterior Oral Cavity Oropharynx Larynx and Hypopharynx Cervical Esophagus Salivary Glands Thyroid Gland References

8 X Contents 11 Post-Therapeutic Follow-Up Principles General Considerations Follow-Up Interval Type, Extent and Costs of Follow-up Examinations The Upper Aerodigestive Tract Neck Thorax Abdomen and Scintigraphy of the Skeletal Bones Possible Strategies References Subject Index

9 Contributors Vilija Avizonis M.D. Radiation Oncologist LDS Hospital Eighth Avenue & C Street Salt Lake City, Utah, USA R. Kim Davis M.D. Grant H. and Mildred Burrows Beckstrand Professor of Surgical Oncology Chief, Division of Otolaryngology, University of Utah, School of Medicine 3C 120 University Health Sciences Center Salt Lake City, Utah, USA Roland Moll M.D. Institute of Pathology Philipps University of Marburg Baldingerstrasse Marburg Germany Jochen A. Werner M.D. Professor and Chairman Department of Otolaryngology, Philipps University of Marburg Deutschhausstrasse Marburg Germany Burkard M. Lippert M.D. Department of Otolaryngology, Philipps University of Marburg Deutschhausstrasse Marburg Germany