1. Prediction score for lymph node metastasis from cutaneous squamous cell carcinoma of the external ear

Transcription

1 1 P a g e 3

2 1. Prediction score for lymph node metastasis from cutaneous squamous cell carcinoma of the external ear Fachklinik Hornheide, Skin Cancer Centre, Department of Cranio- Maxillofacial Surgery, Muenster, Germany Aims The frequency of lymph node metastasis (LNM) is higher in cutaneous squamous cell carcinoma (cscc) of the ear than in other head and neck csccs. Nodal dissemination is associated with a significantly worse prognosis and disease-specific survival. The aim of this study was to establish a prediction model for LNM in patients with cscc of the ear. Materials and methods Tumour characteristics of 353 patients with ear cscc were analysed to assess differences between those with and without LNM and to calculate a prediction score for LNM occurrence. Regional LNM occurred in 10.5% of patients. Fiveyear disease-specific survival was significantly lower in the LNM group than in the control group (59% vs. 99%; p < 0.001). Recurrence number, invasion of cartilage, tumour depth, and tumour grading were the most important predictors for LNM, with correct prediction of LNM in 94.0% of cases. Our prediction score stratified patients into high and low risk groups (p < 0.001) with a sensitivity of 89.2%, a specificity of 94.6%, and an overall accuracy of 94.1%. Conclusion 2 P a g e

3 Our new prediction model was able to accurately identify patients at high risk of LNM who may benefit from elective lymph node surgery. European Journal of Surgical Oncology (EJSO), Available online 20 August Melanotic and non-melanotic malignancies of the face and external ear A review of current treatment concepts and future options Department of Oral and Cranio-Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Skin has the highest incidence and variety of tumors of all organs. Its structure is of great complexity, and every component has the potential to originate a skin neoplasm (SN). Because of its exposed nature, skin is vulnerable to carcinogenic stimuli such as UV radiation. Various entities can cause SN. Nonmelanotic skin cancers (NMSC) are the most common of all cancers, with over one million cases diagnosed annually in the US. Basal cell carcinoma (BCC) accounts for approximately 80% of all NMSC, most of the remaining 20% being squamous cell carcinoma (SCC). The skin of the head and neck is the most common site for tumors, accounting for more than 80% of all NMSC. BCC, SCC, and malignant melanomas (MM) represent 85 90% of all SN. Merkel cell tumors (MCC), lymphoepithelioma-like carcinomas of the skin (LELCS), dermato-fibro-sarcomas, leiomyosarkomas, and Kaposi-sarcomas are less frequent in the facial skin region and the external ear. Based on data from the German Federal Cancer Registry (2003/2004), 140,000 3 P a g e

4 people in Germany were affected by SN (100,000 BCC, 22,000 SCC, 22,000 MM). This number increases considerably if malignant precursors, such as actinic keratosis, are included. Each year, the frequency of SN diagnosis rises by 3 7%. Among all known malignant tumors, MM exhibits the highest rate of increase in incidence. In the past, SN was primarily diagnosed in people aged 50 years or older. However, recently, the risk for developing SN has shifted, and younger people are also affected. Early diagnosis is significantly correlated with prognosis. Resection of SN creates defects that must be closed with local or microvascular flaps to avoid functional disturbing scar formation and deflection of the nose, eyelids, or lips. All therapeutic strategies for SN, the current standard for adjuvant and systemic treatment, and the management of the increasing number of patients under permanent blood thinner medication are described with regard to the treatment of SN. Cancer Treatment Reviews, Volume 40, Issue 7, August 2014, Pages The protective role of carotenoids and polyphenols in patients with head and neck cancer Department of Dietetics and Nutrition, Taipei City Hospital, Taipei, Taiwan, ROC Head and neck cancer is a critical global health problem and approximately 650,000 patients per year are diagnosed with this type of cancer. In addition, head and neck cancer exhibits a high recurrence rate, readily causing second primary cancers in other locations, often yielding a poor prognosis. Current medical and surgical treatment options result in considerable impairment of speaking and swallowing functions, with side effects such as nausea, vomiting, bone marrow suppression, and renal damage, thereby impairing patients' quality of life. Thus, developing a prevention and therapeutic intervention strategy for head and neck cancer is vital. Phytochemicals have been shown to have a unique ability to protect cells from damage and modulation of cell repair. The chemopreventive 4 P a g e

5 activities of phytochemicals have also been demonstrated to be associated with their antioxidant properties and the induction and stimulation of intercellular communication via gap junctions, which play a role in the regulation of cancer cell cycle, differentiation, apoptosis, and stagnate cancer cell growth. Phytochemicals can also regulate cancer cell signaling pathways, reduce the invasion and metastasis of cancer cells, and protect normal cells during treatment, thus reducing the damage caused by chemotherapy and radiotherapy. The most studied of the chemopreventive effects of phytochemicals are the carotenoids and phenolics. Journal of the Chinese Medical Association, Available online 11 October Management of somatic pain induced by treatment of head and neck cancer: Postoperative pain. Guidelines of the French Oto-Rhino-Laryngology Head and Neck Surgery Society (SFORL) Service d ORL et de chirurgie cervico-faciale, hôpital Hôtel-Dieu, CHU, 1, place Alexis-Ricordeau, Nantes cedex, France Objective To present the guidelines of the French Oto-Rhino-Laryngology Head and Neck Surgery Society (SFORL) concerning the management of somatic pain induced by the treatment of head and neck cancer, and in particular the management of early and late post-surgical pain. Methods 5 P a g e

6 A multidisciplinary work group conducted a review of the scientific literature on the study topic. An editorial group subsequently read the resulting guidelines before validation. It is recommended to prevent onset of pain caused by malpositioning on the operating table, as well as pain related to postoperative care. During surgery, it is recommended to spare nerve and muscle structures as far as possible to limit painful sequelae. Management of early postoperative pain upon tumor resection and flap harvesting sites requires patientcontrolled analgesia by morphine pump. Physical therapy is recommended after flap harvesting to minimize painful sequelae. Conclusion Preventive and curative measures should be undertaken for appropriate management of post-surgical pain in the treatment of head and neck cancers. European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 131, Issue 4, September 2014, Pages Prognostic factors for squamous cell cancer of the parotid gland: An analysis of 2104 patients Section of Otolaryngology, Department of Surgery, Yale University School of Medicine, USA Background Parotid gland squamous cell cancer (SCC) occurs as metastasis from cutaneous SCC or primary malignancy. There is limited data on incidence, prognosis, and treatment outcomes. Methods The Surveillance, Epidemiology, and End (SEER) database ( ) identified 2104 adult patients with parotid SCC. 6 P a g e

7 SCC is the second most common parotid malignancy, and its incidence is increasing (annual percentage change 1.7%; ptrend =.004). Age 85 years, tumor size 4 cm, extraparenchymal extension, cervical metastases, and distant metastases were independently associated with disease-specific mortality. Compared to no surgery, surgery was associated with improved 5-year diseasespecific survival (DSS; 44.4% vs 71.0%; p <.001), whereas radiation alone was similar to no treatment (47.0% vs 41.6%; p =.28). Conclusion Surgery and adjuvant radiation therapy (RT) are associated with improved survival compared to radiation alone and no treatment. Patients 85 years of age account for nearly 20% of all patients and have a poor prognosis independent of treatment. Head & Neck, Volume 37, Issue 1, pages 1 7, January P a g e

8 6. Impact of nodal ratio on survival in recurrent nasopharyngeal carcinoma Division of Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China 8 P a g e Background The purpose of this study was to investigate if nodal ratio has a prognostic role in the survival of patients with recurrent nasopharyngeal carcinoma (NPC) in the neck. Methods Patients with recurrent NPC in the neck who were treated in Queen Mary Hospital from 2000 to 2011 were identified. Clinical data, pathological results, and survival outcome were analyzed. Only nodal ratio remained as a statistically significant predictor in multivariate analysis for nodal recurrence (p =.045) and nodal recurrence-free survival (p =.010). All other predictors lost significance when compared with each other and with nodal ratio. Nodal ratio was also a significant predictor for overall survival (OS) in univariate analysis (p =.001) but lost its significance in multivariate analysis. The cutoff points 10% and 15% effectively stratified the patients into 3 risk groups (p =.02). Conclusion In patients with NPC with neck recurrence, nodal ratio (the ratio of positive nodes to the total number of nodes examined) is a strong predictor of further nodal

9 recurrence and nodal recurrence-free survival. Nodal ratio also impacts the OS but loses its significance in multivariate analysis, including concurrent local recurrence. Stratification of patients into low, medium, and high-risk groups according to nodal ratio may have a potential role in guiding therapeutic decisionmaking. Therefore, further exploration in this area is warranted. Head & Neck, Volume 37, Issue 1, pages 12 17, January Robotic modified radical neck dissection by bilateral axillary breast approach for papillary thyroid carcinoma with lateral neck metastasis Department of Surgery, Chung Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea Background The purpose of this study was to evaluate the safety of robotic modified radical neck dissection compared to open modified radical neck dissection. 9 P a g e

10 Methods We enrolled 78 patients who were diagnosed with papillary thyroid cancer and underwent total thyroidectomy, bilateral central neck dissection, and modified radical neck dissection between March 2011 and February Of these patients, 65 underwent an open procedure and 13 underwent a robotic procedure using the bilateral axillary breast approach (BABA). These 2 groups were retrospectively compared. The mean age, sex, body mass index (BMI), and tumor size were not significantly different between groups. There were no differences in the number of retrieved lymph nodes, metastatic lymph nodes, or stimulated thyroglobulin level between the 2 groups. The operation time was longer in the robotic group than in the open group. Conclusion Robotic modified radical neck dissection using BABA is safe and shows oncologic and postoperative outcomes comparable to those of the open procedure. Head & Neck, Volume 37, Issue 1, pages 37 45, January P a g e

11 8. Systemic inflammatory markers as independent prognosticators of head and neck squamous cell carcinoma Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada squamous cell carcinoma (HNSCC). Methods Background The purpose of this study was to investigate the prognostic value of the pretreatment inflammatory markers platelet-to-lymphocyte ratio (PLR) and the neutrophil-tolymphocyte ratio (NLR) in patients with head and neck We conducted a retrospective analysis of patients diagnosed with HNSCC at McGill University Health Center from 2000 to 2011 (273 patients were retained). Hematologic parameters were recorded within 4 weeks of diagnosis. Mortality and recurrence rates were compared according to various PLR and NLR thresholds. Of the total patients, 20.5% died and 11.0% had disease recurrence. PLR >170 was associated with higher mortality (p =.008). The subgroup with a combination of PLR >170 and NLR 3.0 was associated with higher T classification and highest mortality (43%). NLR above 4.2 predicted higher rates of recurrence (p <.0001). The NLR/PLR combination was at least as good as TNM staging in predicting survival. 11 P a g e

12 Conclusion PLR is an independent predictor of mortality; NLR is an independent predictor of recurrence in HNSCC. These parameters might be used to identify advanced stages rapidly and economically. Head & Neck, Volume 37, Issue 1, pages , January Proton therapy for head and neck adenoid cystic carcinoma: Initial clinical outcomes Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana initial disease and 7 (27%) for recurrent disease. Twenty patients were treated postoperatively, 6 after biopsy alone and 24 had positive margins or gross residual disease. Median dose delivered was 72 Gy (relative biological effectiveness [RBE]). Median follow-up was 25 months (range, 7 50 months). The 2-year overall survival was 93% for initial 12 P a g e Background The purpose of this study was to report outcomes of proton therapy in head and neck adenoid cystic carcinoma. Methods We conducted a retrospective analysis of 26 patients treated between 2004 and Twenty patients (77%) had base of skull involvement; 19 (73%) were treated for

13 disease course and 57% for recurrent disease (p =.19). The 2-year local control was 95% for initial disease and 86% for recurrent disease (p =.48). The 2-year distant metastatic rate was 25%. Late toxicity of grade 0 or 1 was seen in 17 patients, grade 2 in 5, grade 3 in 2, grade 4 in 1, and grade 5 in 1. Conclusion Initial outcomes of proton therapy are encouraging. Longer follow-up is required. Head & Neck, Volume 37, Issue 1, pages , January P a g e

14 10. Prognostic factors in squamous cell lip carcinoma treated with high-dose-rate brachytherapy Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain Background The purpose of this study was for us to present our analysis of the results and prognostic factors in squamous lip carcinoma treated with highdose-rate (HDR) brachytherapy. Methods From 1999 to 2010, 102 patients were treated with HDR-brachytherapy, 54 with T1, 33 with T2, and 15 with T4. Eight cases were N+. Twenty-one patients were treated with surgery plus brachytherapy because of close/positive margins. Nine fractions of 5 Gy were given over 5 days in 67% of the patients. Elective neck treatment was performed in 23 cases. The 10-year actuarial local control was 94.6%, nodal regional control was 88.6%, disease-free survival was 84.6%, and cause-specific survival was 93.2%. In the univariate analysis, T4 tumors had higher risk of local failure and T2 of regional relapse. In the multivariate analysis, skin involvement was the only significant factor for tumor progression. Conclusion HDR-brachytherapy yields excellent local control rates. Skin involvement increases the risk of local and cervical recurrence. Elective neck treatment should be done in T2 to T4 tumors or with skin or commissure involvement. Head & Neck, Volume 36, Issue 12, pages , December P a g e

15 درمان دارندگان دفترچه های ن ی روهای مس ل ح آموزش و پرورش کمی ت ه امداد وزارت نیرو بنیاد شهید در این مرکز رایگان. انجام می پذیرد طرف قرارداد بیمه های تامین اجتماعی نیروهای مسلح بیمه ایران بیمه سینا خدمات درمانی امام کمیته امداد بیمه دانا بیمه آسیا خدمات درمانی