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Reconstructive surgery using so-called major flaps following oral cancer ablation; 25 years experience
Oral Presentations / 0 14. Reconstructive Surgery I rate of the tumor-free survival was higher in the BVM+ group (77%) than in the BVM group (55%). Based on the better histological result and higher tumor-free survival rate in the BVM+ group, we recommend the adjuvant use of Culevit tablets in BVM chemotherapy of oro-pharyngeal squamous-cell cancer to increase further the efficacy of treatment in preventing the recidivism. [-G'~'~
DEFINING THE ROLE FOR ADJUVANT RADIOTHERAPY IN T2, T3 NO SQUAMOUS CELL CARCINOMA OF THE ORAL CAVITY
A. Binahmed, R. Nason, A. Abdoh. Department of Surgery, University
of Manitoba Winnipeg, Manitoba, Canada The use of adjuvant radiation is a frequent consideration in the treatment of oral squamous cell carcinoma. This study examines the benefit of postoperative radiation therapy in T2, T3 NO SCC of the oral cavity. An historical cohort of 149 patients from the cancer registry of the Province of Manitoba with squamous cell carcinoma of the oral cavity treated with surgery ± radiotherapy were examined. Kaplan-Meier survival and log-rank test were used to compare sub-groups. A Cox's proportional hazard model was used to examine the effect of adjuvant radiotherapy on 5-year survival. The mean age of the cohort were 64±13 years and 58.4% were males. The site of tumors involved the floor of mouth in 55 patients, tongue in 49 patients, and 86% of patients presented with T2 disease. Surgery alone was used in 105 patients (70.5%) while 44 patients (29.5%) received postoperative radiation. The neck was treated in 71 patients (48%). Margins were close (<2 mm) in 13 and involved in 7 patients. Fifty-two patients failed treatment with the primary involved in 22 and the neck in 30. Absolute survival at 5 year for surgery alone and surgery and radiotherapy were 64% and 56% respectively (P =0.3828). The status of the surgical margin was the only variable with a significant influence on survival (HR 2.0; 95%CI 1.0,4.0; p=0.0454). Treatment failure was higher than expected in this cohort of patients. Adjuvant radiotherapy did not affect treatment outcome. Proper surgical management with an emphasis on adequate surgical margins and elective treatment of the neck may improve survival in T2-3N0 SCC of the oral cavity.
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PREOPERATIVE RADIOCHEMOTHERAPY OF STAGE III AND IV SQUAMOUS CELL CARCINOMA OF THE ORAL CAVITY: COMPLETED PHASE II STUDY WITH A 6-YEAR FOLLOW UP
B. Sinikovic, C. Hofele, J.H. Karstens, A. Eckardt. Department of
Cranio- Maxillofacial and Oral Surgery, Department of Radiation Therapy and Oncology, Medical University of Hannover, Germany, Hannover, Department of Cranio- Maxillofacial and Oral Surgery, Ruprecht-Karls-University, Heidelberg, Germany Additionaly to surgery, the concept of neoadjuvant simultaneous radiochemotherapy in advanced head and neck squamous cell carcinoma (SCC) showed good response rates and improved Iocoregional control. However, several regimes with different time pattern and differences in the choice of applied drugs and radiation dose exist. The purpose of this study was to evaluate the survival, the Iocoregional disease control and the side effects of the described treatment regime. We present an outpatient phase II trial were the combination of taxol and carboplatin with radiotherapy was applied before surgery. Fifty three patients with stage Ill/IV squamous cell carcinoma of the oral cavity and oropharynx were treated from 1998 to 2000. After marking the resection lines, they received taxol (40 mg/m 2) and carboplatin (AUC 1.5) with conventional radiotherapy for five weeks. After recovering period the patients undergo surgery with a microvascular flap defect reconstruction. A six-year follow up was performed. Fifty two patients were evaluable. Side effects like mucositis could be palliatively controlled. Radiochemotherapy leaded to complete remission in 31 (60%) and to partial remission in 21 cases (40%). In 30 patients there was a complete pathological response (58%). The overall survival was computed 67%. The local control of disease was charachterized by a recurrence free survival of 85%. However, complete remission is shown to be the most important prognostic factor with an overall survival of 87% within this group. These results demonstrate the effectiveness of the applied radiochemotherapy regime in advanced staged SCC. Further investigations within a phase III trial are currently undertaken. The encouraging survival time of patients with clinical and pathological complete remission leads to the question if in such cases the tumor resection has to follow the initially set tattooing lines or if a more conservative surgery could bring a increase in quality of life.
27 [-G'~-~
CLINICAL EVALUATION OF HIGH DOSE RATE REMOTE AFTERLOADING SYSTEM FOR T2 TONGUE CANCER
Y. Ueyama, M. Ita, T. Mano, ]i Fukuda, M. Okafuji, M. Mihara, D. Horinaga. Department of Oral and Maxillofacial Surgery, Yamaguchi
University School of Medicine, Japan As for the treatment of oral cancer, especially tongue cancer, a noninvasive treatment is hoped for the functional preservation of oral cavity. Then, the purpose of this study is to evaluate the efficacy of high dose rate remote afterloading system (RALS), which is a non-invasive treatment, for T2 tongue cancer. Six patients with T2 tongue carcinoma were treated with RALS following superselective intraarterial docetaxicel infusion (SI) or external beam radiotherapy (EBRT). For five patients treated with SI (docetaxicelh 30-40 mg/m 2) by Seldinger method at first, the total dose was 54-66 Gy/9-11 fractions/5-6 days in RALS. For one patient treated with EBRT (40 Gy) at first, the total dose was 48 Gy/8 fractions/5 days in PALS. The precedent therapeutic result in tongue carcinoma was partial response in all cases, and all cases showed complete response after PALS. Cervical lymph node metastases were found in three patients: one was found on first visit, two were within six months following the completion of the therapy. Then, a radical neck dissection was carried out in three patients. We confirmed the efficacy of PALS for T2 tongue cancer as the treatment for oral function preservation.
O14. Reconstructive Surgery I
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RECONSTRUCTIVE SURGERY USING SO-CALLED MAJOR FLAPS FOLLOWING ORAL CANCER ABLATION; 25 YEARS EXPERIENCE
I. Mataga, K. Mori, K. Ninomiya. Department of Ora/and Maxi//ofacia/ Surgery II, School of Dentistry at Niigata, The Nippon Dental University, Niigata, Japan Various kind of bony and soft tissue reconstructive surgeries following oral cancer ablation have recently reported from several literatures. Socalled major flaps such as cutaneous, musculocutaneous and osteocutaneous flaps have employed primarily or secondarily. These flaps are devided from two groups of pedicled or revascularized type according to revascular system. For 25 years, from 1977 to 2002, subjectives of 215 so called major flaps in 164 patients were employed in our department. Indication and selection of these flaps were retrospectively discussed. Of 164 patients, 37 (22.6%) was tongue, 23 (14.0%) was lower gingiva and 22 (13.4%) was the foor of the mouth in each primary sites. 104 (63.4%) cancers were histopathologically squamous cell carcinoma. Of total number of 215 major flaps in 164 patients, 109 (50.7%) were pedicled cutaneous or musculocutaneous flaps such as 36 deltoid pectoral (DP) flaps, 47 pectoral major musculocutaneous (PM-MC) flaps, 14 latissimus dorsi (LD-MC) flaps and others were revascularized flaps using anastomoses technique. These revascularized flaps were 68 cutaneous flaps such as 47 forearm flaps, 21 rectus abdominis flaps and 38 osteocutaneous flaps such as 10 iliac,7 scapular, and 21 fibular flaps. There was tendency more revascularized flaps were performed after 1990s. During this period, 14 flaps were unfortunately failed into total necrosis in this series. Rate of total necrosis of the flaps was 7.0% respectively and cumulative successful rate was 93.0%. Pedicled flaps were selected as secondary flaps after total necrosis of revascularized flaps and also indicated in elderly. Reconstruction of the defects using major flaps following oral cancer ablation attributes to the radicality of tumor, to cosmetics and also functional repairment References
[1] Nakayama, B., Matsuura, H., Ishihara, O., Hasegawa, H., Mataga, I., and Torii, S.: Functional reconstruction of a bilateral maxillectomy defect using a fibula osteocutaneous flap with osseointegrated implants. Plast ReconstrSurg 96:1201-1204, 1995.
DEFINING THE ROLE FOR ADJUVANT RADIOTHERAPY IN T2, T3 NO SQUAMOUS CELL CARCINOMA OF THE ORAL CAVITY
A. Binahmed, R. Nason, A. Abdoh. Department of Surgery, University
of Manitoba Winnipeg, Manitoba, Canada The use of adjuvant radiation is a frequent consideration in the treatment of oral squamous cell carcinoma. This study examines the benefit of postoperative radiation therapy in T2, T3 NO SCC of the oral cavity. An historical cohort of 149 patients from the cancer registry of the Province of Manitoba with squamous cell carcinoma of the oral cavity treated with surgery ± radiotherapy were examined. Kaplan-Meier survival and log-rank test were used to compare sub-groups. A Cox's proportional hazard model was used to examine the effect of adjuvant radiotherapy on 5-year survival. The mean age of the cohort were 64±13 years and 58.4% were males. The site of tumors involved the floor of mouth in 55 patients, tongue in 49 patients, and 86% of patients presented with T2 disease. Surgery alone was used in 105 patients (70.5%) while 44 patients (29.5%) received postoperative radiation. The neck was treated in 71 patients (48%). Margins were close (<2 mm) in 13 and involved in 7 patients. Fifty-two patients failed treatment with the primary involved in 22 and the neck in 30. Absolute survival at 5 year for surgery alone and surgery and radiotherapy were 64% and 56% respectively (P =0.3828). The status of the surgical margin was the only variable with a significant influence on survival (HR 2.0; 95%CI 1.0,4.0; p=0.0454). Treatment failure was higher than expected in this cohort of patients. Adjuvant radiotherapy did not affect treatment outcome. Proper surgical management with an emphasis on adequate surgical margins and elective treatment of the neck may improve survival in T2-3N0 SCC of the oral cavity.
[
O
T
3
.
•
PREOPERATIVE RADIOCHEMOTHERAPY OF STAGE III AND IV SQUAMOUS CELL CARCINOMA OF THE ORAL CAVITY: COMPLETED PHASE II STUDY WITH A 6-YEAR FOLLOW UP
B. Sinikovic, C. Hofele, J.H. Karstens, A. Eckardt. Department of
Cranio- Maxillofacial and Oral Surgery, Department of Radiation Therapy and Oncology, Medical University of Hannover, Germany, Hannover, Department of Cranio- Maxillofacial and Oral Surgery, Ruprecht-Karls-University, Heidelberg, Germany Additionaly to surgery, the concept of neoadjuvant simultaneous radiochemotherapy in advanced head and neck squamous cell carcinoma (SCC) showed good response rates and improved Iocoregional control. However, several regimes with different time pattern and differences in the choice of applied drugs and radiation dose exist. The purpose of this study was to evaluate the survival, the Iocoregional disease control and the side effects of the described treatment regime. We present an outpatient phase II trial were the combination of taxol and carboplatin with radiotherapy was applied before surgery. Fifty three patients with stage Ill/IV squamous cell carcinoma of the oral cavity and oropharynx were treated from 1998 to 2000. After marking the resection lines, they received taxol (40 mg/m 2) and carboplatin (AUC 1.5) with conventional radiotherapy for five weeks. After recovering period the patients undergo surgery with a microvascular flap defect reconstruction. A six-year follow up was performed. Fifty two patients were evaluable. Side effects like mucositis could be palliatively controlled. Radiochemotherapy leaded to complete remission in 31 (60%) and to partial remission in 21 cases (40%). In 30 patients there was a complete pathological response (58%). The overall survival was computed 67%. The local control of disease was charachterized by a recurrence free survival of 85%. However, complete remission is shown to be the most important prognostic factor with an overall survival of 87% within this group. These results demonstrate the effectiveness of the applied radiochemotherapy regime in advanced staged SCC. Further investigations within a phase III trial are currently undertaken. The encouraging survival time of patients with clinical and pathological complete remission leads to the question if in such cases the tumor resection has to follow the initially set tattooing lines or if a more conservative surgery could bring a increase in quality of life.
27 [-G'~-~
CLINICAL EVALUATION OF HIGH DOSE RATE REMOTE AFTERLOADING SYSTEM FOR T2 TONGUE CANCER
Y. Ueyama, M. Ita, T. Mano, ]i Fukuda, M. Okafuji, M. Mihara, D. Horinaga. Department of Oral and Maxillofacial Surgery, Yamaguchi
University School of Medicine, Japan As for the treatment of oral cancer, especially tongue cancer, a noninvasive treatment is hoped for the functional preservation of oral cavity. Then, the purpose of this study is to evaluate the efficacy of high dose rate remote afterloading system (RALS), which is a non-invasive treatment, for T2 tongue cancer. Six patients with T2 tongue carcinoma were treated with RALS following superselective intraarterial docetaxicel infusion (SI) or external beam radiotherapy (EBRT). For five patients treated with SI (docetaxicelh 30-40 mg/m 2) by Seldinger method at first, the total dose was 54-66 Gy/9-11 fractions/5-6 days in RALS. For one patient treated with EBRT (40 Gy) at first, the total dose was 48 Gy/8 fractions/5 days in PALS. The precedent therapeutic result in tongue carcinoma was partial response in all cases, and all cases showed complete response after PALS. Cervical lymph node metastases were found in three patients: one was found on first visit, two were within six months following the completion of the therapy. Then, a radical neck dissection was carried out in three patients. We confirmed the efficacy of PALS for T2 tongue cancer as the treatment for oral function preservation.
O14. Reconstructive Surgery I
•
RECONSTRUCTIVE SURGERY USING SO-CALLED MAJOR FLAPS FOLLOWING ORAL CANCER ABLATION; 25 YEARS EXPERIENCE
I. Mataga, K. Mori, K. Ninomiya. Department of Ora/and Maxi//ofacia/ Surgery II, School of Dentistry at Niigata, The Nippon Dental University, Niigata, Japan Various kind of bony and soft tissue reconstructive surgeries following oral cancer ablation have recently reported from several literatures. Socalled major flaps such as cutaneous, musculocutaneous and osteocutaneous flaps have employed primarily or secondarily. These flaps are devided from two groups of pedicled or revascularized type according to revascular system. For 25 years, from 1977 to 2002, subjectives of 215 so called major flaps in 164 patients were employed in our department. Indication and selection of these flaps were retrospectively discussed. Of 164 patients, 37 (22.6%) was tongue, 23 (14.0%) was lower gingiva and 22 (13.4%) was the foor of the mouth in each primary sites. 104 (63.4%) cancers were histopathologically squamous cell carcinoma. Of total number of 215 major flaps in 164 patients, 109 (50.7%) were pedicled cutaneous or musculocutaneous flaps such as 36 deltoid pectoral (DP) flaps, 47 pectoral major musculocutaneous (PM-MC) flaps, 14 latissimus dorsi (LD-MC) flaps and others were revascularized flaps using anastomoses technique. These revascularized flaps were 68 cutaneous flaps such as 47 forearm flaps, 21 rectus abdominis flaps and 38 osteocutaneous flaps such as 10 iliac,7 scapular, and 21 fibular flaps. There was tendency more revascularized flaps were performed after 1990s. During this period, 14 flaps were unfortunately failed into total necrosis in this series. Rate of total necrosis of the flaps was 7.0% respectively and cumulative successful rate was 93.0%. Pedicled flaps were selected as secondary flaps after total necrosis of revascularized flaps and also indicated in elderly. Reconstruction of the defects using major flaps following oral cancer ablation attributes to the radicality of tumor, to cosmetics and also functional repairment References
[1] Nakayama, B., Matsuura, H., Ishihara, O., Hasegawa, H., Mataga, I., and Torii, S.: Functional reconstruction of a bilateral maxillectomy defect using a fibula osteocutaneous flap with osseointegrated implants. Plast ReconstrSurg 96:1201-1204, 1995.