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The clinical significance of the positive surgical margin in oral cancer
Oral P r e s e n t a t i o n s / O 1 9 , Tumor I V food intake was restored in all patients. All patients were dacanulates within 3 weeks after surgery. Long-term results are as follows: three patients developed distant metastases and died of progression; two patients relapsed locally, while another two were found to have regional lymph node metastases, all four were operated. At present 30 patients are alive without evidence of disease and are being carefully followed up; 3 patients have already survived beyond 60 months. (Truncated) [-~--~
THE CLINICAL SIGNIFICANCE OF THE POSITIVE SURGICAL MARGIN IN ORAL CANCER
A. Binahmed, R. Nason, H. Alhajjaj, D. Chemaly, A. Abdoh. Department
of Surgery University of Manitoba Winnipeg, Manitoba, Canada The aim of surgical treatment of squamous cell carcinoma of the oral cavity is adequate resection with a clear margin. This study examines the significance of the positive surgical margin. An historical cohort of 425 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 independent effect of surgical margins on 5-year survival. The mean age of the cohort was 63±12.6 years (52.9% < 65) and 58.8% were males. Seventy-two percent of tumors involved the tongue and floor of mouth, and 43% of patients presented with Stage III and IV disease. The 5-year absolute, disease specific and disease free survivals were 62%, 74.5%, and 60.3% respectively. Survival was related to age > 65 years (HR 1.5; 95% CI 1.1,2.2; P =0.0177), T-Stage (HR 1.4; 95%CI 1.2,1.6; P=0.0002), and N-Stage (HR 1.3; 95%CI 1.0,1.6; P =0.0465). Patients with clear margins had a survival rate of 69% (median survival >60 months) when compared to those with close (58%, median survival > 60 months) and involved margins (38%, median survival 31 months, P =0.0000). After controlling for the other significant prognostic factors, involved surgical margins increased the risk of death at 5 years by 90% (HR 1.9; 95%CI 1.2, 2.9; P =0.0026). The status of the surgical margin is a powerful predictor of outcome. The surgical margin, in contrast to the other prognostic indicators, is under the direct control of the surgeon. [-~--~
CRANIOFACIAL RESECTION FOR ADVANCED MALIGNANT TUMORS IN ORAL AND MAXlLLOFACIAL REGION: A RETROSPECTIVE STUDY OF 70 CASES
Z.'~ Zhang. School of Stomatology, China To evaluate the clinical outcome of craniofacial resection for advanced malignant tumors of oral and maxillofacial regions. Seventy patients who underwent craniofacial resection for malignancies involving the anterior, middle and posterior cranial fossa over a 25-year period between June 1978 and December 2003 in our department were evaluated. The study group consisted of 26 females and 44 males ranging from 6 to 73 years of age with an average of 42.77 years. Twenty-nine patients received radiation therapy and an adjuvant therapy after operation (4500-6800 cGy, with a mean of 5430cGy). Nineteen patients received chemotherapy of various types as an adjuvant therapy. The extent of cranial resections were anterior cranial fossa in 24 cases, middle cranial fossa in 19 cases, posterior cranial fossa in 2 cases, anterior and middle skull base in 14 cases, and middle and posterior cranial fossa in 11 cases. Among them, 24 patients underwent orbital exenteration simultaneously. 22 cases had limited resection of the dural involvement (two cases had brain invasion). Life table was used to calculate the survival rates. The overall follow-up rate was 84.2% (59/70) with 11 patients lost to follow-up. The survival rate at 3 and 5 years was 48.2% (27/56) and 34.6% (17/49), respectively. While the survival rate at 10 years was 23.6%(9/38). The overall incidence of complication was 37.1% (26/70). Our results revealed a considerably fine prospect of craniofacial resection for patients with advanced malignancies in oral and maxillofacial region. [-~--~--] CRANIOFACIAL TUMORS. THE OPERATION AND RECONSTRUCTION V.I. Chissov, A.N. Konovalov, I.V. Reshetov, V.A. Cherekaev, A.I. Belov, A.M. Zaitsev, S.A. Kravtsov. Hertzen Cancer Research Institute,
Moscow, Russia Introduction: The skull base reconstruction is a very important procedure in the cases of radical resection of skull base tumors.
37 Materials and Methods: We presented 72 patients (male 40, female 32), aged 3.5 to 76 years, with skull base tumors extending into the orbits and paranasal sinuses (benign 45, malignant 27). All these lesions were divided into 3 groups: I group. The midline lesions (42 cases) included defects of ethmoid and sphenoid sinuses, frontal sinuses, medial parts of maxillary sinuses. II group. The lateral lesions involved lateral parts of frontal sinus, upper-lateral parts of maxillary sinus as lateral skull base defects (19 cases). III group. Combined skull base defects included both medial and lateral defects with widely opened paranasal sinuses and nasopharynx. (11 cases). Results and Conclusions: It's important to emphasize that the reconstruction with a periosteum flap from frontoparietal area should be preferred in midline defects, a temporalis muscle flap with adjusted periosteum- in lateral defects. The reconstruction with autograft using microsurgery technique (m. latissimus dorsi flap, m. pectoralis, combined flap using m. pectoralis and m. abdominalis rectus musculocutaneous flap, omentus, m. latissimus dorsi with split-rib grafts) is indicated in case of combined defects. It's observed that two patients had nasal cerebrospinal fluid leak which resolved after continuous lumbar drainage. Preoperative planning of optimal method of closure of skull base defect depends on location and expansion of skull base tumor. Keywords: Skull base tumors; Skull base reconstruction
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CLINICAL ANALYSIS OF MALIGNANT MELANOMA WITH MULTIDISCIPLINARY SEQUENTIAL TREATMENT ON ORAL & MAXlLLOFACIAL REGION
W. Guo, Z. Zhang, C. Zhang, W. Qiu. Dept. of Oral & Maxillofacial
Surgery, Affiliated 9th Hospital Shanghai, Second Medical University, China To analyze and evaluate the effects of multidisciplinary sequential treatment in the dealing with malignant melanoma on oral & maxillofacial region. In order to establish the routine of treatment with oral malignant melanoma. From 1994.1-2004.1, the data of 70 patients received by treatments (cryosurgery, chemotherapy, surgery and immunotherapy) with malignant melanoma of oral & maxillofacial region were retrospected. There were 33 males and 30 females, following-up time was 1 to 7 years. Site, the most common site was the palate; the second location was the gingiva, followed by the floor of mouth and tongue. The peak age group of the disease in both sexes was 40-60 years. The middle survival rate of the disease was 4.5 years. The reason of death was metastases in the distance. It is suggested that multidisciplinary sequential treatment be the routine regimen of melanoma on oral & maxillofacial region.
[O•]
COMBINATION THERAPY OF SURGICAL RESECTION AND AFTERLOADING IN PATIENTS WITH ADVANCED HEAD AND NECK SQUAMOUS CELL CARCINOMA
F. Schiefke, G. Hildebrandt, B. Frerich. Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University of Leipzig, Germany The surgical treatment of recurrent head and neck squamous cell carcinoma is a great challenge. One of the main problems in the head and neck area is the certainty of the resected margins. In this case the afterloading therapy offers an additional treatment modality. We present our experience in 12 patients with advanced head and neck carcinoma treated by tumor resection, simultanous defect reconstruction with a microvascular flap and afterloading therapy. From 09/2000 to 09/2004 12 patients (10 male, 2 female, median age: 58.5 years) with local recurrence of head and neck squamous cell carcinoma unterwent an adjuvant afterloading therapy. The afterloading applicators were inserted after tumour resection and defect reconstruction with a microvascular flap. The patients received brachytherapy for 4 to 8 days (dose 21.0-44.8 Gy). The follow up was 1-24 month (median: 7 month). 4 patients died during the follow up. Of the 8 survivors one patient developed a progressive tumour recurrence after brachytherapy. 7 patients are still free of disease. The local side effects were much smaller as compared to those of percutanous radiation. Side effects comprised a pharyngeal fistula and an acute bleeding from the carotid artery in one case, which required immediate surgical intervention and was managed successfully. The results show that afterloading therapy can improve the chance to cure tumour disease and is a treatment option in advanced disease. The combination with microvascular free flap reconstruction is able to avoid postoperative wound healing disturbances.
THE CLINICAL SIGNIFICANCE OF THE POSITIVE SURGICAL MARGIN IN ORAL CANCER
A. Binahmed, R. Nason, H. Alhajjaj, D. Chemaly, A. Abdoh. Department
of Surgery University of Manitoba Winnipeg, Manitoba, Canada The aim of surgical treatment of squamous cell carcinoma of the oral cavity is adequate resection with a clear margin. This study examines the significance of the positive surgical margin. An historical cohort of 425 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 independent effect of surgical margins on 5-year survival. The mean age of the cohort was 63±12.6 years (52.9% < 65) and 58.8% were males. Seventy-two percent of tumors involved the tongue and floor of mouth, and 43% of patients presented with Stage III and IV disease. The 5-year absolute, disease specific and disease free survivals were 62%, 74.5%, and 60.3% respectively. Survival was related to age > 65 years (HR 1.5; 95% CI 1.1,2.2; P =0.0177), T-Stage (HR 1.4; 95%CI 1.2,1.6; P=0.0002), and N-Stage (HR 1.3; 95%CI 1.0,1.6; P =0.0465). Patients with clear margins had a survival rate of 69% (median survival >60 months) when compared to those with close (58%, median survival > 60 months) and involved margins (38%, median survival 31 months, P =0.0000). After controlling for the other significant prognostic factors, involved surgical margins increased the risk of death at 5 years by 90% (HR 1.9; 95%CI 1.2, 2.9; P =0.0026). The status of the surgical margin is a powerful predictor of outcome. The surgical margin, in contrast to the other prognostic indicators, is under the direct control of the surgeon. [-~--~
CRANIOFACIAL RESECTION FOR ADVANCED MALIGNANT TUMORS IN ORAL AND MAXlLLOFACIAL REGION: A RETROSPECTIVE STUDY OF 70 CASES
Z.'~ Zhang. School of Stomatology, China To evaluate the clinical outcome of craniofacial resection for advanced malignant tumors of oral and maxillofacial regions. Seventy patients who underwent craniofacial resection for malignancies involving the anterior, middle and posterior cranial fossa over a 25-year period between June 1978 and December 2003 in our department were evaluated. The study group consisted of 26 females and 44 males ranging from 6 to 73 years of age with an average of 42.77 years. Twenty-nine patients received radiation therapy and an adjuvant therapy after operation (4500-6800 cGy, with a mean of 5430cGy). Nineteen patients received chemotherapy of various types as an adjuvant therapy. The extent of cranial resections were anterior cranial fossa in 24 cases, middle cranial fossa in 19 cases, posterior cranial fossa in 2 cases, anterior and middle skull base in 14 cases, and middle and posterior cranial fossa in 11 cases. Among them, 24 patients underwent orbital exenteration simultaneously. 22 cases had limited resection of the dural involvement (two cases had brain invasion). Life table was used to calculate the survival rates. The overall follow-up rate was 84.2% (59/70) with 11 patients lost to follow-up. The survival rate at 3 and 5 years was 48.2% (27/56) and 34.6% (17/49), respectively. While the survival rate at 10 years was 23.6%(9/38). The overall incidence of complication was 37.1% (26/70). Our results revealed a considerably fine prospect of craniofacial resection for patients with advanced malignancies in oral and maxillofacial region. [-~--~--] CRANIOFACIAL TUMORS. THE OPERATION AND RECONSTRUCTION V.I. Chissov, A.N. Konovalov, I.V. Reshetov, V.A. Cherekaev, A.I. Belov, A.M. Zaitsev, S.A. Kravtsov. Hertzen Cancer Research Institute,
Moscow, Russia Introduction: The skull base reconstruction is a very important procedure in the cases of radical resection of skull base tumors.
37 Materials and Methods: We presented 72 patients (male 40, female 32), aged 3.5 to 76 years, with skull base tumors extending into the orbits and paranasal sinuses (benign 45, malignant 27). All these lesions were divided into 3 groups: I group. The midline lesions (42 cases) included defects of ethmoid and sphenoid sinuses, frontal sinuses, medial parts of maxillary sinuses. II group. The lateral lesions involved lateral parts of frontal sinus, upper-lateral parts of maxillary sinus as lateral skull base defects (19 cases). III group. Combined skull base defects included both medial and lateral defects with widely opened paranasal sinuses and nasopharynx. (11 cases). Results and Conclusions: It's important to emphasize that the reconstruction with a periosteum flap from frontoparietal area should be preferred in midline defects, a temporalis muscle flap with adjusted periosteum- in lateral defects. The reconstruction with autograft using microsurgery technique (m. latissimus dorsi flap, m. pectoralis, combined flap using m. pectoralis and m. abdominalis rectus musculocutaneous flap, omentus, m. latissimus dorsi with split-rib grafts) is indicated in case of combined defects. It's observed that two patients had nasal cerebrospinal fluid leak which resolved after continuous lumbar drainage. Preoperative planning of optimal method of closure of skull base defect depends on location and expansion of skull base tumor. Keywords: Skull base tumors; Skull base reconstruction
~-"~
CLINICAL ANALYSIS OF MALIGNANT MELANOMA WITH MULTIDISCIPLINARY SEQUENTIAL TREATMENT ON ORAL & MAXlLLOFACIAL REGION
W. Guo, Z. Zhang, C. Zhang, W. Qiu. Dept. of Oral & Maxillofacial
Surgery, Affiliated 9th Hospital Shanghai, Second Medical University, China To analyze and evaluate the effects of multidisciplinary sequential treatment in the dealing with malignant melanoma on oral & maxillofacial region. In order to establish the routine of treatment with oral malignant melanoma. From 1994.1-2004.1, the data of 70 patients received by treatments (cryosurgery, chemotherapy, surgery and immunotherapy) with malignant melanoma of oral & maxillofacial region were retrospected. There were 33 males and 30 females, following-up time was 1 to 7 years. Site, the most common site was the palate; the second location was the gingiva, followed by the floor of mouth and tongue. The peak age group of the disease in both sexes was 40-60 years. The middle survival rate of the disease was 4.5 years. The reason of death was metastases in the distance. It is suggested that multidisciplinary sequential treatment be the routine regimen of melanoma on oral & maxillofacial region.
[O•]
COMBINATION THERAPY OF SURGICAL RESECTION AND AFTERLOADING IN PATIENTS WITH ADVANCED HEAD AND NECK SQUAMOUS CELL CARCINOMA
F. Schiefke, G. Hildebrandt, B. Frerich. Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University of Leipzig, Germany The surgical treatment of recurrent head and neck squamous cell carcinoma is a great challenge. One of the main problems in the head and neck area is the certainty of the resected margins. In this case the afterloading therapy offers an additional treatment modality. We present our experience in 12 patients with advanced head and neck carcinoma treated by tumor resection, simultanous defect reconstruction with a microvascular flap and afterloading therapy. From 09/2000 to 09/2004 12 patients (10 male, 2 female, median age: 58.5 years) with local recurrence of head and neck squamous cell carcinoma unterwent an adjuvant afterloading therapy. The afterloading applicators were inserted after tumour resection and defect reconstruction with a microvascular flap. The patients received brachytherapy for 4 to 8 days (dose 21.0-44.8 Gy). The follow up was 1-24 month (median: 7 month). 4 patients died during the follow up. Of the 8 survivors one patient developed a progressive tumour recurrence after brachytherapy. 7 patients are still free of disease. The local side effects were much smaller as compared to those of percutanous radiation. Side effects comprised a pharyngeal fistula and an acute bleeding from the carotid artery in one case, which required immediate surgical intervention and was managed successfully. The results show that afterloading therapy can improve the chance to cure tumour disease and is a treatment option in advanced disease. The combination with microvascular free flap reconstruction is able to avoid postoperative wound healing disturbances.