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A prospective study of salivary function sparing in patients with head and neck cancer receiving intensity-modulated or conventional radiotherapy
Free Papers—Oral Presentations 2008. Sixteen of all cases were of primary recurrence and arrived from another Department, and the rest of tumours (218) were primary adenoma treated by us, and we had six recurrences. Results: The mean follow-up was 65 months. The most frequent location of the recurrence (52%) was in the superficial lobe, being unique in 75%. In most of cases (40%) total parotidectomy preserving the facial nerve was achieved. In 4% of cases complementary radiotherapy was associated after surgery. In some cases (4%) another surgical treatments were achieved. The period of time between the first and second surgery was 105 months. Conclusions: The treatment of choice of the pleomorphic parotid adenomas is surgical. A high degree of vigilance is required in the follow-up of these patients over a long period of time (10–15 years) because of high incidence of recurrences. The recurrences are unique in most of cases and total parotidectomy preserving the facial nerve is the treatment of choice. In some cases complementary radiotherapy and other treatments after surgery are associated with obtaining excellent results. doi:10.1016/j.ijom.2009.03.146
O2.15 The implications of a positive sentinel node in head and neck cancer B. Gurney, M. McGurk, C. Schilling, L. Cascarini, Z. Lei ∗ , the European SENT Group Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: The role of sentinel node biopsy (SNB) is being explored in head and neck surgery. Preliminary data suggest that a positive sentinel node frequently exists in isolation and that if additional positive nodes are present, they lie in close proximity in the neck. If proven, it may allow a more conservative surgical approach for patients with early disease. Methods: A European multicentre retrospective study of 94 patients with positive SNB was performed. All patients had a level I-V neck dissection either electively or within 2 weeks of positive SNB. Neck dissection findings were compared with SNB details. Variable clinical and histological data were collected and correlated to patient outcome. Results: Patients (n = 94) had positive SNB (October 2005–present) across 13
European Centres, with 108 neck sides dissected. Further disease was found upon neck dissection in 37% of SNB positive patients. Of these, 95% had neck disease in the same or adjacent anatomical neck level to that of the positive sentinel node. In 5%, neck disease was found in a non-adjacent level. Conclusions: The data suggest that if an oral cancer patient has a positive SNB, then in over 60% of cases this will be the only cervical node with metastasis. If additional positive nodes are present, then the vast majority (95%) lie close to the positive sentinel node. Further work is needed to examine the reliability of this observation to establish whether with early occult disease, a standard neck dissection might be replaced by a more conservative procedure. doi:10.1016/j.ijom.2009.03.147
O2.16 Mucoepidermoid carcinoma of the oral minor salivary glands H. Shimamoto ∗ , K. Omura, H. Harada, K. Tanaka, K. Sakamoto Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
Mucoepidermoid carcinoma is one of the common malignant neoplasms in the minor salivary glands. We analysed clinicopathological findings of mucoepidermoid carcinoma of the oral minor salivary glands. There were 19 patients who visited our department between 2001 and 2008. They were 8 males and 11 females ranging in age from 11 to 92 years. At the time of diagnosis, 4 patients had cervical lymph node metastasis. No patients had distant metastasis. Surgery was performed in 17 patients and radiotherapy was given in 2 patients due to patient choice. According to Goode’s classification, histological grade of the tumour was low in 7 cases, intermediate in 5 cases and high in 7 cases. Primary tumour was controlled in 6 patients with low-grade tumour, 5 patients with intermediate-grade and 3 patients with high-grade. Four patients with highgrade tumour died of the disease. These results suggested that histopathological grade of the mucoepidermoid carcinoma arising in the oral minor salivary glands correlated with the clinical course and local recurrence could be salvaged by surgery. doi:10.1016/j.ijom.2009.03.148
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O2.17 A prospective study of salivary function sparing in patients with head and neck cancer receiving intensity-modulated or conventional radiotherapy Z. Wang ∗ , H. Hu, C. Yan, H. Shi Division of Radiotherapy, Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background and Objectives: The aim of this prospective study were to assess disease results and improvement of xerostomia in patients with head and neck cancer with intensity modulated radiotherapy (IMRT) as compared with conventional radiotherapy (CRT). Methods: A total of 102 patients with head and neck cancer (12 with definitive and 90 with postoperative radiotherapy) were treated with IMRT (52 cases) or CRT (50 cases) between May 2007 and May 2008. The patients treated with IMRT had least one parotid gland excluded from the planning target volume and the mean dose of the parotid gland was kept at less 26 Gy. The evaluation of salivary function with xerostomia grade and total unstimulated and stimulated salivary flow rates and adverse effects were observed. The treatment results were observed. Results: At a median follow-up of 10 months for patients (range, 7–16), 9 locoregional failures were observed in patients with CRT and only one locoregional failure in patients with IMRT (P < 0.05). The mean doses to the contralateral and ipsilateral parotid glands in IMRT patients were 20.3 ± 5.9 and 26.8 ± 6.2 Gy, respectively. The mean doses to the contralateral and ipsilateral parotid glands in CRT patients were 49.7 ± 9.8 and 48.9 ± 9.4 Gy, respectively. The mean doses of parotid glands in CRT patients were significantly higher than in IMRT patients (P < 0.001).The total unstimulated and stimulated salivary flow rates in IMRT patients were significantly higher than in CRT patients at 6 months after radiotherapy (P < 0.01). 48 patients (96%) with CRT had grade 3 xerostomia, whereas 2 cases (2.8%) only in IMRT showed grade 3 xerostomia (P < 0.01). Conclusion: Our preliminary results show higher locoregional control of IMRT in head and neck cancer. It is effective in prevention of post-radiotherapy xerostomia. doi:10.1016/j.ijom.2009.03.149
O2.15 The implications of a positive sentinel node in head and neck cancer B. Gurney, M. McGurk, C. Schilling, L. Cascarini, Z. Lei ∗ , the European SENT Group Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: The role of sentinel node biopsy (SNB) is being explored in head and neck surgery. Preliminary data suggest that a positive sentinel node frequently exists in isolation and that if additional positive nodes are present, they lie in close proximity in the neck. If proven, it may allow a more conservative surgical approach for patients with early disease. Methods: A European multicentre retrospective study of 94 patients with positive SNB was performed. All patients had a level I-V neck dissection either electively or within 2 weeks of positive SNB. Neck dissection findings were compared with SNB details. Variable clinical and histological data were collected and correlated to patient outcome. Results: Patients (n = 94) had positive SNB (October 2005–present) across 13
European Centres, with 108 neck sides dissected. Further disease was found upon neck dissection in 37% of SNB positive patients. Of these, 95% had neck disease in the same or adjacent anatomical neck level to that of the positive sentinel node. In 5%, neck disease was found in a non-adjacent level. Conclusions: The data suggest that if an oral cancer patient has a positive SNB, then in over 60% of cases this will be the only cervical node with metastasis. If additional positive nodes are present, then the vast majority (95%) lie close to the positive sentinel node. Further work is needed to examine the reliability of this observation to establish whether with early occult disease, a standard neck dissection might be replaced by a more conservative procedure. doi:10.1016/j.ijom.2009.03.147
O2.16 Mucoepidermoid carcinoma of the oral minor salivary glands H. Shimamoto ∗ , K. Omura, H. Harada, K. Tanaka, K. Sakamoto Department of Oral and Maxillofacial Surgery, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
Mucoepidermoid carcinoma is one of the common malignant neoplasms in the minor salivary glands. We analysed clinicopathological findings of mucoepidermoid carcinoma of the oral minor salivary glands. There were 19 patients who visited our department between 2001 and 2008. They were 8 males and 11 females ranging in age from 11 to 92 years. At the time of diagnosis, 4 patients had cervical lymph node metastasis. No patients had distant metastasis. Surgery was performed in 17 patients and radiotherapy was given in 2 patients due to patient choice. According to Goode’s classification, histological grade of the tumour was low in 7 cases, intermediate in 5 cases and high in 7 cases. Primary tumour was controlled in 6 patients with low-grade tumour, 5 patients with intermediate-grade and 3 patients with high-grade. Four patients with highgrade tumour died of the disease. These results suggested that histopathological grade of the mucoepidermoid carcinoma arising in the oral minor salivary glands correlated with the clinical course and local recurrence could be salvaged by surgery. doi:10.1016/j.ijom.2009.03.148
437
O2.17 A prospective study of salivary function sparing in patients with head and neck cancer receiving intensity-modulated or conventional radiotherapy Z. Wang ∗ , H. Hu, C. Yan, H. Shi Division of Radiotherapy, Department of Oral and Maxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Background and Objectives: The aim of this prospective study were to assess disease results and improvement of xerostomia in patients with head and neck cancer with intensity modulated radiotherapy (IMRT) as compared with conventional radiotherapy (CRT). Methods: A total of 102 patients with head and neck cancer (12 with definitive and 90 with postoperative radiotherapy) were treated with IMRT (52 cases) or CRT (50 cases) between May 2007 and May 2008. The patients treated with IMRT had least one parotid gland excluded from the planning target volume and the mean dose of the parotid gland was kept at less 26 Gy. The evaluation of salivary function with xerostomia grade and total unstimulated and stimulated salivary flow rates and adverse effects were observed. The treatment results were observed. Results: At a median follow-up of 10 months for patients (range, 7–16), 9 locoregional failures were observed in patients with CRT and only one locoregional failure in patients with IMRT (P < 0.05). The mean doses to the contralateral and ipsilateral parotid glands in IMRT patients were 20.3 ± 5.9 and 26.8 ± 6.2 Gy, respectively. The mean doses to the contralateral and ipsilateral parotid glands in CRT patients were 49.7 ± 9.8 and 48.9 ± 9.4 Gy, respectively. The mean doses of parotid glands in CRT patients were significantly higher than in IMRT patients (P < 0.001).The total unstimulated and stimulated salivary flow rates in IMRT patients were significantly higher than in CRT patients at 6 months after radiotherapy (P < 0.01). 48 patients (96%) with CRT had grade 3 xerostomia, whereas 2 cases (2.8%) only in IMRT showed grade 3 xerostomia (P < 0.01). Conclusion: Our preliminary results show higher locoregional control of IMRT in head and neck cancer. It is effective in prevention of post-radiotherapy xerostomia. doi:10.1016/j.ijom.2009.03.149