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Controversies in the treatment of merkel cell cancer
Posters 141
The Osteogenic Sarcoma of the Jaws
Kropotov M., Podviaznikoy S. Cancer Research Centre, Moscow, Russia We treated 32 patients with osteogenic sarcoma of the jaws, (21.5% of all 149 patients with malignant nonepithelial tumours of the jaws). Eighteen patients had tumours of the upper jaw and 14 had lower jaw tumours. There were 3 cases of osteogenic sarcoma arising from fibrosis dysplasia which were verified by histological study. We noticed that chondroblastic osteogenic sarcomas and high differentiated type were predominant. In 12 patients (37.5%) accurate preoperative diagnosis was established by X-ray examination and fine needle aspiration cytology. Surgical treatment was performed on 22 patients (69%). Different variance of combined treatment, including chemotherapy (regional or systemic, neo- or adjuvant) were performed on 9 patients (28%). Recurrences were the main causes of unsatisfactory results of treatment and were diagnosed in 15 patients (18%) 15 months after treatment. There were 6 cases (18%) of distant metastasis. Thus, the 5 year survival rate of jaw osteogenic sarcomas is 46.8%. The most important prognostic factor is local spread of tumour.
tissue by means of a photosensitizer and light. 5-Aminolevulinic acid (ALA) is a precursor of protoporphyrin IX (Pp IX) in the synthetic pathway of berne. After topical application of ALA, certain cells have a large capacity to accumulate Pp IX. Pp IX is an active photosensitizer which can be activated by red light (630 nm) causing intracellular free oxygen formation, resulting in cell death. Topical application of A L A was used for the treatment of oral leukoplakia. Six patients suffering from leukoplakia of the oral mucosa for several years, proven by biopsy, were treated. Twenty per cent A L A (as a cream, pH 6) was applied to the lesions and covered with gauze pads for 2 h. Then, the cream was removed and the lesions were illuminated by red light at 630 nm (100 mW/cm 2, 80 J/cm 2) delivered by an argon pumped dye laser. During and after the treatment, patients did not sense any discomfort or pain. One day later, the first signs of cell desquamation could be seen followed by local inflammation and healing. Two of our patients showed a complete response with no remaining leukoplakia, three showed a significant reduction and improvement of the local situation, whereas one patient failed to respond. 5-amino-levulinic acid seems to be a promising treatment modality for oral leukoplakia with major advantages, such as being non-invasive, non-operative and with unlimited repeatability.
The Reconstruction of the Liplinen using the Tongue Flap
Kruehinsky 1t. Centre of Plastic Surgery Avicenna, Minsk, Belarus Sometimes the primary lip's reconstruction, that is performed incorrectly, results in a defect of liplinen. As an alternative method, the liplinen reconstruction by the tongue flap may be used. We usually use the middle part of the tongue tip, as shown in the illustration. As the wounds that are in contact have small surfaces, the tongue is temporarily affixed to the upper lateral teeth to ensure good healing. Prior to this wire loops are made to be used for the tongue fixation. This way of the liplinen reconstruction gives good results.
Photodynamie Therapy of Oral Leukoplakia by Topical Application of 5-Aminolevulinie Acid (ALA)
Kiibler A., C1, Kaus M. 2, Hofele C.1, Ziiller j.l 1Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany 2German Cancer Research Centre (DKFZ), Heidelberg, Germany Photodynamic therapy (PDT) is a new treatment modality which is based on the photochemical destruction of tumour
Controversies in the Treatment of Merkel Cell Cancer
Lasa E, Caubet J., Badia V., Morey 34., Iriarte J., Hipolito F., Llado B., Fortez A. Oral and Maxillofacial Section, Son Dureta Hospital, Palma de Mallorca, Spain Merkel cell carcinoma is a skin neuroendocrine tumour with a high aggressivity. Due to the few cases described in the literature and the high incidence of local recurrence, the different approaches for its management are a matter for discussion. We report two cases in which surgery was the initial treatment. The first patient received postoperative radiation therapy and is currently free from disease 32 months after the diagnosis. The second patient did not receive postoperative radiotherapy and showed multiple recurrences, treated with surgery, radiotherapy and finally with chemotherapy, dying 22 months after the diagnosis. Merkel cell carcinoma has a high percentage of metastases into regional lymph nodes (60%) and approximately 40% of recurrence after excision. The percentage of distant metastases is relatively low (28%). Histologically, it is sometimes difficult to establish a differential diagnosis from other tumours. Immunohistochemical studies demonstrate positivity for cytokeratin and cytoplasmic neuron-specific enolase. The management of this tumour is still under discussion, surgery being the first step followed by wide resection, with or without nodal dissection. Radiotherapy can be used alone when surgery is not possible, or as an adjunct to surgery, thus decreasing the percentage of recurrence, according to several authors. In cases of disseminated disease, chemotherapy is used. We analyze the different modalities of treatment and the role of radiotherapy to prevent recurrence.
The Osteogenic Sarcoma of the Jaws
Kropotov M., Podviaznikoy S. Cancer Research Centre, Moscow, Russia We treated 32 patients with osteogenic sarcoma of the jaws, (21.5% of all 149 patients with malignant nonepithelial tumours of the jaws). Eighteen patients had tumours of the upper jaw and 14 had lower jaw tumours. There were 3 cases of osteogenic sarcoma arising from fibrosis dysplasia which were verified by histological study. We noticed that chondroblastic osteogenic sarcomas and high differentiated type were predominant. In 12 patients (37.5%) accurate preoperative diagnosis was established by X-ray examination and fine needle aspiration cytology. Surgical treatment was performed on 22 patients (69%). Different variance of combined treatment, including chemotherapy (regional or systemic, neo- or adjuvant) were performed on 9 patients (28%). Recurrences were the main causes of unsatisfactory results of treatment and were diagnosed in 15 patients (18%) 15 months after treatment. There were 6 cases (18%) of distant metastasis. Thus, the 5 year survival rate of jaw osteogenic sarcomas is 46.8%. The most important prognostic factor is local spread of tumour.
tissue by means of a photosensitizer and light. 5-Aminolevulinic acid (ALA) is a precursor of protoporphyrin IX (Pp IX) in the synthetic pathway of berne. After topical application of ALA, certain cells have a large capacity to accumulate Pp IX. Pp IX is an active photosensitizer which can be activated by red light (630 nm) causing intracellular free oxygen formation, resulting in cell death. Topical application of A L A was used for the treatment of oral leukoplakia. Six patients suffering from leukoplakia of the oral mucosa for several years, proven by biopsy, were treated. Twenty per cent A L A (as a cream, pH 6) was applied to the lesions and covered with gauze pads for 2 h. Then, the cream was removed and the lesions were illuminated by red light at 630 nm (100 mW/cm 2, 80 J/cm 2) delivered by an argon pumped dye laser. During and after the treatment, patients did not sense any discomfort or pain. One day later, the first signs of cell desquamation could be seen followed by local inflammation and healing. Two of our patients showed a complete response with no remaining leukoplakia, three showed a significant reduction and improvement of the local situation, whereas one patient failed to respond. 5-amino-levulinic acid seems to be a promising treatment modality for oral leukoplakia with major advantages, such as being non-invasive, non-operative and with unlimited repeatability.
The Reconstruction of the Liplinen using the Tongue Flap
Kruehinsky 1t. Centre of Plastic Surgery Avicenna, Minsk, Belarus Sometimes the primary lip's reconstruction, that is performed incorrectly, results in a defect of liplinen. As an alternative method, the liplinen reconstruction by the tongue flap may be used. We usually use the middle part of the tongue tip, as shown in the illustration. As the wounds that are in contact have small surfaces, the tongue is temporarily affixed to the upper lateral teeth to ensure good healing. Prior to this wire loops are made to be used for the tongue fixation. This way of the liplinen reconstruction gives good results.
Photodynamie Therapy of Oral Leukoplakia by Topical Application of 5-Aminolevulinie Acid (ALA)
Kiibler A., C1, Kaus M. 2, Hofele C.1, Ziiller j.l 1Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany 2German Cancer Research Centre (DKFZ), Heidelberg, Germany Photodynamic therapy (PDT) is a new treatment modality which is based on the photochemical destruction of tumour
Controversies in the Treatment of Merkel Cell Cancer
Lasa E, Caubet J., Badia V., Morey 34., Iriarte J., Hipolito F., Llado B., Fortez A. Oral and Maxillofacial Section, Son Dureta Hospital, Palma de Mallorca, Spain Merkel cell carcinoma is a skin neuroendocrine tumour with a high aggressivity. Due to the few cases described in the literature and the high incidence of local recurrence, the different approaches for its management are a matter for discussion. We report two cases in which surgery was the initial treatment. The first patient received postoperative radiation therapy and is currently free from disease 32 months after the diagnosis. The second patient did not receive postoperative radiotherapy and showed multiple recurrences, treated with surgery, radiotherapy and finally with chemotherapy, dying 22 months after the diagnosis. Merkel cell carcinoma has a high percentage of metastases into regional lymph nodes (60%) and approximately 40% of recurrence after excision. The percentage of distant metastases is relatively low (28%). Histologically, it is sometimes difficult to establish a differential diagnosis from other tumours. Immunohistochemical studies demonstrate positivity for cytokeratin and cytoplasmic neuron-specific enolase. The management of this tumour is still under discussion, surgery being the first step followed by wide resection, with or without nodal dissection. Radiotherapy can be used alone when surgery is not possible, or as an adjunct to surgery, thus decreasing the percentage of recurrence, according to several authors. In cases of disseminated disease, chemotherapy is used. We analyze the different modalities of treatment and the role of radiotherapy to prevent recurrence.