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Health-Related Quality of Life in Patients with Oral Carcinoma, a Five-Year Follow-up
Otolaryngology– Head and Neck Surgery Volume 133 Number 2
P032 Lacrimal Sac Neoplasms Russell B Smith, MD (presenter); Katie Geelan-Hansen, MS4; Eric P Wilkinson, MD; Jeffrey A Nerad, MD; Keith D Carter, MD; Kristi E Chang, MD Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA
Objectives: Lacrimal sac neoplasms are rarely encountered and represent a diverse group of pathologies. Management frequently incorporates surgery with or without adjuvant therapy. Due to the location of such tumors, functional deficits and cosmetic deformities may result from therapy. This report will describe the clinical presentation, oncologic therapy, and reconstruction of 11 patients treated for primary lacrimal sac neoplasms. Methods: Retrospective chart review of patients diagnosed with a primary lacrimal sac neoplasm at The University of Iowa Hospital and Clinics from 1988-present. Results: The study included seven males and four females with an average age of 61.9 years. Two cases were benign inverted papillomas. Both were males with an average age of 45 years. The cases were treated with surgical excision and reconstruction. Nine cases were malignant, five males and four females with an average age of 65.6 years. These included: five epithelial neoplasms, three lymphomas, and one melanoma. Most presented with disease limited to the primary site with unilateral epiphora as the most frequent symptom. Two cases presented with distant spread of disease.
Treatment modalities included surgery, chemotherapy, and/or radiotherapy. Four patients with malignant tumors had recurrences (two local, one regional and one distant). All patients with malignant tumors that underwent curative resection also had a reconstruction. Conclusion: Lacrimal sac neoplasms typically present with epiphora. Most lacrimal sac neoplasms are malignant and frequently recur, despite multimodality therapy. Reconstruction of the surgical defect requires attention to be given to the soft tissue deficit, the lacrimal drainage system, and the medial canthus apparatus.
P033 Health-Related Quality of Life in Patients with Oral Carcinoma, a Five-Year Follow-up Mats O. Nordgren, MD (presenter); Magnus Jannert, MD PhD; Morten Boysen, MD; Marianne Ahlner-Elmqvist, RN BEd; Ewa Silander, MD; Kristin Bjordal, MD; Eva B Hammerlid, MD Malmo Sweden; Malmo Sweden; Oslo Norway; Malmo Sweden; Goteburg Sweden; Oslo Norway; Goteberg Sweden
Objectives: To evaluate the health-related quality of life (HRQL) of patients with oral carcinoma in a prospective longitudinal multicenter study at diagnosis, and after one and five years in relation to tumor location and treatment modality. Methods: One hundred twenty two patients (mean age 61 years; 62% males) with oral carcinoma were evaluated with standardized HRQL questionnaires; the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the EORTC QLQ-Head and Neck Cancer Module (EORTC QLQH&N35). Results: Treatment related problems such as sticky saliva, teeth problems and dry mouth got worse between diagnosis and five years after diagnosis. Problems with dry mouth remained a great problem between one and five years after diagnosis. HRQL at diagnosis was associated with survival. The treatment group surgery only showed lesser problems than the other treatment groups over time. Carcinoma in the floor of the mouth showed worse HRQL than other sub sites over time, except at diagnosis. The majority with poor quality of life five years after diagnosis did not experience these problems at the one-year follow-up, and most of them had small tumors stage I/II. Conclusion: For patients with oral carcinoma, HRQL at diagnosis seems to be an important factor for the prognosis of both HRQL over time and survival. It should be recognized that treatment of oral carcinoma often results in long-term side effects such as dry mouth, problems with teeth and sticky saliva.
POSTERS
advanced oral cancer (stage III and IV), treated with upfront surgery with or without adjuvant radiotherapy between 1999 and 2003 was performed. Supraomohyoid and modified radical neck dissection were performed in clinically N0 and N⫹ patients respectively. Patterns of nodal metastasis to neck and nodal relapse were analyzed. Results: A total of 322 neck dissections were performed for tumors located in buccal (27%), alveolobuccal (23%), alveolus (17%), tongue (17%), retromolar trigone (8%), lip (6%), and floor of mouth (2%). Pathological nodal involvement was present in 40.6% of the patients. In 93% of node positive patients, metastasis was confined to levels I, II, and III. Skip metastasis occurred in 4.5% only. Extranodal spread was detected in 18%. A total of 16 patients (6%) had nodal relapse. Factors associated with nodal relapse were presence of three or more positive nodes and extranodal spread (p ⬍ 0.0001). Conclusion: Of advanced oral cancer patients, 40% have pathological nodal metastasis, mostly confined to level I, II and III. In view of low incidence of level IV & V involvement and skip metastasis, more conservative neck dissections are justified in the management of advanced oral cancer.
Scientific Posters P207
P032 Lacrimal Sac Neoplasms Russell B Smith, MD (presenter); Katie Geelan-Hansen, MS4; Eric P Wilkinson, MD; Jeffrey A Nerad, MD; Keith D Carter, MD; Kristi E Chang, MD Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA; Iowa City IA
Objectives: Lacrimal sac neoplasms are rarely encountered and represent a diverse group of pathologies. Management frequently incorporates surgery with or without adjuvant therapy. Due to the location of such tumors, functional deficits and cosmetic deformities may result from therapy. This report will describe the clinical presentation, oncologic therapy, and reconstruction of 11 patients treated for primary lacrimal sac neoplasms. Methods: Retrospective chart review of patients diagnosed with a primary lacrimal sac neoplasm at The University of Iowa Hospital and Clinics from 1988-present. Results: The study included seven males and four females with an average age of 61.9 years. Two cases were benign inverted papillomas. Both were males with an average age of 45 years. The cases were treated with surgical excision and reconstruction. Nine cases were malignant, five males and four females with an average age of 65.6 years. These included: five epithelial neoplasms, three lymphomas, and one melanoma. Most presented with disease limited to the primary site with unilateral epiphora as the most frequent symptom. Two cases presented with distant spread of disease.
Treatment modalities included surgery, chemotherapy, and/or radiotherapy. Four patients with malignant tumors had recurrences (two local, one regional and one distant). All patients with malignant tumors that underwent curative resection also had a reconstruction. Conclusion: Lacrimal sac neoplasms typically present with epiphora. Most lacrimal sac neoplasms are malignant and frequently recur, despite multimodality therapy. Reconstruction of the surgical defect requires attention to be given to the soft tissue deficit, the lacrimal drainage system, and the medial canthus apparatus.
P033 Health-Related Quality of Life in Patients with Oral Carcinoma, a Five-Year Follow-up Mats O. Nordgren, MD (presenter); Magnus Jannert, MD PhD; Morten Boysen, MD; Marianne Ahlner-Elmqvist, RN BEd; Ewa Silander, MD; Kristin Bjordal, MD; Eva B Hammerlid, MD Malmo Sweden; Malmo Sweden; Oslo Norway; Malmo Sweden; Goteburg Sweden; Oslo Norway; Goteberg Sweden
Objectives: To evaluate the health-related quality of life (HRQL) of patients with oral carcinoma in a prospective longitudinal multicenter study at diagnosis, and after one and five years in relation to tumor location and treatment modality. Methods: One hundred twenty two patients (mean age 61 years; 62% males) with oral carcinoma were evaluated with standardized HRQL questionnaires; the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the EORTC QLQ-Head and Neck Cancer Module (EORTC QLQH&N35). Results: Treatment related problems such as sticky saliva, teeth problems and dry mouth got worse between diagnosis and five years after diagnosis. Problems with dry mouth remained a great problem between one and five years after diagnosis. HRQL at diagnosis was associated with survival. The treatment group surgery only showed lesser problems than the other treatment groups over time. Carcinoma in the floor of the mouth showed worse HRQL than other sub sites over time, except at diagnosis. The majority with poor quality of life five years after diagnosis did not experience these problems at the one-year follow-up, and most of them had small tumors stage I/II. Conclusion: For patients with oral carcinoma, HRQL at diagnosis seems to be an important factor for the prognosis of both HRQL over time and survival. It should be recognized that treatment of oral carcinoma often results in long-term side effects such as dry mouth, problems with teeth and sticky saliva.
POSTERS
advanced oral cancer (stage III and IV), treated with upfront surgery with or without adjuvant radiotherapy between 1999 and 2003 was performed. Supraomohyoid and modified radical neck dissection were performed in clinically N0 and N⫹ patients respectively. Patterns of nodal metastasis to neck and nodal relapse were analyzed. Results: A total of 322 neck dissections were performed for tumors located in buccal (27%), alveolobuccal (23%), alveolus (17%), tongue (17%), retromolar trigone (8%), lip (6%), and floor of mouth (2%). Pathological nodal involvement was present in 40.6% of the patients. In 93% of node positive patients, metastasis was confined to levels I, II, and III. Skip metastasis occurred in 4.5% only. Extranodal spread was detected in 18%. A total of 16 patients (6%) had nodal relapse. Factors associated with nodal relapse were presence of three or more positive nodes and extranodal spread (p ⬍ 0.0001). Conclusion: Of advanced oral cancer patients, 40% have pathological nodal metastasis, mostly confined to level I, II and III. In view of low incidence of level IV & V involvement and skip metastasis, more conservative neck dissections are justified in the management of advanced oral cancer.
Scientific Posters P207