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Massive deep lobe parotid tumors: surgical evaluation of diagnostic and treatment modalities
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0251)- Oncology
terial chemotherapy and concurrent radiotherapy were administered to 95 of the patients (89%), 67 of whom (71%) were treated without resection of the primary lesions. All patients received our P-X course of treatment, in which continuous,intra-arterial infusion, of 1.6 mg per day of peplomycin (PEP) was synchronized with 2• Gy per week of linac irradiation given without intermission, until July 1988. From August 1988, patients with advanced or highly malignant disease received PUMP'-X course of treatment, in which multi-drug, intra-arterial chemotherapy consisting of PEP, methotrexate (MTX), 5-FU, and cisplatin (CDDP) was synchronized with 2• Gy per week of linac irradiation that was given biweekly. In the PUMP'-X course, the relatively high 5 mg per day dose of PEP was given continuously over three days, whereas MTX and CDDP (50 mg basic dose for each) were given in bolus. To avoid the often serious side effects of 5-FU, almost all of the patients took from 300 to 600 mg of tegafur-uracil only instead. Of the 67 patients treated non-surgically, 54 achieved complete remission (81%). Although 19 of them had a recurrence (35%), it was controlled surgically in 12 patients. The Kaplan-Meier 10-year survival rate Was 70% for all our 67 non-surgically treated patients. Our long-term study thus demonstrates the viability of non-surgical management for patients with HN-SCC.
8. Massive Deep Lobe Parotid Tumors: Surgical Evaluation of Diagnostic and Treatment Modalities
Vladimir, R, Slobodan, L., Branko, V., Aleksandar, G. Clinic for Maxillofacial Surgery, Skopje, R. Macedonia Deep lobe tumors of parotid gland are rare and peculiar. Their incidence range from 9-12% of parotid tumors in most large series. Different and the most difficult surgical methods in parotid surgery are still presented for these neoplasm and they continue to be diagnostic and therapeutic challenge. The clinical course of 16 patients with massive deep lobe parotid tumors in whom parotid surgery was performed on the Clinic for Maxillofacial surgery in Skopje in the period 1989-1998 was studied. Diagnostic algorithm was including ultrasonography, CT-sialography and MRI with statistical evaluation in tumor parameters. Radical surgery have included total or radical parotidectomy in the entire group. Obtained results reveals that in seria of 229 patients who underwent parotid surgery, 26 were with deep lobe tumors from that 16 with massive deep lobe tumors. Different types of benign tumors were found in 11 cases and in 5 cases malignancy was confirmed with high variability of the morphological appearances and clinical signs. Preoperative facial nerve palsy was found in 4 cases. Total parotidectomy with facial nerve preservation was performed in 11 patient and 5 underwent radical parotidectomy. Postoperative recurrence rate was 7.4% and facial nerve involvement 18.7% wit-h greatest influence of adequate preoperative assessment with'MRI. Conclusion Exact preoperative planing with imaging techniques and posterolateral parotidectomy approach with angular man-
dibular osteotomy produces much better postoperative results in surgery of massive deep lobe parotid tumors.
9. Delayed Neck Lymph Node Metastasis from Squamous Cell Carcinoma of the Oral Cavity
Shingaki, S., Takada, M., Kobayashi, T., Sasai, K., Nakajima, T., Nagashima, K., Hoshina, H.1, Takagi, R. 1 First and 1Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University, Niigata Background Neck lymph node metastasis is the most important prognostic factor in oral carcinomas. The optimal management of the clinically negative neck (NO) remains a controversial issue. The purpose of this study is to examine the extent of nodal metastases and sites of treatment failures in patients who underwent delayed therapeutic neck dissections for delayed development of neck metastases during follow-up after treatment of the primary oral carcinomas. Materials and methods A retrospective analysis of 28 patients with squamous cell carcinoma of the oral cavity who had undergone neck dissections for delayed neck metastases was performed. Primary tumors were located in the tongue in 15, alveolus in 8, cheek in 3, and oropharynx in 2 patients. Three tumors were classified as T1, 18 as T2, and 7 as T4 disease. Results The average time to develop neck metastasis was 9 months (range, 3 to 24 months, 75% within 12 months). The majority of the patients (19 of 28) at the time of neck dissection had clinical stage N1 disease. However, 11 (58%) of these patients were upstaged to pathologic N2 disease. Levels I and II (22 of 28) were the predominant sites of involvement. Multiple positive nodes were noted in 64% (18 of 28) of the patients and 17 (61%) patients had ENS. Among 28 patients followed up to recurrence, 10 (36%) developed neck recurrences (4) or distant metastases (6). Cumulative survival at 5 years for the entire group was 44%. Conclusions The data suggests that when a wait and see policy is used for patients at risk for neck metastasis, they tend to have a high stage neck disease. An elective neck dissection is advisable for such patients.
0251)- Oncology
terial chemotherapy and concurrent radiotherapy were administered to 95 of the patients (89%), 67 of whom (71%) were treated without resection of the primary lesions. All patients received our P-X course of treatment, in which continuous,intra-arterial infusion, of 1.6 mg per day of peplomycin (PEP) was synchronized with 2• Gy per week of linac irradiation given without intermission, until July 1988. From August 1988, patients with advanced or highly malignant disease received PUMP'-X course of treatment, in which multi-drug, intra-arterial chemotherapy consisting of PEP, methotrexate (MTX), 5-FU, and cisplatin (CDDP) was synchronized with 2• Gy per week of linac irradiation that was given biweekly. In the PUMP'-X course, the relatively high 5 mg per day dose of PEP was given continuously over three days, whereas MTX and CDDP (50 mg basic dose for each) were given in bolus. To avoid the often serious side effects of 5-FU, almost all of the patients took from 300 to 600 mg of tegafur-uracil only instead. Of the 67 patients treated non-surgically, 54 achieved complete remission (81%). Although 19 of them had a recurrence (35%), it was controlled surgically in 12 patients. The Kaplan-Meier 10-year survival rate Was 70% for all our 67 non-surgically treated patients. Our long-term study thus demonstrates the viability of non-surgical management for patients with HN-SCC.
8. Massive Deep Lobe Parotid Tumors: Surgical Evaluation of Diagnostic and Treatment Modalities
Vladimir, R, Slobodan, L., Branko, V., Aleksandar, G. Clinic for Maxillofacial Surgery, Skopje, R. Macedonia Deep lobe tumors of parotid gland are rare and peculiar. Their incidence range from 9-12% of parotid tumors in most large series. Different and the most difficult surgical methods in parotid surgery are still presented for these neoplasm and they continue to be diagnostic and therapeutic challenge. The clinical course of 16 patients with massive deep lobe parotid tumors in whom parotid surgery was performed on the Clinic for Maxillofacial surgery in Skopje in the period 1989-1998 was studied. Diagnostic algorithm was including ultrasonography, CT-sialography and MRI with statistical evaluation in tumor parameters. Radical surgery have included total or radical parotidectomy in the entire group. Obtained results reveals that in seria of 229 patients who underwent parotid surgery, 26 were with deep lobe tumors from that 16 with massive deep lobe tumors. Different types of benign tumors were found in 11 cases and in 5 cases malignancy was confirmed with high variability of the morphological appearances and clinical signs. Preoperative facial nerve palsy was found in 4 cases. Total parotidectomy with facial nerve preservation was performed in 11 patient and 5 underwent radical parotidectomy. Postoperative recurrence rate was 7.4% and facial nerve involvement 18.7% wit-h greatest influence of adequate preoperative assessment with'MRI. Conclusion Exact preoperative planing with imaging techniques and posterolateral parotidectomy approach with angular man-
dibular osteotomy produces much better postoperative results in surgery of massive deep lobe parotid tumors.
9. Delayed Neck Lymph Node Metastasis from Squamous Cell Carcinoma of the Oral Cavity
Shingaki, S., Takada, M., Kobayashi, T., Sasai, K., Nakajima, T., Nagashima, K., Hoshina, H.1, Takagi, R. 1 First and 1Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Niigata University, Niigata Background Neck lymph node metastasis is the most important prognostic factor in oral carcinomas. The optimal management of the clinically negative neck (NO) remains a controversial issue. The purpose of this study is to examine the extent of nodal metastases and sites of treatment failures in patients who underwent delayed therapeutic neck dissections for delayed development of neck metastases during follow-up after treatment of the primary oral carcinomas. Materials and methods A retrospective analysis of 28 patients with squamous cell carcinoma of the oral cavity who had undergone neck dissections for delayed neck metastases was performed. Primary tumors were located in the tongue in 15, alveolus in 8, cheek in 3, and oropharynx in 2 patients. Three tumors were classified as T1, 18 as T2, and 7 as T4 disease. Results The average time to develop neck metastasis was 9 months (range, 3 to 24 months, 75% within 12 months). The majority of the patients (19 of 28) at the time of neck dissection had clinical stage N1 disease. However, 11 (58%) of these patients were upstaged to pathologic N2 disease. Levels I and II (22 of 28) were the predominant sites of involvement. Multiple positive nodes were noted in 64% (18 of 28) of the patients and 17 (61%) patients had ENS. Among 28 patients followed up to recurrence, 10 (36%) developed neck recurrences (4) or distant metastases (6). Cumulative survival at 5 years for the entire group was 44%. Conclusions The data suggests that when a wait and see policy is used for patients at risk for neck metastasis, they tend to have a high stage neck disease. An elective neck dissection is advisable for such patients.