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head and neck cancer
Oral and Symposium abstracts, Friday 18 May
Oral abstracts Diagnosis I O41 Usefulness of PET/CT imaging in the pre-operative staging of patients with oral/head and neck cancer C. Nahmias1 *, E. Carlson1 , L. Duncan1 , T. Blodgett2 , J. Kennedy1 , M. Long1 , D. Townsend1 . 1 The University of Tennessee Medical Center, United States, 2 University of Pittsburgh Medical Center, United States Introduction: The major determining factor in survival of patients with oral cancer is the status of the lymph nodes in the neck. We investigated the role of 18 F-FDG PET/CT in predicting preoperatively the presence and extent of neck disease, and hence helping the surgeon decide to perform selective neck dissection in only those patients with reasonable certainty of metastatic disease in the cervical lymph nodes. Methods: Seventy patients were enrolled in the study. Each patient had a PET/CT study before undergoing radical neck dissection. Of the 83 neck dissections performed, 57 were on clinically negative necks (N0), and 26 on clinically positive necks (N+). All resected tissues were exactly localized and documented at each level to allow correlation between histopathological findings and imaging results. Results: Of the 57 N0 necks, 38 were histopathologically negative; there were 7 false positive studies. Of the 26 N+ necks, 22 were histopathologically positive; there was 1 false negative study. Sensitivity and specificity of the PET procedure were 79% and 82% for the N0 neck, and 95% and 25% respectively for the N+ neck. Eleven percent of the 1,678 nodes identified at histopathology were positive for metastases. Sensitivity and specificity of PET for nodal disease were 48% and 99% respectively. Discussion: In patients with N0 necks, a positive test would not help the surgeon in the management of the patient (too many false positive results), nor would a negative test permit the surgeon to avoid performing a neck dissection. In patients with N+ necks, a positive test will confirm the presence of disease. In either case, a negative PET/CT test does not translate to the ability to avoid surgery in the neck. Occult neck disease is not imaged with high enough sensitivity to help the surgeon in deciding which level to dissect, and which to spare. Keywords: pre-operative staging, PET/CT, FDG
O42 Use of MRI to determine the invasion of mandible in oro-mandibular squamous cell carcinoma W.-Y. Cheung1 , K.K.T. Pak2 , K.W. Tang2 , C.M. Ho1 , V. Chan1 *. Kwong Wah Hospital, China, 2 Queen Elizabeth Hospital, China
1
Introduction: To propose a MRI protocol for pre-operative assessment of oro-mandibular squamous cell carcinoma and to determine the accuracy of MRI in mandibular invasion Methods: All patients in our series had biopsy-proven oral cancer and pre-operative MRI: the MR protocol consisted of short tau inversion recovery (STIR) T2-weighted sequence on the axial plane, spin-echo(SE) T1-weighted sequences on the axial and oblique sagittal (affected side) planes, fat-saturated axial and coronal T1-weighted sequences after administration of gadolinium contrast. Mandibular invasion was suspected when the hypointense cortical bone was replaced by tumour on both T1 and STIR T2 weighted sequences. Replacement of marrow fat on both sequences with contrast enhancement was considered positive for medullary involvement. The segmental mandibulectomy margins were determined by the extent of replaced marrow fat. The pathologic reports from the mandibular resection were reviewed for mention of bone involvement. The MRI findings were correlated with the pathologic results, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were assessed. Results: Seventeen patients were included between July 1999 and November 2003. The mean age of patients was 63 years (range 42 to 77 years). Clear resection margins for bone were achieved in all patients. The diagnostic accuracy of MRI for detecting bone invasion was as follows: sensitivity 100%; specificity 92%; PPV 81%; and NPV 100%. There were 3 false positive studies with tumours arising from the floor of mouth, alveolus and retromolar trigone. Conclusion: Magnetic resonance imaging, with its excellent soft tissue contrast and multiplanar capability, is considered the modality of choice in the pre-operative staging of oral cancers. It is also reliable to exclude bone invasion based on its high sensitivity and negative predictive value. The oblique sagittal plane is particularly helpful to assess tumour infiltration along the angle and ramus of mandible. Keywords: MRI, oral cancer, staging, pathology O43 The prediction of mandibular bone invasion with the expression of osteoclast-related cytokines in biopsy specimens of squamous cell carcinoma, adjacent or fixed to the mandible E. Van Cann1 *, R. Vogels2 , M. Merkx2 , R. Koole1 , P. Stoelinga2 , P. Slootweg2 . 1 University Medical Center Utrecht, Netherlands, 2 Radboud University Nijmegen Medical Center, Netherlands Introduction: The purpose of this study is to investigate the possibility to predict mandibular invasion with the expression of osteoclast-related cytokines in biopsy specimens of squamous cell carcinoma (SCC), adjacent or fixed to the mandible. Methods: Biopsy specimens and resection specimens from the pathology archives were used from 68 patients who had been treated for SCC, adjacent or fixed to the mandible. The patients were classified by histological examination into a group with medullary invasion and a group without medullary invasion. The expression of Interleukin (IL)-6, IL-11, and Tumour Necrosis Factor (TNF)-a was studied by immunohistochemical analyses. Results: In the biopsy specimens no differences were found in expression of IL-6 and IL-11. The expression of TNF-a, however, was significantly higher in biopsy specimens of the group with medullary invasion as compared to the group without medullary invasion (P = 0.01). In the resection specimens no differences were found in expression of IL-6, IL-11, and TNF-a between the
Oral abstracts
deterioration of QOL in 10-year survivors of head and neck cancer. Mowry et al. (2006) found good QOL both after concurrent chemoradiotherapy and with surgery + radiotherapy. Shortterm side effects might, however, be different. Females scored significantly lower on QOL tests than males in a series of survivors treated by surgery + radiotherapy (Baumann et al. 2006). Mandibular resection did not seem to influence the QOL, but postoperative radiotherapy did (Cann et al. 2005). Klug et al. (2002) looked at QOL 2 10 years after preoperative CRT + surgery for T2 T4 tumours. The patients reported a very good QOL. Looking at the literature there seems definitely to be a place for a prospective multicenter study, looking at both QOL and functional results after treatment of oropharyngeal carcinomas.
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Oral abstracts Diagnosis I O41 Usefulness of PET/CT imaging in the pre-operative staging of patients with oral/head and neck cancer C. Nahmias1 *, E. Carlson1 , L. Duncan1 , T. Blodgett2 , J. Kennedy1 , M. Long1 , D. Townsend1 . 1 The University of Tennessee Medical Center, United States, 2 University of Pittsburgh Medical Center, United States Introduction: The major determining factor in survival of patients with oral cancer is the status of the lymph nodes in the neck. We investigated the role of 18 F-FDG PET/CT in predicting preoperatively the presence and extent of neck disease, and hence helping the surgeon decide to perform selective neck dissection in only those patients with reasonable certainty of metastatic disease in the cervical lymph nodes. Methods: Seventy patients were enrolled in the study. Each patient had a PET/CT study before undergoing radical neck dissection. Of the 83 neck dissections performed, 57 were on clinically negative necks (N0), and 26 on clinically positive necks (N+). All resected tissues were exactly localized and documented at each level to allow correlation between histopathological findings and imaging results. Results: Of the 57 N0 necks, 38 were histopathologically negative; there were 7 false positive studies. Of the 26 N+ necks, 22 were histopathologically positive; there was 1 false negative study. Sensitivity and specificity of the PET procedure were 79% and 82% for the N0 neck, and 95% and 25% respectively for the N+ neck. Eleven percent of the 1,678 nodes identified at histopathology were positive for metastases. Sensitivity and specificity of PET for nodal disease were 48% and 99% respectively. Discussion: In patients with N0 necks, a positive test would not help the surgeon in the management of the patient (too many false positive results), nor would a negative test permit the surgeon to avoid performing a neck dissection. In patients with N+ necks, a positive test will confirm the presence of disease. In either case, a negative PET/CT test does not translate to the ability to avoid surgery in the neck. Occult neck disease is not imaged with high enough sensitivity to help the surgeon in deciding which level to dissect, and which to spare. Keywords: pre-operative staging, PET/CT, FDG
O42 Use of MRI to determine the invasion of mandible in oro-mandibular squamous cell carcinoma W.-Y. Cheung1 , K.K.T. Pak2 , K.W. Tang2 , C.M. Ho1 , V. Chan1 *. Kwong Wah Hospital, China, 2 Queen Elizabeth Hospital, China
1
Introduction: To propose a MRI protocol for pre-operative assessment of oro-mandibular squamous cell carcinoma and to determine the accuracy of MRI in mandibular invasion Methods: All patients in our series had biopsy-proven oral cancer and pre-operative MRI: the MR protocol consisted of short tau inversion recovery (STIR) T2-weighted sequence on the axial plane, spin-echo(SE) T1-weighted sequences on the axial and oblique sagittal (affected side) planes, fat-saturated axial and coronal T1-weighted sequences after administration of gadolinium contrast. Mandibular invasion was suspected when the hypointense cortical bone was replaced by tumour on both T1 and STIR T2 weighted sequences. Replacement of marrow fat on both sequences with contrast enhancement was considered positive for medullary involvement. The segmental mandibulectomy margins were determined by the extent of replaced marrow fat. The pathologic reports from the mandibular resection were reviewed for mention of bone involvement. The MRI findings were correlated with the pathologic results, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were assessed. Results: Seventeen patients were included between July 1999 and November 2003. The mean age of patients was 63 years (range 42 to 77 years). Clear resection margins for bone were achieved in all patients. The diagnostic accuracy of MRI for detecting bone invasion was as follows: sensitivity 100%; specificity 92%; PPV 81%; and NPV 100%. There were 3 false positive studies with tumours arising from the floor of mouth, alveolus and retromolar trigone. Conclusion: Magnetic resonance imaging, with its excellent soft tissue contrast and multiplanar capability, is considered the modality of choice in the pre-operative staging of oral cancers. It is also reliable to exclude bone invasion based on its high sensitivity and negative predictive value. The oblique sagittal plane is particularly helpful to assess tumour infiltration along the angle and ramus of mandible. Keywords: MRI, oral cancer, staging, pathology O43 The prediction of mandibular bone invasion with the expression of osteoclast-related cytokines in biopsy specimens of squamous cell carcinoma, adjacent or fixed to the mandible E. Van Cann1 *, R. Vogels2 , M. Merkx2 , R. Koole1 , P. Stoelinga2 , P. Slootweg2 . 1 University Medical Center Utrecht, Netherlands, 2 Radboud University Nijmegen Medical Center, Netherlands Introduction: The purpose of this study is to investigate the possibility to predict mandibular invasion with the expression of osteoclast-related cytokines in biopsy specimens of squamous cell carcinoma (SCC), adjacent or fixed to the mandible. Methods: Biopsy specimens and resection specimens from the pathology archives were used from 68 patients who had been treated for SCC, adjacent or fixed to the mandible. The patients were classified by histological examination into a group with medullary invasion and a group without medullary invasion. The expression of Interleukin (IL)-6, IL-11, and Tumour Necrosis Factor (TNF)-a was studied by immunohistochemical analyses. Results: In the biopsy specimens no differences were found in expression of IL-6 and IL-11. The expression of TNF-a, however, was significantly higher in biopsy specimens of the group with medullary invasion as compared to the group without medullary invasion (P = 0.01). In the resection specimens no differences were found in expression of IL-6, IL-11, and TNF-a between the
Oral abstracts
deterioration of QOL in 10-year survivors of head and neck cancer. Mowry et al. (2006) found good QOL both after concurrent chemoradiotherapy and with surgery + radiotherapy. Shortterm side effects might, however, be different. Females scored significantly lower on QOL tests than males in a series of survivors treated by surgery + radiotherapy (Baumann et al. 2006). Mandibular resection did not seem to influence the QOL, but postoperative radiotherapy did (Cann et al. 2005). Klug et al. (2002) looked at QOL 2 10 years after preoperative CRT + surgery for T2 T4 tumours. The patients reported a very good QOL. Looking at the literature there seems definitely to be a place for a prospective multicenter study, looking at both QOL and functional results after treatment of oropharyngeal carcinomas.
69