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O57. Tongue carcinoma in young adults – A retrospective review of treatment and outcome in 144 patients
Background: The surgical margin status is usually considered a major prognostic parameter in oral squamous cell cancer. Other histopathologic signs representing tumor–host relationships, such as different histologic risk scores and frequency of stromal myofibroblasts, are currently believed to have significant prognostic potential. Material and methods: Sections of the resection specimens of tongue carcinoma (N = 51) were subjected to a risk score assignment of three components as previously described by Brandwein et al.: the worst pattern of invasion, lymphocytic infiltration and perineural invasion. Stromal myofibroblasts were assessed immunomorphometrically (alpha-smooth muscle actin stain) on a representative section from each tumor. Patients 660 years were considered ‘‘young” and those >60 years ‘‘old”. Margins were considered ‘‘clear” if the tumor was P5 mm away from them, otherwise they were defined as ‘‘positive”. Kaplan–Meier survival analysis with Log Rank (univariate) and Cox regression (multivariate) tests were used. Results: Frequency of stromal myofibroblasts was an independent parameter associated with disease recurrence (p = 0.008) and patient survival (p = 0.012). Risk score and surgical margin status were associated with recurrence (p = 0.014). Stromal myofibroblasts were inter-related with risk score (p = 0.003). Multivariate analysis revealed that only the age was significantly associated with recurrence (p = 0.04), underscoring the other parameters. Conclusions: Frequency of stromal myofibroblasts and risk score have stronger prognostic potential in terms of disease recurrence compared with the surgical margin status. These parameters in combination with the clinical parameter of age, could aid in assembling an individual profile for each case of tongue squamous cell cancer in an attempt to modify treatment strategies ideally leading towards a personalized treatment approach. doi:10.1016/j.oos.2009.06.141
O57. Tongue carcinoma in young adults – A retrospective review of treatment and outcome in 144 patients P. Sebastian a,*, R. Muwonge b, N.A. George a, R. Sankaranarayanan a,b, D. Raj a, P.G. Balagopal a a b
Regional Cancer Centre, Trivandrum, India International Agency for Research on Cancer, Lyon, France
Aim: To describe the clinical profile, treatment, patterns of failure and factors predictive of recurrence in patients below 45 years with tongue carcinoma. Methods: One hundred and forty-four patients below 45 years who underwent surgery for squamous cell carcinoma of the tongue at the Regional Cancer Centre, Trivandrum, India from April 2002 to December 2006 were retrospectively reviewed. The clinical profile, treatment details, pathological findings, adjuvant treatment and pattern of recurrences that developed on follow up were studied. Factors predictive of recurrences were evaluated. Results: Seventy-two percent of the patients were male. Thirtyseven patients were at stage I, 36 were at stage II, 34 were at stage III and 37 were at stage IV disease. Thirty-eight patients had neoadjuvant chemotherapy prior to surgery. One hundred and twenty patients had a neck dissection on the ipsilateral side while seven patients also had a contralateral neck dissection. 86.5% of tumors were well to moderately differentiated squamous cell carcinomas. Forty-five patients had a close margin of excision, 18 had perineural infiltration and nine had extra capsular spread. Fifty-six patients (39%) had pathological node positivity. Seventy-five patients received postoperative radiotherapy. On follow up, 24 patients (16.6%) had recurrence at the primary site, while 20 patients had
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recurrence in the neck nodes. Twenty-one of these patients who had recurrence underwent salvage surgery. Clinical and pathological node positivity, and multiple levels of node involvement emerged as significant factors predictive of locoregional recurrence. Conclusion: Cancer of the tongue in young adults is a significant problem. The clinical behavior, response to treatment, recurrence pattern and factors predictive of recurrences seem to be similar to tongue cancers occurring in older patients with tobacco habits. Being a retrospective review, no information could be gathered regarding tobacco and alcohol habits. Prospective studies focusing on molecular genetics and the role of HPV in their causation could possibly give new insights into their etiology. doi:10.1016/j.oos.2009.06.142
O58. Quality assurance measures in patients treated for early oral tongue cancer A.C. Hessel, M.A. Moreno *, E.Y. Hanna, A. El-Naggar, J. Lewin, R.S. Weber The University of Texas, M.D. Anderson Cancer Center, United States Objectives: Identifying parameters that provide a basis for assessing how the cancer care delivered to an individual patient adhered to accepted standards of evaluation and treatment. Methods: Retrospective chart review of 117 patients treated for squamous cell carcinoma of the oral tongue (SCCOT) T1–T2/N0–N1 treated in a tertiary referral center between 1998 and 2003. Based on the available medical evidence and institutional guidelines, we analyzed a set of four quality measures considered critical for outcome: (1) TNM staging was performed at patient presentation; (2) oncologic margin status was documented in the chart; (3) patient was referred to radiation therapy if adverse features were identified in definitive pathology; (4) a neck dissection was performed if tumor depth of invasion was 4 mm. or greater. Additionally, 41 clinical endpoints involving all aspects of patient care were analyzed. Results: There were 73 males and 44 females with a median age of 57 years. Forty-one patients (35.2%) presented with stage I disease; 62 (52.9%) stage II and 14 (11.9%) stage III. The overall 5-year survival rate for the series was 68.6%. There was a 90.6% compliance with TNM staging at presentation; 99.2% for documentation of margin status; 98.3% for adequate referral to radiation therapy, and 91% for appropriate neck dissection based on depth of invasion. The overall compliance rate for the set of quality measures was 94.8%. Clinical endpoints related to radiation therapy were met in 100% of the cases, while endpoints related to surveillance were met in 64% of the patients. Conclusion: Overall compliance with accepted institutional guidelines for treatment of SCCOT was acceptable, although there were significant variations when other aspects of patient care were analyzed. Defining and validating a set of quality measures is essential to identify areas for improvement and to compare outcomes among health providers. doi:10.1016/j.oos.2009.06.143
O59. Clinical outcomes for T1–2 N0 oral tongue carcinoma treated with surgery without adjuvant radiation therapy A.W. Jensen a,*, D. Kademani b, R.L. Foote a a
Mayo Clinic College of Medicine, Rochester, MN, United States University of Minnesota Medical Center and Masonic Cancer Center, Minneapolis, MN, United States b
Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122
O57. Tongue carcinoma in young adults – A retrospective review of treatment and outcome in 144 patients P. Sebastian a,*, R. Muwonge b, N.A. George a, R. Sankaranarayanan a,b, D. Raj a, P.G. Balagopal a a b
Regional Cancer Centre, Trivandrum, India International Agency for Research on Cancer, Lyon, France
Aim: To describe the clinical profile, treatment, patterns of failure and factors predictive of recurrence in patients below 45 years with tongue carcinoma. Methods: One hundred and forty-four patients below 45 years who underwent surgery for squamous cell carcinoma of the tongue at the Regional Cancer Centre, Trivandrum, India from April 2002 to December 2006 were retrospectively reviewed. The clinical profile, treatment details, pathological findings, adjuvant treatment and pattern of recurrences that developed on follow up were studied. Factors predictive of recurrences were evaluated. Results: Seventy-two percent of the patients were male. Thirtyseven patients were at stage I, 36 were at stage II, 34 were at stage III and 37 were at stage IV disease. Thirty-eight patients had neoadjuvant chemotherapy prior to surgery. One hundred and twenty patients had a neck dissection on the ipsilateral side while seven patients also had a contralateral neck dissection. 86.5% of tumors were well to moderately differentiated squamous cell carcinomas. Forty-five patients had a close margin of excision, 18 had perineural infiltration and nine had extra capsular spread. Fifty-six patients (39%) had pathological node positivity. Seventy-five patients received postoperative radiotherapy. On follow up, 24 patients (16.6%) had recurrence at the primary site, while 20 patients had
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recurrence in the neck nodes. Twenty-one of these patients who had recurrence underwent salvage surgery. Clinical and pathological node positivity, and multiple levels of node involvement emerged as significant factors predictive of locoregional recurrence. Conclusion: Cancer of the tongue in young adults is a significant problem. The clinical behavior, response to treatment, recurrence pattern and factors predictive of recurrences seem to be similar to tongue cancers occurring in older patients with tobacco habits. Being a retrospective review, no information could be gathered regarding tobacco and alcohol habits. Prospective studies focusing on molecular genetics and the role of HPV in their causation could possibly give new insights into their etiology. doi:10.1016/j.oos.2009.06.142
O58. Quality assurance measures in patients treated for early oral tongue cancer A.C. Hessel, M.A. Moreno *, E.Y. Hanna, A. El-Naggar, J. Lewin, R.S. Weber The University of Texas, M.D. Anderson Cancer Center, United States Objectives: Identifying parameters that provide a basis for assessing how the cancer care delivered to an individual patient adhered to accepted standards of evaluation and treatment. Methods: Retrospective chart review of 117 patients treated for squamous cell carcinoma of the oral tongue (SCCOT) T1–T2/N0–N1 treated in a tertiary referral center between 1998 and 2003. Based on the available medical evidence and institutional guidelines, we analyzed a set of four quality measures considered critical for outcome: (1) TNM staging was performed at patient presentation; (2) oncologic margin status was documented in the chart; (3) patient was referred to radiation therapy if adverse features were identified in definitive pathology; (4) a neck dissection was performed if tumor depth of invasion was 4 mm. or greater. Additionally, 41 clinical endpoints involving all aspects of patient care were analyzed. Results: There were 73 males and 44 females with a median age of 57 years. Forty-one patients (35.2%) presented with stage I disease; 62 (52.9%) stage II and 14 (11.9%) stage III. The overall 5-year survival rate for the series was 68.6%. There was a 90.6% compliance with TNM staging at presentation; 99.2% for documentation of margin status; 98.3% for adequate referral to radiation therapy, and 91% for appropriate neck dissection based on depth of invasion. The overall compliance rate for the set of quality measures was 94.8%. Clinical endpoints related to radiation therapy were met in 100% of the cases, while endpoints related to surveillance were met in 64% of the patients. Conclusion: Overall compliance with accepted institutional guidelines for treatment of SCCOT was acceptable, although there were significant variations when other aspects of patient care were analyzed. Defining and validating a set of quality measures is essential to identify areas for improvement and to compare outcomes among health providers. doi:10.1016/j.oos.2009.06.143
O59. Clinical outcomes for T1–2 N0 oral tongue carcinoma treated with surgery without adjuvant radiation therapy A.W. Jensen a,*, D. Kademani b, R.L. Foote a a
Mayo Clinic College of Medicine, Rochester, MN, United States University of Minnesota Medical Center and Masonic Cancer Center, Minneapolis, MN, United States b
Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122