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P193. Carcinoma buccal mucosa: Management and outcome
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Abstracts / Oral Oncology 47 (2011) S74–S156
patients showed significant nasality and the larynx/hypopharynx group was significantly worse in terms of stability and voicedness compared to the other tumor sites. Ten weeks after treatment, acoustic measures of effort, noise and irregularity deteriorated, in particular for the larynx/hypopharynx group. Only the nasopharynx group showed a positive treatment effect; nasality went back to normal. One year after treatment, to a large extent, voice measures had hardly improved and were still significantly worse than at baseline. Acoustic measures of voicing at 10 weeks and 1 year correlated significantly with larynx radiation doses. Considering articulation, within the group of patients with oral cavity/oropharynx cancer, alveolar-apical fricatives were articulated significantly weaker and more post-alveolar. Ten weeks after treatment, the intra-oral pressure built-up during the articulation of the velar-dorsal plosives decreased significantly for the nasopharynx patients and got significantly worse for both nasopharynx and oral cavity/oropharynx patients 1 year after treatment. Discussion: Voice and glottal closure suffered significantly from treatment effects in particular in larynx/hypopharynx cancer patients, while articulation deteriorated in the nasopharynx and oropharynx/oral cavity group. Since voice and articulation do not recover from the side-effects of treatment, in view of quality of life, speech therapy to improve articulation and velopharyngeal insufficiency should be considered also in this patient group. doi:10.1016/j.oraloncology.2011.06.434
P192. Treatment outcomes in post-cricoid carcinoma K. Thankappan *,a, M. Rajapurkar a, M. Kuriakose a,b, S. Iyer a, B. Sunil a a
Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India b Department of Head and Neck Surgery, Mazumdar-Shaw Cancer Centre, Narayana Hrudayalaya, Bangalore, India Objective: Tumors arising from the post-cricoid region of hypopharynx is rare but aggressive in nature. The etiology, demographics and natural history of malignancies arising from this area is different. There are very few studies in literature that is sub-site specific to this area. This study evaluates the clinico-pathological characteristics and treatment outcomes of carcinoma arising from the postcricoid area alone. Study design: Retrospective case series. Materials and methods: Retrospective review of 30 consecutive patients. Study period was between January 2005 and December 2010 (6 years). Mean follow up was for 26.2 months (range 4–66 months). Clinico-pathological, treatment and outcome parameters were analyzed. Survival analysis was performed using Kaplan–Meier survival curves. Overall survival, disease free survival and loco-regional control was calculated. Early and late morbidity data is also presented. Results: Mean age of these patients was 60.6 years (range 35– 82 years). 17 were males (57%) and 13 were females (43%). Seventeen patients had T4a disease. Nineteen patients underwent curative intent treatment. Five (16.7%) received surgical treatment and the remaining 14(46.7%) underwent an organ preservation regimen with either radiotherapy alone or concurrent chemo-radiotherapy. Surgery included total laryngo-pharyngectomy and esophagectomy, bilateral selective neck dissection levels II–IV and reconstruction with gastric pull up. Twelve patients are alive and disease free at the end of the study. Seven patients died of the disease. The 5 year overall survival and disease free survival is 54.2% and 37.8%, respectively. The loco-regional control rate at the end of 5 years was 40.1%. Two out of five surgical patients attained TEP speech and one patient re-
mained gastrostomy dependent. Among the 14 non-surgical patients 13 retained speech function and 11 had normal oral swallowing. Three patients had stricture and remained gastrostomy dependent. Conclusions: Post-cricoid Squamous cell carcinoma a rare clinical entity. Organ preservation regimens have improved the oncological outcome with acceptable long term morbidity in this subset of patients. Surgery is optimal in carefully selected patients. doi:10.1016/j.oraloncology.2011.06.435
P193. Carcinoma buccal mucosa: Management and outcome R. Gupta*, A. Shankar Pgimer, India Introduction: Carcinoma Buccal mucosa – the commonest cancer of the oral cavity in India often diagnosed at a later stage being the most insensitive part. Most cases in underdeveloped countries present in a relatively advanced stage due to various socio-economic reasons. Surgical excision combined with post-operative radiation has been recommended for advanced stage tumors. Methods: Thirty-two patients of primary buccal carcinoma were analyzed retrospectively at a tertiary care setup between June 2003 and July 2009. Clinical features, local examination, histopathology, lymph node status, radiology, treatment given in all patients were studied. Patients were restaged according to the 2002 American Joint Committee on Cancer (AJCC) Staging system from their disease description. Any carcinoma arising in the oral cavity at the site of, or adjacent to the primary tumor within 5 years of treatment was considered a local recurrence. Patients were treated with surgery, radiotherapy or combined modality according to stage of disease. Kaplan–Meier methods were used for analyzing disease-free survival. Univariate analysis of prognostic factors was performed with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model. Results: The mean age in our group is 50 years (range 40–78). Squamous cell carcinomas predominate (75%), verrucous carcinoma 12.5% ,malignant melanoma two cases and one case of ameloblastic fibrosarcoma respectively. Stage III disease predominates with 40.6% of cases. Median follow up is 8 months (range 2–48 months). Ten patients failed after treatment, five had recurrence at primary site, two had isolated nodal relapse, three developed distant metastases. Five year disease free survival was 44.84%. Significant prognostic factors were the overall stage, the T stage (T1 and T2 vs. T3 and T4),the nodal status (N0 vs. N+) and the type of treatment. Conclusion: Early diagnosis and treatment of cases are required for good prognosis and better outcome. Patients in stage I and II have a good prognosis, and those of stage III and IV receiving radical treatment have a better outcome. doi:10.1016/j.oraloncology.2011.06.436
P194. Angiosarcoma of maxillary sinus: A case report M. Yokoawa*, S. Tanaka, H. Niwa, Y. Makiyam, T. Hirayama, Y. Akimoto Nihon University School of Dentistry at Matsudo, Japan Introduction: Angiosarcoma is an extremely rare neoplasm of maxillary sinus. We report a case of angiosarcoma of the maxillary sinus together with the treatment of surgery and radiotherapy using cyberknife.
Abstracts / Oral Oncology 47 (2011) S74–S156
patients showed significant nasality and the larynx/hypopharynx group was significantly worse in terms of stability and voicedness compared to the other tumor sites. Ten weeks after treatment, acoustic measures of effort, noise and irregularity deteriorated, in particular for the larynx/hypopharynx group. Only the nasopharynx group showed a positive treatment effect; nasality went back to normal. One year after treatment, to a large extent, voice measures had hardly improved and were still significantly worse than at baseline. Acoustic measures of voicing at 10 weeks and 1 year correlated significantly with larynx radiation doses. Considering articulation, within the group of patients with oral cavity/oropharynx cancer, alveolar-apical fricatives were articulated significantly weaker and more post-alveolar. Ten weeks after treatment, the intra-oral pressure built-up during the articulation of the velar-dorsal plosives decreased significantly for the nasopharynx patients and got significantly worse for both nasopharynx and oral cavity/oropharynx patients 1 year after treatment. Discussion: Voice and glottal closure suffered significantly from treatment effects in particular in larynx/hypopharynx cancer patients, while articulation deteriorated in the nasopharynx and oropharynx/oral cavity group. Since voice and articulation do not recover from the side-effects of treatment, in view of quality of life, speech therapy to improve articulation and velopharyngeal insufficiency should be considered also in this patient group. doi:10.1016/j.oraloncology.2011.06.434
P192. Treatment outcomes in post-cricoid carcinoma K. Thankappan *,a, M. Rajapurkar a, M. Kuriakose a,b, S. Iyer a, B. Sunil a a
Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India b Department of Head and Neck Surgery, Mazumdar-Shaw Cancer Centre, Narayana Hrudayalaya, Bangalore, India Objective: Tumors arising from the post-cricoid region of hypopharynx is rare but aggressive in nature. The etiology, demographics and natural history of malignancies arising from this area is different. There are very few studies in literature that is sub-site specific to this area. This study evaluates the clinico-pathological characteristics and treatment outcomes of carcinoma arising from the postcricoid area alone. Study design: Retrospective case series. Materials and methods: Retrospective review of 30 consecutive patients. Study period was between January 2005 and December 2010 (6 years). Mean follow up was for 26.2 months (range 4–66 months). Clinico-pathological, treatment and outcome parameters were analyzed. Survival analysis was performed using Kaplan–Meier survival curves. Overall survival, disease free survival and loco-regional control was calculated. Early and late morbidity data is also presented. Results: Mean age of these patients was 60.6 years (range 35– 82 years). 17 were males (57%) and 13 were females (43%). Seventeen patients had T4a disease. Nineteen patients underwent curative intent treatment. Five (16.7%) received surgical treatment and the remaining 14(46.7%) underwent an organ preservation regimen with either radiotherapy alone or concurrent chemo-radiotherapy. Surgery included total laryngo-pharyngectomy and esophagectomy, bilateral selective neck dissection levels II–IV and reconstruction with gastric pull up. Twelve patients are alive and disease free at the end of the study. Seven patients died of the disease. The 5 year overall survival and disease free survival is 54.2% and 37.8%, respectively. The loco-regional control rate at the end of 5 years was 40.1%. Two out of five surgical patients attained TEP speech and one patient re-
mained gastrostomy dependent. Among the 14 non-surgical patients 13 retained speech function and 11 had normal oral swallowing. Three patients had stricture and remained gastrostomy dependent. Conclusions: Post-cricoid Squamous cell carcinoma a rare clinical entity. Organ preservation regimens have improved the oncological outcome with acceptable long term morbidity in this subset of patients. Surgery is optimal in carefully selected patients. doi:10.1016/j.oraloncology.2011.06.435
P193. Carcinoma buccal mucosa: Management and outcome R. Gupta*, A. Shankar Pgimer, India Introduction: Carcinoma Buccal mucosa – the commonest cancer of the oral cavity in India often diagnosed at a later stage being the most insensitive part. Most cases in underdeveloped countries present in a relatively advanced stage due to various socio-economic reasons. Surgical excision combined with post-operative radiation has been recommended for advanced stage tumors. Methods: Thirty-two patients of primary buccal carcinoma were analyzed retrospectively at a tertiary care setup between June 2003 and July 2009. Clinical features, local examination, histopathology, lymph node status, radiology, treatment given in all patients were studied. Patients were restaged according to the 2002 American Joint Committee on Cancer (AJCC) Staging system from their disease description. Any carcinoma arising in the oral cavity at the site of, or adjacent to the primary tumor within 5 years of treatment was considered a local recurrence. Patients were treated with surgery, radiotherapy or combined modality according to stage of disease. Kaplan–Meier methods were used for analyzing disease-free survival. Univariate analysis of prognostic factors was performed with the log-rank test. Multivariate analysis was performed using the Cox proportional hazards regression model. Results: The mean age in our group is 50 years (range 40–78). Squamous cell carcinomas predominate (75%), verrucous carcinoma 12.5% ,malignant melanoma two cases and one case of ameloblastic fibrosarcoma respectively. Stage III disease predominates with 40.6% of cases. Median follow up is 8 months (range 2–48 months). Ten patients failed after treatment, five had recurrence at primary site, two had isolated nodal relapse, three developed distant metastases. Five year disease free survival was 44.84%. Significant prognostic factors were the overall stage, the T stage (T1 and T2 vs. T3 and T4),the nodal status (N0 vs. N+) and the type of treatment. Conclusion: Early diagnosis and treatment of cases are required for good prognosis and better outcome. Patients in stage I and II have a good prognosis, and those of stage III and IV receiving radical treatment have a better outcome. doi:10.1016/j.oraloncology.2011.06.436
P194. Angiosarcoma of maxillary sinus: A case report M. Yokoawa*, S. Tanaka, H. Niwa, Y. Makiyam, T. Hirayama, Y. Akimoto Nihon University School of Dentistry at Matsudo, Japan Introduction: Angiosarcoma is an extremely rare neoplasm of maxillary sinus. We report a case of angiosarcoma of the maxillary sinus together with the treatment of surgery and radiotherapy using cyberknife.