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P229. Radiofrequency ablation in the treatment of cancer of tong
Abstracts / Oral Oncology 47 (2011) S74–S156
P227. Transoral carbon dioxide (CO) laser microsurgical resection of potentially malignant oral lesions J. Vu *,a, M. Schifter a, C.E. Palme b, H.G. Coleman a,c a
Department of Oral Medicine and Oral Pathology and Special Care Dentistry, Westmead Centre for Oral Health and the University of Sydney, Australia b Department of Otolaryngology, Head & Neck Surgery, Westmead Hospital and the University of Sydney, Australia c Department of Anatomical Pathology, ICPMR, Westmead Hospital, Australia Introduction: Incisional biopsies have inherent limitations in the assessment of widespread, potentially malignant (pre-malignant), oral lesions. The use of the CO2 laser has been reported to be safe and effective in the management of potentially malignant lesions, micro-invasive and frankly invasive squamous cell carcinomas (SCC) of the oral cavity. The objectives of this study were: (1) correlate the clinical features of the lesion (site, size, colour) with the histological findings of the incisional biopsy and resection specimens; (2) compare the histological findings of the biopsies with the resection specimens; and (3) determine the rate of under-diagnosis for invasive oral SCCs from the initial incisional biopsy specimens. Methods: The archived records and slides of 20 patients, who had undergone CO laser resection of potentially malignant oral lesions subsequent to incisional biopsy with proven dysplasia, were retrieved and re-evaluated. Results: The preliminary data suggested that there was no correlation between the clinical features and the histological diagnoses derived from the initial incisional biopsy specimens and the subsequent laser-resected specimens. There was a low rate of under-diagnoses of invasive oral SCC evident on correlating the histological features of the incisional biopsies with the resection specimens. Discussion: The small, but significant rate, of under-diagnosis of invasive oral SCC made on the initial incisional biopsies, validates the use of CO laser to widely resect potentially malignant lesions, in order to improve histological diagnosis. Additional benefits of laser resection include lower morbidity, reduced tissue scarring and wound contracture, thereby improving post-operative surveillance, and may preclude the need for further surgical treatment. Disadvantages include laser-related thermal artefact obscuring the histopathological assessment of the resection specimens. In view of these findings, the question arises whether the incisional biopsy can still be considered the ‘gold standard’ in the management of potentially malignant oral lesions.
S147
alveolar process of lower jaw-4, bottom lip mucous-1. To evaluate the tumor spread the modern methods of patients examination were used, included CT, PET, MRI and fluorescence detection. It was not the dates of tumor generalization. In all the cases the tumor was removed within the limits of healthy tissues with plastic surgery: in 1 case – microsurgery, in 1 case was used pedicle flap, in 2 cases – for plastic were used local tissues. In postoperative period all the patients were treated using immunochemotherapy, in 1 case combined with photodynamic therapy. Conclusions: In all the cases histological detected the infiltrative growth of the tumor into the adjacent bone, vessels and nerves. The follow-up period is from 6 years to 2 months. During the 1st year of follow-up it was no recurrence of the tumor. In 3 years we diagnosed the recurrences and made repeated operation, it was no neck lymph node metastases. Melanoma of oral cavity mucous is a rare morphological form. The main strategy of management is surgical treatment. Necessity of lymphodissection is need to be discussed. doi:10.1016/j.oraloncology.2011.06.471
P229. Radiofrequency ablation in the treatment of cancer of tong I.V. Reshetov*, A.M. Sdvizkov, O.V. Matorin, A.V. Koritskiy P.A. Hertzen Cancer Research Institute, Russia We have availed the experience of the treatment of 30 patients of them by 15 with the localization of the tumor process in the region of tong and 15 in the region of the bottom of the cavity of mouth. The primary histology of tumor was evaluated taking into account data of ultrasonic inspection, CT and biopsy. On histogenesis of tumor process all – planocellular cancer, from them 21 man and 9 women. On the age classes the patients were distributed as follows from 34 to 78 years. The patients were distributed as follows in the stages: 2 stages – 18, 3 stages – 12. According to the nature of tumor process primary tumors comprised – 22, relapses – 8. Type of the previous treatment composed: 12 – the radiation therapy (preoperation – 11, according to the radical program – 4). Depending on the prevalence of the tumor process of interference they were carried out in 10 cases under the overall endotracheal anesthesia, into 20 under the local infiltration anesthesia with the involution. The period of observation in this group is from 3 to 24 months. Regression Continued increase Primary tumor Relapse
16 8
2 4
doi:10.1016/j.oraloncology.2011.06.470
P228. The rare form of the melanoma: Melanoma of oral cavity mucous I.V. Reshetov*, A.M. Sdvizkov, O.V. Matorin, A.V. Koritskiy P.A. Hertzen Cancer Research Institute, Russia Objectives: Melanoma of the head and neck skin according to 22–46%. Very rarely diagnosed the melanoma of oral cavity mucous. It is known that in spite of the same histogenesis the tumors of different organs have a number of characteristics because of the topographo-anatomical localization. The aim of our investigation was establishment of oral cavity pigment tumor management. Methods: From 2000 to 2010 in our hospital entered 16 patients with melanoma of oral cavity (aged from 27 to 64 years). The sites of melanoma localized on upper lip mucous-1, hard palate mucous-10,
The obtained first positive clinical results of the combined treatment of patients with the malignant tumors of tong and bottom of the cavity of mouth with the use of a radio-wave complex ‘‘Metatom-2’’ testify about the prospect of method. The wide spectrum of the possibilities of instrument, the variety of electrodes make it possible to use it with different sizes and localizations of tumor process both in the independent version and in the combination with the standard procedures of beam and chemotherapy. As a whole an improvement in the results of treating the sick localizations indicated must be examined in the plane of integral approach and the procedure of radio-frequency thermo-ablation can become one of the important contemporary it is sectional in the therapeutic chain.
doi:10.1016/j.oraloncology.2011.06.472
P227. Transoral carbon dioxide (CO) laser microsurgical resection of potentially malignant oral lesions J. Vu *,a, M. Schifter a, C.E. Palme b, H.G. Coleman a,c a
Department of Oral Medicine and Oral Pathology and Special Care Dentistry, Westmead Centre for Oral Health and the University of Sydney, Australia b Department of Otolaryngology, Head & Neck Surgery, Westmead Hospital and the University of Sydney, Australia c Department of Anatomical Pathology, ICPMR, Westmead Hospital, Australia Introduction: Incisional biopsies have inherent limitations in the assessment of widespread, potentially malignant (pre-malignant), oral lesions. The use of the CO2 laser has been reported to be safe and effective in the management of potentially malignant lesions, micro-invasive and frankly invasive squamous cell carcinomas (SCC) of the oral cavity. The objectives of this study were: (1) correlate the clinical features of the lesion (site, size, colour) with the histological findings of the incisional biopsy and resection specimens; (2) compare the histological findings of the biopsies with the resection specimens; and (3) determine the rate of under-diagnosis for invasive oral SCCs from the initial incisional biopsy specimens. Methods: The archived records and slides of 20 patients, who had undergone CO laser resection of potentially malignant oral lesions subsequent to incisional biopsy with proven dysplasia, were retrieved and re-evaluated. Results: The preliminary data suggested that there was no correlation between the clinical features and the histological diagnoses derived from the initial incisional biopsy specimens and the subsequent laser-resected specimens. There was a low rate of under-diagnoses of invasive oral SCC evident on correlating the histological features of the incisional biopsies with the resection specimens. Discussion: The small, but significant rate, of under-diagnosis of invasive oral SCC made on the initial incisional biopsies, validates the use of CO laser to widely resect potentially malignant lesions, in order to improve histological diagnosis. Additional benefits of laser resection include lower morbidity, reduced tissue scarring and wound contracture, thereby improving post-operative surveillance, and may preclude the need for further surgical treatment. Disadvantages include laser-related thermal artefact obscuring the histopathological assessment of the resection specimens. In view of these findings, the question arises whether the incisional biopsy can still be considered the ‘gold standard’ in the management of potentially malignant oral lesions.
S147
alveolar process of lower jaw-4, bottom lip mucous-1. To evaluate the tumor spread the modern methods of patients examination were used, included CT, PET, MRI and fluorescence detection. It was not the dates of tumor generalization. In all the cases the tumor was removed within the limits of healthy tissues with plastic surgery: in 1 case – microsurgery, in 1 case was used pedicle flap, in 2 cases – for plastic were used local tissues. In postoperative period all the patients were treated using immunochemotherapy, in 1 case combined with photodynamic therapy. Conclusions: In all the cases histological detected the infiltrative growth of the tumor into the adjacent bone, vessels and nerves. The follow-up period is from 6 years to 2 months. During the 1st year of follow-up it was no recurrence of the tumor. In 3 years we diagnosed the recurrences and made repeated operation, it was no neck lymph node metastases. Melanoma of oral cavity mucous is a rare morphological form. The main strategy of management is surgical treatment. Necessity of lymphodissection is need to be discussed. doi:10.1016/j.oraloncology.2011.06.471
P229. Radiofrequency ablation in the treatment of cancer of tong I.V. Reshetov*, A.M. Sdvizkov, O.V. Matorin, A.V. Koritskiy P.A. Hertzen Cancer Research Institute, Russia We have availed the experience of the treatment of 30 patients of them by 15 with the localization of the tumor process in the region of tong and 15 in the region of the bottom of the cavity of mouth. The primary histology of tumor was evaluated taking into account data of ultrasonic inspection, CT and biopsy. On histogenesis of tumor process all – planocellular cancer, from them 21 man and 9 women. On the age classes the patients were distributed as follows from 34 to 78 years. The patients were distributed as follows in the stages: 2 stages – 18, 3 stages – 12. According to the nature of tumor process primary tumors comprised – 22, relapses – 8. Type of the previous treatment composed: 12 – the radiation therapy (preoperation – 11, according to the radical program – 4). Depending on the prevalence of the tumor process of interference they were carried out in 10 cases under the overall endotracheal anesthesia, into 20 under the local infiltration anesthesia with the involution. The period of observation in this group is from 3 to 24 months. Regression Continued increase Primary tumor Relapse
16 8
2 4
doi:10.1016/j.oraloncology.2011.06.470
P228. The rare form of the melanoma: Melanoma of oral cavity mucous I.V. Reshetov*, A.M. Sdvizkov, O.V. Matorin, A.V. Koritskiy P.A. Hertzen Cancer Research Institute, Russia Objectives: Melanoma of the head and neck skin according to 22–46%. Very rarely diagnosed the melanoma of oral cavity mucous. It is known that in spite of the same histogenesis the tumors of different organs have a number of characteristics because of the topographo-anatomical localization. The aim of our investigation was establishment of oral cavity pigment tumor management. Methods: From 2000 to 2010 in our hospital entered 16 patients with melanoma of oral cavity (aged from 27 to 64 years). The sites of melanoma localized on upper lip mucous-1, hard palate mucous-10,
The obtained first positive clinical results of the combined treatment of patients with the malignant tumors of tong and bottom of the cavity of mouth with the use of a radio-wave complex ‘‘Metatom-2’’ testify about the prospect of method. The wide spectrum of the possibilities of instrument, the variety of electrodes make it possible to use it with different sizes and localizations of tumor process both in the independent version and in the combination with the standard procedures of beam and chemotherapy. As a whole an improvement in the results of treating the sick localizations indicated must be examined in the plane of integral approach and the procedure of radio-frequency thermo-ablation can become one of the important contemporary it is sectional in the therapeutic chain.
doi:10.1016/j.oraloncology.2011.06.472