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P2.29. Risk factors for distant metastasis in patient with clinical stages III and IV squamous carcinoma of the oral cavity
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
170
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
significant prognostic factor for disease free survival and overall survival. There was no significant difference between early stage (stages I–II) and advanced stage (stages III–IV) in disease free survival and overall survival. Conclusions: The buccal squamous cell carcinoma is an aggressive oral cavity cancer with high rate of locoregional recurrence and poor survival. T-stage was significant prognostic factor for disease specific survival and overall survival.
this structure, and significant functional morbidity as a complication of radical neck dissection. doi:10.1016/j.oos.2009.06.430 Further reading 1. Gacek RR. Neck dissection injury of a brachial plexus anatomical variant. Arch Otolaryngol Head Neck Surg 1990;116(3):356–8.
doi:10.1016/j.oos.2009.06.428
P2.26. Management of early stage cancer of the tongue K. Shiga*, T. Ogawa, A. Maki, M. Tateda, T. Kobayashi Tohoku University Hospital, Japan
P2.28. Treatment outcome of squamous cell carcinoma of the lower alveolus H. Imaizumi*, R. Hayashi, M. Ebihara National Cancer Center Hospital East, Japan
Objective: To assess the factor affecting lymph node metastasis in T1 and T2 oral tongue cancers and reveal the necessity of elective neck dissection to treat N0 patients. Study design and setting: A retrospective chart review of 75 patients. Seventy-five patients with T1 or T2 tongue carcinomas were surgically treated in our hospital from 2001 through 2008. In principal, patients with T1N0 tumors underwent only partial glossectomy. Patients with T2N0 tumors underwent partial glossectomy and elective neck dissection. The depth of invasion of tumors and their diameters were analyzed according to the existence of lymph node metastases. Results: The depths of tumors ranged from 1 to 17 mm (average of 7.2 mm) for tumors without lymph node metastases, while they ranged from 5 to 22 mm (average of 11.5 mm) for tumors with lymph node metastases. The shortest depth of tumor invasion was 5 mm that led to lymph node metastasis and no lymph node metastases were observed in patients whose tumor was less than 4 mm in depth of invasion. There was a significant difference between the frequencies of nodal metastasis in patients with tumors less than 4 mm thick and patients with tumors more than 5 mm thick. Three of 5 patients with early T2N0 tumors who did not undergo elective neck dissection had recurrent tumors in the neck and died of disease at 11, 19 and 25 months after the first treatment. The disease-free survival rates at 60 months by Kaplan–Meier analysis were 93% and 70% for T1N0 and T2N0 patients, respectively, with a median follow-up time of 29 months for surviving patients. Conclusion: These data indicate that elective neck dissection should be considered for treating early stage tongue cancer patients with the tumor more than 5 mm thick. doi:10.1016/j.oos.2009.06.429
P2.27. Brachial plexus injury in neck dissections M.J. Monteiro a,*, K. Altman a, A. Khandwala b
Introduction: Lower gingival carcinoma has a strong predilection for bone invasion and often requires resection of the mandible. The aim of this study is to review the outcome of lower gingival carcinoma and to investigate the appropriate indication of mandibular resections. Method: The medical records of 119 patients with previously untreated squamous cell carcinoma of lower alveolus, who were treated with curative intent and seen between 1992 and 2005, were retrospectively analyzed. Mean follow up time was 48 months. Results: There were 71 men and 48 women. The mean age of the patients was 65.9 years. Two patients underwent postoperative radiotherapy and 117 underwent surgery alone. Most patients presented Clinical Stage III or Stage IV (12 and 80 patients, respectively). About 45 patients underwent marginal resections and 69 underwent segmental resections. The local control rates were 73.3 and 79.7%, respectively. Preoperative assessment of bone marrow invasion was found to be present in 10 patients (22.2%) in the marginal group and 65 (94.2%) in the segmental group. Histological bone marrow invasion was present in 21 (46.7%) and 61 (88.4%) patients, respectively. Among the patients with histological bone marrow invasion, the local disease control rates were 57.7% in the marginal group and 78.7% in the segmental group. On the other hand, the 5-year survival rates were 64.4% and 57.9%, respectively, and were not statistically affected by the extent of mandibular resection. Discussion: Marginal resection is worth considering even when preoperative assessment shows that the bone marrow invasion is present, given that the continuity of the mandible can be preserved. Resection of the inferior margin of the mandible, along with preservation of the vertical height of the mandible is essential. Therefore preoperative assessment of the clinical and radiological extent of bone invasion is important. doi:10.1016/j.oos.2009.06.431
a
Brighton and Sussex University Hospitals Trust, United Kingdom b Queen Victoria Hospital, East Grinstead, United Kingdom
Brachial plexus injury as a complication of radical neck dissection is rare. This may occur if a loop of the cephalad cervical division lies abnormally high in the neck. We present the case of a 65-year-old man who developed a C56 root lesion following a modified radical neck dissection. Repair with a sural nerve graft was performed to improve deficit in shoulder and wrist function. Appreciation of the variation in brachial plexus anatomy may help to prevent injury to
P2.29. Risk factors for distant metastasis in patient with clinical stages III and IV squamous carcinoma of the oral cavity J. Gonçalves-Filho, E. Pontes, I.M.G. Agra, L.P. Kowalski* Hospital AC Camargo, Brazil Introduction: The presence of distant metastasis at diagnosis of oral and oropharyngeal carcinoma is uncommon. However, it can
be diagnosed after the initial treatment and is associated with a poor survival. The aim in this study was to evaluate the incidence, risk factors for distant metastasis and long term survival. Methods: This study is based on a retrospective analysis of 106 patients with advanced stage oral carcinoma (all pN+) who underwent surgical treatment between January 1992 to December 2002. We studied the incidence of distant metastasis and survival after the diagnosis. In addition, we also evaluated several potential risk factors for distant metastasis as gender, age, T stage, N stage, local tumor, histologic grade, lymph node size, positive lymph nodes, positive lymph node levels, and others. Results: The incidence of distant metastasis was 19.8% (21/106), and the median overall survival after the diagnosis of distant metastasis was of approximately 3 months. Only one patient (5%) survived more than 12 months. The incidence of distant metastasis did not have any significant correlation with age, gender, T stage, N stage, clinical stage, tumor site, lymph node size, and histologic grade. However, the factors that were significantly associated with the occurrence distant metastasis were number of positive lymph nodes (P2 lymph nodes) (p = 0.026), presence of contralateral positive lymph nodeS (p = 0.002), more than two levels with positive lymph nodes (p = 0.008), and use of adjuvant radiotherapy (p = 0.042). Conclusion: This study confirm that the occurrence of distant metastasis in patient with advanced oral carcinoma is high (20%). The number of pathologic nodes, number of levels with positive lymph nodes and presence of bilateral neck lymph nodes were significantly associated with a higher risk of distant metastasis. Survival after the diagnosis of distant metastasis is usually lower than 1 year. doi:10.1016/j.oos.2009.06.432
P2.30. Postoperative complications after primary curative surgery for advanced oral and oropharyngeal carcinoma J. Gonçalves-Filho, E. Pontes, I.M.G. Agra, L.P. Kowalski* Hospital AC Camargo, Brazil Objective: This study analyze the incidence and risk factors of postoperative complications in patients submitted to primary curative surgery for advanced oral and oropharyngeal carcinoma. Methods: We reviewed the medical charts of 201 patients submitted to surgical treatment for advanced (all pN+) oral and oropharyngeal carcinoma, between January 1992 and December 2002. There were 178 male and 23 female, with a mean age of 57 years (ranging from 27 to 85 years). The tumor sites were oral cavity in 106 (53%) patients and oropharynx in 95(47%). Surgical procedure included 178 (88.6%) en bloc resections and 23 (11.4%) discontinous resections. Neck dissections were performed in all patients (ipsilateral in 111 and bilateral in 90). Results: The hospital stay varied from 3 to 41 days (median, 7 days). Postoperative complications occurred in 140 patients (69.7%). Forty-six patients (23%) had major complications, and 94 patients (46.7%) had minor ones. The most common complications were wound infection and dehiscence (37%, 75 patients). The postoperative mortality was of 2.5% (5 cases). The incidence of overall postoperative complications did not have any significant correlation with patient’s gender, age, tumor site, diameter of the lymph nodes, N stage and type of ipsilateral neck dissection. However, T stage (p = 0.024), clinical stage (p = 0.004), bilateral neck dissection (p = 0.01), and en bloc resection (p = 0.048) were significantly associated with the risk of postoperative complications. The occurrence of major complications was associated with the T stage (p = 0.01) and bilateral neck dissection (p = 0.012). Similarly, minor complications
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were associated with clinical stage (p = 0.002) and bilateral neck dissection (p = 0.004). Conclusion: Surgical treatment of advanced tumors of the oral cavity and pharyngeal is complex and can be performed with acceptable morbidity and low mortality. Clinical stage of the primary tumor, bilateral neck dissection, and en bloc resection were significantly associated with the risk of postoperative complications. doi:10.1016/j.oos.2009.06.433
P2.31. Distant metastases in lip and oral cavity cancers H.-A. Gitt* Practiceclinic Dr.Gitt, Leipzig, Germany Introduction: Distant metastases as a hard symptom of malignancy of tumor disease are found in 8–20% of oral cancer cases, but only 45% of these are confirmed by autopsy. Their prognostic influence is confirmed. The differentiation from second or third primaries is sometimes very complicated. The separation of the findings seems to be necessary because lip cancers,closely associated to skin tumors,are very different to the mucosal cancers of the oral cavity. Methods: The study reports on a retrospective explorative data analysis of 2481 oral cancer patients without any pre-treatment from 14 German hospitals. About 1229 were lip cancers and 1252 were oral cavity cancers. Gender: 78.4% male, 21.6% female. Average age 64.0 years (min. 13.8, max. 92.7). As statistical methods SPSS9, factor and cluster analysis were used. For the life-table method 2400 cases were controllable. Significance level alpha 5%. C-factor equal or greater 2 was 61.5%. Results: Distant metastases were found in 0.8% of lip cancers with great prognostical influence and in 3.4% of oral cavity cancers. Mainly localized in lungs and lymphatic system. A prognostical influence was confirmed. No gender specific results. Correlations to other findings are significant,like tumor localization (posterior third of tongue 8.7%, mandibular gingiva 7.1%),levels to the occlusal plane, infiltration, tumor size and regional metastases. No significant correlations exist in this study to pathohistological diagnosis, tumor mobility, tumor localization in regions (pre-, postcanin, postmolar), growth form (exo/endophytic) and bone destruction (X-ray). Discussion: The influence of distant metastases on prognosis of tumor disease is emphasized, also is underlined the necessity to examine for them. doi:10.1016/j.oos.2009.06.434
P2.32. Pattern of lymph node metastasis in a sample of patients with oral squamous cell carcinoma treated in the Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka A.M. Attygalla*, K. Koji, A. Horie University of Peradeniya, Sri Lanka Introduction: Oral Squamous cell carcinoma (OSCC) is one of the major preventable health problems in Sri Lanka. One of the important prognostic indicators in OSCC is the lymph node metastasis. The aim of this study was to determine the pattern
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
170
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
significant prognostic factor for disease free survival and overall survival. There was no significant difference between early stage (stages I–II) and advanced stage (stages III–IV) in disease free survival and overall survival. Conclusions: The buccal squamous cell carcinoma is an aggressive oral cavity cancer with high rate of locoregional recurrence and poor survival. T-stage was significant prognostic factor for disease specific survival and overall survival.
this structure, and significant functional morbidity as a complication of radical neck dissection. doi:10.1016/j.oos.2009.06.430 Further reading 1. Gacek RR. Neck dissection injury of a brachial plexus anatomical variant. Arch Otolaryngol Head Neck Surg 1990;116(3):356–8.
doi:10.1016/j.oos.2009.06.428
P2.26. Management of early stage cancer of the tongue K. Shiga*, T. Ogawa, A. Maki, M. Tateda, T. Kobayashi Tohoku University Hospital, Japan
P2.28. Treatment outcome of squamous cell carcinoma of the lower alveolus H. Imaizumi*, R. Hayashi, M. Ebihara National Cancer Center Hospital East, Japan
Objective: To assess the factor affecting lymph node metastasis in T1 and T2 oral tongue cancers and reveal the necessity of elective neck dissection to treat N0 patients. Study design and setting: A retrospective chart review of 75 patients. Seventy-five patients with T1 or T2 tongue carcinomas were surgically treated in our hospital from 2001 through 2008. In principal, patients with T1N0 tumors underwent only partial glossectomy. Patients with T2N0 tumors underwent partial glossectomy and elective neck dissection. The depth of invasion of tumors and their diameters were analyzed according to the existence of lymph node metastases. Results: The depths of tumors ranged from 1 to 17 mm (average of 7.2 mm) for tumors without lymph node metastases, while they ranged from 5 to 22 mm (average of 11.5 mm) for tumors with lymph node metastases. The shortest depth of tumor invasion was 5 mm that led to lymph node metastasis and no lymph node metastases were observed in patients whose tumor was less than 4 mm in depth of invasion. There was a significant difference between the frequencies of nodal metastasis in patients with tumors less than 4 mm thick and patients with tumors more than 5 mm thick. Three of 5 patients with early T2N0 tumors who did not undergo elective neck dissection had recurrent tumors in the neck and died of disease at 11, 19 and 25 months after the first treatment. The disease-free survival rates at 60 months by Kaplan–Meier analysis were 93% and 70% for T1N0 and T2N0 patients, respectively, with a median follow-up time of 29 months for surviving patients. Conclusion: These data indicate that elective neck dissection should be considered for treating early stage tongue cancer patients with the tumor more than 5 mm thick. doi:10.1016/j.oos.2009.06.429
P2.27. Brachial plexus injury in neck dissections M.J. Monteiro a,*, K. Altman a, A. Khandwala b
Introduction: Lower gingival carcinoma has a strong predilection for bone invasion and often requires resection of the mandible. The aim of this study is to review the outcome of lower gingival carcinoma and to investigate the appropriate indication of mandibular resections. Method: The medical records of 119 patients with previously untreated squamous cell carcinoma of lower alveolus, who were treated with curative intent and seen between 1992 and 2005, were retrospectively analyzed. Mean follow up time was 48 months. Results: There were 71 men and 48 women. The mean age of the patients was 65.9 years. Two patients underwent postoperative radiotherapy and 117 underwent surgery alone. Most patients presented Clinical Stage III or Stage IV (12 and 80 patients, respectively). About 45 patients underwent marginal resections and 69 underwent segmental resections. The local control rates were 73.3 and 79.7%, respectively. Preoperative assessment of bone marrow invasion was found to be present in 10 patients (22.2%) in the marginal group and 65 (94.2%) in the segmental group. Histological bone marrow invasion was present in 21 (46.7%) and 61 (88.4%) patients, respectively. Among the patients with histological bone marrow invasion, the local disease control rates were 57.7% in the marginal group and 78.7% in the segmental group. On the other hand, the 5-year survival rates were 64.4% and 57.9%, respectively, and were not statistically affected by the extent of mandibular resection. Discussion: Marginal resection is worth considering even when preoperative assessment shows that the bone marrow invasion is present, given that the continuity of the mandible can be preserved. Resection of the inferior margin of the mandible, along with preservation of the vertical height of the mandible is essential. Therefore preoperative assessment of the clinical and radiological extent of bone invasion is important. doi:10.1016/j.oos.2009.06.431
a
Brighton and Sussex University Hospitals Trust, United Kingdom b Queen Victoria Hospital, East Grinstead, United Kingdom
Brachial plexus injury as a complication of radical neck dissection is rare. This may occur if a loop of the cephalad cervical division lies abnormally high in the neck. We present the case of a 65-year-old man who developed a C56 root lesion following a modified radical neck dissection. Repair with a sural nerve graft was performed to improve deficit in shoulder and wrist function. Appreciation of the variation in brachial plexus anatomy may help to prevent injury to
P2.29. Risk factors for distant metastasis in patient with clinical stages III and IV squamous carcinoma of the oral cavity J. Gonçalves-Filho, E. Pontes, I.M.G. Agra, L.P. Kowalski* Hospital AC Camargo, Brazil Introduction: The presence of distant metastasis at diagnosis of oral and oropharyngeal carcinoma is uncommon. However, it can
be diagnosed after the initial treatment and is associated with a poor survival. The aim in this study was to evaluate the incidence, risk factors for distant metastasis and long term survival. Methods: This study is based on a retrospective analysis of 106 patients with advanced stage oral carcinoma (all pN+) who underwent surgical treatment between January 1992 to December 2002. We studied the incidence of distant metastasis and survival after the diagnosis. In addition, we also evaluated several potential risk factors for distant metastasis as gender, age, T stage, N stage, local tumor, histologic grade, lymph node size, positive lymph nodes, positive lymph node levels, and others. Results: The incidence of distant metastasis was 19.8% (21/106), and the median overall survival after the diagnosis of distant metastasis was of approximately 3 months. Only one patient (5%) survived more than 12 months. The incidence of distant metastasis did not have any significant correlation with age, gender, T stage, N stage, clinical stage, tumor site, lymph node size, and histologic grade. However, the factors that were significantly associated with the occurrence distant metastasis were number of positive lymph nodes (P2 lymph nodes) (p = 0.026), presence of contralateral positive lymph nodeS (p = 0.002), more than two levels with positive lymph nodes (p = 0.008), and use of adjuvant radiotherapy (p = 0.042). Conclusion: This study confirm that the occurrence of distant metastasis in patient with advanced oral carcinoma is high (20%). The number of pathologic nodes, number of levels with positive lymph nodes and presence of bilateral neck lymph nodes were significantly associated with a higher risk of distant metastasis. Survival after the diagnosis of distant metastasis is usually lower than 1 year. doi:10.1016/j.oos.2009.06.432
P2.30. Postoperative complications after primary curative surgery for advanced oral and oropharyngeal carcinoma J. Gonçalves-Filho, E. Pontes, I.M.G. Agra, L.P. Kowalski* Hospital AC Camargo, Brazil Objective: This study analyze the incidence and risk factors of postoperative complications in patients submitted to primary curative surgery for advanced oral and oropharyngeal carcinoma. Methods: We reviewed the medical charts of 201 patients submitted to surgical treatment for advanced (all pN+) oral and oropharyngeal carcinoma, between January 1992 and December 2002. There were 178 male and 23 female, with a mean age of 57 years (ranging from 27 to 85 years). The tumor sites were oral cavity in 106 (53%) patients and oropharynx in 95(47%). Surgical procedure included 178 (88.6%) en bloc resections and 23 (11.4%) discontinous resections. Neck dissections were performed in all patients (ipsilateral in 111 and bilateral in 90). Results: The hospital stay varied from 3 to 41 days (median, 7 days). Postoperative complications occurred in 140 patients (69.7%). Forty-six patients (23%) had major complications, and 94 patients (46.7%) had minor ones. The most common complications were wound infection and dehiscence (37%, 75 patients). The postoperative mortality was of 2.5% (5 cases). The incidence of overall postoperative complications did not have any significant correlation with patient’s gender, age, tumor site, diameter of the lymph nodes, N stage and type of ipsilateral neck dissection. However, T stage (p = 0.024), clinical stage (p = 0.004), bilateral neck dissection (p = 0.01), and en bloc resection (p = 0.048) were significantly associated with the risk of postoperative complications. The occurrence of major complications was associated with the T stage (p = 0.01) and bilateral neck dissection (p = 0.012). Similarly, minor complications
171
were associated with clinical stage (p = 0.002) and bilateral neck dissection (p = 0.004). Conclusion: Surgical treatment of advanced tumors of the oral cavity and pharyngeal is complex and can be performed with acceptable morbidity and low mortality. Clinical stage of the primary tumor, bilateral neck dissection, and en bloc resection were significantly associated with the risk of postoperative complications. doi:10.1016/j.oos.2009.06.433
P2.31. Distant metastases in lip and oral cavity cancers H.-A. Gitt* Practiceclinic Dr.Gitt, Leipzig, Germany Introduction: Distant metastases as a hard symptom of malignancy of tumor disease are found in 8–20% of oral cancer cases, but only 45% of these are confirmed by autopsy. Their prognostic influence is confirmed. The differentiation from second or third primaries is sometimes very complicated. The separation of the findings seems to be necessary because lip cancers,closely associated to skin tumors,are very different to the mucosal cancers of the oral cavity. Methods: The study reports on a retrospective explorative data analysis of 2481 oral cancer patients without any pre-treatment from 14 German hospitals. About 1229 were lip cancers and 1252 were oral cavity cancers. Gender: 78.4% male, 21.6% female. Average age 64.0 years (min. 13.8, max. 92.7). As statistical methods SPSS9, factor and cluster analysis were used. For the life-table method 2400 cases were controllable. Significance level alpha 5%. C-factor equal or greater 2 was 61.5%. Results: Distant metastases were found in 0.8% of lip cancers with great prognostical influence and in 3.4% of oral cavity cancers. Mainly localized in lungs and lymphatic system. A prognostical influence was confirmed. No gender specific results. Correlations to other findings are significant,like tumor localization (posterior third of tongue 8.7%, mandibular gingiva 7.1%),levels to the occlusal plane, infiltration, tumor size and regional metastases. No significant correlations exist in this study to pathohistological diagnosis, tumor mobility, tumor localization in regions (pre-, postcanin, postmolar), growth form (exo/endophytic) and bone destruction (X-ray). Discussion: The influence of distant metastases on prognosis of tumor disease is emphasized, also is underlined the necessity to examine for them. doi:10.1016/j.oos.2009.06.434
P2.32. Pattern of lymph node metastasis in a sample of patients with oral squamous cell carcinoma treated in the Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka A.M. Attygalla*, K. Koji, A. Horie University of Peradeniya, Sri Lanka Introduction: Oral Squamous cell carcinoma (OSCC) is one of the major preventable health problems in Sri Lanka. One of the important prognostic indicators in OSCC is the lymph node metastasis. The aim of this study was to determine the pattern
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session II / Oral Oncology Supplement 3 (2009) 162–200