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P88 Sentinel lymph node detection in the surgical treatment of oral cavity and oropharyngeal carcinomas
P85 Correlation of proliferative markers (Ki-67 and PCNA) with survival and lymph node metastasis in oral squamous cell carcinoma: a clinical and histopathological analysis of 113 patients K.W. Baek1,2 *, K.D. Han1,2 , P.Y. Yun1,2 , H. Myoung1,2 , J.H. Lee1,2 , M.J. Kim1,2 . 1 Seoul National University, South Korea, 2 Oral Cancer Institute, Korea Association of Oral and Maxillofacial Surgery, South Korea Introduction: The purposes of this study were to examine the correlations between proliferation markers and survival rate in oral squamous cell carcinoma (OSCC) patients, and to evaluate the efficacy of proliferation markers in predicting lymph node metastasis. Methods: 113 patients from the Department of Oral and Maxillofacial Surgery of Seoul National University Hospital with a histologically confirmed diagnosis of an OSCC were selected. The patients’ age, gender, T score, clinical stage, PCNA and Ki-67 index were analyzed. Survival curves were estimated using Kaplan Meier method. The influences of the variables on the survival were examined by univariate analysis and multivariate regression analysis (Cox proportional hazards model). A chi square- and t-test were used to assess the significance of association between proliferating index and lymph node metastasis. A P < 0.05 was considered significant. Results: Univariate analysis showed that T score had a significant influence on survival, and stage 4 group had a significantly lower survival rate. Lymph node metastasis was also a significant predictor of survival. Using a cut-off point of 25%, those patients with lower Ki-67 scores had survival advantage over those with higher Ki-67 scores. PCNA did not show any differences in survival with a cut-off point of 50%. Ki-67 and PCNA were significantly higher in the primary tumours associated with lymph node metastasis (pN+) than in those without lymph node metastasis (pN0). Multivariate analysis showed that clinical stage and Ki-67 were independent prognostic factors for survival in OSCC patients. Discussion: From this result, it can be postulated that the cancer staging based on the TNM stage was a powerful prognostic variable and Ki-67 had a significant effect on the cumulative survival rate. Keywords: oral squmous cell carcinoma, proliferative marker, PCNA, Ki-67 P86 Swallowing outcome after surgery of the oral cavity or oropharynx: objective videofluoroscopic measures and subjective complaints R. Rinkel *, I. Verdonck-de Leeuw, P. Borggreven, H. Langendijk, J. Roos, E. David, N. Aaronson, R. de Bree, C.R. Leemans. VU University Medical Center, The Netherlands Purpose: The aim of the study was to evaluate swallowing outcome in oral and oropharyngeal cancer patients. Methods: 2 studies were performed. (1) In 55 patients 6 months and 12 months after microvascular reconstructive surgery and adjuvant radiotherapy for advanced oral or oropharyngeal cancer, videofluoroscopic measures including oropharyngeal swallow efficiency (OPSE) and the Penetration/Aspiration Scale were assessed. (2) To obtain more insight in the nature of swallowing problems, the Swallowing Quality of Life Questionnaire (SWAL-QoL) was translated into Dutch (SWALQoL-NL) and validated in a group of 105 patients after treatment for oral and oropharyngeal cancer and 111 subjects randomly chosen from the normal population. Results: Study 1 revealed impaired swallowing status at 6 months which remained impaired at 12 months. Comorbid condition and larger tumors (T3-T4 vs T2) were associated with the most profound swallowing problems. Study 2 revealed good reliability with high internal consistency and test-retest
157 stability of the SWAL-QoL-NL. Correlations between scores on the SWAL-QoL-NL and the EORTC-H&N35 swallowing subscales were between 0.31 and 0.81. The SWAL-QoL-NL differentiated patients (mean = 33) from controls (mean = 6). Tumour size and comorbidity appeared to influence SWAL-QoL-NL. The SWAL-QoL-NL correlated especially with “Global Health Status” within the EORTC-QLQ-C30, thus reflecting the social and emotional burden of swallowing complaints in patients. Conclusions: Swallowing complaints are present and persistent in a large amount of the patients treated for oral or oropharyngeal cancer. The SWAL-QoL-NL is a reliable and valid questionnaire to assess and quantify swallowing complaints in daily life and gives good insight in patient’s complaints. Keywords: swallowing, quality of life, reconstructive surgery, videofluoroscopy P87 Functional reconstruction of dento-alveolar and basal bone of mandible with fibular flap and dental implant Y.D. Kim1 *, J.H. Lee1 , M.J. Kim1 , S.J. Hwang1 , H. Myoung1 , S.M. Kim2 , K.M. Ahn3 , J.Y. Paeng1 , H.Y. Ryom1 . 1 Seoul National University, South Korea, 2 Kangnung National University, South Korea, 3 Ulsan University, South Korea Purpose: Reconstruction with fibular free flap is widely used for the wide mandibular bony defect. Conventional 1 strut type reconstruction is occupied in basal portion of mandible, resulting too short mandibular bone height for wearing prosthesis. To overcome this problem, we developed a technique of 2 strut type mandibular reconstruction, i.e. adding non-vascularized residual fibula segment at superior alveolar portion. We evaluated 2 strut type mandibular reconstruction with functional and mechanical aspects of dental implant. Method: Evaluation of peri-implant marginal bone loss was done in both ‘Fibular flap + Concomitant Bone Graft’ group (FCBG, n = 10) and ‘Fibular flap Only’ group (FO, n = 4) with periodic panoramic view. We checked mobility, peri-implantitis and biting force ratio to natural dentition in follow up period. Lip and cheek support was checked in subject and object view. Results: Peri-implant marginal bone loss was higher in FCBC group (2.04±0.14 mm) than FO group (1.95±0.12 mm). No fixture showed mobility in both group. FCBC group had more similar biting force compared natural dentition. 8 patients was satisfactory of lip and cheek support in FCBC group. Conclusion: 2 strut concomitant fibular flap reconstruction of mandibular defect improved Implant-prosthetic mechanics and lip/cheek support with little problem of additional significant marginal bone loss or implant failure. Keywords: Fibula, reconstruction, Strut, Implant P88 Sentinel lymph node detection in the surgical treatment of oral cavity and oropharyngeal carcinomas B. Cizmarevic *, B. Lanisnik, V. Didanovic. Department For Ent and Head Neck Surgery Maribor, Slovenia Objective: The objective of this study was to determine whether the number and extent of elective dissections could be reduced by mapping of sentinel nodes. Study design: The prospective study included 32 previously untreated patients with squamous carcinoma of the oral cavity and oropharynx. Sentinel nodes were preoperative detected with dynamic and static scintigraphy, intraoperatively were detected with gamma camera. All sentinel nodes were examined with serial sections by pathologist and all lymph neck nodes were examined by classical methods. Results: the status of sentinel lymph nodes represents the status of neck. In all cases with no metastases on sentinel nodes, we did not found metastases at any other lymph nodes.
Poster abstracts
Poster abstracts, Friday 18 May
158 Conclusions: with sentinel nodes technique we can make very limited neck dissections. We can remove only the sentinel node and nodes on this region. But on cases with metastases on sentinel nodes (on serial sections) we need adjuvant therapy. Keywords: sentinel node, oral cavity carcinoma P89 Clinical study of conservative neck dissection for recent 5 years J.R. Jang *, H.J. Park, M.S. Kook, H.K. Oh. Chonnam Nation University Hospital, South Korea Purpose: This study was performed to evaluate the indication and the effect of conservative neck dissection in the oral cancer patients who underwent neck dissection at our department for recent five years retrospectively. Patients and Methods: Twenty four patients (18 male, 6 female) who underwent conservative neck dissection for the treatment of oral cancer. The mean age was 58.2 years (range from 19 years to 79 years). Mean follow up period was 19.6 months. The patient’s data from clinical recordings and radiographic findings was evaluated. Results: Ten patients were clinically and pathologically N0 neck without recurrence. Six patients were clinically N1 or N2 neck and pathologically N0 neck, and 1 patient showed recurrent disease on primary site. Three patients were clinically N0 and pathologically N1 or N2 neck, and 1 patient had recurrent disease on primary site. Five patients were clinically N1 and pathologically N2 neck, and recurrent diseases were shown in 1 primary site and 2 necks. Conclusion: These results are suggested that conservative neck dissection including MRND and SOHND is a reliable and effective method for control of neck node metastasis in oral cancer patients with N0 or N1 neck without serious complications. Keywords: oral cancer, conservative neck dissection P90 Organotypic cultures of human keratinized oral mucosa: an anatomical model for studying the early effects of oral cancer radiotherapy E. Donetti, M. Bedoni *, P. Capone, G. Tartaglia, C. Sforza. University of Milan, Italy Radiotherapy (RT) is the usual non surgical approach for head and neck carcinomas. One limitation of RT is mucositis, which can obligate a partial or complete interruption of RT itself. Mechanisms underlying the early side effects induced by ionizing radiations in human oral mucosa are not yet completely characterized. A valid experimental approach to overcome the ethical and practical limitations of clinical studies in investigating the early epithelial responses to ionizing radiations is represented by organotypic cultures of normal human oral mucosa. The main advantages offered by this ex vivo model are the preservation of (i) the threedimensional arrangement and (ii) the cross talking between the epithelial and connective compartments needed for keratinocyte differentiation. Our first step was to characterize the proliferative status of the normal human keratinized oral epithelium with a time course study. Biopsies (n = 5) were obtained from the premolar area of the upper dental arch from young healthy non-smoking women submitted to oral surgery and cultured in a Transwell system. Bromodeoxyuridine (BrdU) was used for evaluate keratinocyte proliferation. Biopsies were harvested immediately after excision (baseline, B), after overnight incubation (T0), 6 (T6), and 24 (T24) hours later. By immunofluorescence cell proliferation was expressed as number of BrdU positive cells/mm2 of living epithelium. The quantitative analysis of cell proliferation demonstrated that this parameter was similar between B (283.06) and T0 (216.26) groups. In T6 group, proliferation was 60% of that found in B, and in T24 samples decreased at 40%. The mean proliferation rate of T0, T6, and T24 versus baseline
Poster abstracts, Friday 18 May (B) group was not significantly different (one-way analysis of variance). Our results strongly suggest that the optimization and characterization of this ex vivo model can greatly help in improving the knowledge on the early epithelial response after the exposure to different physicochemical stimuli such as ionizing radiations. Keywords: Keratinocyte, proliferation, ionizing radiations P91 Surgical management of tonsil cancer M.S. Kim *, D.I. Sun, Y.H. Joo, S.H. Cho, Y.H. Park. The Catholic University of Korea, South Korea Introduction: Surgery and postoperative radiation therapy have been the main stream management of tonsil cancer. There is a variety of surgical approach methods are used for the resection of tonsil cancer, however, there have only been a few reports of the results of surgical treatment of tonsil cancer. So, on the basis of our experience, we report the results of our surgical treatments of tonsil cancer. Methods: Fifty-three medical records, from 1994 November to 2006 May, of patients surgically treated for tonsil cancer were reviewed. Evaluated were disease status, surgical approach methods, types of the neck dissection, surgical margin, reconstruction methods, postoperative complications, time of oral diet and decannulation, recurrence, and survival rate. Results: Mean follow up periods were 31.9 months. There was 3 patients in Stage I, 11 in Stage II, 7 in Stage III, and 32 in Stage IV. For Tumor excision, 14 patients underwent intraoral approach, 10 mandibulotomy approach, and 29 lateral pharyngotomy approach. Surgical defects were primary closed in 10 patients and reconstructed with pectoralis major myocutaneous flap in 7 patients and radial forearm fasciocutaneous free flap in 31 patients. There were 4 local recurrences, 6 regional recurrences, and 4 distant metastases. The mean time of the beginning of oral diet/decannulation after operation were 18.2/14.6 days in lateral pharyngotomy and 19.4/14.2 days in mandibulotomy. The mean survival period was 61.7 months. Discussion: We suggest that patients with tonsil cancer in selected cases can be effectively treated by primary surgical therapy similar survival rates to combined therapy with avoidance of it’s toxic side effects. Mandible-sparing approaches are thought to be effective procedures in tonsillar cancer for disease control and the preservation of the oral function. Keywords: Tonsil cancer, Surgical treatment P92 The results of neck treatment in cinical N0 tongue cancer M.S. Kim *, D.I. Sun, Y.H. Joo, S.H. Cho, Y.H. Park. The Catholic University of Korea, South Korea Introduction: The status of cervical lymph node is a great influence to the prognosis of the patient with tongue cancer. There has been a great controversies on the treatment of clinical N0 neck. We were to analyze the outcomes of neck treatment in patients with N0 tongue cancer. Methods: The medical records of 47 patients with N0 tongue cancer who had surgical treatment performed at Kangnam St. Mary’s Hospital during 1992 through 2004 were reviewed. Tongue lesions of all patients were treated surgically. 39 patients of all had neck dissection performed and 8 patients of all had without neck dissection. Results: The overall rate of occult neck metastasis was 25.6%. Occult metastasis at level IV was 2 case (5.1%). The regional recurrent rate of neck dissection group and wait-and-see group was 5.1% and 25.0% respectively. Discussion: Due to relatively high overall occult metastasis rate and low recurrence rate at the neck node after the neck dissection, the elective neck dissection should be considered in
157 stability of the SWAL-QoL-NL. Correlations between scores on the SWAL-QoL-NL and the EORTC-H&N35 swallowing subscales were between 0.31 and 0.81. The SWAL-QoL-NL differentiated patients (mean = 33) from controls (mean = 6). Tumour size and comorbidity appeared to influence SWAL-QoL-NL. The SWAL-QoL-NL correlated especially with “Global Health Status” within the EORTC-QLQ-C30, thus reflecting the social and emotional burden of swallowing complaints in patients. Conclusions: Swallowing complaints are present and persistent in a large amount of the patients treated for oral or oropharyngeal cancer. The SWAL-QoL-NL is a reliable and valid questionnaire to assess and quantify swallowing complaints in daily life and gives good insight in patient’s complaints. Keywords: swallowing, quality of life, reconstructive surgery, videofluoroscopy P87 Functional reconstruction of dento-alveolar and basal bone of mandible with fibular flap and dental implant Y.D. Kim1 *, J.H. Lee1 , M.J. Kim1 , S.J. Hwang1 , H. Myoung1 , S.M. Kim2 , K.M. Ahn3 , J.Y. Paeng1 , H.Y. Ryom1 . 1 Seoul National University, South Korea, 2 Kangnung National University, South Korea, 3 Ulsan University, South Korea Purpose: Reconstruction with fibular free flap is widely used for the wide mandibular bony defect. Conventional 1 strut type reconstruction is occupied in basal portion of mandible, resulting too short mandibular bone height for wearing prosthesis. To overcome this problem, we developed a technique of 2 strut type mandibular reconstruction, i.e. adding non-vascularized residual fibula segment at superior alveolar portion. We evaluated 2 strut type mandibular reconstruction with functional and mechanical aspects of dental implant. Method: Evaluation of peri-implant marginal bone loss was done in both ‘Fibular flap + Concomitant Bone Graft’ group (FCBG, n = 10) and ‘Fibular flap Only’ group (FO, n = 4) with periodic panoramic view. We checked mobility, peri-implantitis and biting force ratio to natural dentition in follow up period. Lip and cheek support was checked in subject and object view. Results: Peri-implant marginal bone loss was higher in FCBC group (2.04±0.14 mm) than FO group (1.95±0.12 mm). No fixture showed mobility in both group. FCBC group had more similar biting force compared natural dentition. 8 patients was satisfactory of lip and cheek support in FCBC group. Conclusion: 2 strut concomitant fibular flap reconstruction of mandibular defect improved Implant-prosthetic mechanics and lip/cheek support with little problem of additional significant marginal bone loss or implant failure. Keywords: Fibula, reconstruction, Strut, Implant P88 Sentinel lymph node detection in the surgical treatment of oral cavity and oropharyngeal carcinomas B. Cizmarevic *, B. Lanisnik, V. Didanovic. Department For Ent and Head Neck Surgery Maribor, Slovenia Objective: The objective of this study was to determine whether the number and extent of elective dissections could be reduced by mapping of sentinel nodes. Study design: The prospective study included 32 previously untreated patients with squamous carcinoma of the oral cavity and oropharynx. Sentinel nodes were preoperative detected with dynamic and static scintigraphy, intraoperatively were detected with gamma camera. All sentinel nodes were examined with serial sections by pathologist and all lymph neck nodes were examined by classical methods. Results: the status of sentinel lymph nodes represents the status of neck. In all cases with no metastases on sentinel nodes, we did not found metastases at any other lymph nodes.
Poster abstracts
Poster abstracts, Friday 18 May
158 Conclusions: with sentinel nodes technique we can make very limited neck dissections. We can remove only the sentinel node and nodes on this region. But on cases with metastases on sentinel nodes (on serial sections) we need adjuvant therapy. Keywords: sentinel node, oral cavity carcinoma P89 Clinical study of conservative neck dissection for recent 5 years J.R. Jang *, H.J. Park, M.S. Kook, H.K. Oh. Chonnam Nation University Hospital, South Korea Purpose: This study was performed to evaluate the indication and the effect of conservative neck dissection in the oral cancer patients who underwent neck dissection at our department for recent five years retrospectively. Patients and Methods: Twenty four patients (18 male, 6 female) who underwent conservative neck dissection for the treatment of oral cancer. The mean age was 58.2 years (range from 19 years to 79 years). Mean follow up period was 19.6 months. The patient’s data from clinical recordings and radiographic findings was evaluated. Results: Ten patients were clinically and pathologically N0 neck without recurrence. Six patients were clinically N1 or N2 neck and pathologically N0 neck, and 1 patient showed recurrent disease on primary site. Three patients were clinically N0 and pathologically N1 or N2 neck, and 1 patient had recurrent disease on primary site. Five patients were clinically N1 and pathologically N2 neck, and recurrent diseases were shown in 1 primary site and 2 necks. Conclusion: These results are suggested that conservative neck dissection including MRND and SOHND is a reliable and effective method for control of neck node metastasis in oral cancer patients with N0 or N1 neck without serious complications. Keywords: oral cancer, conservative neck dissection P90 Organotypic cultures of human keratinized oral mucosa: an anatomical model for studying the early effects of oral cancer radiotherapy E. Donetti, M. Bedoni *, P. Capone, G. Tartaglia, C. Sforza. University of Milan, Italy Radiotherapy (RT) is the usual non surgical approach for head and neck carcinomas. One limitation of RT is mucositis, which can obligate a partial or complete interruption of RT itself. Mechanisms underlying the early side effects induced by ionizing radiations in human oral mucosa are not yet completely characterized. A valid experimental approach to overcome the ethical and practical limitations of clinical studies in investigating the early epithelial responses to ionizing radiations is represented by organotypic cultures of normal human oral mucosa. The main advantages offered by this ex vivo model are the preservation of (i) the threedimensional arrangement and (ii) the cross talking between the epithelial and connective compartments needed for keratinocyte differentiation. Our first step was to characterize the proliferative status of the normal human keratinized oral epithelium with a time course study. Biopsies (n = 5) were obtained from the premolar area of the upper dental arch from young healthy non-smoking women submitted to oral surgery and cultured in a Transwell system. Bromodeoxyuridine (BrdU) was used for evaluate keratinocyte proliferation. Biopsies were harvested immediately after excision (baseline, B), after overnight incubation (T0), 6 (T6), and 24 (T24) hours later. By immunofluorescence cell proliferation was expressed as number of BrdU positive cells/mm2 of living epithelium. The quantitative analysis of cell proliferation demonstrated that this parameter was similar between B (283.06) and T0 (216.26) groups. In T6 group, proliferation was 60% of that found in B, and in T24 samples decreased at 40%. The mean proliferation rate of T0, T6, and T24 versus baseline
Poster abstracts, Friday 18 May (B) group was not significantly different (one-way analysis of variance). Our results strongly suggest that the optimization and characterization of this ex vivo model can greatly help in improving the knowledge on the early epithelial response after the exposure to different physicochemical stimuli such as ionizing radiations. Keywords: Keratinocyte, proliferation, ionizing radiations P91 Surgical management of tonsil cancer M.S. Kim *, D.I. Sun, Y.H. Joo, S.H. Cho, Y.H. Park. The Catholic University of Korea, South Korea Introduction: Surgery and postoperative radiation therapy have been the main stream management of tonsil cancer. There is a variety of surgical approach methods are used for the resection of tonsil cancer, however, there have only been a few reports of the results of surgical treatment of tonsil cancer. So, on the basis of our experience, we report the results of our surgical treatments of tonsil cancer. Methods: Fifty-three medical records, from 1994 November to 2006 May, of patients surgically treated for tonsil cancer were reviewed. Evaluated were disease status, surgical approach methods, types of the neck dissection, surgical margin, reconstruction methods, postoperative complications, time of oral diet and decannulation, recurrence, and survival rate. Results: Mean follow up periods were 31.9 months. There was 3 patients in Stage I, 11 in Stage II, 7 in Stage III, and 32 in Stage IV. For Tumor excision, 14 patients underwent intraoral approach, 10 mandibulotomy approach, and 29 lateral pharyngotomy approach. Surgical defects were primary closed in 10 patients and reconstructed with pectoralis major myocutaneous flap in 7 patients and radial forearm fasciocutaneous free flap in 31 patients. There were 4 local recurrences, 6 regional recurrences, and 4 distant metastases. The mean time of the beginning of oral diet/decannulation after operation were 18.2/14.6 days in lateral pharyngotomy and 19.4/14.2 days in mandibulotomy. The mean survival period was 61.7 months. Discussion: We suggest that patients with tonsil cancer in selected cases can be effectively treated by primary surgical therapy similar survival rates to combined therapy with avoidance of it’s toxic side effects. Mandible-sparing approaches are thought to be effective procedures in tonsillar cancer for disease control and the preservation of the oral function. Keywords: Tonsil cancer, Surgical treatment P92 The results of neck treatment in cinical N0 tongue cancer M.S. Kim *, D.I. Sun, Y.H. Joo, S.H. Cho, Y.H. Park. The Catholic University of Korea, South Korea Introduction: The status of cervical lymph node is a great influence to the prognosis of the patient with tongue cancer. There has been a great controversies on the treatment of clinical N0 neck. We were to analyze the outcomes of neck treatment in patients with N0 tongue cancer. Methods: The medical records of 47 patients with N0 tongue cancer who had surgical treatment performed at Kangnam St. Mary’s Hospital during 1992 through 2004 were reviewed. Tongue lesions of all patients were treated surgically. 39 patients of all had neck dissection performed and 8 patients of all had without neck dissection. Results: The overall rate of occult neck metastasis was 25.6%. Occult metastasis at level IV was 2 case (5.1%). The regional recurrent rate of neck dissection group and wait-and-see group was 5.1% and 25.0% respectively. Discussion: Due to relatively high overall occult metastasis rate and low recurrence rate at the neck node after the neck dissection, the elective neck dissection should be considered in