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Primary signet-ring cell adenocarcinoma of the head and neck
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Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
PP 35 Does marginal mandibulectomy (rim resection) improve loco-regional control in the surgical management of floor of mouth squamous cell carcinoma? M. Ho ∗ , A. Pick, T. Boye, D. Mitchell, D. Sutton, J. McCaul Bradford Institute of Health Research, United Kingdom Background: In resection of oral squamous cell carcinoma (OSCC), achieving clear resection margins is an important predictor of loco-regional control and survival. Marginal mandibulectomy has been adopted by some surgeons to improve marginal clearance in the treatment of floor of mouth (FOM) tumours. Methods: Retrospective observational study: FOM tumours resected without marginal mandibulectomy vs. FOM tumours resected with marginal mandibulectomy (2004–2014) were identified from the Bradford Institute of Health Research Head and Neck database. Outcome measures: pTNM stage, grade of tumour differentiation, mucosal and deep margin status, perineural invasion, lymphovascular invasion, invasive tumour front, extracapsular spread, bone involvement, need for adjuvant radiotherapy, loco-regional control and survival. Results: fifty-five patients were identified from the database: 29 (53%) patients had marginal mandibulectomy and 26 (47%) patients had their tumours resected without a mandibular rim resection. Patients in the marginal mandibulectomy group had better mucosal marginal clearance (p = 0.05) and more tumours with perineural invasion (p = 0.006) compared to the group of patients who did not have rim resection of the mandible. There was no significant difference between the two groups for: pTNM stage, deep margin clearance, tumour differentiation, lymphovascular invasion, invasive tumour front characteristics, bone involvement (10% vs. 0%), presence of extracapsular spread (15% vs. 14%), need for adjuvant treatment (21% vs. 22%), loco-regional recurrence (17% vs. 26%) and success rates for salvage of recurrent disease (40% vs. 43%). Conclusion: Although marginal mandibulectomy enabled better mucosal marginal clearance in the resection of FOM OSCC this did not appear to offer a significant advantage in loco-regional disease control. http://dx.doi.org/10.1016/j.bjoms.2015.08.043 P 36 Primary signet-ring cell adenocarcinoma of the head and neck S. Islam ∗ , M. Thomas, D. Laugharne Royal Derby Hospital, United Kingdom Introduction: Primary signet ring cell adenocarcinoma (SRCA) in the head and neck is extremely rare. Our search of
the English literature identified 5 published papers accounting for 15 patients with primary SRCA. We report a further case of this rare lesion. Case summary: A 56 year-old-male presented with a 3 cm submucosal lump in the left retromolar trigone which had been an incidental finding. Following tissue diagnosis and imaging his disease was staged T3 N2b M0, and subsequently he underwent radical surgery with adjuvant radiotherapy. Unfortunately, he began to display signs and symptoms of disseminated disease within 6 months of initial treatment and has been referred for palliative interventions. Discussion: We evaluated the cases previously presented in the literature in order to better understand this rare neoplasm. These patients ranged from 18 to 81 years of age, with a slight female preponderance. The palate represented the most common site, with 12 arising from minor salivary glands and 3 within the parotid. Most tumours were treated with surgical excision alone. Only 6 patients had follow-up data available, none of these had evidence of disease recurrence or metastasis with a mean follow up of 33 months. Conclusion: The majority of primary SRCA in the head and neck would appear to behave in an indolent manner. Our patient represents the third reported case of a biologically aggressive variant of this carcinoma. Further reports of these cases are needed to better evaluate the particular clinical characteristics and prognosis of this rare primary salivary neoplasm. http://dx.doi.org/10.1016/j.bjoms.2015.08.044 P 37 Does the use of post-operative chemoradiotherapy in high-risk oral squamous cell carcinoma really provide any benefit? F. Khalid ∗ , J. Brown, S. Rogers, D. Lowe Warrington and Halton NHS Trust, United Kingdom Introduction: The use of adjuvant chemoradiotherapy in patients who are high risk of recurrence (involved margins and/or extracapsular spread) is well documented and practiced. However this also significantly enhances patient morbidity and affect patients’ quality of life. The aim of this study is to assess the recurrence in patients who were treated with surgery alone or surgery with chemoradiotherapy for the treatment of high-risk oral squamous cell carcinoma. Methods: This is a retrospective review of histopathology and medical records from 1992 to 2009. Included were patients with high-risk squamous cell carcinoma of the oral cavity treated by primary surgery with full records and review history. Review was up to 1st January 2012 to allow a 2-year follow-up for each patient. Recurrence was defined as local, regional, loco-regional and distant metastasis. The recurrence was confirmed either by incisional biopsy, fine needle aspiration cytology or scanning.
Abstracts / British Journal of Oral and Maxillofacial Surgery 53 (2015) e37–e110
PP 35 Does marginal mandibulectomy (rim resection) improve loco-regional control in the surgical management of floor of mouth squamous cell carcinoma? M. Ho ∗ , A. Pick, T. Boye, D. Mitchell, D. Sutton, J. McCaul Bradford Institute of Health Research, United Kingdom Background: In resection of oral squamous cell carcinoma (OSCC), achieving clear resection margins is an important predictor of loco-regional control and survival. Marginal mandibulectomy has been adopted by some surgeons to improve marginal clearance in the treatment of floor of mouth (FOM) tumours. Methods: Retrospective observational study: FOM tumours resected without marginal mandibulectomy vs. FOM tumours resected with marginal mandibulectomy (2004–2014) were identified from the Bradford Institute of Health Research Head and Neck database. Outcome measures: pTNM stage, grade of tumour differentiation, mucosal and deep margin status, perineural invasion, lymphovascular invasion, invasive tumour front, extracapsular spread, bone involvement, need for adjuvant radiotherapy, loco-regional control and survival. Results: fifty-five patients were identified from the database: 29 (53%) patients had marginal mandibulectomy and 26 (47%) patients had their tumours resected without a mandibular rim resection. Patients in the marginal mandibulectomy group had better mucosal marginal clearance (p = 0.05) and more tumours with perineural invasion (p = 0.006) compared to the group of patients who did not have rim resection of the mandible. There was no significant difference between the two groups for: pTNM stage, deep margin clearance, tumour differentiation, lymphovascular invasion, invasive tumour front characteristics, bone involvement (10% vs. 0%), presence of extracapsular spread (15% vs. 14%), need for adjuvant treatment (21% vs. 22%), loco-regional recurrence (17% vs. 26%) and success rates for salvage of recurrent disease (40% vs. 43%). Conclusion: Although marginal mandibulectomy enabled better mucosal marginal clearance in the resection of FOM OSCC this did not appear to offer a significant advantage in loco-regional disease control. http://dx.doi.org/10.1016/j.bjoms.2015.08.043 P 36 Primary signet-ring cell adenocarcinoma of the head and neck S. Islam ∗ , M. Thomas, D. Laugharne Royal Derby Hospital, United Kingdom Introduction: Primary signet ring cell adenocarcinoma (SRCA) in the head and neck is extremely rare. Our search of
the English literature identified 5 published papers accounting for 15 patients with primary SRCA. We report a further case of this rare lesion. Case summary: A 56 year-old-male presented with a 3 cm submucosal lump in the left retromolar trigone which had been an incidental finding. Following tissue diagnosis and imaging his disease was staged T3 N2b M0, and subsequently he underwent radical surgery with adjuvant radiotherapy. Unfortunately, he began to display signs and symptoms of disseminated disease within 6 months of initial treatment and has been referred for palliative interventions. Discussion: We evaluated the cases previously presented in the literature in order to better understand this rare neoplasm. These patients ranged from 18 to 81 years of age, with a slight female preponderance. The palate represented the most common site, with 12 arising from minor salivary glands and 3 within the parotid. Most tumours were treated with surgical excision alone. Only 6 patients had follow-up data available, none of these had evidence of disease recurrence or metastasis with a mean follow up of 33 months. Conclusion: The majority of primary SRCA in the head and neck would appear to behave in an indolent manner. Our patient represents the third reported case of a biologically aggressive variant of this carcinoma. Further reports of these cases are needed to better evaluate the particular clinical characteristics and prognosis of this rare primary salivary neoplasm. http://dx.doi.org/10.1016/j.bjoms.2015.08.044 P 37 Does the use of post-operative chemoradiotherapy in high-risk oral squamous cell carcinoma really provide any benefit? F. Khalid ∗ , J. Brown, S. Rogers, D. Lowe Warrington and Halton NHS Trust, United Kingdom Introduction: The use of adjuvant chemoradiotherapy in patients who are high risk of recurrence (involved margins and/or extracapsular spread) is well documented and practiced. However this also significantly enhances patient morbidity and affect patients’ quality of life. The aim of this study is to assess the recurrence in patients who were treated with surgery alone or surgery with chemoradiotherapy for the treatment of high-risk oral squamous cell carcinoma. Methods: This is a retrospective review of histopathology and medical records from 1992 to 2009. Included were patients with high-risk squamous cell carcinoma of the oral cavity treated by primary surgery with full records and review history. Review was up to 1st January 2012 to allow a 2-year follow-up for each patient. Recurrence was defined as local, regional, loco-regional and distant metastasis. The recurrence was confirmed either by incisional biopsy, fine needle aspiration cytology or scanning.