Essential Cases in Head and Neck Oncology. Группа авторов

above patient elects for primary surgical resection, and the final pathology demonstrates a 1.7 cm SCC with a 6 mm depth of invasion and positive perineural invasion. How would you stage the patient, and what additional treatment would you offer, if any?T1N0: elective neck dissection, no adjuvant RT if cN0.T1N0: adjuvant RT only.T2N0: observation only.T2N0: adjuvant RT only.Answer: d. This patient's tumor should be staged according to the AJCC oral cavity staging criteria. With a depth of invasion >5 mm, this tumor therefore meets the criteria for a T2N0. Perineural invasion has been described as a strong predictor of locoregional failure for lip cancers and is considered an indication for adjuvant RT. Management of this patient with adjuvant RT only would therefore be appropriate. Elective ND followed by potential avoidance of RT if cN0 could be considered. However, the patient would be at increased risk of local failure.

      10 Which of the following is true regarding minor salivary gland cancer tumors?More common in advanced age.Are more common in women.Cervical lymph node metastases are common.The most common site is the oropharynx.Answer: b. The most common site for minor salivary gland cancer is the oral cavity, accounting for 68% of cancers, followed by the oropharynx in 21%, sinonasal tract in 8%, and larynx/trachea in 3%. A particularly common location is the junction between the hard and the soft palate due to the high concentration of minor salivary tissue in this location. These tumors are more common in women and younger groups. The most common pathology of minor salivary gland cancers in the oral cavity is mucoepidermoid carcinoma. Cervical lymph node metastases are rare.

      11 In minor salivary glands tumors:The most common salivary gland cancer of the trachea is mucoepidermoid carcinoma.The most common salivary gland cancer on the hard palate is adenoid cystic carcinoma.Perineural invasion is a feature of acinic cell carcinoma.The most common pathology that develops distant metastases is adenoid cystic carcinoma.Answer: d. The most common pathology that develops distant metastases is adenoid cystic cancer (lungs). The most common tracheal tumor is adenoid cystic carcinoma. The most common minor salivary gland tumor of the hard palate is polymorphous low‐grade adenocarcinoma. Perineural invasion is a feature of adenoid cystic carcinoma.

      12 Which of the following statements regarding the outcome of minor salivary gland cancers is true?The overall survival of minor salivary gland cancer is poor with 5‐year disease‐specific survival of 50–60%.Distant failure is more common than local or regional failure.Patients with high‐grade pathology have similar outcomes to those with low‐grade pathology.The main predictor of outcome is the presence of perineural invasion.Female patients have a poorer survival to male patients.Answer: b. Patients with minor salivary cancer tend to have a very good overall survival of 80% and disease‐specific survival of 80–90%. The main predictors of outcome are stage III/IV disease and high‐grade pathology. Female patients have a superior survival compared to male patients. Distant failure is more common and is the leading cause of death.

      13 Which of the following statements is correct with regards to the primary site of a minor salivary gland cancer?Tumors of the sinonasal tract have a poorer outcome.The most common site in the oral cavity is the floor of the mouth.Tumors of the oropharynx tend to be mucoepidermoid cancer.Tumors arising from the oropharynx have superior outcome to those of the oral cavity.Answer: a. Of all of the subsites, tumors arising from the sinonasal tract tend to have poorer outcomes. This is because they present with a more advanced local stage (T3, T4) and are more likely to have positive margin resection. Within the oral cavity, the most common subsite is the hard palate. In the trachea, the most common pathology is adenoid cystic cancer. Patients with tumors in the oropharynx have similar outcomes to those with oral cavity cancers.

Reference

      1 de Visscher, J.G., Botke, G., Schakenraad, J.A., and van der Waal, I. (1999). A comparison of results after radiotherapy and surgery for stage I squamous cell carcinoma of the lower lip. Head Neck 21: 526–530. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10449668.

Suggested Readings

      1 Amin, M.B., Edge, S., Greene, F. et al. (2017). AJCC Cancer Staging Mannual, vol. 8. Chicago IL: American Joint Committee on Cancer, Springer.

      2 Barttelbort, S.W. and Ariyan, S. (1993). Mandible preservation with oral cavity carcinoma: rim mandibulectomy versus sagittal mandibulectomy. Am. J. Surg. 166 (4): 411–415. https://doi.org/10.1016/s0002‐9610(05)80344‐7. PMID: 8214304.

      3 Bernier, J., Ozsahin, M., Lefebvre, J.L. et al. (2004). Postoperative ioncomitant chemotherapy for locally advanced head and neck cancer. New Engl. J. Med. 350 (19): 1945–1952.

      4 Bernier, J., Cooper, J.S., Pajak, T.F. et al. (2005). Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27 (10): 843–850. https://doi.org/10.1002/hed.20279.

      5 Brown, J.S., Lowe, D., Kalavrezos, N. et al. (2002). Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma. Head Neck 24 (4): 370–383.

      6 Cooper, J.S., Pajak, T.F., Forastiere, A.A. et al. (2004). Postoperative concurrent radiotherapy and chemotherapy for high risk squamous cell carcinoma of the head and neck. New Engl. J. Med. 350 (19): 1937.

      7 D'Cruz, A.K., Vaish, R., Kapre, N. et al. (2015). Elective versus therapeutic neck dissection in node‐negative oral cancer. N. Engl. J. Med. 373: 521–529. https://doi.org/10.1056/NEJMoa1506007.

      8 Ferris, R.L., Blumenschein, G. Jr., Fayette, J. et al. (2016). Nivolumab for recurrent squamous‐cell carcinoma of the head and neck. N. Engl. J. Med. 375 (19): 1856–1867. https://doi.org/10.1056/NEJMoa1602252.

      9 Futran, N.D. and Mendez, E. (2006). Developments in reconstruction of midface and maxilla. Lancet Oncol. 7: 249–258.

      10 Givi, B., Eskander, A., Awad, M.I. et al. (2015). Impact of elective neck dissection on the outcome of oral squamous cell carcinomas arising in the maxillary alveolus and hard palate. Head Neck 38 (Suppl 1): E1688–E1694. https://doi.org/10.1002/hed.24302.

      11 Hanasono, M.M. (2014). Reconstructive surgery for head and neck cancer patients. Adv. Med. 2014: 795483.

      12 Huang, S.H., Hwang, D., Lockwood, G. et al. (2009). Predictive value of tumor thickness for cervical lymph‐node involvement in squamous cell carcinoma of the oral cavity: a meta‐analysis of reported studies. Cancer 115 (7): 1489–1497. https://doi.org/10.1002/cncr.24161.

      13 Linz, C., Müller‐Richter, U.D.A., Buck, A.K. et al. (2015). Performance of cone beam computed tomography in comparison to conventional imaging techniques for the detection of bone invasion in oral cancer. Int. J. Oral Maxillofac. Surg. 44 (1): 8–15.

      14 McCombe, D., MacGill, K., Ainslie, J. et al. (2000). Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979‐88. Aust. N. Z. J. Surg. 70: 358–361. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10830600.

      15 Pfister DG, Spencer S, Adelstein D, et al (2018). NCCN Clinical Practice Guidelines in Oncology, Head and Neck Cancers, (version 2, 2018). Available at: https://www.kankertht‐kepalaleher.info/wp‐content/uploads/2019/02/NCCN‐Clinical‐Practice‐Guidelines‐in‐Oncology‐2018.pdf.

      16 Okay, D.J., Genden, E., Buchbinder, D., and Urken, M. (2001). Prosthodontic guidelines for surgical reconstruction of the maxilla: