Assessment of Carotid Artery Invasion in Patients With Head and Neck Cancer

Abstract

Purpose: Define radiological and histological features in which patients with head and neck cancer would benefit from a carotid artery resection. Resection of the carotid artery has been advocated for local control of advanced squamous cell carcinoma of the head and neck. To provide appropriate preoperative counseling and optimize the utilization of resources, the criteria for patient selection has to be defined. Methods: Thirty-four patients underwent carotid artery resection based on the clinical impression of tumor fixation. Eighteen and 28 patients were evaluated using computed tomography (CT) and histological analysis, respectively. The distance between the tumor cells and external elastic lamina was measured. CT scans were examined to determine the circumference of tumor attachment around the carotid artery. Results: Clinical assessment predicted tumor within 1.8 mm of the carotid artery in 68% of cases. The overall survival for patients with tumor greater than 1.8 mm (N ‫؍‬ 9) was better than that of patients with less (N ‫؍‬ 19) than 1.8 mm (33.3% vs. 5.3%; median 24 versus 9 mo, P ‫؍‬ .0899). Three of six patients (50%) with less than 180 o circumference tumor attachment had tumor within 1.8 mm from the external elastic lamina. Eight of twelve patients (67%) with tumors encompassing more than 180 o of the artery wall had tumor within 1.8 mm from the external elastic lamina. The overall survival rates for patients with tumor attachment greater and less than 180 o were 8.3% and 33%, respectively. Discussion: Tumor invasion into the carotid artery was the strongest predictor of outcome. Clinical assessment was as predictive as CT for tumor invasion. If tumor involvement of the carotid artery is less than 180 o , peeling the tumor is an alternative to carotid artery resection.

Análise da invasão da artéria carótida por metástases linfonodais de carcinoma epidermóide de vias aero-digestivas superiores

“…Carotid artery involvement over 180 degrees has a worse surgical prognosis. 23 Involvement over 270 degrees does not by itself mean carotid wall invasion -as we observed in our series -since inflammation may coexist with lymphadenomegaly. On the other hand, a published paper on carotid artery involvement over 270 degrees assessed by MRI indicated that wall invasion was present in 83% of cases.…”

“…Primary lesions were in the mouth (12), nasopharynx (2), oropharynx (30), hypopharynx (22), larynx (23) and hidden primaries (10). All of the patients presented epidermoid carcinoma metastatic lymphadenomegaly, demonstrated by histopathology.…”

Carotid Resection and Reconstruction Associated with Treatment of Head and Neck Cancer

“…Ultrasound may show echoes between the mass and artery to be attenuated, a fl attened artery, or luminal invasion of the tumor (2). Th ere is a substantial risk of carotid involvement when CT shows 180-degree involvement or <1.8 mm separation between the mass and carotid (3). MRI has a sensitivity of 100% and a specifi city of 88% in suggesting unresectability when >270 degrees of circumferential involvement is seen (4).…”

Carotid Body Tumors: Objective Criteria to Predict the Shamblin Group on MR Imaging

“…15 Others have indicated that, with a degree of circumferential contact between tumor and vessel less than 180°, the tumor can be peeled off the vessel. 16 Although CBTs and squamous carcinomas are entirely different entities, we extrapolated these criteria for radiologically classifying the CBTs in an attempt to aid preoperative decision-making. Although the degree of vessel wall infiltration would be perceived only at surgery or on histology, 4 the above-mentioned studies in squamous cancers of the head and neck led us to hypothesize that an increasing degree of circumference of contact between tumor and vessel could probably indicate a greater degree of wall infiltration.…”