Functional outcome after different oncological interventions in head and neck cancer patients

Mücke, Thomas; Koschinski, Janett; Wagenpfeil, Stefan; Wolff, Klaus‐Dietrich; Kanatas, Anastasios; Mitchell, David A.; Deppe, Herbert; Kesting, Marco

doi:10.1007/s00432-011-1106-x

Cited by 19 publications

(13 citation statements)

References 28 publications

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“…Progression of ORN may lead to pathological fractures, intra‐oral or extra‐oral fistulae and local or systemic infection. Difficulties in mouth opening, mastication and speech frequently arise. In patients treated with external beam radiation therapy (EBRT), osseous alterations usually appear in the body of the mandible (premolar and molar regions), whereas in those managed with brachytherapy, the lingual or buccal surfaces are affected.…”

Section: Resultsmentioning

confidence: 99%

Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review

Chronopoulos

Zarra

Ehrenfeld

et al. 2018

International Dental Journal

210

186

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Osteoradionecrosis (ORN) of the jaws is a pernicious complication of radiation therapy for head and neck tumours. This article aims to provide an update on data related to the definition, epidemiology, staging, and clinical and radiological findings of ORN of the jaws. Using certain keywords, an electronic search was conducted spanning the period from January 1922 to April 2014 to identify the available related investigations. Pooled data were then analysed. ORN is described as exposed irradiated bone that fails to heal over a period of 3 months without evidence of persisting or recurrent tumour. The prevalence of ORN varies in the literature. Several staging or scoring systems of ORN have been proposed. Clinical findings include ulceration or necrosis of the mucosa with exposure of necrotic bone. Radiological findings are not evident in the early stages of ORN. Furthermore ORN may not be apparent in imaging even when the disease is advanced. Taking into account the severity of ORN and the difficulties in diagnosing it early and accurately, the clinician should be aware of this complex entity in order to prevent its appearance or the development of more severe complications.

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Section: Resultsmentioning

confidence: 99%

Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review

Chronopoulos

Zarra

Ehrenfeld

et al. 2018

International Dental Journal

210

186

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“…Although ablative surgery with or without reconstruction is an established therapy for small tumours staged at T 1 and T 2 created controversies exists around the role of neck dissection. Controversy also exists with radiation therapy which is a single use treatment with lifelong post treatment morbidity [3]. The management decision around small stage T1 and T2 SCC particularly thin tumours centers around either a wait-and-see policy or a selective neck dissection of the ipsilateral lymph nodes of level I-IV,which logically should be bilateral in midline lesions [4,5].…”

Section: Introductionmentioning

confidence: 99%

Incidence and outcome for patients with occult lymph node involvement in T1 and T2 oral squamous cell carcinoma: a prospective study

et al. 2014

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BackgroundThe evidence base to inform the decision making process in patients with early stage oral cancer and a clinical and radiological N0 neck remains insufficient to answer the question when it is safe to “watch and wait” and when to proceed with a selective neck dissection.MethodsA total of 327 consecutive cases of histopathologically staged T1–2, N0–1 and M0, but clinically N0, squamous cell carcinoma of the tongue were prospectively analysed. Univariate and multivariate analyses were used for statistical analysis and are represented as Kaplan-Meier analyses or Cox proportional hazard regression analysis.ResultsIn 61 patients (18.65%) lymph node involvement was found in the histopathological processing. The mean survival of all patients was 73.3 ± 48.6 months. The 2-year and 5-year overall survival rates of all patients were 87.5% and 68.4%, respectively. The 2-year and 5-year survival rates for stage N0 were 89.1% and 70.7% compared to 83.3% and 62.9% in N1 situations. The 2-year and 5-year survival rates for stage T1 were 87.9% and 73.6% compared to 87.2% and 65.3% in stage T2, respectively. The time to recurrence in stage N0 was 35.1 ± 30.5 months compared to 25.63 ± 24.6 months in cases with N1 disease. Stage T1 was associated with a time to recurrence of 38.1 ± 33.9 months compared with 27.2 ± 22.7 months in patients classified T2.Variables found to be strongly associated with survival in the univariate analysis included older age, higher tumour and N stage, and grading. Age, tumour stage (p = 0.011, 95% CI, 1.09 to 2.0), nodal stage (p = 0.038, 95% CI, 1.02 to 2.07), and recurrence were independently and significantly associated with survival in the multivariate analysis.ConclusionsThis confirms a high overall disease free survival for patients with T1 and N0 treated with single modality surgery and in common with the literature confirms the poor impact on prognosis of the N positive neck.

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“…The complication rate after free flap reconstruction differs in the literature, depending on the previous oncological interventions, but is reported to be in range between 35 and 50% . Wound infection rates at the site of the flap and neck are reported in range from 22 to 80% . The incidence of infections in clean‐contaminated head and neck cancer surgery without prophylactic antibiotics has been reported at 30–80% …”

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confidence: 99%

“…Avoidance of complications where possible is intuitive. Avoidance of infections, which have been proven to be a predictive factor of free flap failure, putting the reconstructive result at risk and placing the patient at risk of further surgery is essential . The costs of each operation and associated support are very high …”

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confidence: 99%

The value of perioperative antibiotics on the success of oral free flap reconstructions

et al. 2015

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The subject of the presented study was to monitor and compare problems and outcomes of reconstructive surgery with microvascular free flaps in the head and neck region between groups of patients treated with perioperative antibiotics and a group of patients without antibiotics. Patients requiring oral reconstructive surgery following cancer resections with microvascular free flaps were prospectively evaluated (2007-2012). Antibiotic therapy was started 30 min before the operation and administered for 10 days. Three hundred and fifty patients were included (208 male, 59.4%; 142 female, 40.6%; mean age 59.8 ± 13.2 years). 330 patients received perioperative antibiotics. Twenty patients (5.7%) who received no antibiotics for specific reasons served as the control group. Wound infections developed in 33 of 122 patients (27%) who received benzylpenicillin, 17 of 88 patients (19.3%) who received amoxicillin combined with sulbactam and 25 of 120 patients (20.8%) who received cefuroxime. Ten patients (50%) who did not receive antibiotics developed wound infections. Receiving no antibiotics or penicillin showed no benefit (P = 0.11). Those receiving cefuroxime showed significantly lower incidence of wound infections (P = 0.034; risk decreased by the factor 2.88). The use of amoxicillin combined with sulbactam showed the lowest rate of wound infections (P = 0.018; risk decreased by the factor 3.46). The use of amoxicillin combined with sulbactam appears to be the most appropriate prophylactic antibiotic followed by cefuroxime in oral microsurgical free flap reconstructions. These data may serve as a guide until a controlled multicenter prospective trial is performed comparing newer antibiotics against current standards.

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Functional outcome after different oncological interventions in head and neck cancer patients

Cited by 19 publications

References 28 publications

Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review

Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review

Incidence and outcome for patients with occult lymph node involvement in T1 and T2 oral squamous cell carcinoma: a prospective study

The value of perioperative antibiotics on the success of oral free flap reconstructions

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