Recurrent neck disease in oral cancer

Godden, Daryl; Ribeiro, Noel F.F.; Hassanein, Kamal A A; Langton, S.G.

doi:10.1053/joms.2002.33240

Cited by 50 publications

(30 citation statements)

References 24 publications

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“…Some studies have suggested that late neck recurrence is associated with a greater number of positive nodes and a higher incidence of extracapsular spread (ECS); as a consequence, the salvage rates of patients experiencing neck recurrence were poor [11]. Godden reported that 96% of patients with late neck recurrence had ECS [12]. In the current study, fifteen patients in the PND group developed late neck recurrence, with fourteen of them treated by therapeutic neck dissection.…”

Section: Discussionmentioning

confidence: 52%

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

Tsushima

Sakashita

Homma

et al. 2016

Eur Arch Otorhinolaryngol

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Purpose. Prophylactic neck dissection (PND) for patients with clinically N0 (cN0) tongue carcinoma remains controversial. We assessed the efficacy of PND for patients with cN0 tongue squamous cell carcinoma (SCC) and investigated the prognostic role of tumor thickness as assessed by diagnostic imaging in predicting the risk of nodal micrometastasis or late nodal recurrence. Methods. Eighty-eight patients with cN0 tongue carcinomas underwent surgical treatment. Tumor thickness was measured from magnetic resonance (MR) images or computed tomography (CT) scans. Results. The overall survival rates of patients with or without PND were 94% and 81%, respectively (p=0.2857). MR images or CT scans were available for 68 patients. A tumor thickness ≧10mm or ≧5mm did not increase the probability of nodal metastasis, with late nodal metastasis observed in 15% of patients with graphically undetected small tumors. Conclusions. PND appears to have the potential to improve overall survival for patients with cN0 tongue SCC. Careful follow-up management or PND is considered to be needed regardless of tumor thickness in the pre-treatment evaluation

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Section: Discussionmentioning

confidence: 52%

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

Tsushima

Sakashita

Homma

et al. 2016

Eur Arch Otorhinolaryngol

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“…Current management guidelines consider tumor thickness as a factor guiding the necessity of adjuvant neck dissection in oral cavity cancers [2]. Although tumor thickness and depth of invasion are often used synonymously, they are in reality different and should be clearly differentiated [3,4,5,6,7,8,9]. ‘Tumor thickness’ refers to the thickness of the entire tumor mass.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Invasion Depth in Oral Tongue Squamous Cell Carcinoma

Tan

Chia

Tan

et al. 2012

ORL

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Purpose: Staging for tongue carcinoma does not consider its depth of invasion. We aim to determine the prognostic significance of invasion depth in tongue cancer. Materials and Methods: Retrospective review of patients with tongue carcinoma who underwent curative surgery between 2002 and 2005; 67 patients were analyzed. Tumors were divided into 2 groups: group A = invasion depth <4 mm; group B = invasion depth ≥4 mm. Recurrence and survival rates were calculated for each group and compared. Results: The local recurrence rate in group B was significantly higher (10 vs. 29.7%, p = 0.048). Group A patients had a superior 5-year overall survival (68.8 vs. 41.6%, p = 0.012), disease-specific survival (67.1 vs. 41.1%, p = 0.026) and local recurrence-free survival (89.5 vs. 65.4%, p = 0.035). Five-year regional recurrence, locoregional recurrence and distant recurrence-free survival rates were not significantly different between the 2 groups (p = 0.390, p = 0.173 and p = 0.207). The impact of invasion depth on survival was maintained on multivariate analysis (p = 0.031). Conclusion: Invasion depth is an important prognostic indicator in tongue cancer.

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“…6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater. 9 Neck dissection provides nearly definitive information about nodal metastasis.…”

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confidence: 99%

“…If no positive nodes are found, there is little risk of regional recurrence. [5][6][7][8][9][10] Elective neck dissection alone can often represent sufficient treatment for early-stage disease, while guiding the use of adjuvant radiation and chemotherapy when indicated. Nevertheless, with approximately 70% of cN0 cases also pN0, elective neck dissection raises concern over unnecessary surgery and its associated morbidity.…”

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confidence: 99%

Gene Expression Analysis As a Tool in Early-Stage Oral Cancer Management

Mroz

Rocco

2012

JCO

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Elective neck dissection for clinically stage N0 (cN0) disease has been called the gold standard in the management of early-stage oral squamous cell cancer (OSCC), despite advances in imaging technologies and the recent application of sentinel lymph node mapping. 1Approximately 30% of patients with cN0 disease have nodal metastasis found by pathology (pNϩ), [1][2][3][4][5] with poor prognosis, particularly if there is extracapsular spread. 6 To avoid the substantial risk of delayed detection and treatment, 7,8 elective neck dissection has been recommended for cN0 patients with a tumor invasion depth of 4 mm or greater.9 Neck dissection provides nearly definitive information about nodal metastasis. If no positive nodes are found, there is little risk of regional recurrence.5-10 Elective neck dissection alone can often represent sufficient treatment for early-stage disease, while guiding the use of adjuvant radiation and chemotherapy when indicated. Nevertheless, with approximately 70% of cN0 cases also pN0, elective neck dissection raises concern over unnecessary surgery and its associated morbidity.11 Thus, some clinicians instead recommend watchful waiting, hoping to detect and treat any nodal metastasis quickly, 2 whereas others argue that the potential therapeutic benefit of neck dissection outweighs the risk of morbidity.1 Consequently, interest in solving this clinical treatment dilemma has prompted continued investigation into novel ways to improve the management of the cN0 neck in early-stage OSCC.In the article that accompanies this editorial, van Hooff et al 12 report major advances toward a primary-tumor RNA expression signature to help in this choice. With a laboratory-made microarray, this group had previously identified genes whose expression levels in primary oral-cavity tumors were related to nodal metastasis. 13,14 They now have moved their analysis platform to a commercial microarray in a Clinical Laboratory Improvement Amendments/International Organization for Standardization-approved laboratory, finding a gene-expression signature-score cutoff in a "platform transition" cohort that provided 92% negative predictive value in cT1-T2N0 cases (ie, 92% of cases with negative expression signatures were actually metastasis free, based on pathologic evaluation of the neck dissection). They then used that signature cutoff to classify a "validation" cohort of 222 specimens from eight institutions, finding 89% negative predictive value and 86% assay sensitivity for detecting pNϩ cases. Major challenges, however, remain in incorporating these promising technical results into clinical practice.A major reason for Van Hooff et al's successful extension of earlier findings to the more clinically relevant setting of their study is the large number of diagnostic genes-696 genes, with a total of 732 microarray probe sequences-whose primary-tumor expression levels were used quantitatively. The risk of nodal metastasis for each patient was gauged by how closely each of its 732 expression values matched the correspo...

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Recurrent neck disease in oral cancer

Cited by 50 publications

References 24 publications

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

The role of prophylactic neck dissection and tumor thickness evaluation for patients with cN0 tongue squamous cell carcinoma

Prognostic Significance of Invasion Depth in Oral Tongue Squamous Cell Carcinoma

Gene Expression Analysis As a Tool in Early-Stage Oral Cancer Management

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