Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort.

BACKGROUND: Guidelines remain unclear over whether patients with early stage oral cancer without overt neck disease benefit from upfront elective neck dissection (END), particularly those with the smallest tumours. METHODS: We conducted a randomised trial of patients with stage T1/T2 N0 disease, who had their mouth tumour resected either with or without END. Data were also collected from a concurrent cohort of patients who had their preferred surgery. Endpoints included overall survival (OS) and disease-free survival (DFS). We conducted a meta-analysis of all six randomised trials. RESULTS: Two hundred fifty randomised and 346 observational cohort patients were studied (27 hospitals). Occult neck disease was found in 19.1% (T1) and 34.7% (T2) patients respectively. Five-year intention-to-treat hazard ratios (HR) were: OS HR = 0.71 (p = 0.18), and DFS HR = 0.66 (p = 0.04). Corresponding per-protocol results were: OS HR = 0.59 (p = 0.054), and DFS HR = 0.56 (p = 0.007). END was effective for small tumours. END patients experienced more facial/neck nerve damage; QoL was largely unaffected. The observational cohort supported the randomised findings. The meta-analysis produced HR OS 0.64 and DFS 0.54 (p < 0.001). CONCLUSION: SEND and the cumulative evidence show that within a generalisable setting oral cancer patients who have an upfront END have a lower risk of death/recurrence, even with small tumours. CLINICAL TRIAL REGISTRATION: NIHR UK Clinical Research Network database ID number: UKCRN 2069 (registered on 17/02/2006), ISCRTN number: 65018995, ClinicalTrials.gov Identifier: NCT00571883.

Rare presentation of Mycobacterium avium-intracellulare infection.

Mycobacterium avium-intracellulare causes clinical disease mainly in immunocompromised patients with long-standing pulmonary disease, the symptoms of which are identical to those of pulmonary tuberculosis. In patients with AIDS the infection is typically disseminated. Extrapulmonary infection by M. avium-intracellulare is seen in children aged 1-5 years as cervicofacial lymphadenitis. Other extrapulmonary sites are less common and include musculoskeletal, maxillary sinus, mastoid, breast, small bowel, genitourinary tract and cornea. Such infection of the hard palate is rare. We present an unusual case of infection of the palate by M. avium-intracellulare in a 53-year-old diabetic man. To our knowledge, this infection presenting as a palatal lump in a patient without HIV or pre-existing lung disease has not been previously reported.

Spinal cord compression in patients with oral squamous cell carcinoma.

Squamous cell carcinoma (SCC) is the most common malignancy arising in the oral cavity. It can cause severe morbidity and mortality due to its propensity to metastasis. Despite the likelihood of distant metastases, commonly to the lungs, there is little report in the literature of metastatic spread to the spinal vertebrae from oral SCC with secondary spinal cord compression. We report 2 patients with advanced SCC in the tongue who developed signs of spinal cord compression due to metastasis to lumbar vertebrae. The clinical impression of metastasis causing spinal cord compression was confirmed by magnetic resonance imaging.