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1.
Oral Dis ; 29(2): 595-603, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34338394

RESUMEN

OBJECTIVES: To report clinical outcomes of relapsed oropharyngeal squamous cell carcinoma (OPSCC) after definitive intensity-modulated (chemo)radiotherapy [(C)RT]. MATERIALS AND METHODS: Data for all relapsed patients treated for OPSCC with definitive (C)RT between 2010 and 2016 were collected. Primary end-point was post-failure survival (PFS). RESULTS: Overall, 273 OPSCC patients completed definitive (C)RT. Of these, 42 cases (n = 26 human papilloma virus (HPV)-negative; n = 16 HPV-positive) had relapsed (n = 23 persistent disease; n = 19 recurrent disease) and were included in the final analysis. Two-year PFS for the entire population was 30.6%; 20.5% for HPV-negative and 43.8% for HPV-positive patients. Salvage curative surgery was associated with a significantly higher 2 years PFS rate (56.2%) compared with palliative treatment (22.9%) and best supportive care (0%) (p < 0.001). A positive trend in 2 years PFS was recorded in the early complete response cases (49.5%) versus patients who did not achieve a complete response within 3 months of the end of (C)RT (23.0%) (p = 0.11). CONCLUSION: A higher PFS rate is achieved when relapsed OPSCC cases are treated with salvage curative intent. HPV-positive disease and early complete response within 3 months from the end of (C)RT may be related to better PFS.


Asunto(s)
Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Humanos , Infecciones por Papillomavirus/complicaciones , Neoplasias Orofaríngeas/tratamiento farmacológico , Neoplasias Orofaríngeas/radioterapia , Carcinoma de Células Escamosas de Cabeza y Cuello , Neoplasias de la Boca/complicaciones , Virus del Papiloma Humano , Enfermedad Crónica , Neoplasias de Cabeza y Cuello/complicaciones , Pronóstico , Estudios Retrospectivos
2.
Br J Oral Maxillofac Surg ; 59(10): 1308-1312, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34688501

RESUMEN

The incidence of metastases following neck dissection in the apparent lymph node negative neck in oral cancer is between 7% and 33%; early resection of cervical metastases may well increase survival. Modern imaging techniques can reduce the yield of previously undiagnosed metastatic nodes in elective neck dissection (END). An audit of 112 consecutive cases was conducted to determine the proportion of undiagnosed nodal metastases, after END. There were neck metastases in 10 cases (9%), which were mainly (but not all) micrometastic. The 20% likelihood of nodal metastases was only apparent in primary tumours greater than 6 mm thick. The length of inpatient stay was increased from 3.7 to 16.5 days with free vascularised transfer. There were complications including cranial nerve damage. There were two peri-operative deaths. No ipsilateral neck failures occurred, median follow up was 937 days. To reduce unnecessary END, resection can be undertaken as a prior procedure, subsequently only carrying out END on tumours greater than 6 mm, or with unfavourable tumour characteristics.


Asunto(s)
Carcinoma de Células Escamosas , Neoplasias de la Boca , Humanos , Ganglios Linfáticos , Metástasis Linfática , Cuello , Disección del Cuello , Estadificación de Neoplasias , Estudios Retrospectivos
3.
Oral Oncol ; 119: 105365, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34058702

RESUMEN

Head and neck squamous cell carcinoma (HNSCC) has a significant impact on patients' quality of life and treatment can be associated with severe morbidity. Following completion of treatment, patients are followed up in order to detect potentially salvageable recurrences and to manage long-term toxicities. In recent years, a growing interest has been given to risk stratified follow-up interventions to prevent and detect recurrences and manage treatment toxicities in other tumour sites as well as to transfer some of that care to community services. We review the literature for HNSCC and propose a risk stratified follow up protocol to address these issues and assist clinicians in decision making. A shift in patterns of care is suggested in order to provide a basis to improve care for HNSCC patients after complete response to primary treatment.


Asunto(s)
Neoplasias de Cabeza y Cuello , Carcinoma de Células Escamosas de Cabeza y Cuello , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/terapia , Humanos , Recurrencia Local de Neoplasia/terapia , Calidad de Vida , Recurrencia , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia
4.
Radiother Oncol ; 160: 54-60, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33845044

RESUMEN

PURPOSE: To assess TNM 8 staging in discriminating overall survival (OS) amongst patients with locally advanced oral cavity squamous cell carcinoma (OCSCC) treated with surgery and post-operative radiotherapy (PORT), compared to TNM 7. MATERIAL AND METHODS: Data from OCSCC patients treated with surgery and PORT between January 2010 and December 2018 were reviewed. Demographics, tumour characteristics and treatment response data were collected, and patients staged according to both TNM 7 and TNM 8. OS and disease free survival (DFS) were estimated using the Kaplan Meier method. Univariate and multivariable analyses were conducted for factors affecting OS, DFS and early disease recurrence within 12 months. RESULTS: Overall 172 patients were analyzed. Median follow up was 32 months for all patients and 48 months for surviving patients. TNM 8 staging demonstrated significant stratification of OS and DFS amongst the entire cohort, whereas TNM 7 staging did not. On multivariable analysis, TNM 8 stage, performance status (PS) and a positive surgical margin were prognostic for OS. Looking at disease recurrence within 12 months, TNM 8 stage IVB, presence of lymphovascular invasion (LVSI), younger age and lesser smoking history were predictive factors on multivariable analysis. CONCLUSION: TNM 8 is a good development of its predecessor in terms of predicting survival for patients with locally advanced OCSCC. We have also identified younger age (<60 years) and a smoking history of <10 pack years as risk factors for early disease recurrence, potentially representing a separate biological cohort within OCSCC patients.


Asunto(s)
Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Humanos , Persona de Mediana Edad , Neoplasias de la Boca/patología , Neoplasias de la Boca/radioterapia , Neoplasias de la Boca/cirugía , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello
5.
Eur Arch Otorhinolaryngol ; 276(4): 1153-1159, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30666441

RESUMEN

INTRODUCTION: The purpose of this study was to review our recent experience of salvage surgery, comparing larynx and oropharynx recurrence patterns. METHODS: A single centre, retrospective review of salvage surgery for recurrent head and neck cancer including patients between 2008 and 2016. RESULTS: 61 patients were identified, 36 underwent salvage laryngectomy and 25 received oropharyngeal resections. The median overall survival of oropharyngeal recurrent tumors was 26 months (95% CI 15-118 months) and for laryngeal tumors was 23 months (95% CI 11-38 months), p = 0.1008. There was a significant overall survival benefit in patients with negative resection margin. The median survival in the negative margin group was 38 months (95% CI 25-108 months) compared to the positive margin group, 9 months (95% CI 5-15 months), p < 0.0001. CONCLUSION: Survival results following surgical salvage in the larynx and oropharynx appear to be similarly poor. Those patients with clear margins appear to have a significantly better prognosis.


Asunto(s)
Neoplasias Laríngeas , Laringectomía/métodos , Recurrencia Local de Neoplasia , Neoplasias Orofaríngeas , Terapia Recuperativa/métodos , Adulto , Anciano , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/prevención & control , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/cirugía , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Reino Unido
6.
Br J Oral Maxillofac Surg ; 55(3): 298-299, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27682718

RESUMEN

Accurate staging of oral squamous cell carcinoma (oral SCC) is essential. Some clinicians delay diagnostic biopsy until after magnetic resonance imaging (MRI). We retrospectively studied the clinical records and histopathological databases of 58 patients with SCC of the tongue; 39 had biopsy before MRI and 19 afterwards. In the group who had the biopsy first, eight were up-staged, nine were down-staged, and in 22 the T stage was accurate. In those who had MRI first, the corresponding figures were two, six, and 11, respectively. The time between initial biopsy and excision was significantly longer in the MRI group (43 days), than in the biopsy group (16 days) (p<0.001). Differences in staging between the two groups were not significant. Whether the biopsy was taken before or after MRI does not seem to affect the accuracy of clinical staging, and to delay biopsy until after staging may be unnecessary.


Asunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Imagen por Resonancia Magnética , Neoplasias de la Lengua/diagnóstico por imagen , Neoplasias de la Lengua/patología , Biopsia , Humanos , Estadificación de Neoplasias , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Tiempo
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