[Primary Parotid Carcinoma: Influence of a Two-step Procedure on the Oncological Outcome]. / Primäre Parotiskarzinome: Einfluss einer zweizeitigen Operation auf das onkologisches Outcome.

BACKGROUND: Malignancies of the parotid gland represent a rare form of head and neck cancer. Advanced stages are usually recognized as such, whereas early tumor stages are sometimes diagnosed only after parotidectomy due to lack of signs of malignancy. The present study investigates whether this unplanned 2-stage approach has a negative impact on the outcome. MATERIAL AND METHODS: The study includes clinical and histological data of patients with parotid cancer which were treated in the Department of Oto-Rhino-Laryngology and Head and Neck Surgery of the University Medical Center Ulm between 2004 and 2014. RESULTS: 42 patients were included into the study with a median follow-up of 38 months. The RFS and OS at 5 years was 68.6 and 80.1%, respectively, which corresponds to the current literature. 24/42 patients received one-step radical surgery. In 18/42 patients a parotidectomy was performed initially followed by oncologic surgery after receiving histology. The patient group with 2-stage surgery included less advanced tumor stages and more entities with better prognosis. Interestingly, these patients presented with an excellent RFS of 84.4% compared to 56,5% (p=0,16) in the patient group with one-step procedure, correspondent to the tumor stages, entities and the current literature. CONCLUSIONS: According to the available data and compared to the literature, an unplanned 2-stage procedure in clinically silent parotid cancer seems not necessarily to have a negative impact on the outcome. Nevertheless, the preoperative diagnosis should be improved to detect these malignancies more sensitive in early stages.

[Value of fine needle aspiration cytology and core needle biopsy in the head and neck region]. / Stellenwert der Feinnadelaspirationszytologie und Stanzbiopsie im Kopf-Hals-Bereich.

BACKGROUND: Fine-needle aspiration cytology (FNAC) and core-needle biopsy (CNB) represent 2 minimal invasive methods for further assessment of suspect lesions of the head and neck area. However, only limited data on the direct comparison of both methods has been published. The aim of this retrospective study was to evaluate the diagnostic value of FNAC and CNB and to compare their sensitivity and specificity. MATERIAL AND METHODS: Between 2005 and 2012, CNB was performed in 86 patients and FNAC in 408 patients. 52 of 86 CNB-patients and 224 of 408 FNAC-patients underwent surgery afterwards and were included into the study (n=276). In order to compare the results of both methods the corresponding final histopathological finding from surgery was considered. RESULTS: The sensitivity of the FNAC-group was higher (85%) compared to the CNB-group (80%), the specificity (87 vs. 94%) as well as the positive predictive value (64 vs. 97%) was lower. The negative predictive value (92 vs. 71%) and also the false negative value of the FNAC (5 vs. 13%) were superior to the results of the CNB-group. Concerning the false positive value the CNB-group showed better results (2 vs. 15%). CONCLUSION: Both methods are well suited to clarify the dignity of lesions in the head and neck region. In the current case series, FNAC seemed particularly suitable for diagnosis of hematologic diseases and the exclusion of malignancy in suspicious lymph nodes. The GNP has proven to be valid in the detection of tumor recurrences in irradiated or previously operated tissue, furthermore the definitive oncological treatment can be planed, based on the histopathological results obtained by GNP.

[Mucosal Melanoma of the Head and Neck]. / Schleimhautmelanome des Kopf-Hals-Bereichs.

Primary mucosal malignant melanoma of the head and neck is a rare tumor entity with poor clinical outcome. Its growth pattern is characterized by an infiltrative and local destructive behavior. So far no risk factors could be identified. There are practically no early symptoms of the disease, as intermitting nose bleeding or nasal obstruction typically occur in advanced stage. The standard of care remains radical tumor resection with adjuvant radiation in cases of close margin resection. Other therapeutic options like the use of interferon, antibodies or conventional chemotherapeutics have not demonstrated significant clinical benefit so far. Current efforts to investigate the biological and genomic characteristics of these tumors have been constrained by its low incidence. In order to better characterize this rare tumor entity and to establish effective novel targeted therapies it will be necessary to establish an interdisciplinary and multicentric task force.

[Molecular approaches to systemic therapy of adenoid cystic carcinoma of the head and neck area]. / Molekulare Ansatzpunkte für systemische Therapien adenoidzystischer Karzinome im Kopf-Hals-Bereich.

The adenoid cystic carcinoma (ACC) is a neurotropic salivary gland tumor with a high blood-borne metastasis tendency. The treatment of choice for localized disease consists of radical surgical resection and, depending on resection status, adjuvant radiotherapy. Due to the high recurrence rate with limited local therapeutic options and frequent occurrence of distant metastases, one is confronted inevitably with the search for an adequate systemic therapy. ACC shows little response to a variety of chemotherapeutic agents, partial or complete remissions are extremely rare. Beside classical chemotherapies, immunotherapeutics and targeted therapies with more favorable side effect profiles were tested in trials, but due to the small number of patients, a definitive statement on the effectiveness can be hardly made. This results in the need for prospective multicenter studies that allow clear recommendations for systemic therapy of the tumor. The present paper gives an overview of the sub-cellular and genetic characteristics of ACC, which represent possible targets for systemic therapies and have partly already been included in running clinical trials.