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.

Hyperparathyroidism jaw tumour syndrome: a pictoral review.

Hyperparathyroidism jaw tumour syndrome is a rare autosomal dominant inherited endocrine neoplasia syndrome, which predisposes carriers to develop a triad of multiple ossifying fibromas of the maxilla and mandible, parathyroid adenomas and carcinomas (with consequent hyperparathyroidism) as well as renal and uterine tumours. The prevalence of this condition is unknown. Patients typically present initially with symptoms and signs of a jaw tumour. A high index of suspicion is required for the underlying diagnosis to be recognised, enabling appropriate management of jaw lesions, treatment of hyperparathyroidism, if present, as well as early detection of malignant disease and screening of family members. TEACHING POINTS: • HPT-JT is a rare autosomal dominant inherited endocrine neoplasia syndrome. • HPT-JT causes facial disfigurement, morbidity secondary to hyperparathyroidism and malignancy. • Patients can present with ossifying fibromas of the jaw, hypercalcaemia or malignancy. • A high index of suspicion is required for the underlying diagnosis to be recognised. • Management involves screening of family members.

Smoking habits in patient's who have been treated for an oral cancer: validation of self-report using saliva cotinine.

There is a perception amongst health care professional that patients under-report their smoking habits. The aim of this study was to validate self-reported smoking habits in patients who have been treated for an oral cancer using saliva cotinine. In a cross-sectional study100 consecutive patients attending a maxillofacial oncology clinic completed a smoking related questionnaire following which a saliva sample was obtained. Saliva cotinine levels were determined by gas-liquid chromatography. The mean (SD) age 61 (11), 74% male, 26% female. The majority (79%) had Stage I/II disease, which were treated by surgery (49%), radiotherapy (14%) or combined therapy (37%). Average time (SD) since diagnosis was 28 (24) months. 42% were self-reported smokers. Cotinine assessment was possible from 91 patients. Of these 43% (39/91) were smokers by self-report, all were biochemically smokers (cotinine level>14 microg/l). 9.6% (5/52) patients who claimed to be non-smokers by self-report had cotinine levels suggesting recent active smoking. The level of agreement was excellent (kappa = 0.89), and specificity and sensitivity high (1 and 0.90, respectively). Self-reported smoking habits are reasonably accurate in this group of patients. We believe that smoking related research using self-report alone can reliably be carried out in this particular patient group.