Recurrence of laryngeal or hypopharyngeal primary tumor after radical neck dissection for postradiotherapy neck nodal metastases

Objectives To examine the efficacy of selective neck dissection in patients with nodal metastases from head and neck squamous cell carcinoma. Methods A retrospective chart review was performed on a cohort of 156 subjects with clinically positive regional nodal metastases, whose initial management included neck dissection by a single surgeon from 1994–2007. 69 subjects underwent selective neck dissection (SND), while 87 underwent radical or modified radical neck dissection (R/MRND). The majority of subjects (81%) received postoperative radiotherapy. Primary outcomes included 3-year regional recurrence and 5-year overall survival, using Kaplan-Meier analysis. Results Following exclusion of subjects with local recurrence before or concurrent with regional recurrence, there were 4 (8.6%) regional recurrences in the SND group and 15 (22%) in the R/MRND group. 2 and 6 of these recurrences involved the contralateral neck in each group, respectively. Using multivariate analysis we adjusted for differences in nodal and primary tumor stage, primary tumor site, year of surgery, extracapsular spread, and postoperative radiotherapy rates. The lower regional recurrence rate in the SND group remained statistically significant (p=0.02). Overall 5-year survival was 46% in the SND group vs. 34% in the R/MRND group (p=0.23). Conclusions These results demonstrate excellent regional disease control following SND in patients with neck node metastases. SND with adjunctive radiotherapy remains our preferred approach for most patients undergoing therapeutic neck dissection.

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A case series of metastatic lateral cervical lymphadenopathy

International Surgery Journal ◽

10.18203/2349-2902.isj20170848 ◽

2017 ◽

Vol 4 (3) ◽

pp. 988

Author(s):

Amit Narayan Pothare ◽

Karuna Ilamkar

Keyword(s):

Head And Neck ◽

Neck Dissection ◽

Primary Tumor ◽

Radical Neck Dissection ◽

Case Series ◽

Cervical Lymphadenopathy ◽

Neck Region ◽

Signs And Symptoms ◽

Selective Neck Dissection ◽

Occult Metastasis

Background: Metastasis is a common cause of lymphadenopathy, seen mainly in patients above 40 years of age. Regional nodes entrap the tumor cells and setup complex immunological reactions within the nodes. The histological appearance of the nodes often suggests the primary tumor. The head and neck cancers spread to regional nodes via embolism and permeation. Primary site is evident most of times. The nodes are initially mobile but later may becomes fixed. The aim was to study the lateral cervical metastasis secondary to either lymphatic spread from distant primary or occult metastasis, their signs and symptoms, diagnostic procedure and treatment modalities.Methods: The study was conducted from July 2012 to June 2015. All patients having cervical lymphadenopathy secondary to metastasis diagnosed by FNAC, are included in study. Patients are evaluated as a whole, starting with clinical history and examinations as per proforma. In cases of lympahdenopathy where the diagnosis was not established with FNAC, biopsy was performed and efficacy of FNAC has been calculated. Results: Total 37 patients are studied. Most cases occurred in 5th decade of life, followed by 4th decade. More common in male 83.70% as compared to female 16.30% due to tobacco and smoking addiction more common in males. Change in voice is most common presentation in 46% of cases, followed by dysphagia in 35.13% of patients. Primary tumor was evident in 83.78% of cases and occult in 16.22%. Fixed nodes present in 54.05%, reduced mobility in 21.62% and mobile in 24.32%. FNAC was done in all the cases and positive results obtained in 91.8% with sensitivity of 90% and specificity of 98%. In patients treated by neoadjuvant chemotherapy followed by modified neck dissection, no recurrence occurred. Out of 10 patients treated by radical neck dissection only 2 patients had recurrence in follow up period and managed by radiotherapy. In 15 patients treated by radical radiotherapy, 5 patients had local recurrence and required selective neck dissection in follow up.Conclusions: Cervical lymph node metastasis was major presentation of malignancies of head and neck region and also from distant site. Whenever presents, it should raise suspicion of metastatic origin. Early diagnosis of primary tumor followed by aggressive treatment via multimodal approach prolongs survival.

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Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1805 ◽

2016 ◽

Vol 17 (1) ◽

pp. 70-77 ◽

Cited By ~ 2

Author(s):

N Malathi ◽

Tina Elizabeth Jacob ◽

Sharada T Rajan ◽

N Manish

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Primary Tumor ◽

Lymphovascular Invasion ◽

Perineural Invasion ◽

Tongue Carcinoma ◽

Nodal Metastases ◽

Indian Perspective

ABSTRACT Background It is a well-established fact that in squamous cell carcinoma cases, the presence of lymph node metastases decreased the 5-year survival rate by 50% and also caused the recurrence of the primary tumor with development of distant metastases. Till date, the predictive factors for occult cervical lymph nodes metastases in cases of tongue squamous cell carcinoma remain inconclusive. Therefore, it is imperative to identify patients who are at the greatest risk for occult cervical metastases. This study was thus performed with the aim to identify various histopathologic parameters of the primary tumor that predict occult nodal metastases. Materials and methods The clinicopathologic features of 56 cases of lateral tongue squamous cell carcinoma with cT1NoMo/cT2NoMo as the stage and without prior radiotherapy or chemotherapy were considered. The surgical excision of primary tumor was followed by elective neck dissection. The glossectomy specimen along with the neck nodes were fixed in formalin and 5 ìm thick sections were obtained. The hematoxylin & eosin stained sections were then subjected to microscopic examination. The primary tumor characteristics that were analyzed include tumor grade, invading front, depth of tumor, lymphovascular invasion, perineural invasion and inflammatory response. The nodes were examined for possible metastases using hematoxylin & eosin followed by cytokeratin immunohistochemistry. Result A total of 12 cases were found with positive occult nodal metastases. On performing univariate analysis, the histopathologic parameters that were found to be statistically significant were lymphovascular invasion (p = 0.004) and perineural invasion (p = 0.003) along with a cut-off depth of infiltration more than 5 mm (p = 0.01). Conclusion Histopathologic assessment of the primary tumor specimen therefore continues to provide information that is central to guide clinical management, particularly in cases of occult nodal metastases. Clinical significance The study highlights the importance of extensive histopathological screening, which holds the key for establishing occult metastases. Pathological upgrading of tumors is possible following histopathological studies similar to the present one. Presence of occult metastases justify neck dissection in these clinically N0 cases. In an Indian setting, histopathological evaluation assumes a bigger role than other expensive and advanced techniques. How to cite this article Jacob TE, Malathi N, Rajan ST, Augustine D, Manish N, Patil SG. Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective. J Contemp Dent Pract 2016; 17(1):70-77.

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