Examining the Prognostic Impact and Therapeutic Implications of Adjuvant Chemotherapy for Patients with Oral Cavity Squamous Cell Carcinoma and Extranodal Extension

Study Design: Literature review. Objective: To review the current role of radiotherapy (RT) in the management of oral cavity squamous cell carcinoma (SCC). Methods: Review of selected literature. Results: T1-T2N0 SCCs may be treated with either RT alone or surgery with a high likelihood of cure. The pendulum swung toward surgery with postoperative RT (PORT) added depending on the pathological findings in the mid 1980s. Patients with positive margins, extranodal extension (ENE), and/or 4 or more positive nodes receive concomitant chemotherapy (POCRT). Patients with T3-T4 and/or positive regional nodes are treated with surgery and PORT alone or POCRT. The likelihood of cure is moderate to low depending on extent of disease. The likelihood of major complications ranges from 10% to 30% depending on the method of reconstruction and the aggressiveness of postoperative PORT/POCRT. Patients with very advanced disease are treated with palliative RT, chemotherapy, or supportive care. Conclusions: The role of RT in the management of oral cavity SCC is primarily in the postoperative setting with palliative RT being reserved for those with very advanced disease where the likelihood of cure is remote.

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Prognostic impact of extratumoral perineural invasion in patients with oral cavity squamous cell carcinoma

Cancer Medicine ◽

10.1002/cam4.2392 ◽

2019 ◽

Vol 8 (14) ◽

pp. 6185-6194 ◽

Cited By ~ 1

Author(s):

Li‐Yu Lee ◽

Dante De Paz ◽

Chien‐Yu Lin ◽

Kang‐Hsing Fan ◽

Hung‐Ming Wang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Perineural Invasion ◽

Prognostic Impact

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Regional metastasis to anatomies beyond traditional neck dissection boundaries: a multi-institutional analysis focused on unconventional metastases in oral cancer patients

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02057-6 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Weijin Gao ◽

Zhuowei Tian ◽

Xiaodan Fang ◽

Jincai Xue ◽

Zhixiang Li ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Squamous Cell ◽

Metastatic Lymph Nodes ◽

Extranodal Extension ◽

Regional Metastasis ◽

Metastatic Lymph

Abstract Background Regional metastasis sometimes occurs in anatomies that are not included in traditional neck dissections. The purpose of this study was to evaluate the treatment outcomes of squamous cell carcinoma of oral cavity (SCCOC) patients with unconventional metastatic lymph nodes (UMLNs) in sublingual, buccinator, and parotid anatomies. Methods This retrospective multi-institutional analysis of squamous cell carcinoma of oral cavity patients with unconventional metastatic lymph nodes was performed from January 2008 to December 2015. All the included patients received surgical treatment for unconventional metastatic lymph nodes. The end point of the study was to determine the factors influencing these patients’ survival and the corresponding solutions to improve survival. Pathological grade, contralateral metastasis, extranodal extension, and other factors were collected and analyzed by logistic regression and the Cox model. Results A total of 89 patients were identified. Among these patients, 25 (28.1%) received primary treatment, 28 (31.5%) received staged (therapeutic) neck dissections, and 36 (40.4%) had recurrent or residual diseases. Altogether, 45 patients (51%) had buccinator node metastases, 31 (35%) had sublingual metastases, 12 (14%) had parotid metastases, and 1 had both buccinator and parotid metastases. Regarding regional metastases, 31 patients (34.8%) had isolated unconventional metastatic lymph nodes. Adjuvant therapies were administered to 72 (80.9%) patients, 25 (28.1%) of whom were treated with radio-chemotherapies. The overall survival rate was 38.2%. Multivariate analysis found that the subsites of unconventional metastatic lymph nodes (P = 0.029), extranodal extension in both unconventional metastatic lymph nodes (P = 0.025) and cervical lymph nodes (P = 0.015), sites of primary or recurrent squamous cell carcinoma of oral cavity (P = 0.035), and types of neck dissections (P = 0.025) were significantly associated with overall survival. Conclusions Unconventional metastatic lymph nodes are uncommon, yet awareness of potential unconventional metastatic lymph nodes should be heightened. Early surgical interventions are warranted in patients with sublingual or buccinator metastases, while caution should be given to those with parotid metastases. Aggressive en bloc (in-continuity) resections may be mandatory in advanced oral cancer cases for close anatomic locations with possible buccal or sublingual metastases.

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Pathological risk factors stratification in pN3b oral cavity squamous cell carcinoma: Focus on the number of positive nodes and extranodal extension

Oral Oncology ◽

10.1016/j.oraloncology.2018.09.021 ◽

2018 ◽

Vol 86 ◽

pp. 188-194 ◽

Cited By ~ 10

Author(s):

Chun-Ta Liao ◽

Li-Yu Lee ◽

Chuen Hsueh ◽

Chien-Yu Lin ◽

Kang-Hsing Fan ◽

...

Keyword(s):

Risk Factors ◽

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Extranodal Extension

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High-Risk TP53 Mutations Are Associated with Extranodal Extension in Oral Cavity Squamous Cell Carcinoma

Clinical Cancer Research ◽

10.1158/1078-0432.ccr-17-0721 ◽

2018 ◽

Vol 24 (7) ◽

pp. 1727-1733 ◽

Cited By ~ 12

Author(s):

Vlad C. Sandulache ◽

Chieko Michikawa ◽

Pranav Kataria ◽

Frederico O. Gleber-Netto ◽

Diana Bell ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

High Risk ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Tp53 Mutations ◽

Extranodal Extension

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Factors impacting use of adjuvant therapy in lip and oral cavity squamous cell carcinoma: A NCDB analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18556 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18556-e18556

Author(s):

Poornima Ramadas ◽

Dongliang Wang ◽

Danning Huang ◽

Abirami Sivapiragasam

Keyword(s):

Squamous Cell Carcinoma ◽

Multivariate Analysis ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Oral Cavity ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Squamous Cell ◽

Univariate Analysis ◽

Positive Lymph Nodes

e18556 Background: Two trials followed by a combined analysis of the trials in head and neck squamous cell carcinoma (SCC) established that the benefit of adjuvant chemotherapy concurrent with radiation (CRT) was only noted in patients with extracapsular extension of nodal disease (ECE) and positive resection margins (PM). Despite this recommendation, other high-risk pathological features including pT3 or pT4 disease, positive lymph nodes, perineural involvement, vascular tumor embolism and level IV or V lymph node involvement have been noted to increase the risk of recurrence and adjuvant chemotherapy has been utilized for these patients. We report an observational study to evaluate the factors impacting use of CRT in patients with oral cavity and lip SCC. Methods: We conducted a retrospective study of patients with oral cavity and lip SCC who underwent resection of primary tumor with or without neck dissection in the reporting hospital in the NCDB database. We compared demographic, clinical and pathological characteristics of patients who received adjuvant CRT versus radiation alone. Multivariate analysis was performed using logistic regression model. Results: Out of the 58,481 patients reported to have surgery in NCDB from 2004 to 2016, 11,413 patients received adjuvant therapy. In univariate analysis, patients who received CRT were most likely less than 65 years of age, males, patients with no insurance or private insurance, lower Charlson Deyo score, Stage IVA, pT4, grade 2 or higher, tumor size > 4cm, positive lymph nodes, involvement of level IV and V nodes, lymphovascular invasion, ECE and PM. In multivariate analysis, factors which influenced receiving CRT were age between 40 and 65 years, males, Stage IVA (compared to Stage I to III), positive nodes, ECE and PM. A total of 984 patients received CRT without having ECE or PM. Conclusions: In addition to ECE and PM, positive lymph nodes was the major pathological factor in patients receiving CRT compared to RT alone.

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O47 The prognostic impact of bone invasion in squamous cell carcinoma of the oral cavity

Oral Oncology Supplement ◽

10.1016/s1744-7895(07)70082-2 ◽

2007 ◽

Vol 2 (1) ◽

pp. 71

Author(s):

R. Pate ◽

K. Gao ◽

J. Clark ◽

C. O'Brien

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Prognostic Impact ◽

Bone Invasion

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A importância da visão clínica do cirurgião-dentista na detecção de lesões pré-malignas: relato de caso clínico

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v8i4.3191 ◽

2019 ◽

Vol 8 (4) ◽

Author(s):

Thyago Leite Campos de Campos de Araújo ◽

Júlio Leite de Araújo Júnior ◽

Emanuelle de Abreu Moreira Vieira

Keyword(s):

Systematic Review ◽

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Prognostic Impact ◽

Basaloid Squamous Cell Carcinoma ◽

Basaloid Squamous

Introdução: No território brasileiro, a localização anatômica com maior incidência de lesões cancerígenas é em cabeça e pescoço. Sendo caracterizadas como mais agressivas, as lesões localizadas na boca e orofaringe. Afetando, principalmente a capacidade de deglutir e mastigar, no bem estar emocional, na dor e na comunicação. Estes efeitos decorrem da própria doença ou tipo e agressividade do tratamento, gradualmente mais deformantes quando mais tardio o diagnóstico. Objetivo: O presente estudo tem por objetivo relatar um caso de carcinoma in sito em cavidade bucal e orofaringe bem como apresentar uma breve revisão de literatura sobre neoplasias malignas de boca e orofaringe de maior frequência bem como caracterizá-lo clinicamente e alertar sobre os benefícios do diagnóstico precoce. Relato de caso: Paciente, 64 anos, feminina, melanoderma, apresentando lesão eritroplásica em soalho lingual, bordo lateral de língua com extensão para palato mole. Tabagista há 46 anos apresentando ao exame de macroscopia fragmento de tecido mole de formato e superfícies irregulares, consistência elástica, coloração branco acastanhada, medindo em conjunto 1,2 x1,0x 0,5 cm. O exame histopatológico revelou Carcinoma “in situ”. Diante do diagnóstico, a paciente foi encaminhada para o tratamento especializado no hospital de referência na região do Cariri. Conclusão: Conclui-se que o exame clínico minucioso da cavidade oral dos pacientes com fatores de risco 2 e/ou que possuam lesões suspeitas é de fundamental importância para profissionais como o Cirurgião-Dentista e Médico.Descritores: Câncer; Boca; Orofaringe; Odontologia.ReferênciasGupta B, Bhattacharyya A, Singh A, Sah K, Gupta V. Basaloid squamous cell carcinoma - A rare and aggressive variant of squamous cell carcinoma: A case report and review of literature. Natl J Maxillofac Surg. 2018;9(1):64-8.Heera R, Ayswarya T, Padmakumar SK, Ismayil P. Basaloid squamous cell carcinoma of oral cavity: Report of two cases. J Oral Maxillofac Pathol. 2016;20(3):545Tomblinson CM, Nagel TH, Hu LS, Zarka MA, Hoxworth JM. Median lingual lymph nodes: prevalence on imaging and potential implications for oral cavity cancer staging. J Comput Assist Tomogr. 2017;41(4):528-34.Varela-Centelles P, López-Cedrun JL, Fernández-Sanromán J, Seone-Romero JM, Santos de Melo N, Álvarez-Nóvoa P et al. Key points and time intervals for early diagnosis in symptomatic oral cancer: A systematic review. Int J Oral Maxillofac Surg. 2017;46(1):1-10.Jia J, Jia MQ, Zou HX. Lingual lymph nodes in patients with squamous cell carcinoma of the tongue and the floor of the mouth. Head Neck. 2018;40(11):2383-88.Swiecicki PL, Malloy KM, Worden FP. Advanced oropharyngeal squamous cell carcinoma: Pathogenesis, treatment, and novel therapeutic approaches. World J Clin Oncol. 2016;7(1):15-26.Balica NC, Poenaru M, Doroş CI, Baderca F, Preda MA, Iovan VC et al.The management of the oropharyngeal anterior wall cancer. Rom J Morphol Embryol. 2018;59(1):113-19.Dahlstrom KR, Bell D, Hanby D, Li G, Wang LE, Wei Q et al. Socioeconomic characteristics of patients with oropharyngeal carcinoma according to tumor HPV status, patient smoking status, and sexual behavior. Oral Oncol. 2015;51(9):832-38.Bonomo P, Merlotti A, Olmetto E, Bianchi A, Desideri I, Bacigalupo A et al. What is the prognostic impact of FDG PET in locally advanced head and neck squamous cellcarcinoma treated with concomitant chemo-radiotherapy? A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2018;45(12):2122-38.Picard A, Arowas L, Piroth L, Heard I, Ferry T, ORL-HIV-HPV studt group. Head and neck squamous cell carcinoma in people living with HIV in France. Med Mal Infect. 2018;48(8):503-8.

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