The role of panendoscopy in the staging of high risk head & neck squamous cell carcinoma prior to therapy: Is it of value?

5569 Background: Panendoscopy (triple endoscopy) has historically been advocated to adequately stage patients w/ head & neck squamous cancer, especially in the setting of neoadjuvant therapy. This role is controversial by in view of comparable information provided by current imaging techniques Objective: The primary objective was to analyze the results of panendoscopy in a series of patients enrolled in a neoadjuvant chemo radiation protocol. Methods: We reviewed the panendoscopy results of 69 pts w/ stage III/IV head & neck squamous cell carcinoma (H&N ca) treated w/ neoadjuvant chemo radiation at a single institution from 1996–2005. All pts had detailed laryngoscopy/microlaryngoscopy w/ strategic biopsies, esophago-duodeno-scopy (selected biopsies for Barretts) & placement of percutaneous gastrostomy (PEG) & bronchoscopy washings for cytology. Pts were initially treated w/chemo radiation protocols (H&N 53,67); subsequent protocols utilized induction chemotherapy/chemo radiation (H&N 79,86). Results: Two of 69 pts had malignant cells in bronchial cytology in absence of any lung findings (both were NED at 5 yrs). A radiologically occult primary bronchial cancer was found in an additional pt excluding pt from the protocol. Two pts were diagnosed w/ Barrett’s esophagus; another pt also had a synchronous primary cancer of the cervical esophagus. Nine of 69 pts underwent panendoscopy for cervical metastases from an apparent unknown primary ca (at initial diagnosis). The primary cancer was demonstrated in 6 pts at staging panendoscopy and in another patient at follow up panendoscopy. Conclusion: Panendoscopy is essential in staging high risk H & N ca pts prior to initiation of therapy. A detailed laryngoscopy (micro-laryngoscopy) w/ strategic biopsies is required for adequate staging of all cancers of oropharynx & larynx. Esophago-gastro-duodenoscopy had a low but definable yield, but is also necessary for PEG placement to ensure adequate nutrition during neoadjuvant therapy. Bronchoscopy has a limited role in the absence of radiologic chest findings. No significant financial relationships to disclose.