Isolated Donor site Tumour Recurrence at Pectoralis Major Myocutaneous Flap in Oral Cavity Squamous Cell Carcinoma – A Rare Case Report and Review of Literature

Abstract Background: Pectoralis Major MyoCutaneous (PMMC) flap has been commonly used since decades for plastic reconstruction in oral cavity cancer surgery. However, rarely the PMMC donor site develops tumor recurrence. Management includes surgical resection in unifocal lesion or salvage radical chemoradiotherapy in clinico-radiologically nonmetastatic unresectable disease which results in satisfactory tumor related outcomes.Case presentation: A 46 year gentleman known case of Squamous Cell Carcinoma left Retromolar Trigone after surgery and adjuvant radiotherapy presented with isolated recurrence at PMMC flap donor vascular pedicle site which was abutting left subclavian vein and so was managed with concurrent chemo-radiotherapy with curative intent and is on follow up since 2 years with no evidence of recurrence.Conclusions: Isolated PMMC flap donor site recurrence in oral cavity squamous cell carcinoma management is complex, with surgical intervention with excision of such lesions in absence of any other deposits is preferable approach. Concurrent CTRT is an alternative option in curative intent when the lesion is not surgically resectable or the patient refuses surgery.

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Routine Long-term Follow-up in Patients Treated With Curative Intent for Squamous Cell Carcinoma of the Larynx, Pharynx, and Oral Cavity: Does It Make Sense?

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1994.01880330022005 ◽

1994 ◽

Vol 120 (9) ◽

pp. 934-939 ◽

Cited By ~ 109

Author(s):

A. V. M. de Visscher ◽

J. J. Manni

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Curative Intent ◽

Carcinoma Of The Larynx ◽

Long Term Follow Up

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Preoperative combined cisplatin-based chemotherapy and radiotherapy for squamous cell carcinoma of the oral cavity—evaluation of more than 5-year follow up cases

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/s0901-5027(97)81222-2 ◽

1997 ◽

Vol 26 ◽

pp. 126

Author(s):

H. Shimooka ◽

T. Kirita ◽

N. Kamikaidou ◽

K. Yamamoto ◽

K. Ohgi ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell

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Squamous Cell Carcinoma of the Paranasal Sinuses: A Single Center Experience

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1694967 ◽

2019 ◽

Vol 81 (06) ◽

pp. 664-672 ◽

Cited By ~ 1

Author(s):

Marton König ◽

Terje Osnes ◽

Åse Bratland ◽

Torstein R. Meling

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Paranasal Sinuses ◽

Adjuvant Radiation ◽

Curative Intent ◽

Entire Cohort ◽

High Stage ◽

Oncologic Treatment

Abstract Objective Squamous cell carcinoma (SCC) of the paranasal sinuses is usually diagnosed at an advanced stage, making curative therapy difficult. The goal of this study was to evaluate the management and outcomes of patients with SCC treated at our institution. Methods In a population-based consecutive prospective cohort, we conducted an analysis of all patients treated for SCC between 1988 and 2017. Results A total of 72 patients were included, follow-up was 100%. Mean follow-up was 57 months for the entire cohort, and 108 months for patients with no evidence of disease. Eighty-two percent of all patients had high-stage (T4) disease. Fifty-seven patients underwent treatment with curative intent; consisting of surgery with or without oncologic treatment in 34, and of oncologic treatment only in 23 cases. Fifteen patients received palliative treatment. The rates of overall survival for the entire cohort were 55% at 2, 41% at 5, and 32% at 10 years, and corresponding disease-specific survival (DSS) rates were 55, 45, and 34%, respectively. DSS rates after surgical treatment with curative intent were 81% at 2, 65% at 5, and 54% at 10 years. Retromaxillary involvement and nonradical surgery were negative prognostic factors. Best survival was achieved with the combination of radical surgery and adjuvant oncologic treatment. Conclusion Surgical resection with a curative intent yielded 65% at 5-year DSS even in this cohort of patients with high-stage SCC and is still considered as the treatment of choice, preferably in combination with adjuvant radiation therapy and chemotherapy.

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Upfront chemotherapy and accelerated radiotherapy with EGFR inhibition for locally advanced inoperable head and neck cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6040 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6040-6040

Author(s):

C. Mercke ◽

G. Wickart-Johansson ◽

H. Sjödin ◽

G. Adell ◽

J. Nyman ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Locally Advanced ◽

Stage Iv ◽

Resected Specimen ◽

Stage Iv Disease

6040 Background: Concomitant chemoradiotherapy (CT/RT) is the standard treatment for locally advanced head and neck squamous cell carcinoma. However, late toxicity is substantial.This phase II trial explores the feasibility and efficacy of combining neoadjuvant TPF and accelerated RT where the concomitant cytostatic component is replaced with cetuximab (E), a chimeric IgG1 mAb against EGFR. Methods: Patients (pts) had previously untreated stage III/IV M0,WHO 0–1, unresectable squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx and were scheduled for 2 cycles of TPF (docetaxel 75 mg/m2 and cisplatin 75 mg/m2 day 1 and 5-FU 1,000 mg/m2 96 hours CI) every 3 weeks followed by RT (68 Gy/4.5 weeks) with E given one week before (400 mg/m2) and weekly during RT (250 mg/m2). A brachytherapy boost of 8 Gy was given to pts with oral cavity or oropharyngeal tumours. Neck dissection was planned for pts with N2–3 and complete response (CR) at the primary tumour. Tumour response was evaluated according to RECIST with CT, MRI or PET/CT after CT and at 6 weeks follow up. Toxicity (CTC 3.0) and quality of life (EORTC QLQ 30) was registered during and after treatment. Results: From 070401 to 081115 68 pts were enrolled, 56 had stage IV disease (T4, n = 14, N3, n = 9). Median age 57, 60 males, 3 oral cavity, 44 oropharynx, 10 larynx, and 11 hypopharynx. 30 pts were followed beyond 6 weeks and evaluated for response and early toxicity: stage IV disease 24 (T4, n = 6, N3, n = 3), median age 60, 25 males, 18 oropharynx, 5 larynx, and 7 hypopharynx. Remissions after TPF/after RT: CR 1/10, PR 15/18, SD 14/1, and PD 1. TPF as prescribed: 28/30 (pat refusal 1, renal insuff 1, dose reduction 0/28); E as prescribed: 22/30 (dermatitis 4, hypersensitivity 3, liver tox 1). Vital tumour in resected specimen 0/13. Alive at follow-up 29/30 (1 local failure). Conclusions: TPF followed by RT concomitant with E is feasible with manageable toxicities. Dermatitis in the irradiated neck, at least with the present accelerated fractionation, is troublesome to some patients but does not interrupt treatment and heals rapidly. To dispose of feeding tubes after disappearance of acute mucosal reactions has not been a problem. Early survival results are promising. Toxicity and survival results will be updated. [Table: see text]

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Photodynamic Therapy as an Alternative Therapeutic Tool in Functionally Inoperable Oral and Oropharyngeal Carcinoma: A Single Tertiary Center Retrospective Cohort Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.626394 ◽

2021 ◽

Vol 11 ◽

Author(s):

Arnaud Lambert ◽

Lotte Nees ◽

Sandra Nuyts ◽

Paul Clement ◽

Jeroen Meulemans ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Photodynamic Therapy ◽

Oral Cavity ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Standard Treatment ◽

Treated Area ◽

Free Interval

Background: Head and neck cancer is typically treated with surgery, radiotherapy, chemoradiation, or a combination of these treatments. This study aims to retrospectively analyse oncological outcomes, adverse events and toxicity of treatment with temoporfin-mediated photodynamic therapy at a single tertiary referral center. More specifically, in a selected group of patients with otherwise (functionally) inoperable oral or oropharyngeal head and neck squamous cell carcinoma.Methods: Twenty-six consecutive patients who received photodynamic therapy for oral or oropharyngeal squamous cell carcinoma from January 2002 until July 2019 at the University Hospitals Leuven were included. These were (1) patients with an accessible recurrent or new primary tumor in an extensively treated area of the head and neck, not suitable for standard treatment, or (2) patients that were judged medically unfit to undergo standard treatment modalities.Results: Complete tumor response immediately after PDT was obtained in 76.9% of cases. During follow-up, a proportion of CR patients did recur, to reach recurrence-free rates at six months, one year and two years of 60.6%, 48.5% and 32.3%. Local control at the PDT treated area was 42.3% with a median recurrence free interval time of 9 months. Recurrence-free interval was statistically more favorable for oropharyngeal squamous cell carcinoma (with or without oral cavity extension) in comparison to oral cavity squamous cell carcinoma alone (p < 0.001). During a median follow-up period of 27 months, we report new tumor activity in 80.8% of patients. Median overall and disease-specific survival time was 31 and 34 months, respectively. Most reported adverse events were pain after treatment and facial edema. At the end of follow-up, swallowing and upper airway functionality were preserved in 76.9 and 95.7% of patients, respectively.Conclusion: Photodynamic therapy is a valuable treatment option in highly selected patients with oral and/or oropharyngeal (functionally) inoperable head and neck squamous cell carcinoma. Treatment with this alternative modality can induce durable local control in an important fraction of treated patients, with an acceptable toxicity profile.

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Reprint of “Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up”

Oral Oncology ◽

10.1016/j.oraloncology.2020.105042 ◽

2020 ◽

pp. 105042

Author(s):

J.-P. Machiels ◽

C. René Leemans ◽

W. Golusinski ◽

C. Grau ◽

L. Licitra ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Clinical Practice ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Clinical Practice Guidelines ◽

Practice Guidelines

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Incidence of hypothyroidism in head and neck squamous cell carcinoma patients receiving radiotherapy with and without immune checkpoint inhibitors.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18551 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18551-e18551

Author(s):

Jennifer Leddon ◽

Martina Chirra ◽

Arushi Agrawal ◽

Logan Roof ◽

Danny Trotier ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Risk Factor ◽

Oral Cavity ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Primary Tumor ◽

Thyroid Dysfunction ◽

Neck Squamous Cell Carcinoma

e18551 Background: Treatment for locally advanced head and neck squamous cell carcinoma (HNSCC) involves a combination of surgery, chemotherapy, and radiotherapy (RT). RT for HNSCC is a known risk factor for the development of hypothyroidism. Recently, anti-PD1 therapies have been approved for recurrent and metastatic HNSCC and are moving to the forefront of HNSCC care. Similarly, thyroid dysfunction is a common immune-related adverse event following anti-PD1 therapy. Whether the addition of anti-PD1 to RT increases the likelihood of developing hypothyroidism remains unknown. Methods: The rate of hypothyroidism in HNSCC patients receiving RT (+/- chemotherapy and surgery) was compared to HNSCC patients receiving RT + anti-PD1 therapy either concurrently or after RT. Exclusion criteria were preexisting thyroid dysfunction, RT dose < 45 Gy and patients with incomplete treatment records. We defined clinical hypothyroidism as an elevation of TSH with low T3, T4 or elevation of TSH with symptoms requiring levothyroxine initiation. Hypothyroidism incidence was compared using Fisher’s exact test. Results: 153 patients were evaluated. In the RT group (N = 103), patients received RT +/- surgery or chemotherapy. 82/103 (80%) were male, median age was 57 and primary tumor groups included oropharynx 62/103 (60%), larynx 29/103 (28%), oral cavity 9/103 (9%) and other 3/103 (3%). In the RT + anti-PD1 group (N = 50), 36/50 (72%) were males, median age was 57 and primary tumor groups included oral cavity 19/50 (38%), oropharynx 17/50 (34%), larynx 8/50 (16%), and other 6/50 (12%). In the RT group, median follow up after RT was 801 days. In the RT+ anti-PD1 group, median follow up was 595 days from RT and 388 days from anti-PD1. The rate of hypothyroidism was significantly higher in the RT group 22.3% (23/103) versus 6% (3/50)after anti-PD1 therapy (p = 0.011). Multinomial logistical regression found no significant difference in hypothyroidism based on age, sex, or BMI. Larynx as primary tumor location was an independent risk factor for development of hypothyroidism (OR 4.74, p = 0.002). Conclusions: The addition of anti-PD1 therapy to standard HNSCC treatments does not significantly increase the risk of developing hypothyroidism. In fact, this study finds a lower incidence of hypothyroidism in HNSCC patient receiving RT + PD1 therapy which may be due to shorter duration of follow up and lower proportion of laryngeal cancer patients who are at relatively higher risk for surgical hypothyroidism.

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