Prognostic factors and long-term survival in oral squamous cell carcinoma

Objective: this study aimed to evaluate long-term survival and prognostic factors in patients with oral squamous cell carcinoma (OSCC) in an economically poor region of Brazil.Methods: the data were obtained from analysis of medical and mortality records of 210 patients with OSCC treated at an oncology hospital providing services to the Brazilian Unified National Health System in a State of northeastern Brazil between January 2006 and December 2008. Sociodemographic and clinical information, treatment performed, recurrence and evolution were collected. Survival curves were estimated by the Kaplan-Meier method and the log rank and Cox regression tests were used to compare the curves.Results: the median survival in the study period was 47.4 months (95% CI = 38.2 - 56.7). The overall survival rates at 5 and 10 years were 29% and 19.8%, respectivelly. Individuals over 60 years of age (HR = 1.70; 95% CI = 1.06 - 2.73), presence of regional metastasis (HR = 2.51; 95% CI = 1.55 - 4.08), presence of recurrence (HR = 3.18; 95% CI = 1.88 - 5.39) and no surgical treatment (HR = 2.10; 95% CI = 1.31 - 3.35) had a worse prognosis.Conclusions: advanced age, presence of regional metastasis, tumor recurrence and non-surgical treatment predict poorer survival in patients diagnosed with OSCC.

Introducing the GammaPen: All-in-One Gamma Probe for Sentinel Lymph Node Biopsy

Purpose: Using an itra-operative gamma probe after injection of radiotracer during surgery helps the surgeon to identify the sentinel lymph node of regional metastasis through the detection of radiation. This work reports the design and specification of an integrated gamma probe (GammaPen), developed by our company. Materials and Methods: GammaPen is a compact and fully integrated gamma probe. The detector module consists of a thallium-activated Cesium Iodide (CsI (Tl)) scintillator, and a Silicon Photo Multiplier (SiPM), shielded using Tungsten housing. Probe sensitivity, spatial resolution and angular resolution in air and water, and side and back shielding effectiveness were measured to evaluate the performance of the probe based on NEMA NU3 standard. Results: The sensitivity of the probe in the air/water at distances of 10, 30, and 50 mm is 18784/176800, 3500/3050, and 1575/1104 cps/MBq. The spatial and angular resolutions in the air/scattering medium are 40/47 mm and 77/87 degrees at a 30 mm distance from the probe. The detector shielding effectiveness and leakage sensitivity are 99.91% and 0.09%, respectively. Conclusion: The results and surgeon experience in the operating room showed that GammaPen can be effectively used for sentinel lymph node localization.

Identification of risk factors of regional metastasis of differentiated thyroid cancer

Diagnostic difficulties of regional metastases, especially lesion of the central neck, is the main problem with choosing the type of surgical intervention for patients with differentiated thyroid cancer diagnosis. The frequency of differentiated thyroid cancer regional metastasis to the neck lymph nodes is about 60 %. This article includes the search and identification of risk factors of differentiated thyroid cancer regional metastases, as well as a review of the literature on this problem. We have analyzed the results of surgical treatment of patients with papillary thyroid cancer of Stage I–III (T1–4aN0–1bM0) who underwent surgical treatment at the St. Petersburg State Healthcare Institution «City Clinical Oncology Center» in 2018–2019. As a result of the study, the data revealed a relationship between regional metastases and intrathyroid vascular invasion of the primary tumor (p < 0.05), while multifocality, extrathyroid extension and the incidence of BRAF mutation have not demonstrated this correlation (p > 0.05). After the surgical treatment we should focus on the presence of vascular invasion and, if it is detected, perform final thyroidectomy and central lymph node dissection with subsequent radioiodine therapy.

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

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.

Multicentric Medullary Carcinoma Breast - Uncommon Histologic Subtype

Ridolfi et al. in 1977 defined medullary breast carcinoma (MBC) as one of the invasive and malignant subtypes of breast cancer.1 It is a rare breast malignancy accounting for 5 % of breast carcinomas.2 Although MBC is considered as having good prognosis, patients reported as triple-negative breast cancers are associated with aggressive clinical behaviour and poor prognosis.3 Also factors like local invasion, evidence of regional metastasis, etc. will determine the progress of this type of cancer.