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Auris, Nasus, Larynx Feb 2022Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was planned to determine whether Selective...
OBJECTIVE
Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was planned to determine whether Selective Neck Dissection (SND) is oncological safe procedure even in patients with lymph node metastases.
METHODS
OPSCC patients were divided into Modified Radical Neck Dissection (MRND) and SND groups. The outcome measures were overall survival (OS), disease-free survival (DFS) and regional recurrence free survival (RRFS).
RESULTS
Thirty-seven SNDs and 18 MRNDs were performed. Regional relapse rate was 6.1% in SND group whilst 18.8% in MRND group(p=0.19). The 5-year OS, DFS and RRFS rates' differences were not statistically significant between SND and MRND groups (p=0.40, p=0.42 and p=0.18, respectively). At multivariate analysis, advanced stage impacted the 5-year OS and DFS(HR=9.39, p<0.01 and HR=11.03, p=0.04).
CONCLUSIONS
The SND seems to be effective in a TORS framework. The indication should be accurately discussed by the multidisciplinary tumor board.
Topics: Aged; Carcinoma, Squamous Cell; Disease-Free Survival; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Proportional Hazards Models; Robotic Surgical Procedures; Survival Analysis
PubMed: 34092436
DOI: 10.1016/j.anl.2021.05.007 -
Surgical Innovation Dec 2021: Management of the early-stage oropharyngeal carcinoma in trismus patients underlying with multiple head and neck cancer history is a clinical challenge because minimal...
: Management of the early-stage oropharyngeal carcinoma in trismus patients underlying with multiple head and neck cancer history is a clinical challenge because minimal invasive surgery such as transoral robotic surgery or transoral laser microsurgery is contraindicated, while open surgery or concurrent chemoradiation (CCRT) wound cause long-term adverse effect. Therefore, we developed a novel endoscopic surgical approach for these patients. : Four patients were enrolled for endoscopic-assisted oropharyngectomy. The oropharyngeal tumor was resected with an adequate margin via a one-surgeon bimanual approach with the aid of a high-resolution videoendoscopic system, scope holder, and designed surgical instruments. The postoperative surgical margin status, trismus status, perioperative complication, average hospital stay, and follow-up period were recorded. : The endoscopic-assisted oropharyngectomy was successfully applied in all 4 patients with en bloc tumor excision and adequate free margin status. The mean hospital stay was 6.5 days, and all patients could tolerate oral diet within 2 weeks. There was no perioperative complication noted. No tumor recurrence was identified in patients followed up 2 years after surgery. : Endoscopic-assisted oropharyngectomy for patients with trismus and multiple head and neck cancer history is a safe, minimal invasive, and effective treatment choice other than open surgery or CCRT. It provides a safe option for patients with limited mouth opening.
Topics: Endoscopy; Humans; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Robotic Surgical Procedures; Trismus
PubMed: 33745370
DOI: 10.1177/15533506211002131 -
Oral and Maxillofacial Surgery Clinics... Feb 2011Approximately 36,000 people in the United States will be diagnosed with oral or oropharyngeal cancer in 2010. In more than 90% of the cases of oral cavity and... (Review)
Review
Approximately 36,000 people in the United States will be diagnosed with oral or oropharyngeal cancer in 2010. In more than 90% of the cases of oral cavity and oropharyngeal cancers, histopathologic examination reveals squamous cell carcinoma (SCCA). Despite appropriate initial treatment, oral SCCA recurs in 25% to 48% of cases. Several studies have shown that most cancers recur within about 2 years after the initial treatment. Hence, close follow-up of patients is important for the timely detection of recurrences.This article discusses the types of recurrence and the surveillance and treatment of recurrent oral SCCA.
Topics: Carcinoma, Squamous Cell; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Reoperation
PubMed: 21272772
DOI: 10.1016/j.coms.2010.11.002 -
Head & Neck Sep 2012The purpose of this study was to assess the efficacy of primary transoral surgery in the management of T1 oropharyngeal carcinoma.
BACKGROUND
The purpose of this study was to assess the efficacy of primary transoral surgery in the management of T1 oropharyngeal carcinoma.
METHODS
A retrospective evaluation was conducted on the files of all patients treated with primary surgery for pT1 oropharyngeal carcinoma at a tertiary referral center between 1976 and 2005.
RESULTS
A total of 223 cases were assessed. Disease-specific survival was 88% and local control 93%. Transoral surgery with the use of CO(2) laser or electrocautery was adopted in every case. Positive surgical margins and regional disease were found to significantly worsen prognosis. A low rate of complications and satisfactory retention of pharyngeal function were noted.
CONCLUSIONS
Primary transoral surgical treatment is very effective against T1 oropharyngeal carcinoma. A low rate of complications should be expected. However, in every case complete excision of the tumor must be accomplished and the neck included in the primary treatment plan.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Staging; Oropharyngeal Neoplasms; Retrospective Studies; Survival Analysis
PubMed: 22084028
DOI: 10.1002/hed.21916 -
Journal of the National Cancer Institute Dec 1999
Topics: Chemotherapy, Adjuvant; Humans; Multicenter Studies as Topic; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Radiotherapy, Adjuvant; Randomized Controlled Trials as Topic; Survival Analysis; Treatment Outcome
PubMed: 10601369
DOI: 10.1093/jnci/91.24.2065 -
Cancer Imaging : the Official... Mar 2010Tumours in the oral cavity and oropharynx differ in presentation and prognosis and the detection of spread of tumour from one subsite to another is essential for the... (Review)
Review
Tumours in the oral cavity and oropharynx differ in presentation and prognosis and the detection of spread of tumour from one subsite to another is essential for the T-staging. This article reviews the anatomy and describes the pattern of spread of different cancers arising in the oral cavity and oropharynx; the imaging findings on computerized tomography and magnetic resonance imaging are also described. Brief mention is made on the role of newer imaging modalities such as [(18)F]fluorodeoxyglucose-positron emission tomography/computed tomography, perfusion studies and diffusion-weighted magnetic resonance imaging.
Topics: Carcinoma, Squamous Cell; Diagnostic Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Mouth Neoplasms; Neoplasm Staging; Oropharyngeal Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 20233682
DOI: 10.1102/1470-7330.2010.0008 -
Radiologic Clinics of North America Jan 2007Cancers of the oral cavity and pharynx are the most common head and neck cancers in the United States, and squamous cell carcinoma is the most frequent histologic type.... (Comparative Study)
Comparative Study Review
Cancers of the oral cavity and pharynx are the most common head and neck cancers in the United States, and squamous cell carcinoma is the most frequent histologic type. The clinical behavior and outcome of tumors in the oral cavity is distinct from those of the oropharynx. As a general rule, surgical resection is the primary treatment for oral cavity squamous cell carcinoma, whereas oropharyngeal squamous cell carcinomas are treated with radiation with or without chemotherapy. A clear understanding of the anatomy and knowledge of clinical behavior and spread patterns of oral cavity and oropharyngeal squamous cell carcinoma are essential for radiologists to make a meaningful contribution to the treatment of these patients.
Topics: Carcinoma, Squamous Cell; Follow-Up Studies; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Mouth; Mouth Neoplasms; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal Neoplasms; Oropharynx; Palatal Neoplasms; Palate, Soft; Time Factors; Tomography, X-Ray Computed; Tonsillar Neoplasms
PubMed: 17157621
DOI: 10.1016/j.rcl.2006.10.010 -
Current Opinion in Otolaryngology &... Apr 2020The 8th edition tumor, node, metastasis (TNM) classification (TNM-8) introduced a new classification for human papillomavirus (HPV)-mediated oropharyngeal carcinoma... (Review)
Review
PURPOSE OF REVIEW
The 8th edition tumor, node, metastasis (TNM) classification (TNM-8) introduced a new classification for human papillomavirus (HPV)-mediated oropharyngeal carcinoma (HPV+ OPC). This review summarizes its potential therapeutic implications focusing on literature published since 2018.
RECENT FINDINGS
The following are active research areas involved in clinical care and therapy relevant to TNM-8: tumor HPV testing and its clinical implications; stage I disease: treatment selection and lessons learned from recent deintensification trials; emerging strategies addressing stage II and III disease.
SUMMARY
The TNM-8 classification depicts prognosis of HPV+ OPC much more reliably compared with TNM-7. Among the advantages in outcome comparison and stratification for clinical trial entry and conduct, it also enables more satisfactory individual patient consultation to adequately estimate prognosis, and facilitates clinical and translational research. However, clinicians must remain mindful that the TNM classification is not a guideline for treatment but, instead, provides a framework for clinical research and treatment decision-making. The TNM-8 has potential to improve risk-tailored treatment algorithms for HPV+ OPC including selection of treatment modality (primary trans-oral surgery vs. radiotherapy, addition of chemotherapy) and adjusting the intensity of approaches. To realize these goals fully, it is apparent that the TNM-8 needs to evolve further.
Topics: Disease Progression; Humans; Lymphatic Metastasis; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis
PubMed: 32022732
DOI: 10.1097/MOO.0000000000000607 -
The Journal of Laryngology and Otology Sep 2022Spontaneous regression is defined as the partial or complete disappearance of a malignant tumour proven by microscopic examination in the absence of any substantial...
BACKGROUND
Spontaneous regression is defined as the partial or complete disappearance of a malignant tumour proven by microscopic examination in the absence of any substantial treatment. This paper presents the case of an older woman whose advanced-stage tonsillar squamous cell carcinoma was noted to have spontaneously regressed at seven months.
CASE REPORT
A 66-year-old woman presented with a 4-month history of dysphagia and odynophagia in September 2020. An exophytic tumour was seen on the right tonsil; this was diagnosed radiologically and histologically as a squamous cell carcinoma of the tonsils, with tumour-node-metastasis staging of TNM. The patient received best supportive care. Seven months later, the oropharyngeal lesion had disappeared, with no treatment. Subsequent computed tomography imaging showed radiological resolution of the previously noted right-sided oropharyngeal lesion.
CONCLUSION
Several mechanisms of spontaneous regression are discussed. Further studies should review this case in conjunction with other reports of spontaneous tumour regressions, to elucidate underlying mechanisms.
Topics: Aged; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Squamous Cell Carcinoma of Head and Neck; Tonsillar Neoplasms
PubMed: 34641983
DOI: 10.1017/S0022215121002899 -
Cancer Journal (Sudbury, Mass.)Human papillomavirus infection is currently implicated in the majority of oropharyngeal squamous cell carcinoma cases diagnosed in the United States. Circulating tumor... (Review)
Review
Human papillomavirus infection is currently implicated in the majority of oropharyngeal squamous cell carcinoma cases diagnosed in the United States. Circulating tumor DNA (ctDNA) has emerged as a potential biomarker for human papillomavirus-related oropharyngeal squamous cell carcinoma and has the opportunity to improve the diagnosis, treatment, and surveillance of patients with this disease. Changes in ctDNA levels during and after primary therapy may be related to disease response, which can possibly have implications for treatment intensification or de-escalation strategies. Further, ctDNA seems to be sensitive and specific for disease recurrence and may improve upon current methods for assessing both treatment response and failure. In this review, we examine the relevant literature on the use of ctDNA for oropharyngeal cancer treatment and surveillance and discuss current limitations and future directions for this promising biomarker.
Topics: Humans; Circulating Tumor DNA; Human Papillomavirus Viruses; Squamous Cell Carcinoma of Head and Neck; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Papillomavirus Infections; Head and Neck Neoplasms; Biomarkers; Papillomaviridae
PubMed: 37471613
DOI: 10.1097/PPO.0000000000000667