Salvage of Recurrence after Surgery and Adjuvant Therapy: A Multi-institutional Study

2019 ◽  
Vol 161 (1) ◽  
pp. 74-81 ◽  
Author(s):  
Joseph Zenga ◽  
Evan Graboyes ◽  
Tyler Janz ◽  
Virgina Drake ◽  
Eleni Rettig ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Adjuvant Therapy ◽  
Disease Control ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locoregional Recurrence ◽  
Salvage Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Positive Margins

ObjectivesTo determine the oncologic outcomes of patients undergoing salvage surgery for recurrent oral cavity squamous cell carcinoma (OCSCC) and oropharyngeal squamous cell carcinoma (OPSCC) after initial treatment with surgery and adjuvant therapy.Study DesignRetrospective case series with chart review.SettingFive academic tertiary care centers.Subjects and MethodsPatients included those with OCSCC and OPSCC who were initially treated with surgery and adjuvant therapy between 2000 and 2015 and underwent salvage surgery for local and/or regional recurrence.ResultsA total of 102 patients were included (76% OCSCC, 24% OPSCC). Five-year overall survival was 31% (95% CI, 21%-41%) and was significantly improved among patients with human papillomavirus–associated oropharyngeal tumors (hazard ratio [HR], 0.34; 95% CI, 0.11-0.98) and significantly worse for those with postoperative positive margins (HR, 2.65; 95% CI, 1.43-4.93). Adjuvant (chemo)reirradiation was not associated with disease control or survival regardless of margin status. Combined locoregional recurrence was significantly correlated with a positive margin resection (HR, 5.75; 95% CI, 1.94-17.01). Twenty-five patients (25%) underwent a second salvage surgical procedure, of whom 8 achieved long-term disease control.ConclusionPatients presenting with resectable recurrence after initial therapy with surgery and adjuvant therapy have a reasonable salvage rate when a negative margin resection can be attained. Patients with postoperative positive margins have poor survival outcomes that are not significantly improved with adjuvant (chemo)reirradiation. Those with combined locoregional recurrence are at particularly high risk for postoperative positive margins. The functional consequences of salvage surgery and its effect on quality of life are critical in decision making and require further investigation.

Characteristics and Outcomes in Head and Neck Sarcomatoid Squamous Cell Carcinoma: The Cleveland Clinic Experience

2020 ◽  
pp. 000348942097777
Author(s):  
Katie M. Mingo ◽  
Adeeb Derakhshan ◽  
Neelab Abdullah ◽  
Deborah J. Chute ◽  
Shlomo A. Koyfman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Locoregional Recurrence ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Smoking History ◽  
Stage Disease

Objectives: To analyze characteristics, treatment outcomes, and prognostic factors of sarcomatoid squamous cell carcinoma of the head and neck. Study Design: Retrospective chart review. Setting: Tertiary care center. Subjects and Methods: Fifty-five patients were treated for sarcomatoid squamous cell carcinoma of the head and neck between 1996 and 2018. Data collection included clinical history, tumor characteristics, pathology, treatment modality, and outcomes. Mean follow up was 17.1 months. Cox univariate analysis was used to evaluate for associations with locoregional recurrence, distant metastasis, and overall survival. Results: Most patients were white males with a smoking history and median age 66 years (range 41-92) at diagnosis. Twenty-two percent had prior head and neck radiation. Tumor site was most frequently oral cavity (41.8%), followed by larynx (29.1%), and oropharynx (16.4%). Half presented with early T stage disease (15.5% T0, 12.7% T1, 30.9% T2) and the remainder with late stage disease (16.4% T3, 34.5% T4). Locoregional recurrence rate was 60.0%, metastatic recurrence was rate 21.8%, with median time to recurrence of 4 months and mean overall survival of 20 months. Presence of lymphovascular space invasion was statistically associated with locoregional recurrence ( P = .018, HR 3.55 [95% CI 1.24, 10.14]) and poorer overall survival ( P = .015, HR 2.92 [95% CI 1.23, 4.80]). Treatment with multimodality therapy was associated with decreased locoregional recurrence ( P = .039, HR 0.39 [95% CI 0.16, 0.95]) but did not impact overall survival. Conclusion: Sarcomatoid squamous cell carcinoma remains a rare and aggressive disease variant with high recurrence rates and high mortality. High risk features such as lymphovascular space may indicate the need for more aggressive therapy.

scholarly journals Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma

2017 ◽  
Vol 158 (4) ◽  
pp. 660-666 ◽  
Author(s):  
Michael J. Persky ◽  
William G. Albergotti ◽  
Tanya J. Rath ◽  
Mark W. Kubik ◽  
Shira Abberbock ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Robotic Surgery ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tertiary Care ◽  
Positive Margin ◽  
Transoral Robotic Surgery ◽  
Preoperative Imaging ◽  
Positive Margins ◽  
Imaging Characteristics

Objective To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P = .004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P = .002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P = .02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.

Endoscopic Partial Supraglottic Laryngectomies

2009 ◽  
Vol 141 (3) ◽  
pp. 374-381 ◽  
Author(s):  
Marc Remacle ◽  
Georges Lawson ◽  
Anastasios Hantzakos ◽  
Jacques Jamart
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tertiary Care ◽  
Case Series ◽  
University Hospital ◽  
Long Term Results ◽  
Type I ◽  
Swallowing Function ◽  
Supraglottic Squamous Cell Carcinoma

OBJECTIVE: The aim of this study was to evaluate long-term results of endoscopic surgery for supraglottic carcinoma. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care university hospital. SUBJECTS AND METHODS: From 1992 to 2004, 45 patients diagnosed with supraglottic squamous cell carcinoma (two Tis, nine T1N0, 27 T2N0, two T2N1, one T2N2, four T3N0) underwent different types of endoscopic supraglottic laryngectomies according to the European Laryngological Society (ELS) classification: three limited excision (type I); 27 medial without resection of the preepiglottic space (type IIb); one medial with resection of the preepiglottic space (type IIIa); three medial with resection of the preepiglottic space (type IIIb); nine lateral (type IVa); two lateral (type IVb). RESULTS: Overall survival was 93 ± 4 percent (SE) after three years and 89 ± 6 percent (SE) after five years. The median follow-up is 3.7 years. Patients with clinically N0 necks were found to have positive nodes in eight (19%) cases. Two cases of postoperative hemorrhage were controlled by electrocautery. All of the patients without previous treatment for larynx cancer regained swallowing function within five days to three weeks after surgery. Mean duration of hospitalization was 12.5 days. CONCLUSION: Endoscopic partial laryngectomies, as defined by the ELS classification, for selected supraglottic squamous cell carcinoma proved to be an excellent alternative to radiotherapy and open neck surgery.

scholarly journals Retrospective analysis of total laryngectomy with post-operative radiotherapy for CA larynx in a tertiary care centre: a case series

2019 ◽  
Vol 5 (3) ◽  
pp. 653
Author(s):  
S. Mohamed Siddique ◽  
G. Selvarajan
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Total Laryngectomy ◽  
Postoperative Radiotherapy ◽  
Tertiary Care ◽  
Case Series ◽  
Treatment Modalities ◽  
Pharyngocutaneous Fistula ◽  
Operative Care

<p class="abstract"><strong>Background:</strong> Squamous cell carcinoma is the most common malignancy of the larynx. Various treatment modalities are available. Recently, total laryngectomy is a viable option as primary treatment or salvage surgery after radiotherapy than organ preservation surgeries. The aim was to analyse the results of the patients with advanced laryngeal cancers treated with total laryngectomy and postoperative radiotherapy.</p><p class="abstract"><strong>Methods:</strong> It is a retrospective study from January 2015 to June 2018 with 16 patients with squamous cell carcinoma of larynx. Detailed history, examination, radiological, endoscopic evaluation of tumour, tissue biopsy proof and staging was done.  </p><p class="abstract"><strong>Results:</strong> Of the 16 patients (15 male and 1 female), 12 patients (75%) were primary cases and 4 patients (25%) were radiorecurrent. 14 patients (87%) had pre-operative tracheostomy done and 2 patients (13%) had undergone direct laryngectomy. All the 16 patients had transglottic growth. All the patients had undergone total laryngectomy with post-operative radiotherapy. No pharyngocutaneous fistula reported. One patient (6%) had neck edema. One patient (6%) had nodal recurrence.</p><p class="abstract"><strong>Conclusions:</strong> Total laryngectomy with post-operative radiotherapy affords a longer period of survival compared to radiotherapy alone. Minimal complications in our study are attributed to thorough pre-operative evaluation, meticulous surgical technique and post-operative care.</p><p class="abstract"> </p>

Prognostic Impact of Adverse Pathologic Features in Sinonasal Squamous Cell Carcinoma

2020 ◽  
Author(s):  
Anuraag S. Parikh ◽  
Jennifer C. Fuller ◽  
Ashton E. Lehmann ◽  
Neerav Goyal ◽  
Stacey T. Gray ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tertiary Care ◽  
Prognostic Impact ◽  
High Grade ◽  
Positive Margins ◽  
Care Institution ◽  
Pathologic Features ◽  
Tertiary Care Institution

Abstract Objectives This study aimed to describe the impact of adverse clinical and pathologic features in sinonasal squamous cell carcinoma (SCC). Design This study is designed with retrospective chart review. Setting present study conducted at a tertiary care institution. Participants All patients treated surgically for sinonasal SCC at our tertiary care institution between January 2006 and December 2013. Main Outcome Measures Overall survival (OS) and disease free survival (DFS) are the final measurement of this study. Results Forty-eight patients were identified. Mean age at surgery was 65.8 years, and mean follow-up time was 40.7 months. Eighteen patients (38%) had T1–T3 disease, while 30 patients (63%) had T4 disease. Seven patients (8.3%) had nodal disease at presentation. At 2, 5, and 10 years, OS was 71, 54, and 48%, respectively, while DFS was 64, 51, and 45%, respectively. Twelve patients (25%) experienced local recurrences with mean time to recurrence of 15.3 months. Twenty-five patients (52%) had positive margins, 24 (50%) had high-grade tumors, 18 (38%) had perineural invasion (PNI), and 15 (31%) had lymphovascular invasion (LVI). In the univariate analysis, T4 disease (risk ratio [RR] = 2.7) and high grade (RR = 2.4) had a significant association with DFS. In the multivariate analysis, high grade (RR = 4.0 and 4.5) and LVI (RR = 4.1 and 4.7) had a significant association with OS and DFS. Conclusion Our single-institution experience of 48 patients suggests that high grade and LVI are independently associated with survival outcomes in sinonasal SCC, while PNI and microscopically positive margins do not have a significant impact.

scholarly journals Post-Surgery Subcutaneous Seeding of Laryngeal Squamous Cell Carcinoma: A Rare Case

2021 ◽  
pp. 568-572
Author(s):  
Yongquan Jiang ◽  
Wanxin Cao ◽  
Yuanbo Luo ◽  
Ji Xu ◽  
Ying Li ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Head And Neck Cancer ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locoregional Recurrence ◽  
Rare Case ◽  
Laryngeal Squamous Cell Carcinoma ◽  
Primary Lesion ◽  
Lymphogenous Metastasis ◽  
Post Surgery

Laryngeal squamous cell carcinoma (LSCC) is the most common malignant head and neck cancer, with a 40% recurrence rate in the first 3 years after radical treatment. Recurrence of LSCC mostly comprises lymphogenous metastasis, hematogenic metastasis, and locoregional recurrence, while LSCC seeding is rarest: there are only 4 cases reported in PubMed, and none of them is one of subcutaneous seeding. We report a case with post-surgery subcutaneous seeding of LSCC. The final biopsy demonstrated that the subcutaneous seeding of the LSCC was 2 cm away from the primary lesion, with no recurrent foci observed in the larynx and tracheostoma and little relation to the primary lesion. Thus, we drew the conclusion that LSCC surgeries should stick to the principle of the non-tumor technique to prevent subcutaneous seeding.

scholarly journals Local Chemotherapy as an Adjuvant Treatment in Unresectable Squamous Cell Carcinoma: What Do We Know So Far?

2021 ◽  
Vol 28 (4) ◽  
pp. 2317-2325
Author(s):  
Luigi Bennardo ◽  
Francesco Bennardo ◽  
Amerigo Giudice ◽  
Maria Passante ◽  
Stefano Dastoli ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Gold Standard ◽  
Systemic Chemotherapy ◽  
Standard Treatment ◽  
Case Reports ◽  
Case Series ◽  
Surgical Removal ◽  
Local Chemotherapy

Background: Squamous cell carcinoma (SCC) is one of the most common cancers involving skin and oral mucosa. Although this condition’s gold-standard treatment is the surgical removal of the lesions, the physician must propose alternative treatments in some cases due to the patient’s ineligibility for surgery. Among the available alternative therapies, local chemotherapy may represent an initial treatment in combination with radiotherapy or systemic chemotherapy due to the low frequency of side-effects and the lack of necessity for expensive devices. Methods: In this paper, we review all available literature in various databases (PubMed, Scopus-Embase, Web of Science), proposing local chemotherapy as a treatment for cutaneous and oral SCC. Exclusion criteria included ocular lesions (where topical treatments are common), non-English language, and non-human studies. Results: We included 14 studies in this review. The majority were case reports and case series describing the treatment of non-resectable localized SCC with either imiquimod or 5-fluorouracil. We also analyzed small studies proposing combination treatments. Almost all studies reported an excellent clinical outcome, with a low risk of relapses in time. Conclusions: Resection of the lesion remains the gold-standard treatment for SCC. When this approach is not feasible, local chemotherapy may represent a treatment alternative, and it may also be associated with radiotherapy or systemic chemotherapy.

scholarly journals Pembrolizumab in vaginal and vulvar squamous cell carcinoma: a case series from a phase II basket trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeffrey A. How ◽  
Amir A. Jazaeri ◽  
Pamela T. Soliman ◽  
Nicole D. Fleming ◽  
Jing Gong ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Phase Ii ◽  
Squamous Cell ◽  
Single Agent ◽  
Case Series ◽  
Predictive Biomarkers ◽  
Vulvar Squamous Cell Carcinoma ◽  
Metastatic Setting ◽  
Progression Of Disease

AbstractVaginal and vulvar squamous cell carcinoma (SCC) are rare tumors that can be challenging to treat in the recurrent or metastatic setting. We present a case series of patients with vaginal or vulvar SCC who were treated with single-agent pembrolizumab as part of a phase II basket clinical trial to evaluate efficacy and safety. Two cases of recurrent and metastatic vaginal SCC, with multiple prior lines of systemic chemotherapy and radiation, received pembrolizumab. One patient had significant reduction (81%) in target tumor lesions prior to treatment discontinuation at cycle 10 following confirmed progression of disease with new metastatic lesions (stable disease by irRECIST criteria). In contrast, the other patient with vaginal SCC discontinued treatment after cycle 3 due to disease progression. Both patients had PD-L1 positive vaginal tumors and tolerated treatment well. One case of recurrent vulvar SCC with multiple surgical resections and prior progression on systemic carboplatin had a 30% reduction in her target tumor lesions following pembrolizumab treatment with a PD-L1 positive tumor. Treatment was discontinued for grade 3 mucositis after cycle 5. Pembrolizumab may provide some clinical benefit to some patients with vaginal or vulvar SCC and is overall safe to utilize in this population. Future studies are needed to evaluate the efficacy of pembrolizumab in these rare tumor types and to identify predictive biomarkers of response.

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