Colmenares BBE, Gallegos HJF, Hernández HDM, MHernández SJM

Language: Spanish
References: 16
Page: 173-176
PDF size: 53.92 Kb.

ABSTRACT

Antecedents: Cervical treatment of patients with tongue cancer without palpable ganglia (cNO) is controversial. Surgery or radiotherapy over-treat more than 50% of the patients; expectant behavior increases regional recurrence, rescue is complex, and survival decreases. The cervical treatment of cNO tongue cancer depends on the risk of hidden metastases associated to the size of the tumor.
Objective: To know the frequency of hidden ganglionar metastases in cNO-tongue cancer (TC) patients subjected to neck dissection.
Material and methods: Retrospective analysis of the clinical histories of patients with cNO invasive tongue cancer. Clinical correlation with the histological status.
Results: Twenty-two patients were studied, in 16/22 no ganglionar metastases were found (negative predictive value = 72.7%), 6 (27%) had metastatic ganglia (pN+), metastases were more frequent in T3 than in T1-2, without statistical significance. Survival was greater in pNO patients than in pN+ (95 vs. 38%).
The TC was associated to 27% of hidden metastatic ganglia, which justifies the elective treatment of the neck; the histological status of the cervical ganglia is an important prognostic factor and has to be known. However, it is necessary to select the candidates for a radical cervical dissection to avoid over-treatment of patients, which in this study corresponded to 73%.
Conclusion: Probably, applying the concept of lymphatic mapping and biopsy of the sentinel ganglion might allow identifying the patients with hidden cervical ganglionar metastases as candidates for elective treatment of the neck (surgery or radiotherapy).

REFERENCES

1. Shah JP, Lydiatt WM. Buccal mucosa, alveolus, retromolar trigone, floor of mouth, hard palate, and tongue tumors. In: Thawlew SE, Panje WR, Batsakis JG, Lindberg RD, editor. Comprehensive management of head and neck tumors. Philadelphia. WB Saunders 1999; 1: 686-694.

2. Boyle JO, Strong EW. Oral cavity cancer. In: Shah JP, Patel SG; editors. American Cancer Society, atlas of clinical oncology. Cancer of the head and neck. Hamilton London: BC Decker editors. 2001: p.100-26.

3. Andersen PE, Saffold S. Management of cervical metastasis. In: Shah JP. Cancer of the head and neck. Hamilton London. BC Decker. Editors. 2001: p. 274-87.

4. Vandenbrouck C, Sancho-Garnier H, Chassagne D, Saravane D, Cachin Y, Micheau C. Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial. Cancer 1980; 46: 386-90.

5. Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma. Brazilian Head and Neck Cancer Study Group. Am J Surg 1998; 176: 422-27.

6. Batsakis JG. Pathology of tumors of the oral cavity. In: Thawlew SE, Panje WR, Batsakis JG, Lindberg RD. Editors. Comprehensive management of head and neck tumors. an ed. Philadelphia. WB Saunders. 1999: p. 632-72.

7. Gallegos-Hernández JF, Martínez-Gómez H y Flores-Díaz R. La disección radical de cuello en cáncer de vías aéro-digestivas superiores (VADS). Indicaciones, extensión y radicalidad. Cir Cirj 2002; 70: 369-76.

8. AJCC. Cancer Staging Manual. 6th ed. New York: Springer; 2002: p. 23-32.

9. Shah JP, Strong E, Spiro RH, Vikram B. Surgical Grand Rounds. Neck Dissection: current status and future possibilities. Clin Bull 1981; 11: 25-33.

10. Ali S, Tiwari RM, Snow GB. False-positive and false-negative neck nodes. Head Neck Surg 1985; 8: 78-82.

11. Teichgraeber JF, Clairmont AA. The incidence of occult metastases for cancer of the oral tongue and floor of the mouth: treatment rationale. Head Neck Surg 1984; 7: 15-21.

12. Crile G. Landmark article. Dec. 1, 1906: Excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operations. By George Crile. JAMA 1987; 258: 3286-93.

13. Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 1998; 124: 455-9.

14. Shoaib T, Soutar DS, Prosser JE, Dunaway DJ, Gray HW, McCurrach GM, et al. A suggested method for sentinel node biopsy in squamous cell carcinoma of the head and neck. Head Neck 1999; 21: 728-33.

15. Ross GL, Shoaib T, Soutar DS, Mac Donald DG, Camilleri IG, Bessent RG, et al. The first international conference on sentinel node biopsy in mucosal head and neck cancer and adoption of a multicenter trial protocol. Ann Surg Oncol 2002; 9: 406-10.

16. Gallegos-Hernández JF, Flores-Díaz R, Pichardo P. Rhenium colloid and blue dye for lymphatic mapping and sentinel node biopsy in oral cavity cancer. Abstract. 2nd International Conference on Sentinel Node Biopsy in Mucosal Head and Neck Cancer. Zurich, Suiza. 2003.