Regional Recurrence of Squamous Cell Carcinoma of the Nasal Cavity (original) (raw)
Related papers
Clinical Otolaryngology, 2019
This paper aims to provide contemporary epidemiological data on squamous cell carcinoma (SCC) of the nasal cavity, which represents a rare type of head and neck cancer. Design, Setting & Participants A descriptive analysis of people with nasal cavity SCC treated with curative intent from the Head and Neck 5000 study; a multicentre clinical cohort study of people from the UK with head and neck cancer. People with tumours of the nasopharynx, paranasal sinuses and other sub-sites of the head and neck were excluded. Main outcome measures Demographic data and treatment details are presented for all participants. The main outcomes were overall survival and survival according to categories of characteristics (e.g. smoker vs non-smoker); these were explored using Kaplan-Meier plots. Results Thirty people with nasal cavity SCC were included in the study, of which most were male (67%) and current or ex-smokers (70%). The majority (70%) presented with early stage (T1/2, N0) tumours. Cervical lymph node metastases at presentation were rare, occurring in only one person. Nine people died during the follow up period (30%). Worse survival outcomes were seen in people with moderate or severe co-morbidities. Conclusions This paper provides epidemiological data on nasal cavity SCC in the UK. Patterns of disease and survival outcomes are described, identifying high-risk groups. Further studies should explore whether primary treatment modality alters survival.
Squamous cell carcinoma of the nasal cavity: A population-based analysis
The Laryngoscope, 2015
Objectives/Hypothesis: Squamous cell carcinoma of the nasal cavity (NCSCC) is an infrequent malignancy that has been historically difficult to characterize. This study provides new insight into NCSCC utilizing a population-based database. We analyze the propensity for cervical and distant metastasis from NCSCC, as well as survival outcomes. Study Design: Retrospective database analysis. Methods: The Surveillance, Epidemiology, and End Results (SEER) database (2004-2012) was queried for NCSCC cases. Data were analyzed with respect to various demographic and clinicopathologic factors. The results were further examined for regional and distant metastasis. Survival was analyzed using the Kaplan-Meier model. Results: A total of 1,180 cases of NCSCC were identified in the SEER database between 2004 and 2012. The mean age at diagnosis was 65.8 years. American Joint Committee on Cancer stage was known in 1,050 cases, of which 53.4% were stage I, 13.3% were stage II, 10.2% were stage III, and 23.0% were stage IV. By tumor (T) stage classification, T1 was the most common (56.6%), followed by T4 (19.3%). Most cases had no nodal (N) involvement at diagnosis (90.8%). Cervical nodal involvement was present in 9.1% of cases, while distant metastasis was seen in 1.9%. Five-year disease-specific survival was 69.5% overall, 39.6% in cases with neck involvement and 0.0% for metastatic cases. Conclusions: This study represents the only known population-based investigation of NCSCC. Metastasis to cervical nodes or distant sites, especially with T1 tumors, is rare. However, any cervical involvement or distant metastasis discovered on presentation is a poor prognostic indicator.
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: To evaluate the outcome of radiotherapy (RT) for squamous cell carcinoma (SCC) of the nasal skin. Methods and Materials: The charts of 100 patients referred and treated with RT during 1982 to 1993 for SCC of nasal skin were reviewed. Most patients (81%) were treated with orthovoltage X-rays. In general, lesions <2 cm were treated to 35 Gy in 5 fractions. For tumors 2-5 cm, 45 Gy in 10 fractions was commonly used. Lesions >5 cm or those associated with bone or cartilage invasion were typically treated to 50 Gy in 20 fractions. Six patients were lost to follow-up, leaving 94 patients assessable for local or regional failure analysis. Using the UICC staging system, the T stage at first presentation was as follows: T1, 60 patients; T2, 11 patients; T3, 0 patients, T4, 7 patients; TX, 16 patients. Only 1 patient had regional lymph node disease at presentation. Thirty-one patients were treated with surgery, followed by RT. Sixty-three patients were treated with primary RT. Results: The local relapse-free rate was 90% and 85% at 2 and 5 years, respectively. The actuarial 2 and 5-year overall survival rate was 75% and 51%, respectively. The cause-specific survival was 96% at both 2 and 5 years. No Radiation Therapy Oncology Group Grade 4 toxicities occurred. Univariate analysis could not identify any patient, tumor, or treatment factors that were statistically significant prognosticators. Conclusion: RT for SCC of nasal skin achieves excellent outcome, is well tolerated, and should continue to be recommended in the management of this disease.
Squamous cell carcinoma of the nasal vestibule and anterior nasal passages
American Journal of Otolaryngology, 1994
Objectives: Squamous cell carcinoma of nasal vestibule and pyramid is rare, thus classification, treatment protocol, and indications for elective neck treatment are still controversial. Nasal reconstruction is challenging, as well, and prosthesis is still used. Study Design: Retrospective cohort study. Methods: Retrospective review of patients surgically treated from 2010 to 2018 in a single Institution. Advanced tumors were further treated with adjuvant irradiation. Reconstruction strategy included grafts, locoregional and free flaps, and was customized on layers removed. Results: Forty-five patients were enrolled. The 5-year overall survival and disease-free survival were 81.9% AE 7.45% and 61.9% AE 9.09%, respectively. Wang's classification, site of origin, extent of surgery and margins status significantly correlated with prognosis and recurrence rate. Regional recurrences occurred in patients affected by advanced tumors who did not receive any form of elective neck treatment. Conclusion: Multidisciplinary management and a proper reconstructive algorithm are recommended. Adjuvant irradiation and elective neck treatment should be advocated for advanced stage high-risk patients.
Cancer of the Nasal Cavity and Paranasal Sinuses:A Clinico-pathological Study of 277 Patients
Acta Oncologica, 1997
In the period 1963-1991, a total of 277 consecutive patients with malignant tumours of the nasal cavity and paranasal sinuses were treated at Aarhus University Hospital. The major histological types included squamous cell carcinoma (460/0), lymphoma (14%), adenocarcinoma (13%), and malignant melanoma (9%). Kaplan-Meier estimates of 5-year corrected survival (death from cancer) showed the best prognosis for adenoid cystic carcinoma (87%). adenocarcinoma (65%) and lymphoma (56%), and the poorest prognosis for undifferentiated carcinoma (17%) and malignant melanoma (24%). The 5-year corrected survival for squamous cell carcinoma was 35%. Of the 180 patients with treatment failure. the vast majority occurred locally (n = 166); a minor proportion was regional (n = 23) or distant (n = 30). For the 195 patients with carcinoma, the following parameters were of statistical prognostic significance (5-year corrected survival): histological differentiation (moderate-well 65% vs. poor 22%1), primary T-site (nasal cavity 56% vs. maxillary antrum 39%) vs. other sinuses 24%1), tumour stage (T2 68% vs. T3 37"% vs. T4 29'%), nodal stage (NO 48% vs. NI-3 21u/), treatment (radiotherapy + surgery 56% vs. radiation alone 35%).
Lymph node metastasis in maxillary sinus carcinoma
International Journal of Radiation Oncology Biology Physics, 2000
Purpose: To evaluate the incidence and prognostic significance of lymph node metastasis in maxillary sinus carcinoma.Methods and Materials: We reviewed the records of 97 patients treated for maxillary sinus carcinoma with radiotherapy at Stanford University and at the University of California, San Francisco between 1959 and 1996. Fifty-eight patients had squamous cell carcinoma (SCC), 4 had adenocarcinoma (ADE), 16 had undifferentiated carcinoma (UC), and 19 had adenoid cystic carcinoma (AC). Eight patients had T2, 36 had T3, and 53 had T4 tumors according to the 1997 AJCC staging system. Eleven patients had nodal involvement at diagnosis: 9 with SCC, 1 with UC, and 1 with AC. The most common sites of nodal involvement were ipsilateral level 1 and 2 lymph nodes. Thirty-six patients were treated with definitive radiotherapy alone, and 61 received a combination of surgical and radiation treatment. Thirty-six patients had neck irradiation, 25 of whom received elective neck irradiation (ENI) for N0 necks. The median follow-up for alive patients was 78 months.Results: The median survival for all patients was 22 months (range: 2.4–356 months). The 5- and 10-year actuarial survivals were 34% and 31%, respectively. Ten patients relapsed in the neck, with a 5-year actuarial risk of nodal relapse of 12%. The 5-year risk of neck relapse was 14% for SCC, 25% for ADE, and 7% for both UC and ACC. The overall risk of nodal involvement at either diagnosis or on follow-up was 28% for SCC, 25% for ADE, 12% for UC, and 10% for AC. All patients with nodal involvement had T3–4, and none had T2 tumors. ENI effectively prevented nodal relapse in patients with SCC and N0 neck; the 5-year actuarial risk of nodal relapse was 20% for patients without ENI and 0% for those with elective neck therapy. There was no correlation between neck relapse and primary tumor control or tumor extension into areas containing a rich lymphatic network. The most common sites of nodal relapse were in the ipsilateral level 1–2 nodal regions (11/13). Patients with nodal relapse had a significantly higher risk of distant metastasis on both univariate (p = 0.02) and multivariate analysis (hazard ratio = 4.5, p = 0.006). The 5-year actuarial risk of distant relapse was 29% for patients with neck control versus 81% for patients with neck failure. There was also a trend for decreased survival with nodal relapse. The 5-year actuarial survival was 37% for patients with neck control and 0% for patients with neck relapse.Conclusion: The overall incidence of lymph node involvement at diagnosis in patients with maxillary sinus carcinoma was 9%. Following treatment, the 5-year risk of nodal relapse was 12%. SCC histology was associated with a high incidence of initial nodal involvement and nodal relapse. None of the patients presenting with SCC histology and N0 necks had nodal relapse after elective neck irradiation. Patients who had nodal relapse had a higher risk of distant metastasis and poorer survival. Therefore, our present policy is to consider elective neck irradiation in patients with T3–4 SCC of the maxillary sinus.
Outcome in squamous cell carcinoma of the nasal vestibule: A single center experience
Head & Neck, 2014
Background. The purpose of this study was to analyze the outcome of squamous cell carcinomas (SCCs) of the nasal vestibule and to identify factors predicting recurrence. Methods. All patients treated between 1995 and 2012 were included in this study. Outcome was analyzed with respect to modality of therapy, age, sex, tobacco consumption, staging, surgical margins, and histological differentiation pattern. Results. Thirty patients were included. Fourteen patients (47%) were found with T4, 1 patient (3%) with T3, 7 patients (23%) with T2, and 8 patients (27%) with T1 disease. Twenty-one patients (70%) were treated surgically. Six patients (29%) needed postoperative radiation because of insufficient surgical margins. Radiation was the first-line treatment in 9 patients (30%). Surgically treated patients with surgical margins <3 mm had significantly more locoregional recurrence compared to those with sufficient resections. Conclusion. Advanced T4 carcinomas show a high recurrence rate. Insufficient surgical margins are the main predictor for a locoregional recurrence and should be avoided.
Carcinoma of the nasal cavity and paranasal sinuses
Clinical Otolaryngology, 1980
Objective. To evaluate the treatment outcome for sino-nasal carcinomas in Denmark from 1995-2004 and compare the results to the previous Danish survey covering [1982][1983][1984][1985][1986][1987][1988][1989][1990][1991]. Design. Retrospective follow-up. Materials and methods. In the fi ve Danish head and neck oncology centres, charts of all consecutive patients with sino-nasal carcinomas were reviewed and data extracted to a common database. Altogether 242 patients from the period 1995-2004 were identifi ed. Of these 162 (67%) were male and 80 (33%) female. Histologies included squamous cell carcinoma (55%), adenocarcinoma (28.5%), adenoid-cystic carcinoma (5.0%), undifferentiated carcinoma (4.5%), transitiocellular carcinoma (1.7%), mucoepidermoid carcinoma (0.8%), neuroendocrine carcinoma (2.5%), small cell carcinomas (1.2%) and carcinomas not otherwise specifi ed (0.8%). Treatments included radiotherapy alone 79 (33%), surgery alone 29 (12%), combined surgery and radiotherapy 96 (40%), palliative/no treatment 38 (16%). A total of 204 (86%) patients were treated with curative intent. Results. Of the 204 patients treated with curative intent, 94 (46%) relapsed. Most failures were in T-site (63, 30%). N-site failures were 10 (5%) and M-site failures six (3%). Failure occurring in TϩN-site, TϩM-site, NϩM-site and TϩNϩM-site were seven (3%), two (1%), one (0.5%) and fi ve (3%) respectively. The 5-year actuarial local, nodal and loco-regional control rates were 55Ϯ4%, 86Ϯ3%, 49Ϯ4%, respectively. The overall 5-year actuarial survival rate for the entire cohort was 47Ϯ3%, and the corresponding cancer-specifi c 5-year actuarial survival rate was 57Ϯ3%. Female gender, nasal cavity tumour, adenocarcinoma and low clinical stage were signifi cant positive prognostic factors in univariate analysis. A Cox multivariate analysis showed that only tumour site and clinical stage were independent signifi cant prognostic factors. Conclusion. The current series has confi rmed stage and tumour site as independent prognostic factors. Compared to the previous Danish survey covering the period 1982-1991, the overall survival and cancer-specifi c survival rates have improved signifi cantly. Acta Oncol Downloaded from informahealthcare.com by 61.186.136.199 on 05/20/14 For personal use only.