Conservative Neck Dissection in Oral Cancer Patients: a 5 Year Retrospective Study in Malaysia

Balasundram, Sathesh; Mustafa, Wan Mahadzir Wan; Ip, Jolene; Adnan, Tassha Hilda; Supramaniam, Premaa

doi:10.7314/apjcp.2012.13.8.4045

Cited by 7 publications

(10 citation statements)

References 41 publications

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“…The results of the present study indicate that superselective IIb preserving neck dissections are technically feasible and oncologically safe procedures when performed as elective prophylactic procedures in select group of patients. Many other studies too have shown similar disease control and survival with selective or super selective neck dissections even in node-positive disease [ 7 , 15 – 23 ].…”

Section: Discussionmentioning

confidence: 93%

Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity

et al. 2018

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BackgroundThe lymphatic spread from the cancers of the oral cavity follows an orderly progression and involvement of lower nodes without involvement of upper nodes and skip metastasis is rare. Selective neck dissections are increasingly being performed for node-positive patients; however, in node-negative patients the options of wait and watch, prophylactic radiotherapy, and prophylactic elective node dissections are debated. Quality of life and shoulder functions are important to choose the appropriate therapeutic modality.Patients and methodsPatients with oral squamous carcinoma with clinically and radiologically negative neck were randomized to IIb preserving superselective neck dissection or conventional supraomohyoid neck dissection. The primary end point of the study was recurrence of disease (clinical or radiological) and shoulder function as demonstrated by the clinical examination and electromyography. The secondary end point was quality of life as measured by the FACT-HN version 4 questionnaire at the end of 1 year follow-up.ResultsThe mean number of lymph node harvested per patient was 25.6 (range 8–85). Of the 32 patients, 3 had histologically positive node in level Ib, one of these patients had single positive node while the remaining two had three positive nodes in level Ib. At median follow-up of 36 months disease-free survival in IIb, sparing group was 83% compared to 91% in control arm, the difference in survival between two groups was statistically not significant (p = 0.694). EMG of the shoulder showed denervation pattern in 45% patients undergoing IIb preserving surgery at 1 month follow-up compared to 95% in conventional surgery group, this recovered in all patients but one at 3 months and 100% recovery was seen at 6 months.ConclusionsThe results of the present study indicate that superselective IIb preserving neck dissections are technically feasible and appear to be oncologically safe procedures when performed as elective prophylactic procedures in highly select group of patients. A significant number of occult metastasis seen in the present study suggests prophylactic dissection to be better than wait and watch policy. Results also show initial higher shoulder morbidity at 1 month in patients undergoing IIb preserving dissections; however, at the end of 1 year recovery is complete and both procedures are comparable.Trial registrationThe trial is registered at clinicaltrials.gov with registration no NCT00847717; registered on February 19, 2009.

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Section: Discussionmentioning

confidence: 93%

Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity

et al. 2018

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“…Kaplan-Meier estimates of the probability for drug survival were used. When significant interactions were detected, post hoc multiple comparisons were made with the use of the Bonferroni's correction in which p!0.008 was considered statistically significant (34). Table 1 shows the patients' baseline characteristics according to the biological agents they received.…”

Section: Discussionmentioning

confidence: 99%

Treatment responses and their predictors in patients with rheumatoid arthritis treated with biological agents

et al. 2013

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Biological agents represent an important advancement in for the treatment of rheumatoid arthritis (RA), but there is a subset of patients who do not improve despite therapy. This study aimed to determine the efficacy of biological agents for RA and to identify clinical factors that are associated with their response. We studied 98 patients with RA who started an initiating biological agent which was selected from infliximab, etanercept, adalimumab and tociliximab at 4 medical institutions. Etanercept was the most frequently used biological agent followed by infliximab although there was a difference in the selection of the biological agents among medical institutions. We found that etanercept achieved the highest treatment response, remission rate and drug survival rate. A high disease activity in the baseline disease activity score-c-reactive protein (CRP) was shown to be a negative predictor of the treatment response, and high patient global assessment was significantly less likely to achieve a good response. At week 4, decreases in 28 swollen joint counts and CRP were useful as predictors for sustaining the efficacy up to week 48. These data demonstrate that assessments of the disease activity at baseline and the early treatment response may be useful in predicting the efficacy and drug survival rate of biological agents.

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“…Although oral cancer is not amongst the global leading cancers as compared to other cancers (GLOBOCAN, 2018: lung cancer, female breast cancer, prostate cancer, colorectal cancer, stomach cancer and liver cancer) [1], the disfigurement and dysfunction of post-treatment of oral cancer affects the basic functional ability and causes problems with social functioning that interferes with patient's daily lives [2][3][4]. As the tongue is the most commonly diagnosed and the mainstay of treatment [5], tongue resection results in impairment of speech, mastication, swallowing and breathing that significantly affect patients' quality of life besides affecting their ability to communicate [4]. Since oral cancer is in the head and neck region, the impact on physical changes of post-treatment is easily noticed.…”

Section: Introductionmentioning

confidence: 99%

Can post-treatment oral cancer patients’ concerns reflect their cancer characteristics, HRQoL, psychological distress level and satisfaction with consultation?

Aminnudin¹,

Doss²,

Ismail³

et al. 2020

ecancer

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Background: Oral cancer and its treatment impact patients' post-treatment outcomes, challenging clinicians to manage them optimally. Addressing patients' concerns is central to holistic patient-centred care. Objectives: This study aimed to determine post-treatment oral cancer patients' concerns and its relationship with patients' clinical characteristics, health-related quality of life (HRQoL), psychological distress and patient satisfaction with the follow-up consultation. Methods: A total of 85 oral cancer patients were recruited from a three-armed pragmatic RCT study on the patient concerns inventory for head and neck cancer (PCI-H&N), which was conducted at six hospital-based oral maxillofacial specialist clinics throughout Malaysia. Malaysians aged 18 years and above and on follow-ups from 1 month to 5 years or more were eligible. Patients completed the PCI-H&N, functional assessment of cancer therapy-H&N v4.0 and Distress Thermometer at pre-consultation and satisfaction questionnaire at post-consultation. The data were analysed descriptively; multiple linear regression and multivariate logistic regression analyses were used to determine possible predictors of patients' HRQoL and psychological distress. Results: 'Recurrence or fear of cancer coming back' (31.8%) was most frequently selected. 43.5% of patients selected >4 concerns. A significantly high number of concerns were associated with patients of '1-month to 1-year post-treatment' (n = 84%; p = 0.001). A significant association existed between 'time after treatment completed' and patients' concerns of 'chewing/eating', 'mouth opening', 'swelling', 'weight', 'ability to perform', 'cancer treatment' and 'supplement/diet-related'. 'Chewing/eating' was predicted for low Research

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Conservative Neck Dissection in Oral Cancer Patients: a 5 Year Retrospective Study in Malaysia

Cited by 7 publications

References 41 publications

Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity

Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity

Treatment responses and their predictors in patients with rheumatoid arthritis treated with biological agents

Can post-treatment oral cancer patients’ concerns reflect their cancer characteristics, HRQoL, psychological distress level and satisfaction with consultation?

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