Implications of positive surgical margins

Abstract

The recently concluded Head and Neck Intergroup trial tested the addition of three courses of cis-platinum containing chemotherapy to standard treatment of surgery and postoperative radiotherapy for patients with advanced operable squamous cell carcinoma of the head and neck. Only patients with negative surgical margins were eligible for the trial. One hundred twelve patients with positive surgical margins were dropped from the trial but continued to be followed. These patients received a variety of treatments. Positive surgical margins were most often seen in nonglottic primaries and with increasing frequency as the N stage increased. Patients with positive margins who achieved a complete clinical response to subsequent treatment had a median survival of 33.8 months vs. 9.1 months for those with less than a complete clinical response. The addition of chemotherapy did not significantly alter the median survival of the positive margin patients.

Resection margins and other prognostic factors regarding surgically treated glottic carcinomas

“…Consequently, in the present study, all pathology reports were reviewed and resection margins were considered as positive in cases where invasive carcinoma was present at the border of resection on permanent pathology sections. The incidence of positive resection margins in the head and neck area varies from 3% to 60% [24]. Such a significant variation could be the result of a different interpretation of tumor free margins, as well as a high percentage of locally advanced carcinomas in certain reports [10].…”

Effectiveness of vital staining with iodine solution in reducing local recurrence after resection of dysplastic or malignant oral mucosa

“…It is well accepted that patients demonstrating a positive surgical margin (dysplastic/cancerous epithelium within the surgical margin) have a higher incidence of local recurrence. [3][4][5][6] Previously we showed that vital staining with iodine solution could delineate the precise area of the dysplastic epithelium. 8 The dysplastic and cancerous epithelium was not stained with iodine solution, whereas the surrounding normal non-keratinized mucosa was stained brown-black.…”

“…[1][2][3] It has been shown that failure to achieve a clear surgical margin results in increased risk of local recurrence and a subsequently reduced chance of survival. [3][4][5][6] In oral cancer surgery, intraoperative margin assessment is usually performed using direct inspection and palpation and/or frozen section analysis; however, these methods have limitations in ensuring the complete resection of tumor and mucosal epithelium at a risk of malignancy. Vital staining with iodine solution has been employed intra-operatively with success in determining the extent and precise border of the cancerous/dysplastic epithelium, ensuring complete resection of the tumor at the mucosal surface.…”

Precisely defining high-risk operable head and neck tumors based on rtog #85-03 and #88-24: Targets for postoperative radiochemotherapy?

“…Cases of positive margins in the specimen, but negative margins in the patient, were eligible for randomization and classified as ''close'' (ie, < 5 mm). 3 Patient margins that contained disease rendered that patient ineligible for the subsequent randomized phase of the study. However, these patients were monitored for disease outcome, 4 and this information was used for this re-analysis, even though therapy was not dictated by the protocol.…”