The role of squamous cell carcinoma antigen in the management of laryngeal and hypopharyngeal cancer

Abstract

Background. The efficacy of squamous cell carcinoma antigen (SCC‐Ag) in laryngeal cancer to predict those patients who will relapse after primary treatment (surgery or radiotherapy) and its utility to detect relapses early and thereby increase salvage rates and cure were assesed. Methods. Sixty healthy donors and 168 patients with laryngeal cancer were included in this prospective trial. Squamous cell carcinoma antigen was measured at diagnosis in all patients, 24 hours and 1 week after surgery in 113 patients and every 10 Gy of administered dose and 2 weeks after treatment in 49 patients primarily referred to radiotherapy. The marker was determined every 3‐6 months during follow‐up. All patients who relapsed had SCC‐Ag studies before and after salvage treatment. Results. The selected cut‐off value was 1.5 ngr/ml (mean value in control group, 0.65 4+ 2 standard deviation [0.38]). Seventy‐eight percent of patients with cancer had elevated SCC‐Ag values at diagnosis. Squamous cell carcinoma antigen was statistically related to TNM categories (T, P < 0.04; N, P < 0.05; Stage, P < 0.01). Seventy‐five percent of those patients with previously elevated pretreatment values normalized after treatment. Incomplete surgical resection (P < 0.0001) or persistence of the disease after radiotherapy (P < 0.01) were related to high posttreatment values. Squamous cell carcinoma antigen was elevated in 88% of the patients who relapsed. In 55% of the recurrences, SCC‐Ag was elevated 3 months before pathologic confirmation of relapse. Salvage by surgery or radiotherapy was effective in 70% of the patients. Squamous cell carcinoma antigen posttreatment values were the most important factor in predicting disease free survival (DFS) (P < 0.0001) and overall survival (P < 0.03). Conclusions. Squamous cell carcinoma antigen is an excellent marker of residual disease after primary treatment that can lead to the addition of other therapeutic procedures (surgery and postoperative radiotherapy). The absence of posttreatment SCC‐Ag is the best predictor of DFS, its presence detects recurrence in early stages, permitting salvage of an increased proportion of patients primarily referred for palliative treatment.

Current concepts of surveillance and its significance in head and neck cancer

“…[7][8][9][10][11][12][13][14][15][16][17][18] There is a wide variation in the strategies for the specific sites. 6,[19][20][21][22][23][24][25][26] There is no evidence to suggest that any follow-up strategy is more efficient in detecting recurrences or improving the quality of life.…”

Immunoassay for Quantifying Squamous Cell Carcinoma Antigen in Serum

“…Consequently, the serum SCCa concentration is used for monitoring various carcinomas, including those of the uterine cervix, lung, skin, head and neck, esophagus, urothelium, anal canal, and vulva (3,(5)(6)(7)(8)(9)(10). For example, serum SCCa was found increased in 72% and 94% of patients with confirmed cervix and lung squamous cell carcinomas, respectively (5,8 ).…”

Co-expression of the Squamous Cell Carcinoma Antigens 1 and 2 in Normal Adult Human Tissues and Squamous Cell Carcinomas

“…Elevated serum SCCA levels are also found in patients with advanced SCCs of the head and neck, lung, and esophagus. In head and neck SCCs, posttreatment SCCA values are the most important factor in predicting disease-free survival as well as overall survival (Lara and Cuyas 1995).…”