TNM Staging of Cancers of the Head and Neck: Striving for Uniformity Among Diversity

Patel, Snehal G.; Shah, Jatin P.

doi:10.3322/canjclin.55.4.242

Cited by 308 publications

(224 citation statements)

References 20 publications

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“…According to the new TNM classification for head and neck cancer updated in 2010 by the American Joint Committee for Cancer (AJCC) and the Union Internationale Contre le Cancer (UICC), this category includes neoplasms classified as T1aN0M0, T1bN0M0 (stage I), and T2N0M0 (stage II) [2][3][4]. As promoted by guidelines and medical evidence [5,6], early glottic cancer can be treated either with curative radiotherapy (RT) or with surgery, guaranteeing a comparable overall survival.…”

Section: Introductionmentioning

confidence: 99%

Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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After failure of curative radiotherapy (RT), surgery is the main therapeutic option to control recurrent laryngeal cancer. Recurrences after RT for T1-T2 tumours of the glottic larynx are often diagnosed at a more severe stage than the original disease and, thus, usually treated by radical approaches. Our aim is to investigate the feasibility of more conservative strategies for proper treatment of post-RT recurred glottic cancer. We collected and reviewed our files from 1990 to 2006, selecting 75 patients which matched the following inclusion criteria: (1) patient was originally diagnosed with early stage squamous cell carcinoma of the glottic larynx (stage I-II according to 2010 TNM), (2) patient was treated by RT with curative intent, (3) patient presented a recurrence of disease after RT which was surgically treated at our Institution. T stage at first diagnosis was T1a in 41 cases (55 %), T1b in 12 (16 %) and T2 in 22 (29 %). At clinical examination of RT-recurred lesions, we documented advanced lesions (rT3-rT4) in 29 out of 75 patients (39 %). Overall, an upstage was reported for 56 % RT-recurred cancers, while 37.3 % remained at the same stage than the original tumour and 6.7 % were downstaged. Twelve patients (16 %) underwent salvage partial laryngectomy (SPL), while 63 (84 %) received a salvage total laryngectomy (STL). Multivariate analysis showed that rTNM according to the AJCC-UICC of 2010 was the only prognostic factor for both disease-free survival (p = 0.042) and overall survival (p = 0.004). Considering the prognostic impact of rT and rN we documented a statistical significance only in terms of overall survival for both factors (p = 0.004 and p = 0.04, respectively). Although STL remains the most frequent treatment choice for failures after RT in laryngeal carcinomas, SPL represents a valid option for selected patients with limited recurrence and can deliver good oncologic and functional results if performed according to careful indications.

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Section: Introductionmentioning

confidence: 99%

Surgical options in radiotherapy-failed early glottic cancer

Santoro

Meccariello

Mannelli

et al. 2013

Eur Arch Otorhinolaryngol

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“…Squamous cell carcinoma is the most common head and neck cancer (Patel and Shah, 2005). SCC has a focal invasion and its behavior depends on the region that it originates.…”

Section: Introductionmentioning

confidence: 99%

HER2/neu Expression in Head and Neck Squamous Cell Carcinoma Patients is not Significantly Elevated

Sardari¹,

Pardis²,

Andisheh-Tadbir³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Background: HER2/neu, a member of EGFR family, is over expressed in some tumors .The purpose of this study was to determine the salivary level and tissue expression of HER2/neu in patients with head and neck squamous cell carcinoma (HNSCC) and any correlation with clinicopathologic parameters. Methods: An enzymelinked immunosorbent assay (ELISA) was used to evaluate the salivary level and immunohistochemistry (IHC) to assess tissue expression of HER2/neu in 28 patients with HNSCC and 25 healthy controls. Results: The salivary levels of HER2/neu in HNSCC patients was not significantly higher than in the healthy controls (p>0.005). There was no apparent correlation in salivary HER2/neu level with clinicopathological features such as age, sex, grade, tumor size and nodal status. All HNSCC specimens were positive (membranous or/and cytoplasmic) for HER2/ neu, except one sample. Only one HNSCC specimen was stained in cytoplasm purely. All control specimens were membranous and cytoplasmic positive for HER2/neu. There was a significant difference between cytoplasmic staining in case and control groups (p-value<0.05). Conclusion: In our cases, no overexpression of HER2/neu was observed. Thus, our findings suggested that the use of Her-2 as a salivary marker of HNSCC cannot be recommended.

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“…Staging, which can be defined as the quantification of the clinical parameters of the disease, helps in making therapeutic decisions and in establishing a prognosis for the patient. [1][2][3]5,6 The TNM system classifies the anatomical extent of the disease in any part of the body, by using clinical observation and histological and surgical complementation, or diagnostic imaging methods.…”

Section: Declaration Of Interestsmentioning

confidence: 99%

Oral cancer staging established by magnetic resonance imaging

et al. 2011

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The aim of this study was to compare clinical staging and magnetic resonance imaging (MRI) staging for oral cancer, and to assess inter-observer agreement between oral and medical radiologists. A total of 10 patients diagnosed with oral cancer were assessed before treatment. A head and neck surgeon performed clinical TNM staging. Two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI scans, without prior knowledge of the clinical staging. They evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N) and grouping by stages. The data were analyzed using the Kappa Index. There was significant agreement (p < 0.05) between the clinical and MRI staging assessments made by one oral radiologist for N stage, and between those made by one medical radiologist for the T and N stages and for the grouping by stages. In the MRI assessment, there was significant agreement among all four observers for both T stage and grouping by stages. For the N stage, there was no significant agreement between one oral radiologist and one medical radiologist or between both medical radiologists. There was significant agreement among the remaining radiologists. There was no agreement between the clinical and MRI staging. These results indicate the importance of using MRI for the diagnosis of oral cancer. Training initiatives and calibration of medical and oral radiologists should be promoted to provide an improved multidisciplinary approach to oral cancer.

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TNM Staging of Cancers of the Head and Neck: Striving for Uniformity Among Diversity

Cited by 308 publications

References 20 publications

Surgical options in radiotherapy-failed early glottic cancer

Surgical options in radiotherapy-failed early glottic cancer

HER2/neu Expression in Head and Neck Squamous Cell Carcinoma Patients is not Significantly Elevated

Oral cancer staging established by magnetic resonance imaging

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