Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Lanzer, M.
Squamous Cell Cancer of the Head and Neck ¿ a 10 year follow up
Prospective factors and treatment options for patients suffering a squamous cell cancer of the head and neck
[ Dissertation ] Medical University of Graz; 2012. pp. 136
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Reinisch Sabine
- Stammberger Heinz
- Altmetrics:
- Abstract:
- Head and neck cancer is a serious and still growing problem around the world. The increasing incidence of newly diagnosed cancer with the decreasing age of the patients diagnosed, in combination with newly ¿ partly aggressive ¿ therapeutic options, leads to many challenging and unsolved problems. Especially the decision regarding the treatment plan is of outstanding importance. Factors of influence, such as ambition or rejection of the patient as far as for example surgical procedures or radiotherapy are concerned, common physical state of the patient ¿ thinking of the kidney malfunction or blood count, and possibilities as well as limits of chemotherapeutical agents must be considered. What is the pathway for the best treatment plan? What are the factors building the evidence on which more aggressive treatment options are chosen, and how to weigh, whether adjuvant therapy might be a benefit or just an additional burden for the patient? Initially, scientific research in medicine is based either upon the striving for optimization or progress to develop new treatment options, or to improve existing treatment modalities. By analyzing our own treatment decisions we have made for the last 10 years in patients with squamous cell carcinoma of the head and neck, we wanted to evaluate our results and outcomes of our patients and particularly compare the disease free and overall survival of our patients with the outcome of patients described in the Anglo-American literature. The aim of this study was to optimize our treatment modalities, prolong patients survival and - probably most important ¿ reduce patients morbidity. In our results, we were able to conclude various determining variables for survival: 1)It is of outstanding importance, that surgical skills are at highest level to assure negative resection margin whenever possible. Patients not being operated in sano have by far a worse prognosis ¿ even if adjuvant therapies (radiotherapy, chemotherapy or both) are applied. 2)Relationship between excised positive lymph nodes and total number of excised lymph nodes during a neck dissection might play a very important role in future decisions whether adjuvant therapy should be applied or not. The more lymph nodes are not affected with metastatic tumor cells, the better it is for the prognosis. This might be similar to sentinel lymph nodes in other tumor entities. 3)In tumors of the oropharyngeal region and the oral cavity, a bilateral neck dissection is not mandatory in every case, despite the high probability of crossing lymph drainage to the other side. With the exception of tumors bigger than 4cm, infiltration deeper than 4mm, tumor crossing the midline and multiple ipsilateral metastatic lymph nodes, a bilateral neck dissection is not indicated. 4) Radical neck dissection, including excision of the sternocleidomastoid muscle, the jugular vein and the submandibular gland do not lead to better prognosis, despite the high patient morbidity related to this procedure. Instead, combination of selective neck procedures with adjuvant radiotherapy or radio-chemotherapy are effective and tolerated treatment options. Although side effects are known, quality of life is not diminished dramatically. 5) Analog to the literature, we could confirm the negative prognostic factors for overall survival and disease free survival: localization of the tumor in the hypopharyngeal region, size of the tumor and lymph node status ¿ especially if more than one lymph node level is affected. Furthermore the histological factors such as perineural invasion, lymph vessel invasion, blood vessel invasion, conglomerate lymph node and capsule penetration could be unmasked as predictive factors for survival.