Lymphatic vessel density, nodal metastases, and prognosis in patients with head and neck cancer.

OBJECTIVE: To examine the relationship between intratumoral lymphatic vessel density and clinical and pathological variables in patients with head and neck squamous cell carcinoma. DESIGN: Archived paraffin-embedded biopsy specimens were sectioned and stained with hematoxylin-eosin and anti-LYVE-1 antibody, a highly specific marker for lymphatic endothelium. Tumor grade, infiltrating margin, inflammatory infiltrate, and percentage of tumor necrosis were noted and lymphatic vessel density measured using Chalkley point counting. SETTING: Tertiary care center at a university hospital. PATIENTS: A total of 168 previously untreated patients with advanced squamous cell carcinoma (73, larynx; 62, oropharynx; and 33, hypopharynx) treated with primary radiation (with or without planned neck dissection) and salvage surgery from 1992 to 1999. INTERVENTIONS: Measurement of intratumoral lymphatic vessel density in pretreatment tissue biopsy specimen. MAIN OUTCOME MEASURES: Disease-free and disease-specific survival, tumor occurrence, and nodal status. RESULTS: In patients with laryngeal carcinoma there was a significant relationship between the presence of intratumoral lymphatics and nodal metastases at presentation (P = .02) and poorly differentiated tumor grade (P = .02). Patients with high lymphatic vessel density also had a significantly worse disease-specific survival (P = .03). However, this difference was not significant with multivariate analysis. No significant relationship existed between the presence of intratumoral lymphatics and any of the clinical or pathological variables in oropharyngeal and hypopharyngeal carcinoma. CONCLUSIONS: In this patient sample, the development of intratumoral lymphatics in laryngeal carcinoma, but not in oropharyngeal or hypopharyngeal carcinoma, is associated with a spread of the tumor to regional lymph nodes. Detecting tumor lymphatic vessel proliferation is another step in the understanding of tumor biology, and the targeting of lymphatic growth may be of potential therapeutic benefit in selected patients with head and neck squamous cell carcinoma

Aesthetic and Oncologic Outcome after Microsurgical Reconstruction of Complex Scalp and Forehead Defects after Malignant Tumor Resection: An Algorithm for Treatment

Background: Limited follow-up data on aesthetic outcome and survival after microsurgical reconstruction of complex scalp and forehead defects are available. These data are important to improve reconstruction quality and patient counseling. The purpose of this study was to evaluate surgical, aesthetic, and oncologic outcome of free flap scalp and forehead reconstructions in the patient population of two academic centers. Methods: Retrospective data analysis of patients with a microsurgical reconstruction of the scalp or forehead between January of 1999 and June of 2008 was performed. Aesthetic outcome was assessed on a five-point Likert scale for flap color match, contour, and overall aesthetic result. Results: The group consisted of 84 patients with a mean follow-up time of 27 months (range, 1 to 95 months). Mean defect size was 134 cm(2) (range, 20 to 340 cm2), with 46 percent full-thickness bone defects and 16 percent dura defects. The most commonly used free flaps were latissimus dorsi (n = 34) and anterolateral thigh (n = 24). Total flap failure occurred in five patients (6 percent). Disease-free survival and overall survival rates at 5 years were 57 and 65 percent, respectively. Additional operations for aesthetic reasons were performed in 19 patients (23 percent). Panel scores showed a significant lower satisfaction with reconstruction of defects that were located over the frontal scalp compared with other locations (p = 0.004). Conclusions: Microsurgical reconstruction in complex scalp and forehead defects is a safe procedure. From the authors' experience, they suggest an algorithm for reconstruction of these complex reconstructive defects that will most likely result in the best aesthetic result. (Plast. Reconstr. Surg 126: 460, 2010.