Pään ja kaulan alueen levyepiteelisyövän levinneisyyden kartoittaminen

For optimal treatment planning, a thorough assessment of the metastatic status of mucosal squamous cell carcinoma of the head and neck (HNSCC) is required. Current imaging methods do not allow the recognition of all patients with metastatic disease. Therefore, elective treatment of the cervical lymph nodes is usually given to patients in whom the risk of subclinical metastasis is estimated to exceed 15-20%. The objective of this study was to improve the pre-treatment evaluation of patients diagnosed with HNSCC. Particularly, we aimed at improving the identification of patients who will benefit from elective neck treatment. Computed tomography (CT) of the chest and abdomen was performed prospectively for 100 patients diagnosed with HNSCC. The findings were analysed to clarify the indications for this examination in this patient group. CT of the chest influenced the treatment approach in 3% of patients, while CT of the abdomen did not reveal any significant findings. Our results suggest that CT of the chest and abdomen is not indicated routinely for patients with newly diagnosed HNSCC but can be considered in selected cases. Retrospective analysis of 80 patients treated for early stage squamous cell carcinoma of the oral tongue was performed to investigate the potential benefits of elective neck treatment and to examine whether histopathological features of the primary tumour could be used in the prediction of occult metastases, local recurrence, or/and poor survival. Patients who had received elective neck treatment had significantly fewer cervical recurrences during the follow-up when compared to those who only had close observation of the cervical lymph nodes. Elective neck treatment did not result in survival benefit, however. Of the histopathological parameters examined, depth of infiltration and pT-category (representing tumour diameter) predicted occult cervical metastasis, but only the pT-category predicted local recurrence. Depth of infiltration can be used in the identification of at risk patients but no clear cut-off value separating high-risk and low-risk patients was found. None of the histopathological parameters examined predicted survival. Sentinel lymph node (SLN) biopsy was studied as a means of diagnosing patients with subclinical cervical metastases. SLN biopsy was applied to 46 patients who underwent elective neck dissection for oral squamous cell carcinoma. In addition, SLN biopsy was applied to 13 patients with small oral cavity tumours who were not intended to undergo elective neck dissection because of low risk of occult metastasis. The sensitivity of SLN biopsy for finding subclinical cervical metastases was found to be 67%, when SLN status was compared to the metastatic status of the rest of the neck dissection specimen. Of the patients not planned to have elective neck dissection, SLN biopsy revealed cervical metastasis in 15% of the patients. Our results suggest that SLN biopsy can not yet entirely replace elective neck dissection in the treatment of oral cancer, but it seems beneficial for patients with low risk of metastasis who are not intended for elective neck treatment according to current treatment protocols.Pään ja kaulan alueen limakalvojen levyepiteelisyöpää sairastavilla potilailla on usein etäpesäkkeitä kaulan imusolmukkeissa jo taudin varhaisessa vaiheessa. Oikean hoidon valintaa vaikeuttaa usein se, että nykyisillä kuvantamismenetelmillä kaikkia pieniä etäpesäkkeitä ei ole mahdollista havaita. Sen vuoksi yleinen käytäntö on hoitaa kaulan imusolmukkeet varmuuden vuoksi (nk. elektiivinen hoito), mikäli piilevien etäpesäkkeiden riskin arvioidaan olevan vähintään 15-20%. Tämän tutkimuksen tarkoituksena oli kehittää pään ja kaulan alueen levyepiteelisyöpää sairastavien potilaiden hoitoa edeltävää taudin levinneisyyden kartoittamista. Erityisesti pyrimme parantamaan kaulan imusolmukkeiden arviointia ja kaulan elektiivisen hoidon kohdentamista suuontelon syövässä. Rintakehän ja vatsan tietokonetomografian aiheellisuutta ja hyötyä selvitimme suorittamalla kuvaukset sadalle potilaalle, joilla diagnosoitiin uusi pään ja kaulan alueen levyepiteelisyöpä. Potilaan hoitoon vaikuttava merkittävä löydös todettiin vain 3 potilaalla (3%). Tulostemme perusteella rintakehän ja vatsan tietokonetomografia ei ole aiheellinen kaikilla pään ja kaulan levyepiteelisyöpää sairastavilla potilailla, vaan tutkimuksen tarve on harkittava tapauskohtaisesti. Analysoimalla 80 vuosina 1992-2002 hoidetun potilaan tiedot pyrimme selvittämään, hyötyvätkö varhaisen vaiheen kielisyöpää sairastavat potilaat kaulan imusolmukkeiden elektiivisestä hoidosta. Lisäksi tutkimme, voiko tiettyjä kielikasvaimen histopatologisia piirteitä käyttää etäpesäkkeiden, taudin paikallisen uusiutumisen tai potilaiden eloonjäämisen ennustamisessa. Kaulan elektiivinen hoito vähensi merkitsevästi taudin uusiutumisia kaulan imusolmukkeissa, mutta sillä ei todettu vaikutusta eloonjäämiseen. Kasvaimen suuren infiltraatiosyvyyden (syvyyskasvun) ja suuren läpimitan (suuremman pT-luokan) todettiin ennustavan piileviä etäpesäkkeitä kaulan imusolmukkeissa, mutta vain suurempi läpimitta ennakoi kasvaimen paikallista uusiutumista hoidon jälkeen. Mikään tutkituista histopatologisista tekijöistä ei ennustanut eloonjäämistä. Vartijaimusolmuketutkimuksella on rintasyövässä ja melanoomassa pystytty korvaamaan suuri osa varmuuden vuoksi tehdyistä laajoista imusolmukealueiden leikkauksista ja kohdentamaan laajat leikkaukset niitä todella tarvitseville potilaille. Selvitimme, soveltuuko vartijaimusolmuketutkimus myös suuontelon levyepiteelisyövän hoitoon. Vartijaimusolmuketutkimus tehtiin 46 suusyöpäpotilaalle, joilla etäpesäkkeitä ei kliinisesti ollut todettavissa ja joille nykyisen hoitokäytännön mukaisesti tehtiin kaulan imusolmukkeiden poisto varmuuden vuoksi eli nk. elektiivinen kauladissektio. Vartijaimusolmuketutkimuksen herkkyys piilevien etäpesäkkeiden diagnosoimisessa oli 67%. Lisäksi vartijaimusolmuketutkimus tehtiin 13 suusyöpäpotilaalle, joille elektiivistä kauladissektiota ei tehty vähäiseksi arvioidun etäpesäkkeiden riskin takia. Kahdella näistä potilaista (15%) todettiin vartijaimusolmukkeessa etäpesäke, joka siis olisi nykyisen hoitokäytännön mukaisesti jäänyt alkuvaiheessa hoitamatta ilman vartijaimusolmuketutkimusta. Tulostemme perusteella vartijaimusolmuketutkimus ei voi kokonaan korvata elektiivistä kauladissektiota suusyövän hoidossa, mutta se vaikuttaa hyödylliseltä niille potilaille, joilla etäpesäkkeiden riski on pieni ja joille ei sen vuoksi suunnitella elektiivistä kauladissektiota

Kauladissektiot syövän hoidossa

English summar

Kun kilpirauhassyöpä ei paranekaan - erilaistuneen syövän hoito

English summaryPeer reviewe

Reply to "Do not de-escalate oncology care in oropharyngeal cancer routinely"

Non peer reviewe

Hypopharyngeal carcinoma in Finland from 2005 to 2014 : outcome remains poor after major changes in treatment

Purpose Hypopharyngeal carcinoma (HPC) is typically diagnosed at late stages, the patients tend to have serious co-morbidities, distant relapses are frequent, and the related mortality remains high. The treatment paradigm of HPC has remarkably changed from primary surgical approach toward definitive, platinum-based concomitant chemoradiotherapy (CRT). Our aim was to analyze the HPC treatment approaches and outcome in a nationwide series and to make a comparison with a previously published corresponding nationwide patient cohort from the period 1990-1999. Methods We retrospectively reviewed all patients diagnosed with HPC at the five university hospitals in Finland between 2005 and 2014. Results The cohort comprised 231 patients. Treatment with curative intent was offered for 175 (76%) patients and consisted of definitive radiotherapy (RT) or CRT in 156 (89%) patients, while 20 (11%) patients had primary surgery with or without adjuvant RT or CRT. The 5-year estimates for overall survival (OS) and disease specific survival (DSS) for the whole study group were 22.7% and 36.5%, respectively. For patients treated with curative intent, the 5-year estimates for OS and DSS were 29.4% and 44.3%, respectively. Conclusions The treatment approach of HPC in Finland has changed thoroughly, as in the 1990s, 63% of HPC patients with curative treatment intent underwent primary surgery with or without RT, while in the current study, the primary treatment approach was non-surgical in 89% of the patients. However, the survival figures have not changed and remain dismal, but most of the few surviving patients now can retain their larynx.Peer reviewe

Hypopharyngeal carcinoma in Finland from 2005 to 2014: outcome remains poor after major changes in treatment

Purpose Hypopharyngeal carcinoma (HPC) is typically diagnosed at late stages, the patients tend to have serious co-morbidities, distant relapses are frequent, and the related mortality remains high. The treatment paradigm of HPC has remarkably changed from primary surgical approach toward definitive, platinum-based concomitant chemoradiotherapy (CRT). Our aim was to analyze the HPC treatment approaches and outcome in a nationwide series and to make a comparison with a previously published corresponding nationwide patient cohort from the period 1990-1999. Methods We retrospectively reviewed all patients diagnosed with HPC at the five university hospitals in Finland between 2005 and 2014. Results The cohort comprised 231 patients. Treatment with curative intent was offered for 175 (76%) patients and consisted of definitive radiotherapy (RT) or CRT in 156 (89%) patients, while 20 (11%) patients had primary surgery with or without adjuvant RT or CRT. The 5-year estimates for overall survival (OS) and disease specific survival (DSS) for the whole study group were 22.7% and 36.5%, respectively. For patients treated with curative intent, the 5-year estimates for OS and DSS were 29.4% and 44.3%, respectively. Conclusions The treatment approach of HPC in Finland has changed thoroughly, as in the 1990s, 63% of HPC patients with curative treatment intent underwent primary surgery with or without RT, while in the current study, the primary treatment approach was non-surgical in 89% of the patients. However, the survival figures have not changed and remain dismal, but most of the few surviving patients now can retain their larynx.</p

Transoral Robotic Surgery in the Nordic Countries : Current Status and Perspectives

Background: The five Nordic countries with a population of 27 M people form a rather homogenous region in terms of health care. The management of head and neck cancer is centralized to the 21 university hospitals in these countries. Our aim was to gain an overview of the volume and role of transoral robotic surgery (TORS) and to evaluate the need to centralize it in this area as the field is rapidly developing. Materials and Methods: A structured questionnaire was sent to all 10 Departments of Otorhinolaryngology-Head and Neck Surgery in the Nordic countries having an active programme for TORS in December 2017. Results: The total cumulative number of performed robotic surgeries at these 10 Nordic centers was 528 and varied between 5 and 240 per center. The median annual number of robotic surgeries was 38 (range, 5-60). The observed number of annually operated cases remained fairly low ( Conclusions: The present results showing a limited volume of performed surgeries call for considerations to further centralize TORS in the Nordic countries.Peer reviewe