Haan, I.M. de (2013) Incidentie van cervicale lymfekliermetastasen uitgaande van plaveiselcelcarcinomen van de maxilla : Retrospectieve studie naar bet watchful waiting beleid & suggesties vooraanpassing van de Nederlandse Richtlijn 'Mondholte- en Oropharynxcarcinoom'. thesis, Dentistry.
![[img]](https://umcg.studenttheses.ub.rug.nl/style/images/fileicons/text.png) |
Text
Haande.pdf Restricted to Registered users only Download (2MB) |
Abstract
Introduction: The incidence of occult cervical lymph node metastasis caused by squamous cell carcinoma of the maxilla has not been systematically studied in the Netherlands. The current policy on these tumors in the absence of palpable or radiographically visible cervical metastases is 'watchful waiting'. This policy is based on the low risk to the occurrence of occult cervical metastases (less than 20% ). Several studies question this low risk. When the probability of obtaining a regional recurrence is greater than 20%, an elective neck dissection in patients with a clinically negative neck is justified. The aim of this study is to define the incidence of cervical metastasis due to squamous cell carcinoma of the maxilla in the population of the UMCG, VUmc and AvL and to investigate whether elective neck dissection is justified. Patients and methods: This study retrospectively analyzed 41 patients treated at the UMCG for maxillary squamous cell carcinomas in the period 1989-2012. Patients with a doubletumor and patients with a follow-up period less than 2 months were are excluded. Also patients who underwent a neck dissection during the first surgery and who were node positive (eN+) from the start were excluded. The final database is merged with the database of the VUmc and AvL. A total of 112 patients were included of which 96 patients with a clinical negative neck (cNO). Statistical analysis used the Kaplan-Meier method, Log-rank test and Chi-square test. A significance level a of 0.05 is used. Results: The Kaplan-Meier overall survival rate for patients with a cNO neck was 38.8%. In 27.1% of the patients with a cNO neck at the beginning a regional metastasis is determined. No significant association was found between tumor stage T1-T2 or T3-T4 and the development of a regional recurrence (P=0,608). Also no difference (P=0,779) was found in the regional disease free survival rate between patients in which the neck was postoperatively treated with radiotherapy and patients with no neck treatment. Patients with a cNO neck who developed a regional recurrence during the follow up period had a significantly lower life expectancy than patients without development of a regional recurrence. Discussion & Conclusion: This study adds further evidence that there is a need for a change in practice for the management of the cNO neck in squamous cell carcinoma arising in the maxilla. The incidence of regional metastases is well above the limit of 20%. In this study 26 of the 96 patients with a cNO neck at the beginning established a regional recurrence (27 .1%). Because the risk seems to be equivalent, future management of the NO neck for maxillary squamous cell carcinoma should be the same as for squamous cell carcinomas in other oral sites (tongue, floor of the mouth). Therefore an elective selective neck dissection during the initial surgery is recommended for T2, T3 and T4 squamous cell carcinomas of the upper jaw.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Witjes, Dr. M.J.H. kaakchirurg-oncoloog and Afdeling Mondziekten, Kaak- en Aangezichtschirurgie |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:48 |
| Last Modified: | 25 Jun 2020 10:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/960 |
Actions (login required)
 |
View Item |