Review of early stage Floor of Mouth Squamous Cell Carcinoma; The Glasgow Experience. Manjit Dhillon*, S. Doumas, A. Cooper, S. Farooq, J. McMahon, J. Devine Oral & Maxillofacial Surgery, Southern General Hospital, Glasgow, UK INTRODUCTION
RESULTS
Significant variation exists in the clinical management of early stage floor of mouth (FOM) squamous cell carcinoma (SCC) in terms of primary treatment modality (surgery vs brachytherapy vs radiotherapy), extent of resection (periosteal stripping vs rim resection), management of N0 and contralateral neck in tumours close to or crossing the midline. Our preference is primary radical surgery where indicated for early FOM SCC with elective neck dissection when tumour depth exceeds 3-4mm. We present our experience of managing these cases.
57 cases of FOM SCC were identified
Elective Neck Dissection Male/Female Male
Female
Tumour Size & Depth Range Average Tumour size 0.7-29mm 12.9mm Tumour depth 0.4-15mm 4.6mm
OBJECTIVES The objective of this study is to report the overall and disease-specific survival of a consecutive series of patients presenting with early FOM SCC to Southern General Hospital, Glasgow from 2008-2013 and to examine the clinical, pathological and therapeutic factors relating to these cases.
METHODS Patients were identified from the departmental Head & Neck cancer database. Data was collected retrospectively using electronic patient records. 57 consecutive cases of clinically & radiologically T1-T2, N0 SCC were identified from the cancer database between 2008-2013. All patients were previously untreated, and underwent primary curative surgery.
Exclusion Criteria •Non-SCC pathology •Recurrent disease •Synchronous tumours •Cases with incomplete data •Patients unfit for surgery
Raw data was analyzed using Excel, SPSS & Medcalc.
56 cases
pT Stage pT1 N0
pT2 N0
Rim Resection Tumours within 1cm of the resection margin underwent marginal mandibulectomy (46%) to ensure an oncologically safe margin. No patients underwent periosteal stripping. Histopathologically, no cases revealed frank bony invasion, and 1 case demonstrated cortical erosion only.
Average follow-up time was 37.4 months. For Stage 1 & Stage 2 disease Kaplan Meier Survival curves revealed the disease specific survival to be 97.5% & 77.8% and overall survival 92.5% & 77.8% respectively.
Elective Neck Dissection N=38 (68%)
pN+ N=9 (24%)
PORT N=8 (89%)
OS= 63%
No Neck Dissection N=18 (32%)
pNN=29 (76%)
No PORT N=1 (11%)
OS=100%
No PORT N=17 (94%)
OS=93%
OS=94%
PORT N=1 (6%)
OS=0%
Margin Status n=57 46 (81%) 9 (16%) 2 (3%)
21%
79%
Data on neck management was available for 56 cases. 13.5% of pT1 & 25% of pT2 were upstaged to Stage 3 or 4 due to pN+.
