Int. ,L Oral Maxillofac. Surg. 1994; 23:317-318 Printed in Denmark. All rights reserved

Copyright © Munksgaard 1994

International Journal of

Oral & MaxilIofacial Surgery

ISSN 0901-5027

Abstracts from international literature

Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor

c. R. Leemans, R. Tiwari, J. J. P. Nauta, h van der Waal, G. B. Snow Cancer 1994: 73:187-90

The biologic aggressiveness of head and neck carcinoma is shown by its capa- bility to metastasize to regional lymph nodes and its propensity to recur after treatment. The authors report on 244 patients treated at the Department of Otolaryngology and Head and Neck Surgery of the Free University Hospi- tal, Amsterdam, The Netherlands, with excision of primary tumor with inconti- nuity neck dissection, with or without postoperative radiation therapy, be- tween January 1973 and July 1986. All patients had surgical margins free of tumor. The overall recurrence rate was 12.3%. Stages T3-4 and the presence of more than three positive nodes on histopathologic examination were as- sociated with a 16.2% and 26.2% inci- dence in recurrence at the primary site, respectively. No prognostic influence arose from primary tumor localization, three or fewer positive nodes, extra- nodal spread, and postoperative radi- ation therapy. Patients with stages T3-4 disease and those with more than three positive lymph nodes may benefit from novel adjuvant treatment modalities.

H. TIDEMAN

Radiotherapy for adenoid cystic carcinoma of the palate

W. F. Regine, W. M. Mendenhall, d. T. Parsons, S. P. Stringer, N. J. Cassisi, R. R. Million Head Neck 1993: 15:241-4

This paper analyzed 16 patients with

adenoid cystic carcinoma of the palate who were treated with curative intent by radiotherapy alone (9) or surgery and radiotherapy (7). No patient received adjuvant chemotherapy. Follow-up ranged from 3 to 19 years, 69% of the patients having follow-up of more than 5 years. Two patients in the radio- therapy alone group developed local re- currence, and both had long-term sur- gical salvage. No local failures were seen in the combined therapy group. Twelve patients (75%) were alive and disease-free at the end of the study. Two patients died from distant disease, one within each treatment group. One pa- tient in the combined therapy group was alive at 8 years with distant meta- stases, while one in the radiotherapy alone group died of intercurrent disease at 12 years. No significant compli- cations were seen in either treatment group. The role of radiotherapy in the treatment of adenoid cystic carcinoma of the palate is reviewed.

H. TIDEMAN

Epidermoid carcinoma of the oral cavity and oropharynx: validity of the current AJCC staging system and new statistical tools for the prediction of subclinical neck disease

A. F. Ghouri, R. L. Zamora, J. E. Harvey, E. L. Spitznagel, D. G. Sessions Otolaryngol Head Neck Surg 1993: 108: 225-32

The 1983 and 1988 AJCC T- and N-sta- ging systems were compared through the case records of 531 patients with primary epidermoid malignancies of the oral cavity. All patients had a mini- mum follow-up of 5 years. There were 390 patients with early stage (T1, T2) disease and t41 with advanced stage (T3, T4) lesions according to both the

1983 and 1988 T-definitions: 342 pa- tients manifested no clinical nodes (NO), 189 had clinically evident nodes (NI-N3), and none had metastatic dis- ease. Cox regression analysis showed that the 1983/1988 T-stage definitions differentiated survival successfully (P<0.001). The 1988 staging system for nodal disease showed a highly signifi- cant separation of N2 and N3, in con- trast to the 1983 system (P<0.001). Of the 342 patients who were staged N0, 154 had primary neck dissection. Logis- tic regression predicted the incidence of subclinical disease according to the site and the T-stage of the primary tumor with a sensitivity of 78% and a speci- ficity of 95%. It was concluded that the t988 N-stage definition is a better prog- nosticator of survival than the 1983 definition. Furthermore, a logistic re- gression model can be used to predict the probability of subclinical disease in primary oral cavity cancers.

H. TIDEMAN

Reduction of the number of neck treatments in patients with head and neck cancer

R. J. Baatenburg de Jong, P. Knegt, C. D. A. Verwoerd Cancer 1993: 71:2312-18

With modern diagnostic imaging methods, the head and neck oncologist is faced with increasing information on the status of neck nodes of patients with head and neck cancer. It is often difficult to include this new diagnostic information in clinical management be- cause strategies of neck treatment date from times when only clinical examin- ation was available. Computed tomo- graphy, magnetic resonance imaging, and ultrasonography (US) may provide information on the status of neck nodes. In University Hospital Leiden and University Hospital Rotterdam, The Netherlands, US of the neck, when

318

combined with ultrasonographic fine- needle aspiration biopsy (US- UGFNAB), has proved to be an accu- rate diagnostic test for nodal disease. The combined procedure is character- ized by high sensitivity and specificity. Therefore, this method is suitable for detecting, verifying, and excluding no- dal metastases. This paper discusses

how to interpret the new diagnostic in- formation supplied by US-UGFNAB. A different approach in the clinical management of the neck, based on methods from the field of clinical de- cision analysis, is presented. It is con- cluded that US-UGFNAB is a promis- ing combination of cytologic examin- ation and an imaging method in the

examination of patients with squamous cell carcinoma of the upper aerodiges- tive tract. Application of the test may produce an accurate classification of patients with a head and neck tumor and change indications for elective and therapeutic neck treatment.

H. TIDEMAN

Book review C. SCULLY, R. A. CAWSON. Medical

problems in dentistry. 3rd ed. Wright, 1993. 603 pages, black-and-white il- lustrations. Price £30.

The first and second editions of this ex- cellent book were written before the global impact of HIV infection and AIDS. The second edition included "new" systemic diseases, such as AIDS, Legionnaires' disease, Lyme disease, and the MAGIC syndrome, and "new" oral complications of drug therapy. The third edition has taken into consider- ation the influence of HIV infection, viral hepatitis, and other infections such as endocarditis, together with the medicolegal ramifications of dental treatment, and the text has been up- dated accordingly.

Like the previous editions, this edi- tion is clearly and concisely written.

The desired information is easily found thanks to good indexing and careful attention to layout. The many tables en- hance the text and act as a ready refer- ence, although some expansion may be warranted; e.g., Table 2.4 includes li- chenoid drug reactions associated with beta-blockers, but not with angio- tensin-converting enzyme inhibitors, and Table 16.9 does not include non- Hodgkin's lymphoma as an oral mani- festation of HIV infection. In relation to the latter example, lymphomas are mentioned briefly in the text. Recently, HI¥-associated gingivitis and HIV- associated periodontitis have been placed (with alterations in terminology) in the group of oral lesions strongly as- sociated with HIV infection by the EC Clearinghouse on oral problems related to HIV infection and by the WHO col- laborating center on oral manifes-

tations of HIM and this should be re- flected in any further editions.

With the slight change of direction this edition has taken, some of the areas which needed to be emphasized have been taken into account, but there is still a need for some subjects to be dealt with more fully. In particular, the section on infection control should be expanded to include, for example, issues such as re- sheathing of needles, surgery organiza- tion, and zones of contamination.

This edition serves both as a most useful textbook and as a reference guide. It is hard-bound and suitable for both undergraduate and postgraduate students, as well as private dental prac- titioners and hospital dental employees. It is highly recommended as a compen- dium that all dental practitioners will benefit from having readily available.

P READE