Anthony Clifford

Tumor thickness influences prognosis of T1 and T2 oral cavity cancer—but what thickness?

Previous studies have demonstrated that tumor thickness might influence prognosis in oral cancer, but the significant point at which outcome changes has varied from 1.5 mm to 6 mm. The clinical relevance of thickness remains unclear, and a reproducible prognostic “breakpoint” needs to be defined.

Implications for Clinical Staging of Metastatic Cutaneous Squamous Carcinoma of the Head and Neck Based on a Multicenter Study of Treatment Outcomes

Cutaneous squamous cell carcinoma (SCC) of the head and neck is a common cancer that has the potential to metastasize to lymph nodes in the parotid gland and neck. Previous studies have highlighted limitations with the current TNM staging system for metastatic skin carcinoma. The aim of this study was to test a new staging system that may provide better discrimination between patient groups.

Outcomes of primary surgical treatment of T1 and T2 carcinomas of the oropharynx

Oropharyngeal cancers represent 10%–15% of all head and neck cancers. At presentation 60%–70% will have advanced‐stage disease with a high incidence of neck metastases. Primary treatment employing radiotherapy, with or without chemotherapy, is widely prescribed. The aim of this study is to analyze the outcome of definitive surgical management of T1–T2 cancers of the oropharynx.

Influence of bone invasion and extent of mandibular resection on local control of cancers of the oral cavity and oropharynx.

The aim of this paper was to evaluate the influence of bone invasion on treatment outcome among patients with cancers of the oral cavity and oropharynx and to determine whether or not outcome was influenced by the extent of mandibular resection. A review of 127 prospectively documented patients who were treated with marginal or segmental resection for oral (n = 110) and oropharyngeal (n = 17) cancers was undertaken. There were 97 males and 30 females with a median age of 61 years. Clinical T stages were: T1 17 patients, T2 33, T3 22, T4 55. Median followup was 4 years. A total of 94 patients underwent marginal resections and 33 underwent segmental resections. Histological bone invasion was present in 17 patients (16%) in the marginal resection group and 21 patients (64%) in the segmental group (P<0.05). Soft tissue surgical margins were positive in 11 patients (12%) in the marginal group and in seven patients (21%) in the segmental group (P=not significant). Local control did not correlate significantly with T stage, the extent of mandibular resection or the presence of histological bone invasion, but was significantly influenced by positive soft tissue margins (P<0.01). Among patients with bone invasion, the local control rate was higher following segmental resection when compared to marginal resections (87% vs 75%) but this was not statistically significant. Survival was significantly influenced by positive soft tissue margins but not bone invasion or the type of resection. We conclude that bone invasion alone did not predict for local control or survival rates among patients with oral and oropharyngeal cancers. Involved soft tissue margins were highly predictive of local recurrence and decreased survival. Conservative resection of the mandible is safe as long as marginal mandibulectomy does not lead to compromise of soft tissue margins. Segmental resection should be reserved for patients extensive bone invasion or those with limited invasion in a thin atrophic mandible.

Outcome of treatment for advanced cervical metastatic squamous cell carcinoma

Patients with advanced cervical metastases from mucosal squamous cell carcinoma have a poor prognosis because of their high risk of regional and distal failure. This study aims to evaluate the outcomes of patients with clinical N2 or N3 disease managed with surgery and postoperative radiotherapy.

Clinical outcome following total laryngectomy for cancer

Background:  Patients with advanced cancers of the larynx and hypopharynx have been treated with total laryngectomy at the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney in the past. Increasingly, these patients are being managed with organ‐sparing protocols using chemotherapy and radiotherapy. The aim of the present study was to review complication, recurrence and survival rates following total laryngectomy.

ACCURACY OF POSITRON EMISSION TOMOGRAPHY IN THE EVALUATION OF PATIENTS TREATED WITH CHEMORADIOTHERAPY FOR MUCOSAL HEAD AND NECK CANCER

The aim of this study was to evaluate the accuracy of positron emission tomography (PET) in assessing the patients treated with primary chemoradiotherapy for mucosal carcinoma of the head and neck.

Orbital exenterations: an 18-year experience from a single head and neck unit.

Background:  To review the outcomes of the patients who undergo orbital exenteration for malignancy.

Life-threatening anaphylactoid reaction to amifostine used with concurrent chemoradiotherapy for nasopharyngeal cancer in a patient with dermatomyositis: a case report with literature review.

Dermatomyositis is associated with malignancy in approximately 20–25% of cases. The most common associated cancers are ovarian, lung, pancreatic, stomach, colon and non-Hodgkins lymphoma. Nasopharyngeal cancer is not common in the Caucasian population; however, there is a much higher incidence in Asian patients. Radiotherapy is the mainstay of treatment for early nasopharyngeal cancer, but combination chemoradiotherapy is becoming more common for patients with advanced disease since the Intergroup trial 0099 demonstrated improved progression-free survival and overall survival for chemoradiotherapy. Increasingly, the cytotoxic agent amifostine is being used prior to radiotherapy in an attempt to decrease associated morbidities. Amifostine has been found to significantly decrease acute and chronic xerostomia but not mucositis. It appears to be selectively protective to salivary glands and kidneys without being tumor protective. The most common side effects associated with amifostine are nausea, vomiting, hypotension, hypocalcemia and allergic reactions. We describe the case of a man with dermatomyositis and stage IV nasopharyngeal cancer treated with chemoradiotherapy and s.c. amifostine. The patient suffered a life-threatening anaphylactoid reaction to amifostine.

Perineural invasion in oral squamous cell carcinoma: Quantitative subcategorisation of perineural invasion and prognostication

Evidence regarding the prognostic value of perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) and whether PNI alone warrants consideration of adjuvant therapy is controversial. We evaluated whether histopathological sub‐categorization of PNI improves risk stratification.