Fadime Akman

Prognostic factors in lung cancer with brain metastasis

Abstract Background and purpose : Metastasis to the brain develops in 25% of all patients with lung cancer. Although the outcome is usually poor, there seems to be a subset of patients with favorable prognostic factors who may live longer. Prognostic factors were analyzed retrospectively in 103 patients with brain metastases from lung carcinoma to identify patients who would benefit from more intensive treatment strategies. Materials and methods : Between October 1991 and December 1994, 103 patients with brain metastasis from lung cancer were irradiated with palliative intent. Palliation was defined as 50% or more regression of neurological signs and symptoms 2 weeks after the completion of cranial radiotherapy. Local (related to the lung tumor) symptom status at the time of brain metastasis, the presence of metastases other than brain, multiplicity of brain metastases on CT scan and time of occurrence of brain metastasis were the factors which were evaluated with multivariate analysis. Results : Palliation was accomplished in 85% of cases. Palliation duration ranged from 0.5 to 54 months (median 3 months). The overall median survival was 5 months. Only one patient is under follow-up without any symptoms related to the brain metastasis. According to the multivariate analysis survival was significantly decreased in the presence of symptoms related to the primary tumor ( P =0.001). Conclusion : The presence of symptoms related to the primary tumor at the time of brain metastasis is one of the factors that can be used to distinguish patients with a favorable outcome. In patients with favorable prognostic factors and thus longer survival probability, the role of boost dose after whole brain radiotherapy or surgical resection in suitable cases needs to be investigated.

Tumor budding as a prognostic marker in laryngeal carcinoma.

Tumor budding is recognized as an adverse prognostic factor for a few carcinoma types. We evaluated the importance of this finding in 64 laryngeal carcinoma patients treated with surgery and radiotheraphy, with a median follow up of 53 (6-181) months. Budding was determined by re-evaluating hematoxylin-eosin (H&E) stained tumor sections, and classified as mild, moderate, and marked. Budding was not identified in 14 (21.88%) cases. Mild, moderate, and marked budding was observed in 21 (32.81%), 15 (23.44%), and 14 (21.88%) cases, respectively. Only when cases with marked budding were compared with the others, statistically significant results were obtained. In patients with and without marked budding, local disease-free survival, metastatic disease-free survival, and overall survival were 71% and 97% (p=0.72), 77% and 93% (p=0.038), and 77% and 75% (p=0.71), respectively. Marked budding was identified as a prognostic factor by univariate analysis for distant metastasis-free survival. Multi-variate analysis, by which well-recognized prognostic histopathologic parameters were evaluated, revealed that only the number of metastatic lymph nodes and budding were significantly associated with distant metastasis (p=0.02 and p=0.044), respectively. These results suggest that budding might be a valuable prognostic factor, particularly for distant metastasis in laryngeal carcinomas.

Validation of the Medical Research Council and A Newly Developed Prognostic Index in Patients with Malignant Glioma: How useful are Prognostic Indices in Routine Clinical Practice?

Although different prognostic indices for malignant gliomas have been developed, their validity outside of clinical trials has not been widely tested. The aim of this study was to determine whether the Medical Research Council (MRC) brain tumour prognostic index was able to stratify patients for survival managed in routine practice, and secondly to compare the results with our newly developed prognostic score which included tumour grade and only 3 prognostic groups. The MRC and the new prognostic index were calculated for a group of 119 adult patients with malignant glioma managed by surgical resection/biopsy and post-operative radiotherapy. For the MRC and new score, 6 and 3 prognostic groups were defined, respectively. For all patients median survival was 11 (2–66) months. The overall survival rate at 12 and 24 months were 43% and 18%, respectively. The MRC median and two-year survival rates were 14 months and 26% for a score of 1–10, 14 months and 27% for a score of 11–15, 13 months and 22% for a score of 16–20, 8 months and 10% for a score of 21–25, 8 months and 0% for those scoring 26–33. There was only one patient in the 34–38 group. For the new prognostic index, median and two-year survival rates were respectively 16 and 26%; 12 and 23%; 8 and 7% for the good, intermediate and poor prognostic groups. Both indices were significant factors for survival in univariate analysis (MRC index, p = 0.0089, new index p = 0.0002), but not in multivariate analysis. Both the MRC and our newly devised prognostic score were able to separate patients into good and poor prognostic groups, which may aid in treatment decisions, although there was less differentiation between the MRC groups especially over the first year. Both scores use routinely available factors. However, inclusion of tumour grade in the new score may be an advantage over the MRC index.

Assessment of treatment-related thyroid dysfunction in patients with head and neck cancer

OBJECTIVE To assess thyroid dysfunction in head and neck cancer patients who have received external beam radiotherapy according to radiotherapy fields and dose, tumor site and other local or systemic treatments retrospectively and prospectively and propose a follow-up schedule. MATERIAL AND METHODS A total of 378 patients was classified into two groups. Group I (n = 345) consisted of surgically treated 153 laryngeal, 80 nasopharyngeal and 112 oral cavity/oropharyngeal carcinoma patients; these patients were evaluated retrospectively for treatment-related thyroid dysfunction using their data files. Group II included 33 patients with head and neck cancer who were evaluated prospectively. Thyroid function tests were performed at the beginning of the radiotherapy and every three months after the radiotherapy course, and thyroid dysfunction regarding surgery, radiotherapy and chemotherapy was evaluated. RESULTS In Group I, the median follow-up for 153 operated laryngeal carcinoma patients was 44 months. Four (2.6%) of them were found to have clinically apparent hypothyroidism. After a median follow-up of 36 months, none of the 80 nasopharyngeal carcinoma patients showed signs of hypothyroidism. Clinically apparent hypothyroidism was detected in only 1 (0.8%) of the oral cavity/oropharyngeal carcinoma patients after a median follow-up of 25 months. In Group II, 1 (3%) patient was found to have thyroid dysfunction postoperatively prior to radiotherapy. At the time of analysis, 29 (87.8%) patients were euthyroidic, 2 (6.1%) patients had subclinical and 2 (6.1%) patients had clinical hypothyroidism. All patients with thyroid dysfunction have had combined surgery and radiotherapy, and none of the patients treated with radical radiotherapy has experienced hypothyroidism. CONCLUSIONS Even after a short follow-up, the incidence of thyroid dysfunction was 12.2% in head and neck cancer patients treated with combined surgery and radiotherapy. We recommend thyroid function tests in these patients prior to and once every 3-6 months after the radiotherapy course.

Tumor deposits in head and neck carcinomas

Tumor deposits, nodules in the peritumoral adipose tissue with no architectural residue of lymph node, have previously been described in colorectal adenocarcinomas. To date, however, there has been no examination of tumor deposits in head and neck squamous cell carcinoma (HNSCC).

The Prognostic Value of Tumor-Stroma Proportion in laryngeal Squamous Cell Carcinoma Laringeal Skuamöz Hücreli Karsinomlarda Tümör-Stroma Oraninin Prognostik Değeri

Abstract Objective: Tumor-stroma proportion of tumor has been presented as a prognostic factor in some types of adenocarcinomas, but there is no information about squamous cell carcinomas and laryngeal carcinomas. Material and Method: Five digital images of the tumor sections were obtained from 85 laryngeal carcinomas. Proportion of epithelial tumor component and stroma were measured by a soft ware tool, allowing the pathologists to mark 205.6 μm2 blocks on areas as carcinomatous/stromal, by clicking at the image. Totally, 3.451 mm2 tumor areas have been marked to 16.785 small square blocks for each case. Results: Median follow up was 48 months (range 3-194). Th e mean tumor-stroma proportion was 48.63+18.18. Th ere was no diff erence for tumor-stroma proportion when tumor location, grade, stage and perinodal invasion were considered. Although the following results were statistically insignificant, the mean tumor-stroma proportion was the lowest (37.46±12.49) for subglottic carcinomas, and it was 52.41±37.47, 50.86+19.84 and 44.56±16.91 for supraglottic, transglottic and glottic cases. Th e tumor-stroma proportion was lowest in cases with perinodal invasion and the highest in cases without lymph node metastasis (44.72±20.23, 47.77±17.37, 50.05±17.34). Tumor-stroma proportion was higher in the basaloid subtype compared with the classical squamous cell carcinoma (53.76±14.70 and 48.63±18.38 respectively). Th e overall and disease-free survival analysis did not reveal significance for tumor-stroma proportion (p=0.08, p=0.38). Only pathological stage was an independent factor for overall survival (p=0.008). Conclusion: Th is is the first series investigating tumor-stroma proportion as a prognostic marker in laryngeal carcinomas proposing a new method, but the findings do not support tumor-stroma proportion as a prognostic marker. ÖZ Amaç: Tümör-stroma oranı bazı adenokarsinom tiplerinde kötü prognostik faktör olarak tanımlanmış olmakla birlikte skuamöz hücreli karsinomlarda ve özellikle de laringeal karsinomlarda tümör-stroma oranı ile ilgili araştırma bulunmamaktadır. Gereç ve Yöntem: Seksen beş larenjektomi materyalinin tümörü örnekleyen kesitlerinden 5 dijital görüntü kaydedildi. Tümör-stroma oranı bu görüntülerde bilgisayar programının 205,6 μm2 büyüklüğünde küçük kareler oluşturması ve patoloğun bilgisayar faresinde sol/sağ tıklama ile her bir alanı tümör ya da stroma olarak seçmesini sağlayan bir bilgisayar yazılım programı ile hesaplandı. Toplamda her olguda 16.785 tık ile 3.451 mm2 tümör alanı işaretlendi. Bulgular: Ortalama izlem 48 ay (3-194) ve ortalama tümör-stroma oranı 48,63±18,18 bulundu. Tümör yerleşimi, histolojik derecesi, evresi ve perinodal yayılım ile tümör-stroma oranları arasında anlamlı farklılık saptanmadı. İstatistiksel anlamlı sonuç elde edilmemiş olmakla birlikte ortalama tümör-stroma oranının en düşük izlendiği olgular subglottik yerleşimli olup ortalama oran 37,46±12,49 idi. Ortalama tümör-stroma oranı supraglottik olgularda 52,41±37,47, transglottik yerleşimde 50,86±19,84 ve glottik yerleşimde 44,56±16,91 olarak saptandı. Tümör-stroma oranı perinodal invazyon gösteren olgularda (44,72±20,23) düşük iken, perinodal invazyon bulunmayan (47,77±17,37) ve lenf nodu metastazı olmayanlarda 50,05±17,34 daha yüksek bulundu. Bazaloid skamoz hücreli karsinomlarda tümör-stroma oranı (53,76±14,70), klasik skuamöz hücreli karsinomdan (48,63±18,38) daha yüksek saptandı. Hastalıksız sağ kalım ve toplam sağ kalım ile tümör-stroma oranı arasında ilişki bulunmadı (p=0,08, p=0,38). Sadece patolojik evrenin prognostik bağımsız faktör olduğu saptandı (p=0,008). Sonuç: Bu çalışma yeni bir yöntem eşliğinde, laringeal karsinomlarda tümör-stroma oranı’nın prognostik değerini araştıran ilk çalışmadır. Ancak bulgular tümör-stroma oranını prognostik bir belirleyici olarak desteklememektedir.

Pediatric laryngeal cancer with 5-year follow up: case report.

Larynx cancer is the commonest malignancy of upper aerodigestive tract. However, laryngeal cancer is extremely rare in childhood since these tumors are generally not suspected in the differential diagnosis of hoarseness, dysphagia and/or progressive airway obstruction in children; diagnosis can be made relatively late. In this report we would like to present a case of advanced stage pediatric laryngeal carcinoma who was treated with chemoradiotherapy and remained well on her 5-year follow-up.

Tumor deposits in salivary gland tumors

Tumor deposits (TDs), identified in different types of carcinomas are associated with poor prognosis. Salivary gland tumors were evaluated for the first time for TDs in this series. Pathological and clinical features of 25 salivary gland carcinomas primarily treated surgically including neck dissection were determined and all cases were evaluated for TDs in dissection specimens. Seven patients (28%) had TDs. There was no difference for TDs when histological type, tumor grade, tumor localization, pT, pN stage, surgical margin, lymphovascular, perineural invasion, local recurrence, distant metastatic disease and overall survival were considered. Disease‐free survival rates at 12 and 24 months were 52.5%, 28.6% and 73.3%, 57.1%, for cases with and without TDs (P = 0.463). Overall survival rates at 12 and 24 months for these groups were 85.7% and 57.1 versus 86.7% and 66.7% respectively (P = 0.916). Mean estimated recurrence‐free survival time for all cases, TD negative and TD positive cases were: 171.86, 182.72 and 82.42 months, respectively. Mean estimated overall survival time for these groups were 175.80, 186.489 and 89.70 months, respectively. TDs were described in salivary gland tumors for the first time in this series and seem to be associated with poor prognosis requiring further evaluation in larger series.

Evaluation of Lateral Temporal Bone Resection in Locally Advanced Tumours of the Parotid Gland

This study evaluated the effects of lateral temporal bone resection (LTBR) on local tumour control in patients with locally advanced parotid gland tumours. The medical records of seven patients treated with radical parotidectomy combined with LTBR for locally advanced primary parotid tumour at the Otolaryngology Department of Dokuz Eylul University between January 1995 and December 2016 were retrospectively evaluated. Demographic variables, tumour characteristics, treatment properties, postoperative complications, follow-up durations and local, regional and distant recurrences were analysed. Before referral to our clinic, four patients had de novo primary parotid tumours, and three patients had a recurrence of primary parotid tumours. The histopathologic diagnoses were squamous cell carcinoma in two patients, and adenosquamous carcinoma, malignant myoepithelial carcinoma, adenocarcinoma, adenoid cystic carcinoma and spindle cell sarcoma in the other patients. During the follow-up period, one patient died due to postoperative pulmonary embolism in the first month, and four patients died due to distant metastasis without local or regional recurrences. LTBR combined with radical parotidectomy in locally advanced primary malignant parotid gland tumours is a feasible surgical technique for local tumour control. However, the most common cause of death in these cases is distant metastases, despite appropriate resection.