Luiz Paulo Kowalski

Distribution of Metastatic Nodes in N0-1 Patients with Tonsillar Squamous Cell Carcinoma and Its Implications for Selective Neck Dissection

ObjectivenWe aimed to evaluate the pattern of neck metastasis in patients with primary tonsillar carcinoma treated by primary surgery and neck dissection. Impact of the extent of neck dissection and level of metastatic nodes on survival were also evaluated.nnnMethodsnWe evaluated 163 consecutive patients with tonsillar squamous cell carcinoma submitted for neck dissection and staged as cN0-1. Selective neck dissection was performed using a template encompassing levels I-III, whereas radical neck dissection led to the removal at levels I-V. For each patient, number of metastatic nodes, their distribution, and data regarding postoperative treatment and oncologic outcomes were analyzed.nnnResultsnOccult neck metastasis at levels I, IV, and V were rare with two cases each. In the clinically negative (cN0) patients, there were no cases of metastasis at level V and two cases at level I or IV. The extent of neck dissection and level of metastatic nodes had no impact on disease-specific survival or neck recurrence.nnnConclusionnWe conclude that in cN0 patients, removal at levels II and III is mandatory but levels I, IV, and V may be spared.

Oral Mucosal Melanoma: clinico-pathological analysis of 30 cases in a single center

Financial support: None. Conflicts of interest: No conflicts of interest declared concerning the publication of this article. Submitted: June 15, 2017. Accepted: October 18, 2017. The study was carried out at A.C.Camargo Cancer Center (ACCCC), São Paulo, SP, Brasil. abstract Introduction: Oral mucosa melanoma (OMM) is a rare and aggressive disease comprising 0.26% of all head and neck malignant neoplasms. Affected individuals usually present younger than the other individuals with mucosal melanoma. Surgical treatment with extensive surgical resection was defended as the primary treatment modality, with increasing consideration for postoperative radiotherapy. Objective: The objective of this retrospective study with 30 subjects treated at the A.C. Camargo Cancer Center from 1954 to 2014 was to analyze the characteristics and treatments related to the tumor that could be identified as risk factors for the prognosis and consequently the overall survival. Materials and Methods: The data collected were analyzed by the STATA v.12.0 program and the Kaplan-Meier curves and the log rank test were used to compare the survival curves. Of the 30 cases of oral melanoma, 56.7% (17) were men and 43.3% (13) women with a mean age of 59.7% (19 to 88 years). Regarding the symptomatology in the moment of diagnosis, 53.3% (16) of the individuals denied pain and 60% (18) bleeding. Results: Considering the morphological aspects of the lesions, it was observed that 43.3% (13) had a non-ulcerated surface, 93.3% (28) were pigmented and 63.3% (19) were nodular type. From all cases, 33.3% (10) were classified as T3 tumors and 66.7% (20), as T4. Fifty-six point seven percent (17) of the lesions had slow growth and 46.6% (14) of the individuals had palpable lymph node at the time of diagnosis. Twenty three patients (76.7%) underwent radical surgery; 16.7% (5) only cryotherapy and 6.6% (2) chemotherapy. Conclusion: In this study we observed 23 recurrences and identified as significant factors for survival: ulceration, the T stage, the presence of N+ and the modality of therapy.

Abstract 1946: Downregulated microRNAs in salivary rinse from patients with head and neck squamous cells carcinoma.

Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DCnnHead and neck Squamous cell carcinoma (HNSCC) is a disease with high incidence and mortality, and the sixth most common cancer worldwide. The diagnosis is usually made late, after the appearance of visible lesions. The discovery of altered epigenetic profiles in cancer awakened to new paradigms by which molecular mechanisms contribute significantly to carcinogenesis. To date, approximately 1000 miRNAs have been described and it is estimated that they may influence the expression of up to one third of human genes. The deregulation of the expression of miRNAs can directly influence cell proliferation and differentiation and therefore, they can act as oncogenes or tumor suppressors. The aim of this study is to compare the miRNAs expression profiles in saliva samples from patients with HNSCC and normal controls in order to identify potential diagnostic markers for this cancer. Comprehensive miRNA profile was done in 4 salivary rinse samples from HNSCC patients and 3 samples from healthy donors using a Megaplex TaqMan Low Density miRNA Arrays (TLDA) to assess the expression status of miRNAs. 101 miRNAs differentialy expressed were identified. From that, 21 were upregulated in the HNSCC samples while 80 were downregulated in these samples. After a deep revision of the information available from them, we selected candidates to be validated in an independent group of 100 salivary rinses collected from HNSCC patient at diagnoses. A preliminary result indicated that four selected miRNA were down regulated with 90-91% of specificity and 53-64% of sensibility. Our hypothesis is based on the fact that the down regulation confirmed in our results may be related to the potential of tumor suppressor activity of these miRNAs; Besides the validation obtained by our tests, important studies in the literature show agreement with this hypothesis and may add relevant data in developing this study.nnSupported by Fapesp (Grant 2011/15122-9).nnCitation Format: Maria Fernanda A. Pelarin, Maria Aderuza Horst, Ana Carolina Carvalho, Luiz Paulo Kowalski, Andre Luiz Vettore, Bruno Karia. Downregulated microRNAs in salivary rinse from patients with head and neck squamous cells carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1946. doi:10.1158/1538-7445.AM2013-1946

Microsurgical Reconstruction of the Oral Cavity and Oropharynx After Cancer Ablation

Head and neck cancer treatment may cause significant functional and esthetic morbidity with quality-of-life limiting sequelae. Factors like lesion’s topography and extension as well as the function of the compromised structures will determine the characteristics of the defect; the reconstruction modality chosen, the multidisciplinary rehabilitation work and the patient’s adaptation capacity will determine the impact of oral cancer treatment on overall life quality. Therefore, it’s necessary to perform a critical appraisal of the available methods for reconstruction and its interaction with rehabilitation on each patient in order to ensure optimal results (Gal & Futran, 2002).