W. Halfpenny

FDG–PET. A possible prognostic factor in head and neck cancer

Previous studies have shown that high uptake of 18F-fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value on positron emission tomography scan, was associated with poor survival. The aim of this study was to confirm the association and to establish whether a high standardized uptake value had prognostic significance. Seventy-three consecutive patients with newly diagnosed squamous cell carcinoma of the head and neck underwent a positron emission tomography study before treatment. Age, gender, performance status tumour grade, stage, maximal tumour diameter and standardized uptake value were analyzed for their possible association with survival. The median standardized uptake value for all primary tumours was 7.16 (90% range 2.30 to 18.60). In univariate survival analysis the cumulative survival was decreased as the stage, tumour diameter and standardized uptake value increased. An standardized uptake value of 10 was taken as a cut-off for high and low uptake tumours. When these two groups were compared, an standardized uptake value >10 predicted for significantly worse outcome (P=0.003). Multivariate analysis demonstrated that an standardized uptake value >10 provided prognostic information independent of the tumour stage and diameter (P=0.002). We conclude that high FDG uptake (standardized uptake value>10) on positron emission tomography is an important marker for poor outcome in primary squamous cell carcinoma of the head and neck. Standardized uptake value may be useful in distinguishing those tumours with a more aggressive biological nature and hence identifying patients that require intensive treatment protocols including hyperfractionated radiotherapy and/or chemotherapy.

Stomal recurrence following temporary tracheostomy.

The development of a stomal recurrence after temporary tracheostomy for malignant disease of the head and neck is a rare complication, but is a well-recognized phenomenon following total laryngectomy. The risk factors and mechanisms involved are still not well understood. In a review of 265 patients having a temporary tracheostomy for head and neck malignancy, three (one per cent) developed a stomal recurrence. All recurrences occurred in the group where tracheostomy had been performed pre-resection and of these three patients all had N+ disease. The findings suggest that tumour-cell implantation is an important mechanism of stomal recurrence and that operative technique and timing of tracheostomy placement is important in reducing the risk of encountering this complication.

Early fracture of clavicle following neck dissection.

Fracture of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4-0.5 per cent. We report a case where fracture occurred early following a selective neck dissection.