Page 54 - Read Online
P. 54
It is very significant that most of cervical metastases number of patients are necessary to confirm the results
from SCC of the maxilla in the analysed series (71%) obtained from this study.
corresponded with a tumour size larger than 4 cm (T3
and T4 tumours). This rate of cervical metastases from Financial support and sponsorship
big-sized tumours may suggest performing elective neck Nil.
dissection only in patients with advanced disease. This
finding has been observed by an American multicenter Conflicts of interest
[16]
study by Montes et al. about maxillary SCC, which There are no conflicts of interest.
reported a high percentage of cervical metastases in
[21]
T3 and T4 tumours. Meng et al., in their series of 78 REFERENCES
patients with SCC of the maxilla, reported that rates
for positive nodal metastases from T1 and T2 tumours 1. Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node
were lower than 15%, whereas those for T3 and T4 metastases from squamous carcinoma of the oral cavity. Cancer
tumours were higher than 40%. Zhang et al., in a series 1990;66:109-13.
[37]
of 100 patients, observed a 79% of cervical metastases in 2. Woolgar JA. Histological distribution of cervical lymph node
metastases from intraoral/oropharyngeal squamous cellcarcinomas.
patients with T3/T4 SCC of the upper maxilla. Brown et al. Br J Oral Maxillofac Surg 1999;37:175-80.
[10]
reported an 81% of cervical metastases in T3/T4 tumours 3. González-García R, Naval-Gías L, Román-Romero L, Sastre-Pérez J,
[40]
in a series of 43 patients, while Berger et al. in a series Rodríguez-Campo FJ. Local recurrences and second primary tumors
of 171 patients, observed a 78% of cervical metastases from squamous cell carcinoma of the oral cavity: a retrospective
analytic study of 500 patients. Head Neck 2009;31:1168-80.
in patients with T3/T4 stage. Even others authors have 4. Kowalski LP, Bagietto R, Lara JR, Santos RL, Tagawa EK, Santos IR.
reported that all the patients (100%) with advanced-stage Factors influencing contralateral lymph node metastasis from oral
(T3/T4) developed cervical metastases in some point carcinoma. Head Neck 1999;21:104-10.
during the study. [13,30,33,42] 5. Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in planning
a management strategy for the stage N0 neck. Arch Otolaryngol Head
Neck Surg 1994;120:699-702.
Within our meta-analysis, in 24 out of 28 articles, 6. Capote A, Escorial V, Muñoz-Guerra MF, Rodriguez-Campo FJ,
metastases in patients with T3/T4 tumours were Gamallo C, Naval L. Elective neck dissection in early-stage oral
analysed, founding a total of 71% of cervical metastases. squamous cell carcinoma-does it influence recurrence and survival?
These data could demonstrate a significant connection 7. Head Neck 2007;29:3-11.
Hiratsuka H, Miyakawa A, Nakamori K, Kido Y, Sunakawa H, Kohama G.
between T-stage and metastatic cervical status, and may Multivariate analysis of occult lymph node metastasis as a prognostic
suggest that patients with advanced-stage (T3/4) disease indicator for patients with squamous cell carcinoma of the oral cavity.
face a significantly higher risk of metastases. Cancer 1997;80:351-6.
8. Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW, Wei WI,
Kong CK, Book KS, Yuen WC, Lam AK, Yuen NW, Trendell-Smith
It is a fact that most clinicians do not routinely perform NJ, Chan YW, Wong BY, Li GK, Ho AC, Ho WK, Wong SY, Yao TJ.
elective neck dissection when the neck is clinically or Prospective randomized study of selective neck dissection versus
radiographically negative. However, the results from our observation for N0 neck of early tongue carcinoma. Head Neck
systematic review suggest that elective neck dissection 9. 2009;31:765-72.
Montes DM, Schmidt BL. Oral maxillary squamous cellcarcinoma:
should be performed in patients with locally advanced management of the clinically negative neck. J Oral Maxillofac Surg
SCCs of the hard palate and maxillary alveolus, despite 2008;66:762-6.
the fact that SCC of these sites has traditionally been 10. Brown JS, Bekiroglu F, Shaw RJ, Woolgar JA, Rogers SN. Management
believe to have a low rate of occult metastases. of the neck and regional recurrence in squamous cell carcinoma of
the maxillary alveolus and hard palate compared with other sites in
the oral cavity. Head Neck 2013;35:265-9.
In spite of the results observed from this meta-analysis, 11. Simental AA, Johnson JT, Myers EN. Cervical metastasis from
we believe that it is important to highlight that most squamous cell carcinoma of the maxillary alveolus and hard palate.
of the analysed studies are retrospective, with their Laryngoscope 2006;116:1682-4.
intrinsic limitations. Furthermore, several papers are 12. Kruse AL, Grätz KW. Cervical metastases of squamous cellcarcinoma
of the maxilla: a retrospective study of 9 years. Head Neck Oncol
limited by the small number of patients enrolled in the 2009;20:1-28.
study. Therefore, prospective studies with larger series 13. Mourouzis C, Pratt C, Brennan PA. Squamous cell carcinoma of the
are necessary. maxillary gingiva, alveolus, and hard palate: is there a need for elective
neck dissection? Br J Oral Maxillofac Surg 2010;48:345-8.
14. Ogura I, Kurabayashi T, Sasaki T, Amagasa T, Okada N, Kaneda T.
In conclusion, this systematic review shows the fact Maxillary bone invasion by gingival carcinoma as an indicator of
that the rate of metastases in patients with SCC of the cervical metastasis. Dentomaxillofac Radiol 2003;32:291-4.
upper maxilla is high and comparable with metastases 15. Morris LG, Patel SG, Shah JP, Ganly I. High rates of regional failure in
from other oral cavity cancers. Thus, the authors believe squamous cell carcinoma of the hard palate and maxillary alveolus.
Head Neck 2011;33:824-30.
in the need for a change in the management of the N0 16. Montes DM, Carlson ER, Fernandes R, Ghali GE, Lubek J, Ord R,
neck in SCC arising in the maxillary alveolus and hard Bell B, Dierks E, Schmidt BL. Oral maxillary squamous carcinoma: an
palate. Elective neck dissection should be performed in indication for neck dissection in the clinically negative neck. Head
Neck 2011;33:1581-5.
patients with T3/T4 tumours with clinic or radiographic 17. Kermer C, Poeschl PW, Wutzl A, Schopper C, Clemens K, Poeschl
negative necks (N0c). Prospective studies with a large E. Surgical treatment of squamous cell carcinoma of the maxilla and
Plast Aesthet Res || Volume 3 || June 24, 2016 179