Patterns of cervical lymph node metastases in oral tongue squamous cell carcinoma: implications for elective and therapeutic neck dissection.

OBJECTIVES: To determine the patterns of lymph node metastases in oral tongue carcinomas, and examine the implications for elective and therapeutic neck dissection. METHOD: The study entailed a retrospective analysis of 67 patients with previously untreated oral tongue squamous cell carcinoma who had undergone simultaneous glossectomy and neck dissection. RESULTS: Of the 40 clinically node-negative patients, 7 patients had metastatic lymph nodes on pathological examination. No occult metastasis was found at level IV. Of the 27 clinically node-positive patients, the incidence rate of level IV metastasis was 11.1 per cent (3 out of 27 patients). No 'skip metastases' were found at level IV. Level IV metastases were significantly related to clinically staged nodes categorised as over 2a (p = 0.03) and metastasis to level III (p = 0.01). CONCLUSION: Routine inclusion of level IV in elective neck dissection is not necessary for clinically node-negative patients with oral tongue squamous cell carcinoma. Furthermore, extended supraomohyoid neck dissection with adjuvant radiotherapy can be sufficient in the treatment of selected patients with clinically node-positive necks.

Prognostic factors in limited-stage small cell lung cancer of patients treated with combined modality approach.

PURPOSE: To evaluate the combined modality treatment results of patients with limited-stage small cell lung cancer (SCLC), who were treated and followed by the DELCSG. PATIENTS AND METHODS: Sixty-three patients with limited-stage SCLC diagnosed between April 1991 and December 2002 were included. All patients were treated with combined chemotherapy and thoracic radiotherapy. Median age was 59 years (range 36-84), and all patients were male except 4. Surgery was performed for diagnosis in 3 patients. Four cycles of chemotherapy (median) were administered, composed of cisplatin-etoposide (CE) (26 patients), cyclophosphamide-vincristine-adriamycin (CAV) (10 patients) or alternated CE and CAV (18 patients). Nine patients received various chemotherapy regimes other than CE and/or CAV. A total dose of 5000 cGy with 180-200 cGy daily fractions was given to the primary tumor and mediastinum, excluding the spinal cord after 4500 cGy. Prophylactic cranial irradiation (PCI) was performed in 13 (20%) patients. Overall survival (OS) and progression-free survival (PFS) were calculated, beginning from the date of diagnosis and the end of radiotherapy, respectively. Kaplan-Meier method was used for obtaining survival rates. Log-rank test and Cox proportional hazards model were used for univariate and multivariate analyses, respectively. RESULTS: Median follow-up time was 17 months (range 3-131). Median PFS and OS were 12 (range 1-131) and 17 (range 3-131) months, respectively. Two-years PFS and OS rates were 27 % and 38 %, respectively. During follow-up, 27 (43%) patients developed brain metastasis; among them only 3 had received PCI. Univariate analysis showed that addition of PCI significantly improved PFS (p=0.025) and advanced age was a favorable prognostic factor for OS (p=0.039). In the multivariate analysis, advanced age (p=0.034) and addition of PCI (p=0.004) were independent factors increasing PFS, however no significant prognostic factor influencing OS was found. CONCLUSION: Our treatment results are in accordance with the relevant literature. It is also concluded that PCI should be given to all patients with complete response to chemotherapy. However, analysis of prognostic factors should be cautiously evaluated because of small number and heterogeneous distribution of patients in subgroups. Prospective studies are necessary for better determination of prognostic factors.