6th ICHNO Abstract Book

63 / 79

page 64 6th ICHNO
6 th ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
__________________________________________________________________________________________
classification and excessive fluid administration increase
the risk of re-operation for bleeding in patients undergoing
HNC surgery. Moreover, patients with re-operation due to
bleeding have over 5-fold risk for mortality.
PO-133 Occult lymphnode metastasis in early stage OPC
treated with TORS without neck lymphnodes dissection
D. Alterio1, G. Marvaso1, S.F. Zorzi2, L. Preda3, A. Ferrari1,
A. Rappa 4, G. Giugliano2, F. Maffini4, D. Sibio5, C. Francia5,
M. Cossu Rocca6, B.A. Jereczek-Fossa5, M. Ansarin2
1Istituto europeo di Oncologia, Radiotherapy, Milan, Italy
2Istituto europeo di Oncologia, Head and Neck surgery,
Milan, Italy
3Istituto europeo di Oncologia, Radiology, Milan, Italy
4Istituto europeo di Oncologia, Pathology, Milan, Italy
5University of Milan, Oncology and Hematology, Milan,
Italy
6Istituto europeo di Oncologia, Medical Oncology, Milan,
Italy
Purpose or Objective
Standard treatments for early stage (I and II) squamous
cell oropharyngeal cancer (OPC) are both curative
radiotherapy and surgery. Since the incidence of occult
lymph node metastasis for early stage OPC is about 30%,
an elective neck treatment is generally performed. We
retrospectively evaluated consecutive patients (pts) with
early stage (cT1-cT2 cN0) OPC treated with Transoral
Oropharyngeal Robotic Surgery (TORS) without elective
treatment on the neck lymph nodes. Aim of this analysis
was to evaluate both locoregional control and impact on
clinical outcomes of the deferred treatment of the neck
lymph nodes .
Material and Methods
All consecutive pts treated with TORS without elective
treatment on the neck (neither neck dissection, nor
radiotherapy) were evaluated. Lymph node recurrences
were classified as localized in the neck and/or in the
retropharyngeal space (“retropharyngeal nodes”-RPN).
Tumor recurrences of the “parapharyngeal space (PPS)”
were considered separately.
Results
Twenty pts (7 female and 13 male, median age 61 years)
met inclusion criteria. Median follow up was 28 months
(mean 40 months, range 7-97months). Six and 14 pts had
HPV positive HPV negative tumors, respectively. Ten (50%)
pts experienced a locoregional tumor appearance after a
median time of 10 months (mean time 11 months, range
4-17 months). As expected, 35% of patients experienced
clinical appearance of occult lymph node metastasis (only
in the neck lymph nodes in 5 patients, RPN 1 patient, neck
lymph nodes and RPN 1 patient) after a median time of 10
months (mean 11 months, range 7-15 months). Of note, all
three pts with PPS recurrences did not show any evidence
of mucosal lesion in the oropharynx suggesting a
submucosal localization of the tumor recurrence and
authors suggested that this aspect could be probably
related to a residual microscopic disease in the “T-N”
tract (soft tissues and lymphatic network lied between the
tumor and the neck lymph node chains). RPN metastasis
appeared in 15% of pts. For the locoregional recurrences a
second treatment was performed (Table 1). At last follow
up 17 (85%) pts were alive without disease, two pts were
alive with disease (one patient with distant metastasis and
one patient with e second primary tumor in the
supraglottic larynx) and one patient died for non-cancer
related causes. Estimated 2-years overall survival and
locoregional free-survival were 92.9% and 39.4%,
respectively.
Conclusion
TORS without elective treatment of neck lymph nodes
doesn’t represent a standard of care in early stage OPC
but our results suggested that pts treated with salvage
treatments maintained good oncologic results. This study
could provide useful information on both the occult lymph
node metastasis (site and time of their clinical
appearance) and the impact on clinical outcome of the
deferred lymph node treatment in early stage OPC.
PO-134 Retrospective analysis of treatment outcomes
of sinonasal malignancies. Our 22-year experience
P. Tarchini1, P. Farneti2, A. Bellusci 2, V. Sciarretta2, E.
Donini 3, G. Frezza3, A. Tosoni4, A. Brandes4, E. Pasquini5
1Niguarda Ca' Granda Hospital, Ear- Nose and Throat
Unit, Milan, Italy
2Bologna University Medical School, DIMES - Ear- Nose
and Throat Unit of Sant'Orsola Malpighi Hospital,
Bologna, Italy
3Bellaria Hospital- Azienda USL-IRCCS Institute of
Neurological Science, Department of Radiotherapy,
Bologna, Italy
4Bellaria Hospital- Azienda USL-IRCCS Institute of
Neurological Science, Department of Medical Oncology,
Bologna, Italy
5Azienda USL Bologna, Ear- Nose and Throat
Metropolitan Unit, Bologna, Italy
Purpose or Objective
report our experience with surgical management of
sinonasal malignancies
assess the role of oncologic surgery alone or
combined with radiotherapy and/or chemotherapy in
sinonasal malignancies
Material and Methods
A total of 132 patients with the naso sinusal malignancies
between 1994 and 2015 were analyzed retrospectively.
There were 86 males and 46 females; the average age was
59.1 years. The median follow-up time was 57 months
(range 1-216 months). According to the American Joint
Committee on Cancer 7th staging, patients were: 2 (1,5%)
St I, 27 (20,3%) St II, 42 (31,6%) St III, 27 (20,3%) St IVa, 24
(18,0%) St IVb, 10 ( 7,5%) St IVc. The most frequent
histotypes encountered were: adenocarcinoma 44 (33,8%),
adenoid cystic carcinoma 24 (18%), squamous cell
carcinoma 19 (14%), mucosal melanoma 11 (8,3%),
Esthesioneuroblastoma 8 (6%), neuroendocrine nasosinusal
carcinoma 8 (6%). Before the treatment, magnetic
resonance imaging (MRI) and computed tomography (CT)
were performed. 90 (68,2%) patientes were treated with
exclusive endoscopic approach (EEA) and 42 pts (31,8%)
with combined approach. Postoperative treatment were
performed in 57 patients (43,2%): 35 patients received
postoperative radiotherapy alone, 18 pts radiotherapy
concomitant with chemotherapy and 4 pts CT only.
Results
Analyzing the cases based on a surgical technique, EEA and
combined approach, we have noted the lack of
statistically significant difference of survival between the
two approach (5 year disease-specific survival
respectively: 72,4% ± 5,6% vs 68,8% ± 7,8%; p=0,67).
Twelve (9,1%) complications were present in 132 patients
postoperatively without statistical difference between the
two different approaches (10% vs 7.1%).
Conclusion
The results seem to indicate that endoscopic surgery,
when properly planned and in expert hands, may be a valid
alternative to standard surgical approaches for the
management of malignancies of the sinonasal tract; less
aggressiveness do not means less radicality. Follow the
oncologic roles the endoscopic oncologic surgery alone or
combined with external approaches achieves the same
results. Every choice of treatment should be discussed by
a dedicated oncology group formed by neurosurgeons,