Fifty Seventh Annual Meeting
Fifty Seventh Annual Meeting
of the
Irish Otorhinolaryngology /
Head and Neck Society
Lough Eske Castle, Co. Donegal, Ireland
Friday 14th & Saturday 15th October 2016
Program
Thursday 13th October
1600 - 1900 Registration
1900 - 1940 IOS Council Meeting
2000 - 2130 President’s Dinner
(by invitation only)
Friday 14th October
0730 - 0850 Registration
0850 - 0900 Welcome by President / Announcements
0900 - 1100 Free Paper Session 1 (Head & Neck)
Chairpersons - Niall Considine & Robin Adair
0900 - 0908 IMPACT OF NECK-NODAL DISEASE ON SURVIVAL OUTCOMES IN HPV-POSITIVE OROPHARYNGEAL SQUAMOUS CANCER
N Kharytaniuk, P Moloney, L Feeley, S Boyle, G O’Leary, P Sheahan
------
Objective: Presence of neck nodal metastases in patients with primary head-and-neck cancer has traditionally been regarded as an adverse prognostic factor. We previously found that the presence of extracapsular spread does not influence prognosis in p16-positive oropharynx squamous cell carcinoma (OPSCC). Recently, lymph node ratio (LNR) (ratio of positive lymph nodes / total lymph nodes harvested) has been reported as a significant prognosticator in oral cavity SCC. In the present study, we aimed to determine the significance of advanced N-classification (N2b+), number of positive nodes, and LNR on recurrence and survival in OPSCC patients.
Methods: Retrospective review of 86 patients with primary OPSCC or SCC of unknown primary treated at our institution between 1998 and 2014. p16-immunohistochemistry was performed in all cases. LNR was categorised into LNR<10% or LNR≥10%. These were then correlated with disease-specific survival (DSS) and recurrence-free survival (RFS).
Results: 45/86 patients were p16-positive. The mean number of positive nodes was 4.27(range 0-26); the mean LNR was 15% (range 0-80%). For overall cohort, the prognostic value of LNR≥10% was not significant for DSS (p=0.09), nor was RFS (p=0.12). For p16-negative patients, there was a trend towards worse DSS (p=0.07) and RFS (p=0.07) with LNR≥10%, but this was not statistically significant. For p16-positive cases, LNR had no impact on outcomes.
Conclusions: Our findings suggest that LNR is not prognostic in p16-positive OPSCC. The low numbers of p16-negative cases may have precluded us finding a significant impact of LNR in this cohort.
0908 - 0916 UTILITY OF CT AND MRI IN ASSESSMENT OF MANDIBULAR INVASION IN ORAL CAVITY CANCER
A.Nae, P.Sheahan, G.O’Leary, B.Fitzgerald, C. Heffron, L. Feeley, E.Chiriac
------
Objective: Oral squamous cell carcinoma (SCC) may present with early invasion of mandibular bone. Our purpose was to evaluate the efficacy of CT and MRI in detecting mandibular invasion for oral SCC.
Methods: Retrospective study on 72 patients with SCC of floor of mouth, lower alveolus, and retromolar trigone, operated with curative intend in our Department. Preoperative CT and MRI scans were re-reviewed by a Consultant Radiologists, and original histology slides were re-reviewed by 3 pathologists.
Results: Among the 48 patients with preoperative imaging re-reviewed, 24 had histological bone invasion. Combined CT and MRI had a sensitivity of 83% and a specificity of 77%. Positive predictive value was 0.8 and negative predictive value of 0.8. False positive results on CT (5 patients) may have been due to cortical bone not being fully sampled during their standard sampling procedure
Discussions: The results of the present study suggest that combined CT and MRI has diagnostic utility in detecting mandibular invasion caused by oral cancer. Histopathological results might miss cases of minor cortical erosion. Current imaging methods support the diagnosis of mandibular invasion.
0916 - 0924 IMPACT OF POSITIVE MARGINS ON OUTCOMES OF OROPHARYNGEAL SQUAMOUS CELL CARCINOMA ACCORDING TO HUMAN PAPILLOMA VIRUS STATUS
P Molony, N Kharytaniuk, S Boyle, G O'Leary, R Werner, C Heffron, L Feeley, P Sheahan
------
Objective: Positive surgical margins in oropharyngeal squamous cell carcinomas (OPSCC) are an indicator for postoperative chemoradiotherapy (CRT). With CRT over radiotherapy (RT) alone being associated with increased morbidity, we aim to investigate whether impact of positive margins differs according to HPV status.
Methods: Clinical notes and pathological material of patients undergoing primary surgical treatment of OPSCC between January 1998 and January 2015 were reviewed. Patients were identified by review of our Head and Neck Cancer database. Margins were deemed positive if tumour was <1mm from the cut/cauterized margin. HPV status was determined by tumour morphology and p16 immunohistochemistry status, with confirmatory HPV DNA real time PCR in selected cases. Decisions regarding postoperative RT were made on a case by cases basis by a multidisciplinary Head and Neck cancer group.
Results: 177 patients with OPSCC were identified, 65 underwent primary surgical treatment, 10 were excluded, leaving a final study population of 55. 29 tumours were HPV positive, 26 negative. 21 patients (38%) were considered to have positive surgical margins, 12 were HPV positive, 9 negative. Positive margins were a significant predictor of disease specific survival (p=0.02) in the HPV negative cohort, but not the HPV positive (p=0.39) group. Local recurrence was only seen in the HPV negative patients (p=0.002), with margin status being a significant predictor (p=0.02).
Conclusions: Impact of margin status on survival outcomes in OPSCC is strongly dependent on HPV status raising questions regarding the necessity of combined CRT in HPV positive cases with positive margins.
0924 - 0932 NON-INVASIVE AND LABEL-FREE DETECTION OF ORAL SQUAMOUS CELL CARCINOMA USING SALIVA SURFACE-ENHANCED RAMAN SPECTROSCOPY AND MULTIVARIATE ANALYSIS
K Davies, J Connolly, A Kazakeviciute, A Wheatley, P Dockery, M Olivo, I Keogh
Objective: Recently, the use of saliva combined with Raman spectroscopy, a technique that provides a chemical spectral-based fingerprint of biofluids at the molecular level, has been demonstrated as a promising tool in the diagnosis of oral pathology. We report using silver nanoparticle-based surface enhanced Raman spectroscopy (SERS) as a label-free, non-invasive technique for detection of oral squamous cell cancer (OSCC) using saliva and desquamated oral cells.
Method: Saliva samples were collected from cohorts of smokers, those with confirmed oral or oropharyngeal squamous cell carcinoma and from healthy age and sex-matched controls. Saliva was centrifuged to remove oral cells and the remaining saliva was stored frozen until analysis. For SERS spectral measurement, saliva was placed on a silver nanoparticle based substrate. Raman spectra were then collected from saliva using a Witec Raman Spectroscope and statistically analyzed.
Results: A total of 180 SERS spectra were acquired from saliva and 120 SERS spectra from oral cells collected from normal healthy individuals and from confirmed oropharyngeal cancer patients. Notable biochemical peaks in the SERS spectra were tentatively assigned to various components and subjected to multivariate statistical techniques including principal component analysis, linear discriminate analysis (PCA-LDA) and logistic regression (LR) revealing a sensitivity of 89% and 68% and a diagnostic accuracy of 73% and 60% for saliva and oral cells, respectively.
Conclusion: By combining the recent advances in biomedical optics and nanotechnology, our results demonstrate the potential of saliva and oral cell SERS as a promising clinical adjunct for the non-invasive detection of oral cancer.
0932 - 0940 CORRELATION OF CYTOKERATIN 7 BETWEEN PRIMARY SITE AND REGIONAL NODAL DISEASE IN OROPHARYNGEAL SQUAMOUS CELL CARCINOMA
RSR Woods, D Costigan, E O’Regan, M Toner, S Kennedy, CM Martin, JJ O’Leary, CV Timon
------
CK7 is a junctional biomarker with a SEQIKA fragment which stabilises HPV-16 E7 transcripts. It is expressed in normal tonsillar crypt epithelium and expression is associated with HPV-related oropharyngeal SCC. We correlate expression in the primary site and regional disease.
Methods: Data were collected from patients presenting with primary oropharyngeal SCC between January 2003 and December 2012. HPV testing was performed using SPF10 PCR, INNO-LiPA HPV Genotyping and HPV ISH. Immunohistochemical staining was performed for p16 and CK7 in primary site and neck specimens. Slides were analysed and scored using the H scoring system. Expression was correlated with tumour, clinical and epidemiological data using SPSS.
Results: There were 226 cases of oropharyngeal SCC, with regional nodal tissue available in 45 cases. 41% demonstrated p16 positivity and 44% demonstrated HPV positivity (95% HPV-16). CK7 expression was observed in the tonsillar crypt epithelium of both normal tonsils and tumour specimens as well as in regional nodal disease. CK7 expression in the tumour cells was significantly linked to high risk HPV and p16 positivity (p=0.0046). Regarding nodal disease, there was strong correlation for HPV, p16 and CK7 between nodal tissue and primary site, with kappa >8 in all cases. CK7 is significant predictor of tonsil subsite (p=0.02)
Conclusions: CK7 expression in normal tonsillar crypt epithelial cells may provide a selective advantage to HPV-related carcinogenesis at this site, possibly due to the unique propensity of CK7 to bind HPV-16 E7 transcripts. Further weight to this hypothesis is added by the presence of CK7 in regional nodal disease.
0940 - 0948 PRESENTATION AND MANAGEMENT OF OROPHARYNGEAL CANCER IN NORTHERN IRELAND – 2013
C McKenna, E Morgan, G McKenna, A Gavin, F Kee, R Ullah
------
Oropharyngeal cancers include cancers of the tonsil, soft palate and base of tongue. This project audited the presentation and management of these cancers in Northern Ireland in 2013.
Methods: Cases were identified from the Northern Ireland Cancer Registry using ICD-10 codes pertaining to oropharyngeal cancer diagnoses. Clinical data were collected in Microsoft Excel and analysed using SPSS.
Results: 77 oropharynx cancers were diagnosed in 2013 (57 males, 20 females). The largest subsite was tonsil (n=41). The most common presenting symptom was a neck lump (n=40). 50 cases were referred on a red flag pathway and ENT was the most common destination of initial referral (n=60). 50 cases had testing for p16 (p16+,33 and p16-,17). 93% of patients had active treatment. 27 patients had surgical management (primary surgery n=6, primary surgery + neck dissection n=15, neck dissection only n=6). Reconstruction was used in 4 patients (radial forearm free flap). 68 patients had radio/chemoradiotherapy (26 as post-operative RT/42 as primary RT). 35 patients had chemotherapy as part of their management.
Conclusions: This study details the management of oropharynx cancers in Northern Ireland in 2013 and facilitates comparison with other cancer networks. The majority of patients present with neck disease indicating higher stage disease. Variability exists in testing for p16. The majority of patients were treated with curative intent with non-surgical treatment being the most frequent treatment modality. Radial forearm free flap is the reconstructive flap of choice following resective oropharynx surgery, but its use is not commonplace.
0948 - 0956 14 YEAR RETROSPECTIVE REVIEW OF LIP MALIGNANCIES ST JAMES HOSPITAL AND A REVIEW OF THE IRISH NATIONAL CANCER REGISTRY
F O’Duffy, P Lennon, J.P O’Neill, C.I. Timon
------
Objective: We set out to quantify the type, grade and outcomes in a major tertiary head and neck oncology centre and review the National Cancer Registry Ireland (NCRI).
Method: We undertook a retrospective ananlysis of patients undergoing treatment in St James hospital over 14 years. The National Cancer Registry data from 1997-2007 was also examined.
Results: 63 patients were identified in St James over 14 years and 283 nationally over 10 years. The dominant cancer type nationally and locally was squamous cell carcinoma (SCC). In part, due to the location of lip malignacies most are found at early stages and this was confirmed in our study with 88% of cases stages T1 or T2. The remaining 12% had advanced T3 and T4 disease these findings correlate closely with national figures 90.1% T1/2. 11% of patients in St James were node positive on presentation. All of our patients underwent primary surgical excision and reconstruction compared with 93% of patients nationally. Four patients had T4 disease with clinically negative necks, all four received SND and one had a histologically positive nodal finding. Nationally the overall unadjusted 1, 5 and 10-year survivals for patients with SCCs of the lip were found to 91.76%, 70.04% and 53.04% respectively.
Conclusion: Promt diagnosis and staging with complete surgical excision achieving clear margins at first operation is the corner stone for sucessful oncological and cosmetic outcomes. Adjuvant treatment decisions should be informed based on histological findings.
0956 - 1004 ONCOLOGICAL OUTCOMES IN OROPHARYNGEAL SQUAMOUS CELL CARCINOMA IN THE ELDERLY.
S Kennedy, D Hogan, T Ramachandra, G Woods, O. McArdle, P Morris, M Leader, J.P. O'Neill
------
Objective: With prolongation of life, increasing numbers of elderly people are presenting with head and neck carcinoma. Medical co-morbidities coupled with under-representation of older people in clinical trials, increases the challenge of treatment in this group of patients.
Methods:A retrospective chart review identified 79 patients with oropharyngeal squamous cell carcinoma presenting to a large teaching hospital between 2000 and 2015. Sufficient follow-up data was available for 77 patients (97%). The association between older age and outcomes was assessed with chi-squared tests. Multivariate logistic-regression models were used for case-control comparisons.
Results: Twenty-nine patients (37%) were aged 65 or older at diagnosis, with a notable male predominance (n=20, 69%). 79% (n=22) of those aged 65 or older died within the study period versus 48% (n=22) of younger participants, (p=0.02). Older patients were more likely to have stage III disease (OR 23.54; 95% CI 1.61 to 342.6) and N1 disease (OR 6.92; 95% CI 1.28 to 37.2). They were no more likely to require gastrostomy than younger patients, but those that did, were more likely to still require enteral feeding at 12 months (OR 2.37; 95% CI 1.72 to 7.85). In this cohort, older people were less likely to receive chemotherapy (OR 3.91; 95% CI 0.46 to 33.12) and more likely to die (OR 4.40; 95% CI 1.35 to 14.35). Gender, smoking status, sub-site localization of cancer, tracheostomy requirements and disease progression were not significantly different between older and younger patients. Although not statistically significant, there was a trend towards a higher proportion of HPV negative cancer in older patients.
Conclusion: Oropharyngeal squamous cell carcinoma in older people appears to be associated with poorer outcomes both in terms of morbidity and mortality. Optimal treatment regimens balancing the complex needs of this population requires further investigation.
1004 - 1012 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN OROPHARYNGEAL CANCER TREATED WITH RADIOTHERAPY OR CHEMORADIOTHERAPY
S Boyle, G O’Leary, P O’Sullivan, P Sheahan
------
Objective: To investigate the impact of placement of percutaneous endoscopic gastrostomy (PEG) tubes in patients treated with radiotherapy or chemoradiotherapy on weight loss and hospital admission rates in patients with oropharyngeal squamous cell carcinoma (OPSCC).