A study of risk stratification in head and neck carcinomas in a tertiary care hospital
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 1, Pages 488-494
AbstractIntroduction: Head and neck cancer is a common disease worldwide. The prevalence varies among different regions of the world and mirrors the occurrence of risk factors for head and neck cancers. The chronic exposure of risk factors of head and neck cancer to upper aerodigestive tract mucosa leads to cancer or less commonly to field cancerisation, a process of premalignant dysplastic lesions that are at high risk of progression to cancer. Aims: To evaluate the influence of vital pre-treatment variables employed in evaluation and treatment of head and neck carcinomas in predicting prognosis. To assess the feasibility of stratifying head and neck cancer patients into risk groups based on significant variables affecting survival endpoints.
Material and Methods: This is a prospective study conducted in the Department of Surgical oncology at Kidwai Memorial Institute of Oncology over a period of 1 year. Patients attending the cancer OPD were assessed for inclusion in the study. The eligibility criteria were set as given below: Biopsy proven non-metastatic carcinomas of oral cavity, pharynx and larynx, Squamous cell carcinoma-Histology.The protocols included primary chemo RT for the pharyngeal cancers followed by surgery for salvage. For early oral cavity cancers surgery alone or surgery followed by adjuvant CRT and for locally advanced disease surgery followed by CRT was administered.
Result: Regarding site specificity oral cavity cancers were the commonest (59.4%), followed by hypopharynx (20%), oropharynx (11.6 %), and larynx (8.8%)Overall majority of the patients had locally advanced cancers with stage IV (49.5%) and stage III (23.3%) disease. Early head and neck cancers constituted about 27.1% of the study with stage I and stage II cancers contributing 9.4% and 17.7% respectively. Most of the lesions were moderately differentiated carcinomas (63.3%), while poorly differentiated tumors and well differentiated tumors comprised of 9.4% and 27.2% respectively.
Conclusion: Risk stratification of head and neck cancer patients using certain patient, tumor and treatment related variables is feasible. Tumor stage, degree of tumor differentiation, ECOG performance status, treatment related weight loss and treatment interruption are proven prognostic factors affecting survival outcomes.
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