Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :289
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »  Article in PDF (215 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

 
  In this article
 »  Abstract
 » Introduction
 »  Materials and Me...
 » Results
 » Discussion
 » Conclusion
 »  References

 Article Access Statistics
    Viewed183    
    Printed1    
    Emailed0    
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 3  |  Page : 397-398
 

Pediatric head and neck squamous cell carcinoma: A retrospective observational study


Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India

Date of Web Publication24-Feb-2017

Correspondence Address:
G Singh
Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.200676

Rights and Permissions

 » Abstract 

BACKGROUND: Pediatric head and neck squamous cell carcinoma is very rare. Limited data are available in English literature on this issue due to paucity of cases. Hence, we retrieved data of pediatric head and neck cancer in younger age group (≤20 years of age) for evaluation of clinicopathological characteristics, treatment, and outcome of this emerging issue. MATERIALS AND METHODS: A retrospective observational study was conducted from January 2011 to December 2015 in our Department of Radiotherapy. A total of nine patients of age 20 years or younger were identified during this period for analysis in this study. Various parameters such as age, clinical features, clinical stage, and the treatment received by the patients were recorded and analyzed for outcome. RESULTS and DISCUSSION: Median age of presentation was 19 years with male:female ratio 8:1. The most common subsite involved was tongue > buccal mucosa > tonsil > retromolar trigone. Surgery was preferred treatment modality followed by adjuvant therapy (radiotherapy/chemotherapy). Complete response was shown in 62% cases. Disease progression was found in 25% of cases. On median follow-up of 8 months, 25% of patients had developed local recurrence, none showed metastatic disease. CONCLUSION: The rarity of these tumors inevitably results in a paucity of high-level evidence to guide treatment. It has a high impact on the quality of life, cosmetic outcomes, and secondary malignancies may develop with increased survival. More clinical studies to be conducted to establish etiopathological characteristic and treatment guidelines in this issue.


Keywords: Clinicopathological characteristic, outcome, pediatric head neck cancer


How to cite this article:
Sharma D, Singh G. Pediatric head and neck squamous cell carcinoma: A retrospective observational study. Indian J Cancer 2016;53:397-8

How to cite this URL:
Sharma D, Singh G. Pediatric head and neck squamous cell carcinoma: A retrospective observational study. Indian J Cancer [serial online] 2016 [cited 2017 Mar 30];53:397-8. Available from: http://www.indianjcancer.com/text.asp?2016/53/3/397/200676



 » Introduction Top


Pediatric head and neck squamous cell carcinoma (HNSCC) is a rare entity with an incidence of about 1 in 1000 cases of HNSCC in patients 20 years or younger.[1] Etiologically, it is different from that of SCC of older adults as there is least exposure of tobacco and alcohol but is usually associated with certain genetic syndromes such as xeroderma pigmentosum.[2] Surgery is the treatment of choice followed by adjuvant chemotherapy/radiotherapy as per indications. In oropharyngeal cancers, radiation with or without chemotherapy has been used. We herein presented the clinicopathological features and the treatment outcome of the patients of 20 years of age or younger.


 » Materials and Methods Top


We conducted a retrospective study in the Department of Radiation Oncology of our institute, in which patients record from January 2011 to December 2015 were retrieved for HNSCC who are 20 years or younger in age. A total of nine patients were identified during this period. Various parameters such as age, clinical features, clinical stage, and the treatment received by the patients were recorded and analyzed for outcome.


 » Results Top


Median age at the time of presentation was 19 years (range, 12–20 years). Gender predilection was skewed in favor of male (male:female ratio - 8:1). The median interval between the first appearance of symptoms and presentation in the department was 6 months (range, 2–11 months). The most common subsite involved was tongue (five patients) followed by buccal mucosa (two patients) and tonsil and retromolar (one each).

The most commonly used imaging modality was contrast-enhanced computerized tomography in eight patients, followed by magnetic resonance imaging in one patient. Majority of the patients were of Stage IVa followed by Stage III. Two of nine patients had history of tobacco chewing and smoking.

Of nine patients, five patients underwent surgery (four patients underwent supraomohyoid neck dissection whereas one patients underwent modified neck dissection) Radiation was used in seven patients (four adjuvant, two radical, and one palliative). Three patients received chemoradiotherapy. Neoadjuvant chemotherapy was used in one patient. One patient did not receive any treatment and was lost to follow-up.

A total of eight patients were evaluated for survival. Median follow-up duration was 8 months (range, 2–17 months). Complete response was seen in five patients as compared to one patient in which partial response was present and two patients who had progressive disease at 1 month of follow-up. Two patients developed local recurrence in a median period of 4 months, and none of the patients develop metastasis.


 » Discussion Top


SCC of the head and neck is rare in the pediatric population.[1] Very few cases of pediatric SCC have been reported in the medical literature. On the basis of subsite distribution, tongue is most commonly involved site.[3],[4] In the present study, tongue also was the most commonly involved site.

Some of the risk factors for adult HNSCC are tobacco chewing, alcoholism, smoking, and human papilloma infection which are usually not present in pediatric HNSCC. Although in recent years significant shift has been noticed in lifestyle habits including early exposure to smoking, in the present study two cases had an addiction for tobacco/smoking. Pediatric HNSCC is usually associated with genetic conditions such as Fanconi's anemia and xeroderma pigmentosum which play a role in an increased risk of mucosal carcinoma.[2],[5] Five patients were moderately differentiated SCC. Three patients were well-differentiated SCC, and one patient was poorly differentiated SCC.

In a match-paired analysis of SCC of oral tongue by Morris et al., overall survival, disease-free survival (DFS), and recurrence-free survival (RFS) were similar in between the pediatric and the adult group.[6]

Many studies had shown that the DFS and RFS in SCC of the oral tongue in the two age group (younger than 40 years vs. older than 40 years) are similar.[7],[8] In a review from the Armed Forces Institute of Pathology, it also demonstrated good response with adequate surgical treatment.[4] Studies had shown that surgery is suggested as the primary modality because of negative impact on facial growth and soft- and hard-tissue development and increase the risk of developing a second malignancy.[9] Radiotherapy and chemotherapy are used in adjuvant setting as per indication, and upfront chemotherapy has been used to downstage the tumor. In the present study, neoadjuvant chemotherapy is used in one patient.


 » Conclusion Top


Pediatric HNSCC is a poses special challenge to treat as it has impact on the quality of life, cosmetic outcomes, and secondary malignancies may develop with increased survival. Further studies are needed to improve our understanding of the pathogenesis of pediatric HNSCC.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
De Carvalho MB, Sobrinho Jde A, Rapoport A, Fava AS, Mendes AF, Kanda JL, et al. Head and neck squamous cell carcinoma in childhood. Med Pediatr Oncol 1998;31:96-9.  Back to cited text no. 1
    
2.
Keukens F, van Voorst Vader PC, Panders AK, Vinks S, Oosterhuis JW, Kleijer WJ. Xeroderma pigmentosum: Squamous cell carcinoma of the tongue. Acta Derm Venereol 1989;69:530-1.  Back to cited text no. 2
    
3.
Bhanuprasad V, Mallick S, Bhasker S, Mohanti BK. Pediatric head and neck squamous cell carcinoma: Report of 12 cases and illustrated review of literature. Int J Pediatr Otorhinolaryngol 2015;79:1279-82.  Back to cited text no. 3
    
4.
Thompson L, Castle J, Heffner DK. Oral squamous cell carcinoma in pediatric patients: A clinicopathologic study of 20 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:204. [Abstract].  Back to cited text no. 4
    
5.
Kaplan MJ, Sabio H, Wanebo HJ, Cantrell RW. Squamous cell carcinoma in the immunosuppressed patient: Fanconi's anemia. Laryngoscope 1985;95(7 Pt 1):771-5.  Back to cited text no. 5
    
6.
Morris LG, Patel SG, Shah JP, Ganly I. Squamous cell carcinoma of the oral tongue in the pediatric age group: A matched-pair analysis of survival. Arch Otolaryngol Head Neck Surg 2010;136:697-701.  Back to cited text no. 6
    
7.
Friedlander PL, Schantz SP, Shaha AR, Yu G, Shah JP. Squamous cell carcinoma of the tongue in young patients: A matched-pair analysis. Head Neck 1998;20:363-8.  Back to cited text no. 7
    
8.
Fang QG, Shi S, Liu FY, Sun CF. Tongue squamous cell carcinoma as a possible distinct entity in patients under 40 years old. Oncol Lett 2014;7:2099-102.  Back to cited text no. 8
    
9.
Zwetyenga N, Gargiulo M, Demeaux H, Siberchicot F, Majoufre-Lefebvre C. Epidermoid carcinoma of oral cavity in patients less than twenty. Rev Stomatol Chir Maxillofac 2004;105:201-5.  Back to cited text no. 9
    




 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow