|Year : 2016 | Volume
| Issue : 3 | Page : 397-398
Pediatric head and neck squamous cell carcinoma: A retrospective observational study
D Sharma, G Singh
Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||24-Feb-2017|
Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
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
| » Introduction|| |
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. 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. 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|| |
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|| |
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|| |
SCC of the head and neck is rare in the pediatric population. 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., 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., 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.
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., In a review from the Armed Forces Institute of Pathology, it also demonstrated good response with adequate surgical treatment. 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. 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|| |
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.
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Conflicts of interest
There are no conflicts of interest.
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