Faisal Muhammad, Abbas Taskheer, Khaleeq Usman, Adeel Mohammad, Anwer Abdul Wahid, Hussain Raza, Jamshed Arif
Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan.
Cureus. 2017 May 1;9(5):e1203. doi: 10.7759/cureus.1203.
Retromolar trigone squamous cell carcinoma is relatively uncommon and due to its complex anatomy has always remained a challenge in terms of loco-regional control and survival. Surgery, radiotherapy, and chemotherapy as combined modalities have been used but high recurrence rates result in poor outcome.
We have retrospectively evaluated records of 62 patients treated in Head and Neck Oncology unit of Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC), Lahore, Pakistan from 2004 to 2014 who were included based on the criteria of histopathological proven squamous cell carcinoma of retromolar trigone (RMT) treated with radical intent. Diagnostic workup for all patients involved clinical examination, imaging modalities usually magnetic resonance imaging (MRI), computerized tomography (CT), Orthopantomogram (OPG), and chest x-ray (CXR) to evaluate regional and distant metastasis, respectively. Kaplan-Meier survival curves were used to depict survival.
The study was comprised of 36 male and 26 female patients. Treatment modalities used are surgery only (n = 1), radiotherapy alone (n = 13), radiotherapy followed by surgery (n = 10), chemoradiotherapy (n = 16), induction chemotherapy followed by concurrent chemoradiotherapy (n = 19), induction chemotherapy followed by surgery, and radiotherapy (n = 2). Surgical interventions include wide local excisions (n = 6), marginal mandibulectomy (n = 4), and segmental mandibulectomy (n = 4). Surgical margins were clear in 54%, close in 38%, and involved in 8% of patients. AJCC 7th edition showed cT1 8%, cT2 22%, cT3 14%, and cT4 56% while pT1 2%, pT2 3%, and pT4 8%. During follow-up, 18% patients have come up with local recurrence, 22% showed persistent disease while 9% have presented with distant metastasis. The five-year and overall survivals are 38% and 22%, respectively.
Retromolar trigone involvement poses many vital structures at risk of involvement. Late presentation results in involvement of masticator space compromising both mouth opening and surgical outcomes. Surgery and radiotherapy have shown comparable results in disease control. Bone invasion has shown poor outcome in terms of loco-regional control and overall survival.
磨牙后三角区鳞状细胞癌相对少见，由于其解剖结构复杂，在局部区域控制和生存方面一直是一项挑战。手术、放疗和化疗作为联合治疗手段已被应用，但高复发率导致预后不良。
我们回顾性评估了2004年至2014年在巴基斯坦拉合尔绍卡特·汗姆纪念癌症医院和研究中心（SKMCH和RC）头颈肿瘤科接受治疗的62例患者的记录，这些患者基于组织病理学证实的磨牙后三角区（RMT）鳞状细胞癌且采用根治性治疗的标准纳入研究。所有患者的诊断检查包括临床检查、通常为磁共振成像（MRI）、计算机断层扫描（CT）、全景曲面断层片（OPG）和胸部X线（CXR）等影像学检查，分别用于评估区域和远处转移情况。采用Kaplan-Meier生存曲线来描述生存情况。
该研究包括36例男性和26例女性患者。所采用的治疗方式有单纯手术（n = 1）、单纯放疗（n = 13）、放疗后手术（n = 10）、同步放化疗（n = 16）、诱导化疗后同步放化疗（n = 19）、诱导化疗后手术及放疗（n = 2）。手术干预包括广泛局部切除（n = 6）、边缘性下颌骨切除术（n = 4）和节段性下颌骨切除术（n = 4）。54%的患者手术切缘清晰，38%切缘接近，8%切缘受累。美国癌症联合委员会（AJCC）第7版显示临床分期cT1为8%，cT2为22%，cT3为14%，cT4为56%；病理分期pT1为2%，pT2为3%，pT4为8%。在随访期间，18%的患者出现局部复发，22%显示疾病持续存在，9%出现远处转移。五年生存率和总生存率分别为38%和22%。
磨牙后三角区受累使许多重要结构有受累风险。就诊延迟导致咀嚼肌间隙受累，影响张口及手术效果。手术和放疗在疾病控制方面显示出相似的结果。骨侵犯在局部区域控制和总生存方面预后较差。
