台灣頭頸部腫瘤醫學會

楊吉川國際頭頸腫瘤演講

2017 Honored Lecturer

Robert L Witt, MD, FACS
Professor of Otolaryngology-Head & Neck Surgery
Thomas Jefferson University, Philadelphia, PA USA
Affiliate Professor, Biological Sciences
University of Delaware, Newark DE USA
Director Multi-disciplinary Head & Neck Clinic
Helen F. Graham Cancer Center, Christiana Care
Newark DE USA

Topic: Thyroid Molecular Testing Using Ultrasound

Abstract

  1. Surgeon Performed Thyroid Ultrasound Guided FNAC with On-Site Cytopathology improves adequacy and accuracy.
  2. Ultrasound Risk Stratification
  3. Bethesda Cytology Classification for fine needle aspiration.
  4. Molecular alteration testing for Indeterminate thyroid nodules improves specificity analysis and may reduce the number of completion thyroidectomies
  5. Molecular alteration testing for Indeterminate thyroid nodules improves sensitivity analysis and may reduce surgery on benign nodules.
  6. Commercially Available Molecular Testing for Thyroid Cancer:
  7. Gene Mutation Panel: miRInform (Asuragen), now ThyGenX (Interpace)-Rule in cancer
  8. Gene Expression Classifier (Afirma, Veracyte)-Rule out cancer
  9. ThyroSeq v2.1 (CBL Path)- Rule in cancer/rule out cancer
  10. ThyGenX + ThyraMIR (Interpace)-Rule in cancer/rule out cancer
  11. Are Molecular Alteration tests valid predictors of false positives and negatives?
  12. Genetics overview-BRAF, RAS, RET/PTC, PAX8/PPARg, mRNA panels, miRNA panels
  13. Clinical Utility: Do Commercially available tests change management?
  14. Factors that may mute the power of a rule in test and positive predictive value- and impact of new diagnostic category NIFTP
  15. Incorporation of American Thyroid Association Guidelines and Molecular testing.
  16. Algorithm to rule out cancer with molecular testing: prevalence and negative predictive value.
  17. Prognostication with Multiple Mutations
  18. Case examples
  19. Indications favoring rule in testing: FLUS/FN, High Prevalence of cancer at your institution for Indeterminates FNAC, High risk ultrasound features, Highly specific mutation for cancer, Surgeon favoring total thyroidectomy for DTC <4cm.
  20. Indications favoring rule out testing: FLUS/FN, Low prevalence of cancer at your institution for DTC on Indeterminates, Nodules < 4cm, No high risk history, physical or ultrasound features.
  21. Conclusions.

2016 Honored Lecturer

Management of the Neck in the Era of Organ preservation
Jesus E. Medina, MD, FACS
Professor
Department of Otolaryngology Head and Neck Surgery
University of Oklahoma

Topic: Management of the Neck in the Era of "Organ Preservation"

The treatment of advanced carcinomas of the larynx and pharynx has evolved from surgery and postoperative radiation to “organ preservation” strategies with various combinations of radiation and chemotherapy and more recently to tissue-sparing transoral endoscopic and robotic surgery. This has brought up several dilemmas in the management of the cervical lymph nodes, both electively and therapeutically.

The first dilemmas to be addressed in this presentation concern the timing and extent of elective node dissection, as well as the need to address the retropharyngeal lymph nodes, in patients with oropharyngeal tumors treated transorally with endoscopic or robotic assisted resection.

The second dilemma concerns the management of the clinically N0 neck in patients undergoing “salvage”, particularly laryngectomy after failure of treatment with radiation alone or in combination with chemotherapy.

The third set of dilemmas concern the management of patients with clinically obvious lymph node metastases, particularly those with advanced neck disease (N2 – N3), who are initially treated with radiation with or without chemotherapy. Issues to be discussed are whether or not a planned neck dissection should be performed, irrespective of the response of the tumor in the neck, the timing of the decision to dissect the neck nodes and the role of CT and PET scanning in identifying the subset of patients who need a neck dissection and in the decisions about the extent of the node dissection.

2015 Honored Lecturer

Chung-Hwan Baek, MD, PhD
Professor
Department of ORL-HNS
Department of Medical Device Management & Research, SAIHST
Sungkyunkwan University School of Medicine,
Samsung Comprehensive Cancer Center
Korea

2015 topic: Debating issues for the management of tongue squamous cell carcinoma


ABSTRACT

Oral cancer is the eighth most common cancer in worldwide and tongue squamous cell carcinoma(TSCC) is a common cancer in oral cavity. There were several issues of the treatment option for tongue squamous cell carcinoma. Elective neck dissection in patients with the clinical negative neck in early TSCC, safe surgical resection margin, and reconstruction method for TSCC will be discussed.

The treatment of patients with clinical negative neck (cN0) in T1-2 TSCC remains controversial. A conservative trend in the treatment OSCC N0 patients has encouraged the sentinel lymph node biopsy(SLNB). Our study SLNB for cN0 oral tongue SCC provides acceptable oncological outcomes by long-term observation. Despite the false positive rate of 11.7% in the SLNB application group, phase did not affect neck control rate, stringent strategy of follow-up and salvage treatment is mandatory to maintain acceptable outcomes.

Current NCCN Clinical Practice Guideline recommend the adjuvant treatment in case with close resection margins(~5mm) in patients with oral squamous cell carcinoma in spite of tumor size or stage. In our recent study, when the patients were stratified into small (T1-2) and large (T3-4) tumors, close margin was a significant risk factor for local recurrence in T3-4 OSCC(p=0.036, HR=11.079, 95% CI=1.170-104.863), but not in T1-2 OSCC. Close margin was not an independent risk factor of local recurrence in T1-2 OSCC while it significantly increased local recurrence rates in T3-4 OSCC.

Generally, a variety of different methods such as radial forearm free flap(RFFF) and anterolateral thigh free flap(ALTFF) have been used in tongue reconstruction according to the defect size and site. However, RFFF and ALTFF show various features in the donor site morbidity such as tendon exposure, skin graft loss and sensory deficits. Recently, we developed facial artery musculomucosal island flap (FAMMI) to reconstruct small and medium sized defects in tongue and mouth floor. FAMMI flap transferred to the neck through a paramandibular tunnel and transposed to the intraoral area for primary reconstruction of partial glossectomy defects. Intraoral donor site could be closed primarily or secondary with minimal scarring.