Histological grading, growth fraction and DNA-ploidy as criteria for the treatment of pharyngeal and supraglottic squamous cell carcinomas: A preliminary, prospective study

Background. Individualized treatment for patients with squamous cell carcin omas is most desirable. Biologic parameters of tumors may provide relevant criteria to achieve this goal. The aim of this study was: (1) to avoid elec tive neck dissection in patients with squamous cell carcinomas of the phary nx and supraglottis staged NO by ultrasonography; (2) to administer postope rative radiotherapy only in patients staged 'highly aggressive' by biologic tumor parameters, in order to reduce patient morbidity and to improve qual ity of life. Study Design and Methods: This prospective trial was performed in 35 patients (any T stage, N0 or N1 by ultrasonographic examination). Tu mor biopsies were taken for histological examination and for evaluation of some biological tumor markers. These parameters comprised DNA cytometric ex aminations, histological grading of the tumor front and immunohistochemical staining for proliferation markers (MIB1, PCNA). Based on these parameters , tumors were classified into 'low aggressive' (group 1) and highly aggress ive (group 2) behavior. In all patients, second primaries were excluded by endoscopy, and the presenting tumor was resected with clear margins. In cas es of ultrasonographically enlarged lymph nodes, functional neck dissection was performed. When biologic tumor profile showed low aggressive behavior (group 1), no postoperative radiotherapy was advised. In cases of highly ag gressive tumors, radiotherapy was recommended postoperatively independent o f all other parameters (group 2a and 2b). Results: The average followup was 36 months (range 16-65 months). Fifteen patients were included in group 1, 20 patients in group 2. Three patients with highly aggressive tumors who r efused RTx were regarded independently (group 2b). In this pilot study of 3 5 patients, there was no difference in disease-free survival between group 1 and group 2a. Twenty-five of 35 patients were alive with no evidence of d isease 29-65 months after treatment (3 died of disease; 5 died of second pr imary carcinomas; 2 died independent of disease). Eleven of 15 patients sur vived disease free in group 1, 13/17 in group 2a. In group 2b, 2 out of 3 p atients, who were advised but refused postoperative radiotherapy, had recur rences. Conclusions. The results of this preliminary study point towards us efulness of some tumor biologic parameters in decision making for individua lized treatment in patients with squamous cell carcinomas. Copyright (C) 20 01 S. Karger AG, Basel.