PANEL DISCUSSION- CANCER TONGUE

1. PANEL DISCUSSION
APOLLO KOLKATA
CANCER TONGUE
DR KANHU CHARAN PATRO
3/3/2019 1

2. MANY THANKS –DR TANWEER & APOLLO
3/3/2019 2

3. DR ENAM MURSHED KHAN SIR
• Senior Consultant & Head
• Department of Pathology
• Apollo Hospital
• KOLKATA
3/3/2019 3

4. DR SUBRATA SAHA SIR
•Senior Consultant,
•Radiation Oncology
•Apollo Hospital
•KOLKATA
3/3/2019 4

5. DR AKHTER JAWADE
•Senior Consultant,
•Radiation Oncology
•Apollo Hospital
•KOLKATA
3/3/2019 5

6. DR.KAKALI CHOUDHURY MAM
•Assistant Professor,
•Dept of Radiation Oncology,
•RG Kar Medical College
3/3/2019 6

7. DR SHAIKAT GUPTA SIR
 SENIOR CONSULTANT AND
HEAD OF DEPARTMENT AND
DIRECTOR
 SURGICAL ONCOLOGY
 APOLLO HOSPITAL
 KOLKATA
3/3/2019 7

8. DR SOURAV DATTA SIR
SENIOR CONSULTANT & HOD
NARAYANA HOSPITALS
SURGICAL ONCOLOGY
KOLKATA
3/3/2019 8

9. DR VIVEK AGARWALA SIR
Senior Consultant,
NARAYANA HOSPITALS
MEDICAL ONCOLOGY
KOLKATA
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10. APPLICABLE IN ONCOLOGY
ALSO
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11. 45 YEAR HINDU MALE SINGER
• Ulcerative lesion on right side of ant 2/3rd of
tongue
• H/0 ILL FITTED DENTURE
• Maximum dimension 2cm
• Minimal pain
• Clinically NO NODE
• cT1N0M0
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13. EXPLANATION BY ONCO-SURGEON
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14. INVESTIGATION
• BIOPSY- SQUAMOUS CELL CARCINOMA/WD
• ANY IMAGING DO YOU LIKE?
• CT VS MRI
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15. CONTRAST ANAPHYLAXIS
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16. YAMAPURI
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17. CHITRAGUPTA ANALYSIS
CHIEF ACCOUNTANT OF YAMA
PREMATURE DEATH
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19. CANCER
TREATMENT
WITH ORGAN
PRESERVATION
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20. DENTIST
ENT SURGEON
ONCO-SURGEON
RADIATION ONCOLOGIST
SPECIALIST SEARCH
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21. BRACHYTHERAPY
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22. DR SUBRATA SAHA SIR
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25. RECOMMENDATIONS
• ELDERLY
• MEDICALLY IN OPERABLE
• BOOST
• RECURRENCE-RERT
• POSITIVE AND CLOSE MARGIN
• GOOD COSMETIC OUTCOME
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DR SOURAV DATTA SIR

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30. Type of surgery?
Is nodal dissection needed?
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DR SHAIKAT GUPTA SIR

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35. In conclusion, the results of TMH TRIAL
suggest that elective neck dissection at
the time of resection of the primary
tumor confers an overall survival benefit
in patients with early-stage, clinically
node-negative oral squamous-cell
carcinoma
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36. OUTSIDE PATHOLOGY REPORT
PARAMETER REPORT
T SIZE 2CM X 2.5CM X 1CM
TYPE OF GROWTH PROLIFERATIVE
HISTOLOGY WD/SQ
LVI NIL
CM NEGATIVE
ONE MARGIN IS 2MM BUT FREE
NODAL POSITIVE 10 NODE NEGATIVE
PERINODAL EXTENSION NIL
ANY MISSING PARAMETER3/3/2019 36

37. DR ENAM MURSHED KHAN SIR
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1.Each 1-mm increase in clear surgical margin
decreased the risk of death at 5 years by 8% (HR
0.92; 95% CI 0.86, 0.99; P 0 .021).
2.Based on this model, patients with positive
surgical margins had a 2.5-fold increase in risk
of death at 5 years and
3.Those with close ( 3 mm) margins had a 1.5-fold
increase in risk of death (P 0.076) when
compared to patients with margins greater than
3 mm

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46. PATHOLOGY REPORT
PARAMETER REPORT
T SIZE 2CM X 2.5CM X 1CM
TYPE OF GROWTH PROLIFERATIVE
HISTOLOGY WD/SQ
DEPTH OF INVASION 5mm
LVI NA
CM NEGATIVE
NODAL POSITIVE 10 NODE NEGATIVE
PERINODAL EXTENSION NIL
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47. THICKNESS VS DEPTH
all are same?
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49. Fig 3. Representative schema of tumour depth and measurement of depth of invasion.
De Silva RK, Siriwardena BSMS, Samaranayaka A, Abeyasinghe WAMUL, Tilakaratne WM (2018) A model to predict nodal metastasis in patients
with oral squamous cell carcinoma. PLOS ONE 13(8): e0201755. https://doi.org/10.1371/journal.pone.0201755
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201755
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51. GROUP A < 4mm GROUP B > 4mm
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58. PATHOLOGY REPORT
PARAMETER REPORT
T SIZE 2CM X 2.5CM X 1CM
TYPE OF GROWTH PROLIFERATIVE
HISTOLOGY WD/SQ
DEPTH OF INVASION 5mm
LVI NA
PNI POSITIVE
CM NEGATIVE
NODAL POSITIVE 10 NODE NEGATIVE
PERINODAL EXTENSION NIL
3/3/2019 58

59. PERI-NEURAL INVASION – CA TONGUE
Large extratumoral 5-mm
diameter nerve with intraneural
invasion by carcinoma
Several foci (>1) of intratumoral
PNI in a single tumor section (n:
nerve; arrow: tumor
Small (nerve (n) with PNI
completely surrounded by tumor
(arrow)
SMALL nerve (n) with PNI partially
wrapped by tumor (arrow)
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63. Staging criteria is justified in 8th
edition?
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DR SHAIKAT GUPTA SIR

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68. PATHOLOGY REPORT
PARAMETER REPORT
T SIZE 2CM X 2.5CM X 1CM
TYPE OF GROWTH PROLIFERATIVE
HISTOLOGY WD/SQ
DEPTH OF INVASION 5mm
LVI NA
PNI POSITIVE
CM NEGATIVE/one is 2mm
NODAL POSITIVE 10 NODE NEGATIVE
PERINODAL EXTENSION NIL
WPOI 5
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69. DR ENAM MURSHED KHAN SIR
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71. WPOI-WORST PATTERN OF INVASION
Shimizu S /PLOS/2018 27th FEB/HEAD & NECK
WPOI 1
WPOI 2
WPOI 3
WPOI 4
WPOI 5
PUSHING BORDER
FINGER LIKE PROJECTIONS
INVASIVE ISLANDS
[>15 CELLS/ISLAND]
INVASIVE ISLANDS
[>15 CELLS/ISLAND]
INCLUDING SINGLE CELL INVASION
TUMOR SATELLITES
>1MM FORM
TUMOR
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74. In conclusion
1. Our large multicenter international cohort of early-
stage OTSCC confirmed that the DOI (4 mm or
deeper) is a factor highly predictive for locoregional
recurrence and cancer death.
2. We suggest that any cT1-2cN0 OTSCC 4 mm or
deeper, or with a growth pattern characterized by
small cell islands or satellites, should be considered
as a high-risk tumor requiring multimodality
treatment.
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Epithelial to mesenchymal transition

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77. Role of radiotherapy
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78. DR.KAKALI CHOUDHURY MAM PLEASE
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80. Target volume delineation
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82. Interval between surgery and
radiotherapy
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83. DR.KAKALI CHOUDHURY MAM PLEASE
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85. Any role of chemotherapy in
carcinoma tongue-in concurrent
settings?
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86. DR VIVEK AGARWALA SIR PLEASE
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87. EORTC-22931
RTOG-9501
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88. RTOG 9501—At 10 years
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92. • DATA SUGGEST THAT IN LOCALLY ADVANCED HEAD AND
NECK CANCER,
• MICROSCOPICALLY INVOLVED RESECTION MARGINS
AND EXTRACAPSULAR SPREAD OF TUMOR FROM NECK
NODES ARE THE MOST SIGNIFICANT PROGNOSTIC
FACTORS FOR POOR OUTCOME.
• THE ADDITION OF CONCOMITANT CISPLATIN TO
POSTOPERATIVE RADIOTHERAPY IMPROVES OUTCOME
IN PATIENTS WITH ONE OR BOTH OF THESE RISK
FACTORS WHO ARE MEDICALLY FIT TO RECEIVE
CHEMOTHERAPY.
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94. Weekly vs 3 weekly cisplatin
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95. DR VIVEK AGARWALA SIR PLEASE
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97. On follow up regularly
Recurrent lesion at and adjacent to
same site
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99. DR SUBRATA SAHA SIR
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DR SOURAV DATTA SIR

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110. DR.KAKALI CHOUDHURY MAM PLEASE
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112. How to access the irradiated field
If no paper available?
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117. OPINION ABOUT PROTON SBRT?
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122. MANY THANKS
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