Assessment of carotid artery invasion in patients with head and neck cancer.
OBJECTIVE
Define radiological and histological features in which patients with head and neck cancer would benefit from a carotid artery resection. Resection of the carotid artery has been advocated for local control of advanced squamous cell carcinoma of the head and neck. To provide appropriate preoperative counseling and optimize the utilization of resources, the criteria for patient selection has to be defined.


METHODS
Thirty-four patients underwent carotid artery resection based on the clinical impression of tumor fixation. Eighteen and 28 patients were evaluated using computed tomography (CT) and histological analysis, respectively. The distance between the tumor cells and external elastic lamina was measured. CT scans were examined to determine the circumference of tumor attachment around the carotid artery.


RESULTS
Clinical assessment predicted tumor within 1.8 mm of the carotid artery in 68% of cases. The overall survival for patients with tumor greater than 1.8 mm (N = 9) was better than that of patients with less (N = 19) than 1.8 mm (33.3% vs. 5.3%; median 24 versus 9 mo, P = .0899). Three of six patients (50%) with less than 180 degrees circumference tumor attachment had tumor within 1.8 mm from the external elastic lamina. Eight of twelve patients (67%) with tumors encompassing more than 180 degrees of the artery wall had tumor within 1.8 mm from the external elastic lamina. The overall survival rates for patients with tumor attachment greater and less than 180 degrees were 8.3% and 33%, respectively.


CONCLUSIONS
Tumor invasion into the carotid artery was the strongest predictor of outcome. Clinical assessment was as predictive as CT for tumor invasion. If tumor involvement of the carotid artery is less than 180 degrees, peeling the tumor is an alternative to carotid artery resection.
Yoo
G H
GH
Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan 48201, USA.
Hocwald
E
E
Korkmaz
H
H
Du
W
W
Logani
S
S
Kelly
J K
JK
Sakr
W
W
Jacobs
J R
JR
D000206:Actuarial Analysis; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary; D002339:Carotid Arteries / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media; D003376:Counseling; D004547:Elastic Tissue / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010347:Patient Care Planning; D018579:Patient Selection; D016016:Proportional Hazards Models; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000473:pathology* / Q000601:surgery
D003287:Contrast Media