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Determining Adequate Margins in Head and Neck Cancers: Practice and Continued Challenges

  • Head and Neck Cancers (EY Hanna, Section Editor)
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Abstract

Margin assessment remains a critical component of oncologic care for head and neck cancer patients. As an integrated team, both surgeons and pathologists work together to assess margins in these complex patients. Differences in method of margin sampling can impact obtainable information and effect outcomes. Additionally, what distance is an “adequate or clear” margin for patient care continues to be debated. Ultimately, future studies and potentially secondary modalities to augment pathologic assessment of margin assessment (i.e., in situ imaging or molecular assessment) may enhance local control in head and neck cancer patients.

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References

Papers of the particular interest, published recently, have been highlighted as • Of importance •• Of major importance

  1. Looser KG, Shah JP, Strong EW. The significance of “positive” margins in surgically resected epidermoid carcinomas. Head Neck Surg. 1978;1(2):107–11.

    Article  CAS  PubMed  Google Scholar 

  2. Batsakis JG. Surgical excision margins: a pathologist’s perspective. Adv Anat Pathol. 1999;6(3):140–8.

    Article  CAS  PubMed  Google Scholar 

  3. Loree TR, Strong EW. Significance of positive margins in oral cavity squamous carcinoma. Am J Surg. 1990;160(4):410–4.

    Article  CAS  PubMed  Google Scholar 

  4. Sutton DN, Brown JS, Rogers SN, Vaughan ED, Woolgar JA. The prognostic implications of the surgical margin in oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2003;32(1):30–4.

    Article  CAS  PubMed  Google Scholar 

  5. Luryi AL, Chen MM, Mehra S, Roman SA, Sosa JA, Judson BL. Positive surgical margins in early stage oral cavity cancer: an analysis of 20,602 cases. Otolaryngol Head Neck Surg. 2014;151(6):984–90. This is a national database study highlighting the rate of positive margins between different types of institutions and by anatomic location.

    Article  PubMed  Google Scholar 

  6. Anderson CR, Sisson K, Moncrieff M. A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma. Oral Oncol. 2015;51(5):464–9. Review.

    Article  PubMed  Google Scholar 

  7. Yamada S, Kurita H, Shimane T, Kamata T, Uehara S, Tanaka H, et al. Estimation of the width of free margin with a significant impact on local recurrence in surgical resection of oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 2016;45(2):147–52.

    Article  CAS  PubMed  Google Scholar 

  8. NCCN-Principles of surgery-Margins SURG-A page 3 of 9 v1.2015, National Comprehensive Cancer Network Inc. Head and Neck Cancers. This is an oncologic network that develops guidelines and institute standards of care for the treatment of cancer and outcome research. This specific guidance is for the management of Head and Neck Cancers.

  9. Meier JD, Oliver DA, Varvares MA. Surgical margin determination in head and neck oncology: current clinical practice. The results of an International American Head and Neck Society Member Survey. Head Neck. 2005;27(11):952–8.

    Article  PubMed  Google Scholar 

  10. Black C, Marotti J, Zarovnaya E, Paydarfar J. Critical evaluation of frozen section margins in head and neck cancer resections. Cancer. 2006;107(12):2792–800.

    Article  PubMed  Google Scholar 

  11. Maxwell JH, Thompson LD, Brandwein-Gensler MS, Weiss BG, Canis M, Purgina B, et al. Early oral tongue squamous cell carcinoma: sampling of margins from tumor bed and worse local control. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1104–10. This retrospective study compares methods of tumor margin sampling, from the patient/tumor bed (separately submitted) versus from the en bloc specimen, in stage I/II oral tongue squamous cell carcinomas. The results show that the method of margin sampling effects local control rate.

    Article  PubMed  Google Scholar 

  12. Chang AM, Kim SW, Duvvuri U, Johnson JT, Myers EN, Ferris RL, et al. Early squamous cell carcinoma of the oral tongue: comparing margins obtained from the glossectomy specimen to margins from the tumor bed. Oral Oncol. 2013;49(11):1077–82.

    Article  PubMed  Google Scholar 

  13. Woolgar JA, Triantafyllou A. A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol. 2005;41(10):1034–43.

    Article  PubMed  Google Scholar 

  14. Scholl P, Byers RM, Batsakis JG, Wolf P, Santini H. Microscopic cut-through of cancer in the surgical treatment of squamous carcinoma of the tongue. Prognostic and therapeutic implications. Am J Surg. 1986;152(4):354–60.

    Article  CAS  PubMed  Google Scholar 

  15. Guillemaud JP, Patel RS, Goldstein DP, Higgins KM, Enepekides DJ. Prognostic impact of intraoperative microscopic cut-through on frozen section in oral cavity squamous cell carcinoma. J Otolaryngol Head Neck Surg. 2010;39(4):370–7.

    PubMed  Google Scholar 

  16. Patel RS, Goldstein DP, Guillemaud J, Bruch GA, Brown D, Gilbert RW, et al. Impact of positive frozen section microscopic tumor cut-through revised to negative on oral carcinoma control and survival rates. Head Neck. 2010;32(11):1444–51.

    Article  PubMed  Google Scholar 

  17. Jäckel MC, Ambrosch P, Martin A, Steiner W. Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery. Laryngoscope. 2007;117(2):350–6.

    Article  PubMed  Google Scholar 

  18. Kerawala CJ, Ong TK. Relocating the site of frozen sections—is there room for improvement? Head Neck. 2001;23(3):230–2.

    Article  CAS  PubMed  Google Scholar 

  19. Hinni ML, Ferlito A, Brandwein-Gensler MS, Takes RP, Silver CE, Westra WH, et al. Surgical margins in head and neck cancer: a contemporary review. Head Neck. 2013;35(9):1362–70. This is a multifaceted review on surgical margins specifically in head and neck cancers complied by a multidisciplinary group of physicians specializing in the treatment of head and neck cancers.

    Article  PubMed  Google Scholar 

  20. Dik EA, Willems SM, Ipenburg NA, Adriaansens SO, Rosenberg AJ, van Es RJ. Resection of early oral squamous cell carcinoma with positive or close margins: relevance of adjuvant treatment in relation to local recurrence: margins of 3 mm as safe as 5 mm. Oral Oncol. 2014;50(6):611–5.

    Article  PubMed  Google Scholar 

  21. Ansarin M, Santoro L, Cattaneo A, Massaro MA, Calabrese L, Giugliano G, et al. Laser surgery for early glottic cancer: impact of margin status on local control and organ preservation. Arch Otolaryngol Head Neck Surg. 2009;135(4):385–90.

    Article  PubMed  Google Scholar 

  22. Kwok P, Gleich O, Hübner G, Strutz J. Prognostic importance of “clear versus revised margins” in oral and pharyngeal cancer. Head Neck. 2010;32(11):1479–84. This study evaluates the width of free margin and the impact on local recurrence, showing <5 mm as the threshold altering rate of recurrence in oral cavity T1-T4 tumors (retrospective study).

    Article  PubMed  Google Scholar 

  23. Weinstein GS, Quon H, Newman HJ, Chalian JA, Malloy K, Lin A, et al. Transoral robotic surgery alone for oropharyngeal cancer: an analysis of local control. Arch Otolaryngol Head Neck Surg. 2012;138(7):628–34.

    Article  PubMed  Google Scholar 

  24. Boonstra H, Oosterhuis JW, Oosterhuis AM, Fleuren GJ. Cervical tissue shrinkage by formaldehyde fixation, paraffin wax embedding, section cutting and mounting. Virchows Arch A Pathol Anat Histopathol. 1983;402(2):195–201.

    Article  CAS  PubMed  Google Scholar 

  25. Beaumont DG, Hains JD. Changes in surgical margins in vivo following resection and after fixation. Aust J Otolaryngol. 1992;1:51–2.

    Google Scholar 

  26. Braakhuis BJ, Bloemena E, Leemans CR, Brakenhoff RH. Molecular analysis of surgical margins in head and neck cancer: more than a marginal issue. Oral Oncol. 2010;46(7):485–91.

    Article  CAS  PubMed  Google Scholar 

  27. Bradley PJ, MacLennan K, Brakenhoff RH, Leemans CR. Status of primary tumour surgical margins in squamous head and neck cancer: prognostic implications. Curr Opin Otolaryngol Head Neck Surg. 2007;15(2):74–81.

    Article  PubMed  Google Scholar 

  28. Nathan CO, Amirghahri N, Rice C, Abreo FW, Shi R, Stucker FJ. Molecular analysis of surgical margins in head and neck squamous cell carcinoma patients. Laryngoscope. 2002;112(12):2129–40.

    Article  CAS  PubMed  Google Scholar 

  29. van Houten VM, Leemans CR, Kummer JA, Dijkstra J, Kuik DJ, van den Brekel MW, et al. Molecular diagnosis of surgical margins and local recurrence in head and neck cancer patients: a prospective study. Clin Cancer Res : Off J Am Assoc Cancer Res. 2004;10(11):3614–20.

    Article  Google Scholar 

  30. van Houten VM, Tabor MP, van den Brekel MW, Kummer JA, Denkers F, Dijkstra J, et al. Mutated p53 as a molecular marker for the diagnosis of head and neck cancer. J Pathol. 2002;198(4):476–86.

    Article  PubMed  Google Scholar 

  31. de Carvalho AC, Kowalski LP, Campos AH, Soares FA, Carvalho AL, Vettore AL. Clinical significance of molecular alterations in histologically negative surgical margins of head and neck cancer patients. Oral Oncol. 2012;48(3):240–8.

    Article  PubMed  Google Scholar 

  32. Bedard N, Schwarz RA, Hu A, Bhattar V, Howe J, Williams MD, et al. Multimodal snapshot spectral imaging for oral cancer diagnostics: a pilot study. Biomed Opt Express. 2013;4(6):938–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Levy LL, Vila PM, Park RW, Schwarz R, Polydorides AD, Teng MS, Gurudutt VV, Genden EM, Miles B, Anandasabapathy S, Gillenwater AM, Richards-Kortum R, Sikora AG. High-resolution optical imaging of benign and malignant mucosa in the upper aerodigestive tract: an atlas for image-guided surgery. ISRN Minim Invasive Surg. 2012;2012.

  34. Keereweer S, Sterenborg HJ, Kerrebijn JD, Van Driel PB, Baatenburg de Jong RJ, Löwik CW. Image-guided surgery in head and neck cancer: current practice and future directions of optical imaging. Head Neck. 2012;34(1):120–6. Review.

    Article  CAS  PubMed  Google Scholar 

  35. Rosbach KJ, Williams MD, Gillenwater AM, Richards-Kortum RR. Optical molecular imaging of multiple biomarkers of epithelial neoplasia: epidermal growth factor receptor expression and metabolic activity in oral mucosa. Transl Oncol. 2012;5(3):160–71.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, Head and Neck Section, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Blvd, Unit 085, Houston, TX, 77030, USA

    Michelle D. Williams

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  1. Michelle D. Williams
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Correspondence to Michelle D. Williams.

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Michelle D. Williams declares that she has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Head and Neck Cancers

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Williams, M.D. Determining Adequate Margins in Head and Neck Cancers: Practice and Continued Challenges. Curr Oncol Rep 18, 54 (2016). https://doi.org/10.1007/s11912-016-0540-y

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  • DOI: https://doi.org/10.1007/s11912-016-0540-y

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