|Neumeyer, Rita: Metastasierungsverhalten und Prognose von verrukösen Karzinomen - Literaturübersicht und retrospektive Studie - |
From 1980 to 1995 there were treated 24 patients with verrucous carcinoma in the Clinic for Oral and Maxillo-Facial surgery of the Charité and 13 patients with verrucous carcinoma in the Clinic for Otorhinolaryngology of the Charité.
In addition to analysis of patients files there were sent qestionnaires. In 14 cases these could included in the study.
3 patients had lymph node metastases. In 2 cases they were caused by a verrucous carcinoma and in one case by a bad differentiated squamos cell carcinoma. There were no distant metastases.
In no case verrucous carcinoma is known as cause of death.
Thats why the survival rate was investigated on recidivity.
8 patients had relapses. 3 of them had repeated relapses.
The occurrence of relapses was investigated to connections with operation method, age and sex of the patients, and tumor extend. There was only statistic connection to tumor extend. This relation was represented by Kaplan Meier estimation.
It was established that larger tumors relapse more often and faster. Log rank test and Breslow test showed statistic significant results.
Half of the patients had relapse 4 to 9 monthes post operationem.
The assessment of literature showed in 17 cases regional lymph node metastases, and a verrucous carcinoma of the cervix had distant metastases.
The prognosis of verrucous carcinoma is excellent with adequate therapy. Surgery is the method of choice in most cases.
Lymph node treatment should not be routine, it should be taken into consideration only in small dimensions and first of all in large verrucous carcinoma.
Complete excision during first operation is to aim.
Besides conventional surgical excision the application of the CO 2-laser gets in foreground.
Electrosurgery and cryosurgery are to decline in most cases.
Mohs chemosurgery is a good method in the management of relapses.
Radiation therapy is hardly controversial.
Chemotherapy and immunotherapy are still in the beginning.
Early detection is necessary, because the prognosis of verrucous carcinoma is the better the smaller the tumor is.
For finding out the diagnosis and therefore also for therapy and prognosis a very close cooperation between clinical physician and pathologist is necessary.
Re-examinations are necessary to recognize relapses early.
A further clinical study on a large scale is necessary to verify the results.
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