gms | German Medical Science

100 years ago, people were of the firm conviction that carcinomas of the oral cavity, pharynx and larynx only led to remote metastases in exceptional cases (<1%) as a result of their topic. This assumption has been unambiguously refuted. At the time of the first diagnosis, remote metastases are a rare occurrence even now with 1-2%.

318 ENT carcinoma patients given radiosurgery therapy since 1994 were examined in a long-term sequence with regard to the occurrence of tumour progress parameters. 42% of the carcinomas were localised in the 42% oro-pharynx, 34% in the hypopharynx, 15% in the oral cavity and 9% in the supraglottis. The staging showed the following distribution: T2 16.4%, T3 26.4%, T4 57.2%, N0 27%, N1 13%, N2 54%, N3 6%.

By 31.08.2006, 148 patients had died; tumour-dependent 20, local relapse 62, remote formation of metastases 60, secondary carcinoma 5. The probability of developing a clinically relevant remote metastasis in local tumour control was statistically equally as high as the risk of a loco-regional tumour relapse (Z test 0.85). A 5-year survival of 48% was established.

Both kinds of tumour progression were dependent on the initial tumour size (T/N category). The occurrence of remote metastases was not bound to a loco-regional relapse. The significantly more favourable prognosis of the oro-pharynx carcinoma was due to the lower occurrence of remote metastases. Local relapses, on the other hand, occurred with the same frequency in every tumour localisation.

Multi-modal therapy concepts improve the chances of a local tumour control. Remote metastases to be put down to a peri-operative, occult tumour cell dissemination (primarily G0 cells) increasingly determine the survival prognosis.