Initial staging of squamous cell carcinoma of the oral cavity, larynx and pharynx (excluding nasopharynx). Part 2: Remote extension assessment and exploration for secondary synchronous locations outside of the upper aerodigestive tract. 2012 SFORL guidelines - 17/04/13

Doi : 10.1016/j.anorl.2012.09.003

E. de Monès ^a,^⁎ , C. Bertolus ^b, P.Y. Salaun ^c, F. Dubrulle ^d, J.C. Ferrié ^e, S. Temam ^f, D. Chevalier ^g, S. Vergez ^h, F. Lagarde ⁱ, P. Schultz ^j, M. Lapeyre ^k, B. Barry ^l, S. Tronche ^m, D. de Raucourt ⁿ, S. Morinière ^o
^a Service d’ORL et de Chirurgie Cervico-Faciale, Groupe Hospitalier Pellegrin, Centre François-Xavier-Michelet, CHU, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
^b Service de Chirurgie Maxillo-Faciale, Groupe Hospitalier La Pitié-Salpêtrière-Charles Foix, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France
^c Service de Médecine Nucléaire, CHU de Brest, avenue Foch, 29609 Brest cedex, France
^d Service de Radiologie, Hôpital Claude-Huriez, 1, place de Verdun, 59037 Lille cedex, France
^e Service de Radiologie, CHU de Poitiers, 2, rue de La-Miletrie, 86021 Poitiers cedex, France
^f Service d’ORL et de Chirurgie Cervico-Faciale, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif cedex, France
^g Service d’ORL et de Chirurgie Cervico-Faciale, Hôpital Huriez, CHRU, 1, place de Verdun, 59037 Lille cedex, France
^h Service d’ORL et de Chirurgie Cervico-Faciale, Hôpital Rangueil-Larrey, CHU de Toulouse, 24, chemin de Pouvourville, 31059 Toulouse cedex 9, France
ⁱ Service d’ORL et de Chirurgie Cervico-Faciale, CHR d’Orléans, 1, rue Porte-Madeleine, 45032 Orleans cedex 1, France
^j Service d’ORL et de Chirurgie Cervico-Faciale, Hôpital Hautepierre, CHU, 1, avenue Molière, 67098 Strasbourg cedex, France
^k Service de Radiothérapie, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 01, France
^l Service d’ORL et de Chirurgie Cervico-Faciale, Hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
^m SFORL, 26, rue Lalo, 75116 Paris, France
ⁿ Service d’ORL et de Chirurgie Cervico-Faciale, Centre François-Baclesse, avenue du Général-Harris, 14000 Caen, France
^o Service d’ORL et de Chirurgie Cervico-Faciale, Hôpital Bretonneau, CHRU de Tours, 37044 Tours cedex 9, France

Corresponding author. Tel.: +33 05 56 79 59 71.

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Summary

Objectives

This report presents the French Society of ORL (SFORL) guidelines for exploration for remote metastasis and synchronous second cancer in initial staging of head and neck squamous cell carcinoma.

Materials and methods

An exhaustive literature review was analyzed by a multidisciplinary work-group.

Results

The thorax is the most frequent location of remote metastases and synchronous second cancer outside of the upper aerodigestive tract. Thoracic CT is recommended as first-line examination in all cases (grade B). 18-FDG PET/CT is recommended when the thoracic CT image is doubtful or in case of high metastatic risk (grade B), for the detection of non-pulmonary remote metastasis. Esophageal exploration is recommended in case of significant risk of synchronous esophageal cancer (hypopharyngeal or oropharyngeal tumor, chronic alcohol intoxication) (grade B). The reference examination is flexible endoscopy of the upper digestive tract (grade B).

Conclusion

The present grade B recommendations rationalize the roles of the various first-line radiological and endoscopic examinations for remote metastasis and synchronous second cancer, so as to limit the number of examinations performed, thereby reducing the time needed for initial staging.

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Keywords : Squamous cell carcinoma, Oral cavity, Pharynx, Larynx, Initial staging, Metastasis, Synchronous secondary location, CT, MRI, FDG-PET/CT, Flexible endoscopy of the esophagus