Introduction: The pedicled pectoralis major myocutaneous flaphas long been superseded as the reconstruction of first choice formajor head and neck ablative surgery by the development of free tis-sue transfer techniques. The aim of this study is to evaluate the cur-rent use and indications of the pedicled pectoralis major flap inmodern oncological surgical practice.

Methods: A 10 year retrospective review between 1997 and2007. Data recorded included basic demographics, indications forthe pectoralis major flap, staging of disease, type of resection, ASAgrade, previous surgical treatment and post operative complications.

Results: Fifty-two patients were identified and the notes ob-tained for 50 cases. Seventeen pectoralis major flaps were used tosalvage a free flap. The remaining flaps (33) were used as the pre-ferred reconstruction for a variety of indications which included;large volume neck disease with resection of skin (6), salvage surgery(5), in conjunction with free flaps (3), significant medical co-morbid-ity (8). Twenty-nine patients were treated for a primary SCC of thehead and neck of which all patients had Stage IV disease and 15had recurrent disease.

Discussion: The indications for the pectoralis major flap haveradically changed but this flap still has an important role in the man-agement of patients with extensive or recurrent disease, and in thosecompromised by previous radical surgery or significant medical co-morbidity. The options for the management of a failed free flap havebeen evaluated by Wei1 and although a further free flap has beenadvocated the local wound conditions and/or medical conditionmay not always favour further free tissue transfer. In this situationthe pectoralis major flap is often the preferred option.

doi:10.1016/j.oos.2009.06.235

References

1. Wei FC, Demirkan F, Chen HC, et al.. The outcome of failed freeflaps in head and neck and extremity reconstruction: What is nextin the reconstructive ladder. Plast Reconstr Surg2001;108:1154–60.

O151. Evaluation of positron-emission and computed tomogra-phy (PET-CT) imaging service for patients with malignant cervicallymph nodes and an unknown primary tumourM.J. Monteiro *, K. Altman, J. Herold, G. Burkill, I. Francis, J. Dikomite

Brighton and Sussex University Hospitals NHS Trust, United Kingdom

Introduction: The prognosis for patients with metastatic cervicallymphadenopathy and an unknown primary tumour is poor. The liter-ature reports a typical survival period of 1 year from diagnosis in thesecases. However, a median survival period of 23 months has been doc-umented for such patients who subsequently have the primary tu-mour site identified and treated with the appropriate therapy. Only20–27% of primary tumours are identified with conventional radiolog-ical imaging, and 24–40% with standard PET scanning. However, adiagnostic rate of 57% has been reported for PET-CT in the detectionof all occult primary tumours. This study aims to evaluate the use ofPET-CT imaging when applied specifically to the scenario of occultcancer presenting with metastatic cervical lymphadenopathy.

Method: All patients with metastatic cervical lymph nodes pre-senting to the head and neck unit at the Royal Sussex County Hospi-tal between 2004 and 2008, and whose primary tumour could not beidentified by standard diagnostic procedures (CT, MRI, EUA), werereferred for fast-track whole-body PET-CT by the multi-disciplinaryhead and neck cancer meeting. The percentage of primary tumoursfound was calculated.

Results: In 12 (43.5%) of 28 patients referred for PET-CT for met-astatic cervical lymphadenopathy of unknown origin, a primary tu-mour was found.

Discussion: These results provide a detection rate higher thanthat reported with other imaging modalities for occult primary tu-mours in the head and neck region. This has important implicationsfor treatment and prognosis. Further evaluation in larger patientpopulations is required.

doi:10.1016/j.oos.2009.06.236

O152. Evaluation of molecular markers for the assessment ofoccult metastasis in lymph nodes in head and neck squamous cellcarcinomaA. Suresh, S. Duarah, K.R. Hiran, S. Sundaram, V. Kekatpure,M.A. Kuriakose *

Amrita Institute of Medical Sciences, Kochi, India

Nodal metastasis is the single most important prognostic markerof head and neck cancer, which determines recurrence, developmentof distant metastases, and the survival of patients. The managementstrategies for patients with clinically apparent metastases are nowwell established while there is no clear consensus on the manage-ment of occult nodal metastasis. Attempts were therefore made toidentify several clinical, histological and molecular markers thatcan predict nodal metastasis and enable appropriate treatment ofhigh-risk individuals. Lymphoscintigraphy has now been establishedas a reliable and a less invasive technique of identifying the firsttumor-draining lymph node (sentinel node) and thus providingthese sentinel nodes for further analytical studies. Cytokeratin14has been well investigated as a molecular marker for nodal metasta-sis and in this study its expression was assessed along with estab-lished markers of oral cancer, e1F4E (Eukaryotic translationinitiation factor 4E) and Desmoglein 3 (DSG3) in lymph nodes iden-tified by Lymphoscintigraphy in oral cancer patients. Analysis wascarried out by the relative quantification using the Quantitative realtime PCR and by immunohistochemistry (DSG3 and CK14). 45 nodeswere analyzed (40 patients and 5 normals) for the expression ofe1F4E and CK14; the combination of both the markers showed apositive predictive value of 0.88 and an increased sensitivity indetecting pathologically negative patients. Comparative analysis ofDSG3 expression with CK14 and eIF4E has indicated a higher sensi-tivity of detection in the nodes and the efficacy of the use of the com-bination of these markers is currently being evaluated.

doi:10.1016/j.oos.2009.06.237

O153. Neck dissections: Factors affecting outcomes andmorbidityR. Walker, V. Bhatt *, N. Barnard

Worcestershire Acute Hospitals NHS Trust, United Kingdom

Aims and objectives: To study factors affecting morbidity andoutcomes following neck dissections in a single head and neck unit.

Materials and methods: Retrospective audit of records of all pa-tients who underwent neck dissections at Worcestershire Royal Hos-pital. One hundred and fifty patients underwent unilateral or bilateralneck dissections in the period between May 2005 and October 2008.Relationship between various demographic and clinico-pathologicalfactors and morbidity will be sought. Outcomes measured in disease

106 Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122

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free survival, local recurrence, failure in the neck and distant metasta-ses and factors affecting them will also be studied.

We will look at the relation between shoulder morbidity (painand range of motion) and the function of the spinal accessory nerveafter neck dissection. The requirements for and influence of periop-erative blood transfusion on outcome will also be studied. Anyimpact of preradiotherapy haemoglobin levels on efficacy and out-come following radiotherapy will be defined. Lymph node yieldand histopathological features of both the nodes and primarytumour and their influence on outcome will also be studied.

Results: Data is being actively collected. The findings will be sub-jected to analysis and presented at the conference

doi:10.1016/j.oos.2009.06.238

O154. Identification and validation of diagnostic/prognosticmarkers for tongue cancerA. Suresh a, M. Vannan a, K. Dhanya a, E.M. Elango a, K. Thangaraj a,b,M.A. Kuriakose a,*

a Amrita Institute of Medical Sciences, Kochi, Indiab Centre for Cellular and Molecular Biology, Hyderabad, India

India accounts for 1/3 of the oral cancer burden (30% of all can-cers) with the age-adjusted incidence rate of tongue cancers in India(3.7–10.9/100,000) being one of the highest in the world. Tonguecancer is one of the most debilitating diseases due to its aggressivenature and the high rate of loco-regional recurrence (10–30%).Efforts were hence directed towards comparing recurrent and non-recurrent tongue cancer patients by micro array and to validatethe biomarkers in saliva, currently the method for easy and earlydetection of molecular markers. The expressions of 12 patientsundergoing surgical treatment for tongue cancer were profiled usingthe HG U133 Plus 2 Array (Affymetrix). Statistical analysis within thegroups revealed 86 genes in non-recurrent tumors (p < 0.001) and 59in recurrent tumors (p < 0.01). A multivariate analysis using ANOVAacross the different groups showed a total of 44 genes that had a p-value less than 0.01. The recurrent pattern was distinct due to theup-regulation of G-Protein receptors, ABC transporters, Matrixmetallopeptidases and growth factors with a complete absence ofimmune response. Subsets of these markers (MMP1, IL8, IL1B, FN1,FAPA, SERPINH2, ABCG1, COL5A1 and IgLA) were validated in tonguecancer samples. The markers were then validated retrospectively insaliva samples collected from patients and normal controls by Quan-titative Real time PCR. Sixty-eight saliva samples (Normal, PMLs andT1/T2) were assessed for the integrity and specificity of RNA by RT-PCR and sequencing methods. The levels were then correlated withthe clinical details of the patients and a distinct association couldbe observed between the expression of the markers (MMP1, ABCG1,IL8, COL5A1, FN1) and the disease status in the patients. A prospec-tive study with a larger number of samples is currently in progress asan effort to establish these biomarkers in the clinical setup.

doi:10.1016/j.oos.2009.06.239

O155. The presence of occult metastases in non-sentinel lymphnode in oral squamous cell carcinomaA.C. Christensen *, A.B. Bilde, M.H.T. Therkildsen, B.C. Charabi,J.K. Kirkegaard, L.S. Specht

Dept. of ORL – H&N Surgery, Copenhagen University Hospital, DenmarkDept. of Pathology, Copenhagen University Hospital, DenmarkDept. of Oncology, Copenhagen University Hospital, Denmark

Introduction: The presence of lymph node metastases is consid-ered the most important single adverse prognostic factor in head andneck cancer. To determine the presence of metastases in oral squa-mous cell carcinoma (SCC) sentinel-node biopsy (SNB) has provento be technically feasible with a high degree of sensitivity. Many val-idation studies, however, are flawed in their histopathological designin that the histopathologic examination of the sentinel lymph node(SLN) and non-sentinel lymph node (NSNL) are different. The pur-pose of this study was to examine the occurrence of isolated tumourcells and micrometastases in NSLN using the additional step-serialsectioning and immunohistochemistry as for SLN.

Methods: Fifty-one consecutive patients with oral SCC T1–T2 anda clinically N0 neck underwent surgical treatment including SNB-as-sisted neck dissection. The location of the SLN was determined usingdynamic and planar lymphoscintigraphy and SPECT CT. The har-vested SNL and NSNL from the subsequent neck dissection under-went the same histopathologic examination using step-serialsectioning at 150-lm intervals. Two sections from each level werestained with hematoxylin–eosin (H&E) and cytokeratin antibodyAE1/AE3, respectively.

Discussion: We have previously shown that 18% patients withsubclinical (occult) lymph node metastasis were upstaged as a resultof the additional histopathological examination of the SLNs. RoutineH&E staining of the NSLN in our previous study identified only onelymph node with a macrometastasis. Results of the additional histo-pathological examination of the NSNL from the 51 patients are cur-rently being processed and will be presented at the congress.

Conclusion: Our previous study showed SNB-assisted neck dis-section to be technically feasible in identifying subclinical metasta-ses. Whether the NSLN from the subsequent neck dissectioncontain metastatic disease is very important to identify as thismay have implications on the further treatment of the patient.

doi:10.1016/j.oos.2009.06.240

O156. Nodal metastasis in clinical stage I and II tongue and floorof the mouth squamous cell carcinomasD.R. Camisasca a,*, F.L. Dias c, P.A.S. Faria d, D.A. Pereira b, G. Alves b,S.Q.C. Lourenco a

a Pathology Post Graduation Program, Fluminense Federal University(UFF), Brazilb Applied Genetics Laboratory, National Cancer Institute (INCA-RJ),Brazilc Head and Neck Service (INCA-RJ), Brazild Pathology Division (INCA-RJ), Brazil

Introduction: Tongue and floor of the mouth squamous cell car-cinomas (TFSCC) are known for their high incidence of cervicalmetastasis, hence neck dissection is indicated even in stage I and IItumors. This study aimed to evaluate risk factors for regional metas-tasis in TFSCC.

Methods: Thirty-two subjects (20 males and 12 females, ±54.1years old) from a total of 249 TFSCC diagnosed in National Instituteof Cancer (INCA-RJ), Brazil from August 2007 to September 2008were included in the study. They were all submitted to radical sur-gical treatment with free margins followed by neck dissection. Pa-tients were divided in two groups: with and without nodalmetastasis. Clinicopathological variables analysed were sex, age,alcohol and tobacco use, tumor location, disease evolution, thick-ness, perineural invasion, tumor pattern of invasion, and WHO grad-ing. Statistical analysis was performed through chi-square tests.

Results: Sample was mainly composed by smokers (50%) anddrinkers (62%) who complained of tongue tumors (46.9%) which

Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122 107

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