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 Table of Contents  
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 1-78


Date of Web Publication31-May-2021

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-8128.317348

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How to cite this article:
. Abstract. J Head Neck Physicians Surg 2021;9:1-78

How to cite this URL:
. Abstract. J Head Neck Physicians Surg [serial online] 2021 [cited 2022 Dec 5];9:1-78. Available from: https://www.jhnps.org/text.asp?2021/9/3/1/317348

  Clinical Research: ABS-132: Validation of Clinical, Radiological and Pathological 8th AJCC TNM Classification Top

Abhishek Salilranjan Das, Abhishek Das, Aseem Mishra

MPMMCC, Varanasi, Uttar Pradesh, India.

E-mail: [email protected]

Background/Objective: To evaluate disparity in clinical versus radiological versus pathological TNM staging in oral cavity squamous cell carcinoma (OCSCC) patients and its impact on therapeutic decision making. Methods: Retrospective analysis of 100 patients who underwent surgery for OSCC at HBCH & MPMMCC Hospital, Varanasi were evaluated for clinical, radiological and pathological tumor grading. Patients were stratified as pathologically upstaged, downstaged or unchanged. Results: One hundred patients with OCSCC were analyzed. Sixty nine (69%) were males and 31(31%) females with a mean age at presentation 47 years (24–82 years). The highest congruence between clinical and pathological T-staging was seen for cT1 and cT4 at 80% and 72% with pathological T-stage. Similarly, the highest congruence between clinical and pathological N-stage seen for clinical N0 and N3 at 90% and 93% with pathological N-stage. Of clinically early stage patients, 60% remained unchanged, and 40% were upstaged to advanced stage following pathological analysis. Of the clinically advanced stage patients, 70% remained unchanged, and 30% were pathologically downstaged. CECT & CEMRI imaging were found sensitive in upstaging 27% cN0 neck. Conclusions: There seems to be no consensus in clinical, radiological and pathological TNM staging of OCSCC, this may affect treatment planning and prognosis. A meticulous multidisciplinary team approach in practice can be of more therapeutic value than finding a more unified staging system.

  ABS-128: Evaluation of Patients with Cervical Nodal Metastasis in Primary Head and Neck Carcinoma Top

Shari Mitra, Rahul B. Patel, Jairaj Vaishnav, Bhavik Patel, Jaymin A. Contractor

Government Medical College, Surat, Gujarat, India.

E-mail: [email protected]

Background/Objective: An important factor in the prognosis of head & neck carcinoma is the status of cervical lymph nodes. This study was done to evaluate the pattern of nodal metastasis in head and neck carcinoma and to assess the role of FNAC and US guided FNAC in detection of neck metastasis. Methods: This was an observational prospective study in which 209 patients with primary head and neck carcinoma with/without palpable neck nodes were selected. FNAC was done in cases with palpable nodes. In cases with no palpable nodes, US guided FNAC was performed. These reports were then compared with HPE reports to check their accuracy. Results: In this study, the proportion of nodal metastasis was 89.5% in which oral cavity & larynx presented with N1 while oro & hypopharynx presented with N2 nodes. T2 and T3 stage was the most common stage of presentation. USG detected 40.67% cases of clinically non palpable nodes. USG guided FNAC converted 56% cases of clinically palpable N0 to N+ neck. In 27% cases USG guided FNAC helped in detecting neck metastasis missed by simple FNAC. Simple FNAC had 80.8% sensitivity, 91% specificity and 84.7% accuracy, while USG guided FNAC had increased sensitivity, specificity and accuracy. Conclusions: In our study the pattern of the metastasis correlates with drainage pattern of the respective sites. N+: N0 ratio increased as degree of differentiation decreased and T classification increased. For N0 neck, USG & USG guided FNAC is an extremely useful tool to detect clinically non palpable nodal metastasis. For palpable nodes, simple FNAC may suffice.

  ABS-127: Diagnostic Evaluation of Patients with Cervical Metastasis with Occult Primary of Upper Aero-digestive Tract Top

Kartika Ramesh Rao, Anand V. Chaudhari, Jay Suratwala,

Ila B. Upadhya

Government Medical College, Surat, Gujarat, India.

E-mail: [email protected]

Introduction: The incidence reported in the literature has plateaued over the last decade to around 5% of head and neck carcinoma patients due to standardized diagnostic protocols. The systematic evaluation of patients with nodal metastasis is thus important for their optimal treatment and management. Objectives: To know the sensitivity, specificity and accuracy of different investigations to search for the primary in cases of CUP. Methods: 53 patients were studied in this observational study conducted in the department of ENT & Head & Neck, New Civil Hospital, Surat. All patients were subjected to detailed history taking, clinical examination, indirect laryngoscopy and 70o endoscopy on OPD basis. FNAC from neck nodes, radiological evaluation (CT &/or MRI) of neck and thorax and pan-endoscopy was performed. Sensitivity and specificity of these investigations were calculated considering the histopathological report as gold standard. Results: Males were most commonly affected with M:F ratio of 7.83. The most commonly affected age group was 51-75 years. Multiple levels of lymph nodes were more commonly involved (47.17%). Amongst those who had a single level of nodal metastatic involvement, level III was most commonly involved. According to the AJCC classification (7th edition), N3 was found to be the most common presentation. Pan-endoscopy was successful in detecting the primary in 43.4% cases. Imaging (CT,MRI) was successful in 50.94% cases. Sensitivity of pan-endoscopy and imaging was found to be 100%. Specificity and diagnostic accuracy of endoscopy was found to be 96.77% and 98.11% whereas specificity and diagnostic accuracy of imaging was 83.87% and 90.57%. Conclusions: As PET-CT is expensive & available at very few centres, a thorough endoscopic evaluation along with imaging studies are also useful in detecting cases of CUP.

  ABS-123: Prognostic Value of Tumor-Associated Atrophic Glossitis in Tongue Cancers: A Pilot Study Top

Florida Sharin, Pankaj Chaturvedi, Arjun Singh

Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Atrophic glossitis has been attributed to numerous immunological factors that act locally or systemically. Infiltration by cancer cells into the surrounding tissue evokes an inflammatory response followed by the release of neurotransmitters which pave way for perineural invasion(PNI). Perineural invasion is correlated with lymph nodal metastasis and hence the survival outcomes. Based on clinical observation of an atrophic zone around the primary site in tongue cancers, this study was carried out to discover its correlation with other prognostic factors. Methods: A pilot study was done including 100 histologically proven tongue cancers. These were further categorized into two groups based on the presence or absence of atrophic changes around the tumor. The clinical features, stage, biochemical variables, and histopathology were recorded. A multivariate logistic regression was used to identify the association among the various factors. Results: Out of the cohort, 63% of cases had atrophic changes in the tongue surrounding the tumor site. It was also noted that this group had a 22% close/involved margins and a higher rate of infection and platelet count. On multivariate analysis, it was observed that patients with atrophic changes had a significant association with perineural invasion and lymphocytic infiltrate on histopathology (p=0.04). Conclusions: With PNI being significantly associated with patients having atrophic changes we hypothesize that it can be considered as a clinical surrogate marker for perineural invasion especially in the early stages of tongue cancers. However, further studies are necessary to validate this finding.

  ABS-121: Has the COVID 19 Pandemic Caused a Delay in Treatment and Disease Progression of Head Neck Cancers? Analysis from Outpatient Records of a Single Institution Top

Rishik Raj Pathak, Harsh Dhar, Sourav Datta, Agniva Basu, Vaibhav Singh

Narayana Superspeciality Hospital, Howrah, West Bengal, India.

E-mail: [email protected]

Background/Objective: The COVID 19 pandemic has impaired health services globally. The "lockdown '' imposed from 24th March to 30th May 2020 in our country posed unprecedented logistical hurdles .This was postulated to cause disease progression amongst cancer patients unable to seek timely treatment.We analyzed whether this had significant impact on the stage of presentation and treatment intent for patients with Head Neck Cancer presenting to our Outpatient Clinic. Methods: Patient details were obtained from a well maintained electronic medical record system.New patients presenting with Head Neck Cancers (except thyroid) from 1st April to 30th September 2020 and the same time period (1st April to 3oth September) of 2 previous consecutive years were included for analysis, so as to balance for other socio-political reasons for variaitons in number of new patients seen other than the pandemic.Relevant staging information based on clinico-radiological examination and treatment decisions based on disease extent were tabulated. Results: 126 patients from April to September 2020 and 279 patients for the same months of 2 previous years were analyzed. Oral cavity formed the predominant subsite -82.5% of entire cohort followed by larynx-5 % and oropharynx-3%. There was significantly higher incidence of c T4B-19.8% vs 9%,p<0.001, cN2/N3-40.5% vs 20.1%,p<0.001 and cM1-5..3% vs 0.4%,p<0.001,amongst the new patients seen in year 2020 as compared to the 2 previous years. There were significantly more inoperable patients-15.9% vs 5 %, p<0.001 and higher proportion of patients treated with palliative intent-6.3 % vs 3.6%,p=0.16(trending towards significance) in 2020 .The incidence of Oral cancers with high ITF involvement and those given NACT was not significantly different between patients in 2020 compared to previous years. Conclusions: The Covid 19 pandemic and associated lockdown has indeed resulted in significantly more patients presenting with higher disease stage, inoperability and warranting palliative intent of treatment.

  ABS-120: A Prospective Randomized Study Comparing Response and Toxicity between Conventional and Hypofractionated EBRT along with Concurrent Cisplatin Based Chemotherapy in Patients with Locally Advanced Head and Neck Cancer Top

Janmenjoy Mondal, Debjit Ghosh, Abhishek Basu, Subhendu Gangopadhyay, Bidyut Mandal, Diptimay Das, Shinjini Chakrabarty

Medical College and Hospital, Kolkata, West Bengal, India.

E-mail: [email protected]

Background/Objective: Compare the efficacy of hypofractionated EBRT over conventional EBRT with concurrent cisplatin(assessment of Response and Disease Free Survival)in patients with locally advanced H&N CA and toxicities between treatment arms. Methods: Histologically proven 68 cases of H&N CA(carcinoma of oral cavity, oropharynx,hypopharynx,larynx) in TNM stage III-IVB were accrued for the prospective study between Jan '18 & July '19.Radiologic assessment was done as pretreatment staging,4 weeks following treatment and after 3 months.Primary tumour volume and neck nodal volume were added to get the total volume.The patients were randomised into 2 arms and treated with external beam radiotherapy using Theratron 780C Cobalt 60 machine with concurrent cisplatin.Arm A received 66 Gy-70Gy conventional EBRT.Arm B received 55Gy EBRT in hypofractionated regimen [2.75Gy/fraction, 5 days a week, in 20 fractions].Statistical analysis performed. Results: 19 patients(55.9%)remained disease free in study arm compared to 15 patients(44.1%)in control arm.5 patients(14.7%)progressed eventually with treatment- study arm compared to 8(23.5%)patients in the control arm. Overall response(CR+PR)was achieved 82.4% patients in the study arm comparable with control arm,statistically insignificant. Acute skin toxicities(grade 2+) were 38.2vs47.1%(p=0.225);mucositis(grade 3+) was 35.3vs57.1%(p=0.096); dysphagia(grade 3+) was 23.5vs41.2%(p=0.294);late salivary gland toxicities(grade 3+) were 8.8vs50%(p=0.000189);subcutaneous fibrosis(grade 3+) was 11.8 vs50%(p=0.000320). Both the arms had a mean recurrence free survival of 11 months.Log rank analysis(Mantel Cox) gave p-value 0.435. Significant differences in late effects noted indicating increased dose/#(2.75Gyvs.2Gy)-influenced late radiation-related morbidity.With a lower biologic dose in terms of late reactions compared with 70Gy/35fractions,this hypofractionated schedule was associated with greater long-term toxicity. Conclusions: Reducing the overall treatment time by increasing dose per fraction maintaining the BED results in comparable tumour control in patients with HNSCC.This hypofractionated regimen is associated with increased but tolerable acute and late morbidities. The reduction in number of fractions and treatment time allows more efficient use of resources but routine use of this hypofractionated schedule needs further studies.

  ABS-117: Relevance of Deep and Peripheral Margin, Depth of Invasion and PNI in Tongue Carcinoma Recurrence Top

Abdus Sami, Sowrabh Kumar Arora

Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India.

E-mail: [email protected]

Background/Objective: (1) If there is any difference in recurrence rate in tongue carcinoma when compare deep margin vs peripheral margin. (2) If depth of invasion and perineural invasion influence recurrence rate in addition to margins. Methods: We analyzed retrospectively patients of tongue carcinoma from 2016-2018. Minimum follow up was 18 months. Total patients analyzed were 97. Exclusion criteria: (1) Full data not available like on pathology thickness was mentioned in place of depth. (2) Patient with metastatic neck nodal disease. (3) Recurrent carcinoma. (4) Patients with positive margin on final pathology. So patients with close margin vs clear margins were compared. Deep and peripheral margins, depth of invasion and PNI were analyzed to find out correlation with recurrence.Total 40 patients were eligible for study. Results: On statistical analysis, there was no difference in recurrence rate between deep margin and peripheral margin though there was trend suggest compromised deep margin more important in predicting recurrence. On multivariate study, depth of invasion was most important factor in predicting recurrence as out of 14 patient who has upto 5 mm depth of invasion, none have recurrence. Conclusions: Depth of invasion indicator for recurrence in patients of tongue carcinoma. There is trend in our study that deep margin is more important than peripheral margin in predicting recurrence though it is not statistically significance and may require study with more number of patients.

  ABS-111: Surgery and Radiotherapy is not Enough - Does Node Positive Oral cancer Patients Need More Aggressive Treatment? Top

Vinod Krishna Krishnaswamy, Priyadarshan, Raveena R. Nair, Linu Thomas, Rithin George, Aditi Saha, Sajith Babu Thavarool

Malabar Cancer Centre, Thalassery, Kerala, India.

E-mail: [email protected]

Background/Objective: Oral cavity [OC] is the most common site of head and neck squamous cell carcinoma [SCC]. It is a major problem in the Indian subcontinent where it ranks among the top three cancers in the country. The mainstay of treatment for these patients is surgery, which is followed by adjuvant radiotherapy with or without chemotherapy in advanced cancers. The incidence of loco-regional recurrence ranges from 18 to 76%. The overall 5 year survival of OSCC ranges from 41.8 to 47.3 % for stage III and 33.6 to 40.3% for stage IV. This study aims to identify factors associated with overall survival (OS), disease free survival (DFS) and recurrence and to determine the outcome of node positive oral cancer patients who underwent surgery with adjuvant treatment at our centre. Methods: This was a retrospective study of oral cancer patients who underwent surgery during the period from July 2013 to July 2017. The aim was to estimate the overall and disease free survival. The factors affecting survival were studied with multivariate and univariate analysis. Results: A total of 786 years patients underwent surgery for SCC of oral cavity during the study period. 85% had tobacco use mainly in chewable form. Majority (51.1%) had tongue cancers. 34.1% were with T4 tumours. Postoperative radiotherapy was given for 49.1%. Node negative patients had 79% five year survival, node positive had 59%. Median disease free survival was 48.2 months. Conclusions: Node positivity is the single factor affecting recurrence and survival. The overall survival and disease-free survival is better in patients without nodal involvement and in patients with early stages in comparison to the patients with node involvement and in advanced stages. The treatment with surgery followed by adjuvant radiotherapy is not enough in the node positive patients, to achieve a good survival rate.

  ABS-108: Algorithm for Maxillary Defect Reconstruction: An Indian Perspective Top

Priyadarshan Kumar, Sajith Babu

Malabar Cancer Center, Thalassery, Kerala, India.

E-mail: [email protected]

Background/Objective: Maxillary area possesses very important significance in face owing to its function and complex anatomical relationship with surrounding structures. Reconstruction of the maxillary defects following a complex resection challenging. Various classifications and reconstruction options have been proposed in the past. It's difficult to implement owing to resource constraints. Methods: This is a retrospective study of oral cancers and nose & Paranasal sinus cancers with maxillary area defects between Jan 2010 and December 2017. Results: Out of 786 oral cavity and maxillary carcinomas treated at our centre,, 54 were carcinoma of maxilla and 112 were oral cavity carcinomas leading to hard palate and maxillary defects. There were 11 class I defects, 21 class II A, 7class II B, 11 class III and 4 class IV defects. The reconstructions were done with obturator 26, local flaps like submental flap 4, nasolabial flap 3, temporalis flap 11. Regional flap (PMMC) was done in 13 patients. Free soft tissue alone flap was used in 27 and osteocutaneous flap was done in 24. Reconstruction ladder was followed as suggested by James Brown with 75% of class I, II and III defects reconstructed with obturator only. Obturator with its various modifications filled the defects adequately with acceptable compensation of speech and swallow function. Conclusions: Reconstruction of the defect depends on various factors like extent of the defect, dentition, performance status, comorbidity and age of the patient. Best cosmetic result was obtained with osteocutaneous free flap whereas soft tissue flap helps in closure of defects and early healing. Local flaps help in elderly, edentulous patients. Obturator needs continuous care and corrections.

  ABS-107: Hypoalubminemia and Severe Malnutrition are Factors for Adverse Outcome Postsurgery in Patients with Oral Cancer Top

Anshul Jain, Mahesh Sultania, Mohammed Imaduddin, Mahesh Sultania, Gaurav Chhabra, Gaurav Chhabra, Jyoti Ranjan Swain, Dillip Kumar Muduly, Madhabananda Kar

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: The surgical treatment of oral cancer involves en bloc resection of the tumor and neck dissection. Malnutrition affects up to 50% patients suffering from head & neck cancer. Few studies have shown that pre-operative malnutrition has a significant negative effect on post-operative morbidity and mortality. This study was done to analyse nutritional indices as a predictor of post-operative morbidity. Methods: Retrospective analysis of prospectively maintained data of oral cancer patients operated at our institute from June 2018 to May 2020 was performed. The variables included were clinical stage of disease, Clavien-Dindo grade of complications if any, height, weight, Body Mass Index (BMI) and serum albumin. Nutritional Risk Index (NRI) was calculated and patients were categorised into no, mild, moderate and severe malnutrition based on their scores. The data was analysed for relation between BMI, serum albumin and NRI with complications in post – operative period. Results: Total 76 patients were included. Mean age was 51.4 years (range 27 to 80 years). Most of them were males (85.5%) with clinical stage IVA (38%) and tongue being the commonest site (40%). Hypoalbuminemia was associated with increased risk of complications (p < 0.001), however, no correlation of BMI with post-operative complications (p = 0.44) was seen. NRI predicted that pre-operative severe malnutrition leads to post-operative complications (p = 0.027), however, NRI did not show any significant link with occurrence of complications (p=0.37) in the overall cohort. Conclusions: Malnutrition is a common occurrence seen in oral cancer patients and is generally associated with poor post-operative outcomes. Our study suggests that low albumin levels and NRI in severely malnourished patients are factors for adverse outcome post-surgery.

  ABS-106: Management Profile of Head and Neck Cancer Patients Seen in Sate Cancer Institute of India and Its Comparison with Published Covid-19 Guidelines Top

Azhar Jan Battoo, Sheikh Zahoor Ahmad, Tariq Rasool Malik, Saqib Banday, Shah Naveed, Aashiq Ali1

Sheri Kashmir Institute of Medical Sciences, 1Govt. Dental College Srinagar, Srinagar, Jammu and Kashmir, India.

E-mail: [email protected]

Background/Objective: Various guidelines were published by medical institutes throughout the world at the start of the covid-19 pandemic, stressing the need to avoid prolonged surgeries on advanced head and neck cancer lesions and to defer thyroid surgeries. Ours's is a Tertiary Care State Cancer Institute and we hereby present the spectrum of head and neck cancer cases managed by head and neck oncology services of the institute during covid-19 pandemic and compare it with guidelines published by various institutes bearing the commonality of avoiding prolonged head and neck oncology surgeries and deferring thyroid surgeries during covid-19 pandemic. Methods: Retrospective analysis of prospectively maintained data base of head and neck oncology services of the institute was carried out to outline spectrum and stage of head and neck cancer lesions treated during the covid-19 pandemic from 25th march to 31st October 2020. Management profile of head and neck cancer patients seen during this period is documented. Results: A total of 144 head and neck cancer patients were seen during the covid-19 pandemic from 25th march to 31st October 2020. Out of these 144 cases majority were thyroid cancer cases (n = 45), followed by oral cavity (n = 34), larynx (n = 25), parotid (n =11), and nasopharynx (n = 8). Forty-seven patients underwent curative surgery, 15 received curative radiotherapy, one patient was referred to nuclear medicine for curative treatment, having being operated outside. Twenty-five patients received palliative treatment, 16 needed only follow up visits, 18 were lost to follow up or were operated outside, and 21 are waiting for their surgical treatment. One patient died in the pre-operative period. Out of operated patients 21 had thyroid pathology, with seven requiring ipsilateral and/or bilateral neck dissection. Sixteen oral cavity cancer patients were operated, and two patients underwent laryngectomy, one of them on emergent basis. Nine patients had advanced stage cancer of oral cavity and larynx and one patient had advanced parotid malignancy. Nine patients needed complex loco-regional reconstruction, seven needed oral cavity reconstruction and two needed laryngeal reconstruction. Conclusions: Our head and neck cancer management profile show that advanced stage lesion had to be operated in the covid-19 pandemic period, which is in defiance of various guidelines published by medical institutes throughout the world at the start of the covid-19 pandemic.

  ABS-104: Accuracy of Intra-operative Frozen Section for Assessment of Margin Status in Oral Cancer Surgery Top

Priyansh Jain, Madhabananda Kar, Itisha Chaudhary, Chinmaya Mohapatra1, Mahesh Sultania, Dillip Muduly, Amit Adhya, Madhabananda Kar

All India Institute of Medical Sciences, 1Capital Hospital, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Surgery plays a pivotal role in the management of patients with oral cancer. Excision of the tumour with negative margins is the mainstay procedure for oral cavity cancers. Post-operative positive margin status is proven to be an independent predictor of local recurrence and overall survival. Frozen section analysis of margins sent as tissue strips has been proven to be an effective method to assess for intra-opeative margin status. Hence, we conducted this study to analyse the accuracy of intra-operative frozen section in determining the margin status in oral cancer patients. Methods: Retrospective analysis of a prospectively maintained database at a tertiary care centre in Eastern India was done from February 2017 to October 2020. All patients undergoing oral cavity squamous cell cancer surgery with intra-operative frozen section analysis were included. Intra-operative mucosal margins from the anterior, posterior, medial, lateral and deep end were taken from tumour end and sent for frozen section. The patient underwent re-excision in the saem sitting if any of the frozen margins were reported to be positive. Final paraffin block was compared with the frozen section for statistical analysis. Results: A total of 105 patients were included in the study. Mean age of the study population was 51 years. Males to females ratio was 1:4. Out of 105 patients, 38 patients (36%) belonged to stage IVA disease. Neoadjuvant chemotherapy was received by 19 patients (18%). In this study, 528 margins were sent for frozen section analysis. Calculated sensitivity, specificity and accuracy were 100 %, 99.42 % and 99.43 % respectively. At a median follow up 15 months, a total of 19 patients had recurrence and 11 had died. Conclusions: Intra-operative frozen section analysis provides an accurate assessment of margin status. It helps in surgeon's confidence of decreasing margin positivity and avoiding second surgery.

  ABS-103: Is Low-Neck Dissection in Buccal and Alveolo-buccal Cancers an Overtreatment: Our Experience from a Tertiary Care Centre in Eastern India Top

R. Ephraim, Madhabananda Kar, Mahesh Sultania, Dillip Kumar Muduly, Jyoti Ranjan Swain, Amit Kumar Adhya, Sudipta Mohakud

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Buccal and Alveolo-buccal is the most common subsite involved in Oral cancer patients in the Indian subcontinent. Modified or Radical Neck dissection is an integral part of oral cancer management with its pros and cons. However, low-neck dissection (levels IV&V), has not been propitious in these cancers. Methods: Analysis of the data from our prospectively maintained oral cancer database was performed. The patients with histologically proven oral squamous cell carcinoma restricted to buccal and alveolo-buccal subsite, treated with curative resection between January 2017 and May 2020 were included. Patients previously treated, no neck dissection done and unavailable data were excluded. Results: Out of 168 patients in the oral cancer database, 85 were buccal and alveolo-buccal cancers. The median age of the 55 patients enrolled in the present study was 54 years (27-79 years) and 85.5%(47) were males. The stage at initial presentation was stage IV in 60.4%(32), stage III in 18.9%(10), and stage II in 13.2%(7). Modified neck dissection was done in 74.5%(41), selective in 23.8%(13), and radical in 6.7%(1) patients. The mean nodal yield was 44.2(+/-18.9,16–111) and mean node positivity was 2.2(+/-7,0–49). Level specific positivity rates were 14.5% (level IA-8), 25.5% (level IB-14), 18.2% (level IIA-10), 5.5% (level IIB-3), 7.3% (level III-4) and 1.8% each (levels IV,VA&VB-1). No skip metastasis was found in levels IIB, IV&V but one had at level III. Only one patient had positive level IV&V nodes. At a median follow-up of 17.3 months, 23.6%(13) had a recurrence and 16.4%(9) had died. Conclusions: Currently guidelines recommend the modified or radical neck dissection in all clinical node-positive patients, however in our experience it was found that the majority are being over-treated. Hence, we call for the optimization of neck management in the buccal and alveolo-buccal cancers.

  ABS-102: Role of Level V Lymph Node Dissection in Oral Squamous Cell Carcinoma Patients with Clinically Node Positive Patients: A Retrospective Analysis from Eastern India Top

Lalchhandami Colney, Madhabananda Kar, Mohammed Imaduddin, Mahesh Sultania, Dillip Kumar Muduly, Saroj Kumar Majumdar, Amit Kumar Adhya

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Surgery is the mainstay of treatment in Oral cancer. The primary management of neck is modified/radical neck dissection in clinically node positive (cN+) patients. In this study, we aim to analyse the role of level V Lymph Node (LN) dissection in cN+ Oral Squamous Cell Carcinoma (SCC) patients. Methods: We retrospectively reviewed 136 Oral SCC patients who underwent surgery from January 2017 to July 2020. The neck nodes from each station were labeled and processed separately. Group 1 and Group 2 were cN+ patients without and with Level V Lymph Node Dissection respectively. Hazard Ratios (HR) for 3-year OS was estimated based on Cox proportional hazard model. Results: Among 136 Oral SCC patients, 78 patients had cN0. 58 patients with cN+ were analysed in this study. The mean age was 51 years and majority were males (78%). The most common site was tongue (41%). Most of the patients had cT4 disease (58%) with well differentiated histological grade. Majority of the patients had cN1 (65%) disease with 2 patients having cN3 disease. None of the patients had clinically palpable Level V LN. There were 25 patients in Group 1 and 33 patients in Group 2. Only one patient (cN3 disease) had pathological Level V LN positivity. The median 3 yr OS was 72% in both the groups (HR: 1.02; 95% CI 0.32 – 3.2) and in Stage IV disease alone the 3 yr OS was 74% in Group 1 patients versus 64.6% in Group 2 patients (HR: 1.5; 95% CI 0.41-5.6). Conclusions: In this study, no significant 3-yr OS was found to be associated with Level V LND. Level V LND may not be required on Oral SCC patients with cN+ patients.

  ABS-100: Tumor Margin to Depth of Invasion Ratio in Oral Squamous Cell Carcinoma - Independent prognostic Markers for Disease Free Survival and Overall Survival Top

Itisha Chaudhary, Mahesh Sultania, Dipin K. Rajan, Mahesh Sultania, Jyoti Ranjan Swain, Dillip Kumar Muduly, Amit Kumar Adhya, M. Kar

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Depth of invasion is an important prognostic marker in Oral Squamous Cell Carcinoma, however its ratio with surgical margin has not been studied as clinicopathological prognostic marker. The aim of this study is to assess adequate surgical margin using ratio of closest margin to thickness (MTR), depth of invasion (MDR) and tumor maximum size (MSR) in association with local control, disease free survival(DFS) and Overall Survival(OS). We evaluated the ratios and studied its association with local recurrence and survival to determine clinically useful threshold value which can be used as a parameter for adjuvant planning. Methods: Retrospective analysis of prospectively maintained database from 80 patients of OSCC all stages except with skin and bone involvement was done. MSR, MDR, and MTR were calculated and all possible cutoffs between 0.1 and 0.9 were independently tested. All ratios were categorized based on respective median values. Cox proportional hazard regression was used to identify predictors of DFS and OS. Schoenfeld residuals test was used to assess proportional hazard assumption. Akaike's information criterion (AIC) and Bayesian information criterion (BIC) was used to compare different models. Results: Among MTR (AIC=103.17 BIC=105.56), MDR (AIC=100.25 BIC=102.6342) and MSR (AIC=100.95, BIC=103.33), all have very close AIC and BIC. It was minimum for MDR followed by MSR and MTR. So MDR is the best predictor for DFS followed by MSR and MTR at threshold values of MDR of 0.53, MTR of 0.47 and MSR 0.15 for DFS and MDR of 0.6, MTR of 0.6 and MSR of 0.19 for OS. Conclusions: The minimum safe surgical margin can be calculated by multiplying the depth of invasion by 0.53. A greater surgical margin (3.5:1) is required for clearance of tumor if we use depth of invasion over size as a prognostic parameter, as per recent changes in AJCC which considers the depth of invasion in T staging.

  ABS-99: Borderline/Inoperable Oral Cancer Patients with Node Negative Disease Respond Better than Node Positive to Metronomic Therapy Top

Mohammed Imaduddin, Madhabananda Kar, Mahesh Sultania, Jyoti Ranjan Swain, Dillip Kumar Muduly, Saroj Kumar Das Majumdar, Dilip Kumar Parida, Madhabananda Kar

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Oral cavity cancer is the most common cancer detected and the leading cause of cancer-related deaths in Indian males. Limited access to dedicated tertiary cancer centers leads to delay in treatment, which severely affects prognosis. Metronomic therapy has come up in recent times to tide over the waiting period. The present study aims to evaluate the feasibility of metronomic therapy and the factors predicting its response. Methods: The study was a prospective, single-arm cohort study. Patients with borderline/inoperable oral cavity cancer and histologically proven squamous cell carcinoma were included. Recurrent cancers and history of previous oncological treatment were excluded. Metronomic therapy schedule prescribed comprised of oral methotrexate 15 mg/m2 once weekly and oral celecoxib 200 mg twice daily. Patients were evaluated for response clinically at eight weeks using clinical criteria of Response Evaluation Criteria in Solid Tumors 1.1. Results: From July 2018 to August 2020, 58 patients were prescribed metronomic therapy. Mean age was 59.5 years (range 27 to 88 years) with M:F of 3:1. Alveobuccal was the most common oral cavity site involved (79.3%), and Stage IVA was most common (63.7%). At eight weeks of therapy, partial response was seen in 33 patients (56.8%), stable disease in 18 patients (31%) and disease progression in 7 patients (12%). Analysis of factors influencing response to metronomic therapy showed clinically node-negative patients (36.2%) to be significantly associated with better response (p=0.025). Other factors analysed, stage (p=0.84), site of lesion (p=0.45), differentiation (p=0.24), verrucous growth (13.7%; p=0.16) and skin involvement (46.5%; p=0.73), did not show any significant association. Conclusions: Metronomic therapy using oral methotrexate and celecoxib can be used to tide over the waiting period of oral cancer management in overburdened resource-constrained settings. Clinically node-negative oral cancers are associated with a better response.

  ABS-97: Lymph Node Ratio in Oral Cancer Patients is a Significant Predictor of Recurrence and Survival Top

Sachin Arun Ambre, Mohammed Imaduddin, Mahesh Sultania, Dillip Kumar Muduly, Amit Kumar Adhya, Madhabananda Kar

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: The current staging system for Oral Squamous Cell Carcinoma (OSCC) takes into consideration lymph node number, size and extra-nodal extension (ENE) for prognostication. Lymph Node Ratio (LNR) can better predict survival in oral cancer patients. In this study, we evaluate whether LNR can provide prognostic information in operated OSCC patients.Methods: We retrospectively analysed 136 patients operated in Surgical Oncology department, AIIMS Bhubaneswar with curative intent. Lymph node metastasis was found in 53 patients. Here, we evaluated impact of LNR and other factors such as ENE on Disease Free Survival (DFS) and Overall Survival (OS). Results: 136 patients with oral carcinoma were analysed in this study, commonest being tongue carcinoma (41.9%) followed by carcinoma buccal mucosa (35.3%). Most of the cases were stage IV tumors (49.3%). A higher LNR had significant impact on both DFS (p<0.001) and OS(p<0.001). Extranodal extension was associated with lower DFS (p=0.004) and OS (p=0.004). However, factors such as lymphovascular invasion (LVI) had no significant association with DFS (HR=1.47;95%CI 0.55-3.94, p=0.44) or OS (HR=1.69; 95%CI 0.65-4.47, p=0.284). Perineural invasion also had no significant association with DFS (HR=2.25; 95%CI 0.98-5.15, p0.06) or OS (HR=1.02; 95%CI 0.30-3.49, p=0.978). Results were confirmed using multivariate Cox regression. Conclusions: LNR and ENE are important prognostic factors in OSCC outcomes. A higher LNR and presence of ENE leads to shorter DFS and OS in oral cancer patients.

  ABS-96: Level IIB Lymph Node Dissection May be omitted in Early Oral Cancer Top

K. R. Dipin, Itisha Chaudhary, Priyansh Jain, Mahesh Sultania, Dillip Kumar Muduly, Amit Kumar Adhya, Madhabananda Kar

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Incidence of level IIB metastasis in oral cancer is 4 - 6 % as per prior studies. Level IIB dissection is associated with postoperative shoulder pain and weakness due to spinal accessory nerve dysfunction. Aim is to study the role of level IIB dissection, whether it can be avoided during neck dissection, in early (T1, T2 and N0) oral squamous cell cancer. Methods: Retrospective analysis of oral cancer patients during July 2017 to July 2020, who had undergone neck dissection with level wise nodal sampling. Study group comprised of patients T1/T2 primary with clinically N0 neck. Control group comprised of clinically node positive patients and those with T3/T4 primary. Statistical analysis was done using STATA software. Results: There were 97 patients in whom level IIB sampling was done (selective neck dissection in 17 and modified neck dissection in 80) during the study period. Study group had 41 and control group had 56 patients. None of the patients in study group had level IIB positivity on the final histopathology. Even patients in the control arm who had T1/T2 disease with clinically positive neck nodes did not showed level IIB metastasis on final histopathology. Only 4 patients showed metastatic tumour deposits in level IIB nodes, all were with T 4 + clinically node positive disease. Statistical analysis showed level IIB node involvement was significantly associated with T4 disease (p value 0.019) and Node positivity (p value 0.012). Conclusions: Level IIB dissection may be omitted in patients with T1/T2 disease with node negative neck.

  ABS-95: Palliative Care in Oral Cancer: Metronomic Therapy Holds Promise in Low-Income Countries Top

Mohammed Imaduddin, Madhabananda Kar, Mahesh Sultania, Jyoti Ranjan Swain, Dillip Kumar Muduly, Saroj Kumar Das Majumdar, Dilip Kumar Parida, Madhabananda Kar

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Targeted therapies have become the norm in the palliative management of oral cancer patients, but therapy's cost is a significant limitation in low-income countries. The present study evaluated the prospect of the use of low-cost home-based oral metronomic therapy as an alternative in patients with unresectable or inoperable oral cancers. Methods: The study was a prospective, single-arm, cohort study. Patients presenting with unresectable or inoperable cancer and metastatic cancer, either primary or recurrent, were included in the study. Metronomic therapy, a combination of oral methotrexate 15 mg/m2 once a week and oral celecoxib 200 mg twice daily, was started as palliative therapy. The primary endpoint was overall survival. The secondary endpoints were a response to metronomic therapy, compliance, and toxicity. Results: From June 2018 to May 2020, 25 patients were started on metronomic therapy with palliative intent. The median age was 60 years (Range: 35 to 88 years) with a male to female ratio of 5.2:1. At eight weeks of therapy, 11 patients (44%) had a partial response, ten patients had stable disease (40%), and four patients had progressive disease (16%). At a median follow-up of 4.6 months, seven patients (28%) had died. The median overall survival was 8.8 months. The therapy's compliance was 100%, and one patient (4%) developed grade III toxicity. Conclusions: Considering the limitations of cost and availability of resources in low-income countries, oral metronomic therapy in the form of methotrexate and celecoxib should be regarded as an appropriate regimen in the palliative treatment of patients with unresectable, metastatic, or advanced, recurrent cancers.

  ABS-94: Defining the Role of Per-Oral Approach in the Surgical Management of T3 and T4 Squamous Cell Carcinomas of the Oral Cavity Top

Azhar Jan Battoo, Sheikh Zahoor Ahmad, Aashiq Ali1, Tariq Rasool Malik, Saqib Banday, Shah Naveed

Sheri Kashmir Institute of Medical Sciences, 1Govt. Dental College Srinagar, Srinagar, Jammu and Kashmir, India.

E-mail: [email protected]

Background/Objective: Mostly access approach of any sort is used to excise T3/T4 oral cavity squamous cell carcinoma. Although there is published literature defining role of per-oral approach in T1/T2 lesions, literature is scarce on its role in T3 lesions and almost non-existent in defining its efficacy in T4 lesions. We hereby present our experience with employment of per-oral approach in T3/T4 oral cavity squamous cell carcinoma. Methods: We carried out retrospectively analysis of prospectively collected data base to find number of T3/T4 oral cavity squamous cell carcinoma lesions operated in head and neck oncology services of our institute. Note was made of approach used in excising these lesions, dividing the patients operated into two groups-those operated by per oral approach and those who have been operated using access-approach. Results: Total of 58 patients of T4/T4 squamous cell carcinoma were operated in the department from September 2013 to October 2020. Forty-five of these patients were T4, rest of the 13 patients were T3. Access-approach was used only in two patients with T3 lesions while as it was used in 25 out of 45 patients with T4 lesions. Segmental mandibulectomy was carried out in 16 patients whereas paramedian and lateral mandibulotomies were done in seven patients. Marginal mandibulectomy was done in four patients. Surgical margin status was comparable between the two groups. Reconstruction was carried out with loco-regional flaps, with pectoralis major myocutaneous flap being used in 37 patients. In all the patients having their lesions excised per-orally, reconstruction did not need any access-approach. Loco-regional recurrence rate, disease free survival and overall survival was comparable between the two groups, with overall five -year survival being 45 %. Conclusions: Per-oral approach can be used in majority of patients with T3 lesions and can also been used in select T4 lesions without compromising the ability to perform optimal reconstruction. Based on our previous publications and current data, we suggest per oral access to be used as approach of choice for T3 lesions, with its role in excision of T4 lesions to be defined by multi-institutional studies with large sample sizes.

  ABS-92: Advanced Oral Tongue Squamous Cell Carcinoma –Factors Predicting Survival Top

Tejal Patel, Deepak Balasubramanian, Narayana Subramaniam, Yogesh Dhoke, R. Akali Nisha, N. Nageswara Rao, T. Krishnakumar, Subramania Iyer

Amrita Institute of Medical Sciences, Kochi, Kerala, India

E-mail: [email protected]

Background/Objective: To compare the influence of nodal versus primary tumor characteristics on overall and disease free survival in patients having advanced oral tongue squamous cell carcinomas. Methods: Retrospective review of 286 patients with advanced [stage 3 and 4] oral tongue squamous cell carcinoma [as per TNM AJCC 8] treated at a tertiary care center in southern India. All patients underwent surgery followed by RT/CTRT as indicated. SPSS version 23 was used for statistical analysis. Results: The male to female ratio was 3.7:1. The patient's ages ranged from 23 to 86 years. 46.85% of patients had a history of smoking. The median OS was 107 months [1-137 months] and median DFS was 56 months [1-133 months]. On multivariate analysis, lymph node ratio and size of the largest node proved to be statistically significant for overall survival [p=0.013 and p=0.05] and disease free survival [p=0.004 and p=0.48]. The depth of invasion and extra nodal extension were not statistically significant. Conclusions: Nodal status is the single most important prognostic factor for overall survival and not the primary tumor dimension. While DOI may influence survival in early tongue cancers, it does not do the same in cases of advanced disease. It is the lymph node ratio and size of the largest positive node that determines outcome in terms of overall survival. The tumor dimension has a weakly positive correlation with disease free survival. Our study highlights the fact that nodal factors are the single most important predictor of survival in advanced tongue carcinomas.

  ABS-89: Impact of Extent of Pathological Extranodal Extension on the Survival Outcome of Oral Cancer Patients – Prospective 4 Year Study from a Tertiary Cancer Centre Top

Kandathil Joseph Philip, Sherin James, Sangeetha K. Nayanar, M. Geetha, T. P. Sajith Babu, K. Ratheesan

Malabar Cancer Centre, Thalassery, Kannur, Kerala, India.

E-mail: [email protected]

Background/Objective: Extranodal extension (ENE) of metastatic oral squamous cell carcinoma (OSCC) to regional lymph nodes is the most reliable predictor of poor treatment outcomes. It is significantly associated with higher rates of locoregional recurrence, distant metastasis, and decreased survival. The purpose of this prospective study was to determine if the extent of pathological ENE impacts prognosis and survival. Methods: The present study was a prospective observational study (2014-2017; 4 years) held at a tertiary cancer centre over a period of 5 months from April 2020- August 2020. We have prospectively analysed 732 cases of oral cancer, out of which 235 cases had lymph node metastasis and 104 cases showed ENE. Microscopic ENE was measured in millimetres by examining H and E stained sections of metastatic lymph nodes with ENE of OSCC patients and grouped as minor (≤2 mm) and major (>2 mm) respectively. ENE minor and major cases were compared for their overall and disease free survival. Results: There were 104 OSCC patients with nodal metastasis and ENE with a male preponderance and a median age of 60 years. Majority presented with pN3b nodal burden (59.6%). ENE minor predominated (60%) over ENE major cases. There was no statistically significant difference in the survival of patients with ENE minor and major. Patients with N3b nodal staging had a worse prognosis than N2a showing poorer survival outcome. Patients who underwent concurrent CTRT had a better survival as against RT alone or failed to undergo radiation therapy. Conclusions: Patients with ENE minor may have the same risk of adverse outcomes compared with patients with more extensive ENE/ENE major. Accurate pathological nodal staging, especially identifying pN3b is critical and goes a long way in helping head and neck surgeons and oncologist in better risk stratification with personalized aggressive cancer management.

  ABS-87: T4b Oral cavity SCC - Are They Worth Resecting Top

Arnab Kalita, Kaberi Kakati

Dr B Borooah Cancer Institute, Guwahati, Assam, India.

E-mail: [email protected]

Background/Objective: Squamous cell carcinoma is the most common type of malignancy of the oral cavity. According to AJCC 8th edition, a T4b disease is involvement from the masticator space, pterygoid plates, skull base, or encasement of the internal carotid. Our objective is to evaluate whether surgery has a favourable outcome in patients with T4b oral cavity cancer. Methods: A retrospective analysis from a prospectively maintained data was done in the Deptt. of Head and Neck Oncology, Dr. B. Borooah Cancer Institute, Guwahati for a duration of 7 years from 1st January 2010 – 31st December 2017. There were a total of 141 patients. The inclusion criteria was any T4b oral cavity cancer patients completing any modality of treatment. The exclusion criteria was T4b oral cavity cancer patients not completing any modality of treatment /or expired before completion of treatment. The patients were treated with either concomitant CT-RT, surgery followed by CT-RT and only palliative RT. Results: Out of 141 patients who completed treatment, there were 89 males and 52 females. The age group ranged from 24 years to 85 years. 36 patients lost to follow-up following completion of the treatment. Majority of the patients were Ca of Buccal mucosa(122) followed by Ca RMT(17).78 patients received only RT (radical or palliative treatment).41 patients received only CT (radical or palliative treatment). 15 patients received CT-RT. 7 patients underwent surgery and received postoperative CT-RT. Overall 5years survival rates for the CT-RT arm was 31.2%, surgery & adjuvant CT-RT arm was 50% and RT arm was 8.8%. Conclusions: The standard protocol for T4b disease is chemoradiation as palliative treatment. However, there may be a subsite where surgery followed by CT-RT may benefit the overall survival rates. More studies are needed in this regard as our study had limited cases of surgery followed by RT-CT.

  ABS-86: Prevalence of Skip Metastases to Level IIb, Level IV and Level V Lymph Nodes in Oral Cavity Cancer in Eastern Region of India– An Observational Study Top

G. Anupama, Pradipta Kumar Parida, C. Preetam, Anindya Nayak, Amit Kumar Adhya

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Oral squamous cell carcinoma is well known to have a high risk of cervical nodal spread due to rich lymphatic supply, and it is considered as an independent prognostic factor. The typical pattern of nodal spread is to level I, II, III, IV and V in that order. When this is not followed, it is termed "skip metastasis". The knowledge of prevalence and patterns of skip metastasis helps a surgeon to make decisions regard the extent of neck dissection without compromising on the oncological outcome. This prospective observational study was aimed at determining the prevalence of metastasis to level IIb, level IV and level V lymph nodes in cases of OCSCC. Methods: The study included 100 consecutive patients, enrolled based on inclusion and exclusion criteria. After clinical TNM staging, surgery, including neck dissection, was planned and carried out. Postoperatively, histopathology reports were reviewed and analysed. Results: 36 cases were pN+. Skip metastasis to level IIb lymph node was seen only in one case (2.78%), level III metastases in 2 cases (5.5%) and level V in one case (2.78%). No skip metastasis to level IV was noticed. On univariate analysis, tumour size (T) and depth of invasion (DOI) were found to be independent prognostic factors for cervical lymph node positivity. On logistic regression analysis, DOI of 5mm-10mm and >10mm had a significantly higher risk of nodal metastases compared to DOI of <5mm. All four cases (4%) were from SCC of the tongue. Conclusions: Skip metastases to levels IIb, IV and V are uncommon in cases of oral cavity carcinoma. Thus, extensive neck dissection can be avoided in patients to prevent the morbidities associated with the same. We advocate for a study with a larger sample size and a longer follow up for better and more significant results.

  ABS-81: Adjuvant Therapy for Oral Cancer during the COVID-19 Pandemic – A Matched Pair Analysis from an Indian Cancer Unit Top

Arjun Gurmeet Singh, Pankaj Chaturvedi, Florida Sharin1, Natarajan Ramalingam, Vidisha Tuljapurkar, Deepa Nair, Naveen Mummudi,

Kumar Prabhash

Tata Memorial Hospital and HBNI, 1Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: The ongoing pandemic has stretched healthcare systems beyond their capabilities, precipitating into lack of appropriate cancer treatment delivery. The aim was to evaluate the impact of pandemic-related logistic restrictions on oral cancer patients that were scheduled to receive their adjuvant therapy during these trying times. Methods: Oral cancer patients that underwent surgery between February and July 2020, and were scheduled to receive their prescribed adjuvant therapy during the COVID-19 related imposed restrictions (Group-I) were included. These were matched for duration of hospital stay and type of prescribed adjuvant therapy, with a set of patients that were similarly managed 6 months prior to the restrictions (Group-II). Demographic and treatment specific details, including inconveniences faced in obtaining the prescribed treatment were obtained. Factors associated with delay in receiving adjuvant therapy were compared using regression models. Results: 116 oral cancer patients were considered for analysis, comprising of 69% (n=80) adjuvant radiotherapy (RT) alone and 31% (n=36) concurrent chemotherapy (CTRT). The mean hospital stay was 13 days. The number of patients that were not able to receive their prescribed adjuvant therapy were 2.43 times higher in Group-I than Group-II (p-0.038). None of the disease or treatment related factors significantly predicted a delay in completing adjuvant therapy. A majority of delay was present during the initial part of the restrictions, with the most common reason being unavailability of appointments and fear of administering chemotherapy. The number of patients that were delayed beyond 8 weeks after surgery were double in Group-I (n=29) than Group-II (n=15) (p-0.012). Conclusions: These results highlight a small part of the rippling effect these restrictions have on oral cancer patients. As the pandemic unfolds, pragmatic actions may be needed by policy makers to deal with such challenges while ensuring patient rights, safety and wellbeing.

  ABS-80: Prevalence and Pattern of Nodal Metastasis in Level IV/V Group in Oral Cavity Cancer Patients: A Prospective Study Top

Dev Patel, Ashish Jakhetiya, Arun Pandey, F. S. Mehta

Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India.

E-mail: [email protected]

Background/Objective: Metastases to the regional lymph nodes is the single most important prognostic factor in predicting local and distant relapse as well as survival. Prediction of the lymphatic spread could help in choosing the appropriate surgical procedure for both clinically positive and negative neck nodes. To evaluate the prevalence and pattern of nodal metastasis in level IV / V group in oral cavity cancer patients. Methods: Prospectively collected data of the patients with oral cavity squamous cell carcinomas (SCC) treated in department of surgery/surgical oncology at Geetanjali Institute, Udaipur, India between January 2019 and June 2020, were analyzed for nodal involvement. The study included 63 patients with oral cavity SCC. Data pertaining to clinical nodal status, histological grade, pN status, total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded and analysed. Results: Out of 63 patients 33 patients had nodal metastasis on final histopathology. Level IV involvement was seen in 3.80% (3 patients) of the patients and level V involvement was seen in 1.27% (1 patient) of the patients. Isolated involvement of level IV and V was not seen in any patients. Conclusions: None of the patient in present study has skip metastasis to level IV and V. Further we can propose selective dissection of level I to III in oral cavity SCC followed by frozen section and further decision for level IV and V dissection can be taken if found positive or else level IV and V can be avoided to minimize the morbidity.

  ABS-78: Serial Step Slicing in Patients with Pathological Node Negative Oral Squamous Cell Carcinoma Who had Regional and Distant Failures Top

M. P. Sreeram, Sanjeev Kulkarni, Vishnu Kurpad, B. S Srinath, Manjunath Sasthry

Sri Shankara Cancer Hospital and Research Centre, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background/Objective: Neck failure in patients with oral squamous cell carcinoma carries a poor outcome. Elective neck dissection is the recommended treatment option for early oral Squamous cell carcinoma. This retrospective study evaluated the local and regional failures in cN0 and the reliability of serial step slicing (SSS) for those patients who had regional and distant recurrences. The specimens were looked back with SSS to rule out the presence of isolated tumor cells(<0.2mm) or micro metastasis (0.2 to 2 mm). Methods: A retrospective study of 97 patients with cN0 OSCC, T1 to T4 treated at Sri Shankara Cancer Hospital, focusing on regional and local failures and correlation with DOI (depth of invasion) was done. All patients underwent wide local excision of the primary and lymph node clearance of level I to IV. There were 19% with T1, 42% - T2, 16 % -T3, 20% -T4 primary lesions. Results: Perineural invasion was present in 37% of cases. 17% of the patients had lymphovascular invasion. There were 2 regional failures, both in level IV of tongue primary, 11 local recurrences (all were tongue) with 6 positive margins, 3 distant metastasis. SSS was done in the specimens of two patients with regional failure and three with distant failure, to assess the presence of any isolated tumor cells or micro metastasis. All SSS specimens showed no ITS or micrometastasis. Conclusions: SSS has not been established as a routine procedure in head and neck cancer pathology. Few studies have showed the reliability of SSS in sentinel node biopsy. END being the standard approach to cN0 neck, clinicians still faces regional failure even with adequate nodal yield neck dissections. This pilot study did not show any significance in SSS, but definitely requires a future prospective study to answer the question – why pN0 neck fails regionally?

  ABS-77: Does the Reporting of Preoperative FNA of Salivary Gland Neoplasm by Head and Neck Pathologist Have a Better Agreement with the Final Histopathology Report? Top

Siddhanth Sanjay Jain, Shivakumar Thiagarajan, Snehal Shah1, Richa Vaish, Asawari Patil, Devendra Chaukar

Tata Memorial Hospital, Parel, 1Nanavati Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: To assess the agreement between the preoperative FNA and the final histopathology report when reported by a head and neck and a non-head and neck pathologist. Methods: All patients with major salivary gland neoplasm having undergone a preoperative FNA before surgery from Jan 2012 till Dec 2019 at our hospital was included in the study. Their demographic, clinical, and histopathological data were collected from our hospital electronic medical records. Agreement analysis was done to check for concordance between preoperative FNA and final histopathology using SPSS. Results: Out of 435 patients with major salivary gland tumor operated in the mentioned time period, 337 patients satisfied the inclusion criteria. The median age was 49 years (Range: 3-85 years) with the majority being males (n=201, 59.6%%). Parotid was the most common gland involved (n=308,91.4%). The preoperative FNA could identify the tumour as benign or malignant in majority of patients (237,70.6%), irrespective of whether they were reported by head & neck (Kappa-0.421) or non-head & neck pathologist (kappa- 0.397) with a good agreement with the final histopathology. The number of patients with inconclusive or non-diagnostic reports on FNA was similar between the head and neck pathologist and non-head & neck pathologists (p=0.280). The grade of the tumour was mentioned in majority of the pre-operative FNA (n=99, 29.4%). It did not, however, have much agreement with the final histopathology report (kappa-0.219) irrespective of the pathologists who reported it. Conclusions: Pre-operative FNA is a very important investigation in the management of salivary gland neoplasm. The diagnosis made with the preoperative FNA has a fair agreement with the final histopathology when reported by a head & neck pathologist in comparison to non-Head & Neck pathologist.

  ABS-74: Prospective Pilot Study to Find the Incidence of Occult Cervical Lymph Node Metastasis in Patients of Olfactory Neuroblastoma Top

Puja Chatterjee, Rajeev Kumar1, Aanchal Kakkar1, Prem Sagarm1, Ashu Seith Bhalla1, Atul Sharma1

AIIMS, Bhopal, Madhya Pradesh, 1AIIMS, New Delhi, India.

E-mail: [email protected]

Background/Objective: There is no data on the incidence of occult neck metastasis in ONB and no guidelines exist regarding management of N0 neck in Olfactory Neuroblastoma. Nodal metastasis is a predictor of poor overall and disease free survival. In this prospective pilot study, the first of its kind in the world, we attempted to prospectively look for the incidence of occult lymph node metastasis in this group of patients. The results may be able to answer the question, whether to treat neck at initial management of primary tumour or not. Methods: Study period- Jan 2018 to Dec 2019. CEMRI PNS+ neck was done to evaluate the extent of the disease and nodal metastasis. SND (level I-III) was performed in clinically and radiologically N0 cases along with the excision of primary tumor. Results: 2 female and 6 male patients were included in the study. Six Kadish C patients underwent Cisplatin and Etoposide based neoadjuvant chemotherapy and showed very good response. Occult metastases to neck nodes were found in 25% (n=2/8) patients. The metastases were detected in the patients at right level IIA, IB and left IB respectively. Both patients were Kadish C with intracranial extension. Hyams grade and Ki67 labelling did not show any co-relation with occult lymph node metastasis. Conclusions: This prospective pilot study on eight patients, determined the incidence of occult lymph node metastasis in ONB patients to be 25%. This is above the arbitrary value of 20% used for elective neck dissection in aerodigestive tract malignancies. Thus we propose prospective multi-centric studies to validate our findings favoring the role of selective neck dissection in ONB Kadish stage C.

  ABS-73: Factors Influencing the Intraoperative Neuromonitoring Parameters in Patients Undergoing Surgery for Thyroid Malignancy Top

B. Gurukeerthi, Shivakumar Thiagarajan, Parthiban Velayutham, Adhara Chakraborty, Nithyanand Chidambaranathan, Devendra Chaukar

Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Recurrent laryngeal nerve (RLN) palsy is one of the common complications encountered following thyroid surgery in general and more so when it is done for cancer. Studies looking at IONM parameters like current requirement, latency, and amplitude changes that can predict the postoperative RLNP very few. Methods: In this retrospective study, patients who underwent thyroid surgery with the IONM between 1st June 2017 to 31st May 2019 were included. We looked at the association of known factors predisposing to RLN palsy on the IONM parameters and specific patterns, if any, in those who developed postoperative RLN palsy. Results: Eighty-nine patients were included in the final analysis, with a total of 143 nerves at risk of developing RLN palsy. None of the factors influenced vocalis muscle latency by RLN stimulation significantly. Age (>40Years), intraoperative blood loss >500ml, and central compartment dissections significantly influenced in obtaining stable baseline EMG amplitudes. Advanced T-stages (T3-T4), tracheoesophageal groove involvement, and structural injury to RLN significantly influenced the intraoperative use of the current threshold to obtain stable baseline EMG amplitudes. All these factors possibly could influence IONM parameters to help predict postoperative RLN palsy. Conclusions: Surgeons using IONM for thyroid surgery must be aware of these factors influencing the various IONM parameters. These findings could help the surgeons take appropriate intraoperative decisions in order to minimize the risk to the RLN.

  ABS-69: Role of Post-operative Radiation Therapy in Early Stage Oral Cancer: A Retrospective Analysis Top

Kuldeep Thakur, Chirom Amit Singh, Kapil Sikka, Rajeev Kumar, S. Pirabu, Smriti Panda, Alok Thakar

All India Institute of Medical Sciences, New Delhi, India.

E-mail: [email protected]

Background/Objective: The objective of this study is to determine survival benefit of adjuvant radiotherapy in patients with early stage oral cavity squamous cell carcinoma (OCSCC) with depth of invasion (DOI) ≥4mm to 10mm who undergo partial glossectomy and ipsilateral elective neck dissection with or without adjuvant therapy. The secondary aim was to identify the role of adjuvant radiotherapy in adverse prognosticators associated with early stage OCSCC. Methods: A retrospective record of 185 (mean age, 47.5 years) previously untreated, early stage OCSCC patients (stage I and II, AJCC 8th edition), treated surgically with or without adjuvant therapy and a minimum follow-up of 6 months, were analyzed in the cohort. The involvement of the primary site was gingivobuccal complex in 38.9% (n=72) and oral tongue 61.1% (n=113) patients. DOI was ≤4mm in 44.5% (n=69) and >4mm to 10mm in 55.5% (n=86) of patients. Perineural invasion was detected in 17.8% (n=33) and close margins any dimensions, irrespective of margin revision, were seen in 37.8% (n=70) patients. Adjuvant therapy was given to 71 patients (38.4%) and main indications were close margins or poor pathological prognosticators. The median follow-up time was 26 months (range, 4-61 months). Results: On analysis, patients with DOI >4mm OCSCC, the addition of adjuvant therapy did not improve 2 years OS (85% in the surgery with adjuvant therapy group vs. 79% in the surgery alone; p= 0.86) and DFS (p= 0.08). Similarly, in oral tongue cancer with DOI >4mm, the addition of adjuvant therapy did not improve 2 years OS (78% vs. 74%; p= 0.90). The addition of adjuvant therapy in PNI positive cases and close margins did not improve survival. Conclusions: Our study concluded that the addition of adjuvant therapy in early stage OCSCC with DOI >4mm to 10mm, PNI positivity and in close margins does not improve survival.

  ABS-66: TransOral UltraSonic Surgery for Oral cavity, Oropharyngeal and Supraglottic Malignancy: A Prospective Study of Feasibility, Safety, Margins and Functional Outcomes Top

Pirabu Sakthivel, Alok Thakar, Mario Fernandez1, Sumanth Bollu, Rajeev Kumarr, Kapil Sikka

AIIMS, New Delhi, India, 1MD Anderson International, Madrid, Spain.

E-mail: [email protected]

Background/Objective: With the advent of TransOral Robotic Surgery(TORS) the ease of transoral procedures has been dramatically improved.TORS has already proved its feasibility,good functional and oncological outcomes for selected lesions of oral cavity, oropharynx and laryngopharynx, the objective of this study is to investigate the feasibility of TransOral UltraSonic Surgery(TOUSS), a similar new method of surgical approach of oral cavity,oropharyngeal and supraglottic malignancies. Methods: Eighteen patients with malignancies of oral cavity, oropharynx and supraglottis underwent TOUSS with simultaneous neck dissection and adjuvant therapy as indicated, from January2018-April2019 using 35 cm using ultrasonic harmonic scalpel(Thunderbeat). Exposure was achieved FK-retractor (Gyrus Medical, Tuttilngen, Germany) and Olympus ENDOEYE Flex 5 mm-2D/10-mm 3D-deflecting tip video laparoscopes. Parameters evaluated include tumor staging, mouth opening,TOUSS setup time,TOUSS primary removal time,surgical margins,blood transfusions,tracheostomy, postoperative complications, enteral feeding and resumption of oral diet,swallowing outcomes and duration of hospital stay. Results: Eighteen patients underwent complete TOUSS,with simultaneous unilateral or bilateral neck dissection. No procedure was abandoned intraoperatively due to difficulty in extirpation of the tumor. Margins were negative for ten patients(55.6%), was close in five(27.8%) and was positive in three patients(16.7%). Average TOUSS set-up time was 22.5min(range,10–30min) and average TOUSS primary tumor removal time was 35.3min(range,15–60 min). Patients started tolerating oral feeds even in the second post op day (mean,6 days), with the nasogastric tube removed within 2–3 weeks postoperatively (mean,16 days). The average hospital stay was 7.4 days(range2-16 days). Secondary hemorrhage occurred in two cases which required an emergency tracheostomy and ligation of lingual artery and minor cervicopharyngeal fistula occurred in four cases which settled on its own. Conclusions: TransOral UltraSonic Surgery(TOUSS) is a safe and sound alternative method of endoscopic surgical treatment of oral cavity,oropharynx and supraglottic neoplasms. Advantages of this technique include faster resection time,intraoperative assistance from NBI,easy affordability compared to TORS and excellent functional outcomes.

  ABS-60: The Role of Functional Endoscopic Evaluation of Swallowing in Tracheotomy Decannulation Post Oral Cancer Surgery Top

Satyapal Singh, Shamit Chopra, Vibhu Ranjn Shahani1, Anubha Bhartuar

Patel Hospital, Jalandhar, Punjab, 1Rajiv Gandhi Cancer Hospital, New Delhi, India.

E-mail: [email protected]

Background/Objective: A large proportion of surgeries for oral cancer incorporate atracheotomy. Especially in advanced oral cancer resections, the altered postsurgical anatomy significantly impacts the first and second stages of deglutition, resulting in swallowing dysfunction and potential aspiration. There is no priordata on utilization of FEES or any other objective tool to predict successfuldecannulation of tracheotomy in patients with oral cancer. Methods: Two hundred and thirty seven patients with oral cancer treated at our institution between Feb 2017 and Dec 2019 were retrospectively analyzed- 72(30.4%) of these patients underwent tracheostomy. Post surgery, after excluding patients who were not considered candidates for early decannulation, 48(65.7%) underwent FEES with the endpoint of tracheostomy decannulation. The number of FEES procedures required for decannulation was correlated with patient and disease-specific variables utilizing Chi square analysis. Results: The mean number of days from tracheostomy to decannulation was 24.9. Thirty two(66.7%) patients underwent decannulation post the first FEES.However, 33.3% patients needed swallowing therapy followed by a second(18.8%) or a third(14.6%) FEES before they could be decannulated. No patients required a repeat tracheostomy. A significantly higher proportion of individuals at or younger than median age were decannulated earlier, compared with those above(p=0.01). There was no statistically significant difference between early (T1/2) and advanced (T3/4) primary lesions and timing of decannulation(p=0.83), though that may be explained by selection bias. The presence of comorbid diabetes mellitus did not correlate with decannulation timing(p=0.81). Conclusions: FEES is a reliable, minimally invasive and cost-effective tool to aid successful decannulation in oral cancer. It is indicated in older individuals and may have a greater role in advanced stage disease. It helps guide swallowing therapy and thus potentially augments quality of life by tailoring serial evaluations to aid early decannulation, especially prior to initiation of adjuvant therapy.

  ABS-58: Feasibilty of Free Flaps in a High Volume Centre: Our Experience Top

Linu Thomas, Sajith Babu, Sandeep Vijay, A. Anoop

Malabar Cancer Centre, Thalassery, Kerala, India.

E-mail: [email protected]

Background/Objective: Advanced staged tumours often require extensive surgical resection and adjuvant radiotherapy/ chemoradiation based on histopathological report. Extensive surgical resection of tumour often results in large complex defects with loss of soft tissue, bone and skin. The reconstructions of extensive defects after resection have always been challenging. Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Free flap reconstruction is done only for a selected group of patients due to resource limitation. Ideal selection depends on various factors which includes lack of resources, financial constraints, and patient factors. This study was done to highlight the feasibility of free flaps in high volume centres and to discuss the selection criteria. Objectives: To evaluate the success rate of free flap reconstruction at Malabar Cancer Centre from the Dec 2014 to Dec 2019. To identify the factors affecting selection of free flaps. Methods: 125 patients who underwent free flap microvascular reconstructive surgery for head and neck cancer at Malabar cancer center from December 2014 to December 2019 were included in this retrospective observational study. Medical records of patients included in the study were reviewed. Demographic and free flap reconstructive surgical details were obtained and entered into proforma. Results: There were total of 600 Surgeries for head and neck cancer during december 2014 to december 2019. Out of this 579 patients required reconstructions. Of these, 125 patients underwent free flap reconstructive surgery. Others had pedicled flap reconstruction with other flaps like nasolabial flap, myo mucosal flap, submental flap, infrahyoid flap, supraclavicular flap or pectoralis major flap. Among the study population 96 (76.8%) were male and 29 (23.2%) were female. Age group of the study population ranged from 30-68 years ( average 50) with 86.4% above the age of 40 years. Among the various free flaps used, 40 underwent radial forearm free flap (FRAF), 32 underwent anterolateral thigh flap (ALT), 40 underwent fibular osteocutaneous flap(FFF), four had iliac crest bone flap with skin (DCIA), three had lateral arm flaps(LAF), two had scapular flap, three jejunum and one medial sural flap (MSAP). One patient underwent double free flap reconstruction with ALT and FFF. The success rate was 93%. The causes for failures were arterial thrombosis in two patients, venous thrombosis in two patients, inadequate donor vessels in one and unknown cause in 4 others. The most common failures were seen with an anterolateral thigh flap. Two stage reconstruction was done in initial six patients in view of non availability of operation room time. The incidence of surgical site infection and pneumonia was high in this group of patients and hence this method was abandoned in further surgeries. Conclusions: Reconstruction with free flap is feasible in resource limited settings with selection of patients. Selection depends on the type of defects, comorbidity and the extent of nodal disease. Mandibulectomy in dentate patients was the definite indication for free osteocutaneous flap. Two stage reconstruction on consecutive days was detrimental in view of increased infection rate.

  ABS-57: Medullary Carcinoma Thyroid - Is There Non Surgical Options? Top

Raveena R. Nair, Sajith Babu, Sandeep Vijay

Malabar Cancer Centre, Thalassery, Kerala, India.

E-amil: [email protected]

Background/Objective: Medullary carcinoma thyroid is an uncommon malignant tumor of the thyroid gland(MTC) which arises from the parafollicular C cells and is regarded as a neuroendocrine neoplasm. Unlike differentiated thyroid cancers, MTC is an aggressive type with high chances of lymph node metastasis and recurrence. Treatment of MTC is with surgery for operable cancers. Other treatment options are limited. Objectives: (1) To identify the disease profile in a tertiary cancer centre. (2) To identify the various treatment options. (3) To evaluate the treatment algorithm and its impact on survival. Methods: A retrospective analysis of patients who were diagnosed with medullary ca thyroid in our institution from January 2010 to January 2017 was done. The demographic details and clinical data were obtained from medical records. Results: During the study period from January 2010 to January 2017, there were 30 Thyroid cancers treated at Malabar Cancer Centre. Of these, thirty patients were medullary carcinoma of thyroid. Initial presentation was with thyroid swelling in 93.3% ( 28 patients) and with neck nodes in two patients. Fine needle aspiration cytology was confirmatory in all patients. Serum Calcitonin was elevated in all patients except one. Neck nodal metastasis was found on evaluation in 20 Patients. Computerised tomography (CT scan )was the imaging of choice in all patients. Seven patients had metastasis at initial presentation. The commonest metastasis was in lung. Curative intent treatment in the form of surgery was given to 23 out of 30 patients and the rest of the patients were given palliative treatment. The median follow up was 24 months. Overall survival of the whole cohort was 58.8 percent. The five year disease free survival in operated cases of medullary ca thyroid was 52 percent. There were 9 recurrences of which commonest was in neck nodes. Further surgical treatment was done in all 9 patients. Inoperable locoregional tumours were seen in 3 patients. Inoperable and metastatic patients were given palliative RT. Conclusions: Medullary carcinoma of thyroid is an uncommon tumor even in a tertiary oncology institution. Surgery is the main treatment modality and the completeness is associated with less frequent recurrences. Serum calcitonin along with locoregional imaging plays a major role in surveillance. Inoperable tumours and metastatic tumours are not offered any therapy.

  ABS-51: Incidence and Predictors of Cervical Nodal Metastasis in Upper Alveolus and Hard Palate Squamous Cell Carcinoma: A Single Institute Experience Over 9 Years Top

Savankumar Chovatia, Deepak Sarin, Gopal Kumar, Kanika Rana, Karan Gupta, Kunal Gupta

Medanta-The Medicity, Gurugram, Haryana, India.

E-mail: [email protected]

Background/Objective: Primary malignancy of upper alveolus and hard palate is infrequent and incidence of cervical nodal metastasis is said to be low in literature as compare to other subsites of oral cavity. Hence, elective treatment of the neck particularly with small primaries (T1, T2) is controversial. Objective: To analyse the incidence of cervical nodal metastasis (CNM) in upper alveolus & hard palate squamous cell carcinoma (UAHP-SCCA).To define clinical and histopathological predictors of CNM. Methods: Between 2011-2019, 56 UAHP-SCCA patients were analysed. Patient, tumour and treatment characteristics were recorded Patients were restaged by AJCC 8th edition for analysis. Incidence of CNM & clinical and histopathological Predictors of nodal metastasis such as T stage, Clinical site with transverse and longitudinal extension, nodal levels, Perinueral invasion, Lympho-vascular invasion, Depth of invasion, bone invasion were correlated with CNM on univariate and multivariate analysis. Results: 53 patients out of 56 underwent neck dissections and had histopathology available for neck staging, for other 3 patients final neck status has staged based on presence or absence of recurrence on follow up. 23(41.07%) out of 56 patients had CNM on final histopathology. Incidence of CNM showed an increasing trend from 23.52% for T1 to 64.70% for T4. On statistical analysis presence of LVI & PNI, DOI > 5mm, Bone invasion and primary site extension on both transverse & longitudinal axis were found to be strong predictors for CNM. Conclusions: UAHP-SCCA is associated with high rates of cervical nodal metastasis. High rates were observed even with small primary (T1, T2). Elective treatment of the neck is therefore recommended for all UAHP-SCCA.

  ABS-47: Primary Tumor Staging for Oral Cancer and a Proposed Modification Incorporating Perineural Invasion: An International Multicenter Study Top

Nageswara Rao Noothanapati, Subramania Iyer, Shorook Na'ara1, Alberto Deganello2, Shadi Shinnawi1, Davide Mattavelli2, Krishnakumar Thankappan, Ziv Gil3

Department of Head and Neck Onco-Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India, 1Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, Rambam Healthcare Campus, Rappaport School of Medicine, Technion - Israel Institute of Technology, 3Department of Otolaryngology Head and Neck Surgery The Head and Neck Center, Rambam Healthcare Campus, Haifa, Israel, 2Department of Surgical Specialties, Unit of Otorhinolaryngology-Head and Neck Surgery, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

E-mail: [email protected]

Background/Objective: In the 8th edition of the tumor-node-metastasis classification standard (TNM-8), both the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) demonstrate that the current staging system for oral cavity squamous cell carcinoma (OCSCC) offers prognostic variability within specific tumor classifications. Although the addition of depth of invasion (DOI) has improved its predictive value, the system still provides suboptimal staging for some groups. The objective of this study was to determine if the incorporation of perineural invasion (PNI) into the T-classification system would improve the prognostic performance of TNM-8. Methods: We performed an international, multicenter study of 1,049 patients with OCSCC that were surgically treated from 1994-2018 (mean follow-up: 35.9 months).We assessed the impact of PNI on disease-specific and overall survival using a multivariable Cox proportional hazard model. Various classification models were developed within each T-category and evaluated using the Harrel concordance index (C-index), Akaike information criterion (AIC), and visual inspection. Stratification into distinct prognostic categories, with internal validation, was performed using bootstrapping analysis (SPSS and R-software). Results: Through multivariate analysis, PNI was significantly associated with disease-specific survival (P<.001). PNI integration into the staging system resulted in a significantly improved model compared with the current T category alone (lower AIC, P<.001). The optimal model included T-class upstaging with significant improvement in bootstrapped C-index. The PNI-integrated model was superior in predicting differential outcomes between T3 and T4 patients. Conclusions: We propose a new model for T-classification of OCSCC, which is based on incorporating PNI into the staging system. This data can be used for future evaluations of the TNM staging system.

  ABS-46: Cervical Myocutaneous Rotation Flap: Design and its Current Role in Reconstruction of the Lower Lip Defects Top

Shashank Chaudhary, Mudit Agarwal, Abhishek Singh, Kiran Joshi, Sunil Kumar

Rajiv Gandhi Cancer Institute and Reasearch Center, Delhi, India.

E-mail: [email protected]

Background/Objective: Functional reconstruction of both the hard and soft tissue defects play a key role in surgical treatment of head and neck tumours. Reconstruction of the lower lip using bipaddle flap that is used to reconstruct the intraoral defect is associated with oral incompetence or microstomia. Methods: From january 2019 to december 2019, 16 patients underwent composite resection for oral squamous cell carcinoma including a portion of the lower lip. The intraoral defect was reconstructed using locoregional flaps and the lower lip defect was reconstructed with a cervical myocutaneous rotation flap. All patients were followed up and the incidence of flap complications,oral incompetence, drooling and microstomia were recorded. Results: Among the 16 patients, 4 patients had oral incompetence and only 2 among them had significant drooling. None of the patients had microstomia. Flap tip necrosis was seen in 3 patients which was managed by local debridement and secondary suturing. Conclusions: The cervical myofacial rotation flap represents and safe and simple locoregional flap for reconstruction of lower lip defects that otherwise may require a bipaddle locoregional flap.

  ABS-44: Pretreatment Trismus as a Predictor for Disease Free Survival and Overall Survival in Patients of Head and Neck Cancers: A Retrospective Observational Study Top

Jaimanti Bakshi, Jaimanti Bakshi, Naresh K. Panda, Ganesh Agarwal

Post Graduate Institute of Medical Education and Research, Chandigarh, India.

E-mail: [email protected]

Background/Objective: Oral cancer is a highly prevalent and serious health care problem. In India it accounts for over 30% of all cancers with a rate of 20 per 100,000 population.Restricted mouth opening (trismus) in patients with cancer of the head and neck may result in difficulties with daily activities such as eating, chewing, swallowing, breathing, and speaking. It can lead to further problems such as severe pain, weight loss, and poor oral hygiene. This study was aimed to note overall survival and disease free survival with secondary to look the incidence of trismus in patients of oral cancer in relation to the demographic profile, the various subsites of the oral cavity involved, and to determine the risk factors for the same. Methods: This a retrospective study in which patients collected from 2016 to 2018 in the department of otorhinolaryngology and head and neck surgery, PGIMER, Chandigarh were studied and the demographic profiles, subsites of the disease involved, stages at presentation and degree of trismus were investigated. Results: Thirty eight patients having trismus were evaluated. Median overall survival was 64 months in grade I, 40 months in grade II, 18.5 months in grade III, and 7 months in grade IV. Log-rank (Mantel-Cox) test revealed the p value 0.0023 that is significant.Median disease free survival was 64 months in grade I, 33 months in grade II, 15.6 months in grade III, and 7 months in grade IV.Log-rank (Mantel-Cox) test revealed the p value 0.0006 and that is significant. Conclusions: Patient presenting with trismus of higher grade had lower survival as well as lower disease free survival rate with comparison to lower grade trismus.

  ABS-42: Expression of Biomarkers Vimentin and Metastasis Associated 1 Protein in Different Stages of Laryngeal Cancer and Their Impacts on Survival Top

Ganesh Agarwal, Jaimanti Bakshi, Naresh K. Panda, Sushmita Ghoshal, Amanjit Bahl, Roshan Verma, Rijuneeta Gupta

Post Graduate Institute of Medical Education and Research, Chandigarh, India.

E-mail: [email protected]

Background/Objective: Laryngeal cancer is the second most common cancer after the lip and oral cavity cancer of head and neck region . Laryngeal malignancy is the seventh most common malignancy in males in India. Overall survival and disease free survival depends on various factors viz stage of disease, type of treatment, stage of the disease when treatment started, previous history of radiation for other head neck primary, immune status of the patient, types of histology and various types of biomarker that may impact on overall survival .Here we study the expression of biomarkers Vimentin and MTA 1 in laryngeal squamous cell carcinoma and the correlation of VIM & MTA 1 with tumor recurrence and survival in laryngeal cancers at different stages. Methods: This is a prospective cohort study of 90 laryngeal squamous cell carcinoma patient presenting to outdoor patient department of Otolaryngology & HNS at PGIMER, Chandigarh. Tissue specimens and surgical specimen (in case of surgery as the primary treatment /post RT salvage surgery)from 90 patients with LSCC were sent to pathology deptarment for vim and mta1 immunohistochemistry analysis. Results: In our study till now we have enrolled 70 patients and we are getting an unexpected result of positivity with vimentin and MTA1 and there is a correlation between overall and disease free survival and biomarkers Vimentin and MTA1.Out of 33 test samples, 11(32%) came positive for Vimentin and 33 (100%) for MTA1. Conclusions: There is a definite correlation between biomarkers vimentin and MTA1 and different subsites of larynx and stage of the disease. One patient had expired and five patients had recurrence among seventy patients at the interval of one year.

  ABS-41: Skip Metastasis in Carcinoma Tongue, Is It Common Enough? Top

Vartika Vishwani, Biswajyoti Hazarika, Naveen Kumar, Saurabh Tewari

Artemis Hospital, Gurgaon, Haryana, India.

E-mail: [email protected]

Background/Objective: Lymph node status is the most important prognostic factor in oral carcinoma patients. Nodal metastasis from oral tongue squamous cell carcinoma follows a predictable pattern, usually to cervical lymph node level one, two and three.Several studies have suggested that the skip metastasis to level iv and v is a common phenomenon in carcinoma tongue due to the communication between the two sides of the tongue. Because of this reason therapeutic neck dissection including level I to IV lymph nodes is a common practice. The objective of this study is to analyse the incidence of skip metastasis to level IV cervical lymph nodes in clinically node negative carcinoma tongue stage T1 to T4 patients. Methods: Fifty consecutive cases of carcinoma tongue T1 to T4 N0 stage who presented to our OPD were prospectively evaluated. They underwent excision of the primary tumor with neck dissection (levels I-IV).The pathological status of level IV lymph nodes was analysed. Results: Pathologically, isolated level IV cervical lymph nodal involvement was seen in none of the patients. Conclusions: Contrary to the popular hypothesis,skip metastasis is a rare phenomenon to be seen in carcinoma tongue patients.Hence, routine level IV dissection in clinically node-negative patients with oral tongue squamous cell carcinoma can be avoided, thereby reducing the morbidity associated with extensive lymph nodal dissection.

  ABS-38: Validated Predictive Nomograms for Oral Tongue Squamous Cell Carcinoma Applying the AJCC/UICC 8th Edition Staging System Top

Akali Nisha Rajrattansingh, Deepak Balasubramanian, Filippo Marchi1, Francesco Missale1, Cesare Piazza2, Davide Mattavelli3, Krishnakumar Thankappan, Subramania Iyer

Amrita Institute of Medical Sciences, Kochi, Kerala, India, 1IRCCS Ospedale Policlinico San Martino, Genova, Italy, 2Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, Italy and Department of Oncology and Oncohematology, University of Milan, Milan, 3Department of Medical and Surgical Specialties, Unit of Otorhinolaryngology - Head and Neck Surgery, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

E-mail: [email protected]

Background/Objective: Nomograms are user-friendly and effective tools for prediction of survival in cancer patients. Such nomograms prognosticating oral tongue squamous cell carcinoma (OTSCC) have been described. Of these, some do not incorporate depth of invasion (DOI) and other valuable pathological variables, while others do not measure all endpoints. Nomograms applying the 8th edition of the TNM Staging System aimed at predicting overall (OS), disease specific (DSS), locoregional recurrence free (LRRFS) and distant recurrence free survivals (DRFS) for OTSCC are still lacking. Hence, we attempted to develop such a normogram and validate it. Methods: A training cohort of 438 OTSCC patients was retrospectively enrolled from a single institution. An external validation set of 287 patients was retrieved from two independent institutions. Clinical and pathological variables available were: gender, age, tobacco use, treatment, status of the surgical margins, distance of the tumor from the surgical margin (mm), DOI (mm), diameter of the tumor (mm), grading, PNI, LVI, bone invasion, pT, pN category, maximum dimension of metastatic nodes, and evidence of ENE. Results: Internal validation of the multivariable models for OS, DSS, DRFS and LRRFS showed a good calibration and discrimination results with optimism-corrected c-indices of 0.74, 0.75, 0.77, and 0.70, respectively. The external validation confirmed the good performance of OS, DSS and DRFS models (c-index 0.73 and 0.77, and 0.73, respectively), and a fair performance of the LRRFS model (c-index 0.58). Additionally an interactive shinyapp, was developed for the end-points. Conclusions: The OTSCC nomograms being proposed in this paper embrace several fundamental variables which are easily available, have good accuracy, consider the latest edition of the UICC-AJCC staging system and can be used to individually predict the most relevant oncologic outcomes.

  ABS-37: Assessment of Surgical Margin in Post Neo-Adjuvant Chemotherapy Oral Squamous Cell Carcinoma Top

D. Pradeep Kiran Reddy, Rajesh Kantharia, Siddharth Vyas, Shehnaz Kantharia, Niraj Bhatt, Yogesh Mistry

Kailash Cancer Hospital and Research Centre, Vadodara, Gujarat, India.

E-mail: [email protected]

Background/Objective: The role of NACT in oral cancer is not clearly defined. It has shown some benefit in form of tumour shrinkage and resectability, in patients with very locally advanced disease or unresectable oral SCC. In these subset of patients the surgical margin of resection is still controversial. Our study is an attempt to analyze the resection margins as per the post NACT imaging findings. Methods: Eighty eight patients with locally advanced oral squamous cell carcinoma (cT4a and cT4b) were included in the study, a retrospective analysis of the prospectively collected data (from January 2018 to January2020) was done. Patients either received two or three cycles of three drug regimen (TPF) NACT. Response to the NACT was evaluated clinically and radiologically. Patients with stable or progressive disease were not included in the study and were referred for nonsurgical management. For patients who responded to NACT, resection was planned according to the post NACT imaging finding. Frozen section analysis was not performed in any case; surgical margin status was assessed from the final histopathology reports. Results: Of these 88 resection specimens, 62 were buccal mucosa and 26 were tongue squamous cell carcinoma. 54 (61.36%) specimens had free margins of which 39 buccal mucosa SCC and 15 tongue SCC, 16(18.18%) specimens of close margin 10 buccal mucosa SCC and 6 tongue SCC and 18(20.45%) involved margins for 13 and 5 cases for buccal mucosa and tongue SCC respectively. Conclusions: The percentage of free and close/positive surgical margin obtained after resection of tumour based on the post NACT imaging findings was comparable with the surgical margin reported in the literature for locally advanced oral squamous cell carcinoma receiving upfront surgery.

  ABS-36: Establishing an Artificial Intelligence Based Head and Neck Cancer Registry and Evaluation of Impacts of Therapy: Preliminary Results Top

R. K. Gautamjit, Rijuneeta Gupta, Naresh Kumar Panda

Postgraduate Institute of Medical Education and Research, Chandigarh, India.

E-mail: [email protected]

Background/Objective: A cancer registry is an essential part of any rational program of cancer control. Artificial Intelligence and information technology can provide value addition in this venture. Objective: To pilot test an artificial intelligence (AI) based platform (JIYYO) for generating a Head and Neck cancer registry data. Type of Study: Pilot observational study involving follow-up. Study Duration: Patients participating in the study were enrolled from October 2019 to September 2020. The patients were followed up at 3, 6 and 9 months. Methodology: Details of the epidemiology, clinical findings, diagnosis and staging of the disease, and management protocol were entered into questionnaires, generated and uploaded in the Jiyyo platform. Updates, follow up and data analysis were carried out with the Jiyyo platform. Results: Total cases were 672, out of which 572 were evaluated. 473(82.7%) were male and 99(17.3%) were female. Most common presenting symptom was non healing ulcer, seen in 181(31.6%) cases. Ulceroproliferative growth was the most common finding on clinical examination [267(46.7%)]. Smoking was present in 316(55.2%) cases. Oral cavity malignancy had the most number of cases (104) followed by larynx (95). Most common tumour staging at presentation was T4a, seen in 112(19.6%) cases, and nodal staging was N1 (13.1%). Surgery was done in 148(25.8%) cases and radiotherapy in 140(24.5%) cases with post operative radiotherapy given in 45 patients. Disease recurrence in follow up of appropriate patients were seen in 5 cases at 3 months, 10 at 6 months, 9 at 9 months, with local failure (9) being most common. Conclusions: It is feasible to use an AI based platform to build a cancer registry of Head and Neck malignancies and it facilitates easy follow up, data retrieval and sharing.

  ABS-35: Correlation of MRI with Pathological Depth of Invasion for Assessment of "T" Stage in SCC of Oral Tongue Top

Ankur Padmaja, Rajesh Kantharia, Ankur Padmaja, Shehnaz Kantharia, Bhavin Shah, Rajnikant Vasava, Yogesh Mistry

Kailash Cancer Hospital and Research Centre, Goraj

[email protected]

Background/Objective: Correlating the "gold standard" pathological measurement of depth of invasion in case of tongue squamous cell carcinoma with MRI to get an accurate clinical Tumor staging according to AJCC 8th edition and thus the prognosis. Methods: Retrospective analysis of prospectively collected data of 28 patients was done. Depth of invasion was assessed on preoperative MRI scan using optimal method. Histopathological measurement of depth of invasion post surgery was taken with the help of plumb-line technique. Both the readings were compared and evaluated. A correlation of radiologic-versus-pathologic depth of invasion was established. Results: On comparing the pathologic depth of invasion with MRI, 14 out of 28 patients had values within 1mm, 6 had within 2mm and 4 patients had within 4mm of range. More than 5mm of discrepancy was seen in 4 patients who had received NACT. This difference was analysed and attributed to the post chemotherapy oedema. Conclusions: MRI is a predictable imaging technique for the assessment of depth of invasion and is a reliable tool to evaluate the clinical Tumor staging.

  ABS-34: Histology of Early Stage Buccal Mucosa Squamous Cell Carcinoma: A Critical Review Top

Siddharth Mahesh Vyas, Rajesh Arvind Kantharia, Shehnaz Rajesh Kantharia, Zahoor Ahmad Teli, Yogesh Matadin Mistry

Kailash Cancer Hospital and Research Centre, Vadodara, Gujarat, India.

E-mail: [email protected]

Background/Objective: To analyse the incidence of lymph node metastasis in early stage buccal mucosa cancers, correlate it with the depth of invasion and study the percentage of occult metastasis. Through this study, we also attempt to look into subsite specific buccal mucosa data which is lacking in literature and will help us improve the understanding of the disease. Methods: Retrospective analysis of the prospectively collected data of 109 patients with early stage buccal mucosa cancer operated from January 2018 to August 2019 was done. Information regarding the pathological T stage, depth of invasion, presence or absence of cervical node metastasis, occult metastasis, size of the metastatic lymphnodes, and the presence of extracapsular extension was collected from the final histopathology reports. Results: 25 out of 109 (22.94%) patients had cervical node metastasis. 9 (9.68%) patients had occult metastasis. Of these 25 patients, 17 were pathologically staged T2 (68%) while 8 were staged T1 (32%). No metastasis was observed for the patients with depth of invasion less than 4mm. P-value obtained by the Fisher's exact test was 0.003 and validated the hypothesis generated by our results. Conclusions: We conclude that the possibility of cervical node metastasis in early stage buccal mucosa cancers with depth of invasion less than 4mm is negligible and the percentage of occult metastasis stands low. Our study also reflects the lack of robust data in context to early stage buccal mucosa cancers and offers an insight on the importance of subsite specific research.

  ABS-33: Role of Marginal Mandibulectomy in Relation to Oncological Outcome: An Experience of a Tertiary Care Centre of Northeast India Top

Amlan Debbarma, T. Rahman

Dr.B.Borooah Cancer Institute, Guwahati, Assam, India.

E-mail: [email protected]

Background/Objective: As surgery is the first line of treatment in managing oral cancer, attaining safe surgical margins become very imperative so as to achieve satisfactory loco regional control. A dilemma is frequently encountered with the best management of mandible in regard to the inability to acquire an accurate bony invasion status. Objective: (1) To analayse the oncological safety in patient undergoing marginal mandibulectomy. (2) To determine the loco regional control of patients undergoing marginal mandibulectomy. Methods: It is a retrospective study where patients who had undergone marginal mandibulectomy for clinical and radiological evidence of oral cavity cancer without bone involvement from 2016 – 2018 are enrolled. The follow up period is of 3 year. The endpoint of interest is done by assessment of oncological safety as per histological findings, loco regional control and disease free survival period. Results: A total of 112 patients, 65 male and 47 female was included in the study. Bony involvement was noted in 27 patients among which 22 patients had cortical invasion and 5 of them had medullary invasion. Recurrence was noted in 23 patients, 8 of them had locally, 15 regionally and no distant metastasis. 6 patients were lost in follow up and 81 patients (72.32%) were alive without any disease after a follow up period of 3 years. Conclusions: As bone invasion is frequent in oral cancer; marginal mandibulectomy is a critical choice to be made in view of attaining favorable prognosis.

  ABS-32: Image Guided Procedures for Primary Diagnosis of Head and Neck Lesions: Our Institutional Experience Top

Roopa Ganta, Rajesh A. Kantharia, Shehnaz R. Kantharia, Bhavin Bhupendra Shah, Rajinikant Mohan Vasava, Tushar Vishnuprasad Vaishnav

Kailash Cancer Hospital and Research Centre, Vadodara, Gujarat, India.

E-mail: [email protected]

Background/Objective: Patients presenting with suspicious lesion in base of tongue(BOT), larynx, pharynx need direct/Indirect laryngoscopy with biopsy for mapping and to establish primary diagnosis. These procedures have risk of aerosol generation, increasing risk of COVID-19 transmission and were not a part of initial guidelines. All the patients requiring primary diagnosis for these inaccessible Head and Neck lesions were subjected to image guided biopsy/FNAC during this COVID-19 pandemic. Methods: Retrospective analysis of prospectively collected data of 35 patients was done from April to September 2020. Histopathological records along with patients clinical records were reviewed. Results: Out of 35 patients, Biopsy/FNAC material was adequate in 32 patients and inadequate in two patients. Of 35 patients, 23 patients underwent CT Guided biopsies, 11 patients had CT Guided FNA and one patient had USG guided biopsy. Of 23 patients of CT Guided Biopsy, primary lesion was tongue in 16 patients, larynx in two patients and Pyriform sinus(PFS), posterior pharyngeal wall, RMT(retromolar trigone), lower GBS and Tonsil sites each one patient. Of 11 patients of CT Guided FNAC, primary site was PFS in 7 patients, tongue in 2 patients and one patient each had in RMT and soft palate. One patient had undergone USG Guided biopsy for PFS site. The histological diagnosis was established in 88.6% cases(31/35), of which squamous cell carcinoma was found in 74.3% cases(26/35), no malignancy in 8.5% cases(3/35), no specific lesion in 5.7% cases(2/35), no definitive diagnosis in 2.8% cases(1/35) and inadequate in 8.6% cases(3/35). Repeat biopsy in one patient revealed no malignancy and others two patients were not ready for second procedure. Conclusions: Image guided biopsy/FNAC is reliable, has no risk of aerosol generation which is safe for primary health care workers and other hospital staff and was an important tool to establish primary diagnosis during this COVID-19 pandemic.

  ABS-30: Impact of COVID-19 Pandemic on Head and Neck Cancer Surgery in India Top

Hemant Kumar Singh, Deepa Nair1, Vijayraj Patil2, Ganne Chaitanya3

All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, 1Tata Memorial Hospital, Mumbai, Maharashtra, 2Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India, 3University of Alabama at Birmingham, AL, USA.

E-mail: [email protected]

Background/Objective: COVID-19 has impacted the cancer care across India. This study aims to understand changes in oncologic practices particularly with regards to surgery for Head and neck (HN) cancer and preparedness of the hospitals across the various cities and importantly COVID-19 zones during COVID-19 pandemic. Methods: This online questionnaire-based cross-sectional study was distributed to 450 oncosurgeons (surgical oncologists and HN surgeons) across India. Results: A total of 232 oncologists in 188 centers in 75 cities completed the survey. Among 188 centers, general COVID screening, COVID dedicated ward, ICU, ORs (operating rooms) were established in 97.9%, 73.7%, 66.8%, 46.2%, and 33.9% of institutions respectively. Oncologists continued cancer screening (50%), cancer surveillance (79.2%), evaluation of newly diagnosed cases (96.1%), telemedicine follow-up (72.2%). Treatment of preinvasive diseases was postponed by 60% oncologists more at the centers in red zones than the green zones (62.6 % vs 36%, p=0.01). Tracheostomy was avoided by 20% of the HN cancer surgeons due to the risk of aerosolization. Oncologists (40%) had stopped free flap reconstructions and the majority preferred pedicled flaps. N95 was a part of PPE in high-risk HN cancer surgeries in 94% of oncologists. Dedicated cancer centers continued more HN major surgeries more than multispecialty hospitals (p=0.006). Conclusions: Cancer hospitals have executed approaches to continue the care for the patients. The oncosurgeons have embraced PPEs, telemedicine, and continue to care for cancer patients and deliver the services despite limited resources, the significant risk associated, amidst nationwide lockdown.

  ABS-26: A Retrospective Study on Involvement of Submandibular Gland in Squamous Cell Carcinoma of the Tongue Top

Kamal Deep Joshi, Poonam Joshi, Sudhir Nair, Pankaj Chaturvedi, Muddasir Bhati

Department of Head and Neck Surgery, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: This retrospective study was done from 2016 to 2020, with aim to assess the involvement of Submandibular Gland (SMG) by malignancy during neck dissection being done for the Squamous cell carcinoma (SCC) of tongue and to evaluate oncological safety of SMG preservation in SCC of the tongue. Methods: The treatment records of 391 patients were reviewed for demographical data, nodal metastasis and histopathological involvement of SMG by SCC. Results: A total of 555 neck dissected were assessed, out of which 95 necks dissected were positive for nodal metastasis at level Ib. The SMG was involved by squamous cell carcinoma in only 2 cases, both of which were poorly differentiated SCC. No intraglandular lymph nodes were detected in any of the SMG dissected. Conclusions: The study showed that involvement of the SMG by SCC of the tongue is not very common and it may be possible to preserve the SMG during neck dissection in selected cases in SCC of the tongue. The preservation will definitely improve quality of life (QOL) of the patients, as excision of the SMG is one of the prominent factor resulting in xerostomia.

  ABS-24: Content Validation of a Swallowing Exercise Protocol for Radiation Induced Dysphagia in Head and Neck Cancer Patients Top

Janet Jaison Varghese, Venkataraja U. Aithal, B. Rajashekhar

Manipal College of Health Professions, Manipal Academy of Higher Education, Mangalore, Karnataka, India.

E-mail: [email protected]

Background/Objective: Early initiation of swallowing exercises prevents the atrophy of swallowing musculature. The purpose of this study is to validate an exercise protocol to be used in a clinical trial studying the effectiveness of preventative swallowing exercises in head and neck cancer patients. Methods: The process of content validation involved 2 stages: protocol development and expert validation. The exercises protocol was developed following extensive literature review. Eleven experts in field of Speech Language pathology with expertise in dysphagia management in head and neck cancer patients performed the judgmental process. An e-form was circulated with details such as prerequisite, therapy goals and exercise protocol. Rating of experts in a 5-point Likert grading on the following parameters – relevance, ease of performance, safety and appropriateness of intensity and duration were collected. The form also included an open-ended question on adherence strategies and a comment box for any additional comments. Based on expert's inputs on the swallowing protocol, the level of agreement, content validation index and kappa value were calculated. The open-ended questions were assessed using thematic analysis. Results: All the exercises when assessed as individual items produced "excellent" agreement among the experts in term of relevance and safety of their use. The following strategies to improve adherence to dysphagia therapy was suggested by the experts: Caregiver Training,Use of Daily log, Tele-rehabilitation, Video tutorial and Instruction Pamphlet. In addition, it was also suggested to incorporate individualized inter and intra exercise break to address fatigue. The final exercise protocol also considered the altered intensity of Masako maneuver as per opinion of the experts. Conclusions: The proposed protocol has exhibited excellent content validity in the assessed components. It has improved with the addition of the individualized within exercise breaks and inter exercise breaks. The protocol is validated for the start of the empirical trial.

  ABS-23: Outcomes of Adjuvant IMRT in Oral Cavity Cancers: An Audit of Institutional Practice Top

Rabi Shankar Das, Sarbani Ghosh Laskar, Shwetabh Sinha, Naveen Mummudi, Monali Swain, Ashwini Budrukkar

Tata Memorial Centre, Homi Bhaba National Institute, Navi Mumbai, Maharashtra, India.

E-mail: [email protected]

Background: Despite the use of adjuvant radiotherapy after surgery in Head and Neck Cancers, there is paucity of data regarding use of IMRT in this setting. Objectives: To evaluate local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), patterns of failure, and toxicity with adjuvant IMRT. Materials and Methods: From January 2010-June 2020, 113 patients with non-metastatic, oral cavity cancers who had received adjuvant IMRT after radical surgery were evaluated. At recurrence, imaging with recurrent tumor was fused with treatment planning scan, recurrent disease was delineated and classified into Infield, marginal and outfield recurrence. These were propensity score-matched (PSM) (1:1) with a cohort from a prospectively maintained database who had been treated with conventional radiotherapy. Matching was done for age, gender, KPS, site, T-stage, N-stage, RT doses. Toxicities were graded by RTOG criteria. Results: Median follow-up was 21 months. The radiation dose was 60Gy to high-risk PTV and 54Gy to low risk PTV. Ten patients had locoregional recurrences, 3 outfield and 7 infield. All infield recurrences were within high-risk CTV. The estimated 2 year LC, LRC, DFS and OS were 90.5%, 86%, 73%, 85%, respectively. 84 patients from the IMRT and 157 patients from conventional group were analyzed by PSM. At 2 years LC, LRC, and OS between the 2 groups were 93% vs 81% (p=0.042), 88.5% vs 73 % (p=0.03), 82.5% vs 66% (p= 0.007), respectively. Acute grade ≥3 skin reactions and mucositis (p=0.003, p=0.004) and late grade ≥2 dysphagia and xerostomia (p=0.20, p=0.04) was significantly lower in the IMRT group. Conclusions: IMRT is safe in the post-op setting with acceptable disease outcomes and better acute and late toxicity compared to conventional radiotherapy.

  ABS-21: Evaluation of Dosimetric and Volumetric Changes and Toxicity Profile during Adaptive Intensity Modulated Radiotherapy in Locally Advanced Head and Neck Cancer: A Mono Institutional Prospective Study Top

Arnab Kumar Ghosh, Asit Ranjan Deb, Anis Bandyopadhyay,

Bappaditya Chhatui, Niladri Roy, Dhiman Das

Medical College, Kolkata, West Bengal, India.

E-mail: [email protected]

Background/Objective: Head and Neck cancer patients experience weight loss, anatomic change and tumour shrinkage during radiotherapy. This may cause difference between the planned and actual dose delivered to tissues resulting in increased dose to OARs. With modern imaging techniques, it has been possible to monitor changes in patient anatomy during treatment delivery & re-plan for subsequent treatment. We undertook this study to see whether adaptive radiotherapy in head and neck cancer give dosimetric and toxicity improvement over standard IMRT. Methods: Patients with locally advanced carcinoma of pharynx, larynx, non-metastatic, good PS were taken who fit other criteria. IMRT treatment planning was done to a maximum dose of 70 Gy. Repeat CT simulation was done after 18 fractions. 3 planning sets were generated- PRIMARY PLAN. HYBRID PLAN (superimposed original beam configuration on the repeat CT simulation) & ADAPTIVE PLAN. The 3 plans were compared in terms of target coverage and OAR dose. Patients were treated with either the primary plan or the adaptive plan for the rest of the treatment. Specific acute and late toxicities were compared. Results: 32 patients were taken, 16 each in adaptive and standard arm. There was significant decrease in GTVp, GTVn and parotid volume at second CT simulation. In the hybrid plan, there was significant decrease in % GTVprimaryV100 and PTVhighV95 and increase in both parotid mean dose (1.69 ± 1.18 and 1.48 ± 0.85 Gy respectively for the left and right parotid), 8 events in Spinalcord Dmax crossing 45 Gy. At adaptive plan, the target coverage was significantly increased with decrease in parotid mean dose and spinal cord Dmax. On follow- up recovery from grade II xerostomia was better in adaptive arm (18.8% vs 43.3%, p 0.07). Conclusions: Implementation of ART can improve dosimetry of target and OAR with a positive trend towards grade2 xerostomia recovery.

  ABS-20: Oral Cavity Reconstruction with Pedicled and Microvascular Free Falps: A Critical Review Top

Zahoor Ahmad Teli, Rajesh Kantharia, Shehnaz Kantharia, Siddharth Vyas, Yogesh Bhatt, Piyush Doshi

Kailash Cancer Hospital and Research Centre, Vadodara, Gujarat, India.

E-mail: [email protected]

Background/Objective: In Indian subcontinent Oral cavity cancer is the most common cancer in males and second most common in females. 70% of these patients present in advanced stages and resection of these advanced cancers lead to complex Orofacial defects requiring primary reconstruction to restore form, function and cosmesis. Reconstructive options for these Oral cavity defects range from Pedicled Flaps to Microvascular Free Flaps. We evaluated the results of Pedicled and Microvascular Free Flaps for Oral cavity defects following resection of locally advanced Oral cancer. Methods: A retrospective analysis of prospectively collected data of patients who underwent composite resection followed by reconstruction with Pedicled and Microvascular Free Flaps for locally advanced oral cancer from January 2018 to September 2019 was done. The demographic details, primary tumor site, tumor stage, defect type, flap type and rate of complications were analyzed. Results: Primary reconstruction was offered to 540 patients, males 453 and females 87 with Pedicled Flaps for 421 patients and Microvascular Free Flaps for 119 patients. Patient distribution as per current TNM staging was pT1/T2:91, pT3:179 and pT4:270. Reconstruction offered to different Oral cavity sub sites was-Buccal Mucosa:374, Retromolar Trigone:10, Alveolus:75, Tongue:52, Lower Gingivo-Buccal Sulcus:11, Floor of Mouth:4, Upper Gingivo-Buccal Sulcus:5 and lower Lip:9. We classified the types of defects into Mucosal:32, Mucosal with Bone:370, Mucosal with Bone with Skin:101, Mucosal with Skin:14, Skin:3 and Central Mandibular Arch:20. The overall rate of complications in Pedicled Flaps was 12.11% and Microvascular Free Flaps was 21.84%. The success rate for Pedicled Flaps was 100% and for Microvascular Free Flaps was 94.96%. Conclusions: In our study, Microvascular Free Flap reconstruction had a good success rate with satisfactory functional and cosmetic outcomes. The Pectoralis Major Myocutaneous Flap with acceptable functional results and low rate of complications still remains a valuable option for medium and large sized Oral cavity cancer defects.

  ABS-19: Depth of Invasion and its Impact on Tumour Biology in Oropharyngeal Cancers Top

Anand Subash, Surender Dabas, Ashwini Sharma, Reetesh Ranjan, Himanshu Shukla, Bikas Gurung, Ranjit Padhiari

Dr.BL Kapur Hospital, New Delhi, India.

E-mail: [email protected]

Background/Objective: Studies in the past have consistently noted that surgery followed by adjuvant therapy in oropharyngeal cancers is oncologically more sound though functionally debilitating. As a result, globally the standard of care for oropharyngeal cancer remains concomitant chemo-radiotherapy. With integration of surgical robotics and increased understanding of oropharyngeal cancers, the surgical resections are becoming less morbid, with superior local control. These approaches have been used in de-intensification strategies as well. The 8th Edition of AJCC has seen some major changes, the most contentious of them have been depth of invasion (DOI) in oral cancer and a distinct staging for HPV positive and HPV negative oropharyngeal tumors. Now with en-bloc resection of tumour using trans oral robotic approaches, we can now analyze the pathological adverse features in detail and understand tumour adverse features better. And depth of invasion in oropharyngeal cancers is not well conceptualized. The purpose of the current study was to understand the relationship of depth of invasion on pathological adverse features and also the define a cut off for likelihood of cervical nodal metastasis. Methods: Surgical and histopathological reports of patients with oropharyngeal cancers undergoing TORS was extracted. The pathological features were tabulated and analysed.The relationship of DOI with other pathological adverse features was analyzed using multivariate analysis. Results: A total of 92 patients were available for final analysis, of which 50 were from BOT, 39 from tonsil and remaining from soft palate. The mean age was 59 years. The mean DOI was 12mm. DOI only had a statistically significant effect on PNI, and not on other parameters. Conclusions: The understanding of depth of invasion and its implications on tumour biology in oropharyngeal cancers is an unexplored avenue. With increased acceptability of TORS, exploring this further would help us understand and redefine the surgical strategies better.

  ABS-15: Assessment of Quality of Speech and Swallowing in Postoperative Cases of Carcinoma of Tongue with Respect to Technique of Tongue Reconstruction Top

R. Aditi, D. R. Nayak, K. Devaraja, Neethu Mary Mathew

Kasturba Medical College, Manipal, Karnataka, India.

E-mail: [email protected]

Background/Objective: Nearly 355,000 new cases of oral malignancies are detected worldwide yearly. They constitute the sixth most common malignancy; with tongue malignancies being a front-runner especially in countries where tobacco-chewing is endemic. In such cases, surgical resection is the cornerstone of treatment, which leads to functional deficits. Speech and swallowing rehabilitation post-surgery is often neglected, especially in the developing countries due to resource constraints and lack of awareness. This study aims at bridging this gap by analysing the various reconstructive techniques commonly practised in the light of functional outcome. Methods: This was a prospective comparative study conducted over a 2 year period. Cases of T1, T2 and selected T3 oral tongue malignancy who underwent surgery with appropriate reconstruction were included. Speech assessment was done by the Speech Intelligibility Test by a certified Speech-Language Pathologist. Swallowing assessment was done by the MD Anderson Dysphagia Inventory (MDADI) questionnaire. These tests were administered pre-operatively, 1 month post op and at 6 months post op. The results were compared and analysed accordingly. Results: 47 patients were included in the study. They were divided into three categories based on reconstruction- Primary Closure, Secondary Intention and Flap Reconstruction (Which included pedicled flaps such as the pectoralis major myocutaneous flap and free flaps such as the radial forearm free flap). Average long term scores for speech intelligibility in the three groups were 72.7%, 83.3% and 52.8% respectively. MDADI composite scores on long term follow up were 83.2, 79.3 and 57.8 respectively. Conclusions: Healing by secondary intention offers best outcomes in terms of speech intelligibility and primary closure offers best swallowing outcomes in oral tongue malignancy. Flap reconstruction has the worst functional outcomes.

  ABS-11: Functional Reconstruction of Through and Through Cheek Defect with Free Composite Bi-pedelled Anterolateral Thigh Flap Top

Jaykumar V. Patel, Prashant Moon, Girish Mishra, Riddhi Trivedi

Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.

E-mail: [email protected]

Background/Objective: Extensive composite defects involving the lip and cheek present difficult reconstructive challenges in view of functional recovery like oral competence, articulation, speech and mastication. This study presents our results of reconstructing through and through cheek defect with the use of free anterolateral thigh (ALT) flaps. Methods: All the patients with carcinoma of buccal mucosa and cheek who underwent through and through cheek resection and reconstructed with free composite bipedelled anterolateral thigh flap between March 2019 to March 2020 were included in the study. We have assessed the post-operative functional outcome using University of Washington Quality of Life Questionnaire at the end of 6 months duration. We have excluded lost to follow-up and flap failure patients. Results: Fifty patients underwent resection of buccal mucosa cancer, resulted through and through cheek defect was reconstructed with free composite bipedelled anterolateral thigh flap. Mean age was 43 years. Male to female ratio was 4.6:1. Stage 3 disease was in 8 patients and stage 4 disease was in 42 patients. Average size of the flap required was 15 x 7.5 cms, maximum was 24x11 cm. Oral competence was good in 74% patients. 80% patients were able to take semisolid diet, 8% were on liquid diet and 12% were dependant on RT feed. Average physical function (70.47±19.09), socialemotional sub-score (81.72±16.63) and composite scores (76.09±17.86) were good and within acceptable range. Chewing (53±29.29) and swallowing (64±21.57) scored poorly among 12 domains. Conclusions: For extensive through and through cheek defects bipedelled ALT provides good functional outcome. In view of advance disease status extensive resection would be responsible for bone and mucosal loss affecting chewing and swallowing.

  ABS-9: Accuracy of Neck Ultrasonography in Recurrent/Residual Thyroid Cancers Top

Sasi Krishna Kavutarapu, Gouri Pantvaidya, Prathamesh Pai, Anuja Deshmukh, Deepa Nair, Shivakumar Thiagarajan, Abhishek Mahajan, Suman Kumar

Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Thyroid cancers have a very low mortality rate and carry excellent prognosis. Despite this, locoregional recurrences after primary treatment occur in 9-30% of patients. Surgery for residual or recurrent thyroid cancer is thought to be morbid in view of risk of injury to recurrent laryngeal nerve, parathyroids. There is vast literature pertaining to ultrasound in perprimum setting but very meagre in reoperative scenario. Ultrasound is thought to provide the surgeon a roadmap to follow at the time of reoperation, through our study we aimed to look at accuracy of ultrasound in localising residual or recurrent cancer so that unwanted explorations in crucial areas can be avoided, so as to prevent untoward complications. Methods: Our study is a retrospective descriptive analysis of prospectively maintained data. We reviewed thyroid reoperations done for cancer between 2015-2017 at our centre with a primary objective of evaluating sensitivity and specificity of ultrasound in redo setting. Our secondary objectives were to analyse the incidence of complications, overall survival(OS) and disease free survival(DFS). Results: 250 eligible thyroid reoperations were included in the analysis with a median followup of 32months. USG showed an overall sensitivity, specificity, accuracy of 89, 77 and 73% respectively. We also evaluated sensitivity and specificity of sonography in detecting disease at different sites of neck, which is 'thyroid bed>lateral neck>central neck' and 'lateral neck>central bed>thyroid bed' respectively. Our cohort with 267 nerves at risk had a RLN palsy rate of 11.2%; temporary and permanent hypoparathyroidism of 34, 24% respectively. DFS is approximately 70% while majority of recurrences(64%) occurred within one and half year following reoperation. Conclusions: Even in a reoperative scenario, ultrasound is reliable and accurate in deciding for or against resurgery and decide extent of resurgery. Complications in thyroid reoperations are underreported in literature and their incidence can be reduced by utilising newer intraoperative adjuncts.

  ABS-7: Assessment of Cervical Lymphadenopathy in Head and Neck Squamous Cell Carcinoma using Ultrasonic and Computed Tomographic Lymph Node Volume Top

Pallavi Varshney, M. P. Kamath, S. Vijendra Shenoy, Ashvini Kumar,

K. Kshithi, Fayis Mohammed Anwar, Haneesh Amit Domah

Kasturba Medical College, Manipal, Karnataka, India.

E-mail: [email protected]

Background/Objective: Lymph nodal metastases is one of the most important prognostic factor in head and neck squamous cell carcinomas,despite of that its assessment and management is still controversial. Objective: To compare the diagnostic utility of computed tomography (CT) and ultrasound (USG) using different parameters with special emphasis on lymph nodal volume. Methods: Prospective study with cases included for period of 1 year from June 2019 to September 2020. 30 patients with histologically proven squamous cell primary tumours in the head and neck region with age ranging from 18 to 75, 87 lymph nodes were preoperatively selected and analysed. All patients underwent preoperative USG and contrast enhanced CT of the neck followed by excision of the primary tumour with neck dissection. The primary outcome measures included sensitivity, specificity,positive predictive value,negative predictive value and accuracy. A receiver operator curve was plotted for lymph nodal volume on CT to calculate the cut off value and accuracy. Results: 30 participants,24 males and 6 females with mean age of 52.7 years. The median volume on CT was 5412.15mm3 for metastatic and 237.73mm3 for benign nodes and on ultrasound it was 4168.92mm3 for metastatic and 233.10mm3 for benign nodes(p<0.001). The sensitivity,specificity, PPV,NPV and accuracy for volume on USG were 81.8%,98.7%,90%,97.4% and 96.6% and on CT were 81.8%,100%,100%,97.4% and 97.7% respectively. In the receiver operator curve analysis of volume on CT scan,the total area under curve was 0.959(standard error 0.032 and 95% CI) and the cut off was found to be 1337.94mm3. For other parameters the sensitivity for size,shape,SA/LA,fatty hilum,necrosis and enhancement was 72.7%,63.6%,90.9%,54.5%,72.8% and 45.5% whereas specificity was 84.2%,77.6%,36.9%,87.3%,94.8% and 97.4%respectively.

  ABS-3: COVID 19 and Online Postgraduate Training in ORL- HNS: Initial Experience at an Indian Tertiary Centre Top

Shaoni Sanyal, Ranjan Raychowdhury

Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India.

E-mail: [email protected]

Background/Objective: The World Health Organisation (WHO) declared COVID 19 caused by novel corona virus SARS-CoV-2 a pandemic on 11th March 2020. To date India has seen a total of 74,34,432 cases. This pandemic has brought about a paradigm shift in all aspects of our lives. The identification of Aerosol generating procedures (AGPs) such as mastoid surgery, endoscopic sinus surgery and laryngoscopy as major routes of iatrogenic spread effectively led to all elective ORL-HNS surgery being put on hold. The West Bengal University of Health Sciences advised all affiliated institutes to implement online teaching and training, to reduce the risk of disease transmission. We present our initial experience of online post-graduate training in ORL-HNS. Methods: This is a Qualitative descriptive study set in the Dept of ENT & Head-Neck Surgery at a Post graduate training institute in West Bengal. Four hours of online teaching were delivered each week. After 2 months all participants were surveyed regarding their views on the utility of virtual teaching. Results: The response rate of the survey was 87.5%. Of the respondents 78% faced difficulties using the online platform: connecting, audio-visual quality, uploading and downloading material. Online teaching was generally found to be convenient and ensured greater participation. However, the quality of interactive discussion was felt to be better in traditional face to face teaching. Trainees found regular feedback helpful. Conclusions: Although the Covid 19 pandemic has accelerated the use of online teaching there are problems with this format. In a surgical specialty hands on assistance cannot be replaced by viewing operative videos.

  Case Report or Case Series: ABS-134: An Unusual Case of Soft Palate Neoplasm (Lipoma) Top

Mithram Wadia, Ajay Panchal

Smimer Hospital, Surat, Gujarat, India.

E-mail: [email protected]

Background/Objective: Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. 27 Years male patient with swelling over the hard palate and difficulty in speaking since 1 month. Methods: Patient was evaluated radio-logically with CT neck and oral cavity suggestive of Fairly large well defined soft tissue attenuation growth is seen along left side hard palate and extending posteriorly up to its junction with soft palate. No evidence of bone erosion. No evidence of extension. Size of lesion 15X16X14 mm. Results: Operation:- Wide Excision of mass over left hard palate mass under GA. Histopathological Examination:- Pleomorphic adenoma (Mixed salivary gland tumor). Conclusions: Pleomorphic adenoma is the most benign tumour of the major salivary gland. Occurrence of this tumour over the hard palate makes it a rare case.

  ABS-133: An Unusual Case of Soft Palate Neoplasm (Lipoma) Top

Neel Devendra Parmar, Manit Mandal

Smimer Hospital, Surat, Gujarat, India.

E-mail: [email protected]

Background/Objective: A case of 30 years old male patient presented with complain of post-nasal drip, nasal obstruction, snoring and mouth breathing since 3 years. On nasal endoscopy: Smooth surfaced mass seen on upper surface of soft palate extending into posterior part of left nasal cavity. Methods: Patient underwent diagnostic nasal endoscopy, CT PNS, MRI neck and transnasal endoscopic excision under general anaesthesia. Mass sent for histopathological examination which was suggestive of fibrolipoma, a benign neoplasm. Results: Final diagnosis only be done from histopathological report which was suggestive of fibrolipoma. And after surgery patient get relief from his complain. Conclusions: Lipoma is most common tumour especially in trunk and proximal portion of extremities but it is rare in oral cavity. In oral cavity it is most commonly seen in buccal mucosa but it is rare on palate. Treatment for lipoma is surgical excision.

  ABS-131: Schwannoma over Soft Palate: A Case Report Top

Pururava Desai, Anand V. Chaudhari, Bhavik Patel, Shari Mitra, Jaymin A. Contractor

Government Medical College, Surat, Gujarat, India.

E-mail: [email protected]

Background/Objective: Schwannoma or neurilemmoma is a slow-growing, benign, well-encapsulated tumor arising from Schwann cells of nerve sheath. A total of 25–45% of Schwannomas occurs in the head and neck regions, but only 1% are intraoral in origin. The clinical diagnosis is confounded by other tumours such as minor salivary gland tumour, pyogenic granuloma and lipoma. Methods: A 30 year male working as a security guard in school presented with complaint of swelling over soft palate since 5 years. Clinical examination revealed a sessile, soft, non-tender mass of size 2*1 cm2 over posterior part of soft palate which did not bleed on touch. There was not a single significantly palpable neck node. MRI study showed a relatively well-defined lobulated heterogeneously enhancing lesion with altered signal measuring 1.3*1.7*1.6 cm3 on soft palate in left para-median location bulging in oral cavity, suggestive of neoplastic lesion. Results: On histopathological examination of biopsy from swelling there was hyperplastic squamous epithelial lining. Subepithelium showed alternating hypercellular Antoni A and hypocellular Antoni B areas along with areas of vascularization. Hypercellular areas were composed of spindle cells with focally forming palisading arrangement (Verocay bodies). Excision of swelling was done under general anaesthesia. Conclusions: Schwannoma in oral cavity is very rare. It is diagnosed by histopathological examination and has good prognosis after complete surgical excision.

  ABS-130: Thyroglossal Duct Cyst Carcinoma: A Case Report Top

Jithesh Manilal, Rahul B. Patel, Jahanvika Chauhan, Kartika Rao, Jaymin A. Contractor

Government Medical College, Surat, Gujarat, India.

E-mail: [email protected]

Background/Objective: Thyroglossal duct cyst arises from the congenital remnants of the thyroglossal duct formed during the embryogenesis of the thyroid gland and present as a midline neck mass. Incidence varies with age from 70% in children to 7% in adults & only 1% of them convert into carcinomas. In most cases, the diagnosis of carcinoma is only established after the excision of a clinically benign thyroglossal duct cyst. Methods: We report the case of a 32-year-old man diagnosed postoperatively with papillary carcinoma within a thyroglossal duct cyst. He presented with a complaint of painless swelling over the anterior neck for 2 years which moves with deglutition & protrusion of the tongue. Thyroid function tests were normal. FNAC was suggestive of benign follicular nodule (TBSRTC Cat-II). USG neck was suggestive of a lobulated cystic lesion separated from the thyroid gland with suspicious lesion within cyst with calcification & increased internal vascularity. Contrast-enhanced CT scan of the neck showed the possibility of a thyroglossal cyst with malignancy (carcinoma) with normal thyroid gland. Sistrunk's procedure was performed under GA. Results: Histopathological report of the excised specimen showed intracystic papillary thyroid carcinoma developing in a thyroglossal cyst which was confirmative of the radiological findings. The post-operative period was uneventful and the patient was discharged after the 7th postoperative day. Postoperative follow-up was done for 1 year. Conclusions: Thyroglossal duct cyst (TGDC) carcinoma should be suspected in patients presenting with cystic midline neck masses. USG has a key role as an initial investigation in evaluating neck masses. CT or MRI gives more accurate details of neck masses, and hence are routinely advised before surgery. All cystic lesions of the neck should be evaluated by USG to determine the further need for CT or MRI. Complete excision of TGDC carcinoma is often possible and can be curative.

  ABS-125: Tumours of Maxilla Top

Rahulkumar Jayantilal Patel, Anand V. Chaudhari, Darshan Doshi, Ila B. Upadhya, Jaymin A. Contractor

Government Medical College, Surat, Gujarat, India.

E-mail: [email protected]

Background/Objective: The tumours of maxillary sinus are the most common tumours representing 63% of all sinonasal tumours. A study was done to document clinical presentation, investigations, modes & outcome of treatment and prognosis of maxillary tumours. Methods: This was a retrospective-prospective single cohort study of 24 patients with tumours of maxilla who attended ENT department. Detailed history, examination findings, investigations and treatment was noted at follow up period from 1 -3 years. Results: In our study only 16.6 % patients had benign tumours of maxilla while 63% had squamous cell carcinoma (SCC) & 21% had other malignancies. The ratio of benign vs. malignant tumours was 1:5. Benign tumours presented mostly in 2nd and 3rd decade while malignant tumours in 5th and 6th decade. The most common symptom was facial swelling (75%) in both benign & malignant maxillary tumours while nasal symptoms were present in 75% patients with benign tumours and 40% patients with malignancy. On histopathological examination, 75% had SCC while others had sarcoma, spindle cell carcinoma etc. Patients who had only Surgery in T2, T3 lesion without nodal metastasis had a 100% two-year survival. Surgery with postoperative radiotherapy had average two-year survival of 75% while 17.5% patients with metastatic cervical nodes had two-year survival rate of 28.57% only. Conclusions: In our study malignant maxillary tumours were more common than benign. SCC was the commonest malignancy of maxilla. Facial swelling was the common presentation and CECT was useful for bony invasion and tumour staging. Surgery with or without post operative radiotherapy had a good prognosis & better survival rate in patients without cervical metastasis.

  ABS-122: Early Presentation of Osteosarcoma Mandible Top

Bhuvaneshwari Ganeshan, Chandrasekhar Rao1

Gandhi Medical College, Secunderabad, 1Basavatharakam Indoamerican Cancer Institute, Hyderabad, Telangana, India.

E-mail: [email protected]

Background/Objective: Early presentation of osteosarcoma mandible is important to regonize and early treatment is necessary to avoid any further metastasis and better prognosis for the patient. Methods: Case report. Results: How important it is to educate our dentist for any discrepancy from normal regarding notice and send to sample to pathologist for early detection of cancers. Conclusions: Early presentations may b unnoticed n missed so awareness should be made regarding how they can b diagnosed n treated at earliest for better prognosis.

  ABS-116: Ameloblastoma Revisited: Case Series on Dredging Method Top

Ajay Kumar, M. A. Reyazulla, Madan Nanjappa

KIMS Medical College and Hospital, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Ameloblastoma is a bening aggressive epithelial odontogenic tumour with progressive growth potential. Standardized treatment includes surgical resection with 1cm margin. The purpose of this paper is to describe the treatment procedure for being aggressive malignancies of mandible treated with dredging method. Methods: Retrospective study. Results: This is a retrospective study done from 2012-2020, which includes 16 patients diagnosed and treated for Ameloblastoma of mandible. Out of which eight were treated with conservative approach rest were treated with conservative surgical resection with 1cm margin. Among patients treated with conservative method six were male, mean age group was 36 yrs. Lesion involved mandibular body in 62.5%, body and symphysis in 25%, bilateral body and symphysis in 12.5%. Histopathology unicystic variant was 50%, plexiform 25%, follicular 25%. All patients were treated with dredging method to remove the tumour completely, and maintain the form and function of the mandible. Minimum surgical intervention each patient received were 2, ranging from 2-4. On follow up for 5 yrs, local recurrence was 12.5%. Conclusions: This case series throws light on the effectiveness of conservative approach for benign aggressive tumours, helping in restoring the form and function. Proper case selection plays a vital role.

  ABS-115: Impact of COVID-19: The Effect on Patients with Ca larynx and Ca Hypopharynx in a Tertiary Care Centre in India Top

Sanchari Nandi, Bikram Choudhury, Palak Gupta, Bikram Choudhury, Kapil Soni, Darwin Kaushal, Amit Goyal, Nithin P. Nair

AIIMS, Jodhpur, Rajasthan, India.

E-mail: [email protected]

Background/Objective: Since the declaration of SARS-CoV2 Global Pandemic by WHO in March 2020, health care has been overwhelmed and thus a focus on prioritizing on urgent and emergent conditions has become a necessity. The lockdown imposed further setbacks these already stressed services leading to unprecedented logistical difficulties for patients and doctors alike. Especially for patients of Head and Neck cancer this has led to upstaged disease or, more complications at presentation. Laryngeal and Hypopharyngeal lesions requiring an invasive aerosol generating procedure for confirmatory diagnosis are affected even more. Here we assess the effects of this delay in management of Ca Hypopharynx and Larynx patients. Methods: We did a retrospective analysis of patients with Ca Larynx and Ca Hypopharynx who were diagnosed and treated between 24 March and 31 October in 2019 and in 2020. The clinical and radiological details obtained from their medical records, were analysed to assess the effects of the pandemic on surgical upstaging and complication rates. Results: A total of 30 cases of Ca Hypopharynx and Ca Larynx were included. 15 each underwent diagnostic workup in each year during the same period. 46.7% in 2019 and 60% of the cases in 2020 presented with stridor at presentation. 40% cases in 2019 underwent surgical management as per guidelines. This reduced to 6.7% in 2020 due to either higher stage at presentation or, upstaging of disease. Conclusions: The pandemic has led been a detriment to our patients with Ca Hypopharynx and Larynx with late presentation and disease upstaging leading to inoperability. A systemic revamp to contain the situation is an imperative today.

  ABS-113: To Assess the Impact of PPE on the Duration of an Aerosol Generating Surgical Procedure Top

Dipika Prakash, Bikram Choudhury, Kapil Soni, Darwin Kaushal, Amit Goyal

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

E-mail: [email protected]

Background/Objective: The World Health Organization, declared SARS-CoV2 to be a pandemic in March 2020 and its medical implications have been unabated since. Preventing its transmission to health care workers has been a serious problem, with those performing Aerosol Generating Procedure's (AGP's) being at the highest risk of contracting infection. PPE usage has been a double-edged sword as the surgeons have multiple impediments while operating, like partially obscured vision, difficulty in communication with assistant and markedly reduced degree of movement. In addition, wearing PPE leads to physiological changes in the surgeon, which may lead to suboptimal performance, especially in an emergency scenario. We envisaged that this may affect the performance of AGP's and took the example of tracheostomies after standardization of PPE usage intra-operatively. The aim is to assess the impact of PPE on the duration of surgery in patients undergoing emergency tracheostomies. Methods: We accessed data retrospectively on the Institute central patient management system and divided the patients into two cohorts- First, patients who underwent tracheostomy from 25th March to 31st October 2019. Second, we included the patients who underwent tracheostomies in the same period in 2020. We determined the duration of each tracheostomy from our records and subjected the data to statistical analysis. Results: In the defined period, a total of 46 tracheostomies were performed in 2020 and 34 in 2019. Of these, 82.35% and 41.3% were Emergency Tracheostomies in 2020 and 2019 respectively. The average operative time was 48.28minutes in 2020 as compared to 22.6minutes in 2019. Conclusions: This study concludes that there has been a rise in the number of emergency tracheostomies in the lockdown phase which highlights the delays occurring due to the pandemic and resultant lockdown. It also demonstrates that the use of Personal Protective Equipment has led to increased operative times due to multiple factors.

  ABS-110: Analysing Clinical Profile and Surgical Outcome of Adenoid Cystic Carcinoma of Minor Salivary Glands Top

Debayan Dey, M. B. Bharathi, B. S. Rakesh

JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.

E-mail: [email protected]

Background/Objective: Adenoid cystic carcinoma (ACC) is a rare epithelial tumor entity comprising about 1% of all malignant tumor of the oral and maxillofacial region. It occurs predominantly among women with peak incidence between the 5th and 6th decades of life. More frequently developing in minor salivary glands of the hard palate, ACC is a slow-growing locally aggressive tumor with tendency toward local recurrence and propensity for perineural invasion. Histopathologically it is composed of basaloid cells with primarily myoepithelial/basal cell differentiation. It presents three patterns, cribriform, tubular and solid; the solid type is related to a poor prognosis. Surgical excision with wide margins is the treatment of choice, if it metastasizes to lymph nodes, post-surgical radiotherapy is recommended. Methods: A Prospective study conducted from 2016 to 2020 in a single medical institution to investigate the clinical and morphological profile of this tumor and the extent of lymph node metastasis. Results: During this period we diagnosed 9 patients with ACC of minor salivary glands, 7 were male and 2 female. On presentation 6 patients were > 50years. The pathology most commonly affected minor salivary glands of the hard palate mucosa (7). All patients complained of asymptomatic insidious growth and were at least in stage II-pTNM on presentation. Surgery with post-operative radiotherapy was the mainstay treatment. 7 patients underwent maxillectomy with reconstruction. Only 1 patient underwent modified radical neck dissection. We report one death due to distant metastasis involving the brain. Conclusions: Lack of information about the clinical behavior of ACC in response to treatment causes controversy regarding its most effective treatment. Great tendency of this tumor to recur locally and to develop distant metastasis mandates close, lifelong follow-up of these patients.

  ABS-109: Aggressive Fibromatosis in the Infratemporal Fossa: A Case Report Top

Abhijeet Kumar Mishra, C. Preetam, Yash Mittal, K. Vinusree, K. V. Aswathi

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Aggressive fibromatosis is a locally infiltrative collagen forming tumor arising from muscles, connective tissue, fascia and aponeurosis. It has a high potential for recurrence but does not show metastasis. It constitutes 3% of all soft tissue tumors with higher incidence in females. It can be intra-abdominal or extra-abdominal with former being more common. Head and neck aggressive fibromatosis is rare and contributes to around 10% of all aggressive fibromatosis cases. Methods: Here, we report a case of aggressive fibromatosis in a 48 year old male who presented with progressive trismus, ulcerative lesion over right retromolar trigone and right hemifacial pain. He had grade-IV trismus pre-operatively. CECT showed an irregular mildly enhancing soft tissue thickening in right infra-temporal fossa with erosion of pterygoid and zygomatic bone. CEMRI showed an ill defined T2 mildly hyperintense and T1 isointense lesion in the right infratemporal fossa with bulky and hyper-intense pterygoid muscles. Biopsy was done from the ulcer two times and both the times it showed no evidence of malignancy. Surgery was done and a diagnosis of aggressive fibromatosis was confirmed by post-operative histopathological analysis with immunohistochemistry. Grade-IV facial nerve palsy was present in early post-op period. Mouth opening at the time of discharge was 2 finger width. Radiotherapy was planned in a total dose of 66 Gy in 33 fractions of 2 Gy each. Results: Radiotherapy has been completed and the patient is under regular follow up. 3 month post-operatively he is having 2 finger width of mouth opening and grade-III facial nerve palsy. Conclusions: Aggressive fibromatosis though a rare tumor of head and neck should be considered as differential diagnosis of locally invasive lesions of head and neck. Clinical, radiological as well as immunohistochemistry panel will help in early diagnosis of aggressive fibromatosis.

  ABS-105: Outcomes of Endoscopic Management of Paranasal Sinus Malignancies: Institutional Experience Top

Kalyana Sundaram Chidambaram, C. Preetam, G. Anupama, Vinusree K, Aswathi KV, Anurita Swarup

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Sinonasal malignancies management is challenging due to the close proximity of vital structures. Open approaches traditionally have been the gold standard. With better delineation of tumor extent, endoscopic approaches have also emerged as an effective alternative. Objective of this audit is to review the outcomes of PNS malignancies managed by purely endoscopic technique in our institute. Methods: A retrospective review of 17 cases of PNS malignancy, who underwent purely endoscopic management in our institute (2014-2019) was done. Cases undergoing open or endoscopic assisted procedures are excluded. Assessment parameters include factors considered for selecting endoscopic approach, hospital stay, blood loss, complications and margin status. Results: The pathologies evaluated are o Osteo-chondromyxoma (1) o Inverted papilloma with synchronous malignancy (2) o Squamous cell carcinoma of ethmoids (1) o Adenocarcinoma (Ethmoid sinus) (2) o Undifferentiated ethmoidal carcinoma (3) o Olfactory neuroblastoma (3) o Angiosarcoma (1) o Renal cell carcinoma (1) o Inferior turbinate carcinoma (1) o Acinic cell carcinoma (1) o Ameloblastic carcinoma (1) The age range was from 16 to 62 years. The average hospital stay was 5.3 days. The range of blood loss 200 ml to 1200ml. The margin positivity in histopathology was seen in 3 cases (17.6%). The complications encountered were: (1) o Facial numbness (2) o Anosmia (3) o Retro-orbital hematoma (4) o CSF leak (5) o Meningitis (6) o Opthalmoplegia (Temporary) (7) o Blindness (8) o Death. Conclusions: Endoscopic approach helps to reduce blood loss, hospital stay and complications in comparison to external approaches. The margin negative rates are similar to traditional approaches. A small subset of malignant pathologies can be planned for endoscopic management with adequate pre-operative planning and mandatory close post-operative follow up. Skin, subcutaneous tissue, maxillary sinus anterolateral bone erosion, frontal sinus anterior table erosion, sphenoid sinus lateral wall invasion are contra-indications for a pure endoscopic approach as per our experience.

  ABS-101: Fibromyxoid Sarcoma of Left Maxilla Top

Deviprasad Dosemane, Deviprasad Dosemane, Cheryl Sarah Philipose, Deepa Adiga, Sanchit Bajpai, Meera Khadilkar

Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India.

E-mail: [email protected]

Background/Objective: A recurrent mass in the nose can pose diagnostic challenges. More so, if it starts growing rapidly, has many unusual features clinically, rare histopathologically and the patient is unavailable for regular follow-up. Methods: A 47 year old male presented to our OPD, with nose block and mass in the left nasal cavity since 2 months. He was on Anti-Retroviral Therapy. He had a painless, pale grey mass completely occluding left nasal cavity and DNS to right. After a CT-scan, patient underwent septoplasty and Endoscopic Sinus Surgery (ESS), histopathology revealed sinonasal inflammatory polyp. Patient was working in a far-off city, so he returned to us only after a year with similar complaints. After CECT, revision ESS, biopsy was reported as sinonasal inflammatory polyp with secondary changes, was negative for PAS and GMS stain, ruling out fungal sinusitis. Patient again returned similarly after a year, underwent left endoscopic medial maxillectomy, biopsy with IHC markers was reported as inflammatory myofibroblastic tumor. Patient was requested to stay back for regular follow-up only to find out in 2 months that mass was rapidly growing and CECT revealed erosion of anterior and posterior maxillary wall. So, he underwent total maxillectomy. Results: Histopathology with IHC markers- Ki67, SMA, CD34, CD 99, S-100, Vimentin, ALK-1 Desmin, Bcl-2, P40, EMA, Beta-catenin confirmed low grade fibromyxoid sarcoma. Patient refused MUC-4 marker and molecular testing, lost to follow up and expired in August, 2020. Conclusions: It is extremely rare to find this tumor in nose and sinuses, as it is usually found as a slow growing, painless tumor in trunk / deep extremities with prolonged subclinical stage. But this should be kept in mind when we encounter a similar case, because about half of them can recur/ metastasize / cause death.

  ABS-91: PPE - A Double Edged Sword? A Retrospective Analysis of Oncological Otorhinolaryngology at a Tertiary Care Centre Top

Palak Gupta, Bikram Choudhury, Amit Goyal, Darwin Kaushal, Kapil Soni

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

E-mail: [email protected]

Background/Objective: Following the Global pandemic declaration in March 2020, the attention of the healthcare services has largely shifted to cater to the needs of urgent and emergent conditions, instead of a blanket cover. Otorhinolaryngology oncological cases have been stratified into Priority Level Ib and II according to NHS guidelines. Otolaryngologists being at an increased risk of exposure, are advised to wear adequate PPE irrespective of the COVID-19 status of the patient. Prolonged usage of PPE not only causes multiple adverse effects at physiological levels but also reduces the surgical proficiency of the care provider, making surgeries more challenging resulting in an increased number of perioperative complications rate. Aim of this study was to compare the number, types and the perioperative complications of Head and Neck oncological surgeries in the pre and the ongoing COVID 19 Pandemic. Methods: In a Reterospective analysis, 60 Head and Neck oncological surgeries done for biopsy proven neoplasms, between March 23rd and October 31st in the two consecutive years 2019 and 2020 were included and compared. Results: In the similar time interval, 17 cases were done in 2020 and 43 in 2019. 70% of the cases done in 2020 were for the malignant neoplasms out of which 81.8% had perioperative complications. An overall complication rate of 64.7% was seen in cases done in 2020 in contrast to 35.7 % seen in those done in 2019. Conclusions: This study expresses our stringent prioritization and selection of oncological cases post pandemic. PPE related technical difficulties such as impaired vision, dampened communication with assistants and a difficult hand and arm movement increases the rate of perioperative complications in the oncological surgical procedures.

  ABS-85: Clinico-pathologic Profile of Sino-nasal Hemangiopericytoma Top

Kondamudi Dheeraj, Alok Thakar, Chirom Amit Singh, Rajeev Kumar, Kapil Sikka, Pirabu Saktivel

All India Institute of Medical Sciences, New Delhi, India.

E-mail: [email protected]

Background/Objective: To evaluate Clinical, radiological, histopathologic characteristics and management outcomes of HPCs. Methods: Clinical data of 8 patients with sino-nasal hemangiopericytoma, diagnosed by pathology and immunohistochemistry from 2011 to 2020 were analyzed retrospectively. There were 5 males and 3 females, with a median age of 25.6 years. Clinical manifestation included epistaxis and nasal obstruction in all patients. These patients were operated by combined external [four cases by lateral rhinotomy and two cases by midfacial degloving] and endoscopic assisted surgery. Immunohistochemical characteristics were also obtained from pathological records. Results: The mean duration of symptoms was 31 months (6months- 60 months). All patients had epistaxis and nasal obstruction. In addition nasal mass was seen till anterior nares in 4 cases, facial deformity and features of sinusitis in 3 patients. Radiologically the mass was involving bilateral nasal cavity in 3 cases, intracranial extension in two cases, right nasal cavity and PNS in two and left nasal cavity and PNS in one case. These patients were operated by combined external [4 cases by lateral rhinotomy and 2 cases by midfacial degloving] and endoscopic assisted surgery. All patients transfused post surgery . No post operative complication was noted. All the patients were followed up for a period of 6 months to 56 months (median- 28.4 months) after operation. Adjuvant treatment was given for two patients for high MIB index and residual tumor in the form of radiotherapy and chemotherapy. One case died of tubercular meningitis after follow up for 23 months. One patient was lost to follow up. There were no other recurrences in the follow up period. All tumors show strong positivity for vimentin, SMA and negative for CD34. Conclusions: Sinonasal HPCs should be evaluated pre-operatively as a tumour with malignant potential rather than a benign tumour. Completeness of excision is the main predictor of recurrence.

  ABS-84: Spectrum of Osseous Lesions of Nose and Paranasal Sinuses Top

Kavya Sivapuram, M. B. Bharathi

JSS Academy of Higher Education and Research, Mysore, Karnataka, India.

E-mail: [email protected]

Background/Objective: Among the broad spectrum of diseases affecting the nose and paranasal sinus(PNS) osseous lesions are infrequent. Fibro-osseous benign lesions that araise in nose and PNS are osteomas, ossifying fibromas, fibrous dysplasia which are slow growing tumors. Though they share similarities in clinical, radiological and histological presentations they exhibit different behaviours. Another rare osseous benign tumor in this region is chondromesenchymal hemartoma. Ewing's sarcoma(ES), a small round cell tumor is the third most common bone tumor after osteosarcoma and chondrosarcoma. Less than 10% cases of Chondrosarcoma and 1-4% of ES occur in head and neck region. Methods: A retrospective study of patients diagnosed with osseous lesions of nose and PNS over a period of 7 years from 2013 August – 2020 August in our tertiary care centre. Results: We experienced a total of 15 cases. Starting with the most common, 7 cases of osteomas were identified, of which 4 patients were asymptomatic and 3 were symptomatic, two obstructing frontal sinus drainage and other in ethmoid region. 2 patients diagnosed with fibrous dysplasia, 1 ossifying fibroma, one case of chondromesenchymal hemartoma and 1 chondrosarcoma were identified. Rest three had Ewing's sarcoma in sinonasal tract one in maxilla and other two in ethmoid region which are quite rare locations. Headache and nasal obstruction were primary complaints in many patients. Management strategy was based on the type, size, location, presentation and spread of lesions. Conclusions: An early diagnosis and appropriate intervention with a long term surveillance will help in increasing the quality of life. Observation and regular imaging with surgical intervention when required remain as the main stay of treatment for benign lesions. Treatment of choice for ES is a combination of initial biopsy followed by chemotherapy and localized radiotherapy. Our patients are under regular follow up with no evidence of recurrence till date.

  ABS-83: Sebaceous Cell Carcinoma of Nose – A Rare Presentation Top

Sarthak Sachdeva, Lakshmi Vaid, Dhirender Suman

UCMS and GTB Hospital, Delhi, India.

E-mail: [email protected]

Background/Objective: Sebaceous carcinoma is a rare and potentially aggressive cutaneous tumor which arises from sebaceous gland epithelium and is divided into ocular and extraocular types. Extraocular tumors are extremely rare particularly in relation to vestibulum nasi. We hereby report a case of 59 years old male patient who presented to us with an ulceronodular external nasal mass and an uncommon diagnosis of nasal sebaceous carcinoma was reached. Methods: A CECT nose and PNS was done which showed well defined heterogenously enhancing ulceroproliferative soft tissue density lesion measuring 23 X 33 X 27 mm centered at the anterosuperior aspect of nose involving skin and subcutaneous tissue of anterior nares, anterior nasal cavity, nasal tip, columella and anterior nasal septum with no evidence of bony destruction. Biopsy revealed possibility of carcinoma of sebaceous differentiation. Results: Excision of tumor (Partial rhinectomy) with reconstruction using bilateral paramedian forehead flaps was done. Conclusions: Sebaceous carcinoma is a rare and aggressive cutaneous tumor and should be considered in all nasal vestibular masses. An early biopsy is indicated in view of its aggressive nature, metastasis and difficulty to differentiate from other benign and malignant conditions. Over 70% occur in head and neck especially in periocular region( 38.7%). The extraocular commonly is very uncommon to occur in nasal vestibule. Standard surgical resection with wide margins and reconstruction and Mohs micrographic surgery are the common treatments. In large defects, local flaps- transpositio nasolabial, dorsal nasal, cheek advancement or regional flap- pedicled paramedian forehaed or free dorsalis pedis can be used. Distant free flaps- median arm flap, RAFF can also be considered. For inner lining- composite conchal grafts, local flaps, pedicled septal mucosal flap can be used.

  ABS-82: Mucosal Mallignant Melanoma of Nasal Cavity (A Case Report) Top

Manisha Yadav, Vipin Arora, Kavita Goyal

UCMS and GTB Hospital, Delhi, India.

E-mail: [email protected]

Background/Objective: Malignant Melanoma of nasal cavity is an extremely rare tumour and is more aggressive than its cutaneous counterpart. Rarity of this lesion warrants its mention among the differential diagnosis of tumours of nose and paranasal sinuses.We hereby report a case of 48 year male with a right nasal mass x 4-5 years, bilateral nasal blockage x 2-3 years & right eye proptosis x 5-6 months. A reddish brown mass in bilateral nasal cavity (R>L) was noticed on examination. Methods: A MRI was done with findings of a large heterogenous soft tissue mass in both nasal cavity (R>L) measuring ~ 5.1x10.3 cm. Reveals expansile destruction of nasal septum, nasal turbinates and medial walls of maxillary sinus with bulging lamina papyracia. Posterosuperiorly involving posterior ethmoidal air sinuses with possible erosion of planum sphenoidale. Posteriorly blocking bilateral choana (R>L) with partial effacement of the nasopharynx. No intracranial extension. CECT reported the same findings with focal areas of erosion and extension of soft tissue in bilateral orbit (extraconal involvement) (R>L), superiorly reaching upto cribriform plate. Results: Right Total Maxillectomy with Right side orbital exentration was done. Due to its high local recurrence following excision in the adjoining structures it is important to completely excise the tumour. In this case intraoperatively tumour was found involving the intraconal compartment of right orbit, so right sided orbital exentration was done along with right total maxillectomy. Conclusions: The primary malignant melanoma of the nose is extremely rare entity. Early diagnosis and surgical treatment of the melanoma of the nose offer the only possible hope of survival. Despite aggressive treatment, including surgery, radiation & adjuvant therapy, 5years survival rate is between 20 and 46%.

  ABS-79: Spindle Cell Carcinoma of Tongue: A Case Series Top

Deepanjali Mahida, Girish Mishra, Riddhi Trivedi

Pramkhswami Medical College, Anand, Gujarat, India.

E-mail: [email protected]

Background/Objective: Spindle cell carcinoma (SpCC) is a rare form of malignancy found in head and neck areas. It accounts for less than 2% of all oral lesions. It is predominantly seen in males. It is also known as sarcomatoid carcinoma. Larynx is one the most common places it is encountered however it also occurs in nasal cavity, oral cavities, hypopharynx, oesophagus, trachea, skin and breast. Spindle cell carcinoma is a type of poorly differentiated squamous cell carcinoma (SCC) with consist of enlongated epithelial cells which are similar to sarcoma. These tumors can be differentiated with true sarcomas only with help of immunohistochemistry or ultrastructural analysis. Methods: Case series. Results: At Shree Krishna Hospital, over one year, three patients were diagnosed with spindle cell carcinoma in oral cavity specifically over tongue. Out of three patients two were females and one was male all belonging to age group between 40-60 years. After performing biopsy, the specimen was further sent for immunohistochemistry, which confirmed the diagnosis of SpCC. All the patients underwent surgery as all were operable followed by adjuvant treatment. Conclusions: SpCC in the oral cavity is a very rare occurrence. The spindle cells are a variant of Squamous cell carcinoma. It is neither a non-neoplastic mesenchymal reaction nor a malignant admixture of epithelial and mesenchymal neoplasms. SpCC in oral cavity and oropharynx have tendency to be aggressive and also tend to recur and metastasize. In early cases surgery is advantageous to the patients. Role of IHC is not very helpful is such cases as the microscopic pathology report of SpCC is justifiable for the patient to undergo surgery. It is very difficult to predict the biological behavior of SpCC. Tumors with deep invasion have poor prognosis compared to those with early stage tumor.

  ABS-76: Micropapillary Squamous Cell Carcinoma -Larynx Top

K. Nahas, Deviprasad Dosemane, Meera Khadilkar, G. V. Chaithra

Kasturba Medical College, Mangalore, Karnataka, India.

E-mail: [email protected]

Background/Objective: Papillary squamous cell carcinoma is an unusual variation in aerodigestive squamous cell carcinoma that has been associated with a more promising prognosis than conventional squamous cell carcinoma of the head and neck. Methods: A 32 yr. old female patient came to the ent OPD with complaints of difficulty in breathing for 2 yrs. It increased during episodes of upper respiratory tract illness. Video laryngoscopy was done, which revealed multiple papillomatous lesion on both true vocal cords, bilateral vocal cords was mobile with phonation and respiration. She underwent micro laryngeal surgery with excision biopsy with carbon dioxide laser in two sittings. Results: The first specimen revealed features suggestive of Dysplastic epithelium with focal carcinoma in situ, invasion cannot be ruled out. Immunohistochemistry (I.H.C) was recommended. IHC report showed positive for p16, p53,90%, Ki67 leading to a diagnosis of carcinoma in situ. The second specimen revealed micropapillary squamous cell carcinoma. Conclusions: This case offers an example of the importance of taking malignancy into account as a differential diagnosis in patients with benign looking pathology, even when patients are young, healthy and not exposed to any risk factors like smoking, tobacco, alcohol or radiation as HPV-related tumours increase in prevalence in them. Since PSCC of the larynx has a better prognosis compared to standard SCC, for proper management, spot-on recognition is valuable.

  ABS-75: A Rare Huge Ameloblastic Carcinoma Maxilla: A Case Report and Review of Literature Top

Rajendersingh Arora, Sidaksingh Arora, R. R. Soni1, D. G. Adwani, Kanandeepsingh Arora1, Palak Umadiaya1

Sujan Surgical Cancer Hospital and Amravati Cancer Foundation, 1Sujan Surgical Cancer Hospital, Amravati, Maharashtra, India.

E-mail: [email protected]

Background/Objective: WHO classified the odontogenic tumour as Malignant ameloblastoma in 1972 and ameloblatic carcinoma term was described first in 1983 by Shafter et.al and till date only few cases are published in the literature and due to rarity of lesion AC is not very well described and the primary treatment is Surgery. Methods: Presenting a Case of ameloblastic carcinoma maxilla – Lady aged 51 yrs presented with Huge Tumour projecting out of Left mid-face and involving the maxilla and soft tissue and skin with multiple ulceration and pushing the lower eyelid upwards closing the palprabral fissure, extent of tumour was in all possible directions as of maxilla as seen on CT Scan.

  • Superiorly involving part of infro-lateral wall of orbit and IR muscle
  • Medially into the nasal cavity terbinates destroyed and involving ethmoids
  • Posteriorly projecting into retro maxillary space
  • 10 x 8 cm mass projecting out in mid-face and involving the Zygoma and pushing it laterally.

Previous CT (July 2018) showing 59 x 55 mm arising from posterior part & is slow growing. FNAC shows poorly differentiated Sq. Cell Carcinoma. Wide excision was done with Maxillectomy with excision of zygoma and infero-lateral wall of orbit with left nasal cavity and palate the huge defect so created was reconstructed with Anterolateral thigh flap with microvascular reconstruction and fascia lata to repair orbital wall. Facial artery, facial vein and one vein draining IJV were prepared during SOND and plastic surgery team raised the flap and anostomosis was done. Histopathology report came out to be Ameloblastic Carcinoma. Conclusions: It's a rare huge tumour seemingly inoperable but could be resected easily and reconstructed with micro vascular flap and histopathology came out to be Ameloblastic carcinoma relatively slow growing tumour and is radio-resistance and not very well understood entity.

  ABS-68: High Risk Human Papillomavirus and Epstein-Barr Virus Prevalence Status in the Oropharyngeal and Hypopharyngeal Cancer Patients of Northeast India Top

Rupjyoti Das, Tashnin Rahman, Ashok Kumar Das

Dr B Borooah Cancer Institute, Guwahati, Assam, India.

E-mail: [email protected]

Background/Objective: A subset of cancers arising in the head and neck region are associated with oncogenic strains of viruses like Human papillomavirus (HPV) and Epstein - Barr virus (EBV ). These oncogenic virus associated Head and Neck Cancers (HNCs) have been considered to represent different etiological and pathological behaviour. This study was conducted to investigate High Risk HPV (hr-HPV) and EBV infection and its association with life style habits such as tobacco, alcohol consumption etc in hypopharyngeal and oropharyngeal cancer patients of Northeast India. Methods: This study was carried out in the Department of Head and Neck Surgery, Dr B Borooah Cancer Institute. A total of seventy seven (77) primary HPSCC and OPSCC tumor biopsy specimens were collected. These samples were analyzed for hr-HPV DNA and EBV DNA using nested multiplex PCR (NMPCR). The lifestyle and dietary associated factors were collected through a self- designed questionnaire. Results: The presence of hr-HPV was confirmed in 25% (n = 20) and EBV in 58% (n=45) of total patients by nested multiplex PCR (NMPCR). Among hr-HPV positive cases, only one genotype HPV- 16 was found. hr-HPV was found in 50% of the HPSCC and 7% of OPSCCs. Co-infection of hr-HPV and EBV was found in only 16% of the total population. Significant association was observed between hr-HPV infection with alcohol consumption (p-0.025) in HPSCC cases. There was no significant association found between hr-HPV infection with age(p-0.33), gender (p-1.00), betel nut chewing (p-0.70), tobacco chewing (p-0.70), tobacco smoking (p-0.07) and histopathological grading. Conclusions: Our study demonstrates that alcohol consumption may act as risk factor for hr-HPV infection in subset of HPSCC cases from the North-East region of India.

  ABS-67: Sarcomas of the Mandible: A Case Series from a Tertiary Institute Top

Satnam Singh Jolly, Vidya Rattan, Sachin Rai

PGIMER, Chandigarh, India.

E-mail: [email protected]

Background/Objective: Sarcomas of the craniofacial are extremely rare tumors comprising approximately 1% of all head and neck malignancies. Sarcomas of the mandible accounting for only 4%-10% of all the sarcomas in the head and neck. These rare tumors are mesenchymal in origin, with osteosarcoma and chondrosarcoma being the most common histological types, followed by Ewing's sarcoma. A fundamental prognostic factor in head and neck osteosarcoma is complete surgical resection of the tumor with negative margins, which is sometimes impossible in the head and neck region. This poster's objective is to share our experience in a case series of sarcoma of mandible treated with surgery, chemo, and radiotherapy. Methods: Records of patients with sarcoma of mandible treatment were evaluated, and the patients' disease-free status was obtained by follow up. Results: Out of six cases, two died within one year of treatment, and others are surviving with a maximum of 1 year follow up. Conclusions: Local recurrence is the most common site of treatment failure in osteosarcoma of the head and neck, with a reported incidence of 17%-70%. Wide surgical resection with negative margins followed by adjuvant radiotherapy with or without chemotherapy remains the hallmark for a successful outcome.

  ABS-65: Collision Tumour of Thyroid – Clinicopathologic Appraisal of a Rare Entity Top

Sithara Aravind, Sherin James, Vipin Gopinath, Sangeetha Nayanar, T. Sajith Babu

Malabar Cancer Centre, Thalassery, Kerala, India.

E-mail: [email protected]

Background/Objective: Collision tumours (CT) of thyroid refers to coexistence of two or more independent, histologically distinct tumors. Though differentiated thyroid malignancies with multifocality is a common event, it is extremely rare for the gland to harbour more than one type of malignancy at the same time. We undertook an extensive literature search of the PubMed data bases from the year CT of thyroid was first described - till date and identified only 36 cases. All these were case reports and to the best of our knowledge, this is the first documentation of a case series on CT of thyroid. Aims and Objectives: To explore the phenotypic and survival characteristics associated with CT in our population. Methods: Retrospective review of all patients diagnosed with CT of thyroid gland at our centre during the period Jan 2012 – Dec 2019. Results: Of a total 138 thyroid cancer cases treated at our centre, five (3.62%) were diagnosed as CT. Female predominance noted (100%) with median age of 50 years. The chief presenting complaint was swelling in the front of neck (100%). PTC was present in majority of cases (80%)in collision with medullary(MC), follicular, and hurthle cell carcinomas.. Both cases with papillary microcarcinoma showed vascular emboli and patients with a combination of MC and PTC had nodal metastasis. 80% of patients had a good overall survival of more than 2.5 years and is alive without disease at present. Single case of widely invasive follicular carcinoma with MC showed recurrence and succumbed to death. Conclusions: CT of thyroid are extremely rare tumours with limited data. Our study showed features like female predominance, PTC as the most common component and good survival. Metastatic and survival rates are consistent with matched singleton pathology.

  ABS-64: A Case of Epidermoid Cyst of Neck Mimicking a Thyroglossal Cyst Top

Nisarg Desai, Ajeet Kumar Khilnani, Narendra Hirani

Gujarat Adani Institute of Medical Sciences, Bhuj, Gujarat, India.

E-mail: [email protected]

Background/Objective: Swelling in the anterior neck is one of the most common causes of visit to an ENT specialist. The common swellings of anterior neck are thyroid swellings, thyroglossal cyst, pre tracheal lymph node and dermoid. Sometimes there can be difficulty in diagnosis when the swelling is either present at an unusual location or presents with unusual features. Methods: A 44 years old Hindu male patient, resident of Kutch district (Gujarat), a laborer, came to ENT OPD with complaint of a midline neck swelling for 10 years. On inspection, there was a single spherical swelling of 2 X 2 cm in size, with clearly defined edges and smooth surface. USG showed an infra-hyoid exophytic lobulated cystic lesion, separate from thyroid gland, with fine internal echoes with a possible diagnosis of thyroglossal cyst. Cytology reported a benign cystic lesion with a possibility of thyroglossal cyst. To further assist the diagnosis, MRI was done, which showed a well-defined cystic lesion in midline suprahyoid region with no evidence of communication with thyroid gland. Results: During surgery, the cyst was exposed and had a small opening in the anterior wall with yellowish cheesy material coming out. The posterior wall of the cyst could not be identified separately from the underlying strap muscles. Except the thick rim, which could not be excised due to adherence with underlying structures, the cyst was excised and sent for histo-pathological examination. There was no relation of the cyst with hyoid bone. The final histo-pathological diagnosis was a benign epithelial cyst (epidermoid cyst). Conclusions: This is a rare case of an epidermoid cyst of neck mimicking a thyroglossal cyst. There should always be a correlation between radiologist, pathologist and ENT surgeon whenever there is a doubt in diagnosis of a neck swelling. We should be ready for intra-operative surprises.

  ABS-63: Myoepithelioma - An Uncommon Parotid Tumour in an Adolescent Top

Sanchit Bajpai, Vijendra Shenoy

Kasturba Medical College, Mangalore, Karnataka, India.

E-amil: [email protected]

Background/Objective: Myoepitheliomas are uncommon neoplasms of major and minor salivary glands. These tumors are encapsulated and slow growing in nature and are benign in majority of cases only accounting to 1 – 1.5% among all salivary gland tumours . Due to the close resemblance clinically and histologically to pleomorphic adenomas these tumors often go misdiagnosed by clinicians. There is sparse mention in literature about their occurence and mean age of presentation for such tumours is found to be 40 years, thus being an extremely rare entity to encounter in pediatric age group. Methods: Here we seek to report an extremely rare case of a 10-year old patient who presented with a swelling below the right ear. Clinical and radiological evaluation revealed a mass in the parotid gland which was provisionally diagnosed as pleomorphic adenoma. This patient was treated with a superficial parotidectomy and followed up. Results: Final histopathology was suggestive of myoepithelioma of parotid gland. The patient was followed up for one year and showed no recurrence. Conclusions: Myoepitheliomas are salivary gland neoplasms composed of myoepithelial cells. They are extremely rare and belong to a distinct category of tumors as per World Health Organization. These tumors are uncommon, and even more rarely have they been reported in younger age groups. Surgical clearance with ample margins forms the gold standard treatment for such tumours, still having a high propensity to recur.

  ABS-61: To Evaluate the Patterns of Nodal Metastasis in Recurrent and Ipsilateral Second Primary Cancers of Oral Cavity Top

Kunal Gupta, Deepak Sarin, Karan, Gopal Kumar, Kanika Rana, Savan Chovotiya

Medanta-The Medicity, Gurugram, Haryana, India.

E-mail: [email protected]

Background/Objective: Normal lymphatic patterns of drainage get disrupted after treatment (surgery or radiotherapy). No discernible pattern of lymphatic spread are established in recurrent and ipsilateral second primary cancer of oral cavity. This makes decision of neck management in these cases difficult. Objective: To study the pattern of lymph node metastasis in recurrent and ipsilateral second primary oral cancers. To suggest extent of neck dissection in salvage surgery based on patterns these patterns. Methods: Retrospective analysis from 2015 -2019 of patients operated for lateralized recurrent or second primary cancers of oral cavity. Patient characteristics, treatment details and histopathology data was recorded. Metastasis was recorded as infield, out of field, ipsilateral and contralateral. Infield metastasis was defined as metastasis in a level of lymph nodes dissected previously in first surgery. Results: 26(49%) out of 53 patient with lateralized recurrent or ipsilateral second primary cancers underwent surgery and were subsequently included in the study. Of these 26 patients, 19 (73.1%) were recurrent cancers and 7 (26.9 %) were ipsilateral second primary. Nodal metastasis was found in 6 (23.08%) out of 26 patients. Of the 6 patients, 2 had ipsilateral infield metastasis, 1 had ipsilateral out of field metastasis and 3 had contralateral out of field metastasis.Conclusions: No single predictable pattern of lymphatic spread could be established but Contra lateral Neck involvement was found to be common. If Neck management is indicated then contral lateral neck dissection should be included in management.

  ABS-56: An ENT Surgeons Approach to Facial Defect Reconstruction using Basic Flaps: A Case Series Top

Madhuri Arora, Bhushan Kathuria1, Jagat Singh

Pandit B.D. Sharma, PGIMS, 1Kainos Superspeciality Hospital, Rohtak, Haryana, India.

E-mail: [email protected]

Background/Objective: Management of tumors of head and neck falls under the domain of the ENT surgeon. Basal cell carcinoma and verrucous carcinoma involving the face are frequently encountered in the clinics. The lack of access to healthcare and literacy, both impede the patient from receiving timely intervention. Due to limited expertise in the treatment and reconstruction of facial defects, these patients are further referred to a specialist in this field. In such cases, often the referral will lead to the patient being non-compliant with the treatment. The objective of this study is to apply basic knowledge of flaps by an ENT surgeon in treating the carcinoma with subsequent repair and to observe the post-operative outcomes for the patient. Methods: Twenty patients with basal cell carcinoma presenting to the outpatient clinic of ENT in a tertiary care hospital over a period of 1 year in Haryana were treated with wide local excision of the lesion with repair done using local flaps. The patients were followed up in the immediate post-operative period and subsequent follow up visits. Results: Complete excision of the tumor with tumor free margins was feasible in all of the 20 (100%) cases. Reconstruction of facial defects was possible with heedful pre-operative planning and execution. In 17 (85%) of the total 20 cases operated, good functional and aesthetic outcomes were achieved. Three (15%) patients were lost to follow up. Conclusions: In a resource limited setup, knowledge of basic flaps can be of great importance and can go a long way in managing patients without the need for further referral. If carried out meticulously, good functional and aesthetic outcome can be attained without additional mental and financial burden on the patient.

  ABS-55: VATS Ligation of Thoracic duct in Management of High Volume Chyle Leak in Head and Neck Surgery–An Interesting Case and Review of Literature Top

Mihir T. Dani, Parin Patel, Dushyant Mandlik, Kaustubh Patel, Nitin Sharma, Purvi Patel

HCG Cancer Centre, Ahmedabad, Gujarat, India.

E-mail: [email protected]

Background: Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. Persistent high flow chyle leak post-operatively requires prompt and early aggressive management to avert associated morbidity. When Traditional conservative management fails it entails definitive treatment in the form of ligation of the thoracic duct. Video-assisted thoracic surgery (VATS) without a thoracotomy is an effective way of treating such cases and carries minimal morbidity. Objectives: We report herein a case of postoperative high flow cervical chyle leak managed successfully by VATS thoracic duct ligation and present a systematic analysis of the literature to highlight the current trends in the management of thoracic duct injury. Methods: A 61-year female patient case of carcinoma of left buccal mucosa underwent left composite resection along with left modified radical neck dissection, intraoperatively minimal chyle leak on left neck seen, sutured with 3-0 vicryl, on 3rd postop day neck drain showed milky white fluid which was confirmed as chyle. Chyle output was more than 1000/day, immediate conservative and supportive measures started, which failed following which decision was taken to undergo VATS thoracic duct ligation, on next postoperative day, chyle output was reduced remarkably followed by removal of neck drains after 2 days and discharge of a patient with no further post-op complications. Results: Effective management of chyle leak was accomplished with no post-operative complications. Conclusions: Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcomes. Video-Assisted-Thoracoscopic-Surgery (VATS) offers an excellent magnified view of the thoracic structures, minimal access trauma, and a quick postoperative recovery.

  ABS-54: Adenoid Cystic Carcinoma of Floor of Mouth Top


Institute of Medical Sciences.

E-mail: [email protected]

Background/Objective: Management of adenoid cystic carcinoma of floor of mouth. Methods: Complete resection of the tumor under general anaesthesia. Results: After surgery, histopathological examination was done to reveal adenoid cystic carcinoma of minor salivary gland. Conclusions: It has locally aggressive behaviour and high rate of recurrence. Long term follow is adviced due to rate of recurrence and distant metastasis.

  ABS-53: Various Options for Eyelid Reconstruction in Cases of Squamous Cell and Basal Cell Carcinoma of Skin Near Eyelid: A Case Series Top

Sunil Kumar, Mudit Agarwal

Rajiv Gandhi Cancer Institute, Delhi, India.

E-mail: [email protected]

Background/Objective: Eyelids contribute to protection of globe and cornea from any damage and play important role in beautification of face. Our case series was done to find various options for eyelid reconstruction without compromising the oncological safety in squamous cell carcinoma and basal cell carcinoma of skin near eyelid but good cosmetic as well as functional outcome. Methods: Wide local excision of the lesion with 0.5-1 cm margins was performed in all the patients (4 females and 2 males), with a mean age of 55.5 years. In 5 patients reconstruction was done in two stages (Eye globe was covered completely in first stage and after two weeks, the flap was reopened). Anterior lamella was formed by forehead skin and posterior lamella by buccal mucosa. In one patient single stage was required for reconstruction. Mean follow up of the patients was 23 months, with average follow up frequency of 3-6 months. Results: None of the patients reported tumor recurrence till last follow up. One of our patients was a case of corneal dryness which resolved on conservative management. However epiphora was present in 4 patients who had larger defects involving both upper and lower eyelids. Corneal opacity or vision related problems were not noticed by any of the patients. Conclusions: Removal of eyelid should not preclude resection for oncologically safe margins in lesions near eyelids. Eyelid can be reconstructed with various flaps in nearby territory. It can be done with good cosmetic and functional outcomes.

  ABS-50: Primary Amyloidosis of Larynx: A Rare Clinical Entity Top

Aklanta Kumar Gogoi, Nikhilesh Borkar

Sir H N Reliance Foundation Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Primary amyloidosis is the term designated to those forms of amyloidosis in which the condition is not associated with an obvious predisposing disease. Any part of the respiratory system may be severely affected which at a macroscopic level present as nodular lesions, the commonest site being the larynx. However, there have been a very few documented cases of laryngeal amyloidosis in literature. Methods: A 43 year old man had complain of hoarseness of voice since 12 years. He underwent a direct laryngoscopy in a different hospital and subsequently, a biopsy was performed which showed it as laryngeal amyloidosis. He presented to us with complains of aspiration and breathlessness in 2018 following which a DL scopy was done. The DL scopy showed significant narrowing of the supraglottic airway and a lesion in the false vocal cord. A CT scan of neck was undertaken which showed a diffuse endolaryngeal process primarily involving the supraglottic and glottic larynx comprising of an extensive lesion with an endophytic pattern of infiltration along the mucosal-submucosal spaces causing moderate to severe laryngeal airway narrowing. Patient was planned for radiotherapy and he received a dose of 50.4 Gy in 28 fractions. However, the problems of aspiration and difficulty in breathing persisted and he had to be tracheostomised. Results: In view of the persistent complain of aspiration and breathing difficulties along with inability to decanulate, a decision was taken to perform a total laryngectomy with partial pharyngectomy and reconstruction with PMMC patch . The surgery was undertaken after explaining the procedure to the patient and obtaining a written consent for the same. PEG tube and a Ryles tube insertion was done on the operating table during the surgery. Patient presented with complains of dysphagia a month after the surgery. A gastrograffin swallow imaging was performed which showed stricture of the neoesophagus at the C4-5 level vertebrae. This was followed by repeated stricture dilatation at 2nd month and 3rd month postoperatively. However, due to persistent complain of dysphagia and inability to take soft /solid food, a flap debulking as well as scar excision to remove fibrotic bands was done on 4th month post-operatively. Patient's nutrition was maintained through the PEG tube all this time. As of the last OGD scopy done in the 7th post-operative month, a small narrowing was observed at the C5 vetebrae. We were unable to physically assess the patient after this owing to the nationwide COVID 19 pandemic lockdown. Conclusions: Amyloidosis is an very rare clinical entity of the larynx and in the event of such a diagnosis, any systemic involvement should be ruled out. The modalities of treatment varies from simple observation to endoscopic resection with CO2 laser or cold knife to total laryngectomy based on the extension of the disease. In this case owing to persistent complains of aspiration, breathlessness and inability to decanulate the patient, a decision to perform a total laryngectomy with a patch PMMC reconstruction was taken.

  ABS-49: Karapandzic Flap in Reconstruction of Post Surgical Defect in Carcinoma Lower lip Top

Nishtha Chauhan, Akhilesh Singh, Naresh Sharma, Preeti Tiwari, T. Janani, Nitesh Mishra, Ratindra Nath Bera, Mehul Shashikant Hirani

Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

E-mail: [email protected]

Background/Objective: Karapzandic Flap In Reconstruction of Post Surgical Defect in Carcinoma Lower Lip. Methods: A Total no.of 10 elderly male patients with ulceroproliferative growth involving lower lip were included. Results: Wide local excision followed by reconstruction with Karapandzic flap. Conclusions: Karapandzic flap technique is very successful in getting "like"tissue for reconstruction & maintaining the original neuro-vascular integrity of lip.So it can be considered as "Work-House''in reconstructing two third defect of lower lip.

  ABS-48: Paraneoplastic Coagulopathy and Cardiac Metastases in Head and Neck Cancer: A Rare Case Report Top

Ankur Padmaja, Kumar Vinchurkar, Rohan Bhise1, Imtiaz Ahmad1


E-mail: [email protected]

Background/Objective: Subclinical DIC (Disseminated intra-vascular coagulopathy) has a very low incidence and may manifest as a part of paraneoplastic syndrome. Heart is an unusal site for distant metastases in head and neck cancers.Patients have vague symptoms which makes it difficult to diagnose. Methods: Here we present a case of paraneoplastic coagulopathy with subclinical DIC and secondaries in epicardium in a patient with primary cancer of buccal mucosa. Results: Profuse bleeding, constant altered coagulation profile and generalized weakness lead us to investigate and diagnose paraneoplastic coagulopathy due to cardiac metastasis. Conclusions: When patient with malignancy presents with haemorrhage, it is the tumour bleed which is most commonly suspected. Paraneoplastic coagulopathy should be considered if there is no evidence of bleeding from the primary. Thorough search for distant metastases should be done. Acquaintance with paraneoplastic syndrome may help in early diagnosis and increased survival rate of such patients.

  ABS-45: Robotic versus Conventional Neck Dissection: Our experience Top

Ishita Gupta, Mandar Deshpande, Rishi Khosa

Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: With the evolution in surgical techniques and patients' demands, Cosmesis has become an important consideration in treating cancer patients today. The conventional neck dissection technique in oral cancer patients results in large disfiguring scars extending from chin to mastoid process. Robotic neck dissection allows for better scar placement, hence improved patient satisfaction without compromising on oncologic clearance and functional outcomes. With this case series, we share our experience with robotic assisted neck dissection and discuss the pros and cons of the procedure compared to the conventional neck dissection. Methods: This is a comparative study of 40 patients which included patients with T1/T2 oral carcinoma with clinically N0 neck. 20 patients were treated with robotic neck dissection and 20 with conventional neck dissection. Patients' demographic details, operating time, peri-operative complications, drain output and histopathological details were recorded. Results: The average operating time in robotic assisted neck dissection and conventional neck dissection was 205.17 and 95.7 minutes, respectively, which showed a significant difference. The average number of lymph nodes removed in robotic dissection was 21.9 while in conventional it was 24.16, which was not a statistically significant difference. The average blood loss and drain output was found to be less in robotic cases compared to conventional technique. Conclusions: In our experience, Robotic neck dissection gives adequate lymph node clearance similar to conventional technique with lesser amount of blood loss and drain output . Although it has a learning curve, it proves to be a good alternative to early stage oral cancer with clinically N0 neck.

  ABS-43: Complications in Oral Reconstructive Oncologic Procedures Top

Aananya Mishra, Mohan Baliga

Manipal College of Dental Sciences, Mangalore, Karnataka, India.

E-mail: [email protected]

Background/Objective: Over the last several decades the approach to treatment of oral cancer has changed very little with regards to primary tumour extirpation. Perhaps the most significant change in the surgical treatment of cancer is the introduction of free flap for reconstruction post resection. Complications associated with reconstructions in oral oncology is multifactorial ranging from peri to post-operative period. Through this poster we aim to highlight the imperative complications encountered in oral reconstructive oncologic procedures using local and regional flaps. Methods: A retrospective analysis of various reconstructive procedures conducted in the department for the period 2015 Jan – 2020 August to ascertain and categorize the various complications. Out of 225 patients who underwent reconstructive procedures complications ranged from infection, poor healing, flap necrosis, hemorrhage, surgical site infections, partial to full loss of flap, unacceptable aesthetics, MRSA, and ARDS and not to forget development of sialocele and chyle leak and, their management with successful outcome. A special mention will be made on the development of second primary and distant metastasis in OSCC. The mortality complications and quality of life related issues will be excluded in this presentation. Results: Complications rate ranged between 2% to 18% and, they were managed successfully with least morbidity. Conclusions: Outcome in reconstructive oncology with success depends on the wound class, type of operation and operative time.

  ABS-39: Inflammatory Myofibroblastic Tumor in a Known Case of Squamous Cell Carcinoma of Same Site: A Rare Case Report with Review of Literature Top

Srinitya Mulukutla, Sachin Wani, Hiral Shah, Ankit Shah

HCG Cancer Centre, Vadodara, Gujarat, India.

E-mail: [email protected]

Background/Objective: Inflammtory myofirbroblastictumor (IMT) is a rare tumor of unknown etiology. It encompases a spectrum of myofibroblastic proliferation with inflammatory cell infiltrate. Since its first reporting in lung, there have been very few reports of IMT in head and neck region. Here we present the first documented case of IMT in oral cavity of a patient with a previous history of squamous cell carcinoma of same site with review of literature. Methods: a case of IMT arising from buccal mucosa of a 44 year male with a significant past history of squamous cell carcinoma of same site is described. Patient presented with a solitary well defined mass of 4 months duration. Results: The tumor showed a compact proliferation of spindle cells arranged in a storiform pattern, with predominantly lympho – plasmacytic cells infiltration with marked cellular atypia. IHC was positive for Desmin and Vimentin. Conclusions: IMT with its rare incidence, histologic and radiologic similarity to a malignancy, can be a diagnostic controversy. But with thorough understanding of the histology and immune profiling, it can be diagnosed accurately and managed efficiently.

  ABS-31: Unusual Sinonasal Malignancies in a Tertiary Care Center Top

Abhiraj Tiwari, Nikhil Arora, Ashiya Goel, Aarushi Vashist, Madhuri Arora

Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.

E-mail: [email protected]

Background/Objective: Sinonasal malignancies are rare and heterogeneous tumours of nasal cavity and paranasal sinuses which comprise only 3% of tumours of head and neck region. They arise most commonly in the maxillary sinus but other sinuses can also be involved. The patients with unusual sinonasal tumours present with vague symptoms like nasal obstruction, nasal discharge, facial pain etc. which mimics benign sinonasal diseases like nasal polyps. So, the diagnosis requires high level of clinical suspicion followed by accurate diagnosis and proper management. Methods: Here, we present a rare case series comprising of eosinophilic angiocentric fibrosis, sinonasal neuro-endocrine tumour, adenoid cystic carcinoma of nose and sinonasal myxoma. They were diagnosed by clinical findings supplemented by CT Scan and MRI. Biopsy was done to confirm the diagnosis. They were then treated by surgery and post operative radiotherapy and chemotherapy depending on the diagnosis. Results: These rare sinonasal malignancies were treated by surgery and post operative radiotherapy and chemotherapy depending on the diagnosis and had complete remission. Conclusions: The patients with unusual sinonasal tumours present with vague symptoms like nasal obstruction, nasal discharge, facial pain etc. which mimics benign sinonasal diseases like nasal polyps.Hence, a proper clinical suspicion of these malignancies should be there while dealing with the patients presenting with vague sinonasal problems so that timely and effective management can be done.

  ABS-29: Bilateral Nasolabial Flap for Reconstruction of Lower Lip Carcinoma Defects Top

Mehul Shashikant Hirani, Akhilesh Kumar Singh, T. Janani

Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India.

E-mail: [email protected]

Background/Objective: The nasolabial flap is a versatile flap traditionally used for the reconstruction of perioral defects. It is an inferiorly based axial patterned flap based on the facial artery, harvested either unilateral or bilateral. The rich arterial supply of flap that runs deep to mimetic muscles is responsible for better postoperative outcomes. Methods: The case series describes 10 elderly male patients having ulceroproliferative growth involving lower lip region operated by wide local excision and subsequent reconstruction of the defect with bilateral nasolabial flaps. All patients were operated for bilateral neck dissection and were subjected to radiotherapy postoperatively. Results: All the patients had satisfactory healing and oral competency 1 month post operatively with good vascularity of flap and minimal complications. Despite neck dissection vascularity of flap was not compromised due to frank collateral circulation of perioral region.and random patterned blood supply of flap. Most of the patients tolerated radiotherapy well. Conclusions: Nasolabial flap is a predictable method of reconstruction that doesn't cause microstomia, reestablishes oral competence and requires minimal preoperative planning. For intraoral defects, the nasolabial flap can be tunneled through the buccal mucosa and inset in the floor of mouth, buccal mucosa, lip or palate. This flap provides an excellent cosmetic result, with significantly less morbidity and cost compared with free tissue transfer. It requires less surgical time for harvesting & has excellent return to oral functioning. Bilateral nasolabial flap is relatively easy with minimal contraindications provides a better option for lower lip reconstruction of carcinoma defects.

  ABS-28: Unusual Nasopharyngeal Cancers: Report of Two Cases Top

Sushmitha Pittala, Monica Malik, Syed Fayaz Ahmed

Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

E-mail: [email protected]

Background/Objective: Nasopharyngeal carcinoma is the most common tumour of nasal cavity or nasopharynx (NP). We report 2 cases of nasopharyngeal tumors with unusual histology treated by radiotherapy(RT) in our institute. Methods: Case 1: 58-year-old female presented with chief complaint of nasal stuffiness associated with difficulty in breathing for 2 months duration in Nov'2019. She was evaluated with CT PNS dated on 15.11.2019 which showed ill defined, large soft tissue mass measuring ~6.3x4.3x6.4cms involving left aspect of the pharyngeal mucosal space, bulging into nasopharyngeal airway, with features suggestive of neoplastic aetiology - likely nasopharyngeal carcinoma. This is confirmed by biopsy, in which IHC CK 5/6 and EMA are positive and TTF 1 negative, f/c/w Nasopharyngeal papillary Adenocarcinoma(NPAC). We considered patient for RT. Immobilization was done with thermoplastic mask and she was given adaptive RT of 46GY in 23 fractions followed by boost to primary upto 66Gy. Case 2: 60-year-old female who presented with chief c/o swelling in bilateral neck region, progressively increasing in size for 6 months. History of fever, on and off for 6 months. PET CT WB was done, findings suggestive of possible primary in NP posterior to soft palate with metastatic bilateral cervical nodes. Histopathological examination of right cervical node findings consistent with Follicular dendritic cell sarcoma. She was immobilized with thermoplastic mask and simulation was done. She was given radical RT by IMRT technique to a dose of 2GY per fraction for 25 fractions to a dose of 50GY. Results: Case 1: On follow up after 10 months NAD and good response seen. Case 2: On follow up of 2 months patient had good response. Patient expired after 8 months of treatment. Conclusions: NPAC is an extreamly unusual malignancy. FDCS is the uncommon neoplasm occurring primarily in lymph nodes but also in extranodal sites. It is an extremely rare malignant neoplasm of NP.

  ABS-27: Incidence of Level Ia Lymph Nodes Metastasis in Lateralized Oral Cavity Cancer and Feasibility of Submental Flap in Reconstruction Top

Saujanya Suhas Saikar, Kishore Das, Tashnin Rahman, Ashokkumar Das, Raj Jyoti Das, Anupam Das, Kaberi Kakati

Dr B Borooah Cancer Institute, Guwahati, Assam, India.

E-mail: [email protected]

Background/Objective: Submental flap may be an alternative to free flap in oral cavity cancer with advantage of low morbidity, less operating time and in the patients who are not fit for long duration surgery. The incidence of occult lymph node metastasis in oral cavity cancer ranges from 20-40%, and submental flap is not preferred due to concern of occult metastasis in level Ia. In this study we retrospectively evaluated the incidence of level Ia lymph node metastasis in lateralized oral cavity cancer to evaluate the oncological safety of submental flap where free flap is not feasible. Methods: A 3 years retrospective search for oral cancer patients who underwent surgery from January 2017 to December 2019 was conducted and the cases with lateralized disease stage I to IV, unilateral neck dissection were included. Post NACT, Post Radiotherapy, recurrent cancer, midline disease or disease reaching up to midline, floor of mouth and tongue cancers cases were excluded. Results: In our study, total 625 cases were included, out of which 31 patients had level Ia metastasis with the incidence of 4.96%. The incidence of level Ia metastasis when the underlying bone was involved is 2.72%, and 1.76% when the underlying bone was not involved. Conclusios: Incidence of occult metastasis in level Ia is low in our study, therefore submental flap can be a feasible alternative flap in reconstruction of selective lateralized oral cavity cancer.

  ABS-25: An Overview of Anterior Tongue Cancer in North East India: A Single Instituitional 3 Year Retrospective Study Top

Rohan Dey, Ashok Kumar Das, Tashnin Rahman, Raj Jyoti Das, Kishore Das, Anupam Das, Kaberi Kakati

DR. B. Borooah Cancer Institute, Guwahati, Assam, India.

E-mail: [email protected]

Background/Objective: The incidence of oral cancer is very high in north east India, about 58.4 % at the age of 60 years. It is mainly attributed to the habit of consumption of betel nut with lime, chewing tobacco and gutkha. The incidence of tongue cancer is about 37.2 % in north east. The objective of the study was to have an overview of the anterior tongue cancer in a tertiary care centre in northeast India in terms of parameters like progression free survival and overall survival. Methods: A 3 year retrospective study was conducted in the Dept of Head and Neck Oncology, Dr. B. Borooah Cancer Institute, Guwahati from 01/01/2016 to 31/12/2018. All the patients with histologically proven squamous cell carcinoma of anterior tongue who underwent surgery were included in the study. Patients received adjuvant treatment either with radiotherapy or chemo radiotherapy. The follow up period was till September 2020. Patients were followed up either by their visits to hospital or by telephonic conversation. Results: 80 patients were included in the study. Mean age was 54.03 years. Male preponderance was noted, with 60 males and 20 females. Recurrence was present in 30 cases. 16 patients had nodal recurrence, 9 patients had recurrence in primary site and neck nodes and 5 patients had recurrence only at primary site. There were 28 deaths. 3-year progression free survival was 56.90 % and overall survival was 62.80%. Conclusions: Cancer of the anterior tongue is best treated by surgery followed by adjuvant treatment. Early diagnosis and referral to a tertiary centre with expertise is associated with good outcome.

  ABS-18: Unusual Presentations of Thyroid Tumours Top

Saheb Jotsingani, Radhika Patoriya, Girish Mishra, Riddhi Trivedi

Pramukh Swami Medical College, Karamsad, Anand, Gujarat, India.

E-mail: [email protected]

Background/Objective: Thyroid tumours are generally present with a solitary or multiple nodules in the neck(midline). To have a synchronous oral cavity cancer with a thyroid tumour is extremely rare. It is also very sparsely reported in the literature. This case series includes three cases of an unusual presentation of thyroid tumours along with oral cavity tumours. Case Series Review: Case 1: A 37-year-old female presented with a 2cm x 2cm growth at the tip of the tongue with clinically no node present in the neck. A biopsy was suggestive of Squamous Cell Carcinoma (SCC). MRI was suggestive of a left level IV node with no other node in the neck. The node was suggestive of thyroid nodule with Bethesda Type III on fine-needle aspiration cytology. Case 2: A 53-year-old female with growth over the right lower lip, measuring 3cm x 2cm along with a solitary thyroid swelling of 5cm x 5cm. FNAC of the nodule was suggestive of either follicular neoplasm or metastasis of SCC. Hence, a guided biopsy was done which was suggestive of Hurthle cell tumour. Case 3: A 60-year-old female with a previous history of total thyroidectomy followed by radio-iodine-ablation in 2016 presented with a huge mandibular swelling. The biopsy was suggestive of metastasis of follicular carcinoma into the mandible. Such mandibular metastasis of thyroid tumour is extremely rare. Conclusions: Thyroid tumours may present concurrently with oral cavity tumours. We report two cases here where there was concurrent thyroid pathology along with oral cavity tumours. The third is a rare case where primary thyroid malignancy has had a bony metastatic lesion in the mandible. Hence, thyroid mass in oral cavity tumours should be evaluated thoroughly before surgical planning.

  ABS-17: Oral Papillary Lesions-Lesions with Potential for Malignancy: A Case Series Top

Abhinandan Upadhyay, R. Arvind

Manipal College of Dental Sciences, Mangalore, Karnataka, India.

E-mail: [email protected]

Background/Objective: Various papillary lesions occur in the oral cavity like oral squamous papilloma, verrucous carcinoma, verrucous leukoplakia etc. Some of these lesions may be categorized as being potentially malignant. We describe the management of oral papillary lesions and explore their potential for malignant change. Methods: Case 1- Case of a 60 year old female with a cauliflower like growth on the hard palate. The lesion was excised and the resulting defect was reconstructed with free buccal fat pad graft showing good post-operative healing. Histopathologically, it was found to be oral squamous papilloma. Association between HPV, Squamous papilloma and other etiologic factors were assessed. Case2- Case of 75 year old male reporting with a proliferative growth on the left buccal mucosa extending from the corner of the lip to the faucial pillars. The lesion was surgically excised and histopathologic examination revealed verrucous carcinoma. Results: Healing of the surgical site with as confirmed in successive and regular post operative check-ups. Conclusions: The risk for malignant transformation is mostly low, although with variations between different lesions. Local measures with careful follow up of patient is recommended.

  ABS-16: Submandibular Gland Flap for Reconstruction of Head and Neck Defects Top

Bhushan Kathuria, S. P. S. Yadav

Kainos Hospital, Rohtak, Haryana, India.

E-mail: [email protected]

Background/Objective: Management of head and neck cancer defects has been challenging owing to the complexity of the created defects. Various flaps have evolved in the reconstruction of the defects; however, none of them has proved to be ideal. A Submandibular Gland Flap (SMGF) technique has lately emerged as a versatile flap having the advantages of both regional and a free flap. This retrospective analysis has evaluated the effectiveness of this flap. Methods: In this study, eleven patients underwent reconstruction of oral cavity cancer defects with SMGF, out of them, four had tongue defects; six had buccal mucosa defects and retromolar trigone defect in one patient. The outcomes of the SMGF were evaluated in terms of the ease of harvest, functional outcome, perioperative complications, and cosmesis. Results: The mean defect size and the flap dimensions were 4.4x3.9 cm and 3.6x3.3x1.6 cm respectively. The donor sites were closed primarily in all; none required split skin grafting or any other local flaps. The follow up ranged from over seven months to 1 year and during this period minor flap complications such as seroma, wound infection and partial or complete loss were not encountered except one patient suffered wound infection resulting in partial flap necrosis with wound dehiscence. There were no donor-site complications amongst the patients. In the follow-up period, one patient developed nodal recurrence at contra-lateral level II, while the other developed a second primary on the contralateral base of the tongue. Conclusions: This study showed that the SMGF is an excellent flap for the reconstruction of head and neck defects because of its reliability, versatility and the relative ease of application.

  ABS-14: Carcinosarcoma: A Rare Case Report of a Recurrent Mass in the Neck Region Top

Sanika Gurunath Kulkarni

Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Carcinosarcoma, a biphasic malignant mixed tumor, is an extremely rare neoplasm with >1% incidence. This aggressive malignancy is characterized by the presence of two components admixed with each other, i.e., the epithelial component and the mesenchymal component arising from a monoclonal/multiclonal origin or de novo. Methods: Case of carcinosarcoma arising as a mass in the neck region of a 14yearold male. Results: Case reported in this article combines both carcinomatous and sarcomatous components. Conclusions: It is reported because of its rare occurrence in the neck in the younger age group.

  ABS-12: Malignant Melanoma of Maxillary Sinus: A Case Report Top

S. Shivakuma

Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India.

E-mail: [email protected]

Background/Objective: Malignant Melanoma of the para nasal sinuses is a rare aggressive disease, typically presenting at an advanced stage constituting about 1-2% of all malignancies of maxilla. Arising from the melanocytes, the tumour mostly occurs in the 4th decade of life. Clinically, the patient presents with loosening or loss of teeth, bloody nasal discharge, nasal mass and nasal obstruction in later stages. Grossly, melanoma can present as a firm grey-white or pink to black ulcerated mass. Histologically, melanoma is identified because of its prominent melanin pigmentation, marked cytological atypia and nuclear grooves. Melanin can be abundant, scanty or absent (amelanotic melanoma). Immunoperoxidase studies with P16 are useful. Here we discuss a case of Malignant Melanoma of Maxillary sinus for its unique presentation and difficult surgical management. Methods: A 40 yr old male was referred by a dentist who had noticed black tarry mass in the tooth socket (right upper first molar) after tooth extraction for the same. The patient had initially presented to the dentist with complaints of loosening of teeth. The patient was then clinically examined and thoroughly evaluated with requisite investigations. He was then posted for right maxillectomy. During surgery, we observed that the tumour had involved most of the maxilla destroying the normal structure. The tumour was literally in pieces thus making complete surgical excision a challenge. Results: Routine post operative follow up was done. Patient was advised obturator 2 weeks post surgery. Patient has been regularly followed up at monthly intervals for a year now without any issues. Conclusions: Malignant melanoma of the maxillary sinus is a rare tumour (1-2%). This case was unique because of its differential presentation and difficult surgical experience and successful management of the patient with uneventful follow up.

  ABS-10: A Clinical Study on Laryngeal Manifestations among Patients with Pulmonary Tuberculosis Top

G. Naveen, S. Shivakumar

Vinayaka Missions Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India.

E-mail: [email protected]

Background/Objective: In the past few years there is a big resurgence of tuberculosis and the presentation of the same has changed. Tuberculosis of the otorhinolaryngeal region is one of the rarer forms of extra-pulmonary tuberculosis but still poses a significant clinical and diagnostic challenge. The lesions in the larynx can be the earliest presentation of tuberculosis. Anti-tubercular therapy is the treatment of choice and prognosis is very good if it is treated early. Methods: A study has been done on all 300 patients with pulmonary tuberculosis for a period of one year. The incidence of laryngeal manifestations based on age, sex, occupation, socioeconomic status, educational status, immunocompromised status, the laryngeal symptoms and lesions were noted in few patients by detailed examination, is documented and analyzed. Results: Tuberculosis of the larynx can be secondary to pulmonary tuberculosis or a primary manifestation. The incidence was high in males around the age group of 40 - 60 years who are more preferably coolie worker by occupation who were uneducated mostly and belonging to lower class in socioeconomic status. The most common clinical presentation was hoarseness of voice followed by throat pain. Vocal cord was the most common site of tubercular involvement. Conclusions: Tuberculosis is a public awareness issue prevailing in India in these recent years. By this study, we can say that there is incidence of laryngeal manifestations in patients with pulmonary tuberculosis. With the help of this study, we can easily and specifically target a particular group of people in a community for early detection of the disease by proper screening and examination. This study will help in early diagnosis and in providing appropriate treatment in early stage for better prognosis, thus making the community more healthier and safer.

  ABS-8: A Clinico Radiological Study of Adenoid Nasopharyngeal Ratio in Adenoid Hypertrophy in Children Top

Gowri Paramasivam, S. Shivakumar

Vinayaka Missions Kirupanandha Variyar Medical College and Hospital, Salem, Tamil Nadu, India.

E-mail: [email protected]

Background/Objective: There is still a concurrence on the finest procedure of assessing the size of the adenoid and the level of nasopharyngeal obstruction and when to perform adenoidectomy. The main of our study was to determine the clinical symptoms severity score of adenoid hypertrophy in relation to the age, to determine variations of ANR with relation to age sex and BMI and to find out the minimum Adenoid nasopharyngeal ratio beyond which adenoidectomy is required. Methods: 60 Children from age 3-12 years having symptoms of Adenoid hypertrophy were included in the case study. They were investigated with lateral view nasopharynx X-ray for determining the ANR and Diagnostic nasal endoscopy to find out the relationship between both the procedures.BMI was calculated for all children. Results: In our study, the most common age group affected due to Adenoid enlargement was found to be 7-9 years. Snoring and mouth breathing was predominantly present in almost all the children. It was found that children with ANR value >0.7 were the ideal candidates for adenoidectomy. From BMI, the nasopharyngeal depths of obese and overweight children were significantly lower when compared to underweight and normal children. But there was no change in the adenoid size and BMI. The grading of X-ray nasopharynx when compared to the grading of nasal endoscopy it was found that the results were more or less the same. Conclusions: X-ray Nasopharynx contemplates well with symptoms portrayed by patients and gives objective estimate of adenoid enlargement. It also provides us with useful details that may give us an idea to decide on the requirement for surgery based on ANR.

  ABS-5: An Innovative Technique of Neo-pharynx Reconstruction in a Rare Case of Pharyngeal Stenosis Top

Anshu Mangla, Bhushan Kathuria1

PGIMS, 1Kainos Hospital, Rohtak, Haryana, India.

[email protected]

Background/Objective: Pharyngeal stenosis frequently occurs after laryngectomy or laryngo-pharyngectomy, more commonly in patients complicated with a post-operative pharyngo-cutaneous fistula. Oral feeding becomes challenging and can be limited to just liquids. In such cases, dilatations can be performed, but surgery becomes necessary when they are unsuccessful or if there is a complete stricture. The objective of this report is to show that pharyngeal resection & reconstruction with locoregional flap is one of the techniques currently in place which can be useful in such cases. Methods: A 72 -year-old man operated for laryngeal cancer 2 years back, now presented with a pharyngeal stricture 4cm in height causing absolute dysphagia to the patient. Feeding jejunostomy done during the same time was used for maintaining nutrition. The multiple dilatations performed for pharyngeal stenosis were unsuccessful and he underwent pharyngeal resection of the stricture segment, reconstruction for which was done with a supraclavicular artery island flap. Results: The outcome was uneventful. Restoration of normal pharyngeal permeability and swallowing was noted on 12th post-operative day. Post-operative speech was restored. Post-operative follow up after 8 months is also satisfactory. Conclusions: Resection of pharyngeal stenosis with end to end anastomosis can be successfully performed in stenosis of limited height, but in a case of long segment pharyngeal stricture, resection with reconstruction using a loco-regional flap gives satisfactory outcome.

  ABS-4: Temporalis Myofascial Flap in Reconstruction of Maxillary Defect: A Review of Three Cases Top

Nitesh Mishra, Akhilesh Kumar Singh, Janani Anand Kumar, Naresh Kumar Sharma

FDS, IMS, BHU, Varanasi, Uttar Pradesh

E-mail: [email protected]

Background/Objective: Ablative surgery of midface often leads to compromised aesthetics as well as function. Defects caused by ablative surgery need reconstruction that provides satisfactory results with minimal or no compromise in form and function. Various flaps can be used to reconstruct the maxillary defect. However, medium to large-sized defects can only be appropriately reconstructed using free or regional flaps. Moreover, as free flap reconstructions are tedious and require technique sensitive procedure whereas loco-regional flaps are versatile and more predictable. Temporalis myofascial flap (TMF) seems to be one of the best options among all other regional flaps as it has a reliable blood supply, adequate bulk and its anatomical location is close to primary defect This paper intends to provide a review of three cases of maxillary defect reconstruction using TMF with limited complications and to briefly through a light on surgical anatomy, surgical technique, and its importance. Methods: Maxillectomy followed by reconstruction of defect with temporalis myofascial flap. Results: Healing satisfactory with minimal complications with no signs of recurrence after six months of follow-up. Conclusions: Despite the era of free flaps, TMF is a versatile option for the reconstruction of maxillary defect owing to its high predictability, reliable vascular pedicle, and proximity to defects of the oro-facial region. Satisfactory cosmetic and functional results, low donor site morbidity, relative ease of harvesting make TMF as a flap of choice for reconstruction of maxillary defect avoiding more complex reconstructive options.

  ABS-2: Squamous Papilloma of Lip: A Case Report Top

Soumick Ranjan Sahoo, Mandira Sarma

ESIC Model Hospital, Guwahati, Assam, India.

E-mail: [email protected]

Background/Objective: Squamous papilloma is a benign lesion of oral cavity which is caused by human papilloma virus. They usually present as painless asymptomatic exophytic masses and there is proliferation of squamous epithelium. The common site of the lesion is the tongue,soft palate and vermilion border of lips. It usually presents in the age group of 30-50 years. The clinical appearance of squamous papilloma mimics lesions like exophytic carcinoma,verrucous carcinoma which should be kept as differential diagnosis for oral cavity exophytic masses with cauliflower like projections. Diagnosis needs to be confirmed by histopathology. Case History: A 72 year old man presented to ENT OPD with a painless growth in the lower lip near left corner of mouth since 1 year. On examination a solitary,exophytic mass with cauliflower like appearance about 1.5 cm x 1.5 cm was found on lower lip,tenderness absent. A differential diagnosis of verrucous carcinoma, squamous papilloma was made. Routine Preoperative investigations were done and excision was performed under local anaesthesia. Histopathological Examination of excised specimen revealed it to be squamous papilloma with mild dysplasia. Results: Not applicable. Conclusions: Oral squamous papilloma are a group of exophytic masses with cauliflower like projection and hence mimic lesions like verrucous carcinoma. Such lesions are surgically excised,although other modalities of treatment like cryosurgery and intralesional injection of interferon have also been described in literature.Recurrence is uncommon.

  Literature Review: ABS-119: The Role of Salvage Surgery in Patients with Recurrent Oral Cavity Squamous Cell Carcinoma Top

A. Anoop, T. Sajith Babu, P. Sandeep Vijay, Vinod Krishna, Raveena Renshi

Malabar Cancer Centre, Thalassery, Kerala, India.

E-mail: [email protected]

Background/Objective: The overall survival of oral carcinoma has improved over the past decades owing to judicious choice of surgical extent, understanding tumor biology and employment of adjuvant postoperative radiotherapy and chemoradiotherapy. Recurrence has been known to occur around 25% to 45% % in patients treated for oral cancer surgery. Surgical salvage remains the primary option for resectable disease, although proper patient selection is essential. This review of literature aims at identifying the role of salvage surgery for recurrent oral cavity squamous carcinoma. Methods: Data collection has been performed by computer-aided search of the MedLine and PubMed databases. The studies published in the English language and those dealing with "squamous cell carcinoma of the oral cavity were included. Case reports,technical report, review articles were excluded. The abstracts were reviewed and those with apparent relevance was obtained in full text. Results: 8 original papers were selected. Overall recurrence rate in oral cavity squamous cell carcinoma was 29% (16- 49). Overall survival rate of those who received salvage surgery was 46%. Conclusions: It is important to identify the most important patient and tumor factors that can predict reasonable expectations of outcome considering the functional and cosmetic morbidity imposed by salvage surgery. Surgical salvage remains the primary option for resectable disease, although proper patient selection is essential.

  ABS-118: Comparison of Outcome in Oral Cancer Patients Undergoing Segmental Mandibulectomy with Osteocutaneous Free Flaps and Soft Tissue Regional Flaps: A Literature Review Top

P. Sandeep Vijay, Sandeep Vijay, Sajith Babu

Malabar Cancer Centre, Thalassery, Kerala, India.

E-mail: [email protected]

Background/Objective: While surgery remains one of the main modalities of treatment for those with curable oral cavity cancer, segmental mandibulectomy produces severe functional and cosmetic defects. Reconstruction of such complex oro-mandibular defects can be done using microvascular and regional flaps. The fibula flap is the gold standard for mandibular reconstruction due to its long segment of bone with segmental blood supply. But some patients may not be suitable for such fibula flaps due to multiple co-morbidities that will prevent long complicated surgeries. Also a developing country as ours may not have institutions with resources that can carry out such complex surgeries routinely. Fibula flaps do not necessarily ensure dentition also. Review of Literature: Urken et al in 1991 reviewed the functional results of a group of 10 oral cancer patients who underwent microvascular mandibular reconstruction with osseointegrated implants with non reconstructed patients and found a superior level of function in the former group. Mizukami et al in 2013 divided 25 patients with lateral mandible defects into 2 groups and found that vascularised bone flaps gave better deglutition and aesthetic results but similar speech when compared to soft tissue flaps. An-Jou Lin et al in 2018 studied and compared fibula flap and soft tissue flap for mandibulectomy defects and found fibula to have a decreased risk for prolonged tube dependance Bauer et al published a metaanalysis in 2020 comparing the complications following free flaps and soft tissue flaps with plate for mandibulectomy defects and found the latter having delayed plate related issues. Conclusions: Adequate prospective trials are required to give a proper comparison between microvascular bone flaps and soft tissue flaps while restoring mandibular defects.

  ABS-52: Immunotherapy in Head and Neck Cancer: Unlocking the Tumour Biology Conundrum Top

Vasantha Dhara

Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background/Objective: The field of oncology has seen major leaps in cancer treatments with immunotherapy taking the forefront in refractory malignancies. To fully utilize this promising modality it is essential to understand the mechanisms behind the deleterious biological processes occurring in the tumour microenvironment and the rationale behind usage of immunotherapy as a modality. Methods: This poster constructively reviews the tumour microenvironment interactions, highlighting the key elements which are being targeted in immunotherapy. Results: The tumour microenvironment impairs host configuration by virtue of cellular and metabolic processes. The science of immunotherapy targets these critical factors. Conclusions: Various classes of novel immunotherapeutic agents focus on either improving host immunity or attacking the cellular components of the tumour microenvironment. Even though the majority of us follow conventional techniques, it is important to understand the biology of the disease and why immunotherapy can be the game changer.

  Clinical Audit: ABS-114: Audit of Salvage Neck Dissections and Outcomes from a Tertiary Care Hospital Top

Burhanuddin Qayyumi, Ankit Mahuvakar, Vidisha Tuljpurkar, Deepa Nair, Pankaj Chaturvedi

Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: The best management of nodal recurrence remains Salvage Neck Nodal clearance followed by adjuvant therapy. We intend to highlight the various treatment related factors leading to salvage neck dissection (ND) and their survival outcomes. This is the largest series of salvage ND reported till date. Methods: A retrospective analysis of the surgical records from January 2013 till December 2017. Of the 350 cases of salvage ND . 79 patients who had underwent ND as an interval/ staged procedure were excluded. A Total of 271 patients were included in the study. All cases in which surgery for the neck was done along with that of the primary in salvage setting were also excluded and only previously treated HNSCC patients subjected to a salvage ND were included. Results: The most common subsite was Oral cavity [37.2%], followed by oropharynx [27.7%] . The median follow-up was 26 months. Previous treatment history showed Surgery alone done in 41.1%, Surgery plus radiation/radiochemotherapy in 40.3% and followed by radical RT/CTRT in only 11.9%. The median DF survival of the entire cohort was 41 months with a 2 yr OS of 67.1%. Regional recurrence was the most common cause of failure (35.3%) and almost equal number of distant metastasis in (35.1%). The diagnostic accuracy of pre-op FNAC was on 88.73% with a low false negativity of only 3.3%. PETCECT had an over all PPV of 91.18% and NPP of 92.9 %.MND was the most common type of ND 41.8% and selective ND done in only 5.2%. Post salvage only 38.2% received some form of adjuvant therapy. Conclusions: Salvage ND surgery has good DF survival in patients whenever deemed feasible. Salvage of contralateral neck was more common in patients treated surgically during their index treatment. PETCECT- has good NPV and its spatial accuracy in identifying the nodal stations is modest.

  ABS-112: Factor Specific Survival of Stage IV Squamous Cell Carcinoma of Temporal Bone: Institutional Audit Top

Yash Mittal, C. PreetamAbhijeet Mishra, K. V. Aswathi, Vinu Sree, Kalyan Sundaram, Anurita Swaroop

AIIMS, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: The management of stage I-III carcinoma temporal bone yields good outcome in majority of patients. In stage IV lesions the treatment protocols are guided by disease extent and anticipated complications due to involvement/proximity of vital structures. The objective of the review was to analyse our results based on factor specific survival. Methods: A retrospective review of patients with stage IV squamous cell carcinoma of temporal bone treated surgically at our institute from June 2014 to December 2019 was done. A total of 21 patients were included. Modified Pittsburgh staging system was used to stage the disease. All patients were treated with lateral temporal bone resection or subtotal temporal bone resection, with parotidectomy and supra-omohyoid neck dissection, followed by chemo-radiotherapy. Results: The average blood loss and hospital stay was 784 ml and 11.5 days respectively, with a higher incidence in males. Histopathologically margin negative excision was attained in 13 patients. Post-operative complications encountered were facial nerve palsy, ICA injury, CSF otorrhoea, meningitis, skin necrosis and swallowing difficulty. The follow-up ranged from 1.8 years to 6 years. The 2-year disease free survival was 66.66%. Statistically significant correlation with survival was seen with grade of tumor differentiation, nodal positivity, carotid artery involvement and perineural/lymphovascular invasion. Age, sex, positive margin status and dural/intracranial involvement did not have any significant correlation with survival. Conclusions: Factors associated with poor prognosis were poorly differentiated histology, nodal metastasis, carotid artery >180* encasement and presence of lymphovascula/perineural invasion. Margin positivity and dural/intracranial involvement though suggestive of an aggressive disease did not have a significant impact on survival. We recommend total conservative parotidectomy and SOND in all cases with stage IV disease, based on our results.

  ABS-98: Prognostic Factors for Recurrence and Survival in Oral Squamous Cell Carcinoma – Experience of a Single Center from Eastern India Top

Itisha Chaudhary, Mahesh Sultania, Dipin K. Rajan, Mahesh Sultania, Dillip Kumar Muduly, Amit Kumar Adhya, D. K. Parida, M. Kar

All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

E-mail: [email protected]

Background/Objective: Oral Squamous Cell Carcinoma (OSCC) is the second commonest malignancy in males in India. Odisha reports the highest number of cases accounting for 16.93% of all malignancies. Despite aggressive multimodality management, there is almost a 50% chance of recurrence. We present our data of Oral Squamous Cell Carcinoma patients operated in a tertiary care center from Eastern India. Methods: Retrospective analysis of prospectively maintained database of surgically treated patients of oral cancer between January 2017 and July 2020 was done. We analyzed demographic details, clinical and pathological details, surgery and related complications, neo-adjuvant, and adjuvant details, recurrence and survival. The factors associated with recurrence and mortality were analyzed using chi-square test. Disease free survival (DFS) and Overall survival (OS) were calculated using the Kaplan-Meier curve and the Cox regression analysis was done to compare the results. Results: One hundred and sixty-eight patients were analyzed (males–77.38%); 78% of patients consumed tobacco and 17% alcohol. The most common subsite was tongue (40.48%) followed by buccal mucosa (36.90%). The majority of the patients were stage IV disease (47.85%). Around 18% of patients had received neoadjuvant chemotherapy with an almost 60% response rate. Recurrence was reported in 41(25.2%) patients and 28(17.2%) patients had mortality during the follow-up. The final stage of disease (p-value-0.005), presence of extranodal extension (p-value-0.015) and peri-neural invasion (p-value-0.016) were found to be affecting DFS and OS was affected by the Final Stage of disease (p-value-0.002), presence of extranodal extension (p-value-0.024) and Nodal positivity (p-value-0.014) in our analysis. Median DFS duration was 17.4 months. Conclusions: Advanced disease stage at presentation, presence of extra-nodal extension, nodal positivity and perineural invasion are associated with poor survival. Disease free survival and Overall survival in OSCC patients is better in the absence of these poor prognostic factors.

Keywords: Disease free survival, oral squamous cell carcinoma, overall survival

  ABS-72: Pattern of Care and Treatment for T4a Laryngeal and Hypopharyngeal Carcinoma and Their Outcomes Top

Madan P. Gupta, Shiva Kumar Thiagrajan, Gurpreet Singh, Pranav Sathe, Sarbani Lashkar, Kumar Prabash, Devendra Chaukar

TMH, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Though total laryngectomy is the recommended and most often preferred treatment option for T4a laryngeal and hypopharyngeal carcinoma, non-surgical treatment in the form of concurrent chemoradiotherapy (CCRT) is an option in a select few patients, especially those with exolaryngeal spread without cartilage erosion and a functional larynx. Methods: We did this retrospective study to assess the pattern of care and treatment outcomes of treatment naive patients who received both surgical and non-surgical treatment(CCRT) for T4a carcinoma of larynx and hypopharynx between January 2012 to Dec 2016. Results: One hundred and twenty patients satisfied the eligibility criteria and were included in the study for analysis. The median age of the cohort was 61.5 years (Range:24-85 years). Majority of them were men (n=110,91.6%) with laryngeal primary (n=75, 62.5%). They were staged as T4a cancer for only exolaryngeal spread (group A) in 42 patients (35%), only cartilage erosion (both lamina) (group B) in 30 patients (25%), and for both (group C) in 48 patients (40%). The majority of patients with only exolaryngeal spread with the functional larynx (n=25 out of 34) and hypopharyngeal primary (n=17 out of 27) received CCRT. The overall survival was 69.9 months, 75 months, and 69.7 months respectively for the three groups with surgical treatment and 36.3 months, 11.5 months, and 38 months respectively with CCRT. The single most important factor determining the OS on multivariate analysis was the decision between surgery and CCRT (p<0.001, 4.771[2.526-9.013]). Conclusions: T4a Larynx, even those with exolaryngeal spread without cartilage erosion, should be considered for surgery whenever feasible.

  ABS-70: A Clinical Audit of Hemithyroidectomy for Differentiated Thyroid Cancer - Experience from a Tertiary Cancer Center Top

C. Nithyanand, Shivakumar Thiagarajan, Nandhini Menon, Gurupreet Singh, Siddhanth Jain, Pranav Sathe, Adhara Chakraborthy

Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Existing guidelines recommend lobectomy/hemithyroidectomy (HT) for low-risk thyroid cancer. They are considered to be safer with lesser complications compared to total thyroidectomy. However, HT is also associated with certain complications. Methods: We conducted this retrospective clinical audit of all patients who underwent HT for DTC in our institute from January 2012 to December 2018. The aim of the study was to assess the complications following HT and the followup of these patients subsequently. Results: A total of 128 patients satisfied the eligibility criteria. The majority of the patients were women (n=103, 80.5%). The median age of the patients was 36.5 years (Range:19-77 years). Neck swelling was the most common presentation. All patients underwent conventional open hemithyroidectomy. Five patients had 1-2 metastatic nodes in the central compartment however none had metastatic nodes in the lateral neck. Biochemical hypocalcemia (n=16, 12.5%) was the most common postoperative complication followed by recurrent laryngeal nerve palsy (n=5, 3.9%). Twenty-six patients developed hypothyroidism at a median duration of 6.5 months following HT necessitating replacement therapy. None of the patients developed recurrence during follow up (median of 27.5 months.). Conclusions: HT is a feasible treatment option for patients with carefully selected cases of DTC. However, HT is also associated with certain complications that should be kept in mind and patients should be counseled accordingly.

  ABS-62: Head and Neck Surgery during COVID-19 Pandemic: Experience from a Tertiary Care in India Top

Smriti Panda, Chirom Amit Singh, Abhilash Konkimalla, Alok Thakar

AIIMS, New Delhi, India.

E-mail: [email protected]

Background/Objective: Head and neck pathologies requiring surgical intervention are considered a high-risk subsite in the context of COVID-19 pandemic by virtue of their close proximity to the mucosa of the upper aerodigestive tract. The aim of this audit is to elucidate perioperative screening and isolation strategies for head and neck operative procedures at our institution and present our results with emphasis on perioperative outcomes. Methods: Retrospective review of all head and neck surgical procedures undertaken during the pandemic from 23rd April 2020 to 30th September 2020. Results: 100 procedures were performed on 98 patients. COVID-19 status determined by SARS-Cov-2 RT-PCR at baseline was negative for 81, positive in 8 and unknown in 11. The RT-PCR negative subgroup included 40 diagnostic procedures and 41 ablative and or reconstructive procedures for head and neck neoplasms. None of the patients or health-care workers converted to COVID-positive status during the duration of the hospital stay. There were no cases with 30-day mortality. Clavien Dindo grading for post-operative complications was as follows: 1-4, 2-12, 3a-2, 3b-1. 11 patients with unknown COVID-19 status at baseline underwent emergency tracheostomy in a COVID designated operating room for upper airway obstruction secondary to head and neck cancer. Of the 8 procedures conducted on known cases of COVID-19, 6 were tracheostomies performed for COVID ARDS. The rest were maxillectomy for acute invasive mucormycosis and incision and drainage for parotid abscess. Conclusions: By meticulous preoperative COVID-19 screening and isolation, head and neck surgical procedures can be continued to avoid delay in diagnosis and treatment without increasing the risk of transmission of COVID-19 to the patients or health-care workers.

  ABS-59: Reconstruction of Anterior Segmental Mandibular Defect in Oral Oncologic Resections using Pedicled Flaps- Review of Cases and Experience Top

Anand Gupta, Preeti Sharma, Gurvanit Lehl

Government Medical College Hospital, Chandigarh, India.

E-mail: [email protected]

Background/Objective: Mandibular reconstruction in anterior segmental defects is the most challenging situation in the management of oncologic resections. Immediate reconstruction with microvascular free flaps being a gold standard, is not feasible in all cases due to unavailability of the expertise and also patient factors for not tolerating long duration surgeries. At many centers, immediate reconstruction with titanium reconstruction plate is not considered due to fear of complications with post operative radiotherapy. We hereby conducted a retrospective study to review our cases of anterior mandible reconstruction using pedicled flaps. Methods: The patient records of oral malignancy patients treated between January 2015 and July 2020 were searched. Patients treated with anterior segmental resection of mandible followed by immediate reconstruction using titanium reconstruction plate and pedicled flap were included. The data was properly collected for the defined parameters like demographic details, type of bone defect, post operative radiotherapy given, complications, survival status and follow up. Results: A total of 21 patients were included in this study. Titanium reconstruction plate was used in all patients to bridge the defect. Pectoralis musculo- myocutaneous (PMMC) was the most commonly used flap (n=13, 62%), followed by Sternocleidomastoid musculocutaneous (SCM) (n=6, 29%) flap for soft tissue reconstruction. Majority of patients (n=18, 86%) were offered post operative radiotherapy. In complication rates, plate exposure was seen in 2 (9.5%) patients and plate infection was seen in 2 (9.5%) patient. All other patients had good stable occlusion with proper function. The follow up has ranged from 6 to 61 months with mean of 20.6 months. Conclusions: Immediate reconstruction in anterior mandibular resections using titanium reconstruction plate and pedicled flap is a viable solution and it provides proper occlusion and function to the patient. The complication rate is low and good cover of soft tissue on the reconstruction plate prevents its early exposure.

  ABS-40: Audit of Radiation Oncology Practice and Management Plan of Head and Neck Cancers during the COVID-19 Pandemic: Lessons Learnt Top

J. Meenakshi, Sarbani Ghosh Laskar, Shwetabh Sinha, Naveen Mummudi, Monali Swain, Ashwini Budrukkar

Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: To assess the impact of modifications in radiotherapy practice and management plan on Head and Neck Cancers during the COVID-19 pandemic at a tertiary cancer centre. Methods: An audit of all patients who underwent radical intent radiotherapy between 16thMarch 2020 and 15thAugust 2020 (during COVID-19 lockdown) was carried out. Data captured from electronic medical records included: clinico-demographic profile, ideal treatment that patient should have received versus treatment received, reasons for same, compliance, outcomes, and toxicities. Results: One hundred and seventy-three patients were treated, definitive in 67(36%) and adjuvant in 106 (56%). All patients warranting surgery as primary local therapy underwent surgery. Delay in starting RT > 6 weeks after surgery occurred in 11 (10.4%) patients [5 due to lockdown, 1 COVID positive, 5 wound complications]. The most common (44.5%) fractionation schedule was 2.2Gy/ fraction, 5 days/ week, over 5-6 weeks. Of the 102 patients who warranted concurrent chemotherapy 15 could not receive it (4 due to lockdown, 7 due to age and co-morbidities and 4 unknown). Major non-compliance on radiotherapy was seen in 16 (9%) patients (6 due to lockdown, 5 due to machine breakdown, 4 COVID positive and 1 due to toxicities). Acute ≥ grade 2 toxicity was seen in 101 (58%) patients. Median follow up was 4 months (range: 0-7 months). At last follow-up 118 (68%) patients were alive and disease free, 37 (21%) patients had residual/ recurrent disease and 18 patients were lost to follow-up. There was no difference in disease related outcomes (local control) and toxicity between patients receiving conventional or hypofractionated radiotherapy (p=0.17, p=0.49). Conclusions: Despite the pandemic 92.5% patients received standard of care. The modest hypofractionation did not result in inferior outcomes. These early results are encouraging and could pave the way for a "new normal" even after the pandemic.

  ABS-6: Local Flaps for Tongue Cancer Defects: Our Experience Top

Poonam Joshi, Kamal Deep Joshi, Sudhir Nair

Tata Memorial Hospital, Mumbai, Maharashtra, India.

E-mail: [email protected]

Background/Objective: Tongue is an important organ responsible for functions of speech, swallowing and taste. Surgery is the primary treatment for carcinoma of tongue. Primary closure is done for small size defects and medium to large size defects are closed with local, regional or free flaps. In this study, we have evaluated 22 patients of tongue cancer who were reconstructed with local flaps. Methods: This is a retrospective analysis of prospectively collected data from September 2019 to October 2020 at ACTREC, Tata Memorial center, Mumbai. Patients follow up data was recorded for complications along with Performance status scale for head & neck cancer patients (PSS-HN Score). Results: Twenty patients were treatment naïve; one patient was post neoadjuvant chemotherapy and one had recurred post surgery. Majority of the patients were males (19/22, 86%) and 3 were females. Mean age at presentation was 50 years (range:29-73 years). Most of the patients had early stage cancers (T2), however none of them were T1. Thirty two percent (32%) were T3 and 9% were T4. Among these 22 patients, 82% had nodal stage N0. Islanded melolabial flap was done in 14 patients (median size- 8 x 3.5 cm) and none of the patient had any flap failure. Donor site morbidity was a scar in the melolabial crease which healed well and became inconspicuous subsequently. Islanded FAMM flap was done in 4 patients with one patient having complete flap loss. Submental flap was done for two patients and Infrahyoid flap for 1 patient and none had flap or donor site morbidity. Supraclavicular flap was done for 1 patient and had partial necrosis which was managed with local debridement and secondary healing. Marginal nerve paresis was present in 73% of the patients (grade II/III). The mean PSS-HN score was 192.85 at 6 months. Conclusions: Local flaps can provide an alternate option to free flaps in reconstruction of moderate size tongue defects. They have a consistent blood supply with low flap failure rates and need less operative time.

  Basic Science Research: ABS-71: Study to Assess Feasibility of Creating a Tissue Engineered Trachea in Wistar Rat Model; Phase 1 Sutdy Top

Sumanth Bollu, Alok Thakar, Manu Dalela, Sujata Mohanty, Atul Sharma, Ashit Mirdha, Chirom Singh

All India Institute of Medical Sciences, New Delhi, India.

E-mail: [email protected]

Background/Objective: Tracheal reconstruction is a complex surgical procedure associated with high rates of complications and mortality. Recent progress in the application of tissue engineering in airway reconstruction has provided renewed optimism for potential solutions for longer tracheal defects otherwise deemed unsuitable for treatment with a conventional open and endoscopic procedure. Objectives; (1) To demonstrate the efficacy of decellularization and recellularization of rat trachea & to validate the distribution of recellularization of the tracheal scaffolds. (2) To standardize the technique for effective decellularization and recellularization of rat trachea as a precursor for the human allogenic tracheal transplantation. Methods: To validate the above-mentioned objectives, Wister Rat's model was selected. Rat tracheal tissue was harvested and subjected to two different decellularization protocols namely, Triton-X 100 (n=6) and Enzymatic-Detergent method (EDM) (n=6). As part of Qualitative assessment, tracheal tissues were subjected for H&E, DAPI staining, DNA &GAG content quantification assay. Further, we performed scanning electron microscopy and mechanical strength to assess the integrity of collagen and extracellular matrix in tracheal treated samples. Results: Both decellularization protocols were effective in eliminating the cellular components and the antigenic material from tracheal cartilage and soft tissues. DAPI staining of tracheal scaffolds showed a lack of viable nuclear material in pan-cellular layers. The DNA quantification of the EDM, Triton-X 100 and native trachea was 18.56, 9.65, 330.58 ng/mg respectively, and showed a 95% reduction of nuclear material in decellularized scaffolds. Glucosamine glycan's quantification assay and scanning electron microscopy showed well preserved interwoven collagen network and extracellular matrix. Recellularization of the scaffolds with florescent tagged fibroblast showed viable cells with retained morphology. Conclusions: Current decellularization protocols maybe consider to have achieved the optimal balance between the antigen elimination while maintaining the ECM composition and ultrastructures in the tracheal scaffolds. Thus resulting decellularized extracellular matrix may serve as viable tissue engineering scaffold for recellularization.

  ABS-22: Peripheral Blood Cell Parameters as Predictors of Tumor Granulocyte Colony Stimulating Factor Expression; in Patients of Head and Neck Squamous Cell Cancer – A Pilot Study Top

Chaitali Manohar Waghmare, Hemant J. Pawar1, Nikhil Deshpande, Ravindra Karle, Angarkar Nandkishor

RMC and PRH, PMTPIMS, 1PRH, PMTPIMS, Loni, Ghaziabad, Uttar Pradesh, India.

E-mail: [email protected]

Background/Objective: Tumor secreting granulocyte-colony stimulating factor(G-CSF) and/or G-CSF therapy in cancer has been documented as a poor prognostic factor. Tumor G-CSF study is a relatively costly and sparsely available investigation. Therefore this study was undertaken to predict tumor G-CSF score from peripheral blood cell parameters(PBCP) as a cheaper and easily available alternative, in patients of head and neck squamous cell cancer (HNSCC). Methods: After institutional ethics committee approval, prospectively collected data of non-metastatic HNSCC patients registered in radiation oncology department from February to December 2019 was analyzed. PBCP (absolute neutrophil count–ANC, absolute monocyte count–AMC, absolute lymphocyte count–ALC, neutrophil to lymphocyte ratio–NLR, platelet to lymphocyte ratio–PLR) done before any active oncology treatment were noted. Patients whose pre-treatment PBCP and formalin-fixed, paraffin-embedded tissue were available; were studied for tumor G-CSF expression by immunohistochemistry(IHC). A semiquantitative tumor G-CSF score on a scale of zero to 300 was calculated. Data was collected, compiled and analyzed using statistical software SYSTAT version 12.0 by Cranes software, Bengaluru. Results: The data of 47 eligible patients were analyzed. The median age at presentation was 60 years with male to female ratio of 43:4. Most common head and neck sub-site reported was oropharynx (31.92%) and majority of patients presented with stage IVA disease (51.1%). Higher tumor G-CSF score tertile were significantly associated with a higher T-stage (p-value 0.013). The tumor G-CSF score was directly proportional to ANC, AMC and ALC while it was inversely proportional to NLR and PLR (Karl Pearson's correlation). Regression equations to predict the tumor G-CSF score when ANC, AMC, ALC, NLR and PLR are known; were determined. Conclusions: The peripheral blood cell count can predict the tumor G-CSF score. Future studies with large number of patients are needed to elucidate its clinical use.


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