Peters et al used 2 scores at the M.D. Anderson Cancer Center to predict the risk of primary site and of neck recurrence following a cancer of the head and neck. This was used to help plan radiation therapy.
Scores for risk of recurrence:
(1) at the primary site
(2) in the neck
Parameters for primary site recurrence risk:
(1) stage
(2) margins
(3) nerve invasion
(4) neck nodes
|
Parameter |
Finding |
Points |
|---|---|---|
|
stage |
T1 or T2 |
0 |
|
|
T3 |
2 |
|
|
T4 |
4 |
|
margins |
negative |
0 |
|
|
mucosal margin positive on frozen, negative on re-excision |
2 |
|
|
deep margin positive on frozen, negative on re-excision |
3 |
|
|
final margin close (< 5 mm) or positive |
4 |
|
nerve invasion |
none |
0 |
|
|
minor nerve positive |
2 |
|
|
major nerve entrapped (in tumor but not histologically invaded) |
3 |
|
|
major nerve invaded |
4 |
|
neck nodes |
N0 |
0 |
|
|
N1 |
1 |
|
|
N2 or N3 |
2 |
Parameters for recurrence risk in the neck:
(1) number of nodes
(2) number of nodal groups
(3) size and extracapsular extension
(4) direct invasion
|
Parameter |
Finding |
Points |
|---|---|---|
|
number of nodes |
0 |
0 |
|
|
1 |
1 |
|
|
2 or 3 |
2 |
|
|
>= 4 |
3 |
|
|
matted |
3 |
|
number of nodal groups |
0 or 1 |
0 |
|
|
2 |
1 |
|
|
3 |
2 |
|
|
>= 4 |
3 |
|
size and extracapsular extension |
none |
0 |
|
|
< 3 cm in diameter AND no extracapsular extension |
1 |
|
|
>= 3 cm in diameter AND no extracapsular extension |
2 |
|
|
< 3 cm in diameter AND extracapsular extension |
3 |
|
|
>= 3 cm in diameter AND extracapsular extension |
4 |
|
direct invasion |
none |
0 |
|
|
muscle, skin, nerve, vein |
3 |
|
|
carotid artery, base of skull |
4 |
where:
• For maximal nodal size, the table has size as "< 3" and "> 3" with no coverage for "= 3" in the group with no extracapsular extension. The extracapsular group uses 3-6 (>= 3).
risk score for primary site recurrence =
= SUM(points for all 4 parameters)
risk score for recurrence in the neck =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
|
Risk Score for Primary Site Recurrence |
Risk Group |
|---|---|
|
0 |
very low |
|
1 to 6 |
low |
|
7 to 14 |
high |
|
Risk Score for Neck Recurrence |
Risk Group |
|---|---|
|
0 |
very low |
|
1 to 6 |
low |
|
7 to 14 |
high |
Purpose: To evaluate a patient with a head and neck cancer for risk of recurrence using the scores used at M.D. Anderson Cancer Center.
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
Objective: risk factors, criteria for diagnosis, severity, prognosis, stage, response to therapy, interventional radiology
ICD-10: C49.0, C44.4,
