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Long term survival following the detection of circulating tumour cells in head and neck squamous cell carcinoma

Stuart C Winter1, Sally-Anne Stephenson2*, Selva K Subramaniam13, Vinidh Paleri4, Kien Ha1, Conor Marnane5, Suren Krishnan1 and Guy Rees1

Author Affiliations

1 Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia

2 Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia

3 Department of ENT, Head and Neck Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia

4 Department of Otolaryngology, Head and Neck Surgery, Freeman Hospital, Newcastle Upon Tyne, UK

5 Department of Otolaryngology, Head and Neck Surgery. Swansea Hospital, Wales, UK

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BMC Cancer 2009, 9:424  doi:10.1186/1471-2407-9-424

Published: 6 December 2009



Techniques for detecting circulating tumor cells in the peripheral blood of patients with head and neck cancers may identify individuals likely to benefit from early systemic treatment.


Reconstruction experiments were used to optimise immunomagnetic enrichment and RT-PCR detection of circulating tumor cells using four markers (ELF3, CK19, EGFR and EphB4). This method was then tested in a pilot study using samples from 16 patients with advanced head and neck carcinomas.


Seven patients were positive for circulating tumour cells both prior to and after surgery, 4 patients were positive prior to but not after surgery, 3 patients were positive after but not prior to surgery and 2 patients were negative. Two patients tested positive for circulating cells but there was no other evidence of tumor spread. Given this patient cohort had mostly advanced disease, as expected the detection of circulating tumour cells was not associated with significant differences in overall or disease free survival.


For the first time, we show that almost all patients with advanced head and neck cancers have circulating cells at the time of surgery. The clinical application of techniques for detection of spreading disease, such as the immunomagnetic enrichment RT-PCR analysis used in this study, should be explored further.