Important Note: The following information is provided for your education. It should not be relied upon for personal diagnosis or treatment. If you believe that a particular therapy applies to you or someone you care about, be sure to consult a doctor before trying it.
   

On Downloading (Please Read Carefully)   
To download or print the Oral Cancer File, point your mouse to "File" in the top bar of your Explorer or Netscape window, and click once. Now click once on either "Save As" (download), or "Print" (print), and follow the appropriate prompts.
  

Oral Cancer Research: 2002-2006
     
Int J Radiat Oncol Biol Phys. 2006 Nov 1;66(3):731-7.
Gemcitabine and cisplatin in a concomitant alternating chemoradiotherapy program for locally advanced head-and-neck cancer: a pharmacology-guided schedule.
Numico G, Russi EG, Vitiello R, Sorrentino R, Colantonio I, Cipolat M, Taglianti RV, Pelissero A, Fea E, Granetto C, Di Costanzo G, Gasco M, Garrone O, Occelli M, Merlano M.
Medical Oncology, S. Croce General Hospital, Cuneo, Italy. gianmauro.numico@fastwebnet.it

PURPOSE: Administration of gemcitabine together with cisplatin at cytotoxic doses in a chemoradiotherapy regimen is hampered by a high degree of local toxicity. Using the pharmacologic properties of the drug we designed a modified schedule aimed at reducing toxicity while preserving activity. METHODS AND MATERIALS: Patients with squamous cell carcinomas of the oral cavity, pharynx and larynx, bulky T4, and/or N2 to N3 were eligible. Gemcitabine was administered at a dose of 800 mg/m2 on Days 1 and 12 and cisplatin at a dose of 20 mg/m2 on Days 2 to 5, every 21 days for 3 courses. Radiotherapy, delivered with standard fractionation, was given on Days 8 to 12 and 15 to 19 and was repeated 3 times up to a total dose of > or = 60 Gy. RESULTS: A total of 28 patients were selected. Grade 3 to 4 stomatitis was recorded in 25 patients (89%). Thirteen patients (46%) experienced Grade 3 to 4 neutropenia. Febrile neutropenia occurred in 8 patients (29%) and in 2 was complicated by infection and death. The overall complete response rate was 79%. At a median follow up of 71 months, 11 patients had a locoregional relapse (3-year locoregional control, 64%); 6 patients had distant metastases, among whom only 2 were without locoregional recurrence. The 3-year progression-free survival is 39% and 3-year overall survival has been 43%. CONCLUSION: The schedule modification did not attenuate local toxicity. Moreover, infections and especially pneumonia, were a major problem. The high activity of gemcitabine when combined with radiotherapy would most likely be better exploited in the context of modified radiation schemes.

-----

Rev Laryngol Otol Rhinol (Bord). 2006;127(3):187-90.
[Primary sub-mandibular gland tumours: experience based on 68 cases]
[Article in French]
Oudidi A, El-Alami MN, Boulaich M, Jazouli N, Kzadri M.
Hopital des Specialites, Service ORL & Chirurgie Maxillo-Faciale, Rabat, Maroc. otorhino@hotmail.com

Sub-mandibulary gland tumours are less common than tumours of the parotid and pose many clinical and therapeutic challengers. OBJECTIVE: We report our experience of sub-mandibular tumours and review the literature. PATIENTS AND METHODS: Retrospective studies of sub-mandibular gland tumours presenting to our department between 1986 and 2000. RESULTS: 68 cases were reviewed comprising 37 benign and 31 malignant tumours (15 females and 33 males). Average age of patient was 46 years and all presented with a sub-mandibular swelling. Clinical suspicion of malignancy was associated with symptom of pain, cervical adenopathy, nerve palsy, skin and/or bone invasion. CAT Scans were performedd to assess tumour extent / invasion. Definitive diagnosis was by complete excision and pathological examination. Pleomorphic adenoma (n= 32) were the most frequent benign tumours. For malignant lesions (n= 31) the most frequent were: Adenoid cystic carcinoma (n= 10), epidermoid carcinoma (n= 5), adenocarcinoma (n= 5), mucoepidermoid carcinoma (n= 3), malignant non Hodgkinien lymphoma (n= 5). Treatment was by total surgical excision of the submandibular gland for the begnin tumours. For the malignant lesions it was associated acording to their extension with other anatomical region or in case of adenopathy with neck dissection. Radiotherapy was performed in 24 cases and chemotherapy in 10 cases. CONCLUSION: Malignity in sub-mandibular gland tumours is more frequent than in the parotid gland. Any delay in diagnosis or inappropriate management may result in a poor prognosis for the patient.

-----

Schweiz Monatsschr Zahnmed. 2006;116(8):812-20.
[Soft tissue surgery with the diode laser—theoretical and clinical aspects]
[Article in French, German]
Stubinger S, Saldamli B, Jurgens P, Ghazal G, Zeilhofer HF.
Universitatsklinik fur Wiederherstellende Chirurgie, Abteilung fur Kiefer- und Gesichtschirurgie Universitatsspital Basel, Schweiz. sstuebinger@uhbs.ch

Currently laser light of different wavelengths is used for all kinds of surgical procedures in oral and maxillofacial surgery. In this regard especially the diode laser is mainly used, because of its excellent effects on oral soft tissues. On the basis of various oral soft tissue lesions in 40 patients the benefits of the diode laser in daily practice are demonstrated. Intraoperative and postoperative clinical findings were excellent due to the sufficient cutting abilities, the good coagulation effect and the extremely small zone of thermal necrosis to surrounding tissues. By this the diode laser has proven as an alternative solution to conventional electrosurgery and scalpel. The precise treatment in the contact application mode, which allowed an easier and more controlled guidance of the laser beam, was another advantage of the fiber-assisted laser system. In conclusion the results show that the diode laser is a useful instrument in oral soft tissue surgery.

-----

J Oral Maxillofac Surg. 2006 Sep;64(9):1409-14.
Surgical salvage for local and regional recurrence in oral cancer.
Ord RA, Kolokythas A, Reynolds MA.
Professor/Chairman, Department of Oral and Maxillofacial Surgery, University of Maryland, Greenbaum Cancer Center, Baltimore, MD.

PURPOSE: To evaluate local and regional recurrence and the outcomes for salvage surgery in patients for oral cancer. PATIENTS AND METHODS: This study analyzed 354 consecutive patients with oral cancer treated primarily by surgery or surgery combined with adjuvant therapy by 1 surgeon (R.A.O.) between February 1991 and September 2001. RESULTS: Overall recurrence rate was 15.5%; with 5.4% local, 8.5% regional, and 1.4% locoregional. Overall salvage for local recurrence was 52.6% 3-year survival, and statistically significant favorable prognostic factors were salvaged by surgery alone and initial cancer staging of I/II. Overall salvage for regional recurrence was 50%, with recurrence in a previously untreated neck and salvage with radical neck dissection plus radiotherapy giving the best prognosis. No patients with locoregional recurrence were salvaged. CONCLUSIONS: Patients who were stage I/II and were treated initially by surgery alone were the best candidates for salvage if they recurred. Salvage was best achieved with surgery or surgery + adjuvant therapy, and patients recurring within 6 months had a worse survival. Patients with locoregional recurrence or treated with RT +/- chemotherapy alone have negligible survival.

-----

Clin Oral Implants Res. 2006 Aug;17(4):367-74.
Comparison of early telescope loading of non-submerged ITI implants in irradiated and non-irradiated oral cancer patients.
Landes CA, Kovacs AF.
Maxillofacial and Plastic Facial Surgery, The J.-W. Goethe, University Medical Centre, Frankfurt, Germany.

To compare early dental implant loading in irradiated and non-irradiated oral cancer patients in order to accelerate masticatory function improvement and quality of life. One hundred and fourteen non-submerged interforaminal ITI implants were early loaded in 30 patients after 3 weeks in situ (telescoped overdenture). Nineteen patients received 72 implants (63%) after local irradiation; 11 non-irradiated patients received 42 implants (37%) with a 24-month follow-up. At 24 month follow-up, one early failure had occurred in an irradiated patient (=99% functioning implants in situ). Peri-implant bleeding and plaque index were similarly high in both groups (40 to 68% average).The Results of other measured parameters were as follows (values for mean; irradiated; non-irradiated patients with respective standard deviations; significance of comparison): bone loss (0.9+/-0.9; 1.4+/-0.9; 0.4+/-0.5 mM; P<0.01); Periotest((R)) score (-2.7+/-2.7; -2.4+/-2.2; -3.1+/-3.3; P<0.2); gingival recession (0.6+/-0.7 mM; 0.8+/-0.9 mM; 0.4+/-0.5 mM, P<0.02); and peri-implant probing depths (3+/-1.2; 2.6+/-0.6; 3.4+/-1.7 mM; P<0.002). The results suggest reliable non-submerged implantation and early loading. However, bone loss in irradiated mandibles, combined with higher average Periotest values and gingival recession in an oral environment of altered saliva quantity, quality, microflora and local scarring, requires extended follow-up. To cite this article: Landes CA, Kovacs AF. Comparison of early telescope loading of non-submerged ITI implants in irradiated and non-irradiated oral cancer patients. Clin. Oral Impl. Res. 17, 2006; 367-374 doi: 10.1111/j.1600-0501.2005.01227.x.

-----

Laryngoscope. 2006 Aug;116(8):1465-72.
Transoral robotic surgery (TORS) for base of tongue neoplasms.
O'Malley BW Jr, Weinstein GS, Snyder W, Hockstein NG.
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. bert.omalley@uphs.upenn.edu

OBJECTIVE: To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation. STUDY DESIGN: Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs. Transoral robotic surgery (TORS) was then performed on three human patients with tongue base cancers in a prospective human trial. METHODS: Using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs. In the cadaver models, exposure was evaluated using three different retractors, the Dingman, Crowe Davis, and FK retractors. The three human patients underwent TORS surgery of their tongue base cancers under an institutional review board approved prospective clinical trial. The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal, hypoglossal, and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed. RESULTS: The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers, dogs, and human patients. Among the three retractors evaluated, the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability. Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries. CONCLUSIONS: TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients. TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery.

-----

Arch Otolaryngol Head Neck Surg. 2006 Jul;132(7):788-93.
Metastasizing pleomorphic salivary adenoma.
Nouraei SA, Ferguson MS, Clarke PM, Sandison A, Sandhu GS, Michaels L, Rhys-Evans P.
Department of Otolaryngology-Head and Neck Surgery, Charing Cross Hospital, London, England. RN@cantab.net

OBJECTIVE: To address questions about the etiology, behavior, optimal treatment, and prognosis of metastasizing pleomorphic adenoma (MPA), we undertook a review of the literature (1953-2005) and constructed a virtual series of all identified cases of MPA, metastatic lesions that are very occasionally identified in patients with a history of pleomorphic salivary adenoma and, on detailed pathological evaluation, found to exhibit all the histological hallmarks of the preceding benign lesions. DATA SOURCES: A review of the English-language literature between 1953 and 2005 using MEDLINE, secondary references identified from bibliographies of pertinent articles, and a further case from one of our institutions. DATA SYNTHESIS: A virtual case series was constructed and quantitatively analyzed. Forty-two patients with an average age of 33 years were identified. There were 20 male and 22 female patients. There was an overwhelming history of incomplete surgery for pleomorphic salivary adenoma. Most patients had locoregional recurrences before metastasis, and the mean presentation-to-metastasis latency was 16 years. Bone was the most common site for metastases (45%), followed by the head and neck (43%) and lung (36%). There was significant morbidity and mortality from distant disease, with 5-year disease-specific and disease-free survival of 58% and 50%, respectively. Developing distant lesions within 10 years of the primary tumor and presence of metastases in multiple sites were independent predictors of survival on Cox regression analysis. Metastasectomy conferred significant survival advantage over nonoperative treatment (log-rank analysis, P<.02). Chemotherapy and radiotherapy were of limited value. CONCLUSIONS: Meticulous surgery is crucial in preventing MPA. Metastatic disease carries significant morbidity and mortality and should be treated surgically when feasible.

-----

Arch Otolaryngol Head Neck Surg. 2006 Jul;132(7):767-70.
Malignant minor salivary gland tumors of the larynx.
Ganly I, Patel SG, Coleman M, Ghossein R, Carlson D, Shah JP.
Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.

OBJECTIVE: To report our experience in treating patients with malignant minor salivary gland tumors of the larynx. DESIGN: Thirty-three-year retrospective study. SETTING: Tertiary referral center specializing in head and neck surgery. PATIENTS: Twelve patients with malignant minor salivary gland tumors of the larynx were identified from a search of the institutional databases and pathology records at Memorial Sloan-Kettering Cancer Center, New York, NY, between the years 1970 and 2003. All slides were independently reviewed by 2 pathologists (R.G. and D.C.). Details on patient and tumor characteristics, as well as treatment and surgical outcome, were recorded. RESULTS: Ten patients (83%) had adenoid cystic carcinoma and 2 (17%) had myoepithelial carcinoma. Five (42%) were located in the supraglottis and 7 (58%) in the subglottis. Ten (83%) had surgery (6 with adjuvant radiotherapy) and 2 (17%) were treated with radiotherapy alone. Of the 10 patients who had surgery, total laryngectomy was required in 6 (60%), supraglottic horizontal laryngectomy in 2 (20%), and cricotracheal resection in 2 (20%). With a median follow-up of 55 months (range, 1-194 months), 10 patients are alive, 6 of whom have no evidence of disease. Seven patients (58%) developed recurrent disease, 2 of whom had local recurrence alone, 1 had regional recurrence alone, 3 had distant recurrence alone, and 1 had local and distant recurrence. CONCLUSIONS: Up to 60% of patients with malignant minor salivary gland tumors of the larynx will develop recurrent disease locally, regionally, or at distant sites. In adenoid cystic carcinoma, regional recurrence is rare, but distant recurrence is common and may occur up to 10 years after the index therapy. For both adenoid cystic and myoepithelial carcinoma, partial surgery is possible in selected cases, but because of the high propensity for submucosal spread and perineural and lymphovascular invasion, total laryngectomy is usually recommended.

-----

Otolaryngol Head Neck Surg. 2006 Jul;135(1):140-3.
Postoperative radiation therapy for T1 and T2 primary parotid carcinoma: is it useful?
Zbaren P, Nuyens M, Caversaccio M, Greiner R, Stauffer E.
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, CH-3000 Berne, Switzerland. peter.zbaeren@insel.ch

OBJECTIVE: The benefit of postoperative radiation for advanced primary parotid carcinoma has been reported previously, whereas studies to evaluate the usefulness of postoperative radiation for T1 and T2 parotid carcinomas have never been performed. STUDY DESIGN AND SETTING: Retrospective analysis on 58 previously untreated patients with T1 and T2 parotid carcinomas. In 34 patients, postoperative radiation was included in the treatment protocol and in 24 patients, no postoperative radiation was applied. RESULTS: A local recurrence was observed in 8 of 24 (33%) patients without and in 1 of 34 (3%) patients with postoperative radiation (P < 0.5). The 5-year actuarial and disease-free survival rate was 83% and 70% for patients without postoperative radiation and 93% and 92% for patients with postoperative radiation. CONCLUSION AND SIGNIFICANCE: Local recurrence was less often observed in patients with postoperative radiation. Nevertheless, prospective randomized studies are needed to confirm the usefulness of postoperative radiation in early carcinomas. EBM rating: B-3b.

-----

J Oral Maxillofac Surg. 2006 Jul;64(7):1114-20.
Management of adenoid cystic carcinoma of minor salivary glands.
Triantafillidou K, Dimitrakopoulos J, Iordanidis F, Koufogiannis D.
Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece. voula@dent.auth.gr

PURPOSE: Adenoid cystic carcinoma (ACC) is a rare malignant tumor originating from the salivary glands. The characteristic clinicopathologic features of this tumor are perineural spread, local recurrences, and distant metastases. Radical surgery combined with radiotherapy, as mentioned in the literature, is the best method of treatment. This clinical review article is intended to analyze the outcome of management of a group of 22 ACC patients, who were treated in our clinic. METHODS: Between 1985 and 2000, 22 patients with ACC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the "G. Papanikolaou" General Hospital, in Thessaloniki. The age range was 22 to 87 years. The distribution of the primary sites was buccal mucosa (3), floor of the mouth (1), hard palate (3), soft palate (2), junction of hard and soft palate (7), and hard or soft palate with spread in the paranasal sinus etc (6). All the patients were treated radically with surgery. The surgery was combined with radiotherapy in 17 patients. A total dose of 60 Gy in a 30- to 40-day period was given, using conventional 2 Gy fractions per day. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. RESULTS: The mean follow-up range was 4 to 14 years. From the 22 patients, 15 (68.18%) were alive for more than 5 years and 6 (27.7%) had died from the disease. Eight patients were free of the disease for more than 5 years (ranging from 7 to 14), 4 patients were free of the disease for 5 years, and 3 patients were free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence was developed in 2 patients. One recurrence occurred within the first year after the treatment and the second local recurrence occurred 13 years after the initial treatment. Lymph node metastases occurred in 2 patients, 3 years and 7 years after completing the treatment. Distant metastases (lung) occurred in 2 patients, 2 years and 6 years after completing the treatment. The Mann-Whitney statistical analysis was used for comparing the Ki-67 values in correlation with prognosis and location of ACCs. The Ki-67 value was significantly higher in tumors from patients with treatment failure than in nonfailures (P < .001). The Ki-67 expression was also higher in large tumors characterized by wide topical spread (P < .005). CONCLUSIONS: The most proper method of treatment for ACC seems to be radical resection combined with radiotherapy. The treatment failure is associated with positive margins of the excised surgical specimen and named nerve involvement. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.

-----

Gan To Kagaku Ryoho. 2006 Jun;33 Suppl 1:184-8.
[Preoperative chemotherapy with S-1 and low-dose cisplatin for oral squamous cell carcinoma]
[Article in Japanese]
Nakazawa M.
Second Dept. of Oral and Maxillofacial Surgery, Osaka University, Faculty of Dentistry, Japan.

We investigated preoperative chemotherapy with S-1 and low-dose cisplatin for the untreated stage II-IV oral squamous cell carcinoma patients. The chemotherapy consisted of S-1 80 mg/m2/day (day 1-14) and CDDP 5 mg/m2/day (day 1-5 and day 8-12) intravenous drip (less than 1 hour). In the second phase clinical trial of 44 patients, the clinical response rate was 63.7% and the histological response rate by the Oboshi-Shimosato's evaluation was 61.4%. The main adverse events were myelosuppression and gastrointestinal disturbance such as nausea 36.4%, anorexia 27.3%, neutropenia 25% and leukopenia 25%. Grade 3 and 4 adverse events were neutropenia 11.4%, leukopenia 9.1%, thrombocytopenia 4.5% and oligochromemia 4.5%. The two-year overall survival rate was 92.6%. The advantages of this chemotherapy are high response rate, low adverse effects and not to prevent planned therapies such as surgery and radiation. These facts suggest that this chemotherapy is suitable for preoperative chemotherapy.

-----

Clin Chim Acta. 2006 May 19; [Epub ahead of print]
Enzymatic and non-enzymatic antioxidant status in stage (III) human oral squamous cell carcinoma and treated with radical radio therapy: Influence of selenium supplementation.
Elango N, Samuel S, Chinnakkannu P.
Department of Medical Biochemistry, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai-600 113, India.

BACKGROUND: Oxidative stress is implicated in oral carcinogenesis and has been found to be aggravated during radiotherapy. A great deal of attention has been focused on the possible therapeutic implications of selenium as a potent antioxidant. We determined whether selenium supplementation to radiation treated oral cancer patients render improvement in the antioxidant status against oxidative stress. METHOD: Blood samples were collected from stage (III) oral cancer patients before initiating radiotherapy (Group B) (n=63) and this group is bifurcated into Group C-patients given radiotherapy alone (n=27) and Group D-patients given radiotherapy and supplemented with selenium (400 mug/day for 6 months) (n=36). Both Group C and D were followed up for 6 months. We evaluated the plasma selenium concentration, non-enzymatic system including GSH, vitamins E, C, A and ceruloplasmin and enzymatic antioxidant system including superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, glucose-6-phosphate dehydrogenase. RESULTS: The concentrations of selenium, all non-enzymatic antioxidants and the activities of enzymatic antioxidants were found to be lowered in oral cancer patients (Group B), compared to normal (Group A) (p<0.05). Similar decrease in the concentration of selenium and antioxidants status was observed in radiotherapy group (Group C) (p<0.05). On the contrary, selenium group (Group D) showed marked increase in the concentrations of selenium and antioxidant status at 6 months compared to radiation group (Group C) (p<0.05). CONCLUSION: The observed result represents the antioxidant property of selenium through the improvement of antioxidant defense system. Selenium supplementation could be of great interest in protecting cells against oxidative stress.

-----

Rev Stomatol Chir Maxillofac. 2006 Apr;107(2):80-5.
[Treatment of squamous-cell carcinoma of the upper gum and the hard palate]
[Article in French]
Zwetyenga N, Miquel L, Garuet A, Ricard AS, Majoufre-Lefebvre C, Demeaux H, Siberchicot F.
Service de Chirurgie Maxillo-faciale et Stomatologie, CHU de Bordeaux. narcisse.zwetyenga@chu-bordeaux.fr

PURPOSE: The aim of this retrospective study was to determine a rational of treatment of squamous-cell carcinoma of the upper gum and hard palate. PATIENTS AND METHOD: We analyzed retrospectively a series of 34 patients treated over a period of 11 years. RESULTS: There were 19 women (76%); mean age was 67.3 years; 76% had advanced tumors; 28% had neck nodes. The 5-year survival rate was 33.7%; patients without node involvement had better prognosis (p=0.034). The 5-year rate of recurrence-free survival was 61%; patients without node involvement had better prognosis (p = 0.032). At the end of the study, only 42% of patients were still alive. DISCUSSION: This type of tumor is different from those of other locations in the oral cavity or oropharynx. At the present time, surgery associated or not with post-operative radiotherapy seems to be optimal curative treatment. The question of whether neck dissection should be performed remains debated for patients without clinically nodes.

-----

Am J Clin Oncol. 2006 Feb;29(1):32-9.
Definitive radiotherapy for squamous cell carcinoma of the base of tongue.
Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Werning JW, Villaret DB.
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA. mendewil@shands.ufl.edu

OBJECTIVE: To evaluate definitive radiotherapy (RT) for treatment of base of tongue cancer. METHODS: There were 333 patients with squamous cell carcinoma of the base of tongue treated with definitive RT and had follow-up from 0.2 to 26.2 years. Follow-up on living patients ranged from 1.2 to 26.2 years (median, 6.6 years). RESULTS: Local control rates at 5 years were: T1, 98%; T2, 92%; T3, 82%; and T4, 53%. The 5-year rates of local-regional control rates were: I-II, 100%; III, 82%; IVA, 87%; and IVB, 58%. The rates of absolute and cause-specific survival at 5 years were as follows: I-II, 67% and 91%; III, 66% and 77%; IVA, 67% and 84%; and IVB, 33% and 45%. Severe complications developed in 52 patients (16%). CONCLUSION: Our data and review of the pertinent literature reveal that the local-regional control rates and survival rates after RT were comparable to those after surgery, and the morbidity associated with RT was less.

-----

Ned Tijdschr Geneeskd. 2006 Jan 14;150(2):83-8.
[The practice guideline 'Carcinoma of the oral cavity and oropharynx']
[Article in Dutch]
Knegt PP, Keus RB, Roodenburg JL.
Erasmus MC, Postbus 2040, 3000 CA Rotterdam. p.knegt@erasmusmc.nl

With a total incidence of ca. 800 per year, oral cavity or oropharyngeal carcinoma represents only a small fraction of the total number of cases of cancer in The Netherlands. In order to achieve as much nationwide uniformity as possible in its diagnosis, treatment, after-care and follow-up, a practice guideline has now been developed. The diagnosis of the primary tumour and the neck, careful clinical examination is complemented by echography, often combined with a biopsy, MRI and CT, while technetium scintigraphy in combination with an orthopantomogram is used to detect invasion of the mandible. The smaller oropharyngeal carcinomas (T1 and T2), surgery and radiotherapy (external therapy or brachytherapy) are equally useful, but for the larger carcinomas (T3 and T4) in patients in good general condition, surgery in combination with radiotherapy is preferred. When radiotherapy is chosen, then brachytherapy is preferred for the smaller tumours of the tongue and the floor of the mouth. In patients without demonstrable metastases to the lymph nodes, just as in the case oforopharyngeal carcinomas, the decision whether or not to treat the neck depends on the chances that cervical lymph node metastases are present: when the risk is smaller than 20% (as with smaller tumours), then a wait-and-see policy is justified, but if the risk is greater than 20% (as with larger tumours or very thick rumours), then the neck should be treated, either surgically or by radiotherapy. The practice guideline also contains information regarding decision making, information and communication, palliative therapy and symptomatic treatment, psychosocial assistance, prosthetic reconstruction, physiotherapy, oral hygiene, nutrition and dietetics, swallowing and speech rehabilitation, and the policy with regard to smoking and alcohol consumption.

-----

Jpn J Clin Oncol. 2006 Jan;36(1):3-6. Epub 2006 Jan 17.
Is glossectomy necessary for late nodal metastases without clinical local recurrence after initial brachytherapy for N0 tongue cancer? A retrospective experience in 111 patients who received salvage therapy for cervical failure.
Urashima Y, Nakamura K, Kunitake N, Shioyama Y, Sasaki T, Ooga S, Kuratomi Y, Yamamoto T, Kawazu T, Chikui T, Jingu K, Terashima H, Honda H.
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. urash@radiol.med.kyushu-u.ac.jp

PURPOSE: To assess the efficacy of neck dissection (ND) without glossectomy (GL) for late nodal metastases without local recurrence after brachytherapy for N0 tongue cancer. MATERIALS AND METHODS: Among 396 patients with N0 tongue cancer treated with brachytherapy, a retrospective analysis was performed in 111 patients who were clinically diagnosed as having nodal metastases without local recurrence and whose neck lymph nodes turned out to be pathologically positive after salvage surgery. One hundred and five patients had undergone only ND (the ND group), six patients had undergone ND with GL (the ND+GL group). RESULTS: The 5 year disease-free and cause-specific survival rates after salvage therapy for the 111 patients included in this study were 58.1 and 61.9%, respectively. In the ND group, there were only nine patients who had local recurrence after ND. In addition, only six patients (5.7%) had a local recurrence within 2 years in the ND group. Sixty-three patients were free of disease after ND, 31 patients had regional or distant metastases without local recurrence and two patients had progressive disease at ND. In the ND+GL group, four patients were alive without disease and two died from regional or distant metastases. None of the patients in the ND+GL group were found to have malignant tissue in the pathological findings from the excised tongue. CONCLUSION: GL should be avoided or suspended when the clinical evaluation had revealed cervical failure without apparent local recurrence in the mobile tongue cancer patients after initial brachytherapy.

-----

Int J Clin Pharmacol Res. 2005;25(3):115-22.
Phase II study of a novel oral formation of 5-fluorouracil in combination with low-dose cisplatin as preoperative chemotherapy of oral squamous cell carcinoma.
Nakazawa M, Ohnishi T, Ohmae M, Chisoku H, Yui S, Iwai S, Sumi T, Fukuda Y, Kishino M, Yura Y.
Second Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan. nakazawa@dent.osaka-u.ac.jp

TS-1 is a novel oral 5-fluorouracil containing tegaful (prodrug of 5-FU) and two biochemical modulators. These modulators feature effect-enhancing and adverse reaction-reducing activity. We investigated the histological response and toxicities of combination chemotherapy with TS- 1 and low-dose cisplatin and evaluated its usefulness as preoperative chemotherapy Forty-four newly diagnosed patients with stage Il-IV oral squamous cell carcinoma were enrolled in this study from February 2002 to April 2004. Patients were administered TS-1 80 mg/m2/day (days 1-14) and cisplatin 5 mg/m2/day (days 1-5 and 8-12) followed by radical surgery within 2 weeks. The histopathological effect of chemotherapy, which was a surrogate endpoint of this trial, was evaluated with surgical or biopsy specimens. The rate of histological antitumor effect was as follows: complete response (CR) 36.4%, partial response (PR) 25.0%, minor response (MR) 18.1% and no change (NC) 20.5%. The rate of histological response (CR + PR) was 61.4%. The CR rate of effective cases was 59.3%. The main toxicities occurred in bone marrow and the digestive tract. The incidence of severe toxicity such as grade 3 or 4 was 4.5% in anemia, 9% in leukocytopenia, 11.4% in neutropenia, 4.5% in thrombocytopenia and 2.3% in anorexia, diarrhea and urticaria. Most patients showed no toxicity or mild toxicities. TS- 1 with low-dose cisplatin has highly effective antitumor activity and mild toxicities. In particular, the CR rate was very high. It is suggested that this regimen is suitable for neoadjuvant chemotherapy. We expect that this chemotherapy will contribute to avoidance of surgery for small tumors (stages I and II) and will enable function-preserving surgery for advanced tumors.

-----

Int J Oral Maxillofac Surg. 2005 Dec 12; [Epub ahead of print]
Observation of tumour thickness and resection margin at surgical excision of primary oral squamous cell carcinoma-assessment by ultrasound.
Songra AK, Ng SY, Farthing P, Hutchison IL, Bradley PF.
Maxillofacial Unit, Royal London Hospital, Barts and The London NHS Trust, London E1 2BB, UK.

Tumour thickness and the status of resection margins are of prognostic significance in the treatment of oral cancer. In a single blind prospective study, 14 patients with biopsy proven oral squamous cell carcinoma had intraoral ultrasound imaging done preoperatively to measure tumour thickness, and intraoperatively to measure the deep surgical margin half way during resection. The cut surface was demonstrated on ultrasound by placing a metal, ultrasound-reflective, retractor into the surgical cut. The ultrasound measurements were compared to the subsequent histological measurements. Using the threshold of 5mm as indicator of margin clearance, there was agreement in 10 out of 14 cases between ultrasound and histology. Ultrasound detection of close surgical margins had a sensitivity of 83% and a specificity of 63%. For preoperative tumour thickness measurement, ultrasound imaging showed a high degree of correlation with histology (Pearson correlation coefficient=0.95, P<0.01). This original paper demonstrates that high resolution ultrasound imaging applied intraorally is a reliable tool in objectively assessing both the tumour thickness and the surgical margin clearance at the time of surgery.

-----

Gan To Kagaku Ryoho. 2005 Dec;32(13):2024-9.
[Intra-arterial chemotherapy for head and neck cancer]
[Article in Japanese]
Tohnai I.
Dept. of Cell Therapy, School of Medicine, Nagoya University, Japan.

There are historically speaking, three methods of intra-arterial infusion for head and neck cancer. Recently, daily concurrent chemoradiotherapy using new superselective intra-arterial infusion via superficial temporal arterial artery is noted. A catheter with a curved tip is inserted superselectively to the feeding artery of the tumor via the superficial temporal artery. Long-term catheterization is possible in this method. Thirty-five patients with stage III or IV oral cancer were treated. Radiotherapy (total dose:40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using DOC (total dose: 60 mg/m2, 15 mg/m2/week) and CDDP total dose: 100 mg/m2, 5 mg/m2/day) were concurrently performed daily, followed by surgery. In 31 patients, intra-arterial infusion was successful(successful rate: 88.6%), and no major complication was observed. The clinical effects were CR in 25 patients(80.6%), and pathological effects of resected tumor after surgery were pathological CR in 28 (90.3%). This method promises to be new strategy of choice for the treatment of head and neck cancer.

-----

Int J Oral Maxillofac Surg. 2005 Dec 9; [Epub ahead of print]
A comparison of tongue and soft palate squamous cell carcinoma treated by primary surgery in terms of survival and quality of life outcomes.
Brown JS, Rogers SN, Lowe D.
Regional Maxillofacial Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.

In the surgical management of oral cancer the resection and reconstruction of the mobile tongue and soft palate are most important if function is to be maintained. The present trend towards primary laryngeal surgery for early disease has emphasized the importance of primary surgery if good functional outcomes can be achieved. This study compares the functional and health-related quality of life outcomes for primary surgery and reconstruction of the anterior tongue and soft palate. From a cohort of 566 patients treated from 1992 to 2002, 118 fitted the criteria for anterior tongue and 44 for soft palate resection. University of Washington Quality of Life scores were available in around three quarters of patients. In terms of speech and swallowing a 3/4 or total anterior glossectomy had a worse outcome than a 1/4 or 1/2. In patients having a 3/4 or total resection of the soft palate however, the results showed a similar outcome to those with 1/4 or 1/2 resection. The functional results of 3/4 and total soft palate reconstruction were superior to 3/4 and total anterior tongue resections and were similar to the whole cohort. This finding extends the role of functional surgery in the oropharynx for which primary radiotherapy is often preferred to preserve function.

-----

Cancer Gene Ther. 2005 Dec 9; [Epub ahead of print]
Papillomaviruses as targets for cancer gene therapy.
Shillitoe EJ.
1Department of Microbiology & Immunology, Upstate Medical University, State University of New York, Syracuse, NY, USA.

The human papillomaviruses (HPVs) are a diverse group of infectious agents, some of which are a causative agent of human cancers. Cervical cancer and oral cancer are closely associated with specific types of HPV, and the tumors grow only if there is continual expression of the viral E6 and E7 genes. Evidence from in vitro studies shows that when expression of these genes is inhibited by gene therapy approaches such as antisense RNA, ribozymes, or siRNA, the transformed phenotype of the cells is lost. Although it seems possible that clinical applications of this approach could help in the management of cervical and oral cancers there have been no clinical trials of gene therapy for HPV-associated cancers. Since the basic information is now available, a shift to translational research would be greatly welcomed.Cancer Gene Therapy advance online publication, 9 December 2005; doi:10.1038/sj.cgt.7700926.

-----

ORL J Otorhinolaryngol Relat Spec. 2005 Dec 1;67(6):326-330 [Epub ahead of print]
Mandibular Access Osteotomies in Oral Cancer.
Store G, Boysen M.
ENT Department, Rikshospitalet University Hospital, Oslo, Norway.

Purpose: Mandibulotomy is a recognised surgical approach to tumours of the oral cavity and oropharynx. However, the nature and frequency of complications associated with this procedure varies in many studies. We report our experience with access osteotomies, with special reference to radionecrotic complications. Procedures: A retrospective study of 18 consecutive patients undergoing planned mandibular osteotomies as part of the ablative surgery was performed. Various flaps were used for tissue closure: myocutaneous flap (n = 8), nasolabial flap (n = 1) and radial forearm free vascular flap (n = 6). Primary closure using remaining mucosa was achieved in 3 patients. Results: Complete healing of the osteotomy was noted in 13 patients, and 5 patients (27%) developed major wound healing problems and osteoradionecrosis. Dental problems with resorption of the alveolar bone crest and loosening of the teeth adjacent to the osteotomy were seen in 7 patients (39%). Conclusions: Adequate soft-tissue closure is as important for a successful outcome as the type of osteotomy and fixation method applied. Extraction of the incisors is recommended for easier and safer tissue adaptation, especially when flaps are used for coverage and the osteotomy site will be included in the radiation field. Copyright (c) 2005 S. Karger AG, Basel.

-----

Chin Med J (Engl). 2005 Nov 5;118(21):1803-7.
Pre-mental foramen mandibulotomy for resecting tumors of tongue base and parapharyngeal space.
Yu GY, Zhang L, Guo CB, Huang MX, Mao C, Peng X.
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China. gyyu@263.net

BACKGROUND: Resection of tumors arising from the tongue base and the parapharyngeal space is difficult for exposure and manipulation because of their obscure location. The aim of this study was to evaluate the surgical approach of the pre-mental foramen mandibulotomy for resecting the tumors of tongue base and parapharyngeal space. METHODS: Fifty-one patients with tumors of tongue base and parapharyngeal space were treated using the mandibulotomy approach on the pre-mental foramen. In the present study, this technique was described in detail. The patients were followed up for three months to six years with a mean of 26 months. RESULTS: The tumors of tongue base and parapharyngeal space could be exposed clearly and be resected radically by surgical approach of pre-mental foramen mandibulotomy. The surgical complications were reduced. CONCLUSIONS: Compared to other surgical approaches, such as lateral mandibulotomy, midline mandibulotomy, the suprahyoid parapharyngeal approach, and paramedian mandibulotomy, we found that the pre-mental foramen mandibulotomy is the ideal choice for resecting the tumors of tongue base and parapharyngeal space.

-----

Otolaryngol Head Neck Surg. 2005 Nov;133(5):725-8.
The use of the Ligasure Vessel Sealing System in parotid gland surgery.
Prokopakis EP, Lachanas VA, Helidonis ES, Velegrakis GA.
Department of Otolaryngology, University Hospital of Heraklion, Crete, Greece.

OBJECTIVE: To evaluate the role of the Ligasuretrade mark Vessel Sealing System (LVSS; Valleylab, Boulder, CO) in parotid surgery. STUDY DESIGN: A prospective study was conducted on 12 consecutive patients undergoing superficial parotidectomy, performed by using the LVSS device as the primary means of ligation. Inclusion criteria included parotid mass with no preoperative suspicion of malignancy, and no extension to the deep lobe of the parotid gland. Efficacy of hemostasis, cut-closure time, and postoperative complications were assessed. Results were compared with a historical control group, including cases on which the LVSS was not available. RESULTS: LVSS proved effective in providing ligation and hemostasis. There was a mean time gain of 52 minutes, compared with our historical control group. No postoperative bleeding, seroma, salivary fistula, or Frey syndrome were observed. One case of transient facial weakness occurred, which was completely resolved within 6 months. CONCLUSION: LVSS is a safe device for parotid gland surgery, providing sufficient hemostasis and reducing operative time. EBM RATING: B-2.

-----

Med Clin (Barc). 2005 Oct 29;125(15):590-7.
[Oral ulcers]
[Article in Spanish]
Bascones-Martinez A, Figuero-Ruiz E, Esparza-Gomez GC.
Departamento de Medicina Bucal y Periodoncia, Facultad de Odontologia, Universidad Complutense de Madrid, Madrid, Spain.

Ulcers commonly occur in the oral cavity, their main symptom being pain. There are different ways to classify oral ulcers. The most widely accepted form divides them into acute ulcers--sudden onset and short lasting--and chronic ulcers--insidious onset and long lasting. Commonest acute oral ulcers include traumatic ulcer, recurrent aphthous stomatitis, viral and bacterial infections and necrotizing sialometaplasia. On the other hand, oral lichen planus, oral cancer, benign mucous membrane pemphigoid, pemphigus and drug-induced ulcers belong to the group of chronic oral ulcers. It is very important to make a proper differential diagnosis in order to establish the appropriate treatment for each pathology.

-----

Arch Otolaryngol Head Neck Surg. 2005 Oct;131(10):874-8.
Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue.
Schiff BA, Roberts DB, El-Naggar A, Garden AS, Myers JN.
Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston 77030-4009, USA.

OBJECTIVES: To assess the role of selective neck dissection in patients with squamous cell carcinoma (SCC) of the oral tongue with advanced nodal disease, and to assess the role of postoperative radiotherapy in patients with SCC of the oral tongue with pathologically N1 necks. DESIGN: Retrospective study of the medical records of all patients who underwent neck dissection for SCC of the oral tongue from January 1, 1980, to December 31, 1995. Median follow-up was 5.7 years. SETTING: The University of Texas M. D. Anderson Cancer Center, Houston, a tertiary care cancer hospital. PATIENTS: A total of 220 patients with SCC of the oral tongue who received surgical treatment of both the primary tumor and the neck and who had an identifiable type of neck dissection, no synchronous or metachronous lesions, and no evidence of local recurrence. INTERVENTIONS: All patients underwent resection of the primary tumor and neck dissection. The extent of neck dissection was determined by surgeon preference. Some patients received radiotherapy to the neck as well. MAIN OUTCOME MEASURES: Clinical and pathological nodal status, type of neck dissection, and use of radiotherapy. The end points evaluated included the regional control rates. RESULTS: For clinically N+ patients, 5 of 45 treated with selective neck dissection and 1 of 19 treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck. If only patients with significant tumor burden on final pathological examination (clinically N+/pathologically N2) are considered, 4 (25.0%) of 16 patients undergoing selective neck dissection had recurrences in the neck, while none of the 14 patients treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck (P = .07). Of the 50 patients who had pathologically N1 disease, 25 received postoperative radiotherapy and 25 did not. Of the latter, 2 had recurrences in the neck, while none of the 25 patients who received radiotherapy had recurrences in the neck (P = .24). CONCLUSIONS: Selective neck dissection may be sufficient for many N+ patients with SCC of the oral tongue, but some patients with extensive nodal disease may benefit from more aggressive treatment of the neck. Radiotherapy may be beneficial for all of the node-positive patients, but further studies are needed. Prospective, randomized clinical trials will be useful in further defining the role of selective neck dissection in the clinically N2 neck and radiotherapy in the N1 neck for patients with SCC of the oral tongue.

-----

Gan To Kagaku Ryoho. 2005 Sep;32(9):1267-71.
[Clinical trial of chemotherapy by superselective intra-arterial infusion of nedaplatin combined with radiotherapy for
advanced oral cancer]
[Article in Japanese]
Yamshita Y, Shikimori M, Goto M.
Dept. of Oral and Maxillofacial Surgery, Saga Medical School.

Nedaplatin (CDGP) is designed to further improve the anti-tumor effect and to reduce adverse effects of cisplatin (CDDP), such as renal toxicity. We previously reported a combination therapy of superselective intraarterial CDGP infusion, and radiation therapy could be delivered safely with good efficacy for locoregional management of oral cancer. However, both the clinical and pathological response decreased with tumor progression. This study was performed to assess the feasibility of a new chemotherapy regimen by superselective intraarterial infusion of CDGP in patients with advanced oral carcinomas. This regimen is under way in which chemotherapy with 5-FU 500 mg/day on days 1 to 5 and superselective intra-arterial infusion of CDGP on day 6 combined with radiation therapy is being evaluated for locally advanced oral cancer. Eight patients were treated with this regimen. After evaluation of the response, patients underwent surgery as a therapeutic procedure. Both the complete and partial response rates were achieved in each 3 patients (37.5%), respectively. Histological effects classified according to Oboshi-Shimosato's criteria were grade IVa in 2 patients, grade III in 1, grade IIb in 1, grade IIa in 3, and grade I in 1. All patients were free from renal dysfunction, which is one of the adverse effects of CDDP. Moreover, most toxicity was relatively mild in all patients.

-----

Eur J Cancer. 2005 Sep;41(13):1833-41.
Chemoprevention: From research to clinical oncology.
Veronesi U, Bonanni B.
European Institute of Oncology, Via G. Ripamonti, 435, 20141 Milan, Italy.

Chemoprevention is by now an emerging area of clinical oncology addressed to healthy individuals at higher risk for cancer, subjects with precancerous conditions, and patients who are at risk for a second primary cancer. The important results of large trials with various agents and the more accurate methods of risk assessment have already had implications in clinical practice. Recently, a number of compounds have shown to be clinically effective at various organ levels, often covering all the three settings of primary, secondary and tertiary prevention. There is proof today that at least 3 of the 4 'big killers' in oncology - breast, colon and prostate cancer - and oral cancer are to a certain extent preventable by chemopreventive drugs. The missing piece so far is lung cancer. The expanding molecular drug development is providing the tools for a more effective and safer molecular-targeted prevention. Combination chemoprevention and the use of agents with multiple effects are other particularly promising chemoprevention strategies.

-----

Br J Oral Maxillofac Surg. 2005 Aug 8; [Epub ahead of print]
Measures of health-related quality of life and functional status in survivors of oral cavity cancer who have had defects reconstructed with radial forearm free flaps.
Smith GI, Yeo D, Clark J, Choy ET, Gao K, Oates J, O'brien CJ.
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney 2042, Australia.

The aim of this study was to evaluate (by postal questionnaire) quality of life and function in patients who have had resections of oral cancer and reconstruction by radial forearm flaps. Between October 1987 and December 2002, 258 patients had reconstructions by radial forearm flaps after resection of tumours in the oral cavity. Of these, 139 surviving patients were identified from the database and were sent questionnaires comprising five sections: Functional Assessment of Cancer Therapy-General (FACT-G) and -Head and Neck (FACT-HN); University of Washington Quality of Life Scale (UWQoL); Performance Status Scale for Head and Neck Cancer (PSS-HN); and the final section addressed dental rehabilitation and morbidity at the donor site. Sixty-three questionnaires (45%) were returned. In 17 (27%), parts of the questionnaire were incomplete. The median UWQoL score was 623/900, FACT-G was 92/108, FACT-HN was 31/48, and PSS-HN showed that eating in public, understandability of speech and normality of diet were 75/100, 75/100 and 50/100, respectively. The effect of stage and site on quality of life and function did not reach statistical significance. The effect of radiotherapy on speech (p=0.036) and diet (p=0.007) was significant. Patients who worried about their cancer returning had a lower UWQoL score (p=0.016). Ninety percent regarded their arm as disfigured, but 81% felt comfortable wearing short-sleeved shirts. Sensation and function of the hand were reported as normal in 87 and 92%, respectively. We conclude that patients who have had oral cancer have a persistent reduction in quality of life and function long after completion of treatment. The effects can be assessed by postal questionnaire, but the low rate of return (45%) and difficulties with completion reduce the quality of the data. Quality of life and function are essential components of improvements in outcome.

-----

AJNR Am J Neuroradiol. 2005 Aug;26(7):1804-9.
Intra-arterial high-dose chemotherapy with cisplatin as part of a palliative treatment concept in oral cancer.
Rohde S, Kovacs AF, Turowski B, Yan B, Zanella F, Berkefeld J.
Institute of Neuroradiology, Johann Wolfgang Goethe-University Medical School, Frankfurt am Main, Germany.

BACKGROUND AND PURPOSE: Patients with cancer of the oral cavity often present with advanced tumor stages, distant metastasis, or severe comorbidities, which render radical surgery unfeasible. The purpose of this study was to investigate the response rate, technical feasibility, and safety of intra-arterial (IA) chemotherapy as palliative treatment in this situation. METHODS: From November 1997 to December 2003, 64 patients with histologically proven oral squamous cell carcinoma, classified as inoperable, received IA high-dose chemotherapy with cisplatin as a palliative treatment at our institution. To minimize toxic side effects, sodium thiosulfate was given intravenously. Twenty-eight percent of the patients were female; average age was 61.5 years. Clinical staging of primary tumors was TNM (tumor, nodules, metastases) stage IV in 89%, stage III in 6.3% and stage II in 4.7%. After local chemotherapy, additional radiation of the tumor area or radiochemotherapy was performed in 33 patients. RESULTS: There were no major catheter-related complications or severe side effects of IA chemotherapy. After the first cycle, 10% percent of the patients had complete remission (CR), 35% had partial response (PR), and 43.3% presented with stable disease. Mean follow-up interval was 11 +/- 12.9 months. Forty-five patients died after a mean period of 7.6 +/- 7.0 months (median, 5.1 months). The overall 1- and 2-year survival rates were 29.5% and 18%, respectively. There was a trend toward longer survival in patients who received subsequent radiation or radiochemotherapy after IA chemotherapy. CONCLUSION: IA chemotherapy in patients with inoperable carcinoma of the oral cavity as palliative treatment was technically feasible and safe. The overall response rate after IA chemotherapy was 45% (CR 10%; PR 35%). Side effects could be minimized by neutralizing the cytotoxic agent by sodium thiosulfate.

-----

Arch Otolaryngol Head Neck Surg. 2005 Jul;131(7):576-82.
Retromolar trigone carcinoma treated by primary radiation therapy: an alternative to the primary surgical approach.
Ayad T, Gelinas M, Guertin L, Larochelle D, Del Vecchio P, Tabet JC, Olivier MJ, Soulieres D, Charpentier D, Nguyen-Tan PF.
Department of Otolaryngology and Head and Neck Surgery, Notre-Dame Hospital, Montreal, Quebec, Canada. tareckayad@yahoo.ca

OBJECTIVES: To review our experience in the treatment of retromolar trigone carcinoma with radiotherapy as the primary modality and to evaluate the different factors affecting locoregional control and survival. DESIGN: We retrospectively examined 46 patients with squamous cell carcinoma of the retromolar trigone treated primarily with radiotherapy from January 1, 1973, to June 31, 2002. Four had T1, 21 had T2, 17 had T3, and 4 had T4 lesions; 25 had N0, 15 had N1, 5 had N2, and 1 had N3 disease. The overall stage was I in 3, II in 18, III in 18, and IV in 7 patients. All patients received conventional once-daily fraction radiotherapy as the primary modality of treatment. Three patients received chemotherapy. Overall survival, cause-specific survival, and locoregional control were estimated using the Kaplan-Meier method. Log-rank statistics were used to identify significant prognostic factors for overall survival and locoregional control. RESULTS: The median follow-up was 43 (range, 5-217) months overall and 78 (range, 26-188) months for living patients. The 5-year overall survival and cause-specific survival rates were 47% and 78%, respectively. Favorable prognostic factors for cause-specific survival were a lower tumor stage (univariate and multivariate analysis) and a lower nodal stage (multivariate analysis). The 5-year local control rate was 49% after radiotherapy and 67% after salvage surgery. The 5-year regional control rate was 88%. Favorable prognostic factors were a lower nodal stage and a lower overall stage (univariate analysis). The 5-year locoregional control rate for all patients was 42% after radiotherapy and 70% after salvage surgery. CONCLUSIONS: Given the surgical salvage rate in our series and previous published experience, radiation therapy can be used with curative intent for small retromolar trigone carcinomas (T1-T2 lesions). For advanced stages without bone invasion, consideration for concurrent chemotherapy and radiation therapy might increase previous historical locoregional and survival rates.

-----

Laryngoscope. 2005 Jul;115(7):1278-82.
Adenoid cystic carcinoma of the major salivary glands treated with surgery and radiation.
Gurney TA, Eisele DW, Weinberg V, Shin E, Lee N.
Department of Otolaryngology--Head and Neck Surgery, University of California-San Francisco, San Francisco, California 94143, USA. tgurney@ohns.ucsf.edu

OBJECTIVE: To examine patient characteristics, pathologic features, and treatment outcomes of adenoid cystic carcinoma of the major salivary glands. STUDY DESIGN: Retrospective review of patients in an academic medical center. METHOD: Review of medical records regarding demographics, extent of tumor, stage, histologic characteristics, and treatment outcomes of patients treated with surgery and postoperative radiation. RESULTS: Of the 33 patients, 19 (58%) were male, and 14 (42%) were female. The average age of presentation was 49 (range 22-81) years. Of the 29 patients fully staged at the time of diagnosis, 7 (24%) presented at American Joint Committee on Cancer stage I, 9 (31%) at stage II, 4 (14%) at stage III, and 9 (31%) at stage IV. The cribriform histologic subtype was predominant (64%). The majority originated in the parotid gland (21, 64%), with the remaining originating in either the submandibular gland (10, 30%) or the sublingual gland (2, 6%). Local control was 94% at 5 years and 73% at 10 years. Metastatic control was 82% at 5 years and 63% at 10 years. Four patients failed locally and nine failed distally. Overall survival was 85% at 5 years and 69% at 10 years, with a median of 12.9 years. CONCLUSION: Surgical excision with postoperative radiation provides a long period of disease-free survival. Patients were more likely to fail with metastases than with local recurrence.

-----

J Oral Maxillofac Surg. 2005 Jul;63(7):917-28.
Management and outcome of patients with malignant salivary gland tumors.
Bell RB, Dierks EJ, Homer L, Potter BE.
Oral and Maxillofacial Surgery Service, Legacy Emanuel Hospital and Health Center, Portland, OR, USA. bellb@hnsa1.com

PURPOSE: Refined imaging technology, the use of external beam radiation, neutron beam therapy, and chemotherapy, has altered management strategies for patients with salivary gland malignancies during the past 2 decades. Although treatment remains primarily surgical, optimal therapeutic regimens have yet to be fully realized. The purpose of this investigation is to report our experience with the management of patients with a variety of malignant salivary gland neoplasms that were treated with various combinations of surgery, radiation, and chemotherapy and to review treatment outcome in an effort to identify predictors of survival and locoregional control. MATERIALS AND METHODS: The records of all patients with malignant salivary gland tumors presenting for treatment at our institution between 1992 and 2002 were retrospectively reviewed. Variables were collected and outcome measures were defined in terms of overall survival, disease-free survival, and locoregional control. Descriptive statistics were compiled and statistically evaluated. Survival was described using the Kaplan-Meier method. Prognostic factors were assessed using the Cox proportional hazards model. Clinical and reconstructive factors were reviewed. RESULTS: Eighty-five patients (35 males and 50 females) ranging in age from 16 to 89 years (mean, 58.6 years) met the criteria for inclusion in the study. The majority of tumors were located in the parotid gland (n = 42), with a significant minority located in the minor salivary glands (n = 29), followed by the submandibular gland (n = 8) and the sublingual gland (n = 6). Mucoepidermoid carcinoma was the most common neoplasm (n = 40). More than half of the patients presented in early-stage disease (stage I = 36, stage II = 17, stage III = 8, stage IV = 25). All patients were treated with surgery as the primary modality. Neck dissection was performed in 29% of patients, and more than half (56%) were treated with adjuvant external beam radiation therapy to a dose of 50 to 70 Gy. Patients were, in general, immediately reconstructed at the time of ablation using composite free tissue transfer when appropriate, local/regional rotational flaps, or maxillary obturators. The disease-free survival rate and locoregional control rate at 5 years were 77% and 86%, respectively. Stage (P = .0017), grade (P = .00044), cervical lymph node metastasis (P = .03), and age (P = .01) proved to make a statistically significant contribution when describing outcome. Neither site (P = .5), the presence of positive margins (P = .3), nor perineural invasion (P = .7) had a significant impact on survival. CONCLUSIONS: The treatment of salivary gland malignancies remains primarily surgical, although adjunctive radiotherapy may play an important role in those patients with advanced-stage disease. This study confirms the contributions of stage, grade, age, and cervical metastasis for describing survival. The benefits of combined modality therapy awaits prospective clinical trials.

-----

Int J Oral Maxillofac Surg. 2005 Jun;34(4):396-400. Epub 2005 Jan 24.
The use of CO2 laser in the treatment of oral white patches: outcomes and factors affecting recurrence.
Chandu A, Smith AC.
Oral and Maxillofacial Surgery, Austin Health, Heidelberg, Vic., Australia.

Laser therapy has been a favoured treatment regime for oral leukoplakia since the mid 1980s. There is no information in the literature regarding factors affecting outcomes in patients with oral leukoplakia. Forty-three patients (mean age 60.3+/-13.6 years) with 73 primary oral leukoplakia were assessed for outcome and factors affecting survival. Dysplastic lesions were found in the majority of patients. The male to female ratio was 1.7:1 with 74% ex- or current smokers, 27% consuming alcohol and 31% continuing to smoke after treatment. The mean observation time was 47.2+/-28.2 months (range 2-102 months). Disease-free survival was 55.4% at 3 years that dropped to 33.9% after 5 years. The malignant transformation rate was 7.3%. No significant prognostic factors were found on univariate analysis but alcohol consumption (P=0.034) and previous malignancy (P=0.018) were found to be significant prognostic indicators using multivariate analysis. Continuation to smoke approached significance (P=0.061). Similar disease-free survival and malignant transformation rates with minimal complications were found as compared to the literature. Recommendations for minimizing recurrence are presented. Long-term follow up and removal of aetiological factors, such as smoking and alcohol, are advised.

-----

Nippon Jibiinkoka Gakkai Kaiho. 2005 Jun;108(6):689-93.
[Intraarterial concomitant chemoradiation for tongue cancer: analysis of 20 patients]
[Article in Japanese]
Endo S, Suzuki S, Tsuji K, Niwa H, Noguchi Y, Yoshida K, Kida A, Tanaka Y, Himi K, Takemoto A.
Department of Otorhinolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo.

Subjects were 20 patients with tongue cancer treated between April 1996 and December 2002 with intraarterial infusion of cisplatin (60-120 mg/m2) (and docetaxel 10-30 mg/m2) and intravenous infusion of sodium thiosulfate followed by 5-fluorouracil (5-FU) (800-1000 mg/m2) for 3 to 5 days. All patients underwent radiation (50-80 Gy). Ten had stage II, 4 stage III, and 6 stage IV A disease. Complete response at the primary site was achieved in 50% for T2, 67% for T3, and 0% for T4 lesions in those undergoing IA cisplatin followed by systemic 5-FU with concurrent radiation. Complete response at the primary site was achieved in all patients given IA cisplatin and docetaxel followed by systemic 5-FU with concurrent radiation. Disease-specific survival was 75% and overall survival 69% at 5 years. Side effects of treatment were tolerable, except for grade three radiomucositis in 70% of patients and grade three bone marrow depression in one treated with weekly IA chemotherapy.

-----

Oral Oncol. 2005 Jul;41(6):562-7. Epub 2005 Apr 14.
Selection of topically applied non-steroidal anti-inflammatory drugs for oral cancer chemoprevention.
Sood S, Shiff SJ, Yang CS, Chen X.
Susan Lehman Cullman Laboratory for Cancer Research, Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 164 Frelinghuysen Road, Piscataway, NJ 08854, United States.

Topical delivery of non-steroidal anti-inflammatory drugs through the oral mucosa has been used for oral cancer chemoprevention. Local permeation of these agents has been one of the major concerns. Here we propose an approach to predict the permeability of topically applied agents for oral cancer chemoprevention. In theory, the total flux through the oral mucosa (J(max)) can be estimated by adding the transcellular flux (J(TC)) and the paracellular flux (J(PC)). To target the Cox-2 enzyme in oral epithelial cells, it is desirable to maximize the theoretical activity index, the ratio of J(TC) and IC(50) of a Cox-2 inhibitor (J(TC)/IC(50-Cox-2)). Among the 12 commonly used NSAIDs, celecoxib, nimesulide and ibuprofen had the highest values and may be the agents of choice to target Cox-2 in oral epithelial cells through topical application. Based on these calculations, a long-term chemopreventive experiment using celecoxib (3% or 6%) through topical application was performed in a DMBA induced hamster oral cancer model. Both 3% and 6% reduced the incidence of squamous cell carcinoma at the post-initiation stage.

-----

Cancer Biother Radiopharm. 2005 Jun;20(3):267-79.
Chemoembolization using Cisplatin crystals as neoadjuvant treatment of oral cancer.
Kovacs AF.
Oberarzt der Klinik fur Kiefer und Plastische Gesichtschirurgie, Frankfurt-am-Main, Germany.

Chemoembolization for cancer of the head and neck has been used very rarely in the past owing to local characteristics and risks. By combining the antineoplastic activity and embolizing effect in the same drug, a more routine use seems possible. A cisplatin suspension in normal saline (5 mg in 1 mL) with precipitation of microembolizing cisplatin crystals and without additional drugs was prepared. The cisplatin dosage was 150 mg/m(2), the maximum absolute dose 300 mg, and the maximum amount of fluid 60 mL. One hundred and three consecutive patients with previously untreated squamous cell carcinomas of the oral cavity and the anterior oropharynx were treated in a neoadjuvant setting with superselective chemoembolization using the cisplatin suspension. Acceptance by the patients has been excellent with no refusal. Overall response after one intervention has been 73%, with 18.5% showing pathological complete remissions. The highest response rates could be seen in T1-3 tumors and tumors of the oral tongue and floor of the mouth. Measurable acute systemic toxicity has been low. Postembolization syndrome, especially swelling, had to be observed carefully. There have been 3.5% interventional and 10% local complications, which could be significantly reduced by the use of this procedure only in cancers of the oral tongue, floor of the mouth, and mandibular alveolar ridge. Chemoembolization of cancer in the head and neck area can be carried out regularly and safely using this method, and it is highly effective. It could be used as an induction before definitive surgery or radiotherapy. Further investigation is mandatory to assess the potential of chemoembolization for the improvement of local control and survival.

-----

Plast Reconstr Surg. 2005 Jun;115(7):1877-86.
Topical application of photofrin for photodynamic diagnosis of oral neoplasms.
Chang CJ, Wilder-Smith P.
Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. chengjen@adm.cgmh.org.tw

BACKGROUND: The prognosis of patients with oral cancer can be improved by early diagnosis. Exact demarcation of tumor margins could contribute to optimum results in surgical excision and reconstruction. Therefore, the purpose of this study was to evaluate Photofrin (Quadra Logic Technologics, Inc., Vancouver, British Columbia, Canada) with protoporphyrin IX fluorescence as a new diagnostic procedure: photodynamic diagnosis for the detection of hyperplastic and malignant changes in oral tissue. METHODS: Twenty patients with oral neoplasms received 2.5 mg/ml Photofrin solution topically. After a period of 3 hours, the patients underwent fluorescence illumination (lambdaex = 370 to 450 nm). Guided by their visible fluorescence, lesions were biopsied at four suspicious sites for each patient. All specimens were analyzed and measured by a pathologist. A quantitative analysis of the fluorescence contrast between the neoplastic and healthy tissue was performed using the red, green, and blue mode and the gray scale mode. Statistical analysis was performed by means of the analysis of variance test for multiple comparisons. RESULTS: The sensitivity of the neoplastic tissue evaluated using the red, green, and blue and the gray scale modes combined was 92.45 percent in the macroscopic study and 93.75 percent in the microscopic study. The specificity of the neoplastic tissue evaluated using the red, green, and blue and gray scale modes combined was 95.65 percent in the macroscopic study and 97.50 percent in the microscopic study. Five patients (25 percent) displayed hyperkeratosis, nine (45 percent) displayed squamous hyperplasia, and six (30 percent) displayed squamous cell carcinoma. It is likely that Photofrin induced the visible red fluorescence. Some fluorescence could be detected in the surrounding healthy tissue. The intensity of the light was much lower than that from the lesions. The difference between healthy tissue and the lesions as a group was statistically significant. CONCLUSIONS: Light-induced fluorescence detection using topical Photofrin provides a sensitive, noninvasive technique for the early identification of malignant neoplasms in the oral cavity. Further study by the authors will evaluate fluorescence-guided photodynamic therapy for oral cancers in early stages.

-----

Curr Pharm Des. 2005;11(14):1771-7.
The role of COX-2 in oral cancer development, and chemoprevention/ treatment of oral cancer by selective COX-2 inhibitors.
Wang Z.
Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA. zwang@bu.edu

Oral cancer is challenging for clinicians due to its high mortality and increasing incidence rate. Cyclooxygenase-2 (COX-2) is extensively expressed in oral cancer and oral premalignant lesions and seems to be enhanced specifically in high-risk oral lesions. Mounting evidence suggests that these inhibitors may represent a promising approach for chemoprevention or treatment of oral cancer. This review reports on Medline and PubMed literature searches of published articles from 1995 to 2003. Our purpose is to provide a comprehensive examination and discussion of the potential role of COX-2 in oral cancer development and the use of COX-2 inhibitors for oral cancer chemoprevention or treatment. The data in the literature strongly indicate that COX-2 is significantly upregulated in oral cancer and premalignant lesions, and we believe that inhibition of COX-2 would suppress development of oral lesions by affecting several pathways of oral carcinogenesis. Therefore, the COX-2 inhibitors should be investigated as a new treatment, particularly new chemoprevention agents, for patients who are at high risk for developing oral cancer.

-----

Anticancer Res. 2005 Mar-Apr;25(2B):1321-6.
Neutron therapy, prognostic factors and dedifferentiation of adenoid cystic carcinomas (ACC) of salivary glands.
Brackrock S, Krull A, Roser K, Schwarz R, Riethdorf L, Alberti W.
Department of Radiation Oncology, Friedrich-Ebert-Hospital, 24534 Neumunster, Germany. sophie@brackrock.de

PURPOSE: Analysis of the efficacy of fast neutron radiotherapy in the treatment of adenoid cystic carcinomas (ACC) of the salivary glands, identification of prognostic variables and dedifferentiation after radiotherapy. PATIENTS AND METHODS: Histological slides of primary and recurrent lesions of 71 patients were reviewed to confirm the diagnosis and to analyse subtypes. Median follow-up was 52 months. Local control rate and overall survival were analysed in multivariate analysis. Complications are also described. RESULTS: Primary vs. recurrent therapy (p=0.001), margin-status (p=0.01) and subtype (p=0.019) influenced overall survival. Primary vs. recurrent therapy (p=0.001), margin-status (p=0.018) and T-stage (p=0.043) influenced local control rate. Dedifferentiation was seen in only 1/17 cases. CONCLUSION: The calculated prognostic factors illustrate the importance of a radical primary therapy. Histological subtype is a significant additional factor for overall survival and, in case of dedifferentiation, it is a strong predictor of a detrimental outcome.

-----

J Periodontol. 2005 Mar;76(3):406-10.
Is periodontitis associated with oral neoplasms?
Tezal M, Grossi SG, Genco RJ.
Department of Oral Biology, University at Buffalo, Buffalo, NY, USA. mtezal@buffalo.edu

BACKGROUND: Infections have been suggested in the etiology of oral cancer. This study was carried out to evaluate the effect of periodontal disease on oral soft tissue lesions. METHODS: A total of 13,798 subjects aged 20 years and older with at least six natural teeth and who participated in the Third National Health and Nutrition Examination Survey (NHANES III) constituted the study population. Severity of periodontal disease was represented by clinical attachment loss (CAL) and was dichotomized as < or =1.5 mm versus >1.5 mm according to its distributions in the NHANES III population. Three separate dependent variables were employed: 1) tumor (non-specific); 2) precancerous lesions; and 3) any oral soft tissue lesion. The independent effect of CAL on those three dependent variables was assessed by weighted multiple logistic regression analyses adjusting for the effects of number of filled teeth, number of decayed teeth, presence of prosthesis, age, gender, race/ethnicity, education, tobacco, alcohol, occupational hazard, and interaction term "tobacco*occupational hazard." Odds ratios (OR) and their 95% confidence intervals (CI) were calculated. RESULTS: CAL was not related to the presence of any soft tissue lesion (OR = 1.09, 95% CI: 0.91 to 1.31), but was specifically related to the presence of tumor (OR = 4.57, 95% CI: 2.25 to 9.30) and precancerous lesions (OR = 1.55, 95% CI: 1.06 to 2.27). CONCLUSION: This study suggests associations between periodontal disease and the risk for precancerous lesions and tumors generating a hypothesis about a possible relationship between periodontal disease and oral neoplasms. Prospective or well-designed case-control studies with histologically confirmed incident oral cancer cases are necessary to confirm this relationship.

-----

J Environ Pathol Toxicol Oncol. 2005;24(2):141-4.
Black tea (Camellia sinensis) as a chemopreventive agent in oral precancerous lesions.
Halder A, Raychowdhury R, Ghosh A, De M.
Department of Genetics, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratisthan, 99, Sarat Bose Road, Kolkata - 700 026, India. ajantahalder@yahoo.com

Oral carcinoma is the most common malignancy found in adult Indian men and the third most common in adult Indian women. About half of all cases are found to be associated with precancerous lesions, chiefly leukoplakia. We wanted to explore the possible benefits of black tea (Camellia sinensis) administered to patients with oral leukoplakia. Eighty-two subjects with oral leukoplakia underwent micronuclei and chromosomal assays on exfoliated oral mucosal epithelium, after which they received black tea in a fixed regimen. The micronuclei assay was repeated at 6 months, and the chromosomal study at 1 year. After the first year, the first 15 patients entered onto this study showed a significant decrease in the micronuclei frequency and chromosomal aberrations, which correlated with the clinical improvement. Several in vitro and animal studies have suggested the efficacy of tea in the chemoprevention of cancer. To the best of our knowledge, this is the first report on the effect of black tea in oral leukoplakia.

-----

Cancer Lett. 2005 Apr 8;220(2):185-95.
Radiotherapy for oral cancer as a risk factor for second primary cancers.
Hashibe M, Ritz B, Le AD, Li G, Sankaranarayanan R, Zhang ZF.
International Agency for Research on Cancer, Lyon, France; Department of Epidemiology, UCLA School of Public Health and Jonsson Comprehensive Cancer Center, 71-225 CHS, Box 951772, Los Angeles, CA 90095-1772, USA.

Radiation exposure, known to cause DNA damage, may be a potential source of field cancerization of the upper aerodigestive tract. Radiotherapy for head and neck cancers has been examined as a possible risk factor for second primary cancers, but the results have been equivocal. We evaluated the impact of therapeutic radiation for oral cancer on the risk of second primary cancers with data from the Surveillance, Epidemiology, and End Results (SEER) program for 1973-1999. Among 30,221 first primary oral squamous cell carcinoma patients, 6163 (20.4%) patients developed a second primary cancer, 5042 of which were metachronous. Patients treated with radiation only (RR=1.64, 95%CI=1.18-2.29) or radiation with surgery (RR=1.49, 95%CI=1.07, 2.06) had elevated risks of developing a second primary tumor, whereas patients treated with surgery only did not appear to be at increased risk (RR=1.28, 95%CI=0.93, 1.76). Consistent with an expected latent period between radiation exposure and tumor occurrence, radiation became a risk factor after 10 years of follow-up for solid cancers of the oral cavity (RR=2.8, 95%CI=1.5, 5.2), pharynx (RR=5.9, 95%CI=1.7, 20.7), esophagus (RR=3.9, 95%CI=1.1, 13.4) and lung (RR=1.5, 95%CI=1.0, 2.4), and after 1-5 years of follow-up for second primary leukemia (RR=2.5, 95%CI=1.0, 6.7). Radiotherapy for oral cancer appears to be a risk factor for second primary tumors. Further studies that account for chemotherapy and examine frequency and duration of radiotherapy would be of interest in confirming the observed association.

-----

Int J Radiat Oncol Biol Phys. 2005 Mar 1;61(3):762-71.
Accelerated versus conventional fractionated postoperative radiotherapy for advanced head and neck cancer: results of a multicenter Phase III study.
Sanguineti G, Richetti A, Bignardi M, Corvo' R, Gabriele P, Sormani MP, Antognoni P.
Department of Radiation Oncology, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy. gisangui@utmb.edu

PURPOSE: To determine whether, in the postoperative setting, accelerated fractionation (AF) radiotherapy (RT) yields a superior locoregional control rate compared with conventional fractionation (CF) RT in locally advanced squamous cell carcinomas of the oral cavity, oropharynx, larynx, or hypopharynx. METHODS AND MATERIALS: Patients from four institutions with one or more high-risk features (pT4, positive resection margins, pN >1, perineural/lymphovascular invasion, extracapsular extension, subglottic extension) after surgery were randomly assigned to either RT with one daily session of 2 Gy up to 60 Gy in 6 weeks or AF. Accelerated fractionation consisted of a "biphasic concomitant boost" schedule, with the boost delivered during the first and last weeks of treatment, to deliver 64 Gy in 5 weeks. Informed consent was obtained. The primary endpoint of the study was locoregional control. Analysis was on an intention-to-treat basis. RESULTS: From March 1994 to August 2000, 226 patients were randomized. At a median follow-up of 30.6 months (range, 0-110 months), 2-year locoregional control estimates were 80% +/- 4% for CF and 78% +/- 5% for AF (p = 0.52), and 2-year overall survival estimates were 67% +/- 5% for CF and 64% +/- 5% for AF (p = 0.84). The lack of difference in outcome between the two treatment arms was confirmed by multivariate analysis. However, interaction analysis with median values as cut-offs showed a trend for improved locoregional control for those patients who had a delay in starting RT and who were treated with AF compared with those with a similar delay but who were treated with CF (hazard ratio = 0.5, 95% confidence interval 0.2-1.1). Fifty percent of patients treated with AF developed confluent mucositis, compared with only 27% of those treated with CF (p = 0.006). However, mucositis duration was not different between arms. Although preliminary, actuarial Grade 3+ late toxicity estimates at 2 years were 18% +/- 4% and 27% +/- 6% for CF and AF, respectively (p = 0.10). CONCLUSION: Accelerated fractionation does not seem to be worthwhile for squamous cell carcinoma of the head and neck after resection; however, AF might be an option for patients who delay starting RT.

-----

Int J Cancer. 2005 Feb 1; [Epub ahead of print]
The evolution of predictive oncology and molecular-based therapy for oral cancer prevention.
Sudbo J, Reith A.
Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, University of Oslo, Oslo, Norway.

More than 300,000 new cases worldwide are being diagnosed with oral squamous cell carcinoma annually. This aggressive epithelial malignancy is associated with a high mortality and severe morbidity among the long-term survivors. The ability to intervene prior to this advanced stage may improve treatment results. This requires the early identification of molecular events that represent early phases of malignant transition, which is possible through measurement of DNA ploidy in epithelial cells of oral leukoplakia. Recently, we showed that patients with aneuploid dysplastic oral lesions had a 96% rate of oral cancer (26 of the 27 patients received the diagnosis) with a 70% rate within three years, an 81% rate of subsequent cancer (22 of 27), a 74% rate of death from cancer (21 of 27) and virtually no help from complete resection-all hallmarks of biologically aggressive cancer. Standard treatment of oral leukoplakia-a precursor lesion of oral cancer-varies from watchful waiting to complete resection. We have recently demonstrated that complete resection of aneuploid oral leukoplakia does not prevent the occurrence of clinically aggressive and highly lethal oral cancer. Oral carcinogenesis is a complex multifocal process of multiclonal field carcinogenesis and intraepithelial clonal spread. The multifocal nature of early oral carcinogenesis may hinder local treatment modalities. Inhibitors of cyclooxygenase-2 (COX-2) and epidermal growth factor receptor (EGFR), either alone or in combination, may be used for reversing or stopping the oral carcinogenesis at an early stage of disease. The failure of standard treatment to control aneuploid oral leukoplakia justifies clinical trials with new treatment modalities, such as systemic therapy with molecular targeting agents, which in patients with aggressive leukoplakia is tantamount to cancer therapy. (c) 2005 Wiley-Liss, Inc.

-----

J Clin Oncol. 2005 Jan 10;23(2):346-56.
Oral cancer prevention and the evolution of molecular-targeted drug development.
Lippman SM, Sudbo J, Hong WK.
Department of Clinical Cancer Prevention, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. slippman@mdanderson.org

The multifaceted rationale for molecular-targeted prevention of oral cancer is strong. Oral cancer is a major global threat to public health, causing great morbidity and mortality rates that have not improved in decades. Oral cancer development is a tobacco-related multistep and multifocal process involving field carcinogenesis and intraepithelial clonal spread. Biomarkers of genomic instability, such as aneuploidy and allelic imbalance, can accurately measure the cancer risk of oral premalignant lesions, or intraepithelial neoplasia (IEN). Retinoid-oral IEN studies (eg, of retinoic acid receptor-beta, p53, genetic instability, loss of heterozygosity, and cyclin D1) have advanced the overall understanding of the biology of intraepithelial carcinogenesis and of preventive agent molecular mechanisms and targets-important advances for monitoring preventive interventions and assessing cancer risk and pharmacogenomics. Clinical management of oral IEN varies from watchful waiting to complete resection, although complete resection does not prevent oral cancer in high-risk patients. New approaches, such as interventions with molecular-targeted agents and agent combinations in molecularly defined high-risk oral IEN patients, are urgently needed to reduce the devastating worldwide consequences of oral cancer.

-----

Oral Oncol. 2005 Jan;41(1):31-7.
The results of CO2 laser surgery in patients with oral leukoplakia: a 25 year follow up.
van der Hem PS, Nauta JM, van der Wal JE, Roodenburg JL.
Department of Oral and Maxillofacial Surgery, Groningen University Hospital, P.O. Box 30001, 9700 RB Groningen, The Netherlands. p.s.van.der.hem@kchir.azg.nl

Oral leukoplakia is an important premalignant lesion of the oral mucosa. We treat this lesion prophylactically with CO2 laser evaporation. In the period from 1976 to 2001, a group of 200 patients with 282 oral leukoplakias were treated by CO2 laser evaporation. In a follow up period of 1-219 months (mean 52), 251 treated leukoplakias (89.0%) did not show a recurrence. Twenty eight (9.9%) local recurrences were observed in 5 to 168 months after treatment. Three (1.1%) squamous cell carcinoma, occurred in the treated area respectively 7, 17 and 19 month after CO2 laser evaporation. This large study with a long follow up shows that laser treatment is a good prophylactic treatment for oral leukoplakia.

-----

Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):112-8.
Malignant parotid tumors: presentation, clinical/pathologic prognostic factors, and treatment outcomes.
Pohar S, Gay H, Rosenbaum P, Klish D, Bogart J, Sagerman R, Hsu J, Kellman R.
Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA. pohars@upstate.edu

PURPOSE: To determine the important clinical/pathologic prognostic factors and optimal treatment of malignant parotid tumors. METHODS AND MATERIALS: This study was a retrospective chart review of 163 patients treated for malignant parotid tumors at two institutions. Of the 163 patients, 91 were treated with surgical resection and radiotherapy (RT), 56 were treated with surgery alone, and 13 were treated with RT alone. The median follow-up was 5.1 years (range, 0-37 years). RESULTS: Locoregional recurrence occurred in 37% of surgery-only, 11% of surgery plus RT, and 15% of RT-only patients (p = 0.001, Pearson's chi-square test). Cox proportional hazard multivariate analysis revealed that increasing age and higher stage were each statistically significantly (p < 0.05) associated with a poorer overall 5-year survival and cause-specific survival. Only increasing age and the absence of adjuvant RT were shown in Cox proportional hazard multivariate analysis to impact negatively on local failure-free survival. CONCLUSION: In Cox proportional hazards multivariate analysis, only increasing age and stage were statistically significant prognostic factors for survival. The addition of RT to surgery did not improve overall survival but did reduce locoregional recurrence and improve local failure-free survival.

-----

Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):103-11.
The role of radiotherapy in the treatment of malignant salivary gland tumors.
Terhaard CH, Lubsen H, Rasch CR, Levendag PC, Kaanders HH, Tjho-Heslinga RE, van Den Ende PL, Burlage F; Dutch Head and Neck Oncology Cooperative Group.
Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands. C.H.J.Terhaard@azu.nl

PURPOSE: We analyzed the role of primary and postoperative low linear energy transfer radiotherapy in 538 patients treated for salivary gland cancer in centers of the Dutch Head and Neck Oncology Cooperative Group, in search for prognostic factors and dose response. METHODS AND MATERIALS: The tumor was located in the parotid gland in 59%, submandibular gland in 14%, oral cavity in 23%, and elsewhere in 5%. In 386 of 498 patients surgery was combined with radiotherapy, with a median dose of 62 Gy. Median delay between surgery and radiotherapy was 6 weeks. In the postoperative radiotherapy group, adverse prognostic factors prevailed. Elective radiotherapy to the neck was given in 40%, with a median dose of 50 Gy. Primary radiotherapy (n = 40) was given for unresectable disease or M(1), with a dose range of 28-74 Gy. RESULTS: Postoperative radiotherapy improved 10-year local control significantly compared with surgery alone in T(3-4) tumors (84% vs. 18%), in patients with close (95% vs. 55%) and incomplete resection (82% vs. 44%), in bone invasion (86% vs. 54%), and perineural invasion (88% vs. 60%). Local control was not correlated with interval between surgery and radiotherapy. No dose-response relationship was shown. Postoperative radiotherapy significantly improved regional control in the pN(+) neck (86% vs. 62% for surgery alone). A rating scale for different sites, T stage, and histologic type may be applied to calculate the risk of disease in the neck at presentation, and so indicate the need for elective neck treatment. A marginal dose-response was seen, in favor of a dose > or =46 Gy. A clear dose-response relationship was shown for patients treated with primary radiotherapy. Five-year local control was 50% with a dose of 66-70 Gy. CONCLUSIONS: Postoperative radiotherapy with a dose of at least 60 Gy is indicated for patients with T(3-4) tumors, incomplete or close resection, bone invasion, perineural invasion, and pN(+). In unresectable tumors, a dose of at least 66 Gy is advisable.

-----

Brachytherapy. 2004;3(4):240-5.
A comparison of treatments of squamous cell carcinoma of the base of tongue: surgical resection combined with external radiation therapy, external radiation therapy alone, and external radiation therapy combined with interstitial radiation.
Barrett WL, Gluckman JL, Wilson KM, Gleich LL.
Division of Radiation Oncology, University of Cincinnati, 234 Goodman Street, Cincinnati, OH 45267, USA. barretwl@healthall.com

PURPOSE: The outcomes of patients treated at a single institution over a specific time frame using three different therapeutic approaches for cancer of the base of tongue were reviewed. METHODS AND MATERIALS: Between 1992 and 1998, 53 patients were treated with curative intent for base of tongue cancer. Seventeen patients underwent surgical resection with postoperative radiation therapy, 16 patients received definitive external radiation therapy only, and 20 patients were treated with external and interstitial radiation, with neck dissection in 16 of those patients. Local control, survival, and functional status were assessed with each approach. RESULTS: The 5-year actuarial local control and survival for the surgically treated patients were 74% and 44%, respectively. The patients treated with external radiation therapy alone had local control of 28% and 5-year survival of 24%. The patients treated with external and interstitial radiation with neck dissection as indicated had 5-year actuarial local control of 87% and survival of 33%. Survival was not statistically different between the three treatment approaches (p=0.0995) but local control was worse in the definitive external radiation group (p < 0.0001). Speech and swallowing function among the long-term survivors was superior in the definitively irradiated patients compared with the operated patients. CONCLUSION: In this retrospective analysis, survival and local control was lowest in the patients treated with external radiation alone, however, patient selection likely played an important role. Local control was far better with surgical treatment and with external combined with interstitial radiation but survival remains less than 50% with each approach. Surgical treatment was superior for patients with T4 disease. Functional status was higher in the long-term survivors treated nonsurgically.

-----

Cancer Radiother. 2004 Nov;8 Suppl 1:S61-7.
[Primary surgery for base of tongue and tonsillar regions carcinoma: indications, surgical approaches and resections]
[Article in French]
Hamoir M.
Cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique. hamoir@orlo.ucl.ac.be

The oropharynx is a complex anatomical area gathering different subsites. Optimal treatment of oropharyngeal carcinoma remains still controversial. In early stages, surgery and radiation therapy are known to provide comparable oncologic results. Till recently, advanced tumors were best treated using primary radical surgery followed by postoperative radiotherapy, but new "organ sparing" approaches like concurent chemoradiotherapy seem now able to challenge primary surgery with a better functional outcome. This paper is focused on the role of primary surgery for cancer of the base of tongue and the lateral wall of the oropharynx. The surgical indications and the various surgical approaches are debated including advantages, disadvantages and tumor resections allowed by each of them respectively. Before to be considered, suitable oncologic surgery for oropharyngeal cancer should tackle 5 issues: complete resection of the tumor, adequate exposure, function preservation, minimal morbidity and simplicity of technique. During the past decade, significant advances have been observed in reconstructive surgical procedures through the use of microvascular free flaps routinely, which allows a more functional restoration of surgical defect. Current therapeutic strategy for oropharyngeal carcinoma should be settled not only following disease-free survival results but also the functional outcome of each treatment modality respectively.

-----

J Hum Nutr Diet. 2004 Dec;17(6):575.
An audit designed to assess the need for planned pretreatment PEG placement in patients with stage III & stage IV oral cancer.
Dawson FR, Jackson M, Macgregor CA, Soutar DS, Robertson AG, Camilleri I.
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, Scotland Fiona.Dawson@northglasgow.scot.nhs.uk.

Background: Nutritional support is a crucial and challenging part of treatment for patients with oral cancer. The aim of this audit was to assess the need for planned pretreatment percutaneous endoscopic gastrostomy (PEG) placement in this group of patients and to assess diet consistency as a predictor of poor outcomes. Method: This was a retrospective study of 77 consecutive patients with stage III and IV squamous cell carcinoma of the oral cavity treated by radical surgery and post-operative radiotherapy between January 1999 and December 2001. Information was taken from dietitians' records. Patients were divided into two groups according to survival: group 1 (40 patients) comprised nonsurvivors and group 2 (37 patients), survivors. All patients were enterally fed post-operatively. After approximately 10 days, swallowing was assessed and, if deemed competent, patients progressed to a fluid diet. Tube feeding was gradually reduced and then stopped when oral nutrition was sufficient to maintain weight. Patients progressed to soft diet as they were able. During radiotherapy, liquid diet or tube feeding was instigated as required. Results: In group 1, 65% required tube feeding for less than 30 days (mean 17 days), 20% for 31-100 days (mean 51 days) and 15% for over 100 days (mean 231 days). The overall mean length of tube feeding was 97 days. Thirty-eight per cent of nonsurvivors developed recurrence and went on to subsequent operations necessitating further tube feeding for an average of 129 days. In group 2, 70% were tube fed for less than 30 days (mean 11 days), 14% for between 31-100 days (mean 43 days), and 17% for more than 100 days. The overall mean length of tube feeding was 72 days. The dietary consistency of nonsurvivors was worse than survivors throughout treatment. At first presentation, only 37% of nonsurvivors managed a normal diet, 8% managed a near normal diet and 3% required tube feeding, whereas 48% of survivors managed a normal diet and 16% a near normal diet. At 1 year, there was a significant difference between the two groups' diets. No patients in group 1 managed a normal or near normal diet, whilst 62% required tube feeding. In group 2, 12 and 32% managed a normal and near normal diet, respectively and only 9% required or wished to remain on tube feeding to supplement their diet. Five per cent of patients in this group remained nil by mouth due to fistula. Conclusion: Deciding whether a patient has a naso-gastric tube, PEG or radiologically inserted gastrostomy tube placed can be a difficult decision. However, a gastrostomy should be considered prior to treatment in patients whose diet is of poor consistency at presentation or who have an inadequate oral intake to maintain or increase weight and in those with a fistula, expected slow recovery of swallowing function, for example, pharyngeal tumour or undergoing brachytherapy or chemoradiotherapy.

-----

Br J Oral Maxillofac Surg. 2004 Dec;42(6):494-500.
Management of the neck in patients with T1 and T2 cancer in the mouth.
Smith GI, O'brien CJ, Clark J, Shannon KF, Clifford AR, McNeil EB, Gao K.
Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney 2042, Australia.

Our aim in this restrospective study was to evaluate the extent of control of metastatic disease in the neck and the survival of patients with T1 and T2 oral cancer. Methods: All 171 patients with T1 and T2 squamous cell carcinoma (SCC) in the mouth were identified from our computerised database. All had had primary tumours resected and 21 patients with palpable neck nodes had therapeutic neck dissections. Among 150 patients with no palpable nodes, 75 had elective neck dissections, and 75 were observed. The decision to do an elective neck dissection was based on clinical criteria and was not randomised. Results: Cervical nodes contained metastases in 17 of 21 patients who had therapeutic, and 27 of 75 who had elective, neck dissections. Neck metastases developed subsequently in 15 of 75 patients in the observed group, and 9 of these were salvaged by therapeutic neck dissection. The 5-year disease free survival was 19/21 after therapeutic dissection, 72/75 after elective dissection, and 69/75 in the observed group. Patients with cervical nodal metastases had significantly reduced 5-year survival compared with those without (63% and 91%, P = 0.003).

-----

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Nov;98(5):546-52.
Carcinoma of the tongue: a case series analysis of clinical presentation, risk factors, staging, and outcome.
Gorsky M, Epstein JB, Oakley C, Le ND, Hay J, Stevenson-Moore P.
The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.

OBJECTIVE: Oral cancer is primarily a disease of epithelial origin. The tongue is the most common site of oral cancer. Oropharyngeal cancer accounts for approximately 2% of all cancer deaths. The purpose of this study was to analyze a case series of patients with tongue cancer. STUDY DESIGN: The medical records of 322 consecutive patients diagnosed with squamous cell carcinoma (SCC) of the tongue treated from 1979-1994 were reviewed. RESULTS: Patients had a mean age of 61.1 years and a 1.5:1 male to female ratio. Approximately, half of the cancers were diagnosed at an advanced stage and most involved the base of the tongue. The majority of oral tongue tumors were diagnosed at an early stage and had more well-differentiated cell types than those of the base of the tongue. Localized discomfort was the most common complaint (66.5%), present for up to 6 months in patients prior to diagnosis and were related to the oral tongue in 90% of cases. Symptoms associated with base of tongue lesions included neck masses, dysphagia, ear pain, and weight loss. Seventy-nine percent of the patients smoked, 58% consumed alcohol on a daily basis, and 43% consumed more than 4 alcoholic drinks daily. Primary radiotherapy was the treatment of 49.6% lesions, of which 57% were at an early stage at diagnosis. The mean overall survival was 3 years and 5 months, with a 5-year overall survival of 40%. Patients with stage 1 tumors had a disease-specific survival of over 80%. The 5-year survival of patients with cancer of the oral tongue was 43% and cancer of the base of the tongue was 27%. CONCLUSION: The prognosis is poorer for patients presenting with advanced stage and with tumors involving the base of the tongue. Symptoms were more common in tumors of the oral tongue, which likely results in earlier diagnosis. Patients with SCC of the base of the tongue presented with advanced stage of disease and were typically poorly differentiated lesions.

-----

Mol Nutr Food Res. 2004 Nov 11; [Epub ahead of print]
Molecular and cellular effects of green tea on oral cells of smokers: A pilot study.
Schwartz JL, Baker V, Larios E, Chung FL.
University of Illinois, College of Dentistry, Chicago, IL, USA. Fax: +1-312-355-2688.

Studies in cell culture and laboratory animals have shown that green tea and its major component, epigallocatechin-3-gallate, inhibit cell growth and reduce tumor incidence. However, results of epidemiological studies have generated inconsistent, sometimes conflicting data regarding protection by green tea against human cancers. To clarify the findings of these laboratory studies in application to humans, we conducted a pilot intervention study with three heavy smokers (> 10 cigarettes/day) and three nonsmokers (never smokers) in order to evaluate the molecular and cellular effects of drinking green tea using human oral cells as an investigative tool. Green tea total extract (400-500 mg/cup, 5 cups /day) was administered in drinking water to the subjects for four weeks. Two oral cytology samples were taken weekly for measurements of tobacco carcinogen-induced DNA damage, including bulky adducts and oxidized bases, cell growth, DNA content, and apoptosis. The study showed that during the course of green tea administration smoking-induced DNA damage was decreased, cell growth was inhibited, and the percentage of cells in S phase was reduced, cells accumulated in G(1) phase (cyclin D(1) positive), DNA content became more diploid and less aneuploid, and p53, Caspase-3, and TUNEL, markers of apoptosis, were increased. The study, although preliminary, indicates that drinking green tea reduced the number of damaged cells in smokers by inducing cell growth arrest and apoptosis, a mechanism similar to that observed in cultured cells and animals. These results warrant a large-scale intervention trial to further verify the role of green tea in the prevention of oral cancer in smokers.

-----

J Clin Oncol. 2004 Oct 1;22(19):3973-80.
Positron emission tomography in combination with sentinel node biopsy reduces the rate of elective neck dissections in the treatment of oral and oropharyngeal cancer.
Kovacs AF, Dobert N, Gaa J, Menzel C, Bitter K.
Department of Maxillofacial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany. A.Kovacs@em.uni-frankfurt.de

PURPOSE: To assess the impact of a diagnostic ladder including [(18)F]fluorodeoxyglucose positron emission tomography (PET) and lymphoscintigraphy guided sentinel node biopsy (LS/SNB) on neck treatment in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). PATIENTS AND METHODS: Prospectively, 62 patients with resectable T1-3 OOSCC underwent computed tomography (CT) and PET. Patients without neck uptake in PET were defined as cN0 and were accrued for LS/SNB. Results were correlated with histopathology. The traditional guidelines according to CT findings were compared to the actual regimen and the outcome. RESULTS: Sensitivity, specificity, validity, and positive and negative predictive value of PET versus CT were 72% v 89%, 82% v 77%, 79% v 80.5%, 62% v 61.5%, and 88% v 94.5% (not significant). Thirty-eight PET negative patients underwent LS/SNB. Sentinel lymph nodes were found in all 38 patients. Five patients had positive nodes (PET false-negatives) and underwent neck dissection (ND). Fifty-one neck sides in 36 patients who were CT-negative would have been treated with selective ND according to the guidelines, and at least 45 neck sides would have had to undergo extensive ND because of positive CT findings (96 of 124 neck sides). In contrast, PET in combination with LS/SNB spared 59 neck sides, and 41 of 124 neck sides actually underwent ND as a result of PET staging, LS/SNB, and intraoperative decision. After a median follow-up of 35 months, two patients (both cN+ve and pN+ve) suffered from neck relapses. CONCLUSION: Diagnostics using PET in combination with LS/SNB considerably reduced the number of extensive ND in OOSCC as compared to CT without locoregional hazard.

-----

Laryngoscope. 2004 Sep;114(9):1652-5.
Tumors of the accessory lobe of the parotid gland: a 10-year experience.
Lin DT, Coppit GL, Burkey BB, Netterville JL.
Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, TN, USA. derrick.t.lin@vanderbilt.edu

OBJECTIVES/HYPOTHESIS: The differential diagnosis of midcheek masses include pathology arising from normal anatomic structures or from variations of normal accessory parotid gland tissue. Accessory parotid gland tissue has been described as salivary tissue adjacent to Stenson's duct that is separate from the main body of the parotid gland. We report our 10-year experience with the diagnosis and treatment of eight accessory parotid gland neoplasms that have been followed by the senior authors. STUDY DESIGN: This is a retrospective review of our experience with eight accessory parotid gland neoplasms. METHODS: A literature review and retrospective chart review of our experience with accessory parotid gland tumors over the past 10 years. The presentation, evaluation, management, treatment, and outcome were recorded. RESULTS: Eight cases of accessory lobe parotid tumors were identified, which have been followed since the date of initial treatment. All of the patients presented with a slowly growing cheek mass. There was one case of carcinoma expleomorphic adenoma, one case of undifferentiated carcinoma (small cell carcinoma), one case of basal cell adenocarcinoma, one case of benign salivary cyst, two cases of pleomorphic adenoma, and two cases of monomorphic adenoma. A standard facelift approach or modified Blair incision was used to excise these tumors. CONCLUSIONS: Neoplasms of the accessory parotid gland are rare. Management of these tumors include a high index of suspicion, good understanding of the anatomy, and meticulous surgical approach.

-----

J Oral Maxillofac Surg. 2004 Sep;62(9):1064-8.
Does administration of isosorbide mononitrate affect cellular proliferation in oral squamous cell carcinoma? A prospective randomized clinical study.
Downie IP, Umar T, Boote DJ, Mellor TK, Hoffman GR, Brennan PA.
Salisbury District Hospital, Wilts, UK.

PURPOSE: There has been much interest in the role that the signaling molecule nitric oxide (NO) plays in cancer. NO has both tumor-promoting and tumor-inhibiting effects that are dependent on its local tissue concentration. In animal studies, the administration of exogenous NO has reduced both tumor growth and dissemination, and in vitro NO administration causes death of oral cancer cell lines. We evaluated the oral administration of the NO donor drug isosorbide mononitrate (ISMO) on cellular proliferation in patients with oral squamous cell carcinoma. MATERIALS AND METHODS: A prospective randomized double-blind study was performed on 31 patients with biopsy-confirmed oral squamous cell carcinoma. Following incisional biopsy, patients were randomized to receive either ISMO (at a dose of 20 mg twice a day) or placebo tablets for 2 weeks before definitive resection. Cellular proliferation was compared between biopsy and resection specimens, using the immunohistochemical marker Ki-67. RESULTS: No statistical difference was found between Ki-67 indices in initial biopsy and resection specimens after ISMO (P =.23) or placebo (P =.5) administration. There were no obvious clinical changes seen in the tumor during the clinical trial as a result of ISMO administration. CONCLUSION: Although high concentrations of NO are cytotoxic, it is unlikely that administration of NO at an increased dose would be useful in the management of oral cancer because this would result in unacceptable systemic side effects. The possible manipulation of NO in oral cancer is discussed.

-----

Psychooncology. 2004 Sep;13(9):642-53.
Development and pilot testing of a psychoeducational intervention for oral cancer patients.
Katz MR, Irish JC, Devins GM.
Psychosocial Oncology and Palliative Care, Department of Psychiatry, University Health Network-Toronto General Hospital/Princess Margaret Hospital, University of Toronto, Toronto, Canada.

Objective: Oral cancer elicits considerable distress in both the pre and post-treatment periods. This paper details the development, validation and pilot-testing of a psychoeducational intervention for oral cancer patients.Method: An educational booklet covering information about oral cancer and its treatment and effective coping strategies was developed by a multi-disciplinary team. It was evaluated by patient focus groups and content/educational experts, delivered to subjects in pre and post-operative presentations by a health educator, and pilot-tested in a randomized controlled trial versus standard care.Results: Pilot data from 19 subjects (10 psychoeducation, nine standard care) indicates that the intervention is feasible and highly acceptable. At follow-up the intervention group showed a gain in knowledge, less body image disturbance, lower anxiety and a trend toward higher wellbeing.Conclusion: This program, which is currently being evaluated in a larger RCT with extended follow-up, should prove useful in reducing the psychosocial burden of oral cancer and its treatment. Copyright 2003 John Wiley & Sons, Ltd.

-----

Int J Cancer. 2004 Aug 10;111(1):138-46.
mTHPC-mediated photodynamic therapy for early oral squamous cell carcinoma.
Hopper C, Kubler A, Lewis H, Tan IB, Putnam G.
National Medical Laser Centre and The Eastman Dental Institute, London, United Kingdom. c.hopper@ucl.ac.uk

Surgery and radiotherapy are standard treatments for early oral squamous cell carcinoma, both resulting in good tumour control. However, neither of these modalities is without consequent functional or cosmetic impairment, and there are patients in whom both are contraindicated. Furthermore, there is a significant risk of metachronous tumours developing in the oral cavity, and salvage or retreatment with either surgery or radiotherapy poses difficulties. Photodynamic therapy (PDT) offers the potential for improved functional and cosmetic outcomes, while achieving comparable tumour control. We conducted an open-label, multicentre study to assess the efficacy and safety of meta-tetrahydroxyphenylchlorin (mTHPC) in patients with early oral cancer. One hundred twenty-one patients received intravenously administered mTHPC, followed 96 hr later by illumination of the tumour surface with 652 nm laser light. Of these patients, 114 were protocol compliant. A complete tumour response was achieved in 85% of protocol-compliant patients (97 of 114 patients). A complete response was maintained in 85% of responders at 1 year and in 77% at 2 years. One- and 2-year actuarial survival rates were 89% and 75%, respectively. In the opinion of the investigators, tumour clearance was accompanied by excellent cosmetic and functional results, without impact on the patients' performance status. Mild-to-moderate pain at the treatment site, a recognised side effect of PDT in the oral cavity, was reported by 82% of patients but was manageable with appropriate analgesia. Mild-to-moderate skin photosensitivity reactions were reported for 13% of patients. mTHPC offers an effective alternative treatment for early oral squamous cell carcinoma. It is associated with excellent functional and cosmetic results and can be used in conjunction with other standard therapies. Copyright 2004 Wiley-Liss, Inc.

-----

Mund Kiefer Gesichtschir. 2004 Aug 10 [Epub ahead of print]
[Patients with oral squamous cell carcinoma. Long-term survival and evaluation of quality of life-initial results obtained with two treatment protocols in a prospective study]
[Article in German]
Kessler P, Grabenbauer G, Leher A, Schultze-Mosgau S, Rupprecht S, Neukam FW.
Klinik und Poliklinik fur Mund-, Kiefer-, Gesichtschirurgie, Friedrich-Alexander-Universitat, Erlangen-Nurnberg.

INTRODUCTION. In patients with oral cancer the treatment has a strong impact on the quality of life. In recent years different therapeutic concepts have been developed, which include preoperative simultaneous 'neoadjuvant' radiochemotherapy (RCT) and one-stage surgery with tumour ablation and reconstruction. Consideration of long-term survival rates yields substantial evidence that mixed-modality treatment including neoadjuvant RCT is superior to adjuvant therapy concepts based on a surgical approach with postoperative radiation. PATIENTS AND METHODS. In this nonrandomised longitudinal prospective study quality of life was evaluated in two groups made up of a total of 53 patients with squamous cell carcinoma of the oral cavity, 26 of whom underwent neoadjuvant radiochemotherapy with subsequent surgical resection while the remaining 27 received surgical treatment first and then postoperative radiotherapy. The quality-of-life core questionnaire (QLQ C-30) and the head and neck cancer module (H&N 35) of the European Organisation for Research and Treatment of Cancer (EORTC) were used. Long-term survival was estimated according to the Kaplan-Meier test. RESULTS. Postoperatively both groups showed a marked reduction in quality of life, especially in restricted chewing, swallowing and speaking. One year later their quality of life had improved substantially, though without quite reaching the preoperative quality-of-life scores. Both groups showed specific impairments in the symptom scales. With adjustment for the fact that the patients were not randomised, long-term survival was 78% in the neoadjuvant treatment group and 50% in the adjuvant treatment group. CONCLUSION. Temporary limitations in the quality of life can be expected after tumour treatment of the kinds presented here for oral cancer. Neoadjuvant therapy concept is more aggressive and might result in longer disease-free survival. The primary goal should be eradication of the tumour. Nevertheless preservation or reconstruction of a maximum of function is essential for a high level of quality of life. Combined-modality treatments seem to be superior to any kind of monotherapy and should therefore be preferred.

-----

Plast Reconstr Surg. 2004 Aug;114(2):329-38.
Chewing and swallowing after surgical treatment for oral cancer: functional evaluation in 196 selected cases.
Nicoletti G, Soutar DS, Jackson MS, Wrench AA, Robertson G.
Department of Plastic and Reconstructive Surgery, University of Pavia, IRCCS Fondazione Salvatore Maugeri, Italy. gnicoletti@fsm.it

One hundred ninety-six patients treated for oral cancer between 1992 and 1999 self-scored their speech, chewing, and swallowing using a new self-questionnaire (Functional Intraoral Glasgow Scale) developed at Canniesburn Hospital, Glasgow, to assess the functional efficiency of patients treated for intraoral cancer. The patients were distributed into 12 homogeneous groups, according to the site and size of surgical resection, carefully mapped out on standard diagrams of the oral cavity. The functional outcome for chewing and swallowing was correlated to the site and size of resected tissue, to the reconstruction modality, and to radiotherapy and compared with the speech quality. The general trend is very similar for both chewing and swallowing; the smaller the resections, the better the functional outcome. Chewing was mostly affected by resections of the floor of the mouth, whereas swallowing was mostly affected by demolition of the base of the tongue and of the retromolar trigone. Speech showed a better postoperative recovery than chewing and swallowing. The reconstruction modality did not influence the eventual outcome for either function. Radiotherapy in combination with surgery is a negative functional prognostic factor. A correlation between site and size of excision and functional outcome is presented using color multiple-view diagrams for immediate appreciation to identify positive and negative prognostic factors.

-----

Arch Otolaryngol Head Neck Surg. 2004 Jul;130(7):831-6.
Decreased short- and long-term swallowing problems with altered radiotherapy dosing used in an organ-sparing protocol for advanced pharyngeal carcinoma.
Smith RV, Goldman SY, Beitler JJ, Wadler SS.
Department of Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. rsmith@montefiore.org

OBJECTIVE: To determine the effect of a reduced radiotherapy dose on short- and long-term swallowing problems after organ-sparing treatment. DESIGN: Prospective case series. SETTING: Tertiary care referral center. PATIENTS: A consecutive sample of 29 patients with advanced oropharyngeal or hypopharyngeal cancer who were treated with intravenous hydroxyurea and concomitant hyperfractionated, accelerated radiotherapy. INTERVENTIONS: Initial experience with 74.4 Gy of radiation demonstrated severe long-term swallowing problems, prompting a dose reduction to 60.0 Gy. Eighteen patients were followed up for this study in the 74.4-Gy group, while 11 were in the 60.0-Gy group. MAIN OUTCOME MEASURES: Swallowing variables were assessed in both patient groups at 4 months and at 12 months following completion of therapy. RESULTS: Patient demographics and tumor characteristics were similar in each group, while significant differences were noted in the posttreatment clinical swallowing variables. Persistent severe odynophagia at 4 months (89% [16/18] vs 30% [3/10]) and at 12 months (64% [7/11] vs 11% [1/9]) was greater in the 74.4-Gy group (P =.002). Clinical signs of aspiration were also increased in the 74.4-Gy group, with 81% (13/16) vs 11% (1/9) at 4 months and 60% (6/10) vs 11% (1/9) at 12 months (P<.05). Most striking, however, was the incidence of long-term gastrostomy, with 78% (14/18) of patients receiving 74.4 Gy requiring gastrostomy feedings at 12 months compared with 18% (2/11) in the 60.0-Gy group (P =.002). Local control was unchanged by the altered dosing, with median follow-ups of 43.5 and 24.0 months in the 74.4-Gy and 60.0-Gy groups, respectively. CONCLUSION: Decreased radiation doses can maintain disease control and reduce treatment-related long-term swallowing complications.

-----

Clin Oral Investig. 2004 Jun;8(2):52-5.
Sarcomas of the oral and maxillofacial region: a review of 32 cases in 25 years.
Yamaguchi S, Nagasawa H, Suzuki T, Fujii E, Iwaki H, Takagi M, Amagasa T.
Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyou-ku, 113-8549 Tokyo, Japan. yamachan.mfs@tmd.ac.jp

Thirty-two cases of sarcomas involving the oral and maxillofacial region over a period of 25 years were reviewed. The age range was from 5 months to 77 years with a mean age of 42. The male to female ratio was 3:1. The sarcomas were located in the maxilla including the maxillary sinus (n= 13), mandible (n= 13), buccal mucosa (n= 3), temporomandibular fossa (n= 2), and submandibular region (n= 1). Histologically sarcomas were classified as osteosarcoma (n= 9), malignant fibrous histiocytoma (n= 7), rhabdomyosarcoma (n= 5), fibrosarcoma (n= 3), plasmacytoma (n= 2), leiomyosarcoma (n= 2), angiosarcoma (n= 2), liposarcoma (n= 1), and ameloblastic fibrosarcoma (n= 1). Surgical resection was performed in 29 cases. Local recurrence was found in 10 patients and metastasis in 11 patients. Metastases included five regional lymph node metastases and eight distant metastases. The survival of patients with local recurrence or metastasis was poor. Surgery is the most reliable treatment for sarcomas of the oral and maxillofacial region. Adequate excision with safety surgical margin as the initial therapy is important for better survival. The value of radiation therapy and/or chemotherapy is uncertain. The 5-year survival rate of primary cases was 61%.

-----

Plast Reconstr Surg. 2004 Jun;113(7):1940-8.
Surgical management of parotid hemangioma.
Reinisch JF, Kim RY, Harshbarger RJ, Meara JG.
Division of Plastic Surgery, Childrens Hospital Los Angeles, California 90027, USA. jfr654@aol.com

Hemangiomas represent one of the most common childhood neoplasms. They are often managed conservatively, requiring numerous years for spontaneous involution. No effective medical treatment has been reported for children with large, deforming hemangiomas of the parotid gland and overlying cheek. The authors retrospectively studied 17 children who underwent surgical resection of parotid hemangiomas at Childrens Hospital Los Angeles from 1997 to 2003. All 17 patients had improvements in facial asymmetry and deformity. There were no major complications. Minor complications included hematoma (11.8 percent), transient facial nerve palsy (11.8 percent), and blood transfusion (5.9 percent). All operations were performed on an outpatient basis. Surgical resection of parotid hemangiomas provides an aesthetic benefit to young children with low associated morbidity. Early resection by an experienced surgeon should be considered as a treatment option for these disfiguring lesions.

-----

N Engl J Med. 2004 Apr 1;350(14):1405-13.
The influence of resection and aneuploidy on mortality in oral leukoplakia.
Sudbo J, Lippman SM, Lee JJ, Mao L, Kildal W, Sudbo A, Sagen S, Bryne M, El-Naggar A, Risberg B, Evensen JF, Reith A.
Department of Medical Oncology, Norwegian Radium Hospital, University of Oslo, Montebello, Oslo, Norway. jon.sudbo@rh.uio.no

BACKGROUND: Although the standard treatment of oral leukoplakia ranges from watchful waiting to complete resection, the value of these approaches is unknown. METHODS: We studied the relations among resection, ploidy status, and death from cancer in 103 patients with diploid dysplastic oral leukoplakia, 20 patients with tetraploid lesions, and 27 patients with aneuploid lesions. Data on cancer-specific mortality and treatment were obtained from the Cancer Registry of Norway, Statistics Norway, and chart reviews. RESULTS: Primary oral carcinoma developed in 47 of the 150 patients with leukoplakia (31 percent)--5 with diploid, 16 with tetraploid, and 26 with aneuploid leukoplakia--during a mean follow-up of 80 months (range, 4 to 237). The margin status of the initial leukoplakia resection had no relation to the development of oral cancer (P=0.95). Twenty-six of the 47 patients in whom cancer developed (4 with prior tetraploid and 22 with prior aneuploid lesions) had recurrences (55 percent); the recurrences were more frequently multiple and distant (within the oral cavity) among patients with aneuploid lesions than among those with tetraploid or diploid lesions. All 47 patients underwent a standard regimen of surgery and radiation, followed by chemotherapy in the 26 with recurrent cancer. Only patients with aneuploid leukoplakia died of oral cancer; the five-year rate of death from cancer was 72 percent. Aneuploidy-related first carcinomas were diagnosed at a more advanced stage than were carcinomas originating from diploid or tetraploid leukoplakia (P=0.03) and were more likely to be lethal regardless of the stage. CONCLUSIONS: Complete resection of aneuploid leukoplakia does not reduce the high risk of aggressive carcinoma and death from oral cancer. Copyright 2004 Massachusetts Medical Society

-----

Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):187-9.
The use of diathermy scissors in parotid gland surgery.
Ussmueller JO, Jaehne M, Neumann BG.
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Eppendorf, Hamburg, Germany. ussmueller@uke.uni-hamburg.de

OBJECTIVE: To evaluate the benefits, as well as the possible complications, of the use of diathermy scissors in parotid gland surgery. DESIGN: Prospective study of the surgical procedures of the diathermy scissors and a retrospective comparison with a conventionally treated control group concerning cut-closure time. SETTING: Tertiary care referral academic center. PATIENTS: Prospective examination of 30 unselected patients undergoing superficial (n=23) or subtotal/total (n=10) parotidectomies performed with diathermy scissors. Indications were benign tumors (n=18), malignant tumors (n=12), and cystic lesions (n=3). In a control group (n=50), 36 superficial and 21 subtotal/total parotidectomies were performed. RESULTS: The use of diathermy scissors reduces the need to frequently change dissecting and coagulating surgical instruments. The scissors reduce intraoperative bleeding and therefore improve visualization and orientation in the surgical field. Postoperative bleeding or seroma and Frey syndrome were not observed. In 1 case, a salivary fistula was present for 3 weeks. Three cases of transient facial weakness occurred, all of which completely resolved by 6 months after surgery. In the control group, the cut-closure time ranged from 50 to 120 minutes (average, 87.6 minutes) during superficial parotidectomy; it ranged from 80 to 160 minutes (average, 130.0 minutes) during subtotal and total parotidectomy. In comparison, in the study group, the average time gain was 16 minutes during superficial parotidectomy when diathermy scissors were used, a statistically significant difference (P=.03). During subtotal and total parotidectomy with diathermy scissors, the average time gain was 19.3 minutes and was statistically not significant (P=.23). CONCLUSIONS: The results of the present study show that diathermy scissors are very well suited for most of the surgical steps in parotid gland surgery. They provide an elegant, safe, and fast surgical procedure, especially in the hands of an experienced surgeon.

-----

Arch Otolaryngol Head Neck Surg. 2004 Jan;130(1):52-6.
Techniques for radiofrequency ablation of head and neck tumors.
Owen RP, Silver CE, Ravikumar TS, Brook A, Bello J, Breining D.
Department of Surgery, Head and Neck Division, Montefiore Medical Center of the Albert Einstein College of Medicine, Bronx, NY, USA. rowen@montefiore.org

OBJECTIVES: To describe the various techniques that have been developed for application of radiofrequency ablation in the palliative treatment of recurrent and advanced head and neck malignant tumors. DESIGN: Case series with a follow-up of 3 to 18 months. SETTING: Faculty practice, research protocol, tertiary care academic medical center. PATIENTS: Fifteen treatments were administered over a 3-year period to 12 patients with advanced and/or recurrent tumors. Eleven tumors were squamous cell carcinomas of the oral cavity, oropharynx, and maxillary sinus, and 1 tumor was a medullary thyroid carcinoma. Three of the 12 patients were treated on 2 separate occasions. Patients were selected as a referred sample and sent specifically for treatment with radiofrequency ablation because they were not candidates for the standard curative options of radiation or surgery. No patient refused enrollment, nor were any patients withdrawn because of adverse events. INTERVENTION: Radiofrequency ablation is a method of localized hyperthermia resulting in tissue necrosis. Ninety to 150 W of energy is applied, achieving intratumoral temperatures of 60 to 110 degrees C for 5 to 15 minutes per ablation. Techniques have been developed to apply radiofrequency ablation under direct vision, endoscopically, percutaneously, and with ultrasound and computed tomographic guidance. RESULTS: The radiofrequency ablation probe was accurately placed and treatment administered on 15 occasions. No perioperative deaths occurred. One patient suffered a stroke. Subjective patient improvement was reported with regard to pain (n=9), appearance (n=3), and function (n=4).

-----

Arch Otolaryngol Head Neck Surg. 2004 Jan;130(1):28-32.
Presurgical cytoreduction of oral cancer using intra-arterial cisplatin and limited concomitant radiation therapy (Neo-RADPLAT).
Robbins KT, Samant S, Vieira F, Kumar P.
Departments of Otolaryngology and Radiation Oncology, University of Tennessee, Health Science Center, Memphis, USA. ent@siumed.edu

OBJECTIVE: To determine the effectiveness of a cytoreduction strategy for oral cancer using a novel trimodal therapy. METHODS: Prospective analysis of 25 patients treated between October 1995 and June 2000 with a protocol named neo-RADPLAT consisting of 4 weekly intra-arterial infusions of cisplatin (150 mg/m2) and intravenous infusions of sodium thiosulfate (9 g/m2), and concurrent radiation therapy (2 daily doses of 50 Gy) followed by tumor nidusectomy (a conventional surgery) at 8 weeks. Five patients had T2 lesions and 20 patients had T3 lesions; the clinical neck cancer stages were N0 in 12 patients, N1 in 9, and N2 in 4 (2 N2a, 1 N2b, and 1 Nc); and there were 17 tumors of the oral cavity (11 of the oral tongue, 5 of the retromolar trigone, and 1 of the floor of mouth) and 8 of the oropharynx (4 of the tonsillar fossa, 3 of the base of tongue, and 1 of the soft palate). RESULTS: Twenty patients (80%) had a complete response to chemoradiation in the primary site and 11 (79%) had a complete response in the neck. Among the 19 patients who had a tumor nidusectomy after chemoradiation, 5 had residual cancer and required a conventional resection. With regard to major toxicity, there were 6 cases of grade 3 and 1 case of grade 4 hematologic effects, 1 case of grade 3 neurologic effect, 1 case of grade 3 gastrointestinal effect, 1 case of grade 5 cardiac effect, as well as 16 cases of grade 3 mucositis. With a median follow-up of 56 months (range, 28-84 months), the 5-year estimates for overall survival, disease-specific survival, and locoregional control were 54%, 64%, and 74%, respectively. Fourteen patients remain without disease, 6 have died of the disease, and 5 have died of other causes. CONCLUSIONS: Preoperative intra-arterial chemoradiation cytoreduction followed by limited surgery is effective for controlling oral cancer. This tissue-sparing and reduced-radiation strategy may also preserve oral function.

-----

Head Neck. 2004 Jan;26(1):54-62.
Longitudinal health-related quality of life after mandibular resection for oral cancer: a comparison between rim and segment.
Rogers SN, Devine J, Lowe D, Shokar P, Brown JS, Vaugman ED.
Regional Maxillofacial Unit, University Hospital Aintree, Fazakerley, Liverpool L9 1AL England. snrogers@globalnet.co.uk

BACKGROUND: Mandibular resection for oral cancer is often necessary to achieve an adequate margin of tumor clearance. Segmental mandibulectomy has been associated with a poor health-related quality of life (HRQOL), particularly before composite free tissue transfer to reconstruct the defect. Little is published in the literature contrasting the subjective deficit of segmental compared with rim resection. The aim of this study was to use a validated head and neck HRQOL questionnaire to compare rim and segmental mandibular resection in patients having primary surgery for oral cancer. METHOD: There were 224 consecutive patients between 1995 and 1999 who were treated by primary surgery for oral squamous cell carcinoma. One hundred twenty-tree had no mandibular resection, 44 had a rim resection, and 57 had a segmental resection. The University of Washington Quality of life questionnaire (UW-QOL) was administered before treatment, at 6 months, 12 months and after 18 months. RESULTS: Preoperatively, patients undergoing segmental resection reported significantly more pain, chewing problems, and a lower composite UW-QOL score. Postoperatively, the segment group tended to score worse at all time points, particularly in appearance, swallowing, recreation, and chewing; however, the difference between rim and segment was only seen in smaller resections without adjuvant radiotherapy. Little difference was seen between rim or segment for tumors < 4 cm with radiotherapy and between rim and segments for tumors > 4 cm. CONCLUSION: After segmental mandibulectomy and reconstruction using composite free tissue transfer, the UW-QOL scores were relatively good. The only 2 difference between rim and segments was noted in the small resections without radiotherapy, and some of this was reflected in differences at baseline. Copyright 2004 Wiley Periodicals, Inc.

-----

Gan To Kagaku Ryoho. 2003 Dec;30(13):2091-5.
[A clinical study of neoadjuvant radiochemotherapy with docetaxel and cisplatin for oral cancers]
[Article in Japanese]
Terakado N, Shintani S, Nakashiro KI, Hino S, Hamakawa H.
Dept. of Oral and Maxillofacial Surgery, Ehime University School of Medicine.

Docetaxel is classified among the microtubule-inhibiting compounds called taxanes, which are currently used as agents to treat head and neck cancers. To investigate the efficacy and safety of a neoadjuvant radiation therapy combined with docetaxel/cisplatin, we used this combination to treat 6 patients with oral squamous cell carcinoma. The patients received a low-dose fraction of docetaxel (20 mg/m2/week; total dose: 123.0 +/- 35.0 mg) and cisplatin (5 mg/m2/day, 5 days a week; total dose: 160.0 +/- 42.1 mg) combined with simultaneous irradiation of 40 Gy. Of the 6 patients, 5 (83.3%) showed a partial response (PR) and 1 showed no response (NC). Pathological efficacy was revealed in 4 patients (66.7%). All patients experienced stomatitis over grade 2, and 4 experienced neutropenia.

-----

Acta Oncol. 2003;42(7):763-70.
Stage I and II mobile tongue carcinomas treated by external radiation and gold seed implantation.
Kimura Y, Fuwa N, Kamata M, Matsumoto A, Nakamura PK, Nakamura T, Ariji E.
Department of Radiation Oncology, Aichi Cancer Center Hospital, Japan.

The purpose of this study was to analyze the influence of a protocol modification, in which the use of gold seeds was extended and elective neck irradiation was applied, on the treatment results of early carcinoma of the tongue. We analyzed 225 patients with Stage I (93 patients) and Stage II (132 patients) squamous cell carcinomas of the oral tongue. We compared the results between the two periods before (171 patients) and after (54 patients) the modification. The main alterations were the expanded use of gold seeds for tumors less than 5 mm in thickness and the application of elective irradiation for T2 tumors. The 5-year primary control and survival rates improved from 81% to 97% and from 81% to 93%, respectively. The occurrence of late complications-lingual muscle and mandibular bone necroses-was found not to deteriorate after the modification. We concluded that the modification was adequate.

-----

Acta Oncol. 2003;42(7):756-62.
Treatment of squamous cell carcinoma of the oral cavity, oropharynx and hypopharynx--an analysis of 174 patients in south western Finland.
Luukkaa M, Minn H, Aitasalo K, Kronqvist P, Kulmala J, Pyrhonen S, Grenman R.
Department of Oncology and Radiotherapy, Turku University Central Hospital, Turku, Finland. Marjaana.Luukkaa@tyks.fi

The purpose of this study was to determine the efficacy and feasibility of full-dose preoperative radiation therapy (RT) in head and neck cancer presenting in the oral cavity, oro- and hypopharynx, within a single university hospital district. During a seven-year period, 1989 to 1995, 174 patients with squamous cell carcinoma (SCC) of the oral cavity (OC, 70% of all patients), oropharynx (OP, 15%) and hypopharynx (HP, 15%) were referred to Turku University Central Hospital. All patients were seen by a tumor board consisting of an ENT (ear-nose-throat) head and neck surgeon, a radiation oncologist and a dentist. Potentially curative treatment was given to 142 patients. Of these, 88 (62%) had preoperative RT, 6 (4%) postoperative RT, 34 (24%) definitive RT and 14 patients (10%) were treated with surgery only. The radiation dose was > or = 50 Gy. averagely 64 Gy. The major endpoints of the study were local control, overall survival and major complications of the combined treatment. The 5-year relative survival rate (RSR) was 40% for all, and 43% for patients treated with curative intent. For these, the local control at 5 years was 60%; the disease-specific 5-year survival rate was 65% for the patients with lingual SCC, 45% for those with other oral tumor localizations. 64% for the oropharynx patients and 47% for those with tumor in their hypopharynx, while it was 55% for all patients. The preoperative radiotherapy was fairly well tolerated. Ten (7%) of the patients treated with curative intent suffered major complications, and four patients had evidence of osteoradionecrosis. With the exception of patients with early SCC the outcome remains rather poor in this group of cancer patients who often have marked co-morbidity. In our opinion, preoperative radiotherapy to a dose of 62-64 Gy can safely be given, and remains a feasible means to treat patients with oral, oropharyngeal or hypopharyngeal cancer.

-----

Otolaryngol Head Neck Surg. 2003 Dec;129(6):720-5.
Salivary duct carcinoma.
Hosal AS, Fan C, Barnes L, Myers EN.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.

Salivary duct carcinoma (SDC) is a highly malignant tumor that is histologically similar to ductal carcinoma of the breast. This article presents the clinicopathologic features of 15 patients with SDC arising in the salivary glands. The majority of patients were male and aged 65 years or older. The tumor was most often located in the parotid gland. Pain, facial palsy, and presence of calcification in the CT scan were diagnostic features suggestive of SDC. Histologically, 27% of the tumors arose from pre-existing pleomorphic adenoma. Perineural and lymphatic invasion were common findings. There was an extensive cervical lymph node involvement (73%). Distant metastasis was the most common cause of failure. Although SDC exhibits an unpredictable clinical course, total parotidectomy with neck dissection and adjunctive radiation therapy appear to be appropriate for local and regional control of this aggressive neoplasm.

-----

Otolaryngol Head Neck Surg. 2003 Dec;129(6):713-9.
Posterior marginal mandibulectomy in the management of cancer of the oral cavity and oropharynx.
Petruzzelli GJ, Knight FK, Vandevender D, Clark JI, Emami B.
Department of Otolaryngology-Head and Neck Surgery, Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL 60153, USA. gpetruz@lumc.edu

OBJECTIVE: To review a single institution's experience with posterior marginal (ramus) mandibulectomy for mandibular preservation in the management of patients with squamous cell carcinoma of the retromolar trigone or oropharynx. To review the history and surgical technique with emphasis on functional as well as oncologic outcomes. STUDY DESIGN AND SETTING: Retrospective review at a tertiary care academic referral center from 1996 to 2002. RESULTS: Between 1996 and 2002, 382 patients with squamous cell carcinoma of the oral cavity and oropharynx were surgically treated at the Loyola University Medical Center. Medical records were reviewed and 152 patients were identified who had some form of mandibular procedure (segmental resection, marginal resection, or mandibulotomy) performed in conjunction with their tumor resection. Eighteen posterior marginal mandibulectomies were performed for primary cancers of the retromolar trigone, tonsillar fossa, and/or base of the tongue. All patients received adjuvant radiotherapy. Bone invasion of the marginal mandibulectomy specimens by squamous cell carcinoma was observed in 2 cases, neither of which developed a local recurrence. Mean and median overall survivals were 41.4 and 37.5 months, respectively. Functional outcomes were determined by administering the University of Washington Quality of Life instrument administered at 12 months. Patients reported significant alterations in chewing, but all were able to maintain satisfactory oral intake and no patient required a gastrosotomy tube. CONCLUSIONS: A posterior osteotomy of the mandibular ramus is a useful adjunct in the surgical treatment of cancer of the retromolar trigone or oropharynx. Negative surgical margins can be obtained even with focal invasion of mandibular bone. The loss of bone in this area does not significantly affect patients' appearance. Patients report deterioration in chewing following this procedure but are able to maintain a diet of solid food.

-----

J Oral Maxillofac Surg. 2003 Nov;61(11):1289-96.
Marginal and segmental mandibulectomy in patients with oral cancer: a statistical analysis of 106 cases.
Munoz Guerra MF, Naval Gias L, Campo FR, Perez JS.
Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Autonoma University, C/General Ricardos no. 171, 2B, 28025 Madrid, Spain. maxmferm@excite.com

PURPOSE: The treatment of oral squamous cell carcinoma may require mandibular resection to secure adequate margin. This bone resection often is segmental or marginal mandibulectomy. The purpose of this work was to evaluate the local control and survival after surgical treatment of oral cancer, according to these 2 different mandibular resection procedures. PATIENTS AND METHODS: We conducted a retrospective study of a 20-year cohort of 106 patients who underwent marginal or segmental mandibulectomy for oral cancer. All patients had a biopsy-confirmed diagnosis of squamous cell carcinoma involving either the floor of the mouth, mandibular gingiva, retromolar trigone, tongue, buccal mucosa, or oropharynx. The type of mandibular resection and treatment outcome were compared, using an univariate analysis by the Pearson chi(2) test, logistic regression model for multivariate analysis, and Kaplan-Meier method to determine survival. RESULTS: The 5-year observed survival rate was 60.35%. The presence of histologic mandibular invasion increased the local recurrence rate. Early tumor stages (P =.02) were found to be associated with decreased local recurrence rates. Our findings indicate that tumor stage and size of mandibulectomy are more important than the type of mandibulectomy in predicting histologic bone involvement. The cases treated with a greater than 4 cm bone resection showed a lower survival rate than those treated with less than 4 cm mandibulectomy (P =.01). Patients in advanced stages (P =.006) and those with surgical margin (P =.0001) or the bone (P =.003) affected by the tumor showed a statistically significant lower survival rate. However, no statistically significant differences were found between patients treated by marginal or segmental mandibulectomy. CONCLUSIONS: Among the prognostic factors studied, the status of the surgical resection margin, the bony involvement and the size of mandibulectomy affected the prognosis for oral carcinoma. Mandibular conservation surgery is oncologically safe for patients with squamous carcinoma in early stages. The marginal technique was not associated with worse prognosis.

-----

Int J Radiat Oncol Biol Phys. 2003 Nov 1;57(3):693-700.
Postoperative radiotherapy in squamous cell carcinoma of the oral cavity: the importance of the overall treatment time.
Langendijk JA, de Jong MA, Leemans ChR, de Bree R, Smeele LE, Doornaert P, Slotman BJ.
Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. ja.langendijk@vumc.nl

PURPOSE: To test the hypothesis that (1) the distinction between intermediate- and high-risk patients by clustering different prognostic factors results in a significant difference in treatment outcome and (2) a shorter interval between surgery and radiotherapy and shorter overall treatment times of radiation (OTTRT) result in higher rates of locoregional control (LRC). METHODS AND MATERIALS: Included were patients (n = 217) with previously untreated squamous cell carcinoma of the oral cavity treated with radical surgery and postoperative radiotherapy. Patients with extranodal spread or microscopic residual disease and patients with two or more other risk factors (i.e., N2b-N3, >1 nodal level involved, perineural growth, or stage T3-T4) were classified as high-risk patients. Patients with only one other risk factor were classified as intermediate risk. RESULTS: In the intermediate-risk group, the 3-year LRC was 87% as compared with 66% in the high-risk group (p = 0.0005). No association was found between interval and LRC. However, the OTTRT was significantly associated with LRC. The 3-year LRC was 87%, 75%, 69%, and 51% when the OTT was <6 weeks, 6-7 weeks, 7-8 weeks, and >8 weeks, respectively (p = 0.0004). The 3-year overall survival (OS) in the intermediate risk patients was 74% compared with 50% in the high-risk group (p = 0.0014). A significant association was also found between the OS and OTTRT. The OS increased from 50% when the OTTRT was >8 weeks to 74% when the OTT was <6 weeks (p = 0.006). Similar results were found with regard to the disease-free survival (DFS). In the multivariate analysis, both risk group and OTT were significantly associated with LRC, DFS, and OS. No significant interaction term was present between these two factors, which means that the OTT was of importance both for the high-risk and the intermediate-risk patients. CONCLUSION: In the subset of patients with carcinoma of the oral cavity, the classification of high- and intermediate-risk patients by clustering a number of prognostic factors provides important prognostic information regarding LRC, DFS, and OS. The OTT was the most important prognostic factor both in the high-risk and intermediate-risk patients. Reducing the OTT to 6 weeks or less is a rather simple measure to achieve a considerable improvement of the outcome of treatment in this category of patients.

-----

J Oral Maxillofac Surg. 2003 Nov;61(11):1279-84.
Percutaneous endoscopic gastrostomy in patients undergoing resection for oral tumors: a retrospective review of complications and outcomes.
Chandu A, Smith AC, Douglas M.
Oral and Maxillofacial Surgery, School of Dental Science, Austin and Reparation Medical Centre, University of Melbourne, 711 Elizabeth Street, Melbourne, Australia.

PURPOSE: The use of a percutaneous endoscopic gastrostomy (PEG) in patients undergoing resection for oral tumors is not universal, and varying complication rates have been reported. This study reviews our experience with the use of a PEG as an adjunct in this setting. MATERIALS AND METHODS: The records of patients treated for oral tumors by oral and maxillofacial surgery were reviewed retrospectively. All patients undergoing resection for oral tumors and having a PEG were included. Patient age, gender, disease type, and stage, as well as type of operation, were recorded. Data obtained included the timing of PEG placement, duration of PEG use, and PEG complications. Patient weight and body mass index (BMI) were abstracted when recorded preoperatively and about 2 weeks and between 4 and 8 weeks postoperatively. Weight and BMI results were subjected to statistical analysis. RESULTS: Fifty PEGs were placed in 49 patients with oral tumors. The mean age of the patients was 61 years. More than 90% of tumors were squamous cell carcinomas. Most PEG tubes were placed at the time of resection by 1 surgeon and were retained for a mean duration of 114 days. A minor complication rate of 10% and a major complication rate of 8% were noted. Weight decreased significantly by 2.9% from preoperative level to week 2, but there was no other significant difference found between any other weight or BMI measurement. Incidental findings on PEG placement included Barrett's metaplasia in one patient and gastric adenocarcinoma in another. CONCLUSIONS: The use of PEG in patients with oral tumors at our institution was found to be effective in maintaining adequate nutrition, as assessed by weight and BMI, during recovery and convalescence. There is an acceptable low complication rate. Use of an experienced endoscopist and PEG placement at the time of resection are advocated.

-----

J Chemother. 2003 Oct;15(5):495-502.
Postoperative chemotherapy with cisplatin and 5-fluorouracil in cancer of the oral cavity and the oropharynx--long-term results.
Kovacs AF, Ghahremani MT, Stefenelli U, Bitter K.
Clinic for Maxillofacial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Frankfurt am Main, Germany. a.kovacs@em.uni-frankfurt.de

Adjuvant chemotherapy has not yet been proven to have a survival benefit for patients with head and neck cancer. Studies dealing with this topic have had several faults like mingling tumor localizations and treatment modalities. To re-examine the role of postoperative chemotherapy in oral cavity cancer, a single-center study was conducted with the attempt to have higher homogeneity. 122 patients with primary squamous cell carcinoma of the lip, the oral cavity and the oropharynx have been treated with 100 mg/m2 cisplatin bolus infusion and 120-h continuous infusion of 1000 mg/m2 5-fluorouracil following radical surgery; 99 patients completed all 3 cycles. The disease-free and overall survival are reported and compared to a control group of 161 patients with cancer of the lip, the oral cavity and oropharynx treated only with surgery, and a treatment-dependent prognostic index. After a median follow-up of 79 months (range 5-18 years), the current 5-year overall survival of the chemotherapy group was 67% and the 5-year disease-free survival was 57% while the respective data for the control group are 46% and 40%. This difference is statistically significant. The comparison with the prognostic index confirmed this result. The chemotherapy group suffered from fewer local and more neck relapses and had a much longer relapse latency (29 months versus 8 months). The toxicity of the chemotherapy regimen was tolerable. In a homogeneous population with resectable oral cavity and oropharyngeal cancer, postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil resulted in a high overall survival rate which was significantly better than in a comparable population treated only with surgery and better than the survival expectation calculated with the help of a prognostic index. A prospective randomized study of postoperative chemotherapy versus control, exclusively in patients with oral cancer, is warranted.

-----

Strahlenther Onkol. 2003 Oct;179(10):682-9.
[Evaluation of quality of life of patients with oral squamous cell carcinoma. Comparison of two treatment protocols in a prospective study-first results]
[Article in German]
Wiltfang J, Grabenbauer G, Bloch-Birkholz A, Leher A, Neukam FW, Kessler P.
Klinik und Poliklinik fur Mund-, Kiefer-, Gesichtschirurgie, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen-Nurnberg, Germany. Joerg.Wiltfang@mkg.imed.uni-erlangen.de

BACKGROUND: The treatment of oral cancer has a strong impact on the quality of life. In recent years different therapeutic concepts have been developed, these include preoperative simultaneous "neoadjuvant" radiochemotherapy (RCT) and one-stage surgery with tumor ablation and reconstruction. When considering long-term survival, there is substantial evidence that evidenced modality treatment including neoadjuvant RCT is superior to the primary surgical approach with postoperative radiation. PATIENTS AND METHODS: This longitudinal study prospectively evaluates quality of life in two groups consisting of 53 neoadjuvant and primarily surgically treated patients with oral cancer, using the quality-of-life core questionnaire (QLQ-C30) and the head and neck cancer module (H and N 35) of the European Organization for Research and Treatment of Cancer (EORTC). RESULTS: Postoperatively both groups showed a marked reduction in quality of life. 1 year later quality of life had equalized between the two groups to such an extent that the quality of life scores had almost reached the preoperative level. Both groups showed specific impairments in the symptom scales. In the neoadjuvant therapy group however, global health and the emotional status were reduced to a greater degree than in the other group. CONCLUSION: Temporary limitations in quality of life can be expected after tumor treatment of oral cancer as presented here. Neoadjuvant therapy concept is more aggressive and might result in a longer disease-free survival, but the restriction in quality of life is more severe. Primary goal is the eradication of the tumor. Nevertheless preservation or reconstruction of a maximum of function is essential for a high level of quality of life.

-----

Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):489-94.
Long-term outcomes after external beam irradiation and brachytherapy boost for base-of-tongue cancers.
Gibbs IC, Le QT, Shah RD, Terris DJ, Fee WE, Goffinet DR.
Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5302, USA. iris.gibbs@stanford.edu

PURPOSE: To assess long-term efficacy and toxicity associated with external beam irradiation (EBRT) and interstitial (192)Ir implantation for the treatment of squamous carcinoma of the base of tongue. METHODS AND MATERIALS: Between April 1975 and December 1993, 41 patients with base-of-tongue carcinomas were treated with (192)Ir interstitial implants after EBRT at Stanford University. One patient had Stage I, 6 had Stage II, 7 had Stage III, and 27 had Stage IV tumors. Twenty-eight patients had cervical lymph node involvement at diagnosis. All received EBRT to a median dose of 50 Gy (range 48.9-68 Gy) to the primary tumor and regional lymph nodes before brachytherapy. Interstitial implant was performed 2-4 weeks after EBRT. Intraoperatively, nylon catheters were placed via steel trocars into the base of tongue, glossotonsillar groove, and pharyngo-epiglottic fold using a catheter looping technique. Twenty-three of 28 node-positive patients also underwent simultaneous neck dissections. Postoperatively, the (192)Ir seeds were inserted and allowed to remain in place for approximately 35 h to achieve a median tumor dose of 26 Gy (range 20-34 Gy) to a median volume of 73 cc. Survival, local control, and complications were assessed. RESULTS: With a median follow-up of 62 months (range 9-215) for all patients and 90 months for alive patients, the 5-year Kaplan-Meier survival estimate was 66%. The 5-year local control rate was 82%, with 7 patients recurring locally, 2 of whom were salvaged with surgery. Nodal control was achieved in 93% of patients with either EBRT alone or in combination with neck dissection. The 5-year freedom from distant metastasis rate was 83%. Acute complications included transient bleeding (5%) and infection (8%). Late complication included soft-tissue necrosis/ulceration (7%), osteoradionecrosis (5%), and xerostomia. CONCLUSION: Base-of-tongue carcinoma can be effectively treated with EBRT and (192)Ir implant boost. Local control is excellent and complication rates are acceptable.

-----

J Oral Maxillofac Surg. 2003 Oct;61(10):1132-9.
Primary malignant melanoma of the oral mucosa.
Rapidis AD, Apostolidis C, Vilos G, Valsamis S.
Department of Maxillofacial Surgery, and Vice Chairman, Division of Surgery, Greek Anticancer Institute, St Savvas Hospital, Athens, Greece. rapidis@usa.net

PURPOSE: The occurrence of primary oral melanoma is very rare. Large clinical series suggesting appropriate treatment modalities are lacking; the clinician has to rely on case reports to gain insight into the management of this tumor, which is much more aggressive than its skin counterpart.Patients and methods The cases of 5 patients with primary oral melanoma during a 6-year period were retrospectively reviewed. Four patients presented with tumors located in the maxilla. Preoperative workup included microscopic examination of incisional biopsy specimens for the confirmation of the diagnosis and thorough imaging of the body to rule out distant metastases. Histologically significant vertical invasion was found in all patients. No patient had distant metastases initially, and only 1 patient presented with neck disease. Primary treatment included wide local excision in 4 patients and therapeutic modified radical neck dissection in the 1 patient with neck node involvement on presentation. One patient was treated primarily with radiation therapy due to medically compromised status. Adjuvant immunochemotherapy (DAV protocol) was administered to 4 patients. Radiation therapy was used in an adjuvant fashion in 3 patients. RESULTS: All of the patients developed distant metastases to the lung and liver and eventually died of their disease. Survival ranged from 14 to 38 months (mean, 25.6 months). Local recurrence occurred in 1 patient and was attributed to positive surgical margins. Contralateral neck disease developed in the patient who underwent therapeutic neck dissection. CONCLUSIONS: The prognosis of primary oral melanoma remains poor despite adequate locoregional control of the disease. It seems that diagnosis is made late in the course of the disease when the primary tumor has already shed microscopic distant metastases.

-----

Arch Otolaryngol Head Neck Surg. 2003 Sep;129(9):944-8.
Treatment of salivary gland neoplasms with fast neutron radiotherapy.
Douglas JG, Koh WJ, Austin-Seymour M, Laramore GE.
Department of Radiation Oncology, University of Washington Cancer Center, Seattle, USA. drjay@u.washington.edu

OBJECTIVE: To evaluate the efficacy of fast neutron radiotherapy for the treatment of salivary gland neoplasms. DESIGN: Retrospective analysis. SETTING: University of Washington Cancer Center, Neutron Facility, Seattle. PATIENTS: The medical records of 279 patients treated with curative intent using fast neutron radiotherapy at the University of Washington Cancer Center were reviewed. Of the 279 patients, 263 had evidence of gross residual disease at the time of treatment (16 had no evidence of gross residual disease), 141 had tumors of a major salivary gland, and 138 had tumors of minor salivary glands. The median follow-up period was 36 months (range, 1-142 months). MAIN OUTCOME MEASURES: Local-regional control, cause-specific survival, and freedom from metastasis. RESULTS: The 6-year actuarial cause-specific survival rate was 67%. Multivariate analysis revealed that low group stage (I-II) disease, minor salivary sites, lack of skull base invasion, and primary disease were associated with a statistically significant improvement in cause-specific survival. The 6-year actuarial local-regional control rate was 59%. Multivariate analysis revealed size 4 cm or smaller, lack of base of skull invasion, prior surgical resection, and no previous radiotherapy to have a statistically significant improved local-regional control. Sixteen patients without evidence of gross residual disease had a 100% 6-year actuarial local-regional control. The 6-year actuarial freedom from metastasis rate was 64%. Factors associated with decreased development of systemic metastases included negative lymph nodes at the time of treatment and lack of base of skull involvement. The 6-year actuarial rate of development of grade 3 or 4 long-term toxicity (using the Radiation Therapy Oncology Group and European Organization for Research on the Treatment of Cancer criteria) was 10%. No patient experienced grade 5 toxic effects. CONCLUSIONS: Neuron radiotherapy is an effective treatment for patients with salivary gland neoplasms who have gross residual disease and achieves excellent local-regional control in patients without evidence of gross disease.

-----

Acta Otorrinolaringol Esp. 2003 Jun-Jul;54(6):443-8.
[Treatment for the early stages (T1-T2NO) of squamous cell carcinoma of the mobile tongue]
[Article in Spanish]
Gras JR, Orus C, Leon X, Venegas MP, Ganan L, Quer M.
Servicio ORL, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma, Barcelona.

OBJECTIVE: The aim of this study is to define the best local treatment in patients with squamous cell carcinoma of mobile tongue in the early stages (I-II) and to establish the best election for neck management. MATERIAL AND METHODS: We evaluated 90 patients classified as stage I and II between 1984 and 1999. Sixty-eight patients out of the ninety (75%) were treated with radio-therapy and twenty-two (25%) with surgery. Neck dissection was used in 39% (35/90) of patients. RESULTS: The rates of ultimate local control for T1NO lesions were similar for both treatment groups (94% vs. 95%). For T2N0 lesions the ultimate local control did improved in those patients treated with surgery (100%) compared to those that had radiotherapy (77%). Regional control was better in the group that underwent neck dissection compared to the group that had just ganglionar control (89% vs. 79%). CONCLUSIONS: We recommend local surgical treatment for T1-T2NO and in our experience prophylactic treatment of lymph nodes leads to a better regional control.

-----

Gan To Kagaku Ryoho. 2003 Jul;30(7):951-5.
[Combination chemotherapy with nedaplatin and 5-fluorouracil for oral squamous cell carcinomas]
[Article in Japanese]
Yamaoka K, Fukuda M, Kuwajima S, Hagiwara H, Toshima S, Matsuoka A, Ohnuki T, Seki H, Nagai H, Iino M, Sageshima M.
Division of Dentistry and Oral Surgery, Akita University School of Medicine.

We used a new combination chemotherapy with nedaplatin (CDGP) and 5-fluorouracil (5-FU) in eleven fresh patients with oral squamous cell carcinomas. 5-FU was administered at a dose of 1,000 mg/body by continuous infusion for 24 hours on days 1 to 5. CDGP was administered at a dose of 80 or 100 mg/m2 by drip infusion for 120 minutes on day 5. The response rates of total (1- or 2-course) and 2-course group were 54. 5% and 83.3%, respectively. Adverse drug reactions were limited to two cases of grade 3 toxicity with anorexia. The combination chemotherapy with 5-FU and CDGP in place of cisplatin and 5-FU seemed to play an important role as neo-adjuvant chemotherapy for oral squamous cell carcinomas.

-----

Arch Otolaryngol Head Neck Surg. 2003 Jul;129(7):709-11.
Meta-tetra(hydroxyphenyl)chlorin photodynamic therapy in early-stage squamous cell carcinoma of the head and neck.
Copper MP, Tan IB, Oppelaar H, Ruevekamp MC, Stewart FA.
Department of Head and Neck Surgery, Netherlands Cancer Institute, and Otolaryngology, Academic Medical Center Amsterdam, The Netherlands.

OBJECTIVE: Photodynamic therapy (PDT) is a relatively new treatment modality for various types of cancer, including cancer of the head and neck. The advent of the second-generation photosensitizers such as meta-tetra(hydroxyphenyl)chlorin (mTHPC) (Foscan; Scotia Pharmaceuticals, Stirling, Scotland), which are more effective and less phototoxic to the skin than their forerunners, now makes this treatment a feasible alternative to surgery or radiotherapy in specific cases. To evaluate the long-term outcome of this therapy for squamous cell carcinomas of the head and neck, we treated patients with PDT using mTHPC. DESIGN: Prospective study. SETTING: Tertiary cancer referral center. PATIENTS: Twenty-five patients with 29 T1-T2 N0 tumors of the oral cavity and/or oropharynx. INTERVENTION: Photodynamic therapy. MAIN OUTCOME MEASURE: Complete local tumor remission. RESULTS: The mean follow-up of the patients after treatment was 37 months. In 25 (86%) of 29 tumors, a complete remission of the primary tumor was obtained. In the 4 recurrences, salvage was achieved by conventional therapy. In none of the patients was any long-term functional deficit detected. CONCLUSIONS: This study confirms that PDT is a powerful treatment modality that could be considered as an alternative to surgery or radiotherapy in specific cases of head and neck cancer. The major advantage of PDT over these conventional therapies is the reduction in long-term morbidity. Radiotherapy or surgery could be reserved for salvage therapy in the event of a recurrence or second primary tumors.

-----

Laryngoscope. 2003 Jul;113(7):1252-61.
Analysis of treatment results for base of tongue cancer.
Sessions DG, Lenox J, Spector GJ, Chao C, Chaudry OA.
Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.

OBJECTIVE: The study reported the results of treatment for base of tongue cancer with five different treatment modalities with long-term follow-up. STUDY DESIGN: This was a retrospective study of 262 patients with base of tongue cancer treated in the Departments of Otolaryngology-Head and Neck Surgery and Radiation Therapy at Washington University School of Medicine (St. Louis, MO) from July 1955 to January 1998. METHODS: The study population included previously untreated patients with biopsy-proven squamous cell carcinoma of the base of tongue who were treated with curative intent by one of five modalities and were all eligible for 5-year follow-up. The treatment modalities included local resection alone, composite resection alone, radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine statistical significance. RESULTS: The overall 5-year disease-specific survival (DSS) was 49.6% with death due to tumor in 50.4%. The 5-year cumulative disease-specific survival probability (CDSS) was 0.526 (Kaplan-Meier) with a mean of 7.8 years and a median of 5.6 years. Patients with early disease had significantly improved DSS compared with patients with more advanced disease (stages I and II; TN stages T1N0, T2N0, and T2N1; and T stages T1 and T2.). Patients with N0 had better DSS than patients with positive lymph nodes (P =.010). The DSS for all stages by treatment modality included local resection (70.0%), composite resection (47.6%), radiation therapy (40.4%), local resection and radiation therapy (50.0%), and composite resection with radiation therapy (51.5%). Overall and within the stages there was no significant difference in either DSS or CDSS by treatment modality. Local-regional recurrence occurred in 26% of patients, and overall salvage was 10.5%. Patients with clear resection margins did better than patients with close or involved margins (DSS and CDSS). Patients treated with radiation therapy alone had improved capacity to swallow (P =.001), speak (P =.01), and work (P =.001) compared with patients treated with the other modalities. CONCLUSIONS: Cancer of the base of tongue is a lethal disease, and its treatment results in significant disability. No treatment produced a significantly improved survival advantage. Focus on improving local-regional control might improve overall survival. All treatment modalities were associated with major treatment-related complications. Radiation alone produced significantly improved post-treatment function and quality of life compared with the other modalities. Because of the recurrence rates at the primary and neck sites and the high rates of development of distant metastasis and second primary cancers, patients should be monitored for a minimum of at least 4 years.

-----

Br J Radiol. 2003 Jun;76(906):414-7.
Iridium-192 implantation for T1 and T2a carcinoma of the tongue and floor of mouth: retrospective study of the results of treatment at the Royal Berkshire Hospital.
Wadsley JC, Patel M, Tomlins CD, Gildersleve JQ.
Berkshire Cancer Centre and Department of Oral Surgery, Royal Berkshire Hospital, Reading, UK.

Carcinomas of the tongue and floor of mouth are relatively rare tumours, which may be treated using several modalities. We reviewed the results of iridium wire implants performed at the Royal Berkshire Hospital between 1994 and 2000. 24 patients had iridium wire implants as primary treatment for tongue and floor of mouth cancers. Four patients were treated after excision biopsy with close or involved margins. One patient was treated for a recurrence after surgery. The median age at treatment was 61 years. There were 18 men and 11 women. 21 patients had tumours of the tongue and eight of the floor of mouth. 13 had T1 tumours and 11 had T2a tumours. The median follow up was 42 months. The primary tumour was controlled in 22 of the 29 patients by the implant alone. Of the seven patients with local recurrence four were successfully salvaged with surgery. The acturarial 2 year survival rates were: overall survival 81%, disease specific survival 91%, local recurrence free survival 85% and nodal relapse free survival 76%. The recorded complication rate was low, one patient developing radionecrosis of the mandible at 7 years post implant. We believe these results show that brachytherapy remains a treatment option for patients with early tongue carcinoma with a high rate of local control and low toxicity.

-----

Gan To Kagaku Ryoho. 2003 May;30(5):647-52.
[Neoadjuvant chemotherapy with nedaplatin and UFT for oral squamous cell carcinomas]
[Article in Japanese]
Fujimori S, Kurita H, Azegami T, Koike T, Ohtsuka A, Kobayashi H, Tanaka K, Kurashina K.
Dept. of Dentistry and Oral Surgery, Shinshu University School of Medicine.

The purpose of this study was to evaluate the effect of preoperative combination chemotherapy with nedaplatin and UFT for oral squamous cell carcinomas. Eleven patients were enrolled in this study (four men and seven women, with a mean age of 66.3 years). They received oral UFT (300 or 400 mg/day, total 2,100-24,600 mg with an average of 10,700 mg) from the initial diagnosis to the day before surgery. They also received an administration of nedaplatin (80 or 100 mg/m2) about four weeks before the planned surgery. The locoregional response rate (complete response and partial response) was 36.4%, and histological examination of surgical specimens revealed a response rate of 40%. There was no relationship between total dose of UFT and either clinical or histological response. Three patients showed severe neutropenia under 1,000/m3 and all recovered with (two patients) or without (one) the use of G-CSF. No other severe side effect was recognized. From the results of this study it is suggested that this combination therapy is useful for preoperative patients with oral squamous cell carcinoma, and that it is possible for them to undergo the therapy on an out-patient basis.

-----

Laryngoscope. 2003 Jun;113(6):933-5.
Radiation following surgery for oral cancer: impact on local control.
Magge KT, Myers EN, Johnson JT.
Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pennsylvania 15213, USA.

OBJECTIVES: The use of postoperative radiation therapy (RT) is commonly used in the treatment of patients with high-risk squamous cell carcinoma of the head and neck. However, few data exist that quantitate the incremental benefit of RT when administered following surgery. The retrospective study was designed to measure the incremental benefit of adjuvant RT after surgery on control of the primary lesion when compared with patients undergoing surgical therapy alone for squamous cell carcinoma of the oral cavity. STUDY DESIGN: Retrospective chart. METHODS: Previously untreated patients with squamous cell carcinoma of the floor of mouth or oral tongue who were treated between 1974 and 1998 were eligible for study. A minimum follow-up of 2 years was required. Tumor site, stage, and RT data were correlated with local control. RESULTS: Patients with missing or incomplete data and those lost to follow-up or dead as a result of intercurrent disease with follow-up of less than 2 years were censored. A group of 211 patients who could be evaluated was available for the study. Radiation therapy was administered postoperatively to 58 patients, and 153 patients were treated with surgery alone. In the group treated with combined therapy, the average irradiation dose was 5850 cGy; this group included 35 patients who received more than and 16 who received less than 5700 cGy. CONCLUSIONS: The incremental benefit in terms of control of tumor at the primary site for patients receiving postoperative RT was between 0% and 7%. Surgery alone controlled 80% to 85% of primary tumors. The dose of postoperative RT did not correlate with local control.

-----

Chin Med J (Engl). 2003 Feb;116(2):163-5.
Myoepithelial carcinoma of the salivary glands: behavior and management.
Yu G, Ma D, Sun K, Li T, Zhang Y.
Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology, Beijing 100081, China.

OBJECTIVE: To investigate the biological behavior and proper management of myoepithelial carcinomas of salivary glands. METHODS: Twenty-seven cases of myoepithelial carcinoma of salivary glands were retrospectively studied and their detailed clinical and follow-up data were presented. RESULTS: The subjects consisted of 17 men and 10 women aged 16 to 73 years (mean age: 51 years). The parotid gland was the most common site (n = 14) of cancer. Clinical features included extensive local growth, invasion of the surrounding tissues, infrequent cervical lymph node metastasis but high rates of distant metastasis, frequent/multiple recurrences and poor prognosis. CONCLUSIONS: Myoepithelial carcinomas of the salivary gland should be classified as high-grade malignancies. Early and radical surgery with close follow-up are essential for achieving favorable outcomes. Radiotherapy appears to be non-sensitive and elective neck dissection is generally unnecessary.

-----

Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):391-8.
Feasibility and toxicity of combined photon and carbon ion radiotherapy for locally advanced adenoid cystic carcinomas.
Schulz-Ertner D, Nikoghosyan A, Jakel O, Haberer T, Kraft G, Scholz M, Wannenmacher M, Debus J.
Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany. d.ertner@dkfz.de

PURPOSE: To investigate clinical feasibility and toxicity of combined photon and carbon ion radiotherapy in locally advanced adenoid cystic carcinomas (ACC) within a prospective Phase I/II trial. METHODS AND MATERIALS: Between September 1998 and April 2002, 16 patients with histopathologically proven ACC and residual macroscopic tumor were treated with combined photon RT and a carbon ion boost to the macroscopic tumor. Median total tumor dose within the gross tumor volume (GTV) was 72 GyE. Photon radiation therapy (RT) consisted of fractionated stereotactic RT in 7 patients; 9 patients received stereotactic intensity-modulated RT. Carbon ion boost was delivered by intensity-controlled raster scanning at the heavy ion synchrotron (SIS) at the Heavy Ion Research Center (GSI) in Darmstadt. RESULTS: Median follow-up was 12 months. Three patients developed locoregional recurrences 9, 11, and 24 months after RT, respectively. Actuarial local control rates were 80.8% and 64.6% at 1 and 3 years, respectively. Overall survival rates were 100% and 83.3% at 1 and 3 years, respectively. Acute side effects greater than Common Toxicity Criteria (CTC) Grade 2 were observed in 2 patients; no patient developed late effects > CTC Grade 2. CONCLUSIONS: Combined photon and carbon ion RT is feasible and effective in patients with locally advanced ACC. Acute and late toxicity is moderate with respect to the delivered tumor doses and in accordance with the radiobiologic modeling. A Phase III trial is designed.

-----

Acta Otolaryngol. 2003 Jan;123(2):264-8.
Electroporation therapy in head and neck cancer.
Burian M, Formanek M, Regele H.
Department of Otolaryngology, Head and Neck Surgery, General Hospital of Vienna, Vienna Medical School, Vienna, Austria. martin.burian@akh-wien.ac.at

OBJECTIVE: To prove the efficacy of electroporation therapy (EPT) in T1 and T2 squamous cell cancers of the oral cavity and oropharynx. MATERIAL AND METHODS: Twelve patients were treated with EPT within the framework of a European trial. Tumors were infiltrated with a bleomycin solution and subsequently treated with EPT. Four weeks after treatment the necrotic mass at the site of the former tumor was resected with save margins and accurately examined histologically. RESULTS: Whereas 10 specimens were completely free of cancer cells, 2 cases showed viable tumor cells. CONCLUSION: EPT has the potential to serve as an interesting alternative in the treatment of head and neck cancer.

-----

Zhonghua Zhong Liu Za Zhi. 2003 Jan;25(1):91-3.
[Twenty-four cases of carcinoma in pleomorphic adenoma in the salivary gland]
[Article in Chinese]
Huang CP, Wang HS, Tu XY.
Department of Head & Neck Surgery, Cancer Hospital, FuDan University, Shanghai 200032, China.

OBJECTIVE: To study the clinical characteristics, treatment and prognosis 24 cases of carcinoma in pleomorphic adenoma in salivary gland. METHODS: The clinical data of 24 patients with carcinoma in pleomorphic adenoma treated in our hospital from September 1974 to July 1995 were analyzed. RESULTS: The overall 5-year survival rate was 66.7%. The five-year survival rates of patients with carcinoma in pleomorphic adenoma in the major and minor salivary glands were 63.6% and 2/2, respectively. CONCLUSION: Operation is the optimal treatment and extensive resection at the initial operation is suggested. For lumps in the submaxillary gland, preventive neck dissection should be considered. Postoperative radiotherapy can not improve the local-control rate.

-----

Oral Oncol. 2003 Jun;39(4):380-5.
5-Fluorouracil and cisplatin in the treatment of advanced oral cancer.
Andreadis C, Vahtsevanos K, Sidiras T, Thomaidis I, Antoniadis K, Mouratidou D.
3rd Department of Clinical Oncology, Theagenion Cancer Hospital, 2, Alex Simeonidis Str, Thessaloniki 54007, Greece. elkageba@otenet.gr

The benefit of the effect of chemotherapy in patients with advanced head and neck squamous cell tumors have been demonstrated by recent meta-analyses of randomized studies. However, the role of chemotherapy-especially in advanced oral cancer-is not fully clear, because of the very small amount of phase II literature available. From January 1994 to December 2000, a total of 44 pts aged 33-75 years (mean age 60 years) with advanced and histologically proved squamous cell carcinoma's of the oral cavity received at least one chemotherapy course. Seven patients had stage III and 37 stage IV disease. The chemotherapy was the initial therapy in a group of 21 patients. In a second group of 23 patients the chemotherapy was delivered after relapse of their disease. The pre-chemotherapy treatment of the second group was radiotherapy in 11, surgery in 4, combination of radiotherapy and surgery in 8 patients. The chemotherapy regimen consisted of cisplatin 100 mg/m(2) in 3-h infusion, day 1 and 5-FU 1000 mg/m(2) in 24-h infusion, days 1-5. Treatment was repeated every 21 days. A total of 154 treatment courses (3.5 per patient, ranged 1-10) were administered. Myelotoxicity, nausea and vomiting were the major treatment complications. The overall response rate to the induction chemotherapy was 52.3%, with 19% complete (CR), and 33.3% partial response's (PR) and to the chemotherapy for recurrent/metastatic disease 30.4% with 8.7% CR, and 21.7% PR. No difference was found in the median survival of the two subgroups (12 months). The median survival of the responders was 15 months (95% CI 11.3-18.7 months), and of the non-responders 9 months (95% CI 5.6-12.4 months) (P = 0.0067). Chemotherapy with cisplatin and 5-FU combination is effective in pts with advanced squamous cell oral cancer and appears to improve the survival of patients who have a good response. Copyright 2003 Elsevier Science Ltd.

-----

Chin Med J (Engl). 2003 Jan;116(1):134-7.
Craniofacial resection of advanced oral and maxillofacial malignant tumors.
Zhang Z, Qiu W.
Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Second Medical University, Shanghai 200011, China. shhkqyxzzh@online.sh.cn

OBJECTIVE: To evaluate the clinical outcome of craniofacial resection for advanced malignant tumors in oral and maxillofacial regions. METHODS: Forty-six patients who underwent craniofacial resection for malignancies involving the anterior and middle cranial fossa over a 20-year period between June 1978 and December 1997 at our department were evaluated. Twenty patients received radiation therapy and an adjuvant therapy after the operation. Eleven patients received chemotherapy of various types as an adjuvant therapy. RESULTS: The 3- and 5-year survival rates were 48.8% (20/41) and 35.1% (13/37), respectively, while the 10-year survival rate was 20% (4/20). CONCLUSIONS: Our results revealed good prospects of using craniofacial resection on patients with advanced malignancies in the oral and maxillofacial regions.

-----

Cancer Radiother. 2003 Feb;7(1):62-72.
[Brachytherapy in head and neck cancers]
[Article in French]
Mazeron JJ, Noel G, Simon JM, Racadot S, Jauffret E.
Centre des tumeurs, groupe hospitalier Pitie-Salpetriere, 47-83, boulevard de l'hopital, 75651 cedex 13, Paris, France. jean-jacques.mazeron@psl.ap-hop-paris.fr <jean-jacques.mazeron@psl.ap-hop-paris.fr>

Experience accumulated over several decades with radiation of Head and Neck tumours by irradiation has demonstrated the need for a high tumour dose to achieve local control. With external beam irradiation alone, it is difficult to spare adjacent normal tissues, resulting in undesirable late effects on the salivary glands, mandible, and muscles of mastication. Interstitial implantation is ideally suited to deliver a high dose limited to the volume of the primary tumor, thus minimizing sequels. A large experience has been accumulated with low dose rate (LDR) brachytherapy in treatment of carcinoma of oral cavity, oropharynx, and nasopharynx. Recent analysis of large clinical series provided data indicating that modalities of low dose rate brachytherapy should be optimized in treating these tumors for increasing therapeutic ratio. Low dose rate brachytherapy is now challenged by high dose rate (HDR) brachytherapy and pulsed dose rate (PDR) brachytherapy. Preliminary results obtained with these two last modalities are discussed regarding to those of low dose rate brachytherapy.

-----

Rev Stomatol Chir Maxillofac. 2003 Feb;104(1):10-7.
[Squamous-cell carcinoma of the tongue: treatment results and prognosis]
[Article in French]
Zwetyenga N, Majoufre-Lefebvre C, Siberchicot F, Demeaux H, Pinsolle J.
Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Universitaire, Hopital Pellegrin, 33076 Bordeaux-Cedex. zwetyenga@aol.com

OBJECTIVE: The aim of the study was to assess the results of curative treatment of patients with squamous cell carcinoma of the tongue and to evaluate survival and predictive factors of recurrence. PATIENTS AND METHODS: A series of 309 patients with squamous cell carcinoma of the tongue treated with curative intent was studied from January 1988 to December 1999. The percentage of oral tongue cancer was 82.2 and the percentage of cancer of base of the tongue was 17.8. Most patients underwent surgical procedure alone or combined with radiotherapy (92%). We performed 252 neck dissections. Bilateral dissections were performed for cancer of the apex linguae, cancer of the base of the tongue, for patients with N2c neck disease and whenever the primary tumor site crossed the median line. Twenty-five patients (8%) were treated with radiation therapy alone. Mean follow-up was 55 months. The functional results were assessed within a minimum of 10 months postoperative follow-up. RESULTS: In 45.2%, there was histological evidence of node invasion with 53.5% of extracapsular node spread in the neck specimens. Extracapsular node spread did not influence survival or recurrences. Occult cervical metastasis in an elective neck dissection in clinically negative necks was found in about 20% of patients with 47% of extracapsular node spread (41% for cancer of mobile tongue and 80% for those of base of the tongue). About 23% of patients with cancer of base of the tongue staged N0 had histological node invasion in controlateral neck nodes. The postoperative mortality rate was 0.9%. The rate of complications was 17%. The cancer recurred in 41.7% of all cases. Twelve percent of all patients had second primary cancers of the upper aerodigestive tract. The overall survival and non-recurrence rates at 2 and 5 years were higher in cancer of oral tongue than in cancer of base of the tongue. Survival rates were better when neck nodes were clinically or histologically negatives and in early-stage carcinomas. Non-recurrence rates were better when nodes were clinically or histologically negatives and when margins of exeresis were not involved. The functional results were better in oral tongue cancer than in base of the tongue cancer. DISCUSSION: Prognosis (survival and non-recurrence rates and functional results) of squamous cell carcinomas of oral tongue was better than prognosis of those of base of tongue. We recommend an aggressive surgical procedure even in patients with neck classed N0 (with reservations for T1 lesions with small depth of invasion): an ipsilateral supraomohyoid neck dissection for cancer of oral tongue and a bilateral supraomohyoid neck dissection for cancer of base of the tongue, cancer of oral tongue which crosses the median line of the oral cavity and cancer of the apex linguae. Postoperative radiotherapy must be performed when margins are positives and/or when nodes are involved with or without extracapsular spread.

-----

Head Neck. 2003 Mar;25(3):210-6.
Gamma knife radiosurgery for recurrent salivary gland malignancies involving the base of skull.
Lee N, Millender LE, Larson DA, Wara WM, McDermott MW, Kaplan MJ, Sneed PK.
Department of Radiation Oncology, University of California San Francisco, 505 Parnassus Ave., L-08 (Box 0226), San Francisco, California 94143-0226, USA. leen@radonc17.ucsf.edu

BACKGROUND: The management of skull base recurrence of salivary gland tumors is challenging, because complete surgical resection and fractionated reirradiation are seldom possible. Experience is being gained with radiosurgery for this indication. METHODS: From 1994-2000, eight patients with 16 skull base recurrences of salivary gland tumors underwent Gamma Knife radiosurgery at the University of California San Francisco. Local freedom from progression (FFP), regional FFP, locoregional FFP, and survival times were measured from the date of radiosurgery and estimated using the Kaplan-Meier method. RESULTS: All patients experienced symptomatic response, usually pain resolution. The median local FFP, regional FFP, locoregional FFP, and survival times were 15.4, 12.0, 10.0, and 21.2 months, respectively. The 1-year local FFP probabilities are 93% and 59%, respectively. Local FFP, allowing for salvage radiosurgery, was 100% at 1 year and 75% at 2 years. Five of seven patients with locoregional failure underwent repeat radiosurgery, successfully achieving control for an additional 4.4 to 13.4 months in four patients. One patient had radiation necrosis develop. CONCLUSION: Radiosurgery provided good local control and symptomatic relief in patients with recurrent salivary gland malignancies involving the base of skull. In patients with good performance status, radiosurgery should be considered as salvage treatment. Copyright 2003 Wiley Periodicals, Inc. Head Neck 25: 210-216, 2003

-----

Laryngoscope. 2003 Feb;113(2):373-6.
Total glossectomy without laryngectomy as first-line or salvage therapy.
Barry B, Baujat B, Albert S, Nallet E, Depondt J, Guedon C, Gehanno P.
Department of Otorhinolaryngology, Bichat Teaching Hospital, Paris, France. beatrix.barry@bch.ap-hop-paris.fr

OBJECTIVES/HYPOTHESIS: Advanced carcinoma of the tongue can require total glossectomy. Although radiation therapy is of limited efficacy in T3 and T4 tumors involving the base of the tongue, many surgeons are reluctant to suggest highly mutilating surgery. STUDY DESIGN: Retrospective cohort study. METHODS: We compared early postoperative complications, hospital stay duration, function, and oncological outcomes in patients who underwent total glossectomy without laryngectomy as first-line or salvage therapy. RESULTS: Postoperative course and functional outcomes were similar in the two groups. Overall survival was 32% at 3 years and 21% at 5 years. The risk factors for shorter survival were positive margins of resection (P =.002) and tumor spread into the mandible (P =.04). Salvage surgery was not associated with significantly lower survival (P =.09 [NS]). CONCLUSIONS: Postoperative morbidity and functional outcomes are similar after first-line and salvage total glossectomy without laryngectomy. Local tumor control is the main factor influencing survival.

-----

Hosp Med. 2003 Jul;64(7):404-10.
Principles of management in oral cancer.
Swinson BD, Witherow H, Amin M, Kalavrezos N, Newman L.
Department of Maxillofacial Surgery, University College Hospital, Mortimer Market, London WC1E 6AU.

Squamous cell carcinoma is the most common oral malignancy, with a relatively poor prognosis. Treatment of oral cancer has a major impact on afflicted patients because it affects speech, swallowing and mastication. Surgery is the main treatment of oral cancer, as a single modality or combined with radiotherapy. Vigilance is vital for early diagnosis and better overall prognosis.

-----

Am J Surg. 2003 Jul;186(1):57-62.
Carcinoma of the parotid gland.
Zbaren P, Schupbach J, Nuyens M, Stauffer E, Greiner R, Hausler R.
Department of Oto-Rhino-Laryngology, Head, and Neck Surgery, University Hospital, CH-3000 Berne, Switzerland. peter.zbaeren@insel.ch

BACKGROUND: The low incidence and heterogeneity of histiotypes of primary parotid carcinomas makes these tumors histologically and epidemiologically difficult to evaluate. The present study reviews a single institution's experience in the treatment of primary parotid carcinomas during the last 10 years. METHODS: The charts of 98 consecutive patients who had a primary parotid carcinoma and who received primary curative treatment were analyzed retrospectively. The tumors were grouped into high-grade and low-grade malignancies. The effect of treatment modalities on locoregional control, the incidence of locoregional recurrences and distant metastases, and survival rates are evaluated and compared between high- and low-grade malignancies. RESULTS: High- and low-grade malignant tumors were observed in 50 and 48 cases, respectively. Lymph node metastases were detected in 25 of 98 (25%) patients, of whom 8 of 22 (22%) clinically NO staged patients underwent elective neck dissection. In 24 of 26 resected facial nerves, a histologic tumor infiltration was confirmed, in 14 high-grade and 10 low-grade tumors. Local recurrence developed in 13 patients and was associated in 7 with high-grade and in 6 with low-grade tumors. All but 1 of the low-grade malignancies with local recurrence did not receive postoperative irradiation. Regional recurrence developed in 11 patients and distant metastases developed in 10, 3 in combination with a neck recurrence and 1 with a local recurrence. The survival rate at 5 years for low- and high-grade carcinomas was 87% and 56% and the disease-free survival rate 72% and 48%, respectively. CONCLUSIONS: The incidence of occult metastases in clinically N0-elective neck dissection was 22%. A routine elective neck dissection in all N0 parotid carcinomas is suggested. There is no statistically significant difference between low- and high-grade tumors as for the rate of local recurrence and, as all except one of the low-grade malignancies with local recurrence did not receive postoperative irradiation, postoperative irradiation is not only suggested for high-grade carcinomas but also for T2 to T4 low-grade carcinomas.

-----

Anticancer Res. 2003 Mar-Apr;23(2A):931-40.
Adenoid cystic carcinoma of salivary and lacrimal gland origin: localization, classification, clinical pathological correlation, treatment results and long-term follow-up control in 84 patients.
Friedrich RE, Bleckmann V.
Department of Oral and Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Martinistr. 52, D-20246 Hamburg, Germany. rfriedri@uke.uni-hamburg.de

AIM: Adenoid cystic carcinoma (ACC) is a malignant tumor arising from glands. In the maxillofacial region, the salivary glands are particularly affected by ACC and, less frequently, the lacrimal glands. The aim of this study was to determine the outcome of patients with ACC in the maxillofacial region classified according to an internationally accepted staging system. MATERIALS AND METHODS: Over a period of more than 31 years, 84 patients with ACC underwent surgical treatment or a combined treatment in a University Hospital (primaries: 70; local recurrence: 13; distant metastasis: 1). RESULTS: In salivary glands the major glands were affected in 20 individuals, the minor glands in 50, while the glands of the maxillary sinus gave rise to ACC in 8. The lacrimal glands were affected in 6 patients [45 females (53.6%), 39 males (46.4%); age: 13 to 93 years, mean 55.9 years]. Reclassified TNM-stage (UICC, 1987) at the time of diagnosis varied (T0:1, T1:14, T2:13, T3:12, T4:30, NX:1, N0:53, N1:10, N2:5, N3:0, MX:5, M0:59, M1:5). The history of symptoms ranged from 1.82 to 7.3 years, depending on the localization, without any specificity of features. However, swelling and pain were the most frequently recorded findings (> 73%). The therapy of choice has to be the resection of the primary tumor with safety margins. The resection status is important for determining the local control. The resection of the related efferent lymphatics has to be included in the therapeutic concept in patients suspected of having metastasis of the regional lymph nodes. However, hematogenic spread was frequently recorded in our patients, even after several years. An excellent prognosis is only in ACC which is detected early and radically resected. Neither localisation nor the histological subtypes, but tumor stage, had statistically significant impact on prognosis. The differences in survival between surgically-treated patients and those who received radiotherapy as an adjunct were not significant. CONCLUSION: The TNM classification and the analysis of histopathological subtypes provide some information on the tumor biology. The prognosis is uncertain in ACC. Improvement of the current diagnostics and therapy hopefully will come from the development of tumor markers and future molecular genetic investigations.

-----

J Surg Oncol. 2003 Jun;83(2):116-22.
Current management of mucosal melanoma of the head and neck.
Medina JE, Ferlito A, Pellitteri PK, Shaha AR, Khafif A, Devaney KO, Fisher SR, O'Brien CJ, Byers RM, Robbins KT, Pitman KT, Rinaldo A.
Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.

While mucosal-based melanomas of the head and neck region are uncommon lesions, when they do arise they usually follow an inexorably aggressive course. Experience with these tumors is, necessarily, limited; as such, well-worked out treatment protocols for the treatment of such lesions are in short supply. It appears as though mucosal melanomas (MuMs) develop more frequently in the nasal cavity and paranasal sinus region, and less often in the oral cavity. It seems that the incidence of nodal metastasis is significantly lower for sinonasal MuMs than it is for MuMs of the oral cavity; this observation may influence decisions about performing neck dissection as a function of location of the primary MuM. At present, surgical excision remains the mainstay of treatment; however, anatomical complexities within the region can hamper attempts at complete excision. Radiotherapy has not traditionally been relied on for routine treatment of MuM, although some recent reports have challenged this view. Chemotherapy is, at present, employed principally in the treatment of disseminated disease and for palliation. As a diagnostic matter, MuM belongs to the class of tumors that, on light microscopy, may with some regularity be confused with other malignancies (including sarcomas, plasmacytomas, and carcinomas); as a consequence, this is a diagnosis which is often best confirmed by way of ancillary testing via immunohistochemical studies. A better grasp of the best means of treating MuM will likely come only when large referral centers are able to pool their experiences with these uncommon yet virulent malignancies. Copyright 2003 Wiley-Liss, Inc.

-----

Pathologica. 2003 Apr;95(2):115-8.
[Adenoid cystic carcinoma of the anterior segment of the tongue]
[Article in Italian]
Maresi E, Tortorici S, Orlando E, Daniele E, Burruano F.
Istituto di Anatomia e Istologia Patologica, Universita di Palermo. emilianomaresi@hotmail.com

The authors describe a rare case of adenoid-cystic carcinoma localized in the anterior tongue. The neoplasia is made up of epithelial and myo-epithelial cells, organized frequently in islands with cribriform aspect, was circumscribed by a thin fibrous capsule that was focally infiltrated in the proximity of the deep margin. At the physical examination no local regional lymph nodes were absent. The surgical excision and radiotherapy constituted the only therapeutic protocol. Absence of local relapse and/or distant metastasis after eight years from the operation confirm the low aggressiveness of the neoplasia when localized in the anterior part of the tongue.

-----

J Ayub Med Coll Abbottabad. 2002 Oct-Dec;14(4):45-8.
Parotid sparing irradiation for the head and neck cancers.
Ali N, Hameed S, Shah MA.
Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan.

Several authors have shown that xerostomia restricts nutritional intake and limits the ability of patients to maintain normal weight. When both parotids are irradiated, patients never fully regain their normal weight, however if one parotid is irradiated the patients are able to fully recover their weight with in the year. There are certain sites in the head and neck where small and lateralized cancers with diminished risk of contralateral neck metastases can be treated with parotid sparing techniques, i.e., oral cavity, retromolar trigone, anterior tonsillar pillar, tonsillar fossa, and true vocal cord. In these sites it is appropriate to spare the opposite parotid and closely observe the un-irradiated neck. Based on Dr. O' Sullivans long term follow up of patients with cancers of the oral cavity and tonsil, we are encouraged that patients can be irradiated with homo-lateral parotid techniques with out jeopardizing loco-regional control. Hazuka et al and Maesa et al suggested that three dimensional treatment planning may allow the use of parotid sparing techniques in patients who otherwise would not have been considered candidates using conventional radiotherapy techniques.

-----

J Ir Dent Assoc. 2002;48(4):126-31.
Surgical management of pleomorphic adenoma of the palate.
Bataineh AB, al-Dwairi ZN.
Faculty of Dentistry, Jordan University of Science & Technology, Irbid-Jordan.

OBJECTIVES: The purpose of this article is to present an intraoral technique, which allows a wide local excision of pleomorphic adenoma of the palate with adequate mucosal and periosteal margins. STUDY DESIGN: Between September 1992 and May 1994 ten patients with pleomorphic adenoma of the palate were treated by one surgeon at the Oral and Maxillofacial Surgery Unit of the Jordan University of Science and Technology. A surgical technique, which was particularly useful for tumours extending into the soft palate, is described. RESULTS: Nine patients were aged between 15 and 25 years (mean age 20.1 years) and one patient was aged 50 years. Six of the patients were males. The tumour was removed from all ten patients by wide local excision with adequate margins, and after a follow-up period from 5 to 7 years (mean 6.3 years) there were no recurrences. CONCLUSION: This study has shown that wide local excision used for the treatment of pleomorphic adenoma of the palate is to be recommended. A close follow-up is necessary postoperatively.

The Oral Cancer FileSM Compiled and Maintained by    The Center for Current Research, Inc. 708 Aubrey Avenue • Ardmore PA USA 19003 Phone: 610-649-3165 Email: customerservice@lifestages.com Website: www.lifestages.com

©Copyright 1992-date by The Center for Current Research. The Oral Cancer File is a proprietary compilation of the Center for Current Research. The information in the File is solely for your use, and the use of your family, friends, and doctors. The information is the property of the individual researchers and institutions that produced it. It is an infringement of copyright law to attempt to "resell" the information as it is presented here.