| |
Welcome to the Oral Cancer
File
Patients all over the world
have used the information in The Oral Cancer File since 1992,
when the Center for Current Research—one of the first 80
companies on the Internet—was founded. Our highly trained
researchers (all of whom hold Ph.D.s) have searched the advanced
medical database at the National Library of Medicine and compiled
a comprehensive collection of research descriptions on Oral Cancer
and its care.
As you will see, the following research descriptions detail the
findings published in the most respected journals in the field.
Because the research descriptions are written in medical terms,
most people will bring all or parts of the Oral Cancer File to
their doctor for further explanation and discussion. Often your
doctor will have access to full-text articles and other information
that could be useful in planning a successful course of treatment
and prevention. Note that the titles of the journals are abbreviated
according to the National Library of Medicine's format; your
doctor can provide the full title if you need it.
Thank you for accessing the Oral Cancer File. We truly hope the
information fosters better health.
Sincerely,
Gregory A. Fraser, Ph.D.
Director of Research
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.
Previous Oral Cancer
Research: 2002-2006
The
Oral Cancer File also contains summaries of past
research that has shown promise and may still be standard
practice among many physicians.
To
download earlier
research findings on Oral
Cancer, click
HERE.
Latest Research on Oral Cancer
Eur J Cancer Prev. 2008 Aug;17(4):340-4.
Alcohol and tobacco use, and cancer risk for upper aerodigestive
tract and liver.
Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C.
Mario Negri Institute for Pharmacological Research, Milan, Italy. pelucchi@marionegri.it
This study reviews the association between alcohol, tobacco, and the risk of
cancers of the upper digestive and respiratory tract (i.e. oral cavity and
pharynx, larynx, and esophagus) and liver. Alcohol drinking and tobacco smoking
are the major risk factors for upper aerodigestive tract cancers, accounting for
a large proportion (i.e. about three-quarters) of cases in developed countries.
Consumption amount is the strongest alcohol-related determinant of risk, whereas
the pattern of alcohol-related risk with duration is inconsistent. Both dose and
duration of smoking have important effects on the risk of upper aerodigestive
tract cancers. The combined exposure to alcohol and tobacco has a multiplicative
effect on carcinogenesis of this tract. Alcohol and tobacco consumption are also
causally related to liver cancer, although the associations are moderate and a
lower fraction of neoplasms is attributable to these factors as compared with
cancers of the upper aerodigestive tract. An interaction between alcohol
drinking and tobacco smoking has been reported, but the issue is not adequately
assessed.
------
J Oral Maxillofac Surg. 2008 Aug;66(8):1570-9.
Clinical and histopathologic independent prognostic factors in
oral squamous cell carcinoma: a retrospective study of 334 cases.
Arduino PG, Carrozzo M, Chiecchio A, Broccoletti R, Tirone F, Borra E,
Bertolusso G, Gandolfo S.
Department of Biomedical Sciences and Human Oncology, University of Turin,
Turin, Italy. paolo.arduino@gmail.com
PURPOSE: This retrospective hospital-based study reviewed and evaluated the
outcome of patients with oral squamous cell carcinoma (OSCC) with the aim of
identifying factors affecting the clinical course and survival rate. PATIENTS
AND METHODS: Patients with a follow-up of at least 12 months were included. The
data collected were statistically analyzed for the presence of factors valuable
for prognosis; survival curves were processed in accordance with the
Kaplan-Meier method. Differences in the expression of variables in different
grading levels were investigated. Cox's proportional hazard model for Z(i)
covariates (grading, age, T, N) also was calculated. RESULTS: Mean patient age
was 67.7 years in women (n = 152) and 62.4 years in men (n = 182). A total of 98
patients were identified with Broder's/World Health Organization grade 1
histology, 176 with grade 2, and 55 with grade 3; 5 patients were identified as
grade 4 (carcinoma in situ). Gender and risk factors seemed to be unrelated to
prognosis, whereas a significant increase in mortality was seen in patients over
age 70. Histological grading, tumor size, and neck involvement were related, as
independent factors, in predicting survival in patients with OSCC (QM-H > 3.9).
Gender, age, and risk factors had no statistical relationship with cancer
histological differentiation. CONCLUSIONS: Our analysis reveals a statistically
significant relationship among histological Broder's grading of malignancy,
tumor size, locoregional involvement, and survival rates, underscoring the
utility of tumor differentiation in predicting the clinical course and outcome
of OSCC.
------
Laryngoscope. 2008 Aug;118(8):1357-61.
Treatment of base of tongue cancer with paclitaxel, ifosfamide,
and cisplatinum induction chemotherapy followed by chemoradiotherapy.
Hancock SB, Krempl GA, Canfield V, Bogardus C, Kojouri K, Kaneaster SK, Medina
JE.
Department of Otolaryngology, The University of Oklahoma Health Sciences Center,
Oklahoma City, Oklahoma, USA.
OBJECTIVES/HYPOTHESIS: To assess the efficacy of paclitaxel, ifosfamide, and
cisplatinum induction chemotherapy plus concurrent chemoradiation in the
treatment of stage III and IV base of tongue cancer. STUDY DESIGN: Subgroup
analysis of patients with base of tongue cancer enrolled in a single-institution
prospective phase II trial, evaluating an organ-preservation approach in the
treatment of locally advanced head and neck cancer. METHODS: Eighteen patients
with tumors ranging from stage T2-T4, any N, or M0 were treated with a protocol
of induction chemotherapy, with Taxol, ifosfamide, cisplatin every 21 days for
up to three cycles. If the primary tumor exhibited a complete or partial
response, patients were treated with radiation and weekly taxol and carboplatin
for 7 weeks. Surgery was used for those with less than partial response or
disease progression. Neck dissection was performed in cases with clinical or
radiological evidence of persistent disease in the neck 6 to 8 weeks after
completion of treatment. RESULTS: Sixteen patients were male and two were
female; the average age was 55 years (range, 43-65). Fifteen patients had stage
IV disease and three had stage III disease. Of the 18 patients initially
enrolled, 17 patients had a complete response. All 17 patients had no evidence
of loco-regional disease at a median follow-up of 29.6 months. Only 1 of them
developed distant metastases 30 months after completion of treatment. Three
patients required permanent percutaneous endoscopic gastrostomy tubes because of
severe dysphagia associated with concurrent chemoradiation. CONCLUSIONS: The
treatment regimen studied is remarkably effective in stage III and IV base of
tongue cancer with 100% of patients completing the protocol alive to date.
Although some patients required persistent percutaneous endoscopic gastrostomy
use, no patient experienced significant enough toxicity during the protocol to
delay or withdraw from treatment.
------
Br J Cancer. 2008 Jul 8;99(1):93-9. Epub 2008 Jun 24.
Combined effects of bevacizumab with erlotinib and irradiation: a
preclinical study on a head and neck cancer orthotopic model.
Bozec A, Sudaka A, Fischel JL, Brunstein MC, Etienne-Grimaldi MC, Milano G.
Department of Surgery, Centre Antoine-Lacassagne, Nice, France.
Clinical benefit has been demonstrated in patients with head and neck tumours
receiving an anti-epidermal growth factor receptor (EGFR) agent in combination
with radiotherapy (RT). Recent preclinical and clinical studies suggest
beneficial effects from combining anti-angiogenic drugs with RT. To investigate
the effect of combining these approaches, we evaluated in vivo the anti-tumour
efficacy of the anti-angiogenic compound bevacizumab, a highly specific
monoclonal antibody directed against the vascular endothelial growth factor (VEGF),
erlotinib, an EGFR tyrosine kinase inhibitor, and irradiation given alone and in
combination. Investigations were performed using a VEGF-secreting human head and
neck tumour cell line, CAL33, with a high EGFR content, injected as orthotopic
xenografts into the mouth floor of nude mice. Three days after tumour cell
injection, bevacizumab (5 mg kg(-1), 5 days a week, i.p.), erlotinib (100 mg
kg(-1), 5 days a week, orally) and irradiation (6 Gy, 3 days a week) were
administered alone and in combination for 10 days. As compared with the control,
concomitant administration of drugs produced a marked and significant
supra-additive decrease in tumour mass; the addition of irradiation almost
completely abolished tumour growth. The drug association markedly reduced the
number of metastatic nodes and the triple combination significantly reduced the
total number of pathologically positive lymph nodes as compared with controls.
The RT-induced proliferation, reflected by Ki67 labelling, was reduced to
control level with the triple combination. Radiotherapy induced a strong and
very significant increase in tumour angiogenesis, which was no longer observed
when combined with erlotinib and bevacizumab. The efficacy of the combination of
bevacizumab+erlotinib and RT may be of clinical importance in the management of
head and neck cancer patients.
------
N Engl J Med. 2008 Jul 3;359(1):31-42.
Motesanib diphosphate in progressive differentiated thyroid
cancer.
Sherman SI, Wirth LJ, Droz JP, Hofmann M, Bastholt L, Martins RG, Licitra L,
Eschenberg MJ, Sun YN, Juan T, Stepan DE, Schlumberger MJ; Motesanib Thyroid
Cancer Study Group.
Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas
M.D. Anderson Cancer Center, Houston 77230-1402, USA. sisherma@mdanderson.org
BACKGROUND: The expression of vascular endothelial growth factor (VEGF) is
characteristic of differentiated thyroid cancer and is associated with
aggressive tumor behavior and a poor clinical outcome. Motesanib diphosphate (AMG
706) is a novel oral inhibitor of VEGF receptors, platelet-derived growth-factor
receptor, and KIT. METHODS: In an open-label, single-group, phase 2 study, we
treated 93 patients who had progressive, locally advanced or metastatic,
radioiodine-resistant differentiated thyroid cancer with 125 mg of motesanib
diphosphate, administered orally once daily. The primary end point was an
objective response as assessed by an independent radiographic review. Additional
end points included the duration of the response, progression-free survival,
safety, and changes in serum thyroglobulin concentration. RESULTS: Of the 93
patients, 57 (61%) had papillary thyroid carcinoma. The objective response rate
was 14%. Stable disease was achieved in 67% of the patients, and stable disease
was maintained for 24 weeks or longer in 35%; 8% had progressive disease as the
best response. The Kaplan-Meier estimate of the median duration of the response
was 32 weeks (the lower limit of the 95% confidence interval [CI] was 24; the
upper limit could not be estimated because of an insufficient number of events);
the estimate of median progression-free survival was 40 weeks (95% CI, 32 to
50). Among the 75 patients in whom thyroglobulin analysis was performed, 81% had
decreased serum thyroglobulin concentrations during treatment, as compared with
baseline levels. The most common treatment-related adverse events were diarrhea
(in 59% of the patients), hypertension (56%), fatigue (46%), and weight loss
(40%). CONCLUSIONS: Motesanib diphosphate can induce partial responses in
patients with advanced or metastatic differentiated thyroid cancer that is
progressive. (ClinicalTrials.gov number, NCT00121628.) 2008 Massachusetts
Medical Society
------
Arch Otolaryngol Head Neck Surg. 2008 Jul;134(7):743-9.
Biological markers and prognosis in recurrent oral cancer after
salvage surgery.
Agra IM, Carvalho AL, Pinto CA, Martins EP, Filho JG, Soares FA, Kowalski LP.
Department of Head and Neck Surgery-Otorhinolaryngology, Hospital A. C. Camargo,
Rua Professor Antonio Prudente, 211, 01509-900 São Paulo, Brazil.
OBJECTIVE: To analyze the prognostic effect of epidermal growth factor receptor
(EGFR), matrix metalloproteinases 2 and 9, and vascular endothelial growth
factor expression in patients with locally recurrent oral carcinoma after
salvage surgery. DESIGN: Retrospective cohort study. Settings Tertiary center
cancer hospital. PATIENTS: The charts of 111 patients with local recurrence of
oral carcinomas were retrospectively analyzed. The previous treatment consisted
of surgery in 33 patients (30.0%), radiotherapy with or without chemotherapy in
46 patients (41.0%), and surgery with adjuvant radiotherapy in 32 patients
(29.0%). The expression of EGFR, matrix metalloproteinases 2 and 9, and vascular
endothelial growth factor was analyzed with a tissue microarray
immunohistochemical technique. MAIN OUTCOME MEASURES: Overall survival and
cancer-specific survival (CSS). RESULTS: The recurrences were diagnosed in less
than 1 year in 69 patients (62.2%) and in more than 1 year in 42 patients
(37.8%). The prognosis was worse in the group with the disease-free interval of
less than 1 year (P = .01). Patients with more advanced disease (clinical stage
of recurrence, III/IV) had worse rates of CSS (P = .04). Cases that were
positive for EGFR had a 3-year CSS of 27.2%, while EGFR-negative cases had a
3-year CSS of 64.3% (P = .001). The expression of matrix metalloproteinases 2 (P
= .83) and 9 (P = .15) and vascular endothelial growth factor (P = .86) was not
significant in this group. In multivariate analysis, only the disease-free
interval and the overexpression of EGFR were associated with a higher risk of
cancer death. CONCLUSIONS: Local recurrence in oral carcinomas carries a poor
prognosis. A disease-free interval of more than 1 year and a EGFR-negative
expression are the main prognostic factors related to better CSS in patients
treated with salvage surgery.
------
Arch Otolaryngol Head Neck Surg. 2008 Jul;134(7):725-8.
L-myc polymorphism in head and neck nonmelanoma skin and lower
lip cancers.
Gözü A, Ergen A, Dayicioglu D, Yaylim I, Ozsoy Z, Isbir T.
Department of Plastic and Reconstructive Surgery, Vakif Gureba Research and
Education Hospital, Istanbul, Turkey. aydinseye@yahoo.com
OBJECTIVE: To evaluate the presence of L-myc gene variations as a genetic
predisposition to head and neck nonmelanoma skin cancer (HNNMSC) and lower lip
cancer (LLC). DESIGN: A case-control study. SETTING: An academic institute
laboratory. PARTICIPANTS: Twenty-four patients with HNNMSC and 27 with LLC were
compared with 51 age- and sex-matched control subjects. MAIN OUTCOME MEASURES:
Polymerase chain reaction restriction fragment length polymorphism and agarose
gel electrophoresis were used to determine the L-myc oncogene genotypes.
RESULTS: The presence of the LS genotype was found to be significantly increased
in the study group, whereas the LL genotype was not detected. The S allele was
also more frequent in the study group. The SS genotype was found to correlate
with aggressive tumor behavior in patients with HNNMSC and a family history of
cancer. Patients with LLC displayed significantly less of the SS genotype.
CONCLUSIONS: The L-myc gene polymorphism may help detect and prevent HNNMSC and
LLC in susceptible individuals. It may also contribute to estimation of tumor
behavior in patients with HNNMSC.
------
Clin Cancer Res. 2008 Jul 1;14(13):4345-52.
Functional variants of the NEIL1 and NEIL2 genes and risk and
progression of squamous cell carcinoma of the oral cavity and oropharynx.
Zhai X, Zhao H, Liu Z, Wang LE, El-Naggar AK, Sturgis EM, Wei Q.
Department of Epidemiology, The University of Texas M. D. Anderson Cancer
Center, Houston, Texas 77030, USA.
PURPOSE: Human DNA glycosylases NEIL1 and NEIL2 participate in oxidized base
excision repair and protect cells from DNA damage. NEIL1 (MIM:608844) and NEIL2
(MIM:608933) variants may affect their protein functions, leading to altered
cell death and carcinogenesis. To date, only one reported study has investigated
the association between NEIL1 and NEIL2 polymorphisms and cancer risk.
EXPERIMENTAL DESIGN: Genotype and haplotypes of the NEIL1
NT_010194.16:g.46434077G>T (rs7182283) and g.46438282C>G (rs4462560) and NEIL2
NT_077531.3:g.4102971C>G (rs804270) polymorphisms were determined for 872
patients with newly diagnosed squamous cell carcinomas of the oral cavity and
oropharynx (SCCOOP) and 1,044 cancer-free non-Hispanic white control subjects
frequency-matched by age and sex. Crude and adjusted odds ratios (OR) and 95%
confidence intervals (95% CI) were calculated using multivariate logistic
regression, and false-positive report probabilities were also calculated.
RESULTS: We found no overall differences in the frequencies of alleles,
genotypes, and haplotypes of NEIL1 g.46434077G>T and NEIL1 g.46438282C>G
polymorphisms between cases and controls. However, the NEIL2 g.4102971CC
genotype was associated with a significantly increased risk of SCCOOP (adjusted
OR, 1.30; 95% CI, 1.02-1.65); this increase in risk was the highest among
current alcohol drinkers (adjusted OR, 1.87; 95% CI, 1.28-2.72), particularly in
patients with oropharyngeal cancer (adjusted OR, 1.35; 95% CI, 1.04-1.76). The
NEIL2 g.4102971CC genotype was also significantly associated with SCCOOP of
advanced stages. CONCLUSIONS: Polymorphisms of the NEIL2 gene may be markers for
risk and progression of SCCOOP, particularly in patients with oropharyngeal
cancer. Larger studies are needed to confirm our findings.
------
Clin Cancer Res. 2008 Jul 1;14(13):4085-95.
Positive correlations of Oct-4 and Nanog in oral cancer stem-like
cells and high-grade oral squamous cell carcinoma.
Chiou SH, Yu CC, Huang CY, Lin SC, Liu CJ, Tsai TH, Chou SH, Chien CS, Ku HH, Lo
JF.
Institutes of Oral Biology, Traditional Medicine, and Anatomy and Cell Biology,
National Yang-Ming University, Taiwan, People's Republic of China.
PURPOSE: Oral squamous cell carcinoma (OSCC), like many solid tumors, contains a
heterogeneous population of cancer cells. Recent data suggest that a rare
subpopulation of cancer cells, termed cancer stem cells (CSC), is capable of
initiating, maintaining, and expanding the growth of tumor. Identification and
characterization of CSC from OSCC facilitates the monitoring, therapy, or
prevention of OSCC. EXPERIMENTAL DESIGN: We enriched oral cancer stem-like cells
(OC-SLC) through sphere formation by cultivating OSCC cells from established
OSCC cell lines or primary cultures of OSCC patients within defined serum-free
medium. Differential expression profile of stemness genes between enriched
OC-SLC and parental OSCC was elucidated. Furthermore, immunohistochemical
staining of stemness markers on OSCC patient tissues was examined to evaluate
the association between stemness genes and prognosis of OSCC. RESULTS: Enriched
OC-SLC highly expressed the stem/progenitor cell markers and ABC transporter
gene (Oct-4, Nanog, CD117, Nestin, CD133, and ABCG2) and also displayed induced
differentiation abilities and enhanced migration/invasion/malignancy
capabilities in vitro and in vivo. Elevated expression of CD133 was shown in the
enriched OC-SLC from OSCC patients' tumors. Positive correlations of Oct-4,
Nanog, or CD133 expression on tumor stage were shown on 52 OSCC patient tissues.
Kaplan-Meier analyses exhibited that Nanog/Oct-4/CD133 triple-positive patients
predicted the worst survival prognosis of OSCC patients. CONCLUSION: We enriched
a subpopulation of cancer stem-like cell from OSCC by sphere formation. The
enriched OC-SLC possesses the characteristics of both stem cells and malignant
tumors. Additionally, expression of stemness markers (Nanog/Oct-4/CD133)
contradicts the survival prognosis of OSCC patients.
------
J Oral Maxillofac Surg. 2008 Jul;66(7):1343-50.
Immediate impact of primary surgery on health-related quality of
life of hospitalized patients with oral and oropharyngeal cancer.
Biazevic MG, Antunes JL, Togni J, de Andrade FP, de Carvalho MB, Wünsch-Filho V.
School of Dentistry, University of São Paulo, São Paulo, Brazil.
PURPOSE: Oral and oropharyngeal tumor resection may be associated with
disfigurement and dysfunctions that affect essential domains of life. This study
aimed at assessing the immediate impact of primary surgery on the health-related
quality of life for these patients. PATIENTS AND METHODS: Forty-seven patients
with squamous cell carcinoma of the lips, oral cavity, or oropharynx, and
undergoing treatment in the head and neck surgery center of a large general
hospital in the city of São Paulo, Brazil, from October 2005 to September 2006,
completed the University of Washington Quality of Life questionnaire pre- and
postoperatively (before hospital discharge). A paired t test evaluated
differences between assessments; Poisson regression estimated ratios of ratings
attributed to each domain (pain, appearance, activity, recreation, swallowing,
chewing, speech, shoulder pain, taste, saliva, mood, and anxiety) per patient
stratified by sociodemographic, clinical, and behavioral characteristics.
RESULTS: The immediate impact of surgery on health-related quality of life
corresponded to a 31.1% reduction in the overall rating. The most affected
domains were chewing (-73.5%), taste (-61.4%), swallowing (-57.3%), speech
(-46.0%), and pain (-42.3%). Anxiety (+65.5%) was the sole domain that improved
immediately after surgery. Comparisons involving subgroups of patients indicated
that different clinical conditions (regional metastasis, tumor size, and
location) were not associated with discrepant health-related quality of life
immediately after surgery. CONCLUSIONS: The routine pre- and postoperative
assessment of health-related quality of life may contribute to evaluate
treatment effectiveness, which would otherwise rely exclusively on assessing
end-point results such as survival and tumor relapse. This information is
relevant to attenuate the prejudicial impact of surgery on the physical and
psychosocial functioning of patients.
------
Lancet Oncol. 2008 Jul;9(7):667-75.
Smokeless tobacco and cancer.
Boffetta P, Hecht S, Gray N, Gupta P, Straif K.
International Agency for Research on Cancer, Lyon, France. boffetta@iarc.fr
Use of smokeless tobacco products is common worldwide, with increasing
consumption in many countries. Although epidemiological data from the USA and
Asia show a raised risk of oral cancer (overall relative risk 2.6 [95% CI
1.3-5.2]), these are not confirmed in northern European studies (1.0 [0.7-1.3]).
Risks of oesophageal cancer (1.6 [1.1-2.3]) and pancreatic cancer (1.6
[1.1-2.2]) have also increased, as shown in northern European studies. Results
on lung cancer have been inconsistent, with northern European studies suggesting
no excess risk. In India and Sudan, more than 50% of oral cancers are
attributable to smokeless tobacco products used in those countries, as are about
4% of oral cancers in US men and 20% of oesophageal and pancreatic cancers in
Swedish men. Smokeless tobacco products are a major source of carcinogenic
nitrosamines; biomarkers of exposure have been developed to quantify exposure as
a framework for a carcinogenesis model in people. Animal carcinogenicity studies
strongly support clinical results. Cancer risk of smokeless tobacco users is
probably lower than that of smokers, but higher than that of non-tobacco users.
------
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jul;106(1):875-81. Epub
2008 May 27.
Treatment and prognosis of malignant melanoma of the oral cavity:
preoperative surgical procedure increases risk of distant metastasis.
Umeda M, Komatsubara H, Shigeta T, Ojima Y, Minamikawa T, Shibuya Y, Yokoo S,
Komori T.
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of
Medicine, Kobe, Japan. m.umeda@hosp.kobe-u.ac.jp
OBJECTIVE: Many authors have reported that oral melanoma patients showed much
worse prognosis than those with cutaneous melanoma. We investigated treatment
method and prognosis of patients with oral malignant melanoma. STUDY DESIGN:
Twenty-one patients with oral melanoma treated at our hospital were
investigated, with special reference to the influence of preoperative surgical
procedures such as biopsy, incision, or tooth extraction on the prognosis.
RESULTS: All patients underwent surgery followed by immuno-chemotherapy with
dimethyl triazeno imidazole carboxamide (DTIC), ninustine hydrochloride (ACNU),
vincristine (VCR), and biologic response modifier OK-432. Local control was
obtained in 20 of 21 patients. Lymph node metastasis appeared in 13 patients,
but neck failure was not detected in any patients. Distant metastasis occurred
in 9 patients in spite of loco-regional control. Five-year survival rate of 12
patients with no preoperative surgical procedure was 91.7%, while that of the 9
patients who had undergone surgical procedures before treatment was 25.9% (P <
.05). CONCLUSIONS: Oral melanoma patients can obtain a prognosis as good as that
for cutaneous melanoma patients, when the above-mentioned therapy is used
without any preoperative surgical procedures.
------
Cancer Res. 2008 Jun 15;68(12):4945-57.
Topical application of a bioadhesive black raspberry gel
modulates gene expression and reduces cyclooxygenase 2 protein in human
premalignant oral lesions.
Mallery SR, Zwick JC, Pei P, Tong M, Larsen PE, Shumway BS, Lu B, Fields HW,
Mumper RJ, Stoner GD.
Department of Oral and Maxillofacial Surgery, College of Dentistry, The Ohio
State University Comprehensive Cancer Center and Solove Research Institute,
Columbus, Ohio, USA. mallery.1@osu.edu
Reduced expression of proapoptotic and terminal differentiation genes in
conjunction with increased levels of the proinflammatory and
angiogenesis-inducing enzymes, cyclooxygenase 2 (COX-2) and inducible nitric
oxide synthase (iNOS), correlate with malignant transformation of oral
intraepithelial neoplasia (IEN). Accordingly, this study investigated the
effects of a 10% (w/w) freeze-dried black raspberry gel on oral IEN
histopathology, gene expression profiles, intraepithelial COX-2 and iNOS
proteins, and microvascular densities. Our laboratories have shown that
freeze-dried black raspberries possess antioxidant properties and also induce
keratinocyte apoptosis and terminal differentiation. Oral IEN tissues were
hemisected to provide samples for pretreatment diagnoses and establish baseline
biochemical and molecular variables. Treatment of the remaining lesional tissue
(0.5 g gel applied four times daily for 6 weeks) began 1 week after the initial
biopsy. RNA was isolated from snap-frozen IEN lesions for microarray analyses,
followed by quantitative reverse transcription-PCR validation. Additional
epithelial gene-specific quantitative reverse transcription-PCR analyses
facilitated the assessment of target tissue treatment effects. Surface
epithelial COX-2 and iNOS protein levels and microvascular densities were
determined by image analysis quantified immunohistochemistry. Topical berry gel
application uniformly suppressed genes associated with RNA processing, growth
factor recycling, and inhibition of apoptosis. Although the majority of
participants showed posttreatment decreases in epithelial iNOS and COX-2
proteins, only COX-2 reductions were statistically significant. These data show
that berry gel application modulated oral IEN gene expression profiles,
ultimately reducing epithelial COX-2 protein. In a patient subset, berry gel
application also reduced vascular densities in the superficial connective
tissues and induced genes associated with keratinocyte terminal differentiation.
------
Acta Otorhinolaryngol Ital. 2008 Jun;28(3):120-5.
Quality of life in patients treated for cancer of the oral cavity
requiring reconstruction: a prospective study.
Villaret AB, Cappiello J, Piazza C, Pedruzzi B, Nicolai P.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia,
Brescia, Italy. dr.bolton@libero.it
Surgical treatment for cancer of the oral cavity can result in dramatic
aesthetic and functional sequelae partially avoidable by reconstructive
techniques. Many studies concerning quality of life have been carried out in
order to retrospectively assess outcomes after such major oncological
procedures. Aim of this study was to evaluate, in a prospective fashion, the
quality of life as a primary endpoint in patients treated for cancers involving
the oral cavity and requiring reconstruction. The study design consisted of a
prospective evaluation of pre- and post-operative quality of life at 3, 6, and
12 months to assess variations during follow-up using two different
questionnaires: the University of Washington Quality of Life and the Head and
Neck Performance Status Scale. Between May 1999 and October 2004, 92 patients
with oral cancer requiring reconstruction were treated. All were included in the
study, but only 35 (38%) concluded the evaluation protocol at one year after
surgery without evidence of disease. The mean pre- and post-operative (3, 6, and
12 months) scores of the questionnaires and the scores of specific University of
Washington Quality of Life categories (disfigurement, chewing, swallowing,
comprehension of speech) were evaluated. The impact on residual quality of life
of different factors such as gender, extension of tongue and mandibular defects,
type of reconstruction, and radiotherapy was statistically quantified with a
Wilcoxon non-parametric test and logistic regression for multivariate analysis.
Comparison of mean pre- and post-operative scores between the University of
Washington Quality of Life and Head and Neck Performance Status Scale, showed a
similar trend during the study period with a significant decrease at 3 months
after surgery and subsequent gradual improvement at 6 and 12 months. The
majority of patients (77%) preserved normal or near normal functions at 12
months after surgery. The chewing domain worsened considerably (p <0.05), with
poorer outcome in patients undergoing segmental mandibulectomy (p <0.05). By
multivariate analysis, mandibular resection maintained its statistical
significance in the chewing domain (p = 0.038). Moreover, the type of
reconstruction was an independent factor (p = 0.038) that influenced the
University of Washington Quality of Life total score, with better functional
results after free flap reconstruction. Despite the dismal prognosis of patients
affected by advanced oral cavity cancer, reconstructive techniques play a
crucial role in maintenance of satisfactory quality of life.
------
Jpn J Clin Oncol. 2008 Jun;38(6):402-7.
Brachytherapy for oral tongue cancer: an analysis of treatment
results with various biological markers.
Sakata K, Someya M, Nagakura H, Nakata K, Oouchi A, Takagi M, Hareyama M.
Department of Radiology, Sapporo Medical University, School of Medicine, S1W16,
Chuo-Ku, Sapporo 060-8543, Japan. sakatako@sapmed.ac.jp
OBJECTIVE: Low-dose-rate (LDR) brachytherapy is an effective treatment for
tongue cancer. However, little is known about the biological mechanism
underlying this therapy, characterized by delivery of continuous exposures of
LDR irradiation. It is reported that lower microvessel density (MVD), lower
Ki-67 index or higher expression of endogenous hypoxic markers such as carbonic
CA IX and Glut-1 are related to the poor control of tumors treated with external
irradiation. To elucidate the biological characteristics of LDR brachytherapy,
we analyzed our results in cases of tongue cancer treated with LDR brachytherapy
by using immunohistochemical stainings with antibodies against Ki-67 and MVD,
Glut-1 and CA IX. METHODS: The prognostic value of Ki-67 index, MVD and the
expression of CA IX and Glut-1 was assessed in 68 tongue cancers treated with
LDR brachytherapy. The specimens were taken from tongue cancers before radiation
therapy and immunohistochemical staining was performed. RESULTS: The local
recurrence-free survival rates were significantly different between T1+T2 and T3
(P = 0.00067), but not between low and high Ki-67 indexes (P = 0.54), between
low and high MVD (P = 0.071), low and high CA IX indexes (P = 0.062) or low and
high Glut-1 indexes (P = 0.107). T stage, the size of the tumor was the only
significant factor for local control in multivariate analyses (P = 0.0377).
CONCLUSION: LDR could overcome the radioresistence of non-cycling and hypoxic
cells; however, we cannot draw firm conclusions due to the limited number of
patients.
------
Jpn J Clin Oncol. 2008 Jun;38(6):395-401.
Treatment of patients with clinically lymph node-negative
squamous cell carcinoma of the oral cavity.
Jang WI, Wu HG, Park CI, Kim KH, Sung MW, Kim MJ, Choung PH, Lee JH, Choi JY.
Department of Radiation Oncology, Seoul National University College of Medicine,
28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea.
OBJECTIVE: To evaluate treatment outcome and to determine optimal treatment
strategy for patients with clinically lymph node-negative (N0) oral cavity
squamous cell carcinoma (SCC). METHODS: Two hundred and twenty-seven patients
with oral cavity SCC received radiotherapy with curative intent. We
retrospectively analyzed 69 patients with clinically N0 disease. Forty-three
patients were treated with surgery followed by radiotherapy (S+EBRT) and 26 with
radiotherapy alone (EBRT). The median doses administered were 63.0 Gy for S+EBRT
and 70.2 Gy for EBRT. RESULTS: The rates of occult metastasis were 60% for T1,
69% for T2, 100% for T3 and 39% for T4, respectively, among patients who
underwent neck dissection. A contralateral occult metastasis occurred only in
two patients. The median follow-up was 39 months (range, 6-170 months). The
5-year overall survival (OS), disease-free survival (DFS), local control (LC)
and regional control (RC) rates for all patients were 56, 50, 66 and 79%,
respectively. The 5-year OS, DFS, LC and RC rates were 67/39% (P < 0.01), 66/24%
(P < 0.01), 87/30% (P < 0.01) and 73/89% (P = 0.11) for S+EBRT/EBRT,
respectively. CONCLUSIONS: The risk for occult neck metastasis is high in
patients with oral cavity SCC; therefore, elective neck treatment should be
considered. Excellent RC for subclinical disease can be achieved with
radiotherapy alone. However, external beam radiotherapy alone to primary tumor
resulted in poor LC and combined treatment with surgery and radiotherapy
appeared to be a better treatment strategy.
------
J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2008
Apr-Jun;26(2):174-200.
Genetic and environmental factors in head and neck cancer
genesis.
Báez A.
Departments of Pharmacology and Otolaryngology, School of Medicine, University
of Puerto Rico, San Juan, Puerto Rico 00936-5067, USA. abaez@rcm.upr.edu
Head and neck squamous cell carcinoma (HNSCC) include squamous cell carcinomas
of the oral cavity, pharynx, and larynx. Epidemiologic data suggest that the
etiology and pathogenesis of HNSCC are influenced by environmental and
lifestyle-related factors, such as tobacco use, ethanol consumption, papilloma
virus infection, dietary factors and exposure to toxic substances. DNA repair
systems and carcinogen-metabolizing enzymes can increase the risk for HNSCC but
no definite causal mechanism has been demonstrated. There are several
well-characterized entities that are associated with risk and prognosis of head
and neck cancer, including Lynch-II syndrome, Bloom syndrome, Fanconi's anemia,
xeroderma pigmentosum, ataxia telangiectasia, and Li-Fraumeni syndrome. This
review aims to present the current status in our understanding of HNSCC and
highlight controversies relating to the role of several factors in the genesis
of the cancer.
------
Ned Tijdschr Tandheelkd. 2008 Apr;115(4):215-23.
[Reconstruction after surgical treatment of head and neck cancer:
surgical and prosthetic possibilities]
[Article in Dutch]
Schulten EA, Winters HA, Koch AE.
Uit de afdeling Mondziekten en Kaakchirurgie, Orale Pathologie, VU medisch
centrum, Academisch Centrum voor Tandheelkunde Amsterdam (ACTA) te Amsterdam,
Amsterdam. eajm.schulten@vumc.nl
Soft and hard tissue defects in the head and neck region after benign or
malignant tumour resection, can be reconstructed by surgical techniques, such as
tissue transplantation, and/or prostheses. The aim of reconstruction is to
restore the original esthetics and functions of the bone and soft tissues that
have been resected.The introduction of free vascularized osteomyocutaneous
fibula and iliac crest flaps improved the surgical possibilities of
reconstructing the mandible and the maxilla. With respect to oral
rehabilitation, a reconstruction of the mandible and the maxilla should be
carried out in such a way that it provides an adequate base for inserting
endosseous implants, which will retain a removable or fixed prosthesis This
requires good interdisciplinary planning, in which the plan for prosthetic
treatment determines, in part, the choice of reconstruction method.
------
J Craniomaxillofac Surg. 2008 Mar;36(2):75-88. Epub 2008 Jan 28.
Preoperative chemoradiotherapy in the management of oral cancer: A review.
Klug C, Berzaczy D, Voracek M, Millesi W.
Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna,
AKH, Währinger Gürtel 18-20, A-1090 Vienna, Austria (Head: Ewers Rolf, MD, DMD,
PhD).
INTRODUCTION: Multi-modality treatment concepts involving preoperative
radiotherapy (RT) or chemoradiotherapy (CRT) and subsequent radical resection
are used much less frequently than postoperative treatment for oral and
oropharyngeal squamous cell carcinomas. In some centres, however, the
preoperative approach has been established for several years. MATERIAL: The
present review is a compilation of the existing evidence on this subject.
METHODS: In a literature-based meta-analysis, the survival data of 1927 patients
from 32 eligible publications were analysed. RESULTS: The calculated survival
rates of documented patients show remarkably good results with preoperative CRT
and radical surgery. However, the findings of this analysis are based on data
with a large proportion of studies using consecutive patient series. CONCLUSION:
Hard evidence providing sufficient data from prospective randomised studies is
as yet missing for preoperative CRT. Prospective randomised studies are
mandatory in this area.
-----
Med Oral Patol Oral Cir Bucal. 2008 Jan 1;13(1):E15-21.
Gene therapy in the management of oral cancer: review of the literature.
Ayllón Barbellido S, Campo Trapero J, Cano Sánchez J, Perea García MA, Escudero
Castaño N, Bascones Martínez A.
Facultad de Odontología, UCM, Madrid, Spain.
Gene therapy essentially consists of introducing specific genetic material into
target cells without producing toxic effects on surrounding tissue. Advances
over recent decades in the surgical, radiotherapeutic and chemotherapeutic
treatment of oral cancer patients have not produced a significant improvement in
patient survival. Increasing interest is being shown in developing novel
therapies to reverse oral epithelial dysplastic lesions. This review provides an
update on transfer techniques, therapeutic strategies, and the clinical
applications and limitations of gene therapy in the management of oral cancer
and precancer. We highlight the combination of gene therapy with chemotherapy
(e.g., 5-Fluoracil) and immunotherapy, given the promising results obtained in
the use of adenovirus to act at altered gene level (e.g., p53). Other techniques
such as suicide gene therapy, use of oncolytic viruses or the use of antisense
RNA have shown positive although very preliminary results. Therefore, further research into these promising gene therapy techniques is
required to assess their true efficacy and safety in the management of these
lesions.
-----
J Dent Res. 2008 Jan;87(1):14-32.
Erratum in:
J Dent Res. 2008 Feb;87(2):191.
Molecular pathogenesis of oral squamous cell carcinoma: implications for
therapy.
Choi S, Myers JN.
Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer
Center, 1515 Holcombe Boulevard, Unit 441, [corrected] Houston, TX 77030-4009,
USA.
The development of oral squamous cell carcinoma (OSCC) is a multistep process
requiring the accumulation of multiple genetic alterations, influenced by a
patient's genetic predisposition as well as by environmental influences,
including tobacco, alcohol, chronic inflammation, and viral infection.
Tumorigenic genetic alterations consist of two major types: tumor suppressor
genes, which promote tumor development when inactivated; and oncogenes, which
promote tumor development when activated. Tumor suppressor genes can be
inactivated through genetic events such as mutation, loss of heterozygosity, or
deletion, or by epigenetic modifications such as DNA methylation or chromatin
remodeling. Oncogenes can be activated through overexpression due to gene
amplification, increased transcription, or changes in structure due to mutations
that lead to increased transforming activity. This review focuses on the
molecular mechanisms of oral carcinogenesis and the use of biologic therapy to
specifically target molecules altered in OSCC. The rapid progress that has been
made in our understanding of the molecular alterations contributing to the
development of OSCC is leading to improvements in the early diagnosis of tumors
and the refinement of biologic treatments individualized to the specific
characteristics of a patient's tumor.
-----
Am J Surg Pathol. 2007 Nov;31(11):1683-94.
Adenoid cystic carcinoma with high-grade transformation: a report of 11 cases
and a review of the literature.
Seethala RR, Hunt JL, Baloch ZW, Livolsi VA, Leon Barnes E.
Department of Pathology and Laboratory Medicine, University of Pittsburgh
Medical Center, Pittsburgh, PA 15213, USA. seethalarr@upmc.edu
High-grade transformation of adenoid cystic carcinoma (ACC) (previously referred
to as dedifferentiation) is a rare phenomenon that does not fit into the
traditional ACC grading schemes. The importance and minimal criteria for
distinction from solid (grade III) ACC are not well established. We report 11
new cases and review the literature to further define the profile of this tumor.
The median age was 61 years (range: 32 to 72 y) with a male predominance (male
to female ratio of 1.75:1). The most commonly involved sites were sinonasal
(4/11) and submandibular (4/11). Lymph nodes were pathologically positive in 4/7
(57.1%) cases. Distant metastases to the lung (n=2) and soft tissue of the
shoulder (n=1) were observed. Five of 9 patients (55.6%) died, all within 5
years with a median overall survival of 12 months. Histologically, ACC with
high-grade transformation was distinguished from conventional ACC by nuclear
enlargement and irregularity, higher mitotic counts, and the loss of the biphasic ductal-myoepithelial differentiation. Useful supportive
criteria were prominent comedonecrosis and fibrocellular desmoplasia. The most
common morphologies for the high-grade component were poorly differentiated
cribriform adenocarcinoma and solid undifferentiated carcinoma. Micropapillary
and squamoid patterns were occasionally present. Ki-67 and p53 labeling indices
were elevated in the high-grade components, though c-kit and cyclin-D1 were not.
ACC-high-grade transformation is a highly aggressive salivary gland tumor with a
variety of histologic patterns. The high propensity for lymph node metastases
suggests a role for neck dissection in patients with this rare tumor.
-----
J Prosthet Dent. 2007 Nov;98(5):405-10.
Survival analysis and clinical evaluation of implant-retained
prostheses in oral cancer resection patients over a mean follow-up period of 10
years.
Nelson K, Heberer S, Glatzer C.
Associate Professor, Department of Oral and Maxillofacial Surgery, Virchow
Clinic, Charite Campus Virchow, Humboldt University, Berlin, Germany.
STATEMENT OF PROBLEM: Dental implants have been increasingly used for
prosthodontic rehabilitation of patients following oral tumor resection and
postsurgical radiotherapy. However, only a few long-term studies have examined
the implant survival rate and other factors related to prosthodontic treatment
in oral tumor resection patients. PURPOSE: The purpose of this study was to
evaluate the long-term survival of dental implants and implant-retained
prostheses in oral cancer resection patients. MATERIAL AND METHODS: Ninety-three
patients (63 men, 30 women) with a mean age of 59 years (range of 26-89 years)
received 435 implants after the resection of a head and neck tumor. Twenty-nine
patients received postsurgical radiotherapy prior to implant placement. The
factors related to implant survival or failure were monitored over a mean
observation period of 10.3 years (range of 5 to 161 months). Prosthodontic
rehabilitation was evaluated with respect to the rates of technical failures and
complications. Data were analyzed using a Kaplan-Meier curve and comparisons
were made with the log-rank test or the Wilcoxon test (a=.05). RESULTS: Of the
435 implants, 43 implants were lost; the cumulative survival rate was 92%, 84%,
and 69% after 3.5, 8.5, and 13 years, respectively. Twenty-eight implants in 6
patients were counted as lost since the patients had died. Twenty-nine
irradiated patients received 124 implants, of which 6 implants were lost prior
to prosthodontic rehabilitation. In 68 patients with 78 rigid bar-retained
dentures, only minor technical complications were identified. However, all 25
fixed implant-supported restorations had no technical component failures and did
not require technical maintenance. CONCLUSIONS: This study demonstrates that
implant-retained and -supported prostheses in oral cancer resection patients,
irrespective of the cancer treatment procedure, show lower long-term survival
rates than those in patients without prior cancer surgery. Rigid fixation of the
implant-supported prosthesis appears to minimize the complication rates. The
poor implant survival rate was due to the higher mortality rate among these
patients, and not to a lack of osseointegration. (J Prosthet Dent
2007;98:405-410).
-----
J Oral Maxillofac Surg. 2007 Nov;65(11):2181-6.
Oral malignant melanoma: the Amsterdam experience.
Meleti M, Leemans CR, Mooi WJ, van der Waal I.
Unit of Oral Pathology and Medicine, Section of Odontostomatology, Department of
ENT/Dental/Ophthalmological and Cervico-Facial Sciences, University of Parma,
Parma, Italy.
PURPOSE: The purpose of this study was to evaluate the clinical, pathological,
and therapeutic experience of a group of patients with primary oral malignant
melanoma (OMM) in Amsterdam, The Netherlands. PATIENTS AND METHODS: Fourteen
patients (5 males, 9 females, mean age 57.9 years) with histopathologic
diagnosis of OMM were treated at the Department of Oral and Maxillofacial
Surgery/Oral Pathology of the Vrije University Medical Center in Amsterdam
between 1978 and 2005. A pigmented, flat or swollen, irregularly bordered lesion
of oral mucosa was detected in most patients during the first clinical
examination. Pain was the most commonly referred symptom; the palate was the
most frequently affected subsite. Following the mucosal melanoma microstaging
system, all patients staged as stage I (T any N0M0) could be subclassified as
microstage II (invasion up to the lamina propria), except for 1 patient
microstaged as stage III (deep skeletal tissue invasion into skeletal muscle,
bone, or cartilage). Where possible, surgery was the treatment of choice.
Postoperative radiotherapy, using fractions of 6 Gy twice a week for a total
dose of 30 Gy, was given to 3 patients. Three patients were treated primarily
with radiotherapy alone. RESULTS: Five patients developed local recurrence
within 4 to 72 months, and 10 patients developed distant metastases within 6 to
78 months. Ten patients died of their disease within an average interval of 40
months, with a range of 12 to 80 months. Of the 10 patients who qualified for
evaluation of the 5-year-survival rate, 1 was alive with disease and 2 were
alive without evidence of disease, resulting in a 5-year survival rate of 30%.
However, all patients died of their disease before the end of the 10-year
follow-up period. CONCLUSION: Our study confirms that OMM is a rare and
aggressive malignancy with a low 5-year survival rate. An evidence-based
protocol for the best therapeutic approach is not yet available.
-----
J Oral Maxillofac Surg. 2007 Nov;65(11):2159-63.
Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA)
and Use of a Nasal Mupirocin Ointment in Oral Cancer Inpatients.
Miyake M, Ohbayashi Y, Iwasaki A, Ogawa T, Nagahata S.
Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa
University, Kagawa, Japan. dentmm@kms.ac.jp
PURPOSE: Elimination of methicillin-resistant Staphylococcus aureus (MRSA) is of
critical importance in oral and maxillofacial surgery because control is very
difficult once infection of an oral tumor or oral wound with MRSA is
established. PATIENTS AND METHODS: We retrospectively investigated the risk
factors for acquiring MRSA in 518 patients with oral cancer among 1,877
inpatients in our department between 1984 and 2005. RESULTS: The patients with
oral cancer demonstrated a high rate of MRSA colonization and infection (77.8%)
relative to the population as a whole with MRSA isolated percentage in our
department after 1991. The risk factors for MRSA in oral cancer patients are
also related to systemic diseases and physiological and iatrogenic conditions,
including cerebrovascular diseases (77.8%), peripheral arterial catheterization
(69.2%), diabetes (50.0%), tracheotomy (50.0%), renal failure (50.0%), long-term
broad-spectrum antibiotic use (45.7%), and malnutrition (43.3%). However, the
highest risk of MRSA seems to be related to poor hygienic care. CONCLUSIONS:
Beginning in 1999, we implemented a strategy for reducing infection by MRSA that
included nasal mupirocin ointment for patients at high risk of MRSA; since then,
the detection rate has decreased. We suggest that the administration of nasal
mupirocin ointment and provision of scrupulous hygienic care for high-risk
patients are useful and effective measures for decreasing the incidence of MRSA
infection.
-----
Int J Prosthodont. 2007 Sep-Oct;20(5):469-77.
Quality of life related to oral function in edentulous head and
neck cancer patients posttreatment.
Schoen PJ, Reintsema H, Bouma J, Roodenburg JL, Vissink A, Raghoebar GM.
Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics,
University Medical Center Groningen, University of Groningen, The Netherlands.
p.j.schoen@hccnet.nl
PURPOSE: Surgical treatment of malignancies in the oral cavity and subsequent
radiotherapy often result in an oral condition unfavorable for prosthodontic
rehabilitation. This study assessed the quality of life related to oral function
in edentulous head and neck cancer patients following oncology treatment of
malignancies in the lower region of the oral cavity. MATERIALS AND METHODS:
Patients treated between 1990 and 2000 with surgery and radiotherapy for a
squamous cell carcinoma in the oral cavity who were edentulous in the mandible
and had been treated with a conventional, non-implant-retained denture received
an invitation for a clinical check-up (clinical assessment, questionnaires
regarding oral function and quality of life). RESULTS: Sixty-seven of the 84
patients who fulfilled the inclusion criteria were willing to participate in the
study. The mean irradiation dosage that these patients had received in the oral
region was 61.8 +/- 5.4 Gy. Half of the patients (n=33) were not very satisfied
with their prostheses; they wore their mandibular prostheses at most a few hours
per day. It was concluded from the clinical assessment that two thirds of the
patients (n 4) could benefit from an implant-retained mandibular denture.
Analyses of the questionnaires revealed no significant associations between
functional assessments, quality of life, and parameters such as size of the
primary tumor, location of the primary tumor, and different treatment regimes.
Despite cancer treatment, the patients reported a rather good general quality of
life. CONCLUSIONS: Sequelae resulting from radiotherapy probably dominate oral
function and quality of life after oncology treatment. In two thirds of the
patients, improvement of oral function and related quality of life would be
expected with the use of an implant-retained mandibular denture.
-----
J Dent Res. 2007 Aug;86(8):694-707.
Photodynamic therapy in dentistry.
Konopka K, Goslinski T.
Department of Microbiology, University of the Pacific, Arthur A. Dugoni School
of Dentistry, San Francisco, CA, USA; and.
Photodynamic therapy (PDT), also known as photoradiation therapy, phototherapy,
or photochemo-therapy, involves the use of a photoactive dye (photosensitizer)
that is activated by exposure to light of a specific wavelength in the presence
of oxygen. The transfer of energy from the activated photosensitizer to
available oxygen results in the formation of toxic oxygen species, such as
singlet oxygen and free radicals. These very reactive chemical species can
damage proteins, lipids, nucleic acids, and other cellular components.
Applications of PDT in dentistry are growing rapidly: the treatment of oral
cancer, bacterial and fungal infection therapies, and the photodynamic diagnosis
(PDD) of the malignant transformation of oral lesions. PDT has shown potential
in the treatment of oral leukoplakia, oral lichen planus, and head and neck
cancer. Photodynamic antimicrobial chemotherapy (PACT) has been efficacious in
the treatment of bacterial, fungal, parasitic, and viral infections. The absence
of genotoxic and mutagenic effects of PDT is an important factor for long-term
safety during treatment. PDT also represents a novel therapeutic approach in the
management of oral biofilms. Disruption of plaque structure has important
consequences for homeostasis within the biofilm. Studies are now leading toward
selective photosensitizers, since killing the entire flora leaves patients open
to opportunistic infections. Dentists deal with oral infections on a regular
basis. The oral cavity is especially suitable for PACT, because it is relatively
accessible to illumination.
-----
Mayo Clin Proc. 2007 Jul;82(7):878-87.
Oral cancer.
Kademani D.
Division of Oral Diagnosis and Oral and Maxillofacial Surgery, Mayo Clinic, 200
First St SW, Rochester, Minn 55905, USA. kademani.deepak@mayo.edu
Five percent of all tumors occur in the head and neck, and approximately half of
those occur specifically in the oral cavity. Of the 615,000 new cases of oral
cavity tumors reported worldwide in 2000, 300,000 were primary oral cavity
squamous cell carcinomas. Recent data from the Surveillance, Epidemiology, and
End Results Program suggest that 28,900 new cases of oral cancer will be
identified and 7400 deaths attributed to oral cancer each year in the United
States. The sixth leading cause of cancer-related mortality, oral cancer
accounts for 1 death every hour in the United States. However, despite advances
in screening tools, imaging technology, and access to primary care physicians, a
considerable percentage of patients present with advanced-stage disease.
Clinical signs and symptoms of head and neck tumors are often nonspecific and
may be mistaken for other common ailments. Primary care physicians must be aware
of the possibility of oral cancer, particularly the increasing incidence in
young patients without traditional risk factors of alcohol and tobacco abuse. To
improve survival, all patients should be routinely and vigilantly screened for
oral mucosal lesions.
-----
Arch Otolaryngol Head Neck Surg. 2007 Jun;133(6):546-50.
Effect of initial treatment on disease outcome for patients with
submandibular gland carcinoma.
Kaszuba SM, Zafereo ME, Rosenthal DI, El-Naggar AK, Weber RS.
Department of Head and Neck Surgery, The University of Texas M. D. Anderson
Cancer Center, 1515 Holcombe Blvd, Unit 441, Houston, TX 77030, USA.
OBJECTIVE: To elucidate the effect on outcome of initial surgical enucleation
with or without definitive surgical resection and radiation therapy for patients
with submandibular gland carcinoma. DESIGN: Retrospective clinicopathological
review. SETTING: Tertiary referral center. PATIENTS: Eighty-seven consecutive
patients (mean follow-up, 8.7 years) with primary submandibular gland carcinoma.
MAIN OUTCOME MEASURES: Review of proven cases of primary carcinomas of the
submandibular gland treated at our institution during a 33-year period to
determine the effect of the type of biopsy and subsequent treatment on
locoregional disease control, disease-specific survival, and overall survival.
RESULTS: There was no statistically significant difference in locoregional
disease control, disease-specific survival, or overall survival between patients
undergoing enucleation of the gland vs patients undergoing enucleation of the
gland followed by definitive surgical resection before any radiation therapy.
There were no locoregional recurrences among 28 patients treated with
enucleation and radiation therapy, compared with 3 locoregional recurrences (7%)
among 42 patients treated with enucleation followed by definitive surgical
resection before any radiation therapy. Twenty-nine (69%) of 42 patients
undergoing a second surgical procedure had evidence of residual carcinoma in the
final surgical specimen. CONCLUSIONS: En bloc surgical resection followed by
radiation therapy remains the standard treatment for patients with submandibular
gland carcinoma. Patients without clinical and radiographic evidence of disease
after enucleation may be adequately treated with subsequent radiation therapy.
Definitive surgical resection remains the treatment of choice for patients with
clinical or radiographic evidence of disease after enucleation of the gland.
-----
Gan To Kagaku Ryoho. 2007 May;34(5):713-7.
[Nedaplatin (NDP)-combination therapy (NDP/5-FU,NDP/S-1) for oral
cancer]
[Article in Japanese]
Maruoka Y, Ando T, Ogiuchi Y, Ogiuchi H.
Dept. of Oral and Maxillofacial Surgery, School of Medicine,Tokyo Women's
Medical University, Japan.
PURPOSE: The present study evaluated the efficacy and safety of nedaplatin-combination
therapy (NDP/5-FU [5-FU arm] or NDP/S-1 [S-1 arm] ) for the treatment of oral
squamous cell carcinoma. PATIENTS AND METHOD: Previously non-treated oral
squamous cell carcinoma patients were eligible. Patients received 5-FU 600
mg/m(2)iv, as a 24-hour infusion (day 1 to 5) followed by NDP 80 to 100 mg/m(2)
iv (day 1), or S-1 60 to 80 mg/m(2) orally twice a day (day 1 to 14) followed by
NDP 80 mg/m(2) iv (day 8) every 28 days for one or two cycles. RESULTS: In
total, 32 patients (18 in the 5-FU arm, 14 in the S-1 arm) were enrolled. Twenty
patients were male and 12 were female. Median age was 57 years (range 20 years
to 87 years). Thirty-one patients had a performance status (PS) oF 0, and 1
patient had a PS 1. Three patients were stage I, 12 stage III, and 12 were stage
IV. The overall response rate was 69% (5-FU arm,72%;S-1 arm,64%). Two patients
achieved a complete response, 20 patients a partial response, and 10 patients
had no change. Grade 3 leucopenia, grade 3 and 4 thrombocytopenia and liver
injury occurred in 6% (one in the 5-FU arm, and one in the S-1 arm), 9% (two in
the 5-FU arm, and one in the S-1 arm), and 3% (one in the 5-FU arm),
respectively. No other severe toxicities were observed. RESULTS: Response rate
and toxicities were similar in both arms. However, the psychosocial stress on
patients in the S-1 arm was reduced compared to that in the 5-FU arm, which
required hospitalization for a longer period. The outcome in the present study
needs further investigation.
-----
Otolaryngol Head Neck Surg. 2007 May;136(5):783-7.
Clinical presentation, management, and outcome of high-grade
mucoepidermoid carcinoma of the parotid gland.
Emerick KS, Fabian RL, Deschler DG.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
02114, USA. Kevin_Emerick@meei.harvard.edu
OBJECTIVE: To describe clinical features of high-grade (HG) mucoepidermoid
carcinoma (MEC) of the parotid gland and assess clinical outcomes of one
surgical management approach. DESIGN/SETTING/METHODS: Retrospective case series
in a tertiary care academic institution. Pathology records were reviewed from
1977 to 1997, identifying patients with parotid HG MEC. Available medical
records were reviewed for data on clinical features, treatment, and outcome.
RESULTS: Increased stage, increased T stage, presence of neck metastasis, and
distant metastasis were all associated with poor outcome. Wide local excision
and postoperative radiation (XRT) provided 82% local control. XRT alone for N0
disease provided 86% regional control, while XRT and neck dissection yielded 74%
control in N(+) cases. CONCLUSION: High-grade MEC of the parotid gland is an
aggressive disease that frequently presents at advanced stage. Parotidectomy
with modified radical neck dissection and postoperative XRT provides reasonable
local and regional control for patients with N(+) disease. Elective selective
neck dissection and radiation should be considered for T3 and T4 tumors with N0
status.
-----
Am J Health Syst Pharm. 2007 May 1;64(9 Suppl 5):S25-32.
Managing oral chemotherapy: the healthcare practitioner's role.
Viele CS.
University of California San Francisco Medical Center, San Francisco, CA 94044,
USA. carol.viele@ucsfmedctr.org
PUPOSE: Management of the side effect profiles of the new oral cancer
chemotherapeutic agents differs from those of traditional oral chemotherapy and
hormonal therapy. The healthcare practitioner's role in counseling and managing
these toxicities as well as methods for assessing and promoting adherence is
reviewed. SUMMARY: Many side effects from traditional oral cancer
chemotherapeutic agents are the result of their effects on healthy cells as well
as cancer cells. The side effects from the novel targeted therapies differ from
those of traditional chemotherapy. Managing side effects and patient
self-administration in non-traditional settings without supervision may affect
patient adherence, especially with the newer agents. Social and psychological
factors also can affect adherence. Various methods are available to assess
adherence, including obtaining prescription refill histories and performing pill
counts. Counseling patients, asking patients to keep a diary of doses and side
effects, and following up with patients at clinic visits or through telephone
contact are all methods that promote adherence. Patient education should address
the proper dose, frequency, timing with respect to food and other medications,
what to do if a dose is missed, side effects to anticipate, and what to do if
side effects occur. CONCLUSION: Healthcare practitioners play an important role
in educating patients regarding potential side effects to oral chemotherapy and
assessing and promoting adherence to the treatment regimen.
-----
J Oral Maxillofac Surg. 2007 May;65(5):953-7.
Submandibular gland excision: 15 years of experience.
Preuss SF, Klussmann JP, Wittekindt C, Drebber U, Beutner D, Guntinas-Lichius O.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne,
Cologne, Germany. simon.preuss@uni-koeln.de
PURPOSE: The surgical management of submandibular gland diseases has always been
a challenge because it carries a considerable risk of nerve injury. The aim of
this study was to review a single institution's experience of a nonselected case
series of submandibular gland excision over 15 years. MATERIALS AND METHODS: We
retrospectively analyzed 258 unselected submandibular excisions of a tertiary
university center for the histopathologic diagnosis and postoperative morbidity;
119 patients (46%) with sialolithiasis, 88 patients (34%) with sialadenitis, and
51 patients (20%) with submandibular tumors were operated. RESULTS: We found a
high rate of malignant tumors (42%) in the group of submandibular gland tumors.
A low rate of transient palsies of the mandibular branch of the facial nerve
(9%) and lingual nerve (2%) was observed. One patient developed a permanent
paresis of the mandibular branch (<1%). CONCLUSION: Our large series has shown
that standardized submandibular sialadenectomy is a safe operation with a low
rate of complications. Malignant disease is frequent in tumors of the
submandibular gland.
-----
Curr Opin Oncol. 2007 May;19(3):180-7.
Chemoprevention of squamous cell carcinoma of the head and neck.
Wrangle JM, Khuri FR.
Winship Cancer Institute/Emory University, Atlanta, Georgia 30322, USA.
PURPOSE OF REVIEW: The aim of this article is to summarize progress in
understanding of the biology of squamous cell carcinoma of the head and neck and
of trials to prevent malignant conversion of oral premalignant lesions and the
development of second primary tumors in those already treated for squamous cell
carcinoma of the head and neck. RECENT FINDINGS: The understanding of squamous
cell carcinoma of the head and neck biology is rapidly evolving. Clinical trials
for chemoprevention are involving more diverse regimens, following disappointing
results of retinoid monotherapy. In-vitro and animal studies form the rationale
for the next generation of studies, employing combination, synergistic
treatments. SUMMARY: Based on trial data to date, no recommendation for
intervention with a chemopreventive agent can be made. It is clear, however,
that smoking cessation is an effective intervention for preventing oral
premalignant lesions and second primary tumors. Promising trials are being
conducted and designed currently. The future of this area of study will involve
rational choice of multidrug regimens based on current understanding of the
biology of squamous cell carcinoma of the head and neck.
-----
Clin Transl Oncol. 2007 Apr;9(4):251-4.
Low dose rate brachytherapy in lip carcinoma.
Conill C, Verger E, Marruecos J, Vargas M, Biete A.
Institute of Haematology and Oncology, Department of Radiation Oncology,
Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS),
University of Barcelona, Barcelona, Spain. cconill@clinic.ub.es
BACKGROUND: Lip cancer is frequently treated with surgery although radiation
therapy offers comparable results. The aim of the study was to evaluate the
local cure rate in patients with lip carcinoma treated with 192-Ir low dose rate
interstitial brachytherapy. METHODS: Fifty-four patients with a mean age of 70
years (range, 40-90 years) were retrospectively evaluated. The tumour location
was the superior lip in 4 (7.4%) and the inferior lip in 50 (92.6%). Tumour
stage was T1N0 in 33 patients and T2N0 in 21 patients. The radioactive sources
with hypodermic needles in 49 patients (90.7%) and plastic tubes in 5 (9.3%)
were placed parallel and equidistant from one another across the tumour volume
according to the Paris system rules. RESULTS: The median dose was 61.5 Gy
(range, 60-65 Gy). All patients experienced acute brisk skin and mucositis RTOG
grade III around the implanted volume, subsiding within 4-6 weeks after the
implant. Local control was achieved in 98% of patients. The mean follow-up was 7
years. CONCLUSIONS: Low dose rate interstitial brachytherapy with 192-Iridium is
a well established and efficacious way to achieve local control of the tumour in
lip cancer. It offers the advantage of avoiding surgery in an elderly
population.
-----
Cancer Nurs. 2007 Mar-Apr;30(2):112-22; quiz 123-4.
Facilitating oral chemotherapy treatment and compliance through
patient/family-focused education.
Moore S.
Division of Hematology, Oncology and Stem Cell Transplant, Rush University
Medical Center, Chicago, Ill, USA. susan.moore@cancerexpertise.com
Oral chemotherapy is assuming an increasingly important role in cancer therapy.
Pharmaceutical firms continue to invest heavily in oral drug development with
approximately 25% of more than 400 antineoplastic drugs currently in the
development pipeline planned as oral agents. New treatments, patient preference,
and the economic realities of cancer care delivery present physicians, nurses,
pharmacists, and cancer center administrators with a challenge to restructure
and reorganize to provide cost-effective and high-quality care to cancer
patients. Oncology nurses are uniquely positioned to step into new roles
emphasizing patient and family education and support. A discussion of the Health
Belief Model provides an increased understanding of patient motivation and helps
healthcare providers increase compliance among patients using oral therapies.
This article provides an overview of the current status of oral cancer therapy
in the United States and takes into consideration a historical perspective;
illustrates pharmacology, indications, administration, and side effect profile
through an exemplar agent; discusses potential advantages of and challenges to
integration of oral therapies; and discusses alternative methods of patient and
family education to improve compliance and outcome.
-----
Am Fam Physician. 2007 Feb 15;75(4):509-12. Comment in: Am Fam Physician. 2007
Feb 15;75(4):475-6.
Common oral lesions: Part II. Masses and neoplasia.
Gonsalves WC, Chi AC, Neville BW.
Medical University of South Carolina, Charleston, South Carolina, USA.
Certain common oral lesions appear as masses, prompting concern about oral
carcinoma. Many are benign, although some (e.g., leukoplakia) may represent
neoplasia or cancer. Palatal and mandibular tori are bony protuberances and are
benign anomalies. Oral pyogenic granulomas may appear in response to local
irritation, trauma, or hormonal changes of pregnancy. Mucoceles represent mucin
spillage into the oral soft tissues resulting from rupture of a salivary gland
duct. Oral fibromas form as a result of irritation or masticatory trauma,
especially along the buccal occlusal line. Oral cancer may appear clinically as
a subtle mucosal change or as an obvious mass. Oral leukoplakia is the most
common premalignant oral lesion. For persistent white or erythematous oral
lesions, biopsy should be performed to rule out neoplastic change or cancer.
Most oral cancers are squamous cell carcinomas. Tobacco and heavy alcohol use
are the principal risk factors for oral cancer. Family physicians should be able
to recognize these lesions and make appropriate referrals for biopsy and
treatment.
-----
Semin Oncol. 2007 Feb;34(1):3-14.
Small cell carcinoma of the head and neck: a review.
Renner G.
Department of Otolaryngology - Head and Neck Surgery, University of Missouri
School of Medicine, Columbia, MO 65212, USA. rennerg@health.missouri.edu
Small cell carcinoma (SCC) has become recognized as a distinct, though
relatively infrequent, clinical pathology that occurs in multiple sites
throughout the head and neck. Excluding cases that are considered to arise from
skin, SCC in the head and neck has been found to develop in nearly all
structures associated with the upper aerodigestive tract. Among the head and
neck sites, the frequency of SCC is greatest in the larynx, with salivary glands
and the sinonasal region comprising the other principle areas of origin.
Controversy exist as to whether SCC can develop as a distinct entity in the
thyroid, with most tumors that previously would have been considered as SCC now
found to be lymphomas or variant forms of other types of thyroid malignancy.
While there seems to be some differences among tumors arising from the various
subsites, in general all SCC that originate in the head and neck have a tendency
for aggressive local invasion and a strong propensity for both regional and
distant metastasis. Treatment may include surgical resection, radiotherapy,
chemotherapy, or some combination of these modalities. Due to the infrequency of
these tumors, it is very unlikely that any large, controlled study will ever be
done. For this reason, recommendations for treatment of SCC arising in the head
and neck are based primarily on retrospective data from various small case
series and on comparative data for treatment of SCC of bronchogenic and other
extrapulmonary origin. Although patients with truly limited local disease may
enjoy some prolonged survival, most patients with this tumor do poorly despite
all current attempts at treatment.
-----
Laryngoscope. 2007 Feb;117(2):350-6.
Impact of re-resection for inadequate margins on the prognosis of
upper aerodigestive tract cancer treated by laser microsurgery.
Jackel MC, Ambrosch P, Martin A, Steiner W.
Department of Otorhinolaryngology, Hospital of Darmstadt, Darmstadt, Germany.
martin.jaeckel@surfeu.de
OBJECTIVES: Positive or uncertain surgical margins left untreated have a
distinct prognostic relevance in squamous cell carcinoma of the upper
aerodigestive tract. An advantage of transoral laser microsurgery is that it can
be easily repeated if inadequate resection margins are found postoperatively.
The present study investigates the impact of laser surgical reresection on the
outcome of patients. STUDY DESIGN: The authors conducted a retrospective
unicenter study. METHODS: A review of 1,467 patients with squamous cell
carcinoma of the upper aerodigestive tract who were initially treated by
transoral laser microsurgery with curative intent between August 1986 and
December 2002 was conducted. Locoregional control as well as TNM adjusted and
overall survival were analyzed using the Kaplan-Meier method. RESULTS: Three
hundred eighty-six patients have required reresection to obtain clear surgical
margins, in 70 of whom residual carcinoma has been detected in revision
specimens. Patients without need for revision and those in whom revision
specimens were found tumor-free had an almost identical locoregional control (P
= .4611). In patients with positive revision specimens, however, locoregional
control was significantly worsened (P = .0058). Neither the need for reresection
nor the detection of further tumor tissue in revision specimens affected TNM
adjusted or overall survival. CONCLUSIONS: Survival of patients was similar
whether clear resection margins were reached within the first surgical step or
with revision surgery. However, patients in whom reresection specimens contained
residual carcinoma had an increased risk of locoregional failure and should
undergo a further reresection or at least a very close follow up.
-----
Head Neck. 2007 Jan 17; [Epub ahead of print]
Effects of radiotherapy with or without chemotherapy on tongue
strength and swallowing in patients with oral cancer.
Lazarus C, Logemann JA, Pauloski BR, Rademaker AW, Helenowski IB, Vonesh EF,
Maccracken E, Mittal BB, Vokes EE, Haraf DJ.
Voice, Speech and Language Service and Swallowing Center, Northwestern
University Feinberg School of Medicine, Chicago, Illinois.
BACKGROUND.: Oral tongue strength and swallowing ability are reduced in patients
treated with chemoradiotherapy for oral and oropharyngeal cancer. METHODS.:
Patients with oral or oropharyngeal cancer treated with high-dose
chemoradiotherapy underwent tongue strength, swallowing, and dietary assessments
at pretreatment and 1, 3, 6, and 12 months posttreatment. Tongue strength was
assessed using the Iowa Oral Performance Instrument (IOPI). Oral and pharyngeal
residue was evaluated utilizing videofluoroscopy. RESULTS.: Mean maximum tongue
strength dropped a nonsignificant amount immediately after treatment, and then
increased significantly at 6- and 12-months posttreatment completion. Analyses
were adjusted for patient dropout. Tongue strength was not significantly
correlated with swallow observations of percentage oral and pharyngeal residue.
Ability to eat various diet consistencies was reduced after treatment but
improved over time at a rate similar to changes in oral intake and type of diet.
CONCLUSIONS.: Parallel but not significant changes in oral intake, diet, and
tongue strength in the first year post chemoradiation therapy need further study
in a larger population. (c) 2007 Wiley Periodicals, Inc. Head Neck, 2007.
-----
Laryngoscope. 2006 Dec;116(12):2156-61.
Carcinoma of the tongue base treated by transoral laser
microsurgery, part two: Persistent, recurrent and second primary tumors.
Grant DG, Salassa JR, Hinni ML, Pearson BW, Perry WC.
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic,
Jacksonville, Florida 32224, USA.
OBJECTIVES: To report the oncologic and functional outcomes of transoral laser
microsurgery (TLM) in the treatment of persistent, recurrent, and second primary
squamous cell carcinoma of the tongue base. STUDY DESIGN: A two-center
prospective case series analysis. METHODS: Twenty-five patients with persistent,
recurrent, or second primary squamous cell carcinoma of the tongue base were
treated with TLM between 1997 and 2005. Four (16%) patients with persistent
disease at the primary site were considered TX. Eleven (44%) patients with
recurrent disease were pathologically staged rT1 3/11, rT2 2/11, rT3 4/11, T4
1/11, and TX 1/11. Ten (40%) patients with second primary tumors were staged
pT1, 4/10; pT2, 3/10; pT3, 2/10; and pT4, 1/10. Eight (32%) patients underwent
neck dissection. Three (12%) patients received adjuvant radiotherapy. Pre- and
post-treatment organ function was assessed using a clinical Functional Outcome
Swallowing Scale (FOSS) and Communication Scale. RESULTS: The mean follow-up
period was 26 months. The 2-year Kaplan-Meier local control and locoregional
control estimate was 69%. For those patients presenting with
persistent/recurrent or second primary disease, the 2 year local control
estimates were 75% and 68%, respectively. For all patients, the respective 2 and
5 year overall survival estimates were 54% and 26%. Two (8%) patients suffered
postoperative hemorrhage. The average duration of hospitalization was 3.6 days.
The median pretreatment and posttreatment FOSS stage was stage 2 and stage 3,
respectively. CONCLUSIONS: Transoral laser surgery is a rational and effective
treatment in appropriately selected patients with persistent, recurrent, or
second primary tongue base cancer. The low morbidity and mortality and shortened
duration of hospitalization associated with TLM make it an attractive
therapeutic alternative.
-----
Laryngoscope. 2006 Dec;116(12):2150-5.
Carcinoma of the tongue base treated by transoral laser
microsurgery, part one: Untreated tumors, a prospective analysis of oncologic
and functional outcomes.
Grant DG, Salassa JR, Hinni ML, Pearson BW, Perry WC.
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic,
Jacksonville, Florida 32224, USA.
OBJECTIVES: To report the oncologic and functional outcomes of transoral laser
microsurgery (TLM) in the management of untreated primary carcinoma of the
tongue base. STUDY DESIGN: A two center prospective case series analysis.
METHODS: Fifty-nine patients with pathologically confirmed squamous cell
carcinoma of the tongue base were treated with TLM between 1997 and 2005. The
pathological T stage distribution was: T1, 16; T2, 23; T3, 12 and T4, 8.
Thirty-six patients presented with stage IV disease, 12 with stage III, 7 with
stage II and 4 with stage I disease. Neck dissections were performed in 49
patients (83%). Twenty-eight patients (47%) underwent adjuvant radiotherapy. End
points analyzed were local control, loco regional control, disease specific
survival, and overall survival. Organ function was assessed before and after
treatment using a clinical Functional Outcome Swallowing Scale (FOSS) and
Communication Scale (CS) staging system. RESULTS: The mean follow up for all
patients was 31 months. The 2 and 5-year Kaplan-Meier estimates were: local
control, both 90%; loco-regional control, both 88%; recurrence free survival,
both 84% and overall survival 91% and 69% respectively. For all patients the
median stay in hospital was 4 days. The median length of hospital visit for TLM
alone was 2.5 days and 4 days for TLM with neck dissection. Three patients (5%)
suffered minor post-operative hemorrhage. The median pre-operative FOSS stage
was 0 (normal function.) The median post-operative FOSS stage was stage 1
(Normal function with episodic or daily symptoms of dysphagia.) There were no
clinically significant changes in communication function after treatment.
CONCLUSIONS: Transoral laser surgery is a safe and effective treatment for
select early and advanced previously untreated squamous cell cancer of the
tongue base. In addition, the low morbidity and mortality and shortened duration
of hospitalization associated with TLM make it an attractive therapeutic
alternative.
-----
Ann Otolaryngol Chir Cervicofac. 2006 Nov;123(5):221-6.
[Neck dissection for stage N0 oral cavity carcinoma]
[Article in French]
Jegoux F, Caze A, Mohr E, Godey B, Le Clech G.
Service d'ORL et chirurgie maxillo-faciale, CHU Pontchaillou, rue Henri Le
Guillou, 35033 Rennes Cedex 9. frank.jegoux@chu-rennes.fr
OBJECTIVES: The management of N0 neck remains controversial. The purpose of this
study was to evaluate the efficacy of selective neck dissection (SND) in
managing N0 neck of oral cavity carcinomas. MATERIAL AND METHODS: A
retrospective chart review of 77 previously untreated patients with squamous
cell carcinomas of the oral cavity with N0 neck from 1988 to 2001 was performed.
Cervical treatments were "wait and see" policy in 7 cases, neck dissection in 56
cases, radiotherapy alone in 14 cases. 77 neck dissections were performed in
which 62 were selective and 15 were radical modified. RESULTS: On pathologic
examination, the average number of lymph nodes was 10.7 per neck. Occult disease
(cN0pN+) was detected in 32.5%, and occult extracapsular spread (cN0pN+R+) was
detected in 7.8%. The median follow-up was 43 months. The overall neck
recurrence rate in patients with controlled primary disease was 2.4%. Recurrent
disease developed in 2.9% of the cNOpN0 neck. Regional control rate of the
dissected neck was 94%. No cervical recurrence occurred in 11 patients treated
with SND alone. There was no survival or recurrence rate difference in T1T2pN0
patients with or without post-operative radiotherapy. Post-operative
radiotherapy could be avoided in 27% of the dissected neck. One, 3 and 5 years
overall survival rate were 89.3%, 77.7% and 63.2%. CONCLUSIONS: SND is an
effective procedure for staging and treating the clinically negative neck of
oral cavity cancer.
Previous Oral Cancer
Research: 2002-2006
The
Oral Cancer File also contains summaries of past
research that has shown promise and may still be standard
practice among many physicians.
To
download earlier
research findings on Oral
Cancer, click
HERE.
©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.
|
