Effect of body mass index on chemoradiation outcomes in head and neck cancer

Objective: To investigate the association between initial body mass index (BMI) and chemoradiation therapy (CRT) outcomes in head and neck cancer patients. Methods: Retrospective study of 72 patients with American Joint Committee on Cancer stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, or larynx treated with primary concurrent CRT with curative intent over a 5 year period. Logistic and Cox regression analyses were used to determine the association between initial BMI and percutaneous endoscopic gastrostomy tube dependence, tumor recurrence, disease‐free survival, and overall survival while controlling for the independent variables of age, sex, race, site, stage, and smoking and alcohol use. Results: Patients with normal or low BMI (BMI ≤25 kg/m²) were significantly more likely to be percutaneous endoscopic gastrostomy dependent at last follow‐up (odds ratio 4.13; 95% confidence interval [CI] 1.3–12.9; P = .014). This group also had significantly earlier recurrence (hazard ratio 4.4; 95% CI 1.2–15.9; P = .026) and shorter overall survival (hazard ratio 3.6; 95% CI 1.04–12.6, P = .043). Conclusions: The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.     

Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Abstract

Background: Squamous cell carcinoma (SCC) is the most common type of head and neck cancer, and head and neck squamous cell carcinoma (HNSCC) was proved to having a high prevalence of perineural invasion (PNI). Although some reports have revealed a relationship between PNI and the prognosis in HNSCC patients, the contribution of PNI to the prognosis remains unclear.

Objectives: This study was aimed to comprehensively and quantitatively summarize the prognostic value of PNI for the survival of patients with HNSCC.

Material and methods: We conducted PubMed and EMBASE to identify all relevant studies. A meta-analysis and subgroup analysis were performed to clarify the prognostic role of PNI.

Results: A total of 18 studies (n?=?3894) were included. 989 (25.4%) of the 3894 patients exhibited positive PNI, PNI was shown to be significantly associated with overall survival (OS) [hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.88–4.16], disease-free survival (DFS) (HR = 2.42, 95% CI: 1.92–3.05) and disease-specific survival (DSS) (HR = 2.60, 95% CI: 1.86–3.63).

Conclusions: The presence of PNI significantly affected OS, DFS and DSS in patients with HNSCC.     

Outcome of patients treated with palliative weekly Paclitaxel plus Cetuximab in recurrent head and neck cancer after failure of platinum-based therapy

Few therapeutic options are available for recurrent/metastatic head and neck cancer when progression occurs after initial chemotherapy. We analyzed retrospectively the efficacy of weekly Paclitaxel plus Cetuximab as second line of palliative chemotherapy. Patients with squamous carcinoma of head and neck with documented progression after initial treatment were enrolled. Tumor response was evaluated through the response evaluation criteria in solid tumor criteria. The retrospective analysis focused on overall survival (OS) and progression-free survival (PFS). Between 2008 and 2011, 33 consecutive patients were treated. A response rate of 55 % was observed, with median response duration of 5.0 months (95 % CI 3.3–11.1). The median PFS was 4.0 months (95 % CI 2.9–5.0) and the median OS time was 10.0 months (95 % CI 7.9–12.0). Acne-like rash/Folliculitis and chronic anemia were the most common adverse events. A weekly schedule of Paclitaxel plus Cetuximab is a promising regimen for patients with advanced head and neck cancer after failure of platinum-based therapy. Good tolerance of this treatment suggests that would be used in fragile patients.     

Non-squamous malignancy in lymph nodes: the occult primary

The present study presents 105 patients seen at a head and neck specialist clinic with a neck gland which subsequently proved to be a non-squamous malignancy. Of the 105 patients, 50 patients were eventually found to have a tumour in the head and neck region, 30 to have a distant primary and in 25 no primary site was ever found. The majority of patients were diagnosed in the clinic after careful examination and most of the remainder were diagnosed during endoscopy/biopsy. Chest radiography was the most useful investigation for diagnosing primary tumours of the lung. The 5-year-survival for the whole group of 105 patients was 28% (95% CI 17–39). The 5-year-survival for the head and neck primary tumour group was 44% (95% CI 25–60). The median survival of patients with a distant primary tumour was only a 6 months, there was one 5-year-survivor. The median survival for those in whom the primary was never discovered was 18 months. However, a reasonable proportion of these patients survived, five being alive at 5 years. The difference between survival for the three groups was statistically significant (P < 0.001). The most common histological type was undifferentiated/anaplastic tumours (37 out of 105) and this was followed by adenocarcinoma (33 out of 105). There was a significant difference in the survival between these two groups (χ²= 2.02, d.f. = 1, P= NS). Multi-variate analysis suggested that survival was better in the older age group and was affected by histology (P= 0.0093, P= 0.0332 respectively). The present study suggests that the treatment of patients in whom the primary site is eventually found to be in the head and neck region is rewarding with the same survival as a similar group of patients with squamous cell carcinoma. Sixty of the group of 105 patients had excision biopsies of the neck node and this did not affect survival.     

A systematic review of the role of mutant p53 in predicting outcome or response to treatment in head and neck squamous cell carcinoma (HNSCC).

Objectives. To systematically review whether the presence of mutant p53 alters patients’ prognosis in HNSCC. Method. Systematic searches of Medline, the Cochrane database of randomised controlled trials, Embase, review of conference abstracts and bibliographies of retrieved articles were performed. Studies were included if they; (1) considered biopsy proven primary HNSCC from the larynx, oropharynx, hypopharynx, or oral cavity. (2) Reported on the outcome following treatment that included radiotherapy, chemotherapy, surgery or a combination of these. (3) Attempted to assess p53 status and compared this with survival outcomes. (4) Measured survival outcomes at a minimum of 2 years post primary treatment. Primary outcome measures were overall survival (OS) and disease free survival (DFS). Hazard ratio (HR) with 95% confidence intervals (CI), was calculated from available data comparing outcome in mutant versus wild type p53 groups; initially for each study prior to aggregation. Results. 205 papers were fully scrutinised, of these 36 were suitable for meta‐analysis. Larynx: OS HR = 1.00 (95% CI 0.82–1.22); DFS HR = 1.27 (95% CI 0.99–1.63). Oral Cavity: OS HR = 1.50 (95% CI 1.15–1.95), DFS HR = 1.46 (95% CI 1.12–1.91). Oropharynx: OS HR = 1.26 (95% CI 0.92–1.73), DFS HR = 0.45 (95% CI 0.28–0.73). Hypopharynx: OS HR = 1.59 (95% CI 1.07–2.35), no papers had sufficient information from which DFS results could be calculated. Conclusions. The results suggest a survival benefit for the p53 negative group, however there is marked heterogeneity between these studies, so any final conclusion should remain guarded.     

The prognostic influence of prevertebral space involvement in nasopharyngeal carcinoma

Objectives: The purpose of this study was to evaluate the effect of prevetebral space involvement on treatment outcomes in patients with nasopharyngeal carcinoma (NPC) who were treated with radiotherapy/concurrent chemoradiotherpy or concurrent chemoradiotherpy with adjuvant chemotherapy. Design: A retrospective review of case notes from the Kaohsiung Veterans General Hospital archives was performed. Setting: A medical centre in Taiwan. Participants: There were 145 newly diagnosed cases of NPC. Thirty‐nine patients were excluded because of the presence of distant metastasis at the time of presentation, loss of follow‐up and incomplete image information. Main outcome measures: Pearson’s chi‐square tests were used to analyse correlation between tumour invasion and prevetebral space involvement during univariate analysis and logistic regression was applied during multivariate analysis. Kaplan–Meier survival curves were constructed. Multivariate analysis was performed to examine the impact of various prognostic factors. Pearson’s chi‐square and Fisher’s exact test were also used to evaluate the correlation between failure patterns and treatment modality. Results: A total of 106 patients with newly diagnosed NPC were enrolled in this study. Forty‐three patients (41%) in this series were found to have prevertebral space involvement. Patients with prevertebral space involvement conferred a poor overall survival rate and metastasis‐free survival rate compared with those without prevertebral space invasion (P = 0.04 and 0.02 respectively). Multivariate analysis showed that prevertebral space invasion was associated with an increased risk for distant metastasis [hazard ratio (HR) 14, 95% confidence interval (CI) 1.0–17.4; P = 0.03)] and overall survival (HR 7, 95% CI 1.1–135; P = 0.04). In patients with prevertebral space involvement, their metastasis‐free survival rate, with and without adjuvant chemotherapy, was 100% and 72.7% (P = 0.047). This phenomenon was not observed in NPC patients without prevertebral space invasion. Conclusions: The present data revealed that prevertebral space involvement has a close relationship with survival rates and recurrence rates of patients with NPC. Nasopharyngeal carcinoma patients with prevertebral space involvement have more recurrence and poorer survival rates and should be the group to benefit from concurrent chemoradiotherapy followed by adjuvant chemotherapy. Inclusion of prevertebral space involvement may be needed to predict prognosis of NPC and help us to identify the high‐risk group.     

Matched analysis of the prognosis of amelanotic and pigmented melanoma in head and neck

Abstract

Background: The prognosis of mucosal melanoma is poor, and the difference in clinical prognosis between patients with and without pigment needs further study.

Aim: To analyze data with head and neck mucosal melanoma, and compare the prognosis of patients with and without pigment.

Material and methods: The patients of amelanotic melanoma were matched with pigmented type according to age, sex, stage, location of disease, treatment history, tobacco and alcohol history. The Kaplan–Meier and Cox proportional risk regression model was used for analyzation.

Results: 46 patients of amelanotic melanoma and 46 of pigmented type were included in this study. The overall survival rate and progression-free survival rate of patients with pigmented melanoma were higher than in patients with amelanotic melanoma (HR = 0.533, p?=?.035, 95% CI = 0.296–0.957; HR = 0.530, p?=?.034, 95% CI = 0.294–0.953, respectively), and the risk of distant metastases in patients with amelanotic melanoma was significantly higher than that in patients with pigmented melanoma (HR = 0.474, p?=?.046, 95% CI = 0.228–0.987).

Conclusions and significance: The prognosis and disease-free survival of amelanotic melanoma is worse than for the pigmented type group. More identifying the differences in clinical characteristics will help to further individualized treatment decisions.     

Observing stage‐shifts in head and neck squamous cell carcinoma from initial clinical outpatient staging to definite clinical tumour board staging using radiological and endoscopical investigations: will less do?

Clin. Otolaryngol. 2011, 36 , 352–360 Objectives: Staging head and neck squamous cell carcinoma usually is initiated in the outpatient department (OPD) using patient history and physical examination. To reach consensus on stage and therapy, imaging and panendoscopy are more or less routinely applied as additional staging tests. Staging results from the outpatient department were evaluated for tumour and neck stage. We investigated in which situations additional staging tests are needed. Design: Prospective cohort study. Setting: Head and Neck Oncology Group, University Medical Centre. Participants: Of 341 patients, initial staging results from the outpatient department were compared with the ultimate staging results from the tumour board review, which provides the basis for decisions on therapy. Main outcome measures: Tumour stage and neck stage migrations during this staging tract. Results: In staging head and neck tumours are squamous cell carcinomas, additional staging tests like imaging and/or panendoscopy remain necessary to evaluate the primary tumour stage. Average accuracies of T‐staging in oral cavity, pharynx and larynx only amount to 71%, 47% and 61%, respectively. For T1N0 and T2N0 oral cavity tumours, neck assessment in the outpatient department was accurate in 100% (95% CI: 91–100%) and 93% (95% CI: 80–98%), respectively. In the larynx group, this was 100% (95% CI: 91–100%) and 97% (95% CI: 86–100%), respectively. Conclusions: For oral cavity and laryngeal tumours staged as T1‐2N0 in the outpatient department, we concluded that the outpatient department staging is highly predictive of the final pre‐treatment staging. In these cases, computer tomography and/or MRI remain a necessity but additional ultrasound with or without fine needle aspiration cytology can be omitted. In our institution, this would have resulted in a 46% reduction in ultrasound procedures. If T‐stage is upgraded during imaging or panendoscopy, additional staging tests for N‐stage should still be considered.     

Hemithyroidectomy for benign thyroid disease: who needs follow‐up for hypothyroidism?

Objective: To identify the incidence and possible risk factors for the development of hypothyroidism following hemithyroidectomy and to determine a simple protocol for the post‐op monitoring of thyroid function. Design: Prospective study. Setting: Tertiary Referral Centre. Patients: Eighty‐two consecutive patients who underwent hemi‐thyroidectomy between May 2003 and May 2005 were included. The clinical and pathological factors were obtained and statistically analysed. Results: Eighteen per cent of patients became hypothyroid post‐operatively. Multivariate analysis demonstrated that risk factors for hypothyroidism following hemithyroidectomy included a pre‐operative [TSH] >1.6 μIU/L [P = 0.008, hazard ratio (HR) 14, 95% confidence interval (CI) 2–54] and lymphocytic infiltration graded 3+ or more (P < 0.001, HR 42, 95% CI, 8–195%). There was no relationship between age, sex or weight of resected tissue and the risk of hypothyroidism. Conclusion: Patients with raised pre‐operative [TSH] or with lymphocytic infiltration of their thyroid specimen should undergo regular testing of thyroid function within the first year of surgery. In all other patients, thyroid function at 12 months is sufficient.     

Better outcome for parotid versus neck metastasis of head and neck cutaneous squamous cell carcinoma: a new report on reemerging data

IntroductionRegional metastases of cutaneous head and neck squamous cell carcinoma occur in approximately 5 % of cases, being the most important prognostic factor in survival, currently with no distinction between parotid and neck metastasis.ObjectiveThe purpose of this study was to evaluate the prognostic features among patients with head and neck cutaneous squamous cell carcinoma exhibiting regional metastasis.MethodsA retrospective analysis of patients with cutaneous squamous cell carcinoma who underwent parotidectomy and/or neck dissection from 2011 to 2018 at a single institution tertiary center was performed. Patient demographics, clinical, surgical and pathological information, adjuvant treatments, and outcome at last follow-up were collected. Outcomes included disease recurrence and death due to the disease. Prognostic value of clinic pathological features associated with disease-specific survival was obtained.ResultsThirty-eight cases of head and neck cutaneous squamous cell carcinoma with parotid and/or neck metastasis were identified. Overall, 18 (47.3 %) patients showed parotid metastasis alone, 12 (31.5 %) exhibited neck metastasis alone and 8 (21.0 %) had both. A primary tumor in the parotid zone (Hazard Ratio ? HR = 5.53; p = 0.02) was associated with improved disease-specific survival. Poorer disease-specific survival was observed in patients with higher primary tumor diameter (HR = 1.54; p = 0.002), higher depth of invasion (HR = 2.89; p = 0.02), invasion beyond the subcutaneous fat (HR = 5.05; p = 0.002), neck metastasis at first presentation (HR = 8.74; p < 0.001), number of positive lymph nodes (HR = 1.25; p = 0.004), and higher TNM stages (HR = 7.13; p = 0.009). Patients presenting with isolated parotid metastasis during all follow-ups had better disease-specific survival than those with neck metastasis or both (HR = 3.12; p = 0.02).ConclusionHead and neck cutaneous squamous cell carcinoma with parotid lymph node metastasis demonstrated better outcomes than cases with neck metastasis.     

A national cancer database analysis on stereotactic body radiation therapy of head and neck cancers

BackgroundTo evaluate demographic, clinicopathological, treatment factors including biological effective radiation dose (BED) that influence overall survival in head and neck cancer (HNC) patients treated with stereotactic body radiation therapy (SBRT).MethodsBetween 2004 and 2015, 591 SBRT-treated HNC patients were identified from the National Cancer Data Base. A BED using an alpha/beta ratio of 10 (BED₁₀), was used to compare dose fractionation of different SBRT regimens. Overall survival was estimated using the Kaplan Meier method, and log-rank tests were used to determine statistical significance. Cox regression modeling was used to compute crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI).ResultsMedian follow-up was 11.9 (interquartile range, 5.5 to 26.7) months. The 5-year overall survival rate was 15.5%. On multivariate analysis, older age, Charlson-Deyo comorbidity score ≥ 1, history of cancer, tumor, nodal and metastatic stage, and receiving treatment at academic/research program were associated with poor survival. Compared to SBRT alone, superior survival was observed with SBRT with chemotherapy, surgery with SBRT, but not surgery with SBRT and chemotherapy. Improved survival was observed with aa BED₁₀ of ≥59.5 Gy (adjusted HR 0.57, 95% CI 0.46–0.70, P < 0.0001).ConclusionsFactors affecting associated with worse survival in HNC patients treated with SBRT included older age, patient comorbidities, advanced tumor stage, cancer history, and lower biological effective SBRT dose.Level of evidence2b (individual cohort study).     

Preoperative chemotherapy in advanced resectable head and neck cancer: final report of the Southwest Oncology Group

In 1980, the Southwest Oncology Group instituted a multi-institutional, prospective, randomized phase III trial to evaluate whether inductive chemotherapy improved survival in patients with advanced stage resectable squamous cell carcinoma of the head and neck. From a group of 158 eligible patients, 76 were randomized to conventional treatment (surgery and postoperative radiotherapy), and 82 were assigned to experimental treatment (induction chemotherapy, surgery, postoperative radiotherapy). Median follow-up for living patients was approximately 5 years. These analyses include chemotherapy responses and toxicities, surgical complications, radiotherapy toxicities, patient compliance, survival time, and patterns of treatment failure. Overall chemotherapy response was 0.70 (0.19 CR, 0.51 PR). The median survival time for conventional treatment was longer than the time for patients receiving preoperative chemotherapy, although the survival time differences were not statistically significant. This final analysis demonstrates no benefit in survival using preoperative chemotherapy for advanced stage, resectable head and neck squamous cell carcinoma.     

The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome

Conclusion: HPV?+?HNSCC patients have improved Overall Survival (OS), Disease Specific Survival (DSS), Disease Free Survival (DFS), and Progression Free Survival (PFS). The radiotherapy treatment can’t improve the Survival of the HPV-negative HNSCC patients.

Objective: To investigate the role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

Methods: A search in PubMed and Chinese CNKI (2000–2015) was performed. This meta-analysis was done using RevMan 5.1 software. Outcomes included OS, DSS, DFS, PFS, and Treatment responses rates (RR).

Results: A total of 2620 patients in 10 studies were included. The Positive detective rates of HPV and P16 are 32.5% (425/1309) and 42.5% (526/1239). OS and PFS were improved in HPV?+?patients compared to HPV???patients (HR?=?0.48; 95% CI?=?0.37–0.62, p?p?p?p?p?= 0.05).     

A systematic review and meta‐analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy

Objectives: This review examines the effectiveness of positron emission tomography (PET) in the detection of recurrent or persistent head and neck squamous cell carcinoma after radiotherapy or chemoradiotherapy. Design: A systematic review and meta‐analysis of trials of PET for detecting residual/recurrent head and neck squamous cell carcinoma treated by radiotherapy or chemoradiotherapy. Trials were quality assessed using the Quality Assessment of Diagnostic Accuracy Studies tool for assessing diagnostic accuracy studies. Quantitative data were extracted and a bivariate random effects model used to calculate pooled sensitivity and specificity. Setting: Tertiary referral head and neck centre. Participants: Prospective and retrospective studies, excluding reviews, which included patients with head and neck squamous cell carcinoma who had fluorodeoxyglucose PET in the post‐treatment phase following primary treatment by radiotherapy or chemoradiotherapy. Main outcomes measures: Quality assessment, sensitivity, specificity, false positive rates, false negative rates, positive and negative predictive values. Results: Twenty‐seven of 1871 identified studies were eligible for inclusion. The pooled sensitivity and specificity of PET for detecting residual or recurrent head and neck squamous cell carcinoma were 94% [95% confidence interval (CI), 87–97%] and 82% (95% CI, 76–86%) respectively. Positive and negative predictive values were 75% (95% CI, 68–82%), and 95% (95% CI, 92–97%) respectively. Sensitivity was greater for scans performed 10 weeks or more after treatment. Conclusions: Positron emission tomography is highly accurate in this role. However it is less sensitive early after treatment and has poor anatomical detail. PET may reduce the requirement for check endoscopies and planned neck dissections. A protocol for its use in post‐treatment surveillance is proposed.     

Transforming growth factor beta 1 genotype and p16 as prognostic factors in head and neck squamous cell carcinoma

Abstract Conclusion: Transforming growth factor β1 gene (TGFβ1) genotype is a potential p16 independent prognostic factor predicting response to chemoradiotherapy in head and neck squamous cell carcinoma (HNSCC). Objectives: Expression of p16 and epidermal growth factor receptor (EGFR) has been reported to be associated with survival in HNSCC. We have previously reported that genetic polymorphism of TGFβ1 is linked with survival in HNSCC patients who have undergone chemoradiotherapy. We evaluate here whether TGFB1 genotype can serve as a prognostic factor independent of tumor p16 and EGFR expression. Methods: Expression of p16 and EGFR was studied by immunohistochemistry in tumors from 130 HNSCC patients. Peripheral blood DNA was used to genotype 95 patients for single nucleotide polymorphism rs1800470 within the TGFβ1 gene. The minimum follow-up time was 31 months. Results: p16 overexpression was associated with an improved disease-free survival (hazard ratio (HR) = 0.39, 95% CI 0.19-0.78), whereas no evident association was observed between EGFR expression and disease-free survival (HR = 0.90, 95% CI 0.68-1.19). Among the 37 patients who had received chemoradiotherapy, TGFβ1 genotype was associated with disease-free (HR = 0.44, 95% CI 0.19-1.02) and overall survival (HR = 0.31, 95% CI 0.12-0.80) independent of tumor p16 expression.     

Presentation,course, and outcome of head and neck skin cancer in african americans: A case-control study

Background: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset data from these studies suggest that the course of head and neck skin cancer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African-American patients. Methods: Retrospective case-control study including 215 patients with skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanoma, and adnexal tumors) presenting to a tertiary care institution over a 9.5-year period. Cases were defined as African Americans with skin cancer, and the control group included white and Latin-American patients with skin cancer. Results: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was less common in African-American patients (44%) than the control group (76%; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often involved. In the head and neck region, the ratio of BCC to SCC (4:1) was similar among all groups. In contrast, in non–sun-exposed regions, the ratio was 1:8.5 for African-American patients compared with 1:1 for the control group (P < .001). The overall distribution of malignant melanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modality, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < .001), their disease-free interval was similar to the control group. Only the margin status was a significant predictor of disease-free survival by multivariate analysis, with a relative risk of 1.68 (95% CI: 1.58–18.24) Conclusions: Head and neck skin cancer is similar with regard to presentation and distribution in patients of all skin types. Moreover, in contrast to previous reports, the course of head and neck skin cancer may be less aggressive in African Americans, if appropriate treatment is provided. This report suggests that differences in skin cancer in African Americans reported in the literature reflect cancer occurring in non–sun-exposed regions.     

The increase in incidence of cancer of the tongue in the Nordic countries continues into the twenty-first century

Conclusions This study shows that heavy drinking is a risk factor for prolonged delay in presenting with head and neck cancer and for presenting with a large tumour in the head and neck region. Excessive smoking is only a risk factor for being diagnosed with a large tumour, although there is a weak association between smoking and prolonged diagnostic delay.

Objective It is reasonable to assume that prolonged delay in presenting with head and neck cancer is associated with an advanced stage of cancer at diagnosis. In this study we analysed the effects of drinking and smoking habits on diagnostic delay and the T stage of the tumour at diagnosis.

Material and methods A total of 427 patients with newly diagnosed head and neck carcinomas were eligible for this study. Of these, 306 (72%) actually participated: 134 (77%) with an oral tumour; 117 (69%) with a larynx tumour; and 55 (65%) with a pharynx tumour. Diagnostic delay was defined as a period of >30 days between the appearance of the first tumour-related symptoms and the first visit to a physician. T3–4 tumours were defined as advanced tumours. Drinking behaviour was classified into three types: light (0–2 drinks/day); moderate (3–4 drinks/day); and heavy (>4 drinks/day). Smoking habits were classified into 4 types: never; stopped; light (0–20 cigarettes/day); and heavy (>20 cigarettes/day).

Results Logistic regression showed that there were significantly more heavy than light drinkers [p=0.04; odds ratio (OR) 1.8; 95% CI 1.0–3.1] in the delay group than in the non-delay group. Light smokers showed a tendency towards prolonged delay (p=0.06; OR 2.2; 95% CI 1.0–5.0). Both heavy drinking (p=0.01; OR 2.0; 95% CI 1.2–3.6) and heavy smoking (p=0.03; OR 3.1; 95% CI 1.1–8.4) were risk factors for a patient to be diagnosed with a large tumour.     

Simultaneous radio‐ and chemotherapy for squamous cell carcinoma of the head and neck in daily clinical practice: 5 years experience in a University Hospital

Several randomized studies and meta‐analyses have shown that simultaneous radio‐ and chemotherapy prolongs survival in patients with unresectable squamous cell carcinoma of the head and neck as compared with conventional radiotherapy. We assessed the feasibility and effectiveness of simultaneous radiotherapy (35 × 2 Gy) and chemotherapy [cisplatinum 100 mg/m² or carboplatin (AUC 6) on days 1, 22 and 43] in daily clinical practice in a cohort of 87 patients treated at our institute between 1998 and 2002. Eighty patients completed radiotherapy according to schedule. Eighty patients received two courses of chemotherapy and 50 patients three courses. Nephrotoxity, bone marrow suppression and ototoxicity were the most frequent side‐effects. Median weight loss was 8.5%. Median survival was 15 months and 44% of the patients were alive at 2 years. Patients receiving three courses of chemotherapy had a better survival than patients receiving two or less courses. Treatment with simultaneous radio‐ and chemotherapy for advanced head and neck cancer is a demanding, but feasible treatment in daily clinical practice. Survival seems to be comparable with the results achieved in patients selected for clinical trials.     

The GNAS1 T393C Polymorphism Predicts Survival in Patients With Advanced Squamous Cell Carcinoma of the Larynx

Objectives/Hypothesis: In previous studies, we have demonstrated that the T‐allele of a specific single nucleotide polymorphism (SNP) in the Gαs gene (T393C) correlates with increased Gαs expression and hence apoptosis. The T‐allele was associated with a favorable outcome in a variety of human cancers, for example, carcinoma of the urinary bladder, kidney, colorectal, oro‐ and hypopharynx. Study Design: The prognostic value of the T393C SNP was retrospectively evaluated in an unselected series of patients treated with curative intent for laryngeal squamous cell carcinomas including all tumor stages with different therapeutic regimens. Methods: DNA analysis was performed using DNA from paraffin‐embedded tissue samples from 157 patients (142 men, 15 women) with a median follow‐up of 68 (3–143) months. The various genotypes were correlated with the overall survival. Results: Survival was significantly dependent on the T393C genotype in advanced American Joint Committee on Cancer (AJCC) stages (III–IV) with an apparent gene‐dose effect (P = .0437). Five‐year survival rates were 76% for TT, 49% for TC, and 43.5% for CC. In multivariate analysis including age at diagnosis, AJCC stage, grade, gender, and T393C genotypes, patients with CC genotype displayed a higher risk for death with a hazard ratio of 2.59 (95% confidence interval: 1.01–6.64, P = .047) compared with the reference group consisting of T393 homozygous individuals. Conclusions: The T393C SNP is a prognostic marker that could help to identify high risk patients suffering from head and neck cancer.     

Neoangiogenesis and squamous cell carcinoma of the tongue

A tumour can only successfully propagate if it develops its own blood supply. Human cancers show a great propensity for stimulating neoangiogenesis through a variety of mechanisms. The present study investigates the relationship between neoangiogenesis, metastasis and survival in 51 patients with tongue cancer resected surgically, 26 of whom had lymph node metastases treated by radical neck dissection. The vessels were immunolabelled for CD34. Two parameters were studied: the vessel count/mm-₂ (VC) and the vessel count corrected for the relative proportions of carcinoma and stroma (VV). The data were analysed by uni variate and multivariate methods. The median VC was 35 and the VV was 103. Patients with neck node metastases tended to have a lower VV (93) than those with no metastases (114) (P = 0.0489). The tumour specific survival of the whole groups of patients was 59% (95% confidence intervals, 37–74%) and not surprisingly the patients with neck node metastases had a poorer survival than those without neck node metastases (,P = 0.0083). Cox’s proportional hazards model demon strated that patients with a low VC index tended to have a good prognosis (P = 0.0234). Previous studies of neoangiogenesis in head and neck squamous carcinoma have been limited and the present investigation suggests that VV is associated with metastases, and that VC may be an indicator of prognosis.