Neoadjuvant and adjuvant chemotherapy in the multidisciplinary treatment of oral cancer stage III or IV

We performed a retrospective analysis on the effect of initial induction chemotherapy with two courses of cisplatin (each course 120 mg/m² cisplatin on day 1, then 20 mg/m² bleomycin (alone) per day for 5 days with 4 weeks between courses) in 75 consecutive patients with advanced cancer of the oral cavity or lip. Further local therapy consisted of surgery or radiation, depending on tumour location. In 18 resected patients adjuvant chemotherapy was added. This consisted of carboplatin, 400 mg/m² on day 1 then ftorafur alone, 500 mg/m²/day for 30 consecutive days, repeated every month for 4 consecutive months.Among the patients treated in the neoadjuvant setting, complete response was observed in 10 out of 75 patients (13%), and partial response in a further 50 patients (67%) (partial plus complete rate 80%). Of all the patients, 43% in stage III and 26% in stage IV were long-term survivors. Improved survival was observed in surgical patients where adjuvant postoperative chemotherapy was added (P < 0.025).The main toxic effect was vomiting, observed in 71 patients. We noted a low rate of stomatitis (4%) and an important hearing loss (12%).Neoadjuvant and adjuvant cisplatin-based chemotherapy as part of a multidisciplinary approach have a high overall response rate and low toxicity, and should increase survival in cancer of the oral cavity or lip.     

Carcinoma of the tongue and floor of the mouth. Preliminary results of a multidisciplinary approach

Eighty-five patients (74 males, 11 females) with untreated squamous-cell carcinoma of the tongue (40 patients) and the floor of the mouth (45 patients) underwent a multidisciplinary treatment. Follow-up: 6-72 months (median 52 months). T1-4N0M0 lesions (tongue; 32 patients; floor of mouth, 32 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with CMF (cyclophosphamide, methotrexate, fluorouracil) (T1-2: 2 courses; T3-4: 3 courses). 15-20 days after the end of cryo-chemotherapy the patients underwent TCT (T1: 50 Gy to the tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy to the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor of mouth: 13) received the same cryotherapy and chemotherapy, followed by surgery (13 extended suprahyoid dissections, 8 conservative laterocervical dissections, 1 RND). The actuarial survival rate of patients with tongue tumours after 6 years was 81.4% (N0 87.1%; N+ 60.0%). Four months after treatment, 35 patients had reached complete remission (CR). The probability of remaining in CR for 6 years was 53.6% (N0 56.1%; N+ 50.0%). For tumours of the floor of the mouth the actuarial survival rate was 55.2% (N0 56.5%; N+ 48.6%). Four months after treatment, 38 patients had reached CR. The probability of remaining in CR for 6 years was 59.9% (N0 61.5%; N+ 59.3%). A controlled study is recommended in the light of these results and the conservative nature of the protocol.     

Second primary cancers in patients with carcinoma of the lip

The occurrence of second primary cancers in patients with lip cancer was evaluated in order to test certain etiologic hypotheses. All cases of lip cancer reported to the Finnish Cancer Registry in 1953-74 (3303 men, 320 women) were followed up for a second (or third) primary cancer through the files of the Registry either to death or to 31 December 1974 (a total of 25 510 person-years). The expected numbers of cases were calculated on the basis of the incidence rates specific for sex, age, time and residence (urban or rural) in Finland. A higher than expected risk of cancer was found among both urban and rural male lip cancer patients; among women the observed number of new primary cancers did not differ from that expected. A significant excess risk among males was noted for cancers of the lung and larynx (rural patients) and for non-melanomatous skin cancer in locations other than the head and neck (urban patients). The association of cancers of the lip, lung and larynx found earlier on a geographic level supports the hypothesis that tobacco smoking is a common risk factor in these cancers. The differences in the relative risks between urban and rural patients, however, suggest that the risk factors in lip cancer in urban areas might be partially different from those prevalent in the rural population. The results do not support the hypothesis that sunlight is an important risk factor in lip cancer.     

鼻牙槽骨塑形对单侧完全性唇腭裂患儿术后鼻外形的影响

目的：探讨术前鼻牙槽骨塑形矫治对单侧完全性唇腭裂患儿术后长期鼻外形美观与对称性的影响。方法：84例患儿按改良式旋转推进唇裂修复术实施手术。其中，经过术前鼻牙槽骨塑形矫治42例，未经术前鼻牙槽骨塑形矫治42例。均采用术后4～5a照片打分方式进行鼻外形评定，而后分组进行比较。采用SPSS10．0软件包进行配对样本t检验。结果：经过术前鼻牙槽骨塑形矫治和未经术前鼻牙槽骨塑形矫治患儿，术后4～5a鼻外形的美观与对称性平均得分分别为66．62±14．25和66．31±15．08，两者之间无显著统计学差异（P〉0．05）。结论：单纯术前应用鼻牙槽骨塑形矫治纠正单侧完全性唇腭裂患儿鼻畸形，而未对单侧唇裂鼻畸形形成的解剖学机制进行有效干预，手术后良好的鼻外形无法长期维持。     

新生儿完全性唇腭裂术前鼻撑和正畸治疗的临床观察

目的 观察新生儿完全性唇腭裂术前鼻撑和正畸治疗的效果。方法对38例完全性唇腭裂，通过模型测量矫治前后牙槽裂距的改变，观察治疗效果；用鼻外形的评价标准对术后患儿进行初步评价。结果经过108—152天的治疗，26例单侧完全性唇腭裂齿槽左右裂隙较矫治前平均缩小5．3mm，前后裂距较矫治前平均缩小3．5mm；鼻外形评价的优良率为76％。12例双侧完全性唇腭裂齿槽左侧裂隙平均缩小4．7mm，右侧裂隙平均缩小4．2mm，左右裂距平均扩大1．6mm，前后裂距平均缩小5．1mm，前牙槽突宽度平均增大1．2mm；鼻外形评价的优良率为66％。结论对完全性唇腭裂患者在新生儿期做术前鼻撑和正畸治疗，患儿易适应，有利鼻发育，可减小手术的难度，提高整复效果。     

Outcome of local failures after oral cancer – recurrence vs. second primary

J Oral Pathol Med (2010) 39 : 657–661 Background/objective: A high risk of new mucosal malignancies of the upper aerodigestive tract (UADT) is seen in patients successfully treated for oral cancer. The prognosis is unclear for these patients. A typical failure may be located at the site of the first tumor i.e. a local recurrence; or separately as a second primary tumor (SPT). It is unknown whether these two types of local failures have different prognosis. Study design: Longitudinal observational cohort study employing prospectively collected data over 25 years. Methods: The rate of local recurrences and UADT SPTs was analyzed in 151 patients previously treated for T1N0M0 oral squamous cell carcinoma. Survival after failure was compared between patients with local recurrence and local SPT. Results: All patients had a 5‐year cancer specific survival of 86.3%. Of the 151 patients, 20 had a local recurrence, and 16 had an UADT SPT. After a local failure, survival was median 17.2 months for local recurrence and 18.9 for UADT SPT (cancer specific). Time from primary tumor treatment to local recurrence was median 42 and months vs. 125 months for UADT SPTs. A similar linear pattern of presentation over time was seen for both tumor types. Conclusion: Outcome was poor after the date of the local failure. No difference in survival was seen whether the failure was a local recurrence or a second primary tumor. The similarity in survival and pattern of presentation suggests that these two entities may be biologically analogous.     

舌癌复发有关因素的探讨

为深入研究舌癌复发，根据１５２例舌癌患者，其中６１例复发病例的临床资料，对复发的原因进行单因素分析。结果表明：舌癌复发与病程、肿瘤表面最大直径、生长方式、ＴＮＭ分期及治疗手段有关，与病理分级和术后是否修复无关。肿瘤表面最大直径＞３ｃｍ，病程＞６个月，生长方式为浸润型，Ｔ３和Ｔ４期及未进行综合治疗的患者复发率明显增高（Ｐ＜０．０１）。作者还对舌癌复发的治疗和预防进行了初步探讨     

Changes in lip 1 year after modified Millard repair

The aim of this study was to observe changes in the lip 1 year after performing a modified Millard cleft lip repair, by comparing the preoperative and 1-year follow-up appearance of the lip. Twenty-three patients with a unilateral complete cleft were photographed by a standardized method before repair, 7 days after surgery and 12 months after surgery. Lips on the cleft side were measured and compared with the opposite side. Possible results were: equal, longer and shorter. There was no linear correlation between the preoperative and 1-year postoperative appearance of the lip, but there was a linear correlation in lip height between the 7-day and 12-month postoperative results. No matter how severe the initial deformity, primary repair of the cleft lip is crucial in maintaining labial symmetry 1 year after operation.     

Adjuvant management of locally advanced oral squamous cell carcinoma – real-world challenges and opportunities

Patients with locally advanced oral squamous cell cancer (LAOSCC) are treated with adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) following surgical ablation. This depends on the pathological risk factors and aims to reduce the risk of local recurrence and improve survival. Delivery of these aggressive treatments is, however, challenging particularly following major surgery. To inform the adaptations necessary to deliver gold-standard therapy, we aimed to describe real-world delivery of multimodality treatment in LAOSCC, in a UK population with high levels of disease incidence and low socioeconomic status. Patients with LAOSCC (T1-4 N1-3/T3-4 N0) who were treated between October 2014 and October 2016 and had a minimum follow up of 24 months were included. They were identified using the Somerset Cancer Register and data were collected through retrospective case note review. Approval was obtained from the audit departments at the relevant NHS institutions, and data were analysed using IBM SPSS Statistics for Windows version 24 (IBM Corp). The analysis included 129 patients with 82% having an initial performance status (PS) of 0-1. The most frequent change in PS was a one point drop (46%). Twenty of the 93 eligible patients (22%) underwent adjuvant CRT. A total of 37 (40%) began adjuvant CRT/RT within 42 days, and 79 (85%) within 56 days. A delay in initiating adjuvant therapy was associated with higher rates of complications and a longer postoperative hospital stay. Concordance between imaging and pathological nodal staging was poor (cK 0.223). PS frequently declines after complex surgical procedures and long postoperative recovery periods, leading to difficulties providing adjuvant treatments within the national guidance of 42 days. Frequent deviation from planned adjuvant therapies highlights the need for improved treatment strategies.     

Stability of nasal symmetry following primary cleft lip and nasal repair: five years of follow-up

Despite advances in cleft lip treatment, various levels of residual deformity remain after primary repair of cleft lip and palate. The aim of the current study was to compare the stability of short- and long-term postoperative nasal symmetry. This retrospective study included 100 consecutive non-syndromic patients with unilateral complete cleft lip who underwent primary cleft lip repair with follow-up of 5 years. Measurements taken from basal and frontal standard photograph views, obtained preoperatively (T1) and immediately (T2), 1 year (T3), and 5 years postoperative (T4), were analysed. Paired and independent t-tests were applied to assess the significance of differences and relationships, while the inter-class correlation coefficient was used to assess reliability; P < 0.05 was considered significant. The male to female ratio was 1:1; mean age at the time of surgery was 0.43 ± 0.25 years. All patients showed significant improvements following unilateral complete cleft lip repair. All variables measured at T3 revealed a significant relapse when compared to T2, except alar base position, which showed a constant mean across all postoperative follow-ups. Late relapse (T3–T4) was not significant for alar collapse, alar base position, or columellar angle (all P > 0.05). On the other hand, columellar height (P = 0.003), and nostril height (P = 0.038) and width (P = 0.007) showed significant improvements during the late relapse period. In conclusion, the majority of the relapse and changes following the nasal cleft repair occurred within the first postoperative year. However, nasal asymmetries tended to remain stable or reduced during the first 5 postoperative years.     

Wave technique for treatment of lower lip cancer

PurposeThis article reports the authors’ experience with treatment of lower lip cancer using the wave technique.Patients and methodsTwenty-one patients (16 males, 5 females) were treated using the wave technique between September 2009 and October 2010. Patients undergoing the procedure had tumors that were classified as either T1N0M0 or T2N0M0. Lateral defects less than 2 cm in size are generally treated with unilateral flaps, and median defects are closed with bilateral symmetric flaps. If the defect is paramedian and greater than 2 cm in width, two asymmetric flaps are used.ResultsNo recurrence was observed during a 6- to 32 months follow-up (mean 19 months). All patients showed excellent esthetic results with no microstomia.ConclusionsWe modified the straight lines of the staircase technique into round lines of the wave technique, resulting in an esthetic improvement. The goal of the broken lines and round lines is to create less visible scars. The wave technique can be used to close defects of up to two-thirds of the lower lip.     

Results of treatment of cancer of the lip

A study was carried out in Sancti Spiritus Province in the 1984-1986 period about the results of the treatment of lip cancer. Male patients were the most affected by lip cancer (CIE 8-140) in our series. The place of the tumor was predominantly the lower lip (p less than or equal to 0.001). Surgical treatment was used in 96.8% of the cases and the cuneiform (wedge-shaped) exeresis was the most commonly used method in the early stages of the disease (T1 y T2). Casta?ón keloplasty was the reconstructive procedure used in 18.7% of the patients. Local sepsis was present in 31.2% of the patients undergoing surgery, occurring most frequently in upper lip tumors.     

The effectiveness of palliative radiotherapy for bone metastases from head and neck cancer

To evaluate the efficacy of radiation therapy for pain relief of bone metastases from head and neck cancer, a total of 22 patients with head and neck cancer with 30 metastatic bone lesions treated by radiation therapy at the Cancer Institute Hospital were analyzed. These patients were given a dose of 20 to 50 Gy in 10 to 25 fractions using liniac X-ray or electron beam and were divided into two groups. Group A consisted of 10 patients with tongue cancer (tongue cancer group), and group B consisted of 12 patients other than with tongue cancer (non-tongue cancer group). In group A, of the 6 metastatic lesions treated with over 30 Gy, 17% achieved CR (complete pain relief for more than 3 months), 33% showed PR (over 50% extent pain relief), and 50% NC. While, in group B, of the 17 lesions 35% showed Cr, 53% PR and 12% NC. There was a significant difference in the response rate (50% vs 88%, P<0.01) of pain relief between the osseous metastases from tongue cancer group and the non-tongue cancer group, although further prospective studies are necessary to elucidate the radiosensitivity of bone metastases in terms of the histologic difference in head and neck cancer patients.     

单侧完全性唇裂修复术同期矫正鼻畸形疗效观察

目的探讨婴幼儿单侧完全性唇裂I期修复术同期矫正鼻畸形的手术方法、可行性及其疗效。方法对5l例单侧完全性唇裂患儿采用Millard I或Ⅱ式手术方法修复唇裂,同期对其鼻畸形进行初步矫正,包括：恢复患侧鼻翼脚的水平高度,使之与健侧对称;重建患侧鼻底形态;延长患侧的鼻小柱长度;恢复患侧鼻嵴和鼻孔大小;鼻外形均得到改善。结果所有患儿均随访36～48个月,患侧鼻翼外侧脚上提内移,鼻小柱变长。所有患儿均未明昆增加术后瘢痕,随访期间均未出现患侧鼻翼发育障碍所致畸形加重。结论单侧完全性唇裂患儿均伴有较严晕的鼻畸形,在I期唇裂修复术同期矫正鼻畸形可以在不增加附加切口的情况下,获得更佳的畸形矫正疗效,患儿术后鼻部的美观和对称性可得到进一步改善,对患侧鼻部的发育未见明显影响。     

An analysis of distant metastasis cases from HPV-associated oropharyngeal squamous cell carcinoma

Although mostly associated with good survival outcomes, some patients with HPV-positive oropharyngeal squamous cell carcinoma develop distant metastasis and face dire prognosis. The aim of this study was to analyze distant metastatic patients in regards to survival, clinical staging, therapy approach and p16/HPV status.This retrospective single-centre study assessed patients with HPV-associated oropharyngeal cancer with distant metastasis treated in a tertiary referral center from 2005 to 2019. Overall- (OS) and survival after diagnosis of distant metastasis (OMS), clinical staging and different therapy approaches were assessed. Moreover, the overall mortality was assessed, as well as the association of different therapy approaches and p16/HPV status with the survival outcome.Out of 211 patients with HPV-associated oropharyngeal cancer that were treated in the study period, 15 developed distant metastases (7.1%). Median OS and OMS of the total group were 11 months (range 0.1–32 months) and 3 months (range 0.1–21 months), respectively. The overall mortality rate was 53.3% (n = 8). Significantly better outcome was present in patients treated with primary chemoradiotherapy (median OS 17 months vs. not reached, p = .03, median OMS 8 months vs not reached, p = .05). The OMS was significantly better in patients treated with chemotherapy initially after diagnosis (mean OMS 21 months vs 4 months; P = .001). Surgical resection after initial diagnosis was associated with a significantly shorter OMS (median OMS 3 vs. 21 months, p = .005). Interestingly, postoperative adjuvant therapy was delayed in all of these cases due to surgical site complications.Systemic treatment after initial diagnosis may be beneficial in clinical outcome of HPV associated distant metastases. Furthermore, surgical site complications should be treated with immediate care in order to avoid delay of adjuvant therapy. Further studies are warranted for validation of our results.     

Characterization of mast cell subpopulations in lip cancer

BACKGROUND: Lip squamous cell carcinoma (SCC) is the most common form of oral cancer. Human mast cells (MCs), which are increased in lip SCC, are classified by their protease content in tryptase-positive (MC(T)) and tryptase/chymase-positive (MC(TC)). MC proteases are associated with tumor progression and angiogenesis. The aim of this study was to quantify and characterize MC subpopulations in lip SCC. METHODS: Serial sections from lip SCC (n = 21) and normal lip vermilion (n = 8) biopsies were stained immunohistochemically for tryptase and enzymehistochemically for chymase to determine MC subpopulation density and distribution. RESULTS: MC(T) and MC(TC) were increased in lip SCC when compared with normal lip (P < 0.0001), where MC(T) predominated over MC(TC) (P < 0.01). In lip SCC neither subpopulation predominated. Regarding distribution, MC(T) were higher than MC(TC) at the intratumoral stroma, whereas MC(TC) were higher than MC(T) at the peritumoral stroma (P < 0.01). CONCLUSIONS: The results suggest that MC subpopulations may contribute to lip SCC progression. While intratumoral MC(T) may stimulate angiogenesis, peritumoral MC(TC) may promote extracellular matrix degradation and tumor progression at the invasion front.     

双侧完全性唇腭裂新生儿进行鼻-齿槽塑形治疗的临床研究

目的观察鼻-齿槽塑形治疗(presurgical nasal-alveolar molding,PNAM)对双侧完全性唇腭裂婴儿的临床疗效。方法对20例出生10天~3个月的双侧完全性唇腭裂新生儿进行鼻-齿槽的整形,测量治疗前后的双侧上唇裂隙宽度、前鼻突到唇裂距离、鼻小柱长度及唇裂交角,并用SPSS21.0软件进行统计分析。结果经过3~4个月的PNAM治疗后,双侧上唇裂隙宽度、前鼻突到唇裂距离明显减小,鼻小柱长度明显增加,均有统计学意义;唇裂交角增大,但无统计学意义。鼻外形左右基本对称,鼻翼外形恢复不明显,鼻小柱位于面部正中位置。结论 PNAM塑形治疗能有效减少双侧完全性唇腭裂婴儿的上唇裂隙宽度,压低前鼻突,伸长鼻小柱,改善鼻外观,降低手术难度。     

Evaluation of primary dentition in cleft lip and palate children with and without natal/neonatal teeth.

OBJECTIVE: Natal/neonatal teeth are very common in children with complete unilateral and bilateral cleft lip and palate. The extraction of these teeth is the usual treatment in the Hospital for Rehabilitation of Craniofacial Anomalies. The objective of this study was to verify whether these teeth could be of the normal complement or whether they were supernumerary. DESIGN: The primary dentition of children with cleft lip and palate with and without natal/neonatal teeth was compared at the Hospital for Rehabilitation of Craniofacial Anomalies. Subjects: The sample consisted of 55 children with complete unilateral and bilateral cleft lip and palate with natal/neonatal teeth and 54 without. RESULTS: No positive association between these groups and missing lateral incisor or supernumerary or complete dentition was found. CONCLUSION: The extraction of the natal/neonatal teeth did not alter the final complement of primary teeth, and these teeth could be the lateral incisor or supernumerary.     

A double blind randomised trial of IIb or not IIb neck dissections on electromyography, clinical examination, and questionnaire-based outcomes: a feasibility study

The aim of this double-blind randomised controlled trial was to evaluate the feasibility of a study to compare differences using electromyographic (EMG) or nerve conduction studies (NCS), questionnaires completed by patients, and range of movement, after selective supraomohyoid neck dissection in patients with and without level IIb for node-negative oral cancer. Between January 2006 and July 2008 we recruited 57 previously untreated consecutive patients with node-negative T1 or T2 squamous cell carcinomas (SCC) of the anterior two-thirds of the tongue and floor of the mouth. Thirty-eight patients were randomised (32 unilateral and 6 bilateral dissections) into two groups. Preoperatively and at 6 weeks postoperatively we collected EMG or NCS data on trapezius muscle activity (primary outcome), the University of Washington quality of life scale (UWQoLv4), the neck dissection impairment index (NDII), and range of movement. At 6 months data on range of movement and data from the questionnaires were obtained. There was a greater mean fall in trapezius M-response amplitude for those who had IIb dissected, which suggested that inclusion of this level caused additional morbidity. However, it was not significant for patients who had unilateral dissections or for all necks combined. Changes in M-amplitude from baseline to 6 weeks, and from baseline to 6 months were strongly associated with changes in the shoulder domain of the UWQoL and the NDII, but were less strong for change in range of movement. This feasibility study has shown that a randomised controlled trial (RCT) is achievable. The combination of EMG or NCS with questionnaire data preoperatively and to 6 weeks would suffice and would simplify a new study design.     

Effect of CO2 fractional laser on the early control of scar post-secondary repair in patients with a cleft lip

目的 观察比较CO₂点阵激光早期控制唇裂术后二期整复术术区瘢痕的临床疗效。方法 治疗组为43例接受唇裂术后鼻唇畸形二期整复术的患者,早期采用CO₂点阵激光治疗,对照组为70例曾接受一期唇裂手术的患者,对两组6个月后的瘢痕恢复情况进行比较;分析术后距离激光开始治疗时间的长短,性别两因素对激光治疗瘢痕疗效的差异。结果 1）治疗组的疗效优于对照组（P<0.000 1）,治疗组中显效和有效所组成的总有效率达90.7%;2）男女疗效差异无统计学意义（P=0.487）,手术后1年内的患者,手术后距离开始瘢痕治疗的时间<3个月与≥3个月之间,疗效无明显统计学差异（P=0.055）。结论 CO₂点阵激光在唇裂二期整复术术后瘢痕的治疗中具有较为确切的疗效。且与患者的性别无明显相关性。手术后1年内的患者,术后距离开始瘢痕治疗的时间<3个月和≥3个月疗效无差异,因此在唇裂二期手术后的1年内早期对瘢痕进行干预可获得良好的效果。