Pesticides as risk factors for head and neck cancer: A review

Humans may be exposed to pesticides such as fungicides, herbicides, and insecticides, during occupational and non‐occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science, and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred and thirty‐two studies were identified. Thirty‐two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high‐quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure, and type of pesticide.     

头颈部肿瘤患者放射性龋相关性因素分析

目的 通过构建多元线性回归方程探讨放射性龋相关危险因素,为有效预防放射性龋提供依据。方法 收集166例头颈部肿瘤放射治疗后患者,记录其患龋情况（龋失补牙面数）及个人相关信息（包括年龄、性别、放射治疗的方式和剂量等）,并进行多元逐步回归分析。结果 放射性龋的危险因素依次为：菌斑指数、放射治疗的方式、放射治疗后时间和放射治疗的剂量。结论 增强头颈部肿瘤患者的口腔卫生保健意识,尽量采用适形调强放射治疗技术,在有效控制肿瘤的情况下尽可能降低头颈部的放射治疗剂量等措施可减少放射性龋的发生。     

Short- and long-term mortality and causes of death after reconstruction of cancers of the head and neck with free flaps

The use of free flaps to reconstruct cancers of the head and neck is accompanied by appreciable postoperative morbidity and high long-term mortality, but the causes of death and the impact of postoperative complications on survival have not been well studied. We have therefore analysed retrospectively the causes of death and survival of 146 such patients operated on between 2008 and 2016 of whom a total of 62 (43%) had died by the end of 2016. The cause of death was the primary disease in 45 of the 62. The median survival of those who died with the primary cancer as the cause of death did not differ from that of those who died of other causes. In a multivariate Cox model indicators of five-year mortality were male sex, low body mass index (BMI), American Society of Anesthesiologists (ASA) grade more than II, and late medical complications. Neither the size of the tumour nor any operative factors were independent risks for five-year mortality. Ten patients died within six months of operation, all of whom had higher postoperative C-reactive protein concentrations than those who survived for more than six months. The cause of death of most patients who died after free flap operations for head and neck cancer was the primary diagnosis. According to these results, patient-related factors (male sex, ASA grade more than II, low BMI, and low albumin concentration) have an important role in long-term survival, which highlights the importance of careful selection of patients for operative treatment.     

516例头颈部恶性肿瘤根治术后谵妄危险因素分析

目的评估头颈部恶性肿瘤根治术后谵妄的危险因素,为临床制定术后谵妄防治的应对措施提供依据。 方法本研究为回顾性队列研究,纳入2018年10月1日至2021年10月1日于徐州中心医院和上海交通大学医学院附属第九人民医院口腔颌面外科接受头颈恶性肿瘤手术的患者共516例,其中男328例、女188例。对相关危险因素和生命体征进行了回顾和收集。依据谵妄评估量表,将患者分为谵妄组（65例,男44例、女21例）和非谵妄组（451例,男284例、女167例）。采用单变量和多变量Logistic回归分析进行统计学处理。 结果在本项研究中,头颈部恶性肿瘤根治术后谵妄发生率为12.2%（65/516）。组间单因素分析结果显示,年龄（Z = 4.62,P<0.001）、吸烟史（χ² = 5.46,P = 0.019）、酗酒史（χ² = 5.74,P = 0.017）、手术时间（Z = 4.50,P<0.001）、气管切开（χ² = 14.26,P<0.001）、输血（χ² = 22.87,P<0.001）、游离皮瓣移植（χ² = 23.65,P<0.001）、重症监护时间（Z = 2.20,P = 0.028）、术后疼痛VAS值（Z = 3.64,P<0.001）、术后睡眠障碍（χ² = 21.19,P<0.001）、术后发热（χ² = 28.95,P<0.001）与术后谵妄相关。多因素Logistic回归分析结果显示,与谵妄相关的危险因素包括年龄（OR = 1.05,95%CI：1.02 ~ 1.08,P<0.001）、输血（OR = 2.64,95%CI：1.38 ~ 5.03,P = 0.003）、气管切开（OR = 4.02,95%CI：1.61 ~ 10.07,P = 0.003）、术后睡眠障碍（OR = 6.64,95%CI：3.43 ~ 12.84,P<0.001）、发热（OR = 3.28,95%CI：1.39 ~ 7.72,P = 0.007）和术后疼痛视觉模拟评分（VAS）值（OR = 1.42,95%CI：1.17 ~ 1.71,P<0.001）。 结论本研究确定了年龄、是否输血、气管切开、术后睡眠障碍、发热及术后疼痛是头颈部恶性肿瘤根治术后患谵妄的独立危险因素,可采取一定措施,同时提高围手术期的疼痛控制可能有助于预防谵妄的发生。     

TRACHY score: a simple and effective guide to management of the airway in head and neck cancer

Our aim was to provide a simple and effective scoring system to guide decision making in management of the airway. We retrospectively reviewed the casenotes of all patients diagnosed with head and neck cancer and who were treated by resection with primary flap reconstruction. Those factors that were significant (p< 0.05) were analysed by logistic regression to establish their weighting. A total of 149 patients were included, 67 of whom (45%) were managed with endotracheal tubes, and 82 with tracheostomy (55%), of which eight were unplanned and late. From this we produced a score based on: T (T staging), R (Reconstruction), A (Anatomy of tumour), C (Coexisting conditions), H (History of previous treatment for head and neck cancer), Y (lateralitY- bilateral neck dissection). A score of 4 gave a sensitivity of 91.4%, a positive predictive value of 90.9%, a specificity of 90.8% and a negative predictive value of 88.2%. We applied this score to the patients, and it gave a mean score of: 2.1 (intubated), 5.7 (primary tracheostomy), and 4.6 (late tracheostomy). This is the largest published study to our knowledge of tracheostomies in head and neck cancer flap reconstructions that presents a scoring system for management of the airway. This scoring system can appropriately predict those patients who do not need tracheostomy and can act as a reliable screening tool in preoperative planning of the airway. It could aid management, and reduce the incidence of postoperative tracheostomies, with the potential that patients could be managed more safely, with reduced morbidity and mortality.     

Tissue microarray – a high-throughput molecular analysis in head and neck cancer

With the identification of a number of novel markers having diagnostic, prognostic, and therapeutic significance, the application of tissue microarray (TMA) has become a valuable tool for validating candidate markers in cancer research. The TMA is a high-throughput technique, which allows large-scale analyses of hundreds of archival clinical tissue samples using the 'array' approach. This paper highlights briefly its robust technology, technical aspects of its construction, and the validity of the TMA results for oral pathology diagnostics by reviewing data from recent literature particularly with reference to head and neck cancer.     

Dietary and nutritional needs of patients after therapy for head and neck cancer

BackgroundThe number of cancer survivors in the general population is increasing. Oral and dental status affects patients' quality of life and oral function, which, in turn, may affect nutritional intake and general health. The authors review the importance of oral health and the role of the oral health care provider in supporting dietary intake and providing nutritional guidance.MethodsThe authors provide a brief review of oral complications of therapy and nutritional guidelines for patients with head and neck cancer.ResultsOral adverse effects of head and neck cancer treatment include salivary gland dysfunction, taste change, orofacial pain and mucosal sensitivity, oral infection, tissue defects and necrosis, trismus and fibrosis, progressive dental and periodontal disease, and problems with prosthesis function.ConclusionsManaging oral adverse effects of treatment may have an impact on dietary and nutritional intake, as well as on quality of life. Dietary modifications may be needed because of the patient's oral function and may include modification of food texture and flavor, as well as the use of dietary supplements.Clinical ImplicationsAs part of the patient's health care team, dental care professionals should be aware of the oral adverse effects of cancer therapy, as well as their role in recognizing and treating the resulting oral conditions. In addition, they should provide guidance to patients to support their oral dietary and nutritional intake.     

Head and neck squamous cell carcinoma in non‐smoking and non‐drinking patients with multiple tumors: etiologic significance of p53 and Ki‐67 in non‐tumorous epithelium

Background: Non‐smoking and non‐drinking patients with head and neck squamous cell carcinoma have different clinical characteristics than their smoking and drinking counterparts. They are predominantly older female patients with oral cavity tumors, however, both groups show the same percentage of second primary tumors. Expression of tumor suppressor gene p53 and proliferation marker Ki‐67 in mucosal epithelial cells was analyzed to study whether biomarker expression is associated with a history of smoking and drinking and with single and multiple tumors. Methods: Non‐smoking and non‐drinking patients with multiple (n = 18) and single tumors (n = 15), smoking and drinking patients with multiple (n = 15) and single tumors (n = 14) were selected. For all groups, p53 and Ki‐67 expression patterns in non‐tumorous (tumor‐adjacent) mucosa including positivity of dispersed single cells and clusters for p53 and for suprabasal expression of Ki‐67 were immunohistochemically analyzed and compared. Results: p53 expression was significantly higher in users of tobacco and alcohol than in non‐users. Ki‐67 expression was not affected by tobacco and alcohol usage. Both Ki‐67 and p53 were similarly expressed in the groups with single and multiple tumors and hence not significantly related to the number of tumors. Conclusions: Non‐smoking and non‐drinking patients with squamous cell carcinoma have the same risk for developing multiple tumors as their smoking and drinking counterparts. As this occurs without an increased expression of p53 or Ki‐67, the significance of these proteins as biomarkers indicating pre‐malignant mucosal alterations is doubtful. Further research is needed to clarify this predisposition for developing multiple head and neck cancer.     

Study of surgical treatment for elderly patients with head and neck cancer

The aim of this study was to evaluate the clinical results of surgery for head and neck cancer (HNC) in elderly patients and to determine whether surgery for elderly HNC patients is safe and what types of surgery result in the most favourable outcomes for this age group. The cases of 637 elderly patients who were diagnosed with HNC and underwent surgical treatment were studied retrospectively. Patient demographic characteristics and treatment data were extracted from the appropriate patient records and analysed. Age did not significantly predict postoperative complications or death rates. Flap reconstruction surgery had no significant association with necrosis, haemorrhage, infection, need for rescue treatment, or length of intensive care unit stay. Age was not a risk factor for surgical treatment of HNC in the elderly patients. Flap reconstruction should not be considered riskier for elderly patients. The treatment choice for elderly patients with HNC should be based on medical assessments but not on age.     

Postoperative pulmonary complications following major head and neck cancer surgery

The primary aim of this observational study was to describe the incidence of postoperative pulmonary complications (PPCs) in 60 consecutive, surgically treated head and neck cancer patients requiring free flap reconstruction and tracheostomy, using both a prospective and a retrospective outcome measure. Secondary aims were to identify risk factors for PPC development, explore the effects of PPC on outcomes, and describe the provision of postoperative physiotherapy in this population. Postoperative pulmonary complications occurred in nine (15%) patients based on the Melbourne Group Scale and 27 (45%) patients based on Health Information Service coding data. The occurrence of a PPC was not statistically correlated with age, smoking history, comorbidities, operative time, or type of resection or free flap. Patients who developed a PPC, compared to those who did not, had a higher preoperative body mass index (P = 0.022) and were more likely to be sat out of bed earlier post-surgery (P = 0.038). Overall, patients required a median of 9.0 (interquartile range 7.0–11.0) physiotherapy sessions. Patients developing a PPC required significantly more physiotherapy sessions (P = 0.007) and additional days of supplemental oxygen (P = 0.022) as compared to those without a PPC, despite a similar hospital length of stay. In future, targeted physiotherapy interventions may reduce PPCs in this population.     

Dental implants for patients who have had radiation treatment for head and neck cancer

Implant therapy is no longer considered impossible for patients who have received radiation treatment. However, the risk of osteoradionecrosis and failed osseointegration are barriers to implant therapy for this population. This paper reviews the published literature on the effects of radiation on tissue, such as osteoradionecrosis, hyperbaric oxygen therapy, and evaluates implant therapy in patients who have received radiation treatment, focusing on treatment of the mandible. Recommendations for dentists planning implant therapy for patients who have had radiation treatments are presented.     

Salvage surgery in head and neck cancer

Salvage surgery after failed organ preservation treatment offers challenges for both the patient and the surgeon. The outcome is often uncertain and even today, 5‐year overall survival does not exceed 50 per cent. The chemoradiotherapy induced toxicity asks for meticulous discussion and planning in a multidisciplinary manner in a changing environment of increasing incidence of human papillomavirus induced oropharyngeal tumours, evolving surgical techniques and patient participation. Herein, we discuss the latest literature on salvage surgery and the need for identifying the proper prognosticators to ensure for an optimal treatment plan in potentially salvageable patients.     

Complications and outcome after free flap surgery for cancer of the head and neck

We retrospectively studied 136 patients who had free flap reconstruction for cancer of the head and neck at a single centre (2008–2015) to evaluate complications, assess factors associated with them, and analyse their impact on outcome. Preoperative and perioperative data, and surgical and medical complications were recorded, and the impact of the complications on duration of hospital stay and survival were assessed. A total of 86 (63%) patients had complications. Compared with those who did not, they had a higher rate of alcohol abuse (21/86, compared with 5/50, p = 0.039), longer operations (median (IQR) 565 (458–653 compared with 479 (418–556) minutes, p < 0.001), and greater intraoperative loss of blood (725 (400–1150) compared with 525 (300–800) ml, p = 0.042). Complications were more common in patients who had fibular flaps and T4 disease (22/86 compared with 4/50, p = 0.010; 47/80 compared with 16/47, p = 0.015, respectively). Those who had complications also stayed in hospital longer (median (IQR) 9 (7–12) compared with 15 (10–21) days, p < 0.001). Cumulative mortality was higher in patients with late complications (those that occurred after the fourth postoperative day) (61% compared with 36%, p = 0.004). In conclusion, complications in more than half the patients were related to alcohol abuse, a more complicated intraoperative course, and fibular flaps. Complications were associated with a longer hospital stay, and survival was higher in those who did not have late complications than in those who did.     

Hypothyroidism after radiotherapy of head and neck cancer

AimHypothyroidism is not commonly considered as a complication of radiotherapy to the head and neck region. The purpose of this retrospective study was to determine the frequency of thyroid dysfunction in patients after radiotherapy, to compare thyroid hormone levels in irradiated patients with Control group and to predict development of thyroid hypofunction in time.Material and methodThyroid function was measured by means of thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodthyronine (FT3) in 43 patients who had nonthyroid head–neck carcinomas treated by radiotherapy or radiotherapy in combination with other modalities. These data were compared with hormone levels of 40 Control group patients treated solely by surgery.ResultsHypothyroidism was found in 35% of irradiated patients. In comparison with Control group there were significant differences between TSH and FT4 levels, difference between FT3 levels was insignificant. A correlation between hormone levels and follow-up was detected.ConclusionOur results indicate that hypothyroidism is a frequent late side effect of radiotherapy to head and neck. Lifelong monitoring of thyroid function appears to be justified when radiotherapy is a part of treatment protocol.     

Human papillomavirus and cancerous diseases of the head and neck: a systematic review and meta‐analysis

The increasing incidence of head and neck cancer (HNSCC) highlights the need to better understand the role of human papillomavirus (HPV) in the development of these cancers. The aims of this study were to conduct a systematic review and a meta‐analysis concerning observational studies on the association between HPV infection and HNSCC and to quantify this association, thereby obtaining a reliable estimation of the risk of HPV infection in the development of head and neck cancer. Literature searches were performed using PubMed and Scopus databases. StatsDirect 2.7.8 program was used for the analysis. We found 15 case–control studies, 63 prevalence studies, and no cohort studies. The pooled odds ratio (OR) for all the included case–control studies resulted in a value of 1.63 (95% CI 1.27–2.09; P < 0.0001). The highest pooled OR resulted from the analysis of all the studies that examined HPV 16 genotype in association oral cavity (OR 5.36; 95% CI 1.4–20). The strong evidence of association between HPV infection and HNSCC highlights the importance of the introduction of specific tests in the cancer prevention practices to evaluate the presence of the virus, especially in the oral cavity, and the possibility of an extension of the vaccine anti‐HPV in the male population too.