Treatment results of patients with a squamous cell carcinoma of the buccal mucosa

The purpose of this study was to evaluate outcome and value of follow-up of squamous cell carcinoma (SCC) of the buccal mucosa in patients treated at the Radboud University Nijmegen Medical Centre, The Netherlands. A longitudinal cohort study was performed involving 32 patients treated with curative intent (surgery on indication followed by radiotherapy) for SCC of the buccal mucosa from 1987 to 2002, with a minimum follow-up of three years. The prognosis of SCC of the buccal mucosa is comparable to other sites of the oral cavity. The success rate of therapy for a local and/or regional recurrence is very limited. Patients with a second primary tumour (SPT) can be cured if the tumour is detected in an early stage. Routine follow-up used to detect local recurrence or SPT has almost no value after five years and seems of limited value after three years.     

颊黏膜鳞癌的临床研究现状

颊黏膜癌以手术、放化疗、靶向治疗、免疫治疗等综合治疗为主,治疗现状不容乐观。通过整理国内外颊黏膜癌相关研究,对颊黏膜癌的诊断、淋巴结转移规律、治疗现状做一综述,为临床工作提供参考。     

VX2-induced rabbit buccal carcinoma: A potential cancer model for human buccal mucosa squamous cell carcinoma

The buccal mucosa is the site at highest risk of contracting malignancy in habitual betel-quid chewers who expose the buccal mucosa to high doses of carcinogens. Of all oral squamous cell carcinomas (SCCs), those of the buccal mucosa are most associated with the poorest prognoses. Therefore, an animal model would be helpful to evaluate new treatment modalities for buccal SCC. We evaluated whether the VX2 rabbit cancer model could be employed as a cancer model for human buccal SCC. Ten adult male, New Zealand White outbred rabbits were randomly divided into two groups A (n = 2) and B (n = 8). A 0.5 ml VX2 tumor cell suspension containing approximately 40 × 10⁶ vital cells was injected intramuscularly into the right hind paw of the two rabbits of group A. Four weeks later, moderately to poorly differentiated hind paw SCCs were apparent in both rabbits of group A. No abdominal organ metastases, but multiple pulmonary metastases, were found in both animals. Fresh solid tumor pieces (about 5 × 5 mm) obtained from group A animals were subsequently inserted into the surgically created spaces of the left cheeks of the eight rabbits of group B. Ulcerated buccal tumors (moderately to poorly differentiated SCCs) were found in all eight animals 6 weeks later. No internal organ metastases were noted in any of the eight rabbits, but a total of 11 with an average of 2.75 cervical lymph node metastases were found in four of the eight animals. Mandibular bone and tooth pulp invasion by cancer cells was also noted in one animal. In conclusion, our findings indicated that VX2-induced rabbit buccal carcinomas could be a potential cancer model for human buccal mucosa squamous cell carcinoma.     

Radiotherapy of carcinoma of the buccal mucosa

A retrospective study of 399 cases of buccal cancer, presenting to the Tata Memorial Hospital, Bombay, during January to December 1984 was undertaken to define the efficacy of various treatment modalities in different clinical stages. Analysis of treatment technique and response was carried out in 185 cases that completed adequate therapy. Sixty percent of patients with stage I and II disease (21/35) received radiation therapy alone as the primary modality of treatment. Patients (150) with stage III or IV disease received palliative irradiation (57 cases), radical surgery (54 cases), or a combination of both (39 cases). The 2-year disease-free survival (DFS) rates were 48% for radiotherapy and 46% for surgery in the early stages and 5% and 33%, respectively, for advanced stages. Radiotherapy with a modified technique is recommended for the early-stage cancers and preoperative irradiation with adjuvant chemotherapy or hyperthermia for the advanced stages.     

Univariate and multivariate analysis of prognostic significance of betel quid chewing in squamous cell carcinoma of buccal mucosa in Taiwan

BACKGROUND AND OBJECTIVES: While betel quid (BQ) chewing is clearly the most avoidable risk factor of squamous cell carcinoma of buccal mucosa (BMSCC), little is known about the influence of this habit on the prognosis of BMSCC. METHODS: We surveyed 280 patients with BMSCC who were treated during an 8-year period in a cohort study to assess the independent predictive value of pretreatment BQ chewing habit on the prognosis by univariate and multivariate analysis. RESULTS: We found by univariate analysis that sex, age, clinical stage, smoking, and BQ chewing significantly affected the patients' prognosis and only age, clinical stage, and BQ chewing had significant influence on prognosis by multivariate analysis (P < 0.05). Further analysis revealed that the prognostic effect of BQ chewing changed in a dose- and time-dependent manner. The risk of death was 31.4-fold higher in heavy user (duration >30 years, daily consumption >30 quids, age of start <20 years old) when compared to those who chewed BQ to a milder degree (duration <10 years, daily consumption <15 quids, age of start > or =20 years old ) (P < 0.001). CONCLUSIONS: Pretreatment BQ chewing habit worsens the prognosis of BMSCC in Taiwan. BQ chewing is a prognostic indicator that can be used in conjunction with clinical staging to help plan the treatment for the patients.     

Evaluation of the role of radiotherapy in the management of carcinoma of the buccal mucosa

Carcinoma of the buccal mucosa is the commonest intraoral malignancy in south India. This article concerns the results of radiotherapy in cancer of the buccal mucosa. Radiotherapy was used as the first line of management in this series and surgery was reserved for failures even though very few patients opted for salvage surgery. Of the 234 evaluable patients, 42% survived disease-free at the end of 3 years with radiotherapy alone. Eighty-five percent of the patients with Stage I, 63% with Stage II, 41% with Stage III, and 15% with Stage IV disease survived disease-free at 3 years. With radium implant and small-volume beam-directed external radiotherapy, the survival rates were similar (62% versus 64%). The results of external radiation in advanced disease were dismal. Persistent disease after radiotherapy was a serious problem in advanced stages, especially in view of nonacceptance of salvage surgery by a significant proportion of patients. The most effective way of improving cure rates in cancer of the buccal mucosa seems to be early detection.     

Keratosis follicularis of the oral mucosa with oral squamous cell carcinoma

Darier's disease or keratosis follicularis is a genodermatosis which may involve the oral mucosa. Malignant degeneration is rare. We report the first case of the combined manifestation of oral keratosis follicularis and oral squamous cell carcinoma and discuss the possible involvement of ATP2A2 (located in 12q23-24.1) which encodes the sarco/endoplasmic reticulum Ca(2+)-ATP isoform 2 (SERCA2), in the pathogenesis.     

The role of viruses in squamous cell carcinoma of the oropharyngeal mucosa

The development of squamous cell carcinomas of the oropharyngeal mucosa may involve many factors, including viruses. This review examines the evidence that viruses could be involved in the etiology of oral cancer, and shows that the evidence for a role of different viruses varies from very weak to very persuasive. Papillomaviruses are probably involved in the etiology of some carcinomas, particularly those of the oropharynx, and some herpes viruses may be involved as well. On the other hand some viruses can cause cancer in experimental situations but not in humans. Thus the importance of viruses in oral cancer is not always clear and must be evaluated with care. Those viruses that are associated with the disease provide targets for therapy and for diagnostic assays.     

Multimodal treatment for squamous cell carcinoma of the esophagus: results with two different strategies

The prognosis of patients with esophageal cancer treated with esophagectomy alone is disappointing. To improve these results, the addition of chemotherapy and/or radiotherapy to surgery has been proposed. Since 1992, we have enrolled patients with locally-advanced squamous-cell esophageal carcinoma in two successive studies to evaluate the feasibility and efficacy of preoperative chemotherapy and concomitant chemotherapy plus radiotherapy. Between 1992 and 1994, 29 patients were treated with three courses of cisplatin 100 mg/m² on day 1, fluorouracil (5-Fu) (750 mg/m²/day) by continuous infusion days 1 through 5, and folinic acid (200 mg/m²/day) days 1 to 5. Cycles were repeated every 3 weeks. Since November 1996, 21 patients have been included in a 3-week intensive schedule with weekly cisplatin (30 mg/m² on days 1, 8 and 15) and continuous infusion of 5-Fu (300 mg/m², days 1 to 21) plus concurrent hyperfractionated radiotherapy (1.5 Gy twice daily, total dose of 45 Gy, for 3 weeks). In both studies, patients underwent esophagectomy 3 to 5 weeks after induction therapy. In the preoperative chemotherapy scheme, a clinical response was observed in 30% of patients and one patient had a pathological complete response (pCR). The resectability rate was 58%, and five patients (17%) died in the postoperative period. Median survival and 3-year survival rate were 10 months and 4%, respectively. In the chemoradiotherapy study, a clinical response was observed in 19 (90%) of patients. A complete resection was performed in 15 patients (71%) and 7 patients (43% of all resected tumors) had a pCR. There have been no treatment-related deaths. To date, the median survival and 3-year survival rate are 27 months and 41%, respectively. In the chemotherapy study, the most frequent acute high-grade (3 or 4) toxicities were mucositis, observed in 44% of cycles, while severe, esophagitis was detected in 66% of patients treated with chemoradiotherapy. In our experience, preoperative chemotherapy does not seems to improve the results obtained with esophagectomy alone; furthermore, this approach was related to a significant postoperative mortality. On the contrary, concomitant chemotherapy with hyperfractionated radiotherapy has demonstrated a high activity with an encouraging 3-year survival rate. In spite a high incidence of esophagitis, this schedule is feasible without increasing postoperatory risk.     

Good tumor control and survivals of squamous cell carcinoma of buccal mucosa treated with radical surgery with or without neck dissection in Taiwan

The aim was to analyze the survival and prognostic factors in 232 patients with squamous cell carcinoma of the buccal mucosa (BSCC) treated with radical surgery with or without neck dissection (ND). The 5-year survivals for local, locoregional control, overall, disease-free, and disease-specific were demonstrated. Pathologic nodal status was the independent risk factor for local and locoregional control. Both pathologic nodal status and cell differentiation were the significant prognostic factors of disease-free survival. For cT1N0, 11.1% had neck metastases. All were tumor depth of > or =6 mm. Our result showed a relatively better tumor control and survivals in BSCC with radical surgery with or without ND. The possible reason may be due to the benefit from widely surgical resection with ND and post-operative radiotherapy or concurrent chemoradiotherapy in those with risk factors. In treating early cT1N0, we suggest that elective ND is indicated only when tumor depth > or =6 mm.     

Neoadjuvant treatment for esophageal squamous cell carcinoma

Squamous cell carcinoma and adenocarcinoma are types of esophageal cancer, one of the most aggressive malignant diseases. Since both histological types present entirely different diseases with different epidemiology, pathogenesis and tumor biology, separate therapeutic strategies should be developed against each type. While surgical resection remains the dominant therapeutic intervention for patients with operable esophageal squamous cell carcinoma (ESCC), alternative strategies are actively sought to reduce the frequency of post-operative local or distant disease recurrence. Such strategies are particularly sought in the preoperative setting. Currently, the optimal management of resectable ESCC differs widely between Western and Asian countries (such as Japan). While Western countries focus on neoadjuvant or definitive chemoradiotherapy, neoadjuvant chemotherapy followed by surgery is the standard treatment in Japan. Importantly, each country and region has established its own therapeutic strategy from the results of local randomized control trials. This review discusses the current knowledge, available data and information regarding neoadjuvant treatment for operable ESCC.     

皮肤鳞状细胞癌的外科治疗

目的 探讨皮肤鳞状细胞癌的外科治疗方法及效果。方法 收集1981年12月至2011年12月鳞状细胞癌105例,其中手术治疗101例。切除病灶后,根据创面不同部位、大小、深度,选择任意皮瓣、肌皮瓣或皮片修复创面;创面位于面部及关节部位采用分区植皮方法。结果病灶切除后,移植皮片48例,任意皮瓣或肌皮瓣修复53例;随诊6个月以上85例,随诊5年以上52例,16例发生局部复发或远处转移,其中8例死亡,其余患者术区外形良好,局部无复发。结论 皮肤鳞状细胞癌早期发现行完整手术切除仍然是最佳的治疗手段,对手术缺损可以采用整形美容方法修复,实现患者的生存时间和生活质量的提高。     

Combined modality treatment of laryngeal squamous cell carcinoma

Squamous cell carcinoma of the larynx is a major public health concern; it causes substantial morbidity and mortality, and arises chiefly as a result of tobacco and alcohol consumption. Early stage disease is best treated with radiation or surgery alone, but for patients with more locally advanced squamous cell carcinoma of the larynx, combined modality treatment has been shown to benefit selected patients, particularly when cisplatin-based chemotherapy and concurrent radiation therapy are employed, with or without altered fractionated radiation therapy. Substantial laryngectomy-associated quality-of-life decrements can be avoided in selected, potentially resectable patients with organ-sparing approaches, without sacrificing survival. Recently, trials have addressed the role of targeted systemic agents to the epidermal growth factor receptor, and other targets are under investigation. The addition of induction chemotherapy to concurrent chemoradiotherapy is a promising treatment strategy that warrants further evaluation, but has not yet emerged as a standard of care; the toxicity of such regimens must be balanced with the potential benefits on a case-by-case basis, and functional outcomes are often quite variable. Treatment planning, management and follow-up are complex, and thus should ideally be performed in a comprehensive, multidisciplinary fashion, in a center accustomed to a high volume of such cases. Future research directions are described herein.