819例口腔鳞癌病理临床分析

口腔粘膜鳞癌为口腔的常见恶性肿瘤,其发病率、性别、好发年龄及部位分布等在不同的国家和地区不尽相同。为了解天津地区口腔鳞癌的发病情况,对天津市第五中心医院1979．12～2002．7间全部口腔粘膜活检资料进行了分析。     

Occupational exposures and squamous cell carcinoma of the oral cavity, pharynx, larynx, and oesophagus: a case-control study in Sweden

OBJECTIVES: This community based case-referent study was initiated to investigate aetiological factors for squamous cell carcinoma of the upper gastrointestinal tract. METHODS: The study was based on all Swedish men aged 40-79 living in two regions of Sweden during 1988-90. Within that base, efforts were made to identify all incident cases of squamous cell carcinoma of the oral cavity, oropharynx and hypopharynx, larynx, and oesophagus. Referents were selected as a stratified (age, region) random sample of the base. The response was 90% among cases and 85% among referents. There were 545 cases and 641 referents in the final study group. The study subjects were interviewed about several lifestyle factors and a life history of occupations and work tasks. The exposure to 17 specific agents were coded by an occupational hygienist. The relative risk (RR) of cancer was calculated by logistic regression, standardising for age, geographical region, and alcohol and tobacco consumption. RESULTS: Exposure to asbestos was associated with an increased risk of laryngeal cancer, and a dose-response relation was present. The RR was 1.8 (95% confidence interval (95% CI) 1.1 to 3.0) in the highest exposure group. More than eight years of exposure to welding fumes was associated with an increased risk of pharyngeal cancer (RR 2.3 (1.1 to 4.7)), and laryngeal cancer (RR 2.0 (1.0 to 3.7)). There were indications of a dose-response for duration of exposure. Associations were also found for high exposure to polycyclic aromatic hydrocarbons (PAHs) and oesophageal cancer, RR 1.9 (1.1 to 3.2). Exposure to wood dust was associated with a decreased risk of cancer at the studied sites. CONCLUSIONS: Some of the present findings confirm known or suspected associations--such as asbestos and laryngeal cancer. The study indicates that welding may cause an increased risk of pharyngeal as well as laryngeal cancer. The findings corroborate an association between exposure to PAHs and oesophageal cancer.

 

     

Combination chemotherapy of squamous cell carcinoma of the bronchus with cisplatinum and bleomycin followed by radiotherapy: results of a pilot study.

Thirteen patients were entered into an uncontrolled pilot study to investigate the response to, and toxicity of, a combination of cisplatinum (20 mg/m2) and bleomycin (6 mg/m2) infused daily for 5 days and repeated every 21 days up to a maximum of 4 cycles, in the treatment of squamous cell carcinoma of the bronchus. This regimen was subsequently followed by a split course of local irradiation. All patients have been followed to death. Six patients showed a partial response to chemotherapy while 7 showed no response or progressive disease. The median survival was 5 months. The median survival of the responders was 15 months and that of the nonresponders 3 months. Two patients developed the syndrome of inappropriate antidiuretic hormone secretion from which one died. The longest survivor, who died 26 months after the commencement of chemotherapy, had severe mediastinal and pulmonary fibrosis.     

长链非编码RNA在口腔鳞状细胞癌中的研究进展

近年研究发现,多种长链非编码RNA(long non-coding RNA,lncRNA)参与了生物学过程且发挥了重要的调控功能,如胚胎发育、细胞周期调控、干细胞多能性分化、免疫监视等,其异常调节可导致各类疾病包括肿瘤的发生发展,对于多种恶性肿瘤的早期诊断、治疗和预后判断有非常重要的价值。但到目前为止,lncRNA在口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)中的研究报道还较少,本文将结合国内外最新报道对与OSCC相关的lncRNAs的表达及意义和调控机制作一综述,为OSCC的基因诊断和治疗提供新的思路。     

Results of radical radiotherapy for squamous cell carcinoma of the eyelid

Purpose: To analyze the results of radical radiotherapy by electron beams for squamous cell carcinoma (SCC) of the eyelid and to find the possible prognostic factors. Materials and Methods: Records of 38 patients with histologically confirmed SCC of the eyelid who underwent electron beam radiation therapy between 1964 and 2010 in our institution were retrospectively reviewed. Median tumor size was 15 mm (range, 3–40 mm). T stage was T1 in three, T2a in six, T2b in 14, and T3a in 15 patients. Four patients had nodal metastasis. Of the 38 patients, 14 had relapsed disease after prior treatment. Median radiation dose was 60.0 Gy (range, 45.0–70.4 Gy). Median follow-up was 72.5 months (range, 2.0–369 months). Results: 5-year local relapse-free, nodal relapse-free, distant metastasis-free and relapse-free rates for all patients were 71.8%, 77.5%, 90.6% and 58.0%, respectively. In seven patients, lymph node metastases occurred in 11 faciocervical regions. The 5-year overall survival was 79.5%. T stage and radiation dose expressed in EQD_{2 Gy} tended to have impacts on local control. Relapsed patients showed unfavorable local relapse-free rate, however this was without statistical significance. Of the 14 patients who died, 12 succumbed to concurrent diseases. Grade 3 or greater severe late morbidities (CTCAE ver4.0) were observed in nine patients. Due to the morbidities, two patients lost their vision. Conclusion: Radical radiotherapy for SCC of the eyelid yielded good results and could be a treatment option. Whether radiation-dose escalation could improve local control in advanced T stages and relapsed patients needs further study.     

血清鳞状细胞癌抗原及其变化对宫颈鳞状细胞癌新辅助化疗敏感性的预测价值

目的探讨血清鳞状细胞癌抗原(SCC-Ag)在宫颈鳞状细胞癌(SCC)新辅助化疗(NACT)前、后的变化,以及对宫颈SCC患者进行NACT敏感性的预测价值。 方法选择2009年1月至2017年1月,在山西医科大学第二医院妇产科进行手术治疗前接受NACT,并且术中切除组织病理学检查结果证实为宫颈SCC的68例患者为研究对象。对宫颈SCC患者的NACT疗效进行分析。采用配对t检验和配对χ²检验,分别对NACT前、后血清SCC-Ag值及其阳性率进行比较。采用受试者工作特征(ROC)曲线下面积(AUC)对NACT前血清SCC-Ag值及NACT前、后血清SCC-Ag值变化,对宫颈SCC的NACT疗效的预测价值进行分析。采用多因素非条件logistic回归分析,对宫颈SCC的NACT疗效影响因素进行分析。采用χ²检验或Fisher确切概率法,对宫颈SCC患者NACT前、后血清SCC-Ag阳性率及其临床病理特征的关系进行分析。采用成组t检验,对复发与未复发宫颈SCC患者接受NACT前血清SCC-Ag值进行比较。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》的要求,征得所有受试者知情同意,并签订临床研究知情同意书。 结果①宫颈SCC患者的NACT有效率为75.0%(51/68)。②本组68例宫颈SCC患者接受NACT后,血清SCC-Ag值及其阳性率分别为(2.9±1.6)ng/mL和45.6%(31/68),均分别显著低于接受NACT前的(5.1±1.7)ng/mL和91.2%(62/68),并且差异均有统计学意义(t＝7.991,P<0.001;χ²＝32.682,P<0.001)。③NACT前血清SCC-Ag值及NACT前、后血清SCC-Ag值变化值对于预测宫颈SCC患者NACT疗效的ROC-AUC分别为0.839(95%CI：0.717～0.965,P<0.001)与1.000(95%CI：1.000～1.000,P<0.001),最佳临界值分别为3.0、0.6 ng/mL。④对宫颈SCC患者NACT疗效影响因素进行多因素非条件logistic回归分析的结果显示,NACT前血清SCC-Ag值及NACT前、后血清SCC-Ag值变化值均为预测宫颈SCC患者NACT敏感性的独立影响因素(OR＝0.365,95%CI：0.224～0.608,P<0.001;OR＝0.984,95%CI：0.899～0.998,P<0.001)。⑤本研究68例宫颈SCC患者中,合并脉管转移者,其接受NACT前的血清SCC-Ag阳性率高于未合并脉管转移者,合并淋巴结转移者、脉管转移者及国际妇产科联盟(FIGO)临床分期为Ⅱ_A2期患者接受NACT后的血清SCC-Ag阳性率,均分别高于未合并淋巴结转移者、脉管转移者及Ⅰ_B2期患者,并且差异均有统计学意义(P＝0.007,P<0.001,P＝0.035,P<0.001)。⑥本组68例宫颈SCC患者中,13例发生复发,复发率为19.1%(13/68)。复发者接受NACT前的血清SCC-Ag值为(7.1±1.1)ng/mL,高于未复发者的(4.7±1.5)ng/mL,并且差异有统计学意义(t＝5.253,P<0.001)。 结论血清SCC-Ag值及其变化是否可作为预测宫颈SCC患者NACT敏感性的指标,以及预测宫颈SCC复发的指标,因本研究纳入样本量较小,尚待大样本、多中心、随机对照试验进一步研究、证实。     

新辅助化疗联合平消胶囊治疗口腔鳞状细胞癌的临床效果及microRNA的表达变化

目的探讨新辅助化疗联合平消胶囊在治疗口腔鳞状细胞癌的治疗效果及治疗前后microRNA表达水平的变化。方法收集我院98例口腔鳞状细胞癌患者作为研究对象,将其随机分为两组,分别为TPF(多西他赛+顺铂+5-氟尿嘧啶)化疗组和TPF化疗联合平消胶囊治疗组,统计口腔鳞状细胞癌患者在新辅助化疗后的临床有效率;另外,通过提取口腔鳞状细胞癌患者肿瘤组织中的RNA,分析14个与口腔鳞状细胞癌相关的microRNA的表达水平以及与口腔鳞状细胞癌的关系,并比较治疗前后相关microRNA的表达变化。结果 TPF和TPF联合平消胶囊的新辅助化疗的临床有效率分别为63.26%和81.63%。口腔鳞状细胞癌组织中的12个microRNA的表达水平与文献报道基本一致;通过新辅助化化疗后,尽管TPF组与TPF联合平消胶囊组的口腔鳞状细胞癌患者的microRNA表达水平有一定的差异,但两组均趋向于正常水平。结论通过TPF联合平消胶囊的新辅助化疗治疗口腔鳞状细胞癌的临床效果优于单一TPF的化疗;口腔鳞状细胞癌组织中相关的microRNA的表达上调与下调能为口腔鳞状细胞癌的预后判断提供重要的生化指标。     

Factors involved in the diagnosis of oral squamous cell carcinoma in Malaysia

The delay in the diagnosis of oral cancer has been variously reported as being contributed by the clinicians, patients or both. The purpose of this study was to evaluate the referral pattern of 65 patients eventually diagnosed as having oral squamous cell carcinoma. The results showed that 50% of the patients delayed seeking professional help for more than 3 months after being aware of the lesion. The majority of the patients consulted medical practitioners as the first source of help. The mean clinicians' and patients' delay were 10.3 weeks and 28.9 weeks respectively. Dental practitioners showed a tendency to refer more advanced lesions compared to the medical practitioners. The findings raise the concern that lack of patients' awareness, misdiagnosis by clinicians and late detection by dental practitioners prevail thus calling for urgent measures towards early detection of the disease.     

Sociodemographic differences in the incidence of oropharyngeal and oral cavity squamous cell cancers in New Zealand

Objective: To determine whether the incidence of oropharyngeal and oral cavity squamous cell cancers differs by subsite, age, gender, ethnicity and social deprivation. Methods: Using data from the New Zealand cancer registry, a retrospective review was undertaken of incident cases with a histological diagnosis of invasive squamous cell carcinoma (SCC) in the oral cavity or oropharynx. Results: During the period 1981–2010, rates of oropharyngeal cancers (OPC) and oral cavity cancers (OCC) were higher among males and increased with age. The rapid rise in male OPCs was observed in those aged 40–49, 50–59, 60–69 and ≥70 years old. Overall and by gender, Māori had higher OPC rates but lower OCC rates than European/other ethnicities, whereas the inverse was apparent among Pacific Peoples. An upward trend in OPC and OCC rates with increasing deprivation was observed both overall and by gender. Conclusions: The recent rapid rise in male oropharyngeal SCCs occurred primarily among those aged ≥40 years old. Implications: Given oropharyngeal SCCs are more strongly associated with human papillomaviruses (HPV) than OCCs, OPC prevention may be enhanced through HPV vaccination and public health awareness. Clinically, as HPV‐related OPCs have a better prognosis and response to radiotherapy, an improvement in survival rates can be predicted.     

Role of human papillomavirus in the pathogenesis of oral squamous cell carcinoma

Oral cancer is one of the most common cancers and it constitutes a major health problem particularly in developing countries. Oral squamous cell carcinoma (OSCC) represents the most frequent of all oral neoplasms. Several risk factors have been well characterized to be associated with OSCC with substantial evidences. While tobacco and alcohol are the primary risk factors for OSCC development, many epidemiological studies report a strong association with human papillomavirus (HPV) in a subset of OSCC. This article presents our current knowledge on the relationship between HPV and development of OSCC. HPVs are DNA viruses that specifically target the basal cells of the epithelial mucosa. Most experimental data are consistent with the hypothesis that HPV plays a causal role in oral carcinogenesis. Genotypes, such as HPV1 infect epidermal cells, whereas HPV6, 11, 16 and 18 infect epithelial cells of the oral cavity and other mucosal surfaces. Several studies have shown that there is an increased risk of head and neck cancer in the two major HPV 16 oncogenes E6 and E7 -positive patients. The presence of antibodies to HPV E6 and E7 proteins was found to be more associated with tumors of the oro-pharynx than of the oral cavity. However, HPV alone appears to be insufficient as the cause of OSCC but requires other co-factors. Although a viral association within a subset of OSCC has been shown, the molecular and histopathological characteristics of these tumors have yet to be clearly defined.     

饮茶、咖啡与口腔鳞状细胞癌发病关系的病例对照研究

目的 探讨经牛奶分层后饮茶、咖啡对口腔鳞状细胞癌（OSCC）发病的影响。方法 采用病例对照研究方法,收集2010年9月至2016年3月经病理确诊的OSCC新发病例593例和同期经性别、年龄频数匹配的医院体检人群及社区健康人群1 128例。应用非条件logistic回归计算咖啡、饮茶及其相关变量与OSCC发病风险的调整OR值及其95% CI,并进行相乘交互作用分析。采用相对超危险度比、归因比和交互作用指数等指标评价相加交互作用。结果 在总调查人群及饮和未饮用牛奶人群中,饮茶均可显著降低OSCC的发病风险,其调整OR值及95%CI分别为0.54（0.41～0.71）、0.47（0.31～0.71）和0.57（0.40～0.81）。进一步分析发现,开始饮茶年龄≥25岁、饮茶浓度适中、饮温茶、饮用绿茶和乌龙茶在以上3个人群中也均有保护作用,且在饮用牛奶人群中各因素的保护作用更明显。此外,随着每日饮茶量的增加、饮茶年限的延长,OSCC发病风险也随之降低（趋势检验均P<0.05）,但未见饮咖啡与OSCC的发病存在关联。饮茶与饮牛奶之间存在相乘交互作用（OR=0.52,95%CI：0.37～0.71）,但未发现两者存在相加交互作用;饮咖啡与饮用牛奶之间不存在相乘及相加交互作用。结论 饮茶是OSCC发病的保护因素,且饮茶与牛奶间存在交互作用,故适量饮茶、增加牛奶的摄入可一定程度降低OSCC的发病风险。     

口腔鳞状细胞癌中ErbB4和Bcl-2的表达及临床意义

目的:探讨表皮生长因子受体(ErbB4)和B细胞淋巴瘤\白细胞病基因-2(Bcl-2)在口腔鳞状细胞癌中的表达及意义。方法:应用免疫组织化学SP方法检测了10例正常口腔黏膜组织和58例口腔鳞癌中的ErbB4和Bcl-2的表达。结果:ErbB4在正常口腔黏膜组织中未见表达,在口腔鳞癌中表达较强,阳性率为58.6%,与临床分期、病理分级、淋巴结转移有相关性(P0.05)。Bcl-2在正常口腔黏膜组织中未见表达,与临床分期、淋巴结转移无相关性(P0.05),而与病理分级有关(P0.05)。相关分析显示口腔鳞癌中ErbB4的表达与Bcl-2呈正相关(P0.05)。结论:ErbB4和Bcl-2的表达可作为评估和判断口腔鳞癌恶性潜能的重要参考指标。     

Polymorphism in DNA repair genes and oral squamous cell carcinoma in Thailand

DNA repair capacity is essential in maintaining cellular functions and homeostasis. However, the repair capacity can be altered based on DNA sequence variations in DNA repair genes and thus may cause cancer susceptibility. We investigated associations between polymorphisms in DNA repair genes and oral squamous cell carcinoma (OSCC) in a Thai population. Nine known single nucleotide polymorphisms (SNPs) in five common DNA repair genes were investigated: XRCC1 (Arg194Trp and Arg399Gln); XRCC3 (Thr241Met); XPC (PAT and Lys939Gln); XPD (exon 6, and Lys751Gln); and MGMT (Trp65Cys and Leu84Phe). We studied 106 cases and 164 healthy controls that were frequency-matched by age (+/-5 years), gender, and cigarette smoking and alcohol drinking habits. The genotype assays were performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The R version 2.0.1 statistical software was applied for statistical analysis of association. Based on multivariate analyses, we found that the variant genotypes with XRCC3 241Met exhibited a >3-fold elevated risk (OR = 3.3, 95% CI = 1.31-8.36, p = 0.01) for OSCC. There was a marginally significant risk observed in variants with XRCC1 194Trp (OR = 1.81, 95% CI = 0.91-3.63, p = 0.09) and XPD exon 6 (OR = 1.71, 95% CI = 0.93-3.16, p = 0.09). Combination of the variant genotypes of these three susceptibility genes was associated with a highly significant risk for OSCC (OR = 9.43, 95% CI = 1.98-44.9, p < 0.01). From further multivariate analyses, the variants with XRCC1 194Trp and possibly XRCC3 241Met interacted with tobacco and alcohol to further increase the risk (OR = 3.37 95% CI = 1.41-8.02, p < 0.01; OR = 2.92, 95% CI = 0.94-9.04, p = 0.06). On the other hand, increased risk was detected in non-betel chewers (OR = 2.88, 95% CI = 1.31-6.31, p < 0.01; OR = 2.61, 95% CI = 0.97-7.11, p = 0.06) who carry the two variant genotypes, respectively. Males with the variants XRCC1 194Trp or XRCC3 241Met had a higher risk of developing OSCC than males with the corresponding wild-type genotypes (OR = 2.72, 95% CI = 1.34-5.52, p < 0.01; OR = 2.95, 95% CI = 1.12-7.75, p < 0.05). Such association was not detected in females. Interestingly, the risk increased in female carriers of XPD exon 6 (OR = 3.93, 95% CI = 1.14-13.6, p < 0.05). We could not demonstrate a significant interaction of these SNPs with age in this study. Our data indicate that the variant genotypes with XRCC3 241Met and possibly XRCC1 194Trp and XPD exon 6 contribute to OSCC development in a Thai population. In addition, these SNPs influence the repair of DNA damage that is caused by environmental risk factors for oral cancer.     

老年与中青年食管鳞癌患者食管菌群的宏基因组学对比研究

目的探讨老年与中青年食管鳞癌(esophageal squamous cell carcinoma,ESCC)患者食管组织的菌群特征及差异,以助于研究老年ESCC患者潜在的生物标志物。方法采用回顾性研究,选取2018年7月至2019年7月在湖北省十堰市太和医院确诊的72例ESCC患者,其中老年组49例(≥60岁,男性40例,女性9例),中青年组23例(<60岁,男性21例,女性2例),以同期消化内镜中心20名胃镜检查无异常的健康体检者作为对照组(年龄范围35~78岁,中位年龄57岁,男性16名,女性4名)。收集ESCC患者病变食管组织和健康对照组中段食管组织、提取基因组DNA,对细菌16SrRNA基因序列V4高变区扩增,采用Illumina HiSeq测序技术,对比分析老年和中青年ESCC患者菌群特点。采用QIIME和Rstudio软件分析序列数据,统计学方法采用非参数Kruskal-Wallis检验或Wilcoxon秩和检验。结果两组患者菌群Shannon指数[5.17(4.53,5.95)比4.79(3.74,5.97)]、Simpson指数[0.94(0.91,0.96)比0.92(0.83,0.96)]和Chao1[343.55(259.76,570.59)比329.16(268.88,648.00)]指数相似,差异无统计学意义(Z=-0.791、-1.057、-0.380,均P>0.05);Beta多样性老年组与中青年组亦无明显差异(PC1=19.14%、PC2=6.95%,PPC1=0.67、PPC2=0.42)。在门水平,中青年组丰度前五的菌门依次为厚壁菌门(Firmicutes)、拟杆菌门(Bacteroidetes)、变形菌门(Proteobacteria)、放线菌门(Actinobacteria)和梭杆菌门(Fusobacteria),老年组患者丰度最高的五个门分别是厚壁菌门(Firmicutes)、拟杆菌门(Bacteroidetes)、变形菌门(Proteobacteria)、梭杆菌门(Fusobacteria)和放线菌门(Actinobacteria);两组差异显著的是梭杆菌门(Fusobacteria)(Q=0.596,P<0.05)。在属水平,中青年组丰度前五的菌属依次为:普雷沃菌属(Prevotella)、拟杆菌属(Bacteroides)、链球菌属(Streptococcus)、月形单胞菌属(Selenomonas)和韦荣球菌属(Veillonella);而老年组丰度前五的分别是普雷沃菌属(Prevotella)、拟杆菌属(Bacteroides)、链球菌属(Streptococcus)、月形单胞菌属(Selenomonas)和嗜血杆菌属(Haemophilus),两组有显著差异的为梭杆菌属(Fusobacterium)(Q=0.938,P<0.05)。基于未观测状态重建的群落系统发育研究(PICRUSt)功能预测,老年组患者氨酰tRNA生物合成(Aminoacyl.tRNA.biosynthesis)、核苷酸切除修复(Nucleotide.excision.repair)、核糖核酸聚合酶(RNA.polymerase)、核糖体(Ribosome)、克拉维酸生物合成(Clavulanic.acid.biosynthesis)、光合作用(Photosynthesis)和光合作用蛋白(Photosynthesis.proteins)丰度较中青年组降低(均Q=0.734,P<0.05)。结论老年ESCC患者食管菌群与中青年患者的Alpha多样性和Beta多样性无明显差异,但老年患者梭菌属菌群丰度增高。     

Measurement of reoxygenation during fractionated radiotherapy in head and neck squamous cell carcinoma xenografts

Hypoxic tissues lack adequate oxygenation and it has been long established that tumours commonly exhibit hypoxia and that hypoxia is a factor contributing towards resistance to radiotherapy. To develop computer models and make predictions about the affects of tumour hypoxia on treatment outcome, quantitative tumour oxygenation and reoxygenation data from in vivo systems is required. The aim of this study was to investigate the timing and degree of reoxygenation during radiotherapy in a human head and neck squamous cell carcinoma xenograft mouse model (FaDu). Mice were immobilised using a novel restraining system and exposed unanaesthetised in 3 or 5 Gy fractions, up to a maximum of 40 Gy. Partial pressures of oxygen (pO₂) measurements were recorded at six time points throughout the 2 week course of radiotherapy, using a fibre optic system. Tumours receiving 0–30 Gy did not exhibit an increase in pO₂. However, the mean pO₂ after 2 weeks of accelerated fractionated radiotherapy (40 Gy) was significantly increased (P < 0.01) compared to the mean pO₂ of tumours not receiving the full schedule (0–30 Gy). These results lead to the conclusion of an average reoxygenation onset time of 2 weeks in this group of xenografts. A relatively large range of pO₂ values measured at each dose point in the study indicate a large inter-tumour variation in oxygenation among the tumours. Data from this experimental work will be used to define the range of reoxygenation onset times implemented in a Monte Carlo computer model, simulating hypoxic head and neck cancer growth and radiotherapy.     

Relationship between oral poor hygiene and broken teeth with oral tongue squamous cell carcinoma

Previous studies on etiology of squamous cell carcinoma (SCC) of the tongue have reported results with respect to long term exposure to cigarette smoking and alcohol abuse. The aim of this study was to investigate risk factors for SCC of the tongue in a set of patients with minimum exposure to cigarette smoking and alcohol. Sixty four cases with diagnosis of oral tongue SCC were reviewed in this study. The patients underwent surgical management at the educational and therapeutic centers, Imam and Buali Hospitals (Hamedan, Iran) between the dates of January 1990 and December 2006. Eighty five percent of patients were older than 40 years of age. Most of patients had poor oral hygiene, dental decay and halitosis. It appears that poor oral hygiene and nutritional deficiency can be considered as risk factors for the SCC of the tongue in west of Iran.     

The role of simultaneous chemotherapy and radiotherapy in the treatment of locally metastasised tumours of the larynx, pharynx and oral cavity

In The Netherlands each year there are 2300 new patients with a squamous-cell carcinoma of the larynx, pharynx and oral cavity, and of these, one-third has a locally regionally advanced tumour. An operation can then lead to an unacceptable loss of function, whilst radiotherapy alone has no effect on survival. Compared to radiotherapy alone, the combination of radiotherapy and chemotherapy containing cisplatin, when administered simultaneously, produces a higher percentage of patients with loco-regional control and a higher 3-year survival percentage. This improvement in treatment results is accompanied by an increased acute toxicity.     

Total mesorectal excision and preoperative radiotherapy in patients with rectal carcinoma: good preliminary results]

The value of a short course of radiotherapy prior to total mesorectal excision was studied in patients with resectable rectal cancer. The new surgical technique of total mesorectal excision was introduced under appropriate supervision and gave favourable treatment results. The incidence of local recurrence was markedly reduced by preoperative radiotherapy. Long term results should give greater insight into potential improvements in survival rates and any late side effects which may arise as a result of the radiation schedule.