Treatment Delay in Oral and Oropharyngeal Cancer in Our Population: The Role of Socio-Economic Factors and Health-Seeking Behaviour

The objective is to assess the role of socio-economic factors and health-seeking behavior in treatment delay in oral and oropharyngeal cancer in our population. This article adapts—design: prospective study and setting: tertiary care centre. We studied 153 patients with oral and oropharyngeal squamous cell carcinoma who were managed in the department of otolaryngology and head and neck surgery between January 2006 and December 2007. There were 127 male patients (83%) and 26 females (17%) with ages ranging from 22 years to 70 years. Fifty-nine patients (39%) presented to us with early stage disease (i.e. stage I and II), whereas, 94 patients (61%) presented with late stage disease (i.e. stage III and IV). Of the 59 patients presenting with early stage disease, 20 were illiterate and 39 literate with 28 patients (47%) belonging to low socio-economic status and 32 patients (54%) having an access to primary health centre (PHC). Of the 94 patients presenting with late stage disease, 53 were illiterate and 41 literate with 58 patients (62%) belonging to low socio-economic status and 38 patients (40%) having an access to primary health centre. Literacy, socio-economic status, access to primary health centre and health-seeking behavior of our population has a significant association with the stage of presentation of patients with oral and oropharyngeal cancer.     

Clinicopathologic risk factors for distant metastases from head and neck squamous cell carcinomas

Aims

The aim of this study is to investigate the clinicopathologic risk factors associated with distant metastases (DMs) from head and neck squamous cell carcinomas (HNSCCs).

Methods

Between February 1990 and February 2000, a retrospective analysis of 391 HNSCC patients was performed. The frequency and the clinicopathologic risk factors for DM were evaluated by using univariate χ² tests and multiple stepwise logistic regression models. Statistical analysis of overall survival was performed by using Kaplan–Meier method.

Results

44 patients (11.3%) developed DM in clinic. In a univariate analysis, clinical N stage, primary tumor site, level of tumor invasion, pathologic N stage and number of levels with pathologic lymph node were found to be significantly associated with the risk of DM. In a multivariate analysis, the most significant risk factors were number of levels with pathologic lymph node, level of tumor invasion, and primary tumor site. Kaplan–Meier analysis showed that overall survival rates of 44 patients with DMs in clinic were 56.8% at 1 year, 9.1% at 3 years, and 6.8% at 5 years, respectively.

Conclusions

The number of levels with pathologic lymph node, the site of primary tumor and the level of tumor invasion are decisive risk factors in determining the development of DM in head and neck SCC patients. Patients with multilevel nodal involvement in neck, with laryngeal and hypopharyngeal carcinomas, and patients with primary tumor invasion into muscular, bone or cartilage have the highest risk of developing DM.     

经颞浅动脉灌注PDD-Fudr/5Fu治疗头颈部鳞状细胞癌

 目的　观察经颞浅动脉灌注PDD +Fudr/ 5 Fu治疗头颈部鳞状细胞癌的疗效。方法　从 1996年 1月～ 2 0 0 0年 12月有 89例头颈部鳞状细胞癌给予动脉化疗 ,A组 4 9例予PDD +Fudr方案 ,B组 4 0例予PDD + 5Fu方案 ,方法与剂量两组相同。结果　A组的总有效率为 83.7% (41/ 4 9) ,其中CR10 .2 % ,PR73.5 % ,SD16 .3% ;B组的总有效率为 75 .0 % (30 / 4 0 ) ,其中CR2 .5 % ,PR72 .5 % ,SD2 5 % ,统计学上两组有效率无明显差异 (P >0 .0 5 )。而口腔溃疡在A组的发生率明显低于B组 ,经 χ2 检验 ,两组有显著差异。结论Fudr在头颈部鳞状细胞癌的辅助化疗中是安全、低毒、高效的 ,值得推荐。     

局部晚期头颈部鳞癌同步放化疗研究进展

同步放化疗(CCRT)是治疗局部晚期头颈部鳞癌的新热点。对以手术治疗为主的局部晚期头颈部鳞癌而言,CCRT的疗效与以手术为主的综合治疗的疗效相似,同时保全了器官及功能;对传统采用非手术治疗的局部晚期头颈部鳞癌而言,CCRT取得了更理想的局部控制率、无远处转移率和生存率。因此,CCRT为局部晚期肿瘤的临床治疗提供了新的模式。     

局部晚期头颈部鳞癌同步放化疗研究进展

同步放化疗（CCRT）是治疗局部晚期头颈部鳞癌的新热点。对以手术治疗为主的局部晚期头颈部鳞癌而言，CCRT的疗效与以手术为主的综合治疗的疗效相似，同时保全了器官及功能；对传统采用非手术治疗的局部晚期头颈部鳞癌而言，CCRT取得了更理想的局部控制率、无远处转移率和生存率。因此．CCRT为局部晚期肿瘤的临床治疗提供了新的模式。     

ErbB4 expression in squamous cell carcinoma of the head and neck

This study set out to delineate ErbB4 overexpression and its impact on prognosis in squamous cell carcinoma (SCC) of head and neck (H&N) origin. Thirty-six of the 47 evaluated SCC of H&N origin came from the larynx, oropharynx, or oral cavity. Twenty-four patients had stage III–IV, 17 had stage I–II, and 6 had recurrent disease. Immunohistochemical stains were performed on paraffin sections using the avidin–biotin–peroxidase method. Forty-five patients received radiation therapy, 24 primary treatment and 21 postoperatively. Nineteen patients with advanced stage disease received concomitant chemotherapy. ErbB4 was highly stained in 24/47 (51%) patients and weakly stained in another 13/47 (28%) patients. Age, gender, site, stage, and treatment approaches similarly distributed between the groups. Overall survival (OS) and disease-free survival (DFS) were similar in ErbB4-positive and ErbB4-negative groups. In conclusion, although ErbB4 is not a prognostic parameter for OS and DFS in H&N SCC, it is highly overexpressed. The high overexpression rate may lead to initiation of anti-ErbB4 targeted therapy in this cohort of patients.     

Dose to the inferior pharyngeal constrictor predicts prolonged gastrostomy tube dependence with concurrent intensity-modulated radiation therapy and chemotherapy for locally-advanced head and neck cancer

Background and purpose

To determine if dose and/or dose-volume parameters to anatomic swallowing structures are predictive of gastrostomy tube (PEG) dependence from chemotherapy-intensity modulated radiotherapy (IMRT) in locally advanced head and neck cancer (LAHNC).

Methods and materials

A retrospective study was performed on 141 consecutive patients with LAHNC (squamous cell) treated with definitive chemoIMRT with weekly concurrent carboplatin and paclitaxel. Late dysphagia was assessed by length of PEG requirement. Analysis of IMRT dose was retrospectively performed for critical swallowing structures.

Results

Approximately 62% of patients required PEG, the majority placed during treatment. Mean and median time for PEG was 7.7 and 4.4 months respectively (range 1.4–43.8). Only IMRT dose to the inferior constrictor was significantly associated with length of PEG. Mean dose (of individual mean doses) was 47 Gy for prolonged PEG use versus 41 Gy for PEG ?12 months. V₄₀ to the inferior constrictor also correlated with PEG >12 months (p = 0.02) with a mean V₄₀ of 48% versus 41% for PEG ?12 months.

Conclusions

IMRT dose to the inferior constrictor correlated with persistent dysphagia requiring prolonged PEG use. Maintaining mean inferior constrictor dose to ?41 Gy and V₄₀ to ?41% may help minimize gastrostomy tube dependence.     

Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study

BackgroundHead and neck (H&N) cancers are a heterogeneous group of malignancies, affecting various sites, with different prognoses. The aims of this study are to analyse survival for patients with H&N cancers in relation to tumour location, to assess the change in survival between European countries, and to investigate whether survival improved over time.MethodsWe analysed about 250,000 H&N cancer cases from 86 cancer registries (CRs). Relative survival (RS) was estimated by sex, age, country and stage. We described survival time trends over 1999–2007, using the period approach. Model based survival estimates of relative excess risks (RERs) of death were also provided by country, after adjusting for sex, age and sub-site.ResultsFive-year RS was the poorest for hypopharynx (25%) and the highest for larynx (59%). Outcome was significantly better in female than in male patients. In Europe, age-standardised 5-year survival remained stable from 1999–2001 to 2005–2007 for laryngeal cancer, while it increased for all the other H&N cancers. Five-year age-standardised RS was low in Eastern countries, 47% for larynx and 28% for all the other H&N cancers combined, and high in Ireland and the United Kingdom (UK), and Northern Europe (62% and 46%). Adjustment for sub-site narrowed the difference between countries. Fifty-four percent of patients was diagnosed at advanced stage (regional or metastatic). Five-year RS for localised cases ranged between 42% (hypopharynx) and 74% (larynx).ConclusionsThis study shows survival progresses during the study period. However, slightly more than half of patients were diagnosed with regional or metastatic disease at diagnosis. Early diagnosis and timely start of treatment are crucial to reduce the European gap to further improve H&N cancers outcome.     

Gene expression profiling to predict outcome after chemoradiation in head and neck cancer

PURPOSE: The goal of the present study was to improve prediction of outcome after chemoradiation in advanced head and neck cancer using gene expression analysis. MATERIALS AND METHODS: We collected 92 biopsies from untreated head and neck cancer patients subsequently given cisplatin-based chemoradiation (RADPLAT) for advanced squamous cell carcinomas (HNSCC). After RNA extraction and labeling, we performed dye swap experiments using 35k oligo-microarrays. Supervised analyses were performed to create classifiers to predict locoregional control and disease recurrence. Published gene sets with prognostic value in other studies were also tested. RESULTS: Using supervised classification on the whole series, gene sets separating good and poor outcome could be found for all end points. However, when splitting tumors into training and validation groups, no robust classifiers could be found. Using Gene Set Enrichment analysis, several gene sets were found to be enriched in locoregional recurrences, although with high false-discovery rates. Previously published signatures for radiosensitivity, hypoxia, proliferation, "wound," stem cells, and chromosomal instability were not significantly correlated with outcome. However, a recently published signature for HNSCC defining a "high-risk" group was shown to be predictive for locoregional control in our dataset. CONCLUSION: Gene sets can be found with predictive potential for locoregional control after combined radiation and chemotherapy in HNSCC. How treatment-specific these gene sets are needs further study.     

2-[18F]-Fluoro-2-deoxy-D-glucose positron emission tomography as guidance for primary treatment in patients with advanced-stage resectable squamous cell carcinoma of the larynx and hypopharynx.

BACKGROUND: High uptake of 2-[(18)F]-fluoro-2-deoxy-D-glucose (FDG) is associated with unfavorable results. Pretreatment FDG uptake was evaluated as a predictor of survival and guidance for primary surgery or radiotherapy (RT) in patients with squamous cell carcinoma (SCC) of the larynx and hypopharynx. MATERIALS AND METHODS: Seventy-nine consecutive patients with newly diagnosed advanced resectable SCC of the larynx and hypopharynx underwent FDG positron emission tomography (PET) before surgical resection plus RT and chemotherapy (surgery group, n=40) or RT with chemotherapy and surgical salvage (RT group, n=39). Age, tumor stage, histological grade, treatment strategy, and standardized uptake value (SUV) were analyzed for association with local control and survival. RESULTS: Overall local control and survival in the two groups did not differ (P>0.1). In univariate analysis, nodal positivity (P=0.014) and SUV>8.0 (P=0.007) were associated with poorer disease-free survival (DFS). In multivariate analysis, SUV remained an independent determinant of DFS (P=0.014). When patients with SUV>8.0 in the two treatment groups were analyzed separately, those in the surgery group tended to have a higher 3-year DFS than those in the RT group, despite no statistical significance (48% vs. 27%, P=0.085). CONCLUSIONS: High FDG uptake is associated with poor survival in patients with advanced laryngopharyngeal SCC. Patients with high FDG uptake may be better treated by surgical resection followed by RT and chemotherapy.     

Cutaneous manifestations associated with malignancy of the head and neck

Most cutaneous malignancies of the head and neck (HN) are non-melanoma skin cancers, predominantly basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Less common entities include Merkel cell carcinoma (MCC), sebaceous carcinoma (SC), and angiosarcoma. Treatment is based on histology subtype, stage, and extent of involvement. Surgery is the primary means of treatment and includes wide local excision, Mohs micrographic surgery, sentinel lymph node biopsy, and cervical lymphadenectomy. Multidisciplinary management including radiation and targeted chemotherapy are critical adjuncts to surgery. Surgical planning must balance oncologic, functional, and cosmetic considerations. This review addresses cutaneous manifestations of primary malignancies of the HN and dermatologic complications of small molecule inhibitors used for targeted therapy. A working knowledge of both the cutaneous malignancies (CM) in the head and neck as well as the secondary dermatologic manifestations is relevant to multiple disciplines including dermatology, medical oncology, radiation oncology, and surgical oncology.     

Quality of life after surgical treatment for oral and oropharyngeal cancer: a prospective longitudinal assessment of patients reconstructed by a microvascular flap

The aim of this study was to document changes from baseline to 6 and 12 months after treatment in health-related quality of life (HRQOL) in relation to sociodemographic and clinical parameters among advanced oral/oropharyngeal cancer patients treated with reconstructive surgery and adjuvant radiotherapy. The HRQOL of 80 consecutive patients was assessed by the EORTC QLQ-C30 and QLQ-H&N35 questionnaires, pretreatment and 6 and 12 months posttreatment. Several patterns of HRQOL changes were distinguished: most general HRQOL issues do not change after treatment or improve compared to baseline scores (emotional functioning, pain, insomnia, constipation) and most head and neck specific issues deteriorate after treatment but return to pretreatment levels at 12 months, except for senses, opening mouth, sticky saliva, and coughing which remain deteriorated in the long term. Although improvement to baseline levels was noted, it should be kept in mind that baseline levels of patients are often deviant from “normal” scores from the general population. Tumour site and stage, comorbidity, and extensive resections were significantly associated with HRQOL outcomes, as were marital status and age. These results, obtained in a homogenous group of patients, may serve as HRQOL benchmarks for future studies investigating surgical and other treatment modalities.     

无法切除的复发头颈部鳞癌的姑息放疗

为评价头颈部鳞癌术后复发患者行姑息放疗的疗效及其影响因素，对１９８８年７月至１９９６年２月在我科接受姑息放疗的１０６例患者的资料行回顾性分析。结果：放疗后ＣＲ２２．６％（２４／１０６），ＰＲ３８．７％（４１／１０６），ＮＲ３８．７％（４１／１０６）；总有效率为６１．３％（６５／１０６）；放疗后挽救性手术成功率为４／９；疗后６３．２％（６７／１０６）的患者Ｋａｒｎｏｆｓｋｙ得分上升，症状减轻，生存质量提高；１、２、３年生存率分别为５４．７％（５８／１０６）、２１．７％（２３／１０６）和５．７％（６／１０６）；远处转移率２９．２％（３１／１０６），放疗并发症１０．４％（１１／１０６）。结论：姑息放疗是晚期头颈部鳞癌术后复发患者一种较好的治疗选择；为了提高疗效，放射剂量应尽可能高于５０Ｇｙ，采用超分割连续放疗技术和避免分段。     

头颈鳞癌的术前化疗效果

[目的]研究术前化疗能否提高手术切除率,降低局部复发率。［方法］104例头颈鳞癌病人分成试验组（58例）：术前化疗 手术 术后放疗组;对照组（46例）：手术 术后放疗,但不用术前化疗。手术方式为原发癌切除 颈淋巴结清扫术,用或不用肌皮瓣修复头颈部组织缺损。术后放疗剂量50Gy～60Gy。术前化疗用PFP方案即DDP＋5－Fu＋PYM。［结果］试验组部分缓解67.2%,微效17.2%。试验组和对照组3年局部复发率分别为27.6%、52．2％（P＜0.01）;但3年内远处转移率无差异,分别为34．5%、34．8%,中位生存期分别为23个月和22个月,3年生存率分别为65．5%和56．5%（P＞0.05）。［结论］术前新辅助化疗,可以缩小瘤体,提高手术切除率,减少局部复发。     

头颈部肿瘤放疗对唾液腺的损伤

唾液腺损伤是头颈部肿瘤放疗的最常见并发症之一,放射性唾液腺损伤及功能障碍的机制包括射线对唾液腺细胞的直接损伤、射线间接引起唾液腺组织营养血管的闭锁及放射引起的自身免疫介导唾液腺损伤.另外,放射性唾液腺损伤及功能障碍还涉及到腺体体积的缩小和分泌功能的减退、以及对损伤的预防和治疗等.     

EB病毒基因在喉鳞状细胞癌中的表达

目的：ＥＢ病毒感染与喉鳞状细胞的发生发展是否有关迄今未明。本文目的在于了解ＥＢ病毒基因在喉鳞状细胞癌组织中的表达情况，探讨各种ＥＢ病毒基因产物在喉鳞状细胞癌发生发展中的生物学意义。方法：采用原位杂交和免疫组化技术，检测２９例不同分化类型喉鳞状细胞癌组织中ＥＢ病毒编码的小ＲＮＡ（ＥＢＥＲｓ）、潜伏感染膜蛋白（ＬＭＰ１）、ＥＢ病毒核抗原（ＥＢＮＡ－１）、溶解感染立即早期基因编码蛋白ＺＥＢＲＡ、早期基因编码蛋白ＥＡ－Ｄ、晚期基因编码蛋白ＶＣＡ和ＭＡ。结果：各检测指标在未分化癌、低分化和中分化鳞癌均有一定比例的阳性，但在２例高分化鳞癌均为阴性。发现ＥＢ病毒潜伏性和溶解性感染基因产物表达分别随着癌分化程度增高而减弱和增强。７例低分化和１例中分化鳞癌ＬＭＰ－１除胞膜和胞浆阳性外，胞核也呈明显阳性。２例低分化和１例中分化鳞癌中有少量癌细胞ＺＥＢＲＡ阳性。结论：部分喉鳞状细胞癌尤其是未分化和低分化鳞癌的发生发展与ＥＢ病毒感染密切相关，提示癌细胞的分化程度与ＥＢ病毒基因表达的差异有关。     

Metastases to the parotid gland - A review of the clinicopathological evolution,molecular mechanisms and management

Metastases to the parotid gland are the commonest cause of parotid malignancies in many regions of the world including Australia. The most common etiology of these metastases is head and neck cutaneous squamous cell carcinoma (HNcSCC) followed by melanoma of the head and neck. This article focuses on the management of the aforementioned pathologies including Merkel cell carcinoma (MCC).