Second salvage surgery with extended vertical lower trapezius island myocutaneous flap reconstruction for advanced re-recurrent oral and oropharyngeal squamous cell carcinoma

The purpose of this study was to evaluate the outcomes of second salvage surgery with extended vertical lower trapezius island myocutaneous flap (TIMF) reconstruction for patients with re-recurrent oral cavity and oropharyngeal squamous cell carcinoma (SCC). The subjects were 23 patients with advanced re-recurrent oral and oropharyngeal SCC undergoing second salvage surgery and reconstruction with a TIMF. A TIMF with a skin paddle measuring 6 cm × 7 cm to 10 cm × 22 cm was used to reconstruct the major defects. Three patients experienced minor complications: minor flap failure (n = 1), wound dehiscence at the donor site (n = 1), and an orocutaneous fistula (n = 1). The patients were followed for 3–72 months. Fifteen patients were alive with no evidence of disease, two were alive with disease, and six died of local recurrence or distant metastases. Second salvage surgery remains an effective treatment modality for select patients with advanced re-recurrent oral and oropharyngeal SCCs, and the extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing the major defect following second salvage surgery.     

Impact of treatment on quality of life for oral and oropharyngeal carcinoma

This study evaluates the changes in quality of life (QoL) from pre-treatment to 3 years after commencement of treatment and its relation to therapeutic variables in patients with oral and oropharyngeal carcinoma. QoL was assessed using the EORTC QLQ-C30 questionnaires and the EORTC head and neck cancer specific module QLQ-H&N35. QoL data were obtained prior to treatment and 1 and 3 years after treatment began. Of 128 patients, 69 completed all the questionnaires over the course of 3 years. Variable deterioration of QoL scores was detected before treatment. Most of the parameters worsened significantly after treatment and during the first year, and improved by the third year. Patients who underwent surgical treatment combined with adjuvant radiotherapy and chemotherapy generally showed worse scores and needed a long time to recover from the disease and the treatment adverse effects. This long-term prospective study performed using the EORCT questionnaires in a homogeneous group of patients with oral and oropharyngeal carcinoma may allow better understanding of the impact of treatment and the changes in QoL that occur.     

Epstein-Barr virus in tobacco-induced oral cancers and oral lesions in patients from India

D'Costa J, Saranath D, Sanghvi V, Mehta AR: Epstein-Barr virus in tobacco-induced oral cancers and oral lesions in patients from India. J Oral Pathol Med 1998; 27: 78–82. © Munksgaard, 1998.
We examined 103 oral squamous cell carcinomas (OSCC), 100 oral lesions consisting primarily of leukoplakia (82 cases), and 76 clinically normal mucosa specimens from the contralateral site in the oral cavity of individuals with oral lesions, for the presence of Epstein-Barr virus (EBV). Polymerase chain reaction (PCR) was used to amplify a 239 bp fragment of the BamHIL region of the EBV genome, followed by Southern blot hybridization with EBV oligonucleotide probe to increase further the specificity and sensitivity of the assay system. Since EBV seropositivity is frequent in populations, we also examined the peripheral blood cells (PBC) from 141 patients (50 oral cancer patients, 91 patients with oral lesions) for the presence of EBV We detected EBV in 25 of 103 (25%) OSCC, 13 of 100 (13%) oral lesions, 3 of 76 (4%) clinically normal mucosa samples and 10 of 141 (7%) PBC. Our results indicate that EBV may contribute as one of the multiple factors in oral cancers, in a certain proportion of Indian patients.     

口腔癌下颌骨侵犯途径及方式的研究进展

口腔癌常易侵犯下颌骨,且下颌骨的侵犯对其治疗及预后中十分重要.作为一个重要的功能器官,下颌骨的保存在口腔癌的治疗过程中受到越来越多医师的关注.然而,当口腔癌侵犯下颌骨后,是否应该保存及通过何种方式保存下颌骨尚存在争议.而这些争议的根源来源于目前对于口腔癌侵犯下颌骨的途径及方式不明确.本文将对口腔癌下颌骨侵犯的途径及方式的研究进展进行综述.     

Racial disparities in being recommended to surgery for oral and oropharyngeal cancer in the United States

Weng Y, Korte JE. Racial disparities in being recommended to surgery for oral and oropharyngeal cancer in the United States. Community Dent Oral Epidemiol 2012; 40: 80–88. © 2011 John Wiley & Sons A/S Abstract – Objectives: To investigate the impact of race on the likelihood of patients being recommended for surgery after a diagnosis of oral and oropharyngeal cancer. Methods: A total of 68 445 cases of oral and oropharyngeal cancer were extracted from the 1988 to 2005 Surveillance, Epidemiology, and End Results (SEER) database. County‐level rurality data and income data were merged using the US Department of Agriculture Rural‐Urban Continuum Codes dataset and US Census Bureau Small Area Income & Poverty Estimates dataset. We used logistic regression analyses to investigate the impact of race on being recommended to surgery for oral and oropharyngeal cancer, adjusting for demographic, socioeconomic, and clinical factors. Stratified analyses were further conducted by tumor site and rural/urban status. Results: Recommendation to surgery varied significantly by race, with black patients less likely than white patients to be recommended to surgery for their oral and oropharyngeal cancer. The racial difference in recommendation to surgery varied significantly by age, geography, and tumor subsite. Racial disparities are most evident in lip and buccal cancer from rural areas (OR, 4.4; 95% CI, 2.6–7.5); and least evident in oropharyngeal cancer from urban areas (OR, 1.2; 95% CI, 1.1–1.3). The magnitude of the racial disparity is attenuated with increasing age. Conclusions: We observed substantial racial disparities in surgery recommendation for oral and oropharyngeal cancer in the United States. Our results suggest the need to improve accessibility to better health care in racial minority groups, particularly in rural areas, and call for individual and institutional efforts to avoid physician bias related to the patient’s sociodemographic characteristics in healthcare service.     

Human papillomavirus and oral and oropharyngeal carcinoma: the essentials

There is a global increase in the prevalence of human papillomavirus (HPV)‐driven oropharyngeal squamous cell carcinoma (OPSCC) in Australia and New Zealand. Risk factors for HPV‐positive OPSCC are male gender, white race, age older than 40 but younger than 59 years old, having multiple lifetime sex partners, having oro‐genital and oro‐anal sex. High‐risk HPV subtypes play a major role in the pathogenesis of OPSCC, however, they play a much lesser role in oral squamous cell carcinoma (OSCC). Among the laboratory tests used to detect oncogenic HPV infection, polymerase chain reaction is a sensitive method but does not reflect the role of HPV in oncogenesis. While widely used, p16 immunohistochemistry is both a sensitive and a specific surrogate marker for oncogenic HPV infection in OPSCC, but not in OSCC. However, it is a useful prognostic marker in OPSCC. The current gold standard to accurately detect oncogenic HPV infection is E6/E7 mRNAin situ hybridization. Because both HPV‐positive and p16‐positive OPSCC have better short‐term prognoses there is current debate and trials on treatment de‐escalation in HPV‐positive OPSCC. Dental practitioners can play an important role in early diagnosis of HPV‐positive OPSCC.     

Patients with oral cancer developing from pre‐existing oral leukoplakia: do they do better than those with de novo oral cancer?

Background:  It has been suggested that patients with squamous cell carcinomas derived from oral leukoplakia have a better prognosis than patients with carcinomas that are not associated with oral leukoplakia.
Aim:  To study the mortality rate of 19 patients with a squamous cell carcinoma derived from pre-existing oral leukoplakia.
Method:  The mortality rate of 19 patients with a proven oral squamous cell carcinoma derived from a pre-existing oral leukoplakia was compared with that of a similar size group of patients with oral carcinoma without a pre-existing oral leukoplakia, being matched for gender, age, smoking habits, use of alcohol, oral subsite and histopathologic grade. Treatment in all patients was primarily by surgical excision. The mortality rates up to 5 years have been computed according to the Kaplan–Meier method.
Result:  No significant difference of the mortality rates up to 5 years of follow-up was observed between the two groups of patients.
Conclusion:  Patients with oral cancer developing from pre-existing oral leukoplakia do not do better than those with de novo oral cancer.     

HPV and other risk factors of oral cavity/oropharyngeal cancer in the Czech Republic

OBJECTIVE: An association between high-risk human papillomavirus (HR HPV) infection and a risk of development of a subgroup of head and neck cancers has been proposed recently. The main risk factors of oral and oropharyngal cancer observed in our population are smoking and alcohol consumption. The incidence of oral/oropharyngeal tumours in the Czech Republic is relatively high and there are no data available about the prevalence of HPV DNA presence in these tumours. MATERIALS AND METHODS: Eighty patients with a primary oropharyngeal cancer were enrolled. The presence of HPV DNA has been evaluated by polymerase chain reaction in 68 cases from which the tumour tissue and demographical and clinical data were available. The typing of HPV was performed by nucleotide DNA sequencing. RESULTS: The HPV DNA was detected in 51.5% of samples tested. Among the HPV DNA positive tumours, 80% contained HPV16. In the analysed group there were 54 men and 14 women. The prevalence of HPV DNA was lower in oral (25%) than in oropharyngeal (57%) tumours, and higher in never smokers (100%) and never drinkers (68.8%). HPV DNA presence was not related to gender, age, number of lifetime sexual partners or practice of oral-genital sex, size of tumour or presence of regional metastases. CONCLUSIONS: The difference in the prevalence of HPV DNA positive tumours between cases of oral cavity and oropharyngeal carcinoma exposed and not exposed to tobacco or alcohol support the theory that HPV DNA positive tumours form an aetiologically distinct subgroup of head and neck tumours.     

Exploring awareness, attitudes, and perceived role among oral health providers regarding HPV-related oral cancers

Objectives: Human Papillomavirus (HPV), the most common STI in the United States, is increasingly being associated with a number of cancers, including oral cancers (OC). This may change the approach of oral health providers (OHP) towards screening and identifying OC in their patients. Methods: Five focus groups were conducted in February and March 2009 with dentists and dental hygienists. Participants were recruited via presentations at monthly meetings of local dental and dental hygiene professional associations, and through association mailing and telephone lists. Results: A total of 38 OHP participated in the focus groups (17 dentists and 21 hygienists). Analysis of focus group data was framed by three general content areas regarding HPV‐related OC and the HPV vaccine, including: a) knowledge; b) attitudes; and c) perceived roles. Sub‐themes that emerged included issues related to the HPV vaccine, the role of professional organizations, and concerns with gender roles and confidentiality. Conclusions: As public awareness of the link between HPV and OC increases, OHP play an important role in addressing this issue with their patients. The current study clearly identified areas that must be addressed among OHP in order for effective and comfortable communication regarding the HPV‐OC link and the potential uses of the HPV vaccines to take place, including: a) increasing knowledge of the HPV‐OC link and HPV vaccine; and b) clarifying screening procedures, role, and expectations.     

口腔癌患者术后吞咽障碍评价与其早期预后的相关性研究

目的 通过对口腔癌患者术后吞咽障碍的评价,观察其与口腔癌患者早期吞咽障碍预后的相关性.方法 选取2016年9月至2019年9月于辽宁中医药大学附属医院确诊并手术治疗的口腔癌患者124例,经口腔修复后进行洼田饮水试验评估及电视X线透视吞咽功能(VFSS)检查,比较两种方法评价吞咽障碍效果.根据成功随访3个月的95例患者是...     

Self-awareness of premalignant oral lesions among veterans attending six U.S. Veterans Affairs Medical Centers

Early identification is key to reducing the morbidity and mortality of oropharyngeal cancer. This study identified factors associated with self-awareness among patients newly diagnosed with a premalignant oral lesion. Data describing sociodemographics, medical/dental histories, tobacco/alcohol use and oral health were obtained by questionnaire and clinical examination of 73 veterans at six U.S. Veterans Affairs Medical Centers. Lesion types included homogenous and non-homogenous leukoplakia, smokeless tobacco lesion (STL), papilloma, lichen planus and erythroplakia. Prior to diagnosis, 29 subjects (39.7%) were unaware of their lesion. In bivariate analyses, lesion self-awareness was associated with anatomic location, multifocal/generalized appearance, pain, oral sores, and cigar use (p<0.05). Awareness varied with lesion diagnosis and was more likely with STL and less likely with homogenous leukoplakia (p<0.05). In multivariate analyses, awareness was predicted by the presence of a lesion on easily visible mucosa (adjusted odds ratio, OR=11.2) and a history of mouth sores (OR=11.2). These findings identified marked variations in patient self-awareness of oral premalignant conditions.     

Prognostic and predictive factors in oral cancer: the role of the invasive tumour front

Most decisions for cancer patients are now made on the basis of prognostic and predictive factors. However, due to the limited prognostic value of conventional tumour/nodal/ metastasis staging and histopathological grading in oral cancer, a large group of patients are still over- or under-treated with significant personal and socioeconomical impact. Recent work indicates that morphological and functional characteristics of the invasive tumour front underlie the biological aggressiveness of oral cancer. Incorporation of these concepts into a prognostic system will better reflect the biologic diversity of oral cancer and more accurately predict clinical outcomes and responses to particular types of adjuvant therapy.     

Raman spectroscopy in oral cavity and oropharyngeal cancer: a systematic review

Due to the high incidence of head and neck cancer and under-diagnosis in the early stages, non-invasive and highly accurate diagnostic tests are required for cancer detection. Recent advances in Raman spectroscopy techniques have yielded promising sensitivity and specificity results in the evaluation of cancer. The aim of this study was to investigate the potential value of Raman spectroscopy in oral cavity and oropharyngeal cancer diagnosis based on currently available scientific papers. A search of the PubMed database was performed using a specific strategy and according to the PRISMA guidelines. Raman spectroscopy achieved a maximum accuracy of 98% in cancer detection, while accuracy was 97.24% for tumour grading evaluation, 95% for cancer treatment assessment, and 77% for the detection of cancer recurrence. Moreover, early-stage cancer can be identified by Raman spectroscopy investigation of liquid biopsy samples. An in vivo technique with direct mucosa examination by fibre-optic Raman spectroscopy obtained a maximum accuracy of 94% in cancer diagnosis. The most prominent markers of the presence of malignancy were an increase in Raman signal intensity for proteins, nucleic acids, and water and a decrease for lipids. These cancer discriminants were detected in both fingerprint and high wavenumber regions. In conclusion, Raman spectroscopy is a promising tool for oral cavity and oropharyngeal cancer screening.     

A rational approach to prevent recurrences after definitive treatment of oral cancers by surgery

Oral Cancer is a major problem not only in the Indian Subcontinent, but also in large areas of South and South East Asia where tobacco habits (chewing and smoking) are prevalent.     

Influence of close resection margins on local recurrence and disease-specific survival in oral and oropharyngeal carcinoma

There is a lack of consistency among published reports in the definition of what constitutes close resection margins (1-5mm) in the surgical treatment of oral and oropharyngeal squamous cell carcinoma (SCC). Our aim was to define what would constitute close resection margins in predicting local recurrence and disease-specific survival. The study comprised 192 previously untreated patients with oral and oropharyngeal SCC who were recruited at the Southern General Hospital, Glasgow, from 2001 to 2007 with a minimum follow-up of 2 years. Resection was the primary treatment and the surgical margins were recorded for all patients. Statistical analyses were aided by the Statistical Package for the Social Sciences, version 15.0, and MedCalc software. The status of the surgical margins was evaluated using a receiver operating characteristic (ROC) curve to define the cut-off point. Cox's proportional hazard model was used to establish predictive factors for local recurrence and disease-specific survival. Of 192 patients, 23 (12%) had involved margins (<1.0mm), 107 (56%) had close margins (1.0-2.0mm (16.1%); 2.1-3.0mm (12%); 3.1-4.0mm (10.4%); 4.1-5.0mm (17.2%), and 62 (32.3%) had clear margins (>5mm). No predictive cut-off point was found that related close surgical margins to local recurrence. However, there was a significant adverse association between surgical margins ≤1.6mm and disease-specific survival. In recommending postoperative adjuvant treatment for oral and oropharyngeal SCC, we suggest that surgical margins within 2mm should be considered as the cut-off. However, other clinical and pathological prognostic factors should also be taken into consideration when recommending further treatment.