Osteomyocutaneous flap reconstruction for major mandibular defects

Mandibular defects after composite resections for carcinoma of the buccal mucosa require immediate restitution of both form and function with an acceptable cosmetic result. The pectoralis major osteomyocutaneous flap (PM-OMC) provides restoration of bone, soft tissue and skin with minimum morbidity. The procedure is technically simple, and in our series reconstruction using this flap has been performed by consultants, fellows and residents in training. We present a series of 116 PM-OMC flaps with good postoperative mastication in more than 70% of cases, and satisfactory swallowing and intelligible speech in 85% patients. © Wiley-Liss, Inc.     

Prospective study of oral microbiome and colorectal cancer risk in low-income and African American populations

Oral microbiome may play an important role in cancer pathogenesis. However, no study has prospectively investigated the association of the oral microbiome with subsequent risk of developing colorectal cancer (CRC). We conducted a nested case–control study including 231 incident CRC cases and 462 controls within the Southern Community Cohort Study with 75% of the subjects being African-Americans. The controls were individually matched to cases based on age, ethnic group, smoking, season-of-study enrollment and recruitment method. Oral microbiota were assessed using 16S rRNA gene sequencing in pre-diagnostic mouth rinse samples. Multiple bacterial taxa showed an association with CRC risk at p <0.05. Oral pathogens Treponema denticola and Prevotella intermedia were associated with an increased risk of CRC, with odds ratios (ORs) and 95% confidence intervals (CIs) of 1.76(1.19–2.60) and 1.55(1.08–2.22), respectively, for the individuals carrying these bacteria compared to non-carriers. In the phylum Actinobacteria, Bifidobacteriaceae was more abundant among CRC patients than among controls. In the phylum Bacteroidetes, Prevotella denticola and Prevotella sp. oral taxon 300 were associated with an increased CRC risk, while Prevotella melaninogenica was associated with a decreased risk of CRC. In the phylum Firmicutes, Carnobacteriaceae, Streptococcaceae, Erysipelotrichaceae, Streptococcus, Solobacterium, Streptococcus sp. oral taxon 058 and Solobacterium moorei showed associations with a decreased risk of CRC. Most of these associations were observed among both African- and European-Americans. Most of the associations were not significant after Bonferroni correction for multiple testing, which may be conservative. Our study suggests that the oral microbiome may play a significant role in CRC etiology.     

Salivary analysis of oral cancer biomarkers

Background:

Oral cancer is a common and lethal malignancy. Direct contact between saliva and the oral cancer lesion makes measurement of tumour markers in saliva an attractive alternative to serum testing.

Methods:

We tested 19 tongue cancer patients, measuring the levels of 8 salivary markers related to oxidative stress, DNA repair, carcinogenesis, metastasis and cellular proliferation and death.

Results:

Five markers increased in cancer patients by 39–246%: carbonyls, lactate dehydrogenase, metalloproteinase-9 (MMP-9), Ki67 and Cyclin D1 (CycD1) (P⩽0.01). Three markers decreased by 16–29%: 8-oxoguanine DNA glycosylase, phosphorylated-Src and mammary serine protease inhibitor (Maspin) (P⩽0.01). Increase in salivary carbonyls was profound (by 246%, P=0.012); alterations in CycD1 (87% increase, P=0.000006) and Maspin (29% decrease, P=0.007) were especially significant. Sensitivity values of these eight analysed markers ranged from 58% to 100%; specificity values ranged from 42% to 100%. Both values were especially high for the CycD1 and Maspin markers, 100% for each value of each marker. These were also high for carbonyls, 90% and 80%, respectively, and for MMP-9, 100% and 79%, respectively.

Conclusion:

The significance of each salivary alteration is discussed. As all alterations correlated with each other, they may belong to a single carcinogenetic network. Cancer-related changes in salivary tumour markers may be used as a diagnostic tool for diagnosis, prognosis and post-operative monitoring.     

Oral contraceptives, reproductive history and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition

Background:

Oral contraceptive use and reproductive factors may initiate long-term changes to the hormonal milieu and thereby, possibly influence colorectal cancer risk.

Methods:

We examined the association of hormonal and reproductive factors with risk of colorectal cancer among 337 802 women in the European Prospective Investigation into Cancer and Nutrition, of whom 1878 developed colorectal cancer.

Results:

After stratification for center and age, and adjustment for body mass index, smoking, diabetes mellitus, physical activity and alcohol consumption, ever use of oral contraceptives was marginally inversely associated with colorectal cancer risk (hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.83–1.02), although this association was stronger among post-menopausal women (HR, 0.84; 95% CI: 0.74–0.95). Duration of oral contraceptive use and reproductive factors, including age at menarche, age at menopause, type of menopause, ever having an abortion, parity, age at first full-term pregnancy and breastfeeding, were not associated with colorectal cancer risk.

Conclusion:

Our findings provide limited support for a potential inverse association between oral contraceptives and colorectal cancer risk.     

Prospective Evaluation of Quality of Life in Patients Undergoing Primary Surgery for Oral Cancer: Preoperative and Postoperative Analysis

Background: The purpose of the present study was to compare the preoperative and postoperative health related quality of life (HRQoL) of a sample of patients undergoing primary surgery for oral cancer in 2012-13. Materials and Methods: A cross-sectional, prospective study of 54 patients in a Brazilian population was performed. HRQoL was measured preoperatively (after histopathological diagnosis) and postoperatively (2 months after surgery) using the University of Washington Quality of Life Questionnaire (UW-QOL). Clinicopathological, sociodemographic and lifestyle data were collected. Results: Surgery had a negative impact on most HRQoL domains, but pain, mood and anxiety scores were significantly improved. Most patients rated their health-related and overall postoperative HRQoL as good or very good. Conclusions: The UW-QOL was efficient at measuring HRQoL in our sample of patients with oral cancer. Surgery had a negative impact on HRQoL, especially due to sequelae affecting the stomatognathic system, yet patients classified their postoperative health-related and overall QoL as positive. Qualitative studies are necessary for confirmation of our results and further exploration.     

Molecular imaging of glucose uptake in oral neoplasia following topical application of fluorescently labeled deoxy‐glucose

The clinical value of assessing tumor glucose metabolism via F‐18 fluorodeoxyglucose (FDG) PET imaging in oncology is well established; however, the poor spatial resolution of PET is a significant limitation especially for early stage lesions. An alternative technology is optical molecular imaging, which allows for subcellular spatial resolution and can be effectively used with topical contrast agents for imaging epithelial derived cancers. The goal of this study was to evaluate the potential of optical molecular imaging of glucose metabolism to aid in early detection of oral neoplasia. Fluorescently labeled deoxyglucose (2‐NBDG (2‐[N‐(7‐nitrobenz‐2‐oxa‐1,3‐diazol‐4‐yl)amino]‐2‐deoxy‐D ‐glucose)) was applied topically to tissue phantoms, fresh oral biopsies (n = 32) and resected tumors specimens (n = 2). High‐resolution imaging results show that 2‐NBDG can be rapidly delivered to oral epithelium using topical application. In normal epithelium, the uptake of 2‐NBDG is limited to basal epithelial cells. In contrast, high‐grade dysplasia and cancers show uptake of 2‐NBDG in neoplastic cells throughout the lesion. Following 2‐NBDG labeling, the mean fluorescence intensity of neoplastic tissue averages 3.7 times higher than that of matched nonneoplastic oral biopsies in samples from 20 patients. Widefield fluorescence images of 8‐paired oral specimens were obtained pre and postlabeling with 2‐NBDG. Prior to labeling, neoplastic samples showed significantly lower autofluorescence than nonneoplastic samples. The fluorescence of neoplastic samples increased dramatically after labeling; the differential increase in fluorescence was on average 30 times higher in neoplastic samples than in normal samples. Topical application of 2‐NBDG can therefore provide image contrast in both widefield and high‐resolution fluorescence imaging modalities, highlighting its potential in early detection of oral neoplasia. © 2008 Wiley‐Liss, Inc.     

Perceived concepts of continuity of care in people with colorectal and breast cancer--a qualitative case study analysis

We aimed to develop ideas on continuity of cancer care. In-depth qualitative interviews were conducted with 28 people. Seven had cancer. Each person with cancer nominated a close person and a primary and secondary health care professional. We examined from four perspectives: experiences of the initial diagnosis; subsequent treatment; views on continuity of care; information given about the illness; psychological/physical impact of cancer and communication with professionals, family and friends. Perceived continuity of care was influenced by the actions of patients', involvement of close contacts and engagement in shared decision making. Additionally communication between primary and secondary care, the role of various health professionals and hospital administrative systems strongly influenced continuity of care. Informational, management and relational continuity have been previously described. Our data uncovered the effect of patients' actions and the involvement of close friends and families on continuity of cancer care. People with cancer should be enabled to influence continuity of their care. Full recognition of the role of health professionals, different approaches to sharing information with patients and tightening of hospital administrative systems should also be considered.     

Prospective cost-effectiveness analysis of genomic profiling in breast cancer

BackgroundThe cost-effectiveness of the 70-gene signature (70-GS) (MammaPrint®) has earlier been estimated using retrospective validation data. Based on the prospective 5-year survival data of the microarRAy-prognoSTics-in-breast-cancER (RASTER) study, the aim here was to evaluate the cost-effectiveness reflecting the actual use in clinical practice, including reality-based compliance rates.MethodsCosts and outcomes (quality-adjusted-life-years (QALYs)) were calculated in node-negative (N?) patients included in the RASTER study (n = 427). Sensitivity and specificity of the 70-gene and Adjuvant! Online (AO) were based on 5-year distant-disease-free survival (DDFS). Subgroup analyses were performed for two groups for whom benefit of the 70-gene had earlier been reported: (1) ductal, oestrogen receptor-positive (ER+), tumour diameter 10–30 mm, grade II, age 40–70; (2) ductal, oestrogen receptor-positive, tumour diameter 5–30 mm, grade II/III and age 40–70.ResultsBased on 5-year survival data, the cost-effectiveness of the 70-gene signature versus AO was prospectively confirmed. The total health care costs per patient were €26,786 for the 70-gene and €29,187 for AO. The quality adjusted life years yielded 12.49 and 11.88, respectively. The subgroups retrieved slightly higher life gains and higher costs, but all resulted finally in a favourable position for the 70-gene signature.ConclusionsThe use of the 70-gene signature, as judged appropriate by doctors and patients and supported by a low risk 70-gene signature as an oncological safe choice, was also found to be cost-effective.     

The association of cigarette smoking and anxiety, depression and fears of recurrence in patients following treatment of oral and oropharyngeal malignancy

Psychological factors, including distress and fears of recurrence, may be implicated in explaining why head and neck oncology patients continue or refrain from smoking. The aim was to determine the role of psychological factors in understanding smoking behaviour in a consecutive group of cancer patients attending a Regional Maxillofacial Unit over an assessment period of 12 months. A consecutive sample (n = 87) was assessed at 3, 7, 11 and 15 months following initial treatment. Measures of psychological distress included the Worry of Cancer Scale and the Hospital Anxiety and Depression Scale. Patient self-report assessed tobacco consumption. At follow-up, 73 patients successfully completed the four timed assessments (84% response rate). Twenty patients were consistent smokers (27%), 37 (51%) abstained, 7 (10%) returned to smoking, whereas 9 (12%) ceased to smoke by the final 15-month follow-up. Between the consistent smokers and abstainers there was a significant raised level of distress in the smoking group at each assessment after the initial baseline. Fear of recurrence was weakly related to smoking behaviour. The level of cigarette consumption at baseline was a significant predictor (adjust r (2) = 0.37) of psychological distress at 15 months in committed smokers. Previous duration of tobacco consumption prior to illness predicted psychological distress in abstainers (standardized coefficient = 0.29, n = 30, P < 0.036). In conclusion, past and current smoking behaviour is associated with psychological distress in patients with oral and oropharyngeal malignancy in their first 15 months of recovery following initial treatment. This behaviour successfully identified a psychologically at-risk group.     

Oral contraceptive use and reproductive factors and risk of ovarian cancer in the European Prospective Investigation into Cancer and Nutrition

Background:

It is well established that parity and use of oral contraceptives reduce the risk of ovarian cancer, but the associations with other reproductive variables are less clear.

Methods:

We examined the associations of oral contraceptive use and reproductive factors with ovarian cancer risk in the European Prospective Investigation into Cancer and Nutrition. Among 327 396 eligible women, 878 developed ovarian cancer over an average of 9 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models stratified by centre and age, and adjusted for smoking status, body mass index, unilateral ovariectomy, simple hysterectomy, menopausal hormone therapy, and mutually adjusted for age at menarche, age at menopause, number of full-term pregnancies and duration of oral contraceptive use.

Results:

Women who used oral contraceptives for 10 or more years had a significant 45% (HR, 0.55; 95% CI, 0.41–0.75) lower risk compared with users of 1 year or less (P-trend, <0.01). Compared with nulliparous women, parous women had a 29% (HR, 0.71; 95% CI, 0.59–0.87) lower risk, with an 8% reduction in risk for each additional pregnancy. A high age at menopause was associated with a higher risk of ovarian cancer (>52 vs ⩽45 years: HR, 1.46; 95% CI, 1.06–1.99; P-trend, 0.02). Age at menarche, age at first full-term pregnancy, incomplete pregnancies and breastfeeding were not associated with risk.

Conclusion:

This study shows a strong protective association of oral contraceptives and parity with ovarian cancer risk, a higher risk with a late age at menopause, and no association with other reproductive factors.     

Prospective evaluation of cognitive function in patients with early breast cancer receiving adjuvant chemotherapy

Aim: To assess cognitive function prospectively in women with early breast cancer before, during and after the administration of adjuvant chemotherapy. Methods: Between May 2000 and November 2001, 35 assessable patients were entered into the study. Thirty‐one received oral cyclophosphamide, methotrexate and 5‐fluorouracil (CMF) and four received epirubicin and cyclophosphamide followed by CMF ((cyclophosphamide, methotrexate and 5‐fluorouracil)). Testing consisted of the completion of a battery of neuropsychological and psychological inventories and was performed prior to chemotherapy and repeated after 3 (n = 31) and 6 months (n = 30) of chemotherapy and also 6 months after the completion of chemotherapy (n = 27). Results: Prior to chemotherapy a proportion of the patients already exhibited some evidence of impairment of cognitive function. However, on completion of chemotherapy, the neuropsychological scores for short‐term verbal memory and verbal learning were significantly lower than prior to, or 6 months after chemotherapy. In all other domains, cognitive function either remained constant or even appeared to improve. Symptom scales showed that fatigue, nausea and vomiting, constipation and diarrhea were worst half way through the chemotherapy. Quality of life scales indicated that functioning was best after completion of chemotherapy. Conclusion: Patients with early breast cancer may have impaired cognitive function before chemotherapy. Although transient deteriorations in verbal memory and verbal learning were observed on completion of chemotherapy, overall, cognitive function did not decline. It is likely that practice effects influenced our findings.     

Gene expression analysis of head and neck squamous cell carcinoma survival and recurrence

The squamous cell carcinomas represent about 90 % of all head and neck cancers, ranking the sixth most common human cancer. Approximately 450,000 of new cases of head and neck squamous cell carcinoma (HNSCC) are diagnosed every year. Unfortunately, because of diagnosis at the advanced stages and early metastasis to the lymph nodes, the HNSCC is associated with very high death rate. Identification of signature biomarkers and molecularly targeted therapies could provide more effective and specific cancer treatment, prevent recurrence, and increase survival rate. We used paired tumor and adjacent normal tissue samples to screen with RT² Profiler™ PCR Array Human Cancer PathwayFinder^TM. Total of 20 up-regulated genes and two down-regulated genes were screened out. Out of 22 genes, 12 genes were subsequently validated to be significantly altered in the HNSCC; the samples were from all 41 patients. Five year survival and recurrence selected genes that could represent the biomarkers of survival and recurrence of the disease. We believe that comprehensive understanding of the unique genetic characteristics of HNSCC could provide novel diagnostic biomarkers and meet the requirement for molecular-targeted therapy for the HNSCC.     

Cardiac function following combination therapy with paclitaxel and doxorubicin: An analysis of 657 women with advanced breast cancer

Background:To determine the cardiotoxicity of paclitaxel (T) plusdoxorubicin (A) combination therapy in women with advanced breast cancer. Todefine a dose range of A for use in AT. Patients and methods:The effect of cumulative A dose on risk ofcongestive heart failure (CHF) and alterations of myocardial contractility(left ventricular ejection fraction [LVEF] decrease 20% or to<50%) was estimated from pooled data from 10 trials of AT. Results:Thirty-one of 657 patients (4.7%) developed CHFat a median of 6.6 months (range 0.3–24.6) after initiation of AT. CHFwas stabilized in 29 patients at a median of 17.3 months after diagnosis(range 4.1–31.2 months). The risk of developing CHF was 5%at a total A dose 380 mg/m². In patients who received a totalA dose >440 mg/m², the incidence of CHF was >25% butsimilar to that of A monotherapy. The risk of CHF was similar in womenreceiving AT or A monotherapy at a dose 380 mg/m²(2%–3%). LVEF progressively decreased in patients whoreceived AT, especially at a cumulative A dose >380 mg/m². LVEFdecreases were more frequent in patients who later developed CHF, but themajority of CHF patients did not experience LVEF alterations prior tosymptoms. LVEF recovered after discontinuation of A in 25 of 67 women whodeveloped LVEF <50%. Conclusion:The reported cardiac effects are consistent withanthracycline-related cardiotoxicity. AT is associated with a cardiac risksimilar to that of A monotherapy up to a cumulative A dose of 340–380mg/m².     

Prospective medical analysis of radiation therapist image repositioning during image-guided radiotherapy

Purpose

Radiation oncologists are responsible for deciding which day-to-day variations are acceptable or not in the treatment setup. However, properly qualified and trained radiation therapists might be capable to perform image registration. We evaluated in our centre the capability and accuracy of radiation therapists to validate positioning images in a prospective study.

口腔癌下颌骨边缘切除的临床应用

[目的]对口腔癌的下颌骨边缘切除的效果进行评价。[方法]对248例行下颌骨切除的口腔癌病人的临床资料进行了回顾性研究 ,其中82例行边缘性切除 ,166例行骨段切除 ,比较两组病人的复发率和生存率。[结果]边缘切除和骨段切除两组病人的局部复发率分别为15 6 %和16 3 % ,5年生存率分别为52 2 %和55 7 % ,无显著性差异。[结论]下颌骨边缘切除对于无明显破坏或仅有轻度下颌骨破坏的口腔癌是一种有效的下颌骨处理方法 ,既能取得良好的局部控制效果又能较好地保存病人的口腔功能。     

宫颈癌根治术后近期膀胱功能的尿动力学分析

目的:探讨广泛全子宫切除术后患者近期膀胱功能的变化及其意义.方法:63例ⅠB1～ⅡA期宫颈癌患者在宫颈癌根治术前及术后接受尿动力学检测,包括充盈性膀胱测压、压力流率同步测定和括约肌肌电图检查.结果:宫颈癌根治术后近期膀胱初感容量和残余尿量均较术前明显增加(P＜0.01),最大膀胱容量、顺应性、最大尿流率及最大尿流率时的逼尿肌压力均较术前明显降低(P＜0.01).术后,34例患者(54.0%)尿动力学检测发现存在近期膀胱功能障碍,包括逼尿肌受损、低顺应性膀胱、膀胱流出道梗阻、逼尿肌外括约肌协同失调及逼尿肌过度活动,其中低顺应性膀胱和逼尿肌受损发生率明显高于术前(P＜0.01).18例患者(28.6%)发生术后尿潴留,尿潴留患者的逼尿肌受损发生率(66.7%)和逼尿肌过度活动发生率(33.3%)均明显高于非尿潴留患者(分别为20.0%和4.4%).结论:宫颈癌根治术后患者近期膀胱功能改变明显,可表现为多种类型的膀胱功能障碍,并以低顺应性膀胱和逼尿肌受损为主,而逼尿肌受损可能是导致术后尿潴留的主要原因.尿动力学检查对于术后膀胱功能障碍的病因分析及指导治疗具有重要意义.     

Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness

Breast cancer is the most common cancer in women in the industrialized world and a leading cause of death. Breast self-examination (BSE) is one of the methods for an early detection of breast cancer. In the present study the effectiveness of a campaign promoting BSE and breast awareness was analysed. Seminars were conducted in 2003 in Lower Saxony, Germany by a female gynaecologist and a social pedagogue and included a lecture, an individual training in BSE in a separate room and a talk about the importance of regular BSEs. Questionnaires were handed out immediately after the seminar and were sent by post 1 year later. Attendance of the seminar resulted in a significantly higher percentage of monthly BSEs (21.4% before vs. 61.9% after the teaching). Furthermore, 92.1% of the women who did not perform a monthly BSE stated that at least they examined their breasts more frequently after attending the seminar. The data demonstrate that the seminars in BSE had profound effects on the compliance of women in carrying out BSE regularly and correctly, without influence of age or education.     

Immediate mandibular stabilization following resection of advanced oral cavity carcinoma using the Joe Hall Morris external fixation device.

Internal mandibular fixation after resection of advanced oral cavity carcinoma with mandibulectomy has a significant complication rate. We placed the Joe Hall Morris (JHM) external mandibular appliance in 29 patients undergoing mandibulectomy for advanced oral cavity carcinoma. Fourteen patients received postoperative radiation therapy (RT). Three of 29 patients (10%) had complications associated with the JHM appliance: one patient had a broken connecting bar, a second had loosening of a single pin, and a third had loss of fixation requiring complete replacement of the appliance. Complications not associated with the appliance occurred in 8 patients (28%) including mandibular exposure (1), orocutaneous fistula (2), partial flap dehiscence (4), and flap necrosis (1). Oral continence was maintained in 26 patients, and occlusion was normal in 27. The appliance was removed in 12 weeks to 6 months in all patients. The JHM appliance allows for a reliable and rapid immediate fixation of the mandible with acceptable functional and aesthetic results, and no delay or interference with postoperative radiotherapy. Since the life expectancy of these patients is short, most do not require subsequent permanent fixation after removal of the appliance.