Deterioration in quality of life and depressive symptoms during radiation therapy for head and neck cancer.

OBJECTIVE: The aim of this study was to assess the quality of life and psychologic profile during radiation therapy for head and neck cancer. STUDY DESIGN AND SETTING: The University of Washington QoL instrument and the Hospital Anxiety and Depression Scale were administered to 202 patients at two or three time points during radiation therapy. RESULTS: A total of 118 (54.6%) patients completed the questionnaires at the beginning and at the end of the study. A mid-treatment dataset was also available for 67 (31.0%) patients. There was a statistically significant deterioration in composite QoL scores (P < 0.000) and a statistically significant increase in depression (P < 0.000). There was no difference in anxiety levels (P = 0.276). CONCLUSION: Patients undergoing radiation are increasingly depressed as treatment progresses, with worsening QoL during the treatment. SIGNIFICANCE: This study underlines the need for good psychologic support during radiation therapy in head and neck cancer.     

Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: a diagnostic meta-analysis

BACKGROUND: The sentinel node biopsy concept has been gaining support in the head and neck cancer literature during only the last few years, and several pilot studies have been published. This procedure aims to avoid unnecessary treatment to the clinically negative neck by identifying the patients with occult neck disease. METHODS: We performed a systematic review and a diagnostic meta-analysis of all published literature regarding sentinel node biopsies in head and neck cancer until December 2003 using established guidelines. Using the pooled sensitivity rates obtained from the meta-analysis and treatment outcomes from published literature, we created a decision analysis model to identify the treatment arm with better payoffs. RESULTS: A total of 301 patients with oral cavity primary tumors and 46 patients with oropharyngeal primary tumors from 19 articles were included for the meta-analysis. The pooled sensitivity result using the random effects model was 0.926 (95% confidence interval, 0.852-0.964). The cumulative payoff for the sentinel node biopsy arm was lower than that for the elective node dissection arm by about 1%. The payoffs were assigned for the recurrence and mortality rates only and did not take into account the morbidity caused by the procedures. CONCLUSIONS: The sentinel node biopsy procedure has shown high sensitivity rates in pilot studies for oral and oropharyngeal squamous cell cancer across the globe and is reliable and reproducible. This study provides a firm evidence base for forthcoming trials on the role of sentinel node biopsy in head and neck cancer.     

The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis

Clin. Otolaryngol. 2010, 35 , 364–372 Background: Laryngeal dysplasia is a pre-malignant condition with wide variability in rates of malignant transformation reported in the literature. The management and follow-up strategies of these lesions vary widely. Objectives: To assess the risk of and interval to malignant transformation in patients with laryngeal dysplasia, the effect of different treatment modalities on malignant transformation and the effects that risk factors such as smoking, excessive alcohol intake and histological grade may have on this. Type of review: Systematic of observational studies with attempted meta-analysis. Search strategy: A structured search of Medline (1966 to January 2010), EMBASE (1980 to January 2010), CINAHL (1981 to January 2010) and Cochrane databases (CENTRAL, Cochrane Library, 1995 to January 2010). Results: Nine hundred and forty cases from nine studies were included in the analysis. Overall malignant transformation rate was 14% (confidence interval 8, 22) and mean time to malignant transformation was 5.8 years. The malignant transformation rate is higher with increased severity of dysplasia grade – severe/CIS 30.4%versus mild/moderate 10.6% (P < 0.0002). Treatment modality did not show significant effects. Conclusions: Laryngeal dysplasia carries a significant risk of malignant transformation. This risk triples with increasing severity of dysplasia. Transformation often occurs late and is not related to the grade of dysplasia. There is little evidence, therefore, to support the early discharge of patients with mild/moderate dysplasia, which is practised by some clinicians.     

Current theories for the development of nonsmoking and nondrinking laryngeal carcinoma

The pivotal risk of smoking and alcohol in laryngeal cancer has meant that evidence for alternate cofactors has been indicative to date. A number of case series, however, contain a few patients who are life-long nondrinkers and nonsmokers and question what other cofactors may contribute. Gastroesophageal reflux disease makes a small but significant contribution to the causal development of laryngeal cancer; however, what remains to be understood is the mechanism of its action. Bile reflux appears to be an additional causative factor in achlorhydrics. After controlling for the effects of alcohol and tobacco, exposure to oncogenic types of human papilloma virus is associated with an increased risk of laryngeal carcinoma. Evidence does not support asbestos exposure itself as increasing the relative risk of laryngeal cancer. A dietary increase in vegetables and fruit may confer an advantage in reducing the laryngeal cancer incidence. Inherited differences in cell cycle control systems, DNA repair systems, and carcinogen-metabolizing enzymes can increase the risk for laryngeal cancer, but as yet, no causal mechanism has been demonstrated.     

Interleukins 7 and 12 are expressed in head and neck squamous cancer

Interleukin 7 (IL-7) and IL-12 have major roles in cell-mediated tumour immunity. In head and neck squamous cell cancer, depressed cell-mediated immunity is well documented and may account for the poor prognosis. This is the first study to assess intratumour expression of IL-7 and IL-12 in head and neck squamous cell cancer (HNSCC). Immunohistochemistry was used to identify IL-7 and IL-12 expression in snap-frozen tumour specimens from 25 patients with HNSCC and the results of immunohistochemical staining were semiquantitatively graded. Both IL-7 and IL-12 were expressed in all tumour samples and expression was not related to tumour stage or site. A trend towards better survival was associated with high expression of IL-7 and IL-12, this being more pronounced with IL 7. The universal expression suggests that the depressed cell-mediated immunity in HNSCC is not caused by reduced production of IL-7 and IL-12. Further studies with larger cohorts, especially of IL-7, are certainly warranted.