Initial staging of squamous cell carcinoma of the oral cavity, larynx and pharynx (excluding nasopharynx). Part I: Locoregional extension assessment: 2012 SFORL guidelines

OBJECTIVES

To set out good practice guidelines for locoregional extension assessment of squamous cell carcinoma of the head and neck (excluding nasopharynx, nasal cavities and sinuses).

MATERIALS AND METHODS

A critical multidisciplinary review of the literature on locoregional extension assessment of squamous cell carcinoma of the head and neck was conducted, applying levels of evidence in line with the French health authority's (HAS) literature analysis guide of January 2000.

CONCLUSION

Based on the levels of evidence of the selected articles and on work-group consensus, graded guidelines are set out for clinical, endoscopic and imaging locoregional extension assessment of head and neck cancer.

Nodal recurrence of sinonasal cancer: does the risk of cervical relapse justify a prophylactic neck treatment?

BACKGROUND

Sinonasal cancers are rare and no high-level evidence exists to determine their optimal management. Prophylactic neck treatment issue remains controversial. The aim of this study was to analyze the pattern of neck failure and to identify any prognostic factors that may influence neck control.

METHODS

A retrospective review of 155 consecutive patients treated for sinonasal malignancy, without prophylactic neck treatment, between 1995 and 2005 at tertiary cancer center was performed. Demographic, clinical, morphological and pathological parameters were correlated with oncologic outcomes.

RESULTS

Eight out of 155 patients (5%) presented initially with neck node metastasis. Complete remission was obtained for 133 patients after treatment completion. During follow up, 16 out of 133 patients (12%) were affected with regional recurrence. Neck failure occurred in 8 out of 51 patients with local failure and in 8 out of 82 patients locally controlled. Isolated nodal failure was observed in 5 patients initially cN0 out of 133 (3.8%) representing 7.3% of all recurrences and 3 of them underwent successful salvage therapy. None of the tested factors were significantly associated with neck control (p>0.05). Lymph node at diagnosis time was significantly and independently associated with poor survival (p=0.0012).

CONCLUSION

Isolated neck relapse, when local control is achieved, is rare and salvage treatment is effective. Routine prophylactic neck treatment has little interest. However, this approach could be profitable to few selected patients, who remain to be defined. Further investigations are needed.

Abstract 3799: Polyamine Transport System (PTS) activity and hijacking in cancer cells: New option in Head and Neck tumors treatment with the polyamine-containing drug candidate F14512

The Polyamine Transport System, although not clearly identified at the molecular level in eukaryotic organisms, was found over activated in many types of cancer cells, such as leukemia, prostate, melanoma and NSCLC. Polyamines are implicated in many biological functions, and the need for polyamines in tumor cells, conveyed by the PTS, is crucial. New therapeutic strategies consist to use this transport system to deliver a cytotoxic agent specifically into cancer cells. Head and neck cancer remains the 6th common cancer with a very poor survival rate indicating the crucial need for new targeted strategies. For this study, we used 4 Head and Neck (H & N) cancer cell lines representative of various localizations: CAL 33 and CAL 27 from base of the tongue, Fadu from the pharynx and SQ20B from the larynx. Here, using a polyamine-coupled fluorescent probe, we show that the PTS is active in all head and neck cancer cell lines regardless the tumor localization. In these models, flow cytometry demonstrated that the PTS incorporates quickly, massively and specifically the probe into cancer cells. Confocal microscopy observations revealed that the spermine probe accumulates into the cell nuclei, the site of action of F14512 which is a potent topoisomerase II inhibitor. Considering this property, we evaluated the potential of the F14512 (Pierre Fabre laboratories, France) in these H & N cancer cell lines. F14512 contains a PTS-recognized spermine side chain attached to an epipodophyllotoxin moiety targeting topoisomerase II. We found that F14512 presents a much higher cytotoxicity than etoposide in the 4 cell lines. Competition assays showed that this effect is dependent of the PTS activity and confirmed the targeted action of F14512 against cells with active PTS. The high efficiency of F14512 in the head and neck cancer cell lines is reported here for the first time and may be of interest for the future development of this novel drug candidate, currently in phase 1 clinical trial in leukemia. Studies are in progress, using fresh tumor biopsies from patients with head and neck cancer, to analyze the PTS status of the tumors using the specific spermine-containing fluorescent probe and to evaluate the activity of F14512.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3799. doi:1538-7445.AM2012-3799

Laryngeal preservation with induction chemotherapy for hypopharyngeal squamous cell carcinoma: 10-year results of EORTC trial 24891

BACKGROUND

We report the 10-year results of the EORTC trial 24891 comparing a larynx-preservation approach to immediate surgery in hypopharynx and lateral epilarynx squamous cell carcinoma.

MATERIAL AND METHODS

Two hundred and two patients were randomized to either the surgical approach (total laryngectomy with partial pharyngectomy and neck dissection, followed by irradiation) or to the chemotherapy arm up to three cycles of induction chemotherapy (cisplatin 100 mg/m(2) day 1 + 5-FU 1000 mg/m(2) day 1-5) followed for complete responders by irradiation and otherwise by conventional treatment. The end points were overall survival [OS, noninferiority: hazard ratio (preservation/surgery) ≤ 1.428, one-sided α = 0.05], progression-free survival (PFS) and survival with a functional larynx (SFL).

RESULTS

At a median follow-up of 10.5 years on 194 eligible patients, disease evolution was seen in 54 and 49 patients in the surgery and chemotherapy arm, respectively, and 81 and 83 patients had died. The 10-year OS rate was 13.8% in the surgery arm and 13.1% in the chemotherapy arm. The 10-year PFS rates were 8.5% and 10.8%, respectively. In the chemotherapy arm, the 10-year SFL rate was 8.7%.

CONCLUSION

This strategy did not compromise disease control or survival (that remained poor) and allowed more than half of the survivors to retain their larynx.

[Elements of completeness and results of the first year of registration of the "Registre général des cancers de Lille et de sa région"]

BACKGROUND

In 2005, following the first cancer plan of the national health authorities, a general cancer registry was established in northern France, in a territory designated as a "zone in proximity to the city of Lille" (ZPL). The aim of the present work was to evaluate the completeness of the registry's first year of incident cancer registration (2005) and to compare the observed cancer incidence in the "ZPL" with the estimated incidence in France.

METHODS

Completeness was assessed using the average number of sources per case, the percentage of histological verification and a method of independent case ascertainment (mortality/incidence ratio). A direct standardization on the world population was used to calculate the ZPL/France ratios of standardized incidence rates. Analyses were conducted for 21 cancer sites.

RESULTS

In 2005, 3635 cases of invasive cancer were recorded by the registry. The average number of sources per case was 2.7 and histological proof was available for 91.4% of cases. Mortality/incidence ratios showed satisfactory completeness of the data for men for most cancer sites. For women however, for cancer sites for which the number of cases was low, data will have to be confirmed during the subsequent years of observation. A lack of completeness was found for cutaneous melanoma. In men, an overincidence was identified for cancers of lip-mouth-pharynx, larynx, esophagus, lung, liver, bladder, kidney and colon-rectum. In women, an overincidence has been identified for cancers of lip-mouth-pharynx, liver, bladder, colon-rectum, corpus uteri and ovaries.

CONCLUSION

The first year of incidence validated at the "Registre général des cancers de Lille et de sa région" shows a completeness of records with regards to studied criteria. The comparison with national data shows an overincidence of cancers related to tobacco and alcohol consumption in the geographical area covered by the registry. The incidence of lip-mouth-pharynx cancer in men is the highest of all French registries.

Endoscopic repair of anterior or middle skull base cerebrospinal fluid leaks after tumour resection

OBJECTIVES

This study analysed the factors influencing the risk of recurrence following endoscopic repair of CSF leaks of the anterior and middle skull base after endonasal skull base tumour resection.

PATIENTS AND METHODS

A retrospective review was conducted on 17 patients operated between May 2007 and December 2010 by endonasal endoscopic resection of anterior or middle skull base tumour who presented an intraoperative CSF leak. Epidemiological data (body mass index [BMI], age, gender) and type of leak (site, size) were studied.

RESULTS

CSF leaks involved the roof of the ethmoid sinus (one patient), cribriform plate (three), posterolateral wall of the sphenoid sinus (six) or the sella turcica (seven). The CSF leak recurrence rate after the first endoscopic procedure was 29.4% (5/17). Failures were not influenced by gender, age, BMI or size of the leak. All recurrences involved the sella turcica or the lateral wall of the sphenoid sinus. The success rate after a second endoscopic procedure was 88.2%.

CONCLUSION

Endonasal endoscopic repair of anterior and middle skull base meningeal injuries after tumour resection is a minimally invasive and effective technique. The main challenge of this method consists of ensuring effective control of the postoperative defect after tumour resection in the sphenoidal region, as this region was the only potential risk factor for recurrence identified in this study.

Galectin fingerprinting in Warthin's tumors: lectin-based approach to trace its origin?

Warthin's tumor of the parotid gland is assumed to originate from the proliferation of epithelial inclusions within parotid lymph nodes. In that case, these cells are supposed to retain characteristics similar to common salivary gland ductal cells. Using immunohistochemical fingerprinting with four members of the family of adhesion/growth-regulatory galectins and comparison to intra- and interlobular ducts, marked similarities were noted for presence of galectins-3, -7 and -8. Notably, profiles of lectin binding, determined by applying human lectins as probes, were also similar when testing biotinylated galectins-3 and -8. Besides defining the galectin histochemical parameters in Warthin's tumors this study adds support to the hypothesis of heterotopia.

Galectin-8 up-regulation during hypopharyngeal and laryngeal tumor progression and comparison with galectin-1, -3 and -7

AIM

To define specific staining patterns for the adhesion/growth-regulatory lectin tandem-repeat-type galectin-8 in hypopharyngeal and laryngeal tumor progression and relate these parameters to galectins 1, 3 and 7 in the quest to explore the galectin network.

MATERIALS AND METHODS

The level of expression of galectin-8 was determined immunohistochemically in a series of 18 and 16 cases of tumor-free epithelium, 24 and 10 cases of low-grade dysplasia, 22 and 15 cases of high-grade dysplasia located in peri-tumoral area of 74 and 37 hypopharyngeal and laryngeal carcinomas.

RESULTS

Marked upregulation in galectin-8 staining intensity and immunopositive area in malignancy versus dysplasia was seen in hypopharyngeal cancer (p<10(-6)), in laryngeal cancer for labeling index and high-grade dysplasia/carcinoma (p<10(-6)). No correlation to recurrence was delineated.

CONCLUSION

The presented data revealed a divergence within the galectin-1, -3, -7 and -8 network during tumor progression.

The helicase-like transcription factor is a strong predictor of recurrence in hypopharyngeal but not in laryngeal squamous cell carcinomas

AIMS

To examine the immunohistochemical expression of helicase-like transcription factor (HLTF) in relation to the prognosis of hypopharyngeal (HSCCs) and laryngeal (LSCCs) squamous cell carcinomas, and to characterize the HLTF protein variants expressed in biopsy specimens of head and neck squamous cell carcinoma (HNSCC) as well as the HeLa cell line.

METHODS AND RESULTS

HLTF expression was determined by immunohistochemistry on a series of 100 hypopharyngeal (stage IV) and 56 laryngeal SCCs (stages I, II and IV). The HLTF variants were defined using reverse transcriptase-polymerase chain reaction and Western blots in 13 fresh HNSCC biopsies and in HeLa cells. High levels of HLTF expression were associated with rapid recurrence rates in a subgroup of 81 stage IV hypopharyngeal SCCs (with complete follow-up). A 95-kDa HLTF variant truncated at the carboxyl-terminal domain was detected in addition to the 115-kDa full-size protein in HNSCC biopsies, while six variants were observed in HeLa cells.

CONCLUSIONS

Our results demonstrate, for the first time, that hypopharyngeal SCCs presenting high levels of HLTF have a worse prognosis. The quantitative determination of HLTF in hypopharyngeal SCCs was an independent prognostic marker alongside tumour node metastasis staging. HNSCCs expressed the truncated HLTF variant lacking the domains involved in DNA repair.

Ethnic differences in the distribution ofCYP3A5gene polymorphisms

The genetic polymorphism affecting the CYP3A5 enzyme is responsible for interindividual and interethnic variability in the metabolism of CYP3A5 substrates. The full extent of the CYP3A5 genetic polymorphism was analysed in French Caucasian, Gabonese and Tunisian populations using a polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) strategy. In the three populations, eight, 17 and ten single nucleotide polymorphisms (SNPs), respectively, were identified, among which nine correspond to rare new mutations. Also identified were 16 alleles including eight new allelic variants. Significant differences were observed in the distribution of these alleles. Particularly, the frequency of the CYP3A5*3C null allele in French Caucasians (81.3%) and in Tunisians (80.0%) is higher than in the Gabonese population (12.5%) (p < 0.001). Considering the CYP3A5 genotypes of the tested individuals, only 10.4% of French Caucasians and 30.0% of Tunisians were identified as CYP3A5 expressors. In contrast, 90.0% of Gabonese subjects appear to express the CYP3A5 protein.

[Preoperative corticosteroid treatment and nasal polyposis]

OBJECTIVES

Impairment of the surgical view by bleeding in endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps (CRSwNP) contributes to the risk of skull base injuries. The aim of this study was to investigate the effect of a short course of a systemic corticoid treatment on bleeding and surgical field quality during endoscopic ethmoidectomy for CRSwNP.

METHODS

A prospective study was conducted on 40 patients. Before surgery, 21 of them (group B) were treated with 1 mg/kg per day of prednisolone for seven days. They were compared with the 19 other patients (group A) on intraoperative blood loss and surgery duration.

RESULTS

The two groups shared identical clinical features (Lidholdt endoscopic grading). There was no statistical difference in terms of bleeding, although the Lund-Mackay CT score was higher in group B (19/24 vs. 21/24, p=0.05). The surgical procedure was shorter in group B (72 min vs. 85 min, p=0.05).

CONCLUSION

Preoperative treatment with systemic corticosteroids does not seem to reduce surgical blood loss. However, we noted a decrease in the procedure's duration. By reducing mucous inflammation, this treatment could improve the local conditions and help the surgeon in the mucous eradication.

Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy

BACKGROUND

Both induction chemotherapy followed by irradiation and concurrent chemotherapy and radiotherapy have been reported as valuable alternatives to total laryngectomy in patients with advanced larynx or hypopharynx cancer. We report results of the randomized phase 3 trial 24954 from the European Organization for Research and Treatment of Cancer.

METHODS

Patients with resectable advanced squamous cell carcinoma of the larynx (tumor stage T3-T4) or hypopharynx (T2-T4), with regional lymph nodes in the neck staged as N0-N2 and with no metastasis, were randomly assigned to treatment in the sequential (or control) or the alternating (or experimental) arm. In the sequential arm, patients with a 50% or more reduction in primary tumor size after two cycles of cisplatin and 5-fluorouracil received another two cycles, followed by radiotherapy (70 Gy total). In the alternating arm, a total of four cycles of cisplatin and 5-fluorouracil (in weeks 1, 4, 7, and 10) were alternated with radiotherapy with 20 Gy during the three 2-week intervals between chemotherapy cycles (60 Gy total). All nonresponders underwent salvage surgery and postoperative radiotherapy. The Kaplan-Meier method was used to obtain time-to-event data.

RESULTS

The 450 patients were randomly assigned to treatment (224 to the sequential arm and 226 to the alternating arm). Median follow-up was 6.5 years. Survival with a functional larynx was similar in sequential and alternating arms (hazard ratio of death and/or event = 0.85, 95% confidence interval = 0.68 to 1.06), as were median overall survival (4.4 and 5.1 years, respectively) and median progression-free interval (3.0 and 3.1 years, respectively). Grade 3 or 4 mucositis occurred in 64 (32%) of the 200 patients in the sequential arm who received radiotherapy and in 47 (21%) of the 220 patients in the alternating arm. Late severe edema and/or fibrosis was observed in 32 (16%) patients in the sequential arm and in 25 (11%) in the alternating arm.

CONCLUSIONS

Larynx preservation, progression-free interval, and overall survival were similar in both arms, as were acute and late toxic effects.

Adhesion/growth-regulatory tissue lectin galectin-1 in relation to angiogenesis/lymphocyte infiltration and prognostic relevance of stromal up-regulation in laryngeal carcinomas

BACKGROUND

Galectin-1 has been found to modulate lymphocyte invasion in inflammation and to be involved in angiogenesis in models, thus prompting examination of its clinical relevance in laryngeal cancer.

PATIENTS AND METHODS

Immunohistochemical processing of tissue sections (n=53) from patients with stage I/II (n=35) and stage IV (n=18) laryngeal squamous cell carcinoma (LSCC) with a specific anti-galectin-1 antibody and monitoring of CD45/CD31 positivity was combined with quantitative morphometric analysis.

RESULTS

Lectin presence in the tumor and endothelial cells was positively correlated, while a negative relationship to the number of CD45-positive lymphocytes was demonstrated. No association was seen with the extent of neovascularization. The mean optical density (MOD) of lectin-dependent staining in the tumor stroma was significantly increased compared to normal stroma.

CONCLUSION

Galectin-1 was not associated with angiogenesis in the studied cohort while galectin-1 in endothelial cells may negatively influence lymphocyte invasion and the mean optical density for the stromal galectin-1 signal is up-regulated in tumors.

Lund-Mackay score is predictive of bleeding in ethmoidectomy for nasal polyposis

OBJECTIVES

To assess the correlation between intraoperative bleeding during endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps and objective parameters of disease severity.

STUDY DESIGN

A prospective cohort of 40 patients with nasal polyposis treated by endoscopic ethmoidectomy was analyzed from January 2007 to July 2007.

METHODS

Polyp size and CT scan opacifications were noted. The surgical procedure was performed with a standardized protocol. Intraoperative blood loss was measured. The Spearman test was used to correlate these data.

RESULTS

On nasal endoscopy, the mean polyps' size score was 2.2 (+/- 0.65). On CT scan, the Lund-Mackay grading was 17.2/24 (+/- 5.8). The rate of flow of intraoperative bleeding was 0.077%/min (+/- 0.070%/min). A significant positive correlation was found between the CT scan score and the rate of flow of intraoperative bleeding for the patients who were surgically treated for the first time (n = 23, Spearman Rho = 0.411, p = 0.05).

CONCLUSION

The Lund-Mackay CT score is useful in predicting intraoperative bleeding during endoscopic ethmoidectomy. It could help to identify patients for whom specific measures like preoperative treatment with antibiotics and steroids, topical perioperative preparation of the nose or hypotensive anesthesia are required in order to reduce the risk of intraoperative complications.

CYP2A13 genetic polymorphism in French Caucasian, Gabonese and Tunisian populations

Since human CYP2A13 is expressed in the respiratory tract and is involved in the activation of tobacco-specific nitrosamines, some of the previously reported sequence variations may contribute to inter-individual and inter-ethnic differences in the susceptibility of tobacco-related tumorigenesis. The aim was to compare the frequencies of the 578C > T (Arg101Stop), 3375C > T (Arg257Cys) and 7520C > G (3'-untranslated region) mutations in several populations. The frequencies of the 578C > T polymorphism were 3.8, 0 and 1.0% in French Caucasians, Gabonese and Tunisians, respectively. In the same populations, the frequencies of the 3375C > T mutation were 0, 15.3 and 4.2%, respectively, whereas the frequencies of the 7520C > G mutation were 1.0, 20.8 and 7.3%, respectively. Marked inter-ethnic variations in CYP2A13 were identified and confirmed. These findings provide data for further studies that associate CYP2A13 haplotypes with an incidence of smoking-related tumours in respect of ethnicity.

CYP2F1 genetic polymorphism: identification of interethnic variations

Since human cytochrome P450 2F1 (CYP2F1) is predominantly expressed in lung tissue and is involved in the metabolism of various pneumotoxicants with potential carcinogenic effects, variations in the nucleotidic sequence of its gene may contribute to interindividual and interethnic differences in the susceptibility to lung tumorigenesis. The aim of the current study was to compare the frequency of a previously reported frameshift mutation, namely c.14_15insC, responsible for the synthesis of a severely truncated protein, between several populations of different ethnic origins. The frequencies of this polymorphism were 26.1, 51.6, 42.7 and 22.9% in French, Gabonese, Senegalese, and Tunisian population samples, respectively, thereby representing a substantial inter ethnic variation in the CYP2F1 gene. These findings provide data for further studies that investigate the potential association of CYP2F1 haplotypes with an incidence of lung cancer genesis in respect of ethnicity.

Characterisation of novel defective thiopurine S-methyltransferase allelic variants

Human thiopurine S-methyltransferase (TPMT, EC 2.1.1.67) is a key enzyme in the detoxification of thiopurine drugs widely used in the treatment of various diseases, such as inflammatory bowel diseases, acute lymphoblastic leukaemia and rheumatic diseases. The TPMT gene is genetically polymorphic and the inverse relationship between TPMT activity and the risk of developing severe hematopoietic toxicity is well known. In this study, the entire coding sequence of TPMT, together with its 5'-flanking promoter region, was analysed in patients with an intermediate phenotype for thiopurine drug methylation. Four polymorphisms were identified, two previously described, c.356A>C (p.Lys(119)Thr, TPMT*9) and c.205C>G (p.Leu(69)Val, TPMT*21), and two novel missense mutations, c.537G>T (p.Gln(179)His, TPMT*24) and c.634T>C (p.Cys(212)Arg, TPMT*25). Structural investigations, using molecular modeling, were undertaken in an attempt to explain the potential impact of the amino acid substitutions on the structure and activity of the variant proteins. Additionally, in order to determine kinetic parameters (K(m) and V(max)) of 6-thioguanine (6-TG) methylation, the four variants were expressed in a recombinant yeast expression system. Assays were performed by HPLC and the results were compared with those of wild-type TPMT. The p.Leu(69)Val and the p.Cys(212)Arg substitutions encode recombinant enzymes with a significantly decreased intrinsic clearance compared to that of the wild-type protein, and, consequently, characterise non-functional alleles of TPMT. The p.Lys(119)Thr and the p.Gln(179)His substitutions do not affect significantly the catalytic activity of the corresponding variant proteins, which prevents to unambiguously describe these latter alleles as defective TPMT variants.