Smad7 Promotes Healing of Radiotherapy-Induced Oral Mucositis without Compromising Oral Cancer Therapy in a Xenograft Mouse Model

PURPOSE

We previously reported preventive and therapeutic effects of Smad7, a multifunctional protein, on radiotherapy (RT)-induced mucositis in mice without promoting human oral cancer cell survival or migration in vitro. The current study aims to determine whether a Smad7-based biologic can treat existing oral mucositis during radiotherapy for oral cancer and whether this treatment compromises RT-induced cancer cell killing in neighboring oral cancer.Experimental Design: We transplanted human oral cancer cells into the tongues of mice and applied craniofacial irradiation to simultaneously kill tumor cells and induce oral mucositis, thus modeling RT and mucositis in oral cancer patients. We topically applied a recombinant human Smad7 protein fused with the cell-penetrating Tat tag (Tat-Smad7) to the oral mucosa of tumor-bearing mice post RT when oral mucositis began to develop.

RESULTS

Topically applied Tat-Smad7 penetrated cells in both the oral mucosa and oral cancer, attenuating TGFβ and NF-κB signaling as well as inflammation at both sites. Tat-Smad7 treatment alleviated oral mucositis with reductions in DNA damage and apoptosis in keratinocytes, but increased keratinocyte proliferation compared with vehicle-treated mucositis lesions. In contrast, adjacent oral cancer exposed to Tat-Smad7 did not show alterations in proliferation or direct DNA damage, but showed increased oxidative stress damage and apoptosis compared with tumors treated with vehicle.

CONCLUSIONS

Our results suggest that short-course Tat-Smad7 application to oral mucositis promotes its healing but does not compromise the cytotoxic effect of RT on oral cancer and has context-specific effects on oral mucosa versus oral cancer.

[The influence of dental status on local immunity of oral cavity of elderly and senile patients with squamous cell carcinoma of the oral cavity mucosa.]

This article presents the results of a study of the dental status of 60 elderly and senile patients with squamous cell carcinoma of the oral mucosa. The use of removable and non-removable dentures, carious lesions of teeth, dental plaque, sharp edges of the crown seals were studied as components of the dental status.

Mandible reconstruction with patient-specific implants: Case report of five consecutive patients

The purpose of this case report was to assess whether patient-specific implants (PSI: Xillocs) and soft tissue flaps contribute in reconstructing large mandibular defects. Five patients with a medical situation and history not suitable for free microvascular bone flaps were operated with PSI and evaluated. The mean follow-up time was 12 months. The excellent fit, convenient surgery, and esthetic outcome were seen as the major advantages. The PSI can, in the authors' experience, be considered as a useful alternative provided they are well embedded by viable tissue and attached to vital resection margins of the recipient bone.

Incidental finding of subgemmal neurogenous plaque upon retrospective evaluation of oral lymphoepithelial cysts

PURPOSE

We aimed to compare the histomorphological features of oral lymphoepithelial cysts (OLC) in different locations of the oral cavity and to verify the association between oral lymphoepithelial cysts and subgemmal neurogenous plaque (SNP) on biopsies from the lateral border of the tongue.

METHODS

All cases diagnosed as OLC from the Oral Pathology Service at the School of Dentistry/University of São Paulo were retrieved. For all the cysts located in the tongue, their association to SNP was analyzed. Immunohistochemical staining against S100 was performed to confirm the diagnosis of SNP.

RESULTS

Thirty-one cases were selected for morphological analysis and SNP was identified in 40% of cases, all of them positive for S100. In these cases, macroscopic analysis demonstrated two independent fragments. Microscopic analysis showed that cysts located in the floor of the mouth and ventral surface of the tongue showed less intense exocytosis, less formation of lymphoid follicles, and predominantly a moderate inflammatory infiltrate.

CONCLUSIONS

OLC have a similar histological pattern regardless the location within the oral cavity and. In some cases, the biopsy specimen may be accompanied by a SNP as an adjacent independent structure.

[Systematic retrospective study of oral cancer-related quality of life scale]

OBJECTIVE

The quality of life (QOL) related to oral cancer has recently become a focus of clinical studies. This study aims to systematically review the current research situation of QOL of local and foreign oral cancer patients and explore the existing related problems and future research directions to provide references and solutions.

METHODS

Through relevant key words, PubMed, Wiley InterScience, Science Direct, CNKI, and Wanfang databases were first searched. The related target literature from 2000 to 2017 were screened. Finally, the frequency of oral cancer related to QOL scale used in literature was calculated, and the related scales were briefly introduced.

RESULTS

From the target literature, 218 English target literature, 55 Chinese target literature, 24 English scales, and 12 Chinese scales were selected. The most widely used scales for assessing the QOL of patients with oral cancer were as follows: University of Washington Quality of Life Questionnaire (UW-QOL), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck 35 (EORTC QLQ-C30/H&N35), 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), and Oral Health Impact Profile (OHIP).

CONCLUSIONS

The QOL related to oral cancer was well underway, and the study of geographical distribution was widespread. However, the work on self-developed scale remains inadequate. UW-QOL, EORTC QLQ-C30/H&N35, and FACT-H&N can be utilized as the preferred scales for evaluating the QOL of oral cancer patients. A specific disease-related function scale can also be selected according to specific research objectives.

Turmeric and Curcumin as Topical Agents in Cancer Therapy

An ethanol extract of turmeric (« Curcuma longa ») as well as an ointment of curcumin (its active ingredient) were found to produce remarkable symptomatic relief in patients with external cancerous lesions. Reduction in smell were noted in 90 % of the cases and reduction in itching in almost all cases. Dry lesions were observed in 70 % of the cases, and a small number of patients (10 %) had a reduction in lesion size and pain. In many patients the effect continued for several months. An adverse reaction was noticed in only one of the 62 patients evaluated.

The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient

Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing should be undertaken during oncology follow-up. We report the use of the Patient Concerns Inventory in a routine head and neck cancer clinic setting over a seven-year period, summarising the number of available clinics, the number of patients completing the inventory within a clinic, the range of clinical characteristics and the concerns they wanted to discuss. Methods The data were analysed from oncology follow-up clinics between 1 August 2007 and 10 December 2014. Audit approval was given by the Clinical Audit Department, University Hospital Aintree. Results There were 386 patients with 1198 inventories completed at 220 clinics, median 6 (range 4-7) per clinic. The most common concerns raised by patients across all the clinic consultations were dry mouth (34%), fear of recurrence (33%), sore mouth (26%), dental health (25%), chewing (22%) and fatigue/tiredness (21%). Conclusions The incorporation of the Patient Concerns Inventory as part of routine oncology clinics allows for a more patient initiated and focused consultation available to the majority of patients throughout their follow-up. The inventory allows for greater opportunity to provide holistic targeted multiprofessional intervention and support.

Impact of Oral Cancer on Quality of Life

The clinical manifestations of oral cancer and the effects of treatment can have a negative impact on a patient's quality of life. Physiologic functions, cosmetic appearance, and psychological well-being can become compromised during the diagnosis, treatment, and survivorship of patients with oral cancer. This article addresses the relationship of oral cancer and quality of life, as well as the different aspects affected by this condition.

Fanconi anaemia and oral squamous cell carcinoma: management considerations

Fanconi anaemia (FA) is a rare multi-system genetic disorder where patients are susceptible to the development of oral malignancies. Clinicians involved in their management should be vigilant in detecting lesions early, and an individualised treatment plan should then be formulated. Although surgery forms the mainstay of oncological treatment, adjuvant therapy can be instituted with care. Unfortunately, prognosis is poor, and close long-term follow-up is required. This short report describes pertinent management considerations in relation to a case of oral squamous cell carcinoma.

[Evaluation of nutrition risk and analysis of relative factors of patients with oral and maxillofacial cancer]

PURPOSE

To evaluate the potential nutrition risk and analyze relative factors in patients with oral and maxillofacial cancer, and explore the treatment method of nutrition risk.

METHODS

Eighty eight patients with oral and maxillofacial cancer were included in the present study. Their age, height, weight, clinical classification, level of hemoglobin、albumin and prealbumin，present treatment were recorded and patients' body weight index (BMI) was calculated and scored based on a table of nutrition risk evaluation. The data were analyzed using SPSS 17.0 software package.

RESULTS

In 88 cases of patients with oral and maxillofacial cancer, 18 patients had malnutrition (BMI<18.5 kg/m²), accounting for 20.45%; 49 patients had nutrition risk (NRS2000≥3 points), accounting for 55.68%.

CONCLUSIONS

Patients with oral and maxillofacial cancer had high nutrition risk. The older the age, the higher the nutrition risk will be. Anemia, low albumin and low prealbumin will increase the incidence of nutrition risks.

[A Contrivance for Closure and Dressing of Orocutaneous Fistula Developed in Advanced Oral Cancer]

Orocutaneous fistula sometimes occurs in locallyadvanced unresectable or recurrent oral squamous cell carcinoma. The developed orocutaneous fistula results in constant leakage of saliva, ingested foods and liquids and decline in patients' quality of life(QOL). A 47-year-old Japanese man had received treatment for tongue carcinoma. At the routine follow-up, a cystic lesion in the right submandibular region was detected. Biopsyof the specimen of the cystic lesion revealed squamous cell carcinoma. After chemotherapy, an orocutaneous fistula between the right oropharyngeal and the right submandibular region developed and graduallyincreased. Although closure and dressing of the orocutaneous fistula with various materials was attempted, it was ultimatelyunsuccessful. Finally, application of a rubber film and silicone adhesive agent to the skin was successful for closure and dressing of the fistula. Orocutaneous fistula is one of major contributors to decline in patients' QOL. The sharing of information regarding effective methods or materials for closure and dressing of orocutaneous fistula is necessaryto maintain patients' QOL.

[Development of a quality of life instrument for evaluation of the quality of life scale for Chinese patients with oral cancer]

PURPOSE

To develop a quality of life instrument for Chinese patients with oral cancer and to assess its reliability, validity and sensitivity.

METHODS

A 44-item QOL questionnaire was developed with reference to the 36-item medical outcomes study on short-form health status (SF-36) and University of Washington Quality of Life Questionnaire (UW-QOL), combining with China's population and socio-cultural characteristics, named as Zhengzhou university oral cancer quality of life (ZZU-QOL) scale. Based on 271 patients, student's t test, correlation analysis, factor analysis were performed for its reliability and validity using SPSS 19.0 software package.

RESULTS

Test-retest reliability: in all areas and for total score between 2 measurements of the correlation coefficient in the range of 0.86-1.00, there was no significant difference. Homogeneity reliability: Cornbrash'a coefficient in all fields was larger than 0.6, indicating the scale had good reliability. Construct validity: ZZU-QOL, SF-36 analysis and UW-QOL scale factor selected by the first seven cumulative contribution factor variance were 69.3%, 63.4% and 66.5%. The criterion validity with SF-36 and UW-QOL was 0.768 and 0.634, respectively. The ZZU-QOL scale can sensitively distinguish differences in preoperative and postoperative quality of life of oral cancer.

CONCLUSIONS

The ZZU-QOL scale is practical, reliable and valid, and might be used for measuring the quality of life in Chinese patients with oral cancer.

Oral Squamous Papilloma of Edentulous Mouth Interfering with Denture Retention

Soft tissue overgrowths inside oral cavity can present with wide range of clinical manifestations and some of them can asymptomatic. Oral squamous papilloma is one of that asymptomatic lesion described in the literature with extremely low virulence and infectivity rate. Soft tissue overgrowths can sometimes interfere with denture retention. Here we report a case of squamous papilloma in a 60 years old edentulous female who presented with loss of denture retention.

Euflammation Attenuates Central and Peripheral Inflammation and Cognitive Consequences of an Immune Challenge after Tumor Development

OBJECTIVE

Repeated subthreshold bacterial exposures in rodents cause novel euflammation that attenuates neuroinflammation and sickness behaviors upon subsequent infectious challenges to the host without eliciting illness behavior. The investigation of bacterial exposure effects on brain and behavior is clinically relevant because bacterial-based antitumor treatments are used successfully, but are suboptimal due to their illness side effects. In addition, behavioral consequences (depression, cognitive impairments) to homeostatic challenges that are associated with inflammation are prevalent and reduce the quality of life in cancer patients and survivors. Therefore, this study tested the potential for euflammation to attenuate behavioral consequences of an immune challenge in tumor-bearing mice.

METHODS

Mice with and without oral tumors in their flank underwent the established peripheral euflammatory protocol or vehicle treatment, followed by an acute peripheral immune challenge (lipopolysaccharide [LPS] injection) or PBS. Cognitive function and sickness behavior were assessed after the challenge, and peripheral and central inflammatory responses were measured.

RESULTS

Euflammation reduced LPS-induced peripheral and central inflammation in all mice; however, neuroinflammation was less attenuated in tumor-bearing mice compared with tumor-free controls. LPS-induced lethargy and cognitive impairments were more pronounced among tumor-bearing mice and were effectively attenuated with euflammation. Cognitive changes were independent of brain-derived growth factor gene expression in the hippocampus.

CONCLUSION

These results suggest that induction of euflammation may be useful in alleviating the negative side effects of bacterial-based tumor treatments and in potentially attenuating common behavioral comorbidities associated with cancer or other chronic diseases.

Squamous Cell Carcinoma of the Buccal Mucosa: A Single Institute Retrospective Analysis of Nodal Involvement and Survival

BACKGROUND

The magnitude of head and neck (H&N) cancers in the Indian subcontinent is very high. Neck nodal involvement is indicative of higher stage and subsequent adverse prognosis when compared with node negative disease. The frequency of such spread is greater than 20% for most H&N squamous cell carcinomas (SCC). The purpose of this study was to analyze the pattern of nodal metastasis in patients presenting with SCC of buccal mucosa (BM) and correlate it with survival.

PATIENTS AND METHODS

Ninety-nine cases of carcinoma BM who received post op radiotherapy were analyzed retrospectively. Medical records were reviewed and data collected from the hospital case files. Patients were analyzed for age and sex distribution, tumor staging, metastasis and overall survival.

RESULTS

The majority of cases were T4 lesions (n=40, 40.40%), followed by T2 lesions (n=35, 35.35%). T3 lesions constituted for 19.19% cases (n=19) while there were five cases (5.05%) of T1 lesions. 62 patients (62.62%) had positive neck nodes, with/without adverse pathologic features mandating post-operative radiotherapy, while 37 patients (37.37%) did not have any neck nodal involvement. The mean overall survival of the node negative patients (n=37) was 14.51 months (range 02-61 months) and was significantly more (p=0.03) than that of the node positive patients [10.82 months (range 01-35 months)]. A statistically significant difference in survival was also seen between the node negative patients and patients with >3 positive neck nodes (p=0.04).

CONCLUSION

Neck nodal involvement in cases of carcinoma BM is an adverse prognostic indicator. The number of pathological positive neck nodes can be used as a predictor of treatment outcome.

Excision of oral pyogenic granuloma in a diabetic patient with 940nm diode laser

Pyogenic granuloma (PG) is a common, acquired, benign vascular reactive proliferation that typically develops as a small erythematous papule on the skin or oral mucosal surface. Oral PG is often caused by constant low-grade infection, minor trauma, poor oral hygiene, and due to hormonal disturbances. It shows a striking predilection for the gingiva. Lesions can be excised surgically with removal of the underlying causes. However, this modality may be associated with unnecessary complications. Recently, different laser wavelengths have been used for removal of oral PG. Herein, we present a case of gingival PG in a 51-year-old uncontrolled diabetic woman. The lesion was excised successfully with a 940nm diode laser as a conservative and non-stressful procedure that resulted in a bloodless surgical and post-surgical course with rapid healing, minimal pain, swelling, and scarring. The 940nm Diode laser offers a new efficient noninvasive tool for excising oral soft tissue lesions, especially in medically compromised patients.

The bidirectional association between oral cancer and esophageal cancer: A population-based study in Taiwan over a 28-year period

Previous studies have revealed that patients with oral or esophageal cancer are at higher risk for subsequently developing a second primary malignancy. However, it remains to be determined what association exists between oral cancer and esophageal cancer particularly in Asian countries where squamous cell carcinoma is the predominant type of esophageal cancer. A population-based study was carried out in Taiwan, where the incidence rates of both oral and esophageal squamous cell carcinomas are high, to test the hypothesis that oral cancer or esophageal cancer predisposes an individual to developing the other form of cancer. Our results showed that patients with primary oral cancer (n=45,859) had ten times the risk of second esophageal cancer compared to the general population. Within the same cohort, the reciprocal risk of oral cancer as a second primary in primary esophageal cancer patients (n=16,658) was also increased seven-fold. The bidirectional relationship suggests common risk factors between these two cancers. The present study is not only the first population-based study in Asia to validate the reciprocal relationship between oral and esophageal squamous cell carcinomas, but also will aid in the appropriate selection of high-risk patients for a future follow-up surveillance program.

Patient Perception of Speech Outcomes: The Relationship Between Clinical Measures and Self-Perception of Speech Function Following Surgical Treatment for Oral Cancer

PURPOSE

Treatment for oral cancer can result in speech impairments that can have varying impacts on patient quality of life. This study explored the relationship between clinical measures of speech impairment and the perception that patients had of this change in the early stage of recovery.

METHOD

This was a quasi-experimental 1-group pre-post study design carried out on 10 patients with surgical intervention for oral cancer. Two clinical measures (word intelligibility and consonant phoneme error) and 2 patient-perception measures (Speech Handicap Index total score and Speech Handicap Index patient criteria score) were collected at preoperative and 1-month postoperative appointments.

RESULTS

Qualitative analysis revealed discordance between clinical and patient-perceived measures in 4 of 10 patients. Change in consonant phoneme error and change in word intelligibility were significantly correlated (r = .827). Furthermore, on average, statistically significant relationships were not found between clinical and patient-perceived measures or between the 2 patient-perception measures.

CONCLUSIONS

Discordance between clinical and patient-perceived measures was observed in almost half of the sample, indicating that clinical tests did not fully explain the extent of impairment perceived by patients. Speech outcomes should focus on both types of measures, and patient perception outcomes should be carefully considered when recommending speech therapy.

Comparison of orofacial pain of patients with different stages of precancer and oral cancer

Orofacial pain impairs a patient's speech, swallowing, eating and interpersonal relations. Thirty-seven patients with a premalignant oral lesion, 124 patients with oral squamous cell carcinoma (OSSC), and 21 patients with a recurrence of OSSC were evaluated for their orofacial pain. The University of California San Francisco Oral Cancer Pain Questionnaire was administered to these patients at their initial visit, before they were prescribed analgesics for pain and before any treatment. Significant differences with respect to orofacial pain between the groups could be evaluatedwere observed. Patients with recurrence had the highest facial pain and patients with precancer had the lowest. Patients with OSSC and recurrence of OSSC reported significant levels of orofacial pain and functional restriction because of pain. Moreover, patients with recurrence of OSSC experienced significantly higher function-related pain, rather than pain qualities. These findings suggest that an important predictor for recurrence of OSSC may be the onset of orofacial pain that is exacerbated during function. The present study examined orofacial pain depending on the disease severity of precancer and oral cancer patients. Earlier recognition of symptoms of OSSC may improve early detection of its recurrence.

Diagnostic challenges with intraoral myeloid sarcoma: report of two cases & review of world literature

BACKGROUND

Myeloid sarcomas (MS) are rare extramedullary tumors composed of blasts of myeloid lineage that either precede, follow or present concomitantly with acute myeloid leukaemia (AML) or myeloproliferative neoplasms. The diagnosis of MS is especially challenging in patients without an antecedent history of leukemia.

METHODS

We present 2 cases of intraoral MS that presented as de novo lesions. A detailed review of cases of intraoral MS that either preceded or presented along with leukemia has been done with emphasis on diagnostic criteria used.

RESULTS

Two male patients aged 28 and 5 years presented with MS with one patient presenting with concomitant AML. A combination of morphological and immunohistochemical methods was used for diagnosis. A thorough review of world literature revealed 44 cases of intraoral MS that presented as de novo lesions.

CONCLUSION

Intraoral MS is a rare tumor with poor prognosis. It may be diagnostically challenging due to its protean clinical manifestations and histological overlap with other tumors.

Oral Lesions in HIV Infection in Developing Countries: an Overview

HIV infection is a major global health problem affecting developing and developed countries alike. Oral lesions that are associated with this disease are important, since they affect the quality of life of the patient and are useful markers of disease progression and immunosuppression. Oral lesions in HIV infection have been well-documented in developed countries, but there are fewer reports on oral lesions from developing countries. Oral candidiasis is the most common opportunistic infection seen in all continents. Kaposi’s sarcoma has been reported only from Africa and Latin America, while histoplasmosis and penicilliosis were reported in patients with advanced disease from Thailand. HIV-associated salivary gland disease has a high prevalence in Africa and Latin America, especially in the pediatric group. It is clear that there are considerable regional variations in the oral manifestations of HIV infection, depending both on the populations studied and on the clinical expertise available, among other factors. Well-designed and -documented studies are necessary for the correct assessment of the nature and magnitude of the problem in developing countries, if oral health measures are to be effectively formulated for the HIV-infected.

Cytomegalovirus Co-infection in AIDS-associated Oral Kaposi’s Sarcoma

The increasing appearance of AIDS-associated oral Kaposi’s sarcoma (KS) in South Africa may be ascribed to the later start of the HIV epidemic, more patients reaching stages III and IV, and the inaccessibility of most patients to anti-retroviral therapy. The objective of this study was to demonstrate cytomegalovirus (CMV) co-infection in oral KS and to consider its possible significance. We reviewed 20 cases of oral KS in known HIV-positive patients without active CMV disease. HHV8 PCR and CMV immunohistochemistry were performed. HHV8 DNA was present in all cases. CMV inclusions were detected in five cases. The significance of CMV co-infection in oral KS is unclear. The inclusions suggest active infection, although there is no evidence to support CMV in the pathogenesis of KS. Nonetheless, it is vital that physicians be alerted to active CMV infection, so that timely intervention and careful observation can be instituted, ensuring early diagnosis and treatment.