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Studer G, Zwahlen RA, Graetz KW, Davis BJ, Glanzmann C. IMRT in oral cavity cancer. Radiat Oncol 2007; 2:16. [PMID: 17430599 PMCID: PMC1855346 DOI: 10.1186/1748-717x-2-16] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 04/12/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Except for early T1,2 N0 stages, the prognosis for patients with oral cavity cancer (OCC) is reported to be worse than for carcinoma in other sites of the head and neck (HNC). The aim of this work was to assess disease outcome in OCC following IMRT.Between January 2002 and January 2007, 346 HNC patients have been treated with curative intensity modulated radiation therapy (IMRT) at the Department of Radiation Oncology, University Hospital Zurich. Fifty eight of these (16%) were referred for postoperative (28) or definitive (30) radiation therapy of OCC.40 of the 58 OCC patients (69%) presented with locally advanced T3/4 or recurred lesions. Doses between 60 and 70 Gy were applied, combined with simultaneous cisplatin based chemotherapy in 78%. Outcome analyses were performed using Kaplan Meier curves.In addition, comparisons were performed between this IMRT OCC cohort and historic in-house cohorts of 33 conventionally irradiated (3DCRT) and 30 surgery only patients treated over the last 10 years. RESULTS OCC patients treated with postoperative IMRT showed the highest local control (LC) rate of all assessed treatment sequence subgroups (92% LC at 2 years). Historic postoperative 3DCRT patients and patients treated with surgery alone reached LC rates of approximately 70-80%. Definitively irradiated patients revealed poorest LC rates with approximately 30 and 40% following 3DCRT and IMRT, respectively.T1 stage resulted in an expectedly significantly higher LC rate (95%, n = 19, p < 0.05) than T2-4 and recurred stages (LC approximately 50-60%, n = 102).Analyses according to the diagnosis revealed significantly lower LC in OCC following definitive IMRT than that in pharyngeal tumors treated with definitive IMRT in the same time period (43% vs 82% at 2 years, p < 0.0001), while the LC rate of OCC following postoperative IMRT was as high as in pharyngeal tumors treated with postoperative IMRT (>90% at 2 years). CONCLUSION Postoperative IMRT of OCC resulted in the highest local control rate of the assessed treatment subgroups. In conclusion, generous indication for IMRT following surgical treatment is recommended in OCC cases with unfavourable features like tight surgical margin, nodal involvement, primary tumor stage >T1N0, or already recurred disease, respectively.Loco-regional outcome of OCC following definitive IMRT remained unsatisfactory, comparable to that following definitive 3DCRT.
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Affiliation(s)
- Gabriela Studer
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Roger A Zwahlen
- Department of Cranio-Maxillofacial Surgery, University Hospital, Zurich, Switzerland
| | - Klaus W Graetz
- Department of Cranio-Maxillofacial Surgery, University Hospital, Zurich, Switzerland
| | - Bernard J Davis
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Christoph Glanzmann
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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103
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Mallery SR, Stoner GD, Larsen PE, Fields HW, Rodrigo KA, Schwartz SJ, Tian Q, Dai J, Mumper RJ. Formulation and in-vitro and in-vivo evaluation of a mucoadhesive gel containing freeze dried black raspberries: implications for oral cancer chemoprevention. Pharm Res 2007; 24:728-37. [PMID: 17372698 PMCID: PMC2391087 DOI: 10.1007/s11095-006-9192-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 11/10/2006] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of these studies was to formulate mucoadhesive gels containing freeze dried black raspberries (FBR) and to determine optimum parameters for a subset of FBR bioactive compounds including anthocyanin stability, absorption and penetration in-vitro and in-vivo. MATERIALS AND METHODS Berry gels were prepared having FBR at 5% and 10% w/w and final pHs ranging from 3.5 to 7.5. A HPLC assay was developed to quantify and determine the stability of the anthocyanins in the gels. A single time-point study was performed to determine anthocyanin uptake when the gels were applied to oral mucosa. Penetration of anthocyanins into human oral tissue explants was determined as a function of gel pH and FBR content. A HPLC-mass spectroscopy assay was utilized to quantify the anthocyanin levels in human oral tissue explants, saliva, and blood. RESULTS The stability of anthocyanins in the gel was directly related to gel pH and storage temperature. Maximum stability of anthocyanins was found at lower pH (pH 3.5) and storage temperature (4 degrees C). Anthocyanins contained in mucoadhesive berry gel formulations were readily absorbed into human oral mucosa tissue as evidenced by detectable blood levels within 5 min after gel application. There was a trend for greater penetration of anthocyanins into tissue explants for berry gels with a final pH of 6.5 versus pH 3.5. CONCLUSIONS Formulation and characterization of a novel gel formulation for local delivery of chemopreventive compounds to human oral mucosal tissues has been described. The results show anthocyanin stability was dependent upon gel pH and storage temperature and also demonstrate that the gel composition is well-suited for absorption and penetration into the target oral mucosal tissue site.
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Affiliation(s)
- Susan R Mallery
- Department of Oral Maxillofacial Surgery & Pathology, College of Dentistry, The Ohio State University, Columbus, OH 43210-1241, USA.
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Blackburn TK, Bakhtawar S, Brown JS, Lowe D, Vaughan ED, Rogers SN. A questionnaire survey of current UK practice for adjuvant radiotherapy following surgery for oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2007; 43:143-9. [PMID: 16807074 DOI: 10.1016/j.oraloncology.2006.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
A postal questionnaire was sent to 281 members of the British Association of Head and Neck Oncologists (BAHNO) to survey, which patients should receive adjuvant radiotherapy following primary surgery for oral and oropharyngeal squamous cell carcinoma (O&OSCC). Two hundred and one clinicians were involved in decision making for adjuvant radiotherapy in O&OSCC, of which, 132 (66%) responded. Apart from general agreement that patients with involved margins or extracapsular spread (ECS) should have adjuvant radiotherapy and that in patients with small tumours with clear margins and no neck metastasis, radiotherapy should be avoided, opinion was divided. Considerable variation in opinion in the UK was identified for a subgroup of intermediate risk patients as to whether they should have adjuvant radiotherapy. The majority of respondents (95%) would consider submitting patients to a prospective multi-centre trial. There is a need for research regarding adjuvant radiotherapy for O&OSCC patients at intermediate risk of relapse following primary surgery.
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Affiliation(s)
- Tim K Blackburn
- Merseyside Head and Neck Cancer Centre, Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Liverpool, Merseyside L9 7AL, United Kingdom.
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Álvarez Marcos CA, Llorente Pendás JL, Franco Gutiérrez V, Fernández Espina H, Alonso Guervós M, Suárez Nieto C, Hermsen M. Tumour Recurrence in Squamous Head and Neck Cancer. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s2173-5735(07)70324-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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106
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Liao CT, Chang JTC, Wang HM, Ng SH, Hsueh C, Lee LY, Lin CH, Chen IH, Huang SF, Cheng AJ, Yen TC. Salvage therapy in relapsed squamous cell carcinoma of the oral cavity: How and when? Cancer 2007; 112:94-103. [DOI: 10.1002/cncr.23142] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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107
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Jeong WJ, Jung YH, Kwon SK, Hah JH, Kwon TK, Sung MW, Kim KH. Role of Surgical Salvage for Regional Recurrence in Laryngeal Cancer. Laryngoscope 2007; 117:74-7. [PMID: 17202934 DOI: 10.1097/01.mlg.0000240184.75588.dc] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to analyze the pattern of regional recurrence in laryngeal cancer, evaluate the role of surgical salvage, and identify factors affecting salvage outcome. METHODS Retrospective analysis was conducted on medical records from a 16-year period. Of 463 patients diagnosed with laryngeal cancer, 25 patients with regional recurrence managed with salvage neck dissection were identified and subject to study. Isolated local recurrences and all distant metastases were excluded. RESULTS All patients were male with a median age of 61 years. The overall rate of regional recurrence was 5.4%. Median time to regional recurrence was 13 months. Isolated regional recurrence occurred in 76% of cases, whereas locoregional recurrence occurred in 24%. A 5-year survival rate for patients undergoing neck dissection as salvage management was 61.2%. Patients with recurrence in the contralateral neck were definitely associated with poor prognosis. Although standard statistical significance was not met, trends for poorer salvage result were identified in patients with a history of local recurrence before regional recurrence, recurrence in a previously dissected neck, and recurred node size of 3 cm or above. CONCLUSIONS Our study shows that salvage neck dissection for regional recurrence in laryngeal cancer is an acceptable approach. Surgical eradication of disease should be warranted whenever possible. Prudent planning of management is mandatory in the presence of history of local recurrence before regional recurrence, previously dissected neck, large size of recurrent node, and contralateral neck recurrence.
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Affiliation(s)
- Woo-Jin Jeong
- Department of Otolaryngology-Head & Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
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108
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Suzuki M, Terada A, Ogawa T, Suzuki H, Hasegawa Y. Salvage Surgery for Radiation Failure in Oral, Oropharyngeal, and Hypopharyngeal Squamous Cell Carcinoma. ACTA ACUST UNITED AC 2007; 110:461-5. [PMID: 17633115 DOI: 10.3950/jibiinkoka.110.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Few reports have covered salvage surgery after radiotherapy, especially with chemotherapy for oral, oropharyngeal, and hypopharyngeal squamous cell carcinoma. The feasibility of salvage surgery is unclear. We analyzed postoperative complications and prognosis after salvage surgery for local recurrence after definitive radiotherapy. Subjects were 37 patients with oral, oropharyngeal, and hypopharyngeal squamous cell carcinoma treated from 1994 to 2003. Of these, 14 (37.8%) had postoperative complications. The complication rate was significantly high in the reconstructive operation group (p = 0.031) and the chemotherapy group (p = 0.049). The 5-year overall survival rate after salvage surgery was 70.7%. Although there was no significant improvement, the prognosis was good in early-stage groups with primary tumors. We found that salvage surgery after definitive radiotherapy was effective for recurrent oral, oropharyngeal, and hypopharyngeal squamous cell carcinoma. We stress the need to pay attention to postoperative complications in reconstructive operation and chemotherapy groups.
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Affiliation(s)
- Masahiro Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center, Nagoya
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109
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White JS, Weissfeld JL, Ragin CCR, Rossie KM, Martin CL, Shuster M, Ishwad CS, Law JC, Myers EN, Johnson JT, Gollin SM. The influence of clinical and demographic risk factors on the establishment of head and neck squamous cell carcinoma cell lines. Oral Oncol 2006; 43:701-12. [PMID: 17112776 PMCID: PMC2025692 DOI: 10.1016/j.oraloncology.2006.09.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 01/15/2023]
Abstract
The purpose of this study was to generate stable cell cultures from head and neck squamous cell carcinomas (HNSCC), and retrospectively analyze the factors associated with successful cell line establishment. Fifty-two HNSCC cell lines were isolated from a series of 199 tumors collected between 1992 and 1997 at the University of Pittsburgh Medical Center. Cell lines were characterized at the molecular and cellular level to determine the features associated with cell line formation. Successful cell line formation was dependent on multiple factors, including gene amplification involving chromosomal band 11q13, local and/or regional involvement of lymph nodes, and alcohol usage. The establishment of HNSCC cell lines enriches the resources available for cancer research. Our findings indicate that generation of stable cell lines from HNSCC is biased towards tumors with a poor prognosis. Our 52 stable lines comprise one of the largest series of HNSCC cell lines in the literature, with complete demographic, histopathologic, clinical, and survival data.
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Affiliation(s)
- Jason S. White
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Joel L. Weissfeld
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Camille C. R. Ragin
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Karen M. Rossie
- Department of Oral Medicine and Pathology, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Christa Lese Martin
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Michele Shuster
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Chandramohan S. Ishwad
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
| | - John C. Law
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Eugene N. Myers
- Department of Otolaryngology, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Jonas T. Johnson
- Department of Otolaryngology, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
| | - Susanne M. Gollin
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, School of Medicine and School of Dental Medicine, Pittsburgh, Pennsylvania
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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Chen AM, Bucci MK, Singer MI, Garcia J, Kaplan MJ, Chan AS, Phillips TL. Intraoperative radiation therapy for recurrent head-and-neck cancer: the UCSF experience. Int J Radiat Oncol Biol Phys 2006; 67:122-9. [PMID: 17084543 DOI: 10.1016/j.ijrobp.2006.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 08/16/2006] [Accepted: 08/17/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To review a single-institutional experience with the use of intraoperative radiation therapy (IORT) for recurrent head-and-neck cancer. METHODS AND MATERIALS Between 1991 and 2004, 137 patients were treated with gross total resection and IORT for recurrence or persistence of locoregional cancer of the head and neck. One hundred and thirteen patients (83%) had previously received external beam radiation as a component of definitive therapy. Ninety-four patients (69%) had squamous cell histology. Final surgical margins were microscopically positive in 56 patients (41%). IORT was delivered using either a modified linear accelerator or a mobile electron unit and was administered as a single fraction to a median dose of 15 Gy (range, 10-18 Gy). Median follow-up among surviving patients was 41 months (range, 3-122 months). RESULTS The 1-year, 2-year, and 3-year estimates of in-field control after salvage surgery and IORT were 70%, 64%, and 61%, respectively. Positive margins at the time of IORT predicted for in-field failure (p = 0.001). The 3-year rates of locoregional control, distant metastasis-free survival, and overall survival were 51%, 46%, and 36%, respectively. There were no perioperative fatalities. Complications included wound infection (4 patients), orocutaneous fistula (2 patients), flap necrosis (1 patient), trismus (1 patient), and neuropathy (1 patient). CONCLUSIONS Intraoperative RT results in effective disease control with acceptable toxicity and should be considered for selected patients with recurrent or persistent cancers of the head and neck.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, San Francisco, Comprehensive Cancer Center, San Francisco, CA.
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111
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Ord RA, Kolokythas A, Reynolds MA. Surgical Salvage for Local and Regional Recurrence in Oral Cancer. J Oral Maxillofac Surg 2006; 64:1409-14. [PMID: 16916677 DOI: 10.1016/j.joms.2006.05.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate local and regional recurrence and the outcomes for salvage surgery in patients for oral cancer. PATIENTS AND METHODS This study analyzed 354 consecutive patients with oral cancer treated primarily by surgery or surgery combined with adjuvant therapy by 1 surgeon (R.A.O.) between February 1991 and September 2001. RESULTS Overall recurrence rate was 15.5%; with 5.4% local, 8.5% regional, and 1.4% locoregional. Overall salvage for local recurrence was 52.6% 3-year survival, and statistically significant favorable prognostic factors were salvaged by surgery alone and initial cancer staging of I/II. Overall salvage for regional recurrence was 50%, with recurrence in a previously untreated neck and salvage with radical neck dissection plus radiotherapy giving the best prognosis. No patients with locoregional recurrence were salvaged. CONCLUSIONS Patients who were stage I/II and were treated initially by surgery alone were the best candidates for salvage if they recurred. Salvage was best achieved with surgery or surgery + adjuvant therapy, and patients recurring within 6 months had a worse survival. Patients with locoregional recurrence or treated with RT +/- chemotherapy alone have negligible survival.
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Affiliation(s)
- Robert A Ord
- Department of Oral and Maxillofacial Surgery, University of Maryland, Greenbaum Cancer Center, Baltimore, MD 21201-1754, USA
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112
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Kissun D, Magennis P, Lowe D, Brown JS, Vaughan ED, Rogers SN. Timing and presentation of recurrent oral and oropharyngeal squamous cell carcinoma and awareness in the outpatient clinic. Br J Oral Maxillofac Surg 2006; 44:371-6. [PMID: 16624459 DOI: 10.1016/j.bjoms.2005.08.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Accepted: 08/16/2005] [Indexed: 11/18/2022]
Abstract
The aim of this study was to assess the timing of outpatient review appointments in relation to tumour recurrence. A retrospective review of 278 consecutive previously untreated patients with oral and oropharyngeal squamous cell carcinoma (SCC) between 1995 and 1999 was performed. Information on the time of recurrence, site, presentation, treatment and outcome was collected. There were 54 (19%) patients who developed recurrent disease. Recurrence occurred at a median time of 8 months after the initial operation and most (49/54) within 2 years. Thirty-five patients (65%) presented with a new lump (7 local, 22 regional and 5 locoregional). Our policy is to review patients once a month for the first year and every other month for the second year. Patients were seen less frequently than expected, and one in five patients attended half or less than half as frequently as intended in the first year. Although 20 patients were aware of new symptoms from their recurrent disease fewer than half (9) brought their appointment forward. This study has emphasised the need for close clinical follow-up of patients previously treated for oral/oropharyngeal SCC if recurrent tumours are to be discovered and treated at the earliest opportunity.
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Affiliation(s)
- D Kissun
- Regional Maxillofacial Unit, University Hospital Aintree, Fazakerley, Liverpool, UK.
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113
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Koo BS, Lim YC, Lee JS, Choi EC. Recurrence and salvage treatment of squamous cell carcinoma of the oral cavity. Oral Oncol 2006; 42:789-94. [PMID: 16455287 DOI: 10.1016/j.oraloncology.2005.11.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 11/24/2005] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the incidence and predictive factors for recurrence of oral squamous cell carcinoma (SCC) and outcome according to salvage treatment modality. A retrospective analysis of 127 oral cavity cancer patients who underwent surgery with or without postoperative radiotherapy as initial treatment was performed. Thirty-six patients (28%) were observed with recurrences and/or metastases mostly at the primary site and neck. Seventy-eight percent of recurrences occurred within one year, and 92% within two years after the initial treatment. The rate of recurrence and/or metastases was significantly higher in patients with an advanced pathologic stage, pathologic lymph node and positive resection margin compared to those with an early pathologic stage, negative lymph node and negative resection margin (p<0.05). Especially, regarding the relationship between the rate of locoregional recurrence and local or regional factors, resection margin status was a particularly important, and potentially preventable, independent predictor for locoregional control. Patients who underwent salvage surgery with or without postoperative radiotherapy had significantly improved salvage and total survival times compared with patients who received chemotherapy and/or radiation therapy for their recurrence.
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Affiliation(s)
- Bon Seok Koo
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seodaemun-gu, 134 Shinchon-dong, Seoul, Republic of Korea
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114
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Agra IMG, Carvalho AL, Ulbrich FS, de Campos OD, Martins EP, Magrin J, Kowalski LP. Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 2006; 28:107-13. [PMID: 16388526 DOI: 10.1002/hed.20309] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Therapeutic decisions in recurrent oral and oropharyngeal squamous carcinoma (SCC) remain controversial. METHODS Two hundred forty-six consecutive patients who underwent salvage surgery for recurrent squamous cell carcinoma (SCC) of the oral cavity and oropharynx were studied. The tumor sites were lip, 33 cases; oral cavity, 143; oropharynx, 70. The previous treatment was surgery in 73 patients, radiotherapy in 96, combined surgery and radiotherapy in 76, and chemotherapy in one. The clinical stage of recurrence was I/II in 51 cases and III/IV in 195 cases. The disease-free interval (DFI) was less than 1 year in 156 cases and greater than 1 year in 90 cases. RESULTS The rate of recurrence was 54.9%, and the overall 5-year actuarial survival rate was 32.3%. The significant prognostic factors in multivariate analysis were restage (p = .049) and DFI (p = .045). CONCLUSION Patients with recurrent oral and oropharyngeal SCC at initial clinical stages (rCS I and II) and with a DFI greater than 1 year had a favorable prognosis.
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Affiliation(s)
- Ivan Marcelo Gonçalves Agra
- Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Câncer A C Camargo, Rua Professor Antonio Prudente, 211, 01509-900 São Paulo, Brazil
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115
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Kunkel M, Helisch A, Reichert TE, Jeong JH, Buchholz HG, Benz P, Bartenstein P, Wagner W, Whiteside TL. Clinical and prognostic value of [(18)F]FDG-PET for surveillance of oral squamous cell carcinoma after surgical salvage therapy. Oral Oncol 2005; 42:297-305. [PMID: 16316775 DOI: 10.1016/j.oraloncology.2005.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 08/09/2005] [Indexed: 10/25/2022]
Abstract
[(18)F]FDG-PET was found to be useful for recurrence detection in patients with oral squamous cell carcinoma (OSCC), as a negative PET scan predicted a favorable outcome and survival. Here, we evaluate PET performance in the management of OSCC patients with recurrent/second primary disease after potentially curative second-line therapy. Forty one OSCC patients underwent salvage surgery and 31/41 had received radiation therapy. Thirty five/41 developed recurrent and 6/41 second primary OSCC. Patients had PET evaluation 8.4months (median) after surgery and were followed for at least 6months until disease recurrence or death. For surviving patients, the median follow-up was 33.6months after PET. In OSCC patients who had undergone potentially curative second-line therapy, PET had an overall sensitivity of 85% (92% for recurrence or second primaries, 88% for lymph node failure and 73% for distant metastases). Overall survival was 71% in the PET negative group and 35% in the PET positive group (p<0.01, log-rank test). Moderate glucose metabolism (standardized uptake value4) suggested promising outcome, while SUV>4 indicated a fatal disease course. The data suggest that [(18)F]FDG-PET can facilitate re-staging and clinical management in "high-risk" patients with OSCC.
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Affiliation(s)
- Martin Kunkel
- Department of Oral and Maxillofacial Surgery, University Hospital Mainz, Augustusplatz 2, 55101 Mainz, Germany
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116
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Pathak KA, Gupta S, Talole S, Khanna V, Chaturvedi P, Deshpande MS, Pai PS, Chaukar DA, D'Cruz AK. Advanced squamous cell carcinoma of lower gingivobuccal complex: patterns of spread and failure. Head Neck 2005; 27:597-602. [PMID: 15825204 DOI: 10.1002/hed.20195] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Carcinoma of the gingivobuccal complex is commonly associated with the use of smokeless tobacco known as "quid." METHODS We conducted a retrospective chart review of 511 patients with advanced cancer of gingivobuccal complex surgically treated during 1994 to 1995. We evaluated patterns of disease failure in these patients and correlated disease-free survival with various prognostic factors. RESULTS During a median follow-up of 46 months, 159 locoregional recurrences and 11 distant metastases were detected in 148 patients. Seventy-nine percent of the recurrences appeared within 18 months of surgery, and the median survival for patients with recurrent disease was less than 4 months. Two-year and 5-year disease-free survival rates were 64% and 57%, respectively. On multivariate analysis, disease-free survival showed significant correlation with skin involvement and extracapsular spread. CONCLUSIONS Gingivobuccal cancers usually fail locoregionally. Soft tissue infiltration and extracapsular spread of nodal disease influence disease-free survival.
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Affiliation(s)
- Kumar Alok Pathak
- Head and Neck Service, Department of Surgery, Tata Memorial Hospital, Parel, Mumbai, 400012 India.
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117
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Amar A, Curioni OA, Franzi SA, Rapoport A. Recidivas locais após tratamento cirúrgico do carcinoma epidermóide de cabeça e pescoço em estágio avançado. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000200003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar os resultados do tratamento de resgate das recidivas locais nos pacientes com carcinoma epidermóide das vias aerodigestivas superiores submetidos a tratamento cirúrgico. MÉTODO: Foram revisados os prontuários de 943 pacientes submetidos à ressecção do tumor primário e esvaziamento cervical entre 1977 e 1996, e selecionados 107 pacientes com recidiva no sítio primário. Foram avaliados os resultados do tratamento de resgate, bem como os motivos para a não realização do mesmo. RESULTADOS: A principal queixa no diagnóstico da recidiva foi dor. O tratamento de resgate foi realizado em 45% dos pacientes e o principal motivo para a não realização do mesmo foi a extensão da recidiva. Foram resgatados 54% dos pacientes com recidiva no estádio rT1T2 em comparação com 31% dos pacientes rT3T4 (p = 0,04). Apenas quatro (8%) dos pacientes resgatados estavam assintomáticos por período superior a 12 meses após o re-tratamento, todos resgatados com cirurgia. O intervalo de tempo entre o tratamento inicial e a recidiva apresentou mediana de oito meses e as novas recidivas ocorreram na mediana de cinco meses. CONCLUSÃO: As recidivas locais após tratamento cirúrgico extenso apresentam prognóstico reservado.
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118
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Iyer SG, Pradhan SA, Pai PS, Patil S. Surgical treatment outcomes of localized squamous carcinoma of buccal mucosa. Head Neck 2004; 26:897-902. [PMID: 15390193 DOI: 10.1002/hed.20096] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of the study was to analyze the outcomes after surgical therapy (peroral wide excision) for early squamous carcinoma of the buccal mucosa. METHODS This is a retrospective study of localized squamous carcinoma of the buccal mucosa treated with peroral wide excision at a major tertiary-care hospital. RESULTS A total of 147 consecutive patients were analyzed. One hundred eight patients (73.5%) had no recurrence, whereas 18 (12.2%) had a local recurrence, 11 (7.5%) had regional metastasis, and 10 (6.8%) had locoregional recurrence over a median follow-up of 46 months. Most patients with local recurrences (15 patients, 83.3%) and regional metastases (eight patients, 72%) could be salvaged with treatment. In contrast, only four patients (40%) with locoregional recurrence could be salvaged. Most of the recurrences in this study group occurred within 2 years of primary treatment (29 [74%] of 39 patients). Three-year actuarial overall survival rate and disease-free survival rates were 91% and 77%, respectively. CONCLUSIONS Peroral wide excision seems to be an adequate procedure for early squamous carcinoma of buccal mucosa. Histologic grade of the tumor emerged as the only prognostic factor of significance for recurrence in this study.
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Affiliation(s)
- Shridhar Ganpathi Iyer
- Division of Head and Neck Surgery, Department of Surgery, Tata Memorial Hospital Parel, Mumbai, India 400016.
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119
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Lin YC, Hsiao JR, Tsai ST. Salvage surgery as the primary treatment for recurrent oral squamous cell carcinoma. Oral Oncol 2004; 40:183-9. [PMID: 14693243 DOI: 10.1016/s1368-8375(03)00150-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The choice of salvage modalities of recurrent squamous cell carcinoma (SCC) of the oral cavity remains controversial. We investigated the feasibility of the surgical salvage treatment as a primary option. From 1989 to 1999, curative intended surgery was performed on 191 patients with SCC of the oral cavity at National Cheng Kung University Hospital in Taiwan. These patients were divided into fresh group and salvage group. Survival and complication rates were analyzed for both groups. Patients with early and late recurrent stage had 60 and 38% 5-year absolute survival after salvage surgery. The overall complication rate was higher in the salvage group (60.7 vs 30.4%, P<0.0001), but the major complication rate was not significantly different between these groups (P=0.121). Surgery achieves an acceptable survival in recurrent oral SCC without increasing the major complication rate. Thus surgery is concluded to be a reliable and feasible treatment of choice.
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Affiliation(s)
- Yen-Chun Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Rd., Tainan 704, Taiwan
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120
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Kunkel M, Förster GJ, Reichert TE, Jeong JH, Benz P, Bartenstein P, Wagner W, Whiteside TL. Detection of recurrent oral squamous cell carcinoma by [18F]-2-fluorodeoxyglucose-positron emission tomography: implications for prognosis and patient management. Cancer 2003; 98:2257-65. [PMID: 14601097 DOI: 10.1002/cncr.11763] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with recurrent oral squamous cell carcinoma (OSCC) have a dismal prognosis and represent a therapeutic challenge. A positron emission tomography (PET) scan with [(18)F]-2-fluorodeoxyglucose ([(18)F]FDG) can improve early cancer detection. The current study evaluates the prognostic value of [(18)F]FDG-PET scan in patients with recurrent OSCC. METHODS The authors studied 97 patients with previously resected OSCC who were restaged by PET scanning. Of the 97 patients, 64 had no evidence of clinical disease and 33 were suspected of having disease by imaging, clinical findings, or pathologic evaluation. The median follow-up period was 35.4 months after a PET scan. The end points included disease recurrence, a disease recurrence-free period 6 months after a PET scan, or death. RESULTS The overall sensitivity of a PET scan did not exceed 90% and its specificity varied from 67% for local disease recurrence/second primaries to 99% for lymph node metastasis. Increased [(18)F]FDG uptake predicted increased hazard of death (hazard ratio: 6.83; P = 0.00034) and proved to be a highly predictive marker of disease status. A significant association was established for incremental standardized uptake values and 3-year patient survival (P=0.0089), indicating that intense glucose metabolism in the tumor is a negative marker of survival in recurrent OSCC. Overall, survival was longer in patients with a negative rather than a positive PET scan (P < 0.00001). CONCLUSIONS PET scanning was found to be highly valuable for diagnosing OSCC recurrence in a postoperative setting. It provided prognostic information and played an important role in patient counseling and management.
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Affiliation(s)
- Martin Kunkel
- Department of Oral and Maxillofacial Surgery, University Hospital Mainz, Mainz, Germany
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121
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Wong LY, Wei WI, Lam LK, Yuen APW. Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery. Head Neck 2003; 25:953-9. [PMID: 14603456 DOI: 10.1002/hed.10310] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The efficacy of salvage treatment of recurrent head and neck squamous cell carcinomas (HNSCC) after primary curative surgery was evaluated. METHODS The management outcome of 377 patients who had recurrent squamous cell carcinoma of oral cavity, oropharynx, hypopharynx, and larynx after primary curative surgery was reviewed. RESULTS The surgical salvage rates of recurrence were 29% local, 30% tracheostomal, 56% unilateral nodal recurrence of previously undissected neck, 32% of unilateral neck recurrence after prior neck dissection, and 11% lung metastasis. The 5-year tumor-free actuarial survival rates of those patients who received surgical salvage was 35% for local recurrence, 32% for unilateral nodal recurrence of the previously undissected neck, and 18% for nodal recurrence of the previously dissected neck. One patient of six with tracheostomal recurrence salvaged with surgery and one patient of six with lung metastasis salvaged with lobectomy survived without tumor at 5 years. There was no 5-year survivor of all patients salvaged with other nonsurgical methods. The mean survival of patients without surgical salvage was 6 months. CONCLUSIONS There was a moderate chance of cure after surgical salvage of locoregional recurrent HNSCC. Surgical salvage was, however, only feasible for early recurrent tumor. Close follow-up surveillance of early recurrence is essential after primary treatment of patients.
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Affiliation(s)
- Ling Yuen Wong
- Division of Otorhinolaryngology, Department of Surgery, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
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122
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Abstract
CONTEXT Local and regional recurrences are frequent in patients with squamous cell carcinoma of the upper aerodigestive tract and early diagnosis is important for salvage treatment. OBJECTIVE To identify the period of highest risk for the development of recurrences after surgical treatment of squamous cell carcinoma of the upper aerodigestive tract, in spite of radical therapy, in order to plan the follow-up for these patients. TYPE OF STUDY Cross-sectional, descriptive. SETTING Department of Head and Neck Surgery/Otorhinolaryngology, Heliópolis Hospital (Hosphel), São Paulo, Brazil. PARTICIPANTS A review was made of the hospital records of 889 patients with squamous cell carcinoma of the upper aerodigestive tract surgically treated between October 1977 and December 1996: 364 had oral cavity tumors, 107 had tumors of the oropharynx, 152 of the hypopharynx and 266, larynx tumors. The disease was stage I in 14 patients, stage II in 117, stage III in 352, stage IV in 397 and 9 patients were not staged. MAIN MEASUREMENTS The interval between treatment and recurrence of disease was evaluated. The results were expressed as medians, quartiles (25% to 75%) and percentiles (10% to 90%). The annual incidence of recurrences and second tumors was calculated. RESULTS Seventy-four percent of the recurrences were diagnosed within 18 months post-treatment. The local and regional recurrences and distant metastases showed medians of 270, 210 and 435 postoperative days respectively. The incidence of a second primary tumor varied from 2 to 3.1% a year. CONCLUSION The majority of recurrences occurred within 18 months after the initial surgical treatment. The incidence of a second tumor remained stable after the first post-treatment year.
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Affiliation(s)
- Ali Amar
- Department of Head and Neck Surgery/Otorhinolaryngology, Hospital Heliópolis, São Paulo, Brazil
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123
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Wenig BL. New therapies for locoregionally advanced and locoregionally recurrent head and neck cancer. Cancer Treat Res 2003; 114:315-30. [PMID: 12619548 DOI: 10.1007/0-306-48060-3_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Barry L Wenig
- Feinberg School of Medicine, Northwestern University, USA
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Abstract
Despite advances in surgery, radiotherapy, and chemotherapy, the survival of patients with oral squamous cell carcinoma has not significantly improved over the past several decades. Treatment options for recurrent or refractory oral cancers are limited. Gene therapy for oral cancer is currently under investigation in clinical trials. The goal of cancer gene therapy is to introduce new genetic material into target cells without toxicity to non-target tissues. This review discusses the techniques used in cancer gene therapy for oral squamous cell carcinoma and summarizes the ongoing strategies that are being evaluated in clinical trials.
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Affiliation(s)
- S Xi
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA, USA
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125
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Ampil FL, Nathan CAO, Lian TF, Stucker FJ, Hardin JC, Aarstad RF. Salvage treatment of recurrent skin cancer of the midface. Am J Clin Oncol 2002; 25:580-2. [PMID: 12478003 DOI: 10.1097/00000421-200212000-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nine patients with recurrent cutaneous cancers of the midface were treated by definitive surgery (with adjuvant radiotherapy in five individuals). The clinical courses were marked by local and regional relapses in six cases. Although the prognosis may be generally poor, aggressive therapy, as feasible, seems warranted in these patients because death was not typically rapid after reappearance of disease in several patients.
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Affiliation(s)
- Federico L Ampil
- Department of Radiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA
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126
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Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Italy.
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127
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Strategies for the management of recurrent head and neck squamous cell carcinoma. Curr Opin Otolaryngol Head Neck Surg 2001. [DOI: 10.1097/00020840-200104000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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128
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Lamont JP, Nemunaitis J, Kuhn JA, Landers SA, McCarty TM. A prospective phase II trial of ONYX-015 adenovirus and chemotherapy in recurrent squamous cell carcinoma of the head and neck (the Baylor experience). Ann Surg Oncol 2000; 7:588-92. [PMID: 11005557 DOI: 10.1007/bf02725338] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The E1-b attenuated adenovirus, ONYX-015 (Onyx Pharmaceuticals, Richmond, CA), has demonstrated antitumoral activity in patients with recurrent squamous cell carcinoma of the head and neck. This study evaluated the effects of intratumoral ONYX-015 injection combined with systemic chemotherapy. METHODS Inclusion criteria included: (1) recurrent squamous cell carcinoma of the head and neck, not surgically salvageable, (2) target tumor amenable to direct injection, and (3) no prior chemotherapy for recurrent disease. Patients received ONYX-015 (10(10) plaque-forming units) intratumorally for 5 days, cisplatin (80 mg/m2) on day 1, and 5-fluorouracil (800-1000 mg/m2) on days 1-5. This cycle was repeated every 3 weeks. Serial physical examination and computed tomography were used to assess tumor size and treatment response. RESULTS Fourteen patients were enrolled, and nine patients were evaluable for response at the time of enrollment. The mean age of the evaluable patients was 60.8 years (range, 46-71 years). Mean maximum tumor diameter was 4.8 cm (range, 1.9-10.5 cm). Treatment-related toxicity included nausea (n = 7, 77.8%), vomiting (n = 5, 55.6%), mucositis (n = 5, 55.6%), pain at the injection site (n = 5, 55.6%), constipation (n = 4, 44.4%), and fatigue (n = 4, 44.4%). Locoregional tumor control was obtained in all nine patients (100%) (mean observation time, 157 days). Complete clinical response was seen in three patients (33.3%), partial response was seen in three patients (33.3%), minor response was seen in one patient (11.1%), and two patients (22.2%) had stable disease. Median time to local progression of disease has not been reached (range, 35-356 days). CONCLUSIONS ONYX-015 adenovirus plus systemic cisplatin and 5-fluorouracil provides antitumor activity and local tumor control in patients with recurrent squamous cell carcinoma of the head and neck. This novel treatment approach offers hope for patients with limited treatment alternatives and provides the foundation for a phase III clinical trial.
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Affiliation(s)
- J P Lamont
- Baylor University Medical Center and US Oncology, Dallas, Texas, USA
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