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Yamakawa N, Okura M, Hasegawa T, Otsuru M, Sakai H, Hirai E, Rin S, Yamada SI, Yanamoto S, Yokota Y, Umeda M, Kurita H, Ueda M, Akashi M, Kirita T. Prognostic value of a mandibular canal staging system for primary lesions in patients with lower gingival squamous cell carcinoma: a multicenter, retrospective study. Int J Clin Oncol 2024; 29:1122-1132. [PMID: 38696052 DOI: 10.1007/s10147-024-02542-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/22/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND The Union for International Cancer Control and American Joint Committee on Cancer tumor staging system is used globally for treatment planning. As it may be insufficient for tumor staging of lower gingival carcinomas, we proposed the mandibular canal tumor staging system. In this study, we aimed to compare the two systems for such tumor staging and to identify prognostic markers. METHODS This multicenter, retrospective study included patients with lower gingival squamous cell carcinoma who underwent radical surgery during 2001-2018. We compared survival rates (Kaplan-Meier estimator) and patient stratification according to the two systems. RESULTS The proposed system yielded more balanced patient stratification than the existing system. Progression in the tumor grade according to the proposed system was associated with a poorer prognosis. The 5-year overall and disease-specific survival rates for the entire cohort were 74.9% and 81.8%, respectively. Independent factors affecting overall survival were tumor stage according to the proposed system, excision margins, and number of positive nodes, whereas those affecting disease-specific survival were excision margins and number of positive nodes. CONCLUSIONS Subsite-specific tumor classification should be used for patients with oral cancer, and our results suggest that mandibular canal tumor classification may be effective for patients with lower gingival carcinoma.
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Affiliation(s)
- Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
| | - Masaya Okura
- Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, 1-15-6 Asahi-Cho, Matsusaka, Mie, 515-8557, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Hironori Sakai
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Eiji Hirai
- Oral and Maxillofacial Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan
| | - Shin Rin
- Department of Clinical Oral Oncology, National Hospital Organisation Hokkaido Cancer Center, 3-54 Kikusui 4-2, Shiroisi-Ku, Sapporo, Hokkaido, 003-0804, Japan
| | - Shin-Ichi Yamada
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Souichi Yanamoto
- Department of Oral Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami Ward, Hiroshima, 734-8553, Japan
| | - Yusuke Yokota
- Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Michihiro Ueda
- Department of Clinical Oral Oncology, National Hospital Organisation Hokkaido Cancer Center, 3-54 Kikusui 4-2, Shiroisi-Ku, Sapporo, Hokkaido, 003-0804, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
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Mattavelli D, Montenegro C, Piazza C. Compartmental surgery for T4b oral squamous cell carcinoma involving the masticatory space. Curr Opin Otolaryngol Head Neck Surg 2024; 32:55-61. [PMID: 38193497 PMCID: PMC10919272 DOI: 10.1097/moo.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW This review aims to describe the oncological outcomes of T4b oral squamous cell carcinomas (OSCC) with masticatory space involvement as well as the surgical approaches that are able to achieve compartmental 'en bloc' resection of these lesions. RECENT FINDINGS The masticatory space is subdivided into infra-notch and supra-notch spaces according to the axial plane passing through the mandibular notch between the coronoid process and the condyle neck. Compartmental resection for T4b OSCC with masticatory space invasion can be successfully achieved via purely external approaches or combining external and transnasal endoscopic routes. Infra-notch T4b OSCC showed survival outcomes comparable to T4a OSCC, thus prompting treatment with curative intent. SUMMARY Compartmental resection of the masticatory space is technically feasible with comprehensive control of tumour margins. Use of a transnasal endoscopic anterior route within a multiportal approach may provide better control of margins at the level of the pterygo-maxillary fissure. Equivalent survival outcomes between T4a and infra-notch T4b OSCC are reported. Thus, a downstaging of the latter to T4a is advisable and compartmental surgery of such advanced lesions could be considered as a first-line treatment option in selected patients.
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Affiliation(s)
- Davide Mattavelli
- Department of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, School of Medicine, Brescia, Italy
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Kadian A, Takkar P, Sharma A, Sharma P. Evaluation of response to neoadjuvant chemotherapy in technically unresectable moderately advanced oral cavity cancers. J Cancer Res Ther 2024; 20:750-754. [PMID: 39023578 DOI: 10.4103/jcrt.jcrt_172_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 10/06/2022] [Indexed: 07/20/2024]
Abstract
BACKGROUND Moderately advanced and technically unresectable oral cavity cancers have a poor prognosis. Neoadjuvant chemotherapy might be beneficial in such patients by reducing tumour bulk and allowing definitive surgery. AIM To evaluate the response of neoadjuvant chemotherapy in moderately advanced technically unresectable oral cavity cancers. METHODOLOGY Prospective observational study - secondary data analysis of patients with moderately advanced oral cavity cancer, which were treated with neoadjuvant chemotherapy (NACT) during the period November 2014-April 2016. Data was analysed for information on patient characteristics, chemotherapy received, toxicity, clinical response rates, local treatment offered and pathological response rates. The statistical analysis was performed with SPSS version 20. RESULTS 30 patients, with a median age of 52 years were analyzed. Buccal mucosa was the most common sub site (50%). Three drug regimen was utilized in all patients. Resectability was achieved in 14 patients (46.67%). Febrile neutropenia was seen in 3 patients (10%). The overall response rate was 31%. CONCLUSION NACT was effective in converting moderately advanced technically unresectable oral cavity cancers to operable disease in approximately 47% of patients. Post NACT, there is significant association between clinical and pathological findings of response rates. There is no increase in surgical complication rates following NACT.
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Affiliation(s)
- Abhishek Kadian
- Department of Surgery Army College of Medical Sciences, New Delhi, India
| | - Puneet Takkar
- Department of OncoSurgery, Malignant Disease Treatment Center Command Hospital, Pune, Maharashtra, India
| | - Ankit Sharma
- Department of Surgery Military Hospital, Meerut, Uttar Pradesh, India
| | - Prateek Sharma
- Department of ENT, JIET Medical College and Hospital, Pali Road, Jodhpur, Rajasthan, India
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Rich BJ, Samuels SE, Azzam GA, Kubicek G, Freedman L. Oral Cavity Squamous Cell Carcinoma: Review of Pathology, Diagnosis, and Management. Crit Rev Oncog 2024; 29:5-24. [PMID: 38683151 DOI: 10.1615/critrevoncog.2023050055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Squamous cell carcinoma of the oral cavity presents a significant global health burden, primarily due to risk factors such as tobacco smoking, smokeless tobacco use, heavy alcohol consumption, and betel quid chewing. Common clinical manifestations of oral cavity cancer include visible lesions and sores, often accompanied by pain in advanced stages. Diagnosis relies on a comprehensive assessment involving detailed history, physical examination, and biopsy. Ancillary imaging studies and functional evaluations aid in accurate staging and facilitate treatment planning. Prognostic information is obtained from histopathological factors, such as tumor grade, depth of invasion, lymphovascular invasion, and perineural invasion. Notably, lymph node metastasis, found in approximately half of the patients, carries significant prognostic implications. Effective management necessitates a multidisciplinary approach to optimize patient outcomes. Surgical resection is the backbone of treatment, aimed at complete tumor removal while preserving functional outcomes. Adjuvant therapies, including radiation and chemotherapy, are tailored according to pathological factors. Further work in risk stratification and treatment is necessary to optimize outcomes in squamous cell carcinoma of the oral cavity.
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Affiliation(s)
| | | | - Gregory A Azzam
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Gregory Kubicek
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Laura Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
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Sarma MK, Missong AK, Sharma M, Debnath A, Mahanta N, Choudhury MM. Comparison of Post-Operative Complications in Oral Cancer Treated with and without Neoadjuvant Chemotherapy. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1116-S1118. [PMID: 37694015 PMCID: PMC10485539 DOI: 10.4103/jpbs.jpbs_196_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 09/12/2023] Open
Abstract
Aim The aim of the present study was to compare the treatment outcome in oral cancer cases treated with neoadjuvant chemotherapy (NACT) and upfront surgery in localized advance disease. Materials and Methods A randomized, prospective study was conducted in 20 cases. Patients were divided into two groups. Group A was taken up for upfront surgery and group B was taken up for surgery after two to three cycles of NACT based on patients' response, performance, and compliance. Results Neither group showed statistically significant differences in clinical characteristics. In the present study, satisfactory outcomes were seen in nine patients belonging to NACT group and eight patients of non-NACT group had satisfactory outcomes after surgery, which were found to be statistically significant (P = 0.001). Conclusion NACT may be considered as a treatment option for oral squamous cell carcinoma patients, particularly those with locally advanced tumors. Further prospective studies are needed to validate these findings in patients.
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Affiliation(s)
- Mridul Kumar Sarma
- Department of Head and Neck Oncology, State Cancer Institute, Guwahati Medical College, Assam, India
| | - Ajit K. Missong
- Department of Head and Neck Oncology, State Cancer Institute, Guwahati Medical College, Assam, India
| | - Moitrayee Sharma
- Department of Head and Neck Oncology, State Cancer Institute, Guwahati Medical College, Assam, India
| | - Asim Debnath
- Department of Head and Neck Oncology, State Cancer Institute, Guwahati Medical College, Assam, India
| | - Neelakshi Mahanta
- Department of Medical Oncology, State Cancer Institute, Guwahati Medical College, Assam, India
| | - Mrinmoy M. Choudhury
- Department of Head and Neck Oncology, State Cancer Institute, Guwahati Medical College, Assam, India
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Chaudhuri T, Rudresha AH, Lakshmaiah KC, Babu KG, Dasappa L, Jacob LA, Suresh Babu MC, Lokesh KN, Rajeev LK. Induction chemotherapy in locally advanced T4b oral cavity squamous cell cancers: A regional cancer center experience. Indian J Cancer 2017; 54:35-38. [DOI: 10.4103/ijc.ijc_131_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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Okura M, Yanamoto S, Umeda M, Otsuru M, Ota Y, Kurita H, Kamata T, Kirita T, Yamakawa N, Yamashita T, Ueda M, Komori T, Hasegawa T, Aikawa T. Prognostic and staging implications of mandibular canal invasion in lower gingival squamous cell carcinoma. Cancer Med 2016; 5:3378-3385. [PMID: 27758080 PMCID: PMC5224841 DOI: 10.1002/cam4.899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/16/2016] [Accepted: 08/16/2016] [Indexed: 11/08/2022] Open
Abstract
A multi-institutional study was undertaken to determine whether mandibular canal (MC) invasion and mandibular medullary bone invasion are independent factors in lower gingival squamous cell carcinoma (SCC). A total of 345 patients with lower gingival SCC were retrospectively reviewed. Mandibular bone invasion was categorized into three types; no bone invasion; invasion through cortical bone (medullary); and MC invasion. The overall survival rate and factors affecting local, regional, and distant failures were assessed by Cox proportional hazards regression analysis and Kaplan-Meier estimates. Bone invasion was present in 201 (58%) patients, of whom 107 (31%) had medullary invasion and 94 (27%) had MC invasion. Using the International Union Against Cancer (UICC) staging system and American Joint Committee on Cancer (AJCC) system, 171 (50%) patients were classified as T4a. When the bone invasion criteria were excluded from the UICC/AJCC system definition, 152 T4a tumors were downstaged and reclassified to T1 in 12 (3%), to T2 in 98 (28%), and to T3 in 42 (12%). In Cox multivariate analysis, MC invasion was an independent predictor of overall survival but medullary bone invasion was not. Medullary bone invasion was an independent variable for distant control. The current T staging system has restricted prognostic utility. The authors recommend a modified T staging system, whereby tumors with MC invasion instead of medullary bone invasion are classified as T4a, and tumors are first classified as T1 to T3 based on size and then upstaged by one T classification in the presence of medullary invasion.
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Affiliation(s)
- Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mitsunobu Otsuru
- Division of Surgery, Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yoshihide Ota
- Division of Surgery, Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takahiro Kamata
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Tetsuro Yamashita
- Department of Oral and Maxillofacial Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Michihiro Ueda
- Department of Oral and Maxillofacial Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomonao Aikawa
- The First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka, Japan
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8
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Impact of metronomic neoadjuvant chemotherapy on early tongue cancer. Cancer Chemother Pharmacol 2016; 78:833-40. [DOI: 10.1007/s00280-016-3141-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
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Lee D, Wada K, Taniguchi Y, Al-Shareef H, Masuda T, Usami Y, Aikawa T, Okura M, Kamisaki Y, Kogo M. Expression of fatty acid binding protein 4 is involved in the cell growth of oral squamous cell carcinoma. Oncol Rep 2014; 31:1116-20. [PMID: 24425381 DOI: 10.3892/or.2014.2975] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/27/2013] [Indexed: 11/05/2022] Open
Abstract
Fatty acid binding proteins (FABPs) are a family of small and highly conserved lipid chaperone molecules with highly varied functions. Among them, fatty acid binding protein 4 (FABP4, also known as aP2) is highly expressed by adipocytes, macrophages and dendritic cells. Although the role of FABP4 in cancer is still unclear, it has been reported to be highly expressed by human tumors such as ovarian and bladder cancers. In the present study, we investigated the expression and role of FABP4 in oral squamous cell carcinoma (SCC) and its expression in oral SCC tissues. Immunohistochemical staining revealed that FABP4 expression in the tumor tissue was much higher than that in the non-tumor area of the same specimen. In the in vitro studies, an FABP4-knockdown SCC cell line (established through FABP4-specific siRNA) showed inhibited growth, and inhibited expression and activation of mitogen-activated protein kinase (MAPK). These results indicate that expression of FABP4 plays an important role in the cell growth of oral SCC through the MAPK pathway.
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Affiliation(s)
- Doksa Lee
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Koichiro Wada
- Department of Pharmacology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yoshitaka Taniguchi
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Hani Al-Shareef
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Tomotake Masuda
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yu Usami
- Clinical Laboratory, Osaka University Dental Hospital, Suita, Osaka 565-0871, Japan
| | - Tomonao Aikawa
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Masaya Okura
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yoshinori Kamisaki
- Department of Pharmacology, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
| | - Mikihiko Kogo
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Suita, Osaka 565-0871, Japan
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Sumioka S, Sawai NY, Kishino M, Ishihama K, Minami M, Okura M. Risk Factors for Distant Metastasis in Squamous Cell Carcinoma of the Oral Cavity. J Oral Maxillofac Surg 2013; 71:1291-7. [DOI: 10.1016/j.joms.2012.12.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/28/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022]
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Yanamoto S, Yamada SI, Takahashi H, Kawasaki G, Ikeda H, Shiraishi T, Fujita S, Ikeda T, Asahina I, Umeda M. Predictors of locoregional recurrence in T1-2N0 tongue cancer patients. Pathol Oncol Res 2013; 19:795-803. [PMID: 23677778 DOI: 10.1007/s12253-013-9646-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 04/24/2013] [Indexed: 01/15/2023]
Abstract
Locoregional recurrence of oral tongue squamous cell carcinoma (OTSCC) has been considered a poor prognostic entity in terms of survival rate. The purpose of this study was to evaluate the incidence of locoregional recurrence and to identify significant risk factors for locoregional recurrence in early-stage OTSCC. We retrospectively reviewed the records of 58 patients who underwent radical surgery for T1-2N0 OTSCC. The local recurrence and regional recurrence rates were 10.3 % (6/58 patients) and 15.5 % (9/58 patients) in this study, respectively. The survival rate of patients with local recurrence was 66.7 %, which was significantly lower than that (96.2 %) of patients without local recurrence, whereas the survival rates of patients with or without regional recurrence were not significantly difference. Pattern of invasion (POI), neoadjuvant chemotherapy (NAC) and the status of the surgical margin were identified as factors influencing local recurrence. In particular, the status of the deep surgical margin was a high potential independent risk factor. The deep surgical margin was resected closely in many NAC-treated cases, suggesting that NAC may lead to local recurrence and a poor outcome. No efficacy of NAC was observed, suggesting that the standard treatment for early OTSCC is surgery alone.
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Affiliation(s)
- Souichi Yanamoto
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan,
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Yanamoto S, Yamada S, Takahashi H, Yoshitomi I, Kawasaki G, Ikeda H, Minamizato T, Shiraishi T, Fujita S, Ikeda T, Asahina I, Umeda M. Clinicopathological risk factors for local recurrence in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2012; 41:1195-200. [DOI: 10.1016/j.ijom.2012.07.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/24/2012] [Accepted: 07/19/2012] [Indexed: 11/25/2022]
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Kusayama M, Wada K, Nagata M, Ishimoto S, Takahashi H, Yoneda M, Nakajima A, Okura M, Kogo M, Kamisaki Y. Critical role of aquaporin 3 on growth of human esophageal and oral squamous cell carcinoma. Cancer Sci 2011; 102:1128-36. [DOI: 10.1111/j.1349-7006.2011.01927.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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14
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Fujita K, Nozaki Y, Yoneda M, Wada K, Takahashi H, Kirikoshi H, Inamori M, Saito S, Iwasaki T, Terauchi Y, Maeyama S, Nakajima A. Nitric oxide plays a crucial role in the development/progression of nonalcoholic steatohepatitis in the choline-deficient, l-amino acid-defined diet-fed rat model. Alcohol Clin Exp Res 2009; 34 Suppl 1:S18-24. [PMID: 18986378 DOI: 10.1111/j.1530-0277.2008.00756.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The pathogenesis of nonalcoholic steatohepatitis (NASH) is still unclear. Recently, the 2-hit hypothesis was proposed, in which nitric oxide production, representing oxidative stress, was proposed as a very important candidate for the second hit. METHODS The total study period was 10 weeks. A total of 20 rats were randomly divided into 2 groups. Group 1 was administered the Choline-Deficient, l-Amino Acid-Defined diet to produce a NASH model, and Group 2 as control received the Choline-Sufficient, l-Amino Acid-defined diet. The blood and tissue concentrations of nitrate + nitrite were measured using the Griess reagent and the expression levels of inducible nitric oxide synthase (iNOS) proteins and mRNA was determined by Western blotting. RESULTS In regard to nitric oxide (NO) and NO metabolites, there were significant differences in the blood (especially portal venous blood) as well as tissue (liver and visceral fat) concentrations between the 2 animal groups; the amounts of NO metabolites in the tissues were much higher in the NASH models. The level of nitrotyrosine was much markedly higher in the NASH models than in the controls. In regard to the tissue expression of iNOS a significant difference between the 2 groups was found in the visceral fat, especially in the mesenterium. CONCLUSIONS Based on these results, we hypothesize that the iNOS expression and NO levels in the visceral fat increase, with increased diffusion of NO and its metabolites into the liver, resulting in increased nitrotyrosine formation in the liver; this, in turn, induces inflammation, apoptosis, and fibrosis in the liver, which are one of the characteristic features of NASH.
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Affiliation(s)
- Koji Fujita
- From the Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Okura M, Iida S, Aikawa T, Adachi T, Yoshimura N, Yamada T, Kogo M. Tumor thickness and paralingual distance of coronal MR imaging predicts cervical node metastases in oral tongue carcinoma. AJNR Am J Neuroradiol 2007; 29:45-50. [PMID: 17947369 DOI: 10.3174/ajnr.a0749] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The presence of cervical lymph node metastases is an important prognostic factor for oral tongue cancer. The accurate preoperative assessment is essential for treatment. Several studies have suggested that histologic tumor thickness is related to the metastases. The aim of this study was to determine whether MR images of oral tongue tumor have the potential to predict cervical lymph node metastases. MATERIALS AND METHODS A total of 43 patients with squamous cell carcinoma of the oral tongue were investigated. Tumor thickness, sublingual distance between tumor and sublingual space, and paralingual distance between tumor and paralingual space, as determined from coronal MR imaging, were preoperatively estimated. Logistic regression analysis was used to identify independent predictors of lymph node metastases. RESULTS Univariate logistic regression analysis showed that T classification, N classification, and 3 measured MR imaging distances (millimeters) were significantly associated with lymph node metastases. Multivariate logistic regression analysis showed that tumor thickness (odds ratio, 1.34; 95% confidence interval [CI], 1.11-1.63; P < .005) and paralingual distance (odds ratio, 0.53; 95% CI, 0.35-0.82; P < .005) were significant predictors for lymph node metastases. The probability of metastases was estimated with these models. The preoperative decision (20% probability) as to whether to perform neck dissection could be based on tumor thickness of >9.7 mm and paralingual distance of <5.2 mm. CONCLUSION MR images provide satisfactory accuracy for the preoperative estimation of the tumor thickness and the paralingual distance, which are valuable for predicting cervical lymph node metastases.
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Affiliation(s)
- M Okura
- First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
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Ishida H, Wada K, Masuda T, Okura M, Kohama K, Sano Y, Nakajima A, Kogo M, Kamisaki Y. Critical role of estrogen receptor on anoikis and invasion of squamous cell carcinoma. Cancer Sci 2007; 98:636-43. [PMID: 17355262 PMCID: PMC11158041 DOI: 10.1111/j.1349-7006.2007.00437.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Estrogen receptor (ER) plays an important role in various physiological functions. We examined whether ERalpha and ERbeta are expressed in squamous cell carcinoma (SCC), and whether ER is a potential target for antitumor therapy. High-level expression of ERbeta, but not ERalpha, was observed in tumor cells of human primary SCC tissues and various SCC cultured cell lines. Treatment with ER antagonist (tamoxifen), but not agonist (estradiol), caused apoptotic cell death of SCC cells in a concentration- and time-dependent manner. Adhesion of SCC was inhibited by the treatment with tamoxifen, but not with estradiol. Tamoxifen reduced the phosphorylation of focal adhesion kinase (FAK), resulting in decreases in phosphorylation of extracellular signal-related kinase (Erk) and mitogen-activated protein kinase. Inhibition of FAK phosphorylation is accompanied by disorder of the cytoskeletal component actin. The cell death caused by tamoxifen is therefore the result of direct interference in cell adhesion, which is called 'anoikis', involving a decrease in intracellular FAK signaling. Expression of epidermal growth factor receptor was also inhibited by treatment with a high concentration of tamoxifen. Knockdown of ERbeta by small interfering RNA inhibited the proliferation of SCC. In addition, tamoxifen strongly inhibited invasion of SCC. These results imply a potentially important role for ER, whose inhibition may be effective for the treatment of SCC and the prevention of invasion and metastasis.
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Affiliation(s)
- Hiroyuki Ishida
- Department of Pharmacology, Graduate School of Dentistry, Osaka University, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
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Sturgis EM, Moore BA, Glisson BS, Kies MS, Shin DM, Byers RM. Neoadjuvant chemotherapy for squamous cell carcinoma of the oral tongue in young adults: a case series. Head Neck 2006; 27:748-56. [PMID: 16086413 DOI: 10.1002/hed.20240] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Squamous cell carcinoma of the oral tongue (SCCOT) in the young population has emerged as a growing worldwide health problem. Standard therapies, consisting primarily of surgery with possible adjuvant radiotherapy, have resulted in only modest improvements in survival in recent decades, whereas the treatments for SCCOT continue to impair oral function. With the increased use and improved functional results of neoadjuvant chemotherapy in the treatment of squamous cell carcinoma of other upper aerodigestive tract sites, we have reviewed our experience with neoadjuvant chemotherapy in young patients with SCCOT. METHODS A retrospective review was conducted of all patients younger than 45 years (N = 49) with previously untreated SCCOT evaluated at a comprehensive cancer center from July 1995 to August 2001. Charts were reviewed to obtain demographic data, comorbidities, nutritional status, tumor status, treatment and response information, and follow-up data. RESULTS Fifteen patients were identified who received neoadjuvant chemotherapy with taxane-based regimens before undergoing glossectomy and neck dissection. Thirteen of these patients (87%) exhibited stage III or IV disease at presentation, and all exhibited at least a partial response at the primary site. Pathologically positive nodes were identified in only six patients (40%), although 13 (87%) had clinically or radiographically suspicious nodes at presentation. Adjuvant radiation therapy was administered to seven patients (47%). With a median follow-up of 39 months, no patient has had local or regional recurrence, although three patients (20%) have had distant metastases develop; one patient with an isolated distant metastasis was successfully salvaged with radiation. By comparison during the same period, 34 young adult patients with SCCOT were treated with surgery with or without postoperative radiotherapy but without the use of chemotherapy. Although these patients had lower T classifications (18% vs 67% T3/T4; p = .0007), incidence of nodal metastases (15% vs 87% N+; p < .0001), and overall disease stage (24% vs 87% stage III/IV; p < .0001) than the neoadjuvant chemotherapy group, the overall survival (82%), disease-specific survival (88%), and recurrence-free survival (82%) of the surgery-first group was similar to that of the neoadjuvant chemotherapy group (87%, 87%, and 80%, respectively). CONCLUSIONS This retrospective investigation demonstrates that neoadjuvant chemotherapy with taxane-based regimens may play a role in the successful treatment of SCCOT in young adult patients. Ultimately, this treatment plan may lead to improved functional outcomes in young patients with SCCOT by allowing function-sparing surgery and avoiding postoperative radiotherapy, without sacrificing disease control and survival, but a prospective trial is needed. We have initiated a prospective clinical trial to further investigate the impact of neoadjuvant chemotherapy in patients younger than 50 with SCCOT.
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Affiliation(s)
- Erich M Sturgis
- Department of Head and Neck Surgery, Unit 441, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA.
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Okura M, Isomura ET, Iida S, Kogo M. Long-term outcome and factors influencing bridging plates for mandibular reconstruction. Oral Oncol 2005; 41:791-8. [PMID: 16051516 DOI: 10.1016/j.oraloncology.2005.03.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 03/20/2005] [Indexed: 11/23/2022]
Abstract
Vascularized bone grafts have become the preferred method of mandibular reconstruction. However, the technique is considered to increase both the operating time and blood loss, which might be associated with an increased morbidity and mortality. We conducted a retrospective analysis of 100 consecutive patients who underwent immediate bridging plate reconstruction. The median follow-up duration was 70 months. The 5-year overall survival rate was 69.9%. Cox multivariate analysis revealed that red blood cell transfusion was an independent prognostic factor for the overall survival. The plate survival with no complications was 62.2% at 5 years. Anterolateral defects and preoperative radiotherapy emerged as an independent adverse factor for plate survival. The use of bridging plates is an option for lateral mandibular reconstruction with no preoperative irradiation to avoid the risk from blood transfusion.
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Affiliation(s)
- Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Japan.
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Masuda T, Wada K, Nakajima A, Okura M, Kudo C, Kadowaki T, Kogo M, Kamisaki Y. Critical Role of Peroxisome Proliferator-Activated Receptor γ on Anoikis and Invasion of Squamous Cell Carcinoma. Clin Cancer Res 2005; 11:4012-21. [PMID: 15930335 DOI: 10.1158/1078-0432.ccr-05-0087] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Peroxisome proliferator-activated receptor gamma (PPARgamma) plays a important role in various physiological functions. We examined whether PPARgamma is expressed in primary squamous cell carcinoma and lymph node metastasis and whether PPARgamma is a potential target for tumor therapy. EXPERIMENTAL DESIGN AND RESULTS A high-level expression of PPARgamma was observed in tumor cells of human primary squamous cell carcinoma, lymph node metastasis, and squamous cell carcinoma cell lines. Treatment with PPARgamma-specific antagonists, but not agonists, caused apoptotic cell death on squamous cell carcinoma cell lines in a concentration-dependent manner. Small interfering RNA for PPARgamma also inhibited cell adhesion and growth of squamous cell carcinomas. The phosphorylation of focal adhesion kinase (FAK) was decreased by treatment with PPARgamma antagonists, and resulted in decreases in phosphorylation of Erk and mitogen-activated protein kinase. Furthermore, PPARgamma antagonists decreased the adhesion of squamous cell carcinomas into fibronectin-coated plates, indicating the inhibition of interaction between squamous cell carcinomas and fibronectin. Expression of integrin alpha5, a counter adhesion molecule for fibronectin, was inhibited by the treatment with PPARgamma antagonists. These results indicate that the decrease in integrin alpha5 and following inhibition of cell adhesion may cause the inhibition of FAK signaling pathways. PPARgamma antagonists also strongly inhibited invasion of squamous cell carcinoma via down-regulation of CD151 expression. CONCLUSIONS The cell death caused by the PPARgamma antagonists was a result of direct interference with cell adhesion "anoikis" involving intracellular FAK signaling pathways. These results imply a potentially important and novel role for the inhibition of PPARgamma function via the use of specific antagonists in the treatment of squamous cell carcinoma and the prevention of tumor invasion and metastasis.
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Affiliation(s)
- Tomotake Masuda
- Department of Pharmacology, Graduate School of Dentistry, Osaka University, Suita, Osaka, Japan
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Okura M, Kagamiuchi H, Tominaga G, Iida S, Fukuda Y, Kogo M. Morphological changes of regional lymph node in squamous cell carcinoma of the oral cavity. J Oral Pathol Med 2005; 34:214-9. [PMID: 15752256 DOI: 10.1111/j.1600-0714.2005.00304.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regional immune responses with various types of cancer have been studied histopathologically, however, the prognostic value remains conflicting. The aim of this study was to evaluate morphological changes related to lymph node metastasis and the prognostic value for oral cavity squamous cell carcinoma. METHODS With histopathologic whole architecture of 430 lymph nodes, gross area, germinal center (GC) area, paracortical area (PA), and tumor area were measured. RESULTS Metastatic node had significantly lower distribution ratio of PA to lymphoarea than that of tumor-free node. GC area was not constantly associated with lymph node metastasis. In Cox multivariate analysis, the mean ratio of PA to gross area/lymphoarea was an independent prognostic factor. CONCLUSIONS The proportion of PA to gross/lymph area was associated with lymph node metastasis and long-term survival and may be useful in stratification of those patients for a requirement of adjuvant treatments.
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Affiliation(s)
- Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan.
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Taniguchi Y, Okura M. Prognostic significance of perioperative blood transfusion in oral cavity squamous cell carcinoma. Head Neck 2003; 25:931-6. [PMID: 14603453 DOI: 10.1002/hed.10313] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The influence of perioperative blood transfusion on survival in squamous cell carcinoma of the head and neck is still not convincingly determined. To investigate the effect of perioperative allogeneic transfusion on survival in stage II-IV squamous cell carcinoma of the oral cavity, we studied a consecutive series of 105 patients undergoing primary tumor resection and neck dissection. METHODS Retrospective analyses were performed using Cox proportional hazards models with 16 variables. RESULTS Perioperative red blood cell transfusion was required in 64 (61%) patients. Multivariate analysis demonstrated that the number of positive nodes and > or =3 units of red blood cell transfusion were an independent prognostic indicators. The calculated odds ratio for death after > or =3 units transfused was 5.79 (95% confidence interval, 1.56-21.53, p <.01). CONCLUSIONS More than 3 units of allogeneic red blood cells transfused might shorten the survival of patients with oral cavity cancer.
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Affiliation(s)
- Yoshitaka Taniguchi
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita-city, Osaka 565-0871, Japan
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Okura M, Tamaki Y, Furukawa S, Matsuya T. Bilateral multiple pulmonary metastases in a patient with double advanced cancer of the head and neck. Int J Oral Maxillofac Surg 2003; 32:430-2. [PMID: 14505631 DOI: 10.1054/ijom.2002.0339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A case of advanced gingival cancer is described. The cancer invaded into the mandible and skin of the cheek and was associated with cervical lymph node metastases, mediastinal lymph node metastases, and bilateral multiple pulmonary metastases. The patient received neoadjuvant chemoradiotherapy and local immunotherapy, followed by curative surgery for the primary and neck lesions. Histopathological examination of the primary cancer and the upper and middle cervical nodes (n = 7) indicated a diagnosis of squamous cell carcinoma. Sections of the lower cervical nodes (n = 5) revealed well-differentiated thyroid carcinoma, suggesting that the mediastinal and pulmonary lesions were of thyroid origin. After total thyroidectomy and mediastinal dissection followed by treatment with radioiodine, the multiple pulmonary nodules disappeared. There has been no evidence of recurrent tumour for 5 years.
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Affiliation(s)
- M Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Licitra L, Grandi C, Guzzo M, Mariani L, Lo Vullo S, Valvo F, Quattrone P, Valagussa P, Bonadonna G, Molinari R, Cantù G. Primary chemotherapy in resectable oral cavity squamous cell cancer: a randomized controlled trial. J Clin Oncol 2003; 21:327-33. [PMID: 12525526 DOI: 10.1200/jco.2003.06.146] [Citation(s) in RCA: 177] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prognosis of patients with advanced oral cavity cancer is worth improving. Chemotherapy has been reported to be especially active in oral cavity tumors. Here we repeat the results of a randomized, multicenter trial enrolling patients with a resectable, stage T2-T4 (> 3 cm), N0-N2, M0 untreated, squamous cell carcinoma of the oral cavity. PATIENTS AND METHODS Patients were randomly assigned to three cycles of cisplatin and fluorouracil followed by surgery (chemotherapy arm) or surgery alone (control arm). In both arms, postoperative radiotherapy was reserved to high-risk patients, and surgery was modulated depending on the tumor's closeness to the mandible. Patients' accrual was opened in 1989 and closed in 1999. It included 195 patients. RESULTS In the chemotherapy arm, three toxic deaths were recorded. No significant difference in overall survival was found. Five-year overall survival was, for both arms, 55%. Postoperative radiotherapy was administered in 33% of patients in the chemotherapy arm, versus 46% in the control arm. A mandible resection was performed in 52% of patients in the control arm, versus 31% in the chemotherapy arm. CONCLUSION The addition of primary chemotherapy to standard surgery was unable to improve survival. However, in this study, primary chemotherapy seemed to play a role in reducing the number of patients who needed to undergo mandibulectomy and/or radiation therapy. Variations in the criteria used to select patients for these treatment options may make it difficult to generalize these results, but there appears to be room for using preoperative chemotherapy to spare destructive surgery or radiation therapy in patients with advanced, resectable oral cavity cancer.
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Wang Y, Shi XH, He SQ, Yao WQ, Wang Y, Guo XM, Wu GD, Zhu LX, Liu TF. Comparison between continuous accelerated hyperfractionated and late-course accelerated hyperfractionated radiotherapy for esophageal carcinoma. Int J Radiat Oncol Biol Phys 2002; 54:131-6. [PMID: 12182982 DOI: 10.1016/s0360-3016(02)02892-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare the treatment results and toxicity of continuous accelerated hyperfractionated (CAHF) and late-course accelerated hyperfractionated (LCAF) radiotherapy (RT) for esophageal carcinoma. METHODS AND MATERIALS Between August 1996 and March 1999, 101 patients with squamous cell carcinoma of the esophagus were randomized into two groups: 49 to the CAHF group and 52 to the LCAF group. Patients in the CAHF group received RT at 1.5 Gy/fraction b.i.d. (6-h interval), 5 d/wk, to a total dose 66 Gy in 44 fractions during 4.4 weeks. The patients in the LCAF group received conventional fractionation RT, 1.8 Gy/fraction, to a dose of 41.4 Gy in 23 fractions during 4.6 weeks, followed by accelerated fractionation RT using reduced fields, b.i.d., at 1.5 Gy/fraction, with a minimal interval of 6 h between fractions. The total dose was 68.4 Gy in 41 fraction during 6.4 weeks. Patient age, gender, performance score, diet, lesion location, lesion length, stage, and fractionation (CAHF or LCAF) were entered into the univariate and multivariate analyses. RESULTS All patients finished the treatment course, except for 1 patient in the CAHF group because of severe acute esophagitis. The rate of Grade I, II, and III acute bronchitis was 18.4% (9 of 49), 30.6% (15 of 49), and 8.2% (4 of 49) in the CAHF group and 13.5% (7 of 52), 21.2% (11 of 52), and 3.8% (2 of 52) in the LCAF group, respectively. However, the difference between the two groups was not statistically significant (p = 0.084). The rate of Grade I, II, III, and IV acute esophagitis was 6.1% (3 of 49), 32.7% (16 of 49), 46.9% (23 of 49), and 14.3% (7 of 49) in the CAHF group and 26.9% (14 of 52), 32.7% (17 of 52), 7.7% (4 of 52), and 1.9% (1 of 52) in the LCAF group, respectively. The difference was statistically significant (p < 0.001). The local control rate at 1, 2, and 3 years was 88.7%, 83.9%, and 55.9% in the CAHF group and 80.7%, 71.4%, and 57.1% in the LCAF group, respectively (p = 0.1251). The 1-, 2-, and 3-year survival rate was 79.6%, 51.6%, and 37.6% in the CAHF group and 80.0%, 57.6%, and 41.2% in the LCAF group, respectively (p = 0.5757). Multivariate analysis showed that age and lesion length were independent significant prognostic factors for local control rate, and age was for the overall survival rate. The fractionation schedule had no significant prognostic effect. CONCLUSION CAHF and LCAF result in similar 1-, 2-, and 3-year local control and survival rates. CAHF resulted in more severe acute esophagitis and may be less well tolerated than LCAF. The treatment results after the CAHF and LCAF regimens were better than those of historical conventional RT.
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Affiliation(s)
- Yang Wang
- Department of Radiation Oncology, Cancer Hospital of Medical Center, Fudan University, Shanghai, P.R. China.
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