Correlation of tumor burden with in vitro lymphocyte reactivity and antibodies to herpesvirus tumor-associated antigens in head and neck squamous carcinoma

Prevalence of herpes simplex virus in malignant laryngeal lesions

OBJECTIVE

To determine the prevalence of herpes simplex virus (HSV) in malignant laryngeal lesions.

STUDY DESIGN

Retrospective review.

MATERIALS AND METHODS

Paraffin-embedded, histologically confirmed specimens containing benign laryngeal lesions, squamous cell carcinoma of the larynx, and squamous cell carcinoma of the oral cavity were identified from archived surgical specimens. Biopsies of normal-appearing oral cavity tissue were also obtained from fresh-frozen cadavers. These tissues were analyzed for the presence of HSV DNA using polymerase chain reaction techniques. Patient charts were reviewed for patient demographics, risk factors, stage, clinical course, treatment, and outcome.

RESULTS

HSV was detected in nine laryngeal squamous cell carcinomas (75%) and in none of the benign laryngeal lesions (P = .0001). HSV was also found in three oral cavity squamous cell carcinomas (25%) and in none of the controls (P = .049).

CONCLUSION

HSV is more prevalent in squamous cell carcinoma of the larynx and oral cavity than in their respective control groups, suggesting a role for carcinogenesis. HSV is more prevalent in squamous cell carcinoma of the larynx than of the oral cavity. Further studies to determine the role of HSV as a cocarcinogen and its interrelationship with other environmental factors in laryngeal cancer are warranted.

Adult respiratory papillomatosis: human papillomavirus type and viral coinfections as predictors of prognosis

Pathologic material and the records of 29 patients with laryngeal papillomatosis were reviewed. The relationship between the type of human papillomavirus (HPV) and the presence of viral coinfections was correlated with clinical outcome. Using polymerase chain reaction, paraffin-embedded specimens were analyzed for the presence of HPV, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV). The HPV type could be identified in 24 patients' specimens. Twenty-one patients were infected with HPV type 6. The other 3 were infected with HPV type 11 or 16. Three patients developed squamous cell carcinoma, of whom 2 had HPV type 11 or 16. We found HSV, EBV, and CMV in 50%, 12.5%, and 0% of specimens, respectively. An aggressive clinical course was observed in 17 patients. Evidence of coinfection with other viruses was identified in 11 (65%) of these patients. In contrast, a benign clinical course was observed in 7 patients, of whom 2 (29%) had viral coinfections. We conclude that the HPV type and the presence of viral coinfections may be predictive of an aggressive clinical course.

Oncogenes, tumor suppressors and viruses in oral squamous carcinoma

The pathogenesis of oral squamous cell carcinoma involves recognised carcinogens in tobacco and/or alcohol but other factors, including viruses, may also have a role. This paper reviews the gene changes revealed in oral carcinoma, the evidence implicating viruses, and mechanisms whereby viruses may affect gene function.

Pathogenesis of oral submucous fibrosis. Relationship to risk factors associated with oral cancer

Oral submucous fibrosis (OSF) is a chronic disease of the oral mucosa characterized by inflammation and a progressive fibrosis of the lamina propria and deeper connective tissues. It is a condition predominantly seen among people of Indian origin, and an epidemiologic survey done a decade ago showed no less than 250,000 cases in India, a figure that must have increased sharply. OSF is a condition with a high risk of malignant transformation; to date, no conclusive etiologic agent has been identified, although plenty of data have been generated on various aspects of the disease. These include genetic, carcinogenic, immunologic, viral, nutritional, and autoimmune possibilities, all of which also have been implicated in the development of oral cancer. This article reviews existing evidence on the pathogenesis of OSF and its relation to oral cancer and suggests a possible multifactorial model to explain the disease process.

Viruses in the aetiology of oral carcinoma? Examination of the evidence

This paper examines the evidence for an aetiological role for viruses in the development of oral carcinoma. Several viruses have been sought in oral cancer and evidence found for some, particularly herpes simplex and human papillomavirus. However, the evidence also suggests that these viruses are ubiquitous agents and a number of criteria must be met before these potentially oncogenic agents can reliably be implicated in human carcinogenesis. In contrast, there is no evidence that viruses such as adenovirus, Epstein-Barr virus, and retroviruses play any role in oral carcinogenesis.

Viruses and chronic disorders involving the human oral mucosa

Viruses have been implicated in the etiology of several chronic disorders of the oral mucosa. Most of these associations have been with DNA viruses, particularly certain herpesviruses, which are associated, for example, with some cases of erythema multiforme and with hairy leukoplakia. Papillomaviruses are associated with various papillomatous lesions, focal epithelial hyperplasia, and possibly with some carcinomas. Viruses may possibly be associated with recurrent aphthae, Behçet's syndrome, and some dermatoses. The literature concerning these possible associations is reviewed. However, much more research needs to be done before the full story of viral associations with oral mucosal disorders can be written.

Oral cancer

In the U.S. oral cancer accounts for 2.1% of all cancers and 1% of cancer deaths. Two to three times as many males as females are affected. Blacks have more intra-oral cancer than whites, and their incidence and mortality rates have increased in recent years. The etiologic process very likely involves several factors. The major etiologic agents are tobacco (all types) and alcoholic beverages. Herpes simplex virus, human papilloma virus, and Candida have been implicated. Host factors include poor state of dentition, nutritional aberrations, cirrhosis of liver, lichen planus, and immunologic impairmant. Cellular changes include amplification of some oncogenes, alterations in antigen expression, production of gamma-glutamyl transpeptidase, and disturbance of keratin and involucrin production. Experimentally, cancer is readily produced on the hamster cheek pouch and rat oral mucosa. Unlike oral cancer in humans, most experimental lesions are exophytic, and they rarely metastasize.

Snuff tumorigenesis: effects of long-term snuff administration after initiation with 4-nitroquinoline-N-oxide and herpes simplex virus type 1

The tumor promoting effects of snuff was studied in Lewis rats initiated with 4-nitroquinoline-N-oxide (4-NQO) and Sprague Dawley rats repeatedly inoculated with herpes simplex virus type 1 (HSV-1). The test substances were administered in a surgically created canal in the lower lips of the rats. There were 15 rats in each test group and 10 rats in the control group. In the groups treated with 4-NQO and 4-NQO + snuff, 8 and 12 tumors (5 and 9 malignant) were found, respectively. In the group subjected to HSV-1 only, 3 tumors were found (2 malignant), in the group subjected to snuff only, 4 tumors were found (3 malignant) and in the group subjected to the combination of HSV-1 and snuff, 13 tumors were found (7 malignant). In the control group only one malignancy was found. The study did not show any promoting effects of snuff in the oral cavity after initiation with 4-NQO. Neither was there any increase in the number of oral tumors in rats treated with HSV-1 and snuff. However, there was a marked increase in the number of malignant tumors outside the oral cavity in the group treated with HSV-1 and snuff, underlining the importance of interactions between these two agents in the development of malignant lesions.

Monoclonal antibodies to HSV-infection-related antigens cross-react with tumor cell lines and tumor tissue sections

The purpose of our study was to evaluate a possible association between herpes simplex virus (HSV) and various tumors, including oral squamous cell carcinoma (SCC). To this end, we tested the binding of appropriate monoclonal antibodies to a panel of cell lines and tumor sections. The 25 monoclonal antibodies were reactive with HSV-infected cells but not with uninfected cells. Of these antibodies, three bound to several SCC cell lines and to one non-SCC cell line (K562). One of these three antibodies also reacted with sections of oral SCC tumors, the adjacent mucosa, and normal esophageal epithelium. In contrast, it did not bind to sections of kidney, spleen, esophageal smooth muscle, and skin. To evaluate whether the observed antibody binding could reflect an actual infection by HSV, hybridization experiments between K562 DNA and HSV DNA were performed. HSV DNA sequences were found in K562 DNA at a ratio of 0.1 genome-equivalents/cell. Although these data do not characterize the nature of the relationship, they clearly confirm the postulated association of HSV with some tumors (in particular oral SCC).

Oncogenic potential of sexually transmitted viruses with special reference to oral cancer

Recent changes in social mores have been accompanied by a noted increase in the frequency of sexually transmitted diseases. Viruses that have been identified as causative agents for a large proportion of these diseases have also been associated with various malignant states. Concomitantly, the number of cases of oral cancer (considered to occur usually around or after the fifth decade of life) reportedly has been increasing among young adults. The oncogenic potential of several sexually transmitted viruses (HSV, HPV, CMV, and LAV/HTLV III) and their possible role in the development of malignant conditions, in particular oral cancer, are discussed in this review.

Natural cytotoxicity in draining lymph nodes of squamous cell cancer in the maxillofacial region

There is at present very little information available, including the presented preliminary data, concerning NK activity in patients with head and neck cancer. The objective of the present investigation was to study NK activity in peripheral blood (PB) and regional lymph nodes (LNs) in patients with different stages of head and neck cancer. Furthermore, phenotypic characterization of lymph node cells was performed. Finally, the in vitro response of mononuclear cells isolated from blood and lymph nodes to interferon was investigated.

Systemic and regional natural cytotoxicity in patients with head and neck cancer

Forty patients with squamous carcinoma of the oral cavity (head and neck cancer) were investigated for natural killer-cell (NK) activity in peripheral blood (PB) and tumour-draining lymph nodes (LNs). For measuring NK activity a 4 hrs 51Cr release assay and K 562 target cells were used. Mononuclear cells of PB (PBMNC) and LNs (LNMNC) were separated by Ficoll Hypaque gradient centrifugation. NK activity was determined before tumour surgery. LNs were obtained either at the time of surgery of the primary tumour (en bloc neck dissection)--"immediately dissected LNs (ID-LNs)" or some time after removal of the primary tumour, especially for prophylactic purposes,--"delayed dissected LNs (DD-LNs)". Preoperatively, NK activity was clearly stage-dependent, patients with stages T1-2 displaying mean values similar to those of a control group without malignant disease, whereas values were significantly lower in patients with stages T3-4. Spontaneous cytotoxicity was significantly lower in LNMNC than in PBMNC of identical donors. NK activity was significantly lower in ID-LNs than in DD-LNs. These results suggest some negative influence of the primary tumour in the spontaneous cytotoxicity in both PB and tumour-draining LNs. In vitro incubation at +37 degrees together with addition of lymphoblastoid interferon (IFN-alpha) achieved a significantly stimulation of NK activity in both PBMNC and LNMNC.

Gastrointestinal cancer-associated antigen (GICA) in oral carcinoma

Gastrointestinal cancer-associated antigen (GICA) is detected by means of a monoclonal antibody in the serum and pathologic tissues of patients with gastrointestinal tumors. This article compares serum and salivary GICA and carcinoembryonic antigen (CEA) levels in 19 healthy control subjects, 17 patients with benign oral cavity lesions, and 11 patients with squamous cell carcinoma of the oral cavity. Serum CEA levels were similar in all three groups, whereas salivary CEA levels were higher in patients with squamous cell carcinoma than in the control subjects (p less than 0.001) and the patients with benign lesions (p less than 0.025). Serum GICA levels gave the opposite result and were significantly lower in squamous cell cancer when compared with control subjects (p less than 0.0001) and patients with benign lesions (p less than 0.02). Values of GICA in saliva of patients with oral cancer were also lower than in the control subjects (p less than 0.02). The possible significance of this difference between the two antigens is discussed.

Carcinoma of the paranasal sinuses. Results of a prospective pilot study

Sixty patients with paranasal sinus cancer were treated from January 1976 until July 1981 according to a standard protocol in which surgery is combined with a low dose of irradiation and a topically applied cytostatic drug. The local control rate was 65%. Mutilation was clearly reduced. The actuarial 2-year and 5-year survival rate was 76% and 65%, respectively. The actuarial 5-year survival rate for squamous cell carcinoma and undifferentiated carcinoma of the maxillary sinus was 52%. For adenocarcinoma of the ethmoid sinus the actuarial 5-year survival rate was 100%. The results of this prospective pilot study suggest that it may be possible to achieve better results with less aggressive treatment.

Plasma exchange in six patients with advanced cancers of the head and neck

Six patients with advanced squamous cell cancers of the head and neck, with serum IgA greater than or equal to 400 mg/dl and IgE less than or equal to 1000 IU/ml, underwent a trial of six 2-liter plasma exchanges over a 2-3-week period. Disease progressed in patients 1, 2, and 4, who died on days 44, 72, and 159. The tumor in patients 3 and 6 regressed significantly, repeatedly in patient 3 over each of four courses of apheresis. Tumor recurred in both patients after cessation of treatment, and they died at days 420 and 79. Patient 5, with inoperable disease, received full-dose radiotherapy immediately following the course of apheresis, and showed complete response in the primary lesion and a major response in the extensive lymph node metastases, dying on day 421 of apparently unrelated causes. Serum IgE in the three patients experiencing tumor regression rose paradoxically during plasmapheresis. Only patient 3 had an elevated level of soluble E-receptor suppressor factor prepheresis; the serum of patient 6 was lymphocytotoxic prepheresis but this activity decreased or disappeared during each of the exchanges studied. Controlled trials are now indicated.

Oral carcinoma: evidence for viral oncogenesis

Since early this century, when Rous (1911) first demonstrated the association of a tumour (chicken sarcoma) with a transmissible agent, evidence has accumulated on possible associations between viruses and various neoplasms. There is now conclusive evidence linking some RNA viruses (Temin, 1972) and DNA viruses (Rapp, 1973) with tumours in animals--including sub-human primates (Leading article, 1982). Indeed, a serious complication of hepatitis B infection in man is now recognised to be hepatocellular carcinoma. (Editorial, 1982). The evidence association other viruses with human neoplasms is not unequivocal but there are strong associations between, for example, herpesviruses and some human malignant neoplasms (Klein, 1972; Rapp, 1973; zur Hausen, 1975).

Detection of RNA complementary to herpes simplex virus in human oral squamous cell carcinoma

Biopsy specimens from patients with oral squamous cell carcinoma were examined by in situ hybridisation for evidence of RNA complementary to herpes simplex virus (HSV) type 1, HSV type 2, and adenovirus type 2. RNA complementary to HSV was found in 66% of carcinomas and 33% of non-malignant lesions from other patients. In a further study with internally paired controls, RNA complementary to HSV was found in 53% of carcinoma biopsy specimens but in no biopsy specimens of normal oral mucosa from the same patients. RNA complementary to HSV was found in over 50% of oral squamous cell carcinomas.

Immunology and oral cancer

This paper summarises the evidence for the involvement of the immune response in the development of neoplasia, discusses the immunological abnormalities found in patients with head and neck carcinoma, and outlines recent attempts at treatment of patients with head and neck carcinoma by modulation of the immune response (immunotherapy).

Immunobiologic staging of patients with carcinoma of the head and neck

For decades immunologic deficiencies have been documented in patients with carcinoma, and many investigators have attempted to utilize this information in determining prognosis more accurately. Determining prognosis more accurately would be most helpful with Stage III patients, since at present there are no useful guidelines as to which Stage III patients would benefit from aggressive surgery and/or radiation therapy and which would not. Assays of cellular immunity--such as skin testing, determining peripheral T-lymphocyte counts, and assessing lymphocyte reactivity--have achieved extremely limited clinical application. These assays are too expensive and/or too difficult to perform in the routine clinical setting. Total lymphocyte counts, however, are readily available in the clinical setting and can be helpful in determining prognosis. Other readily available clinical information, such as age and pretreatment serum immunoglobulin levels, can also be of value in determining prognosis. In this study, logistic regression was utilized to determine the prognostic implications of stage, age, and pretreatment total lymphocyte counts in 132 patients with carcinoma of the head and neck. Although each variable determined prognosis accurately less than 70% of the time, the stage, age, lymphocyte prognostic index (SALPI) accurately predicted outcome at 3 year follow-up 80% of the time (Pr. less than .0001). Discriminant function analysis was utilized to determine the prognostic implications of pretreatment serum immunoglobulins in 243 patients with head and neck carcinoma. A serum immunoglobulin prognostic index (SIPI) was derived which was based on the observations that elevated levels of immunoglobulin A (IgA) indicated a poor prognosis, while elevated levels of immunoglobulin E (IgE) and immunoglobulin D (IgD) indicated a favorable prognosis (Pr. less than .009). The SIPI was not as accurate as the SALPI in determining prognosis; however, when the indices were used simultaneously, concurring indices predicted the outcome of Stage III patients correctly 86% of the time.

Etiology of oral squamous cell carcinoma

The traditional list of etiological factors related to oral squamous cell carcinoma namely, tobacco, alcohol, syphilis, and oral sepsis has been expanded to include iron deficiency, chronic candidosis, and herpes simplex virus. The development of current concepts in these areas is discussed. In evaluating the need for future research, special emphasis is given to the concepts of multifactorial etiology and the role of mutagens. Suggestions for future research are discussed.

Immunology of head and neck cancers

Despite the ever growing collection of data concerning the function of the immune system in patients with epidermoid carcinoma of the head and neck, the precise mechanism by which these tumors effect the body's surveillance against foreign antigen is as yet unidentified. If these specific immunological characteristics of the cancer cell can be identified, laboratory analysis of these "markers" could lead to detection and treatment of cancer in its earliest stages. Included in this chapter is a review of the embryological development of the immune system, a description of the components of the immune system and their responses to invasion by tumor antigen. Measurements of immuno responsiveness of the individual are important in determining the pretreatment state of immuno-competence and in predicting prognosis following treatment. Measurements of T-lymphocyte functions and their response to immuno-manipulations can also aid in predicting which patients will benefit from immunotherapy. Finally, categorization of the multiple forms of immunotherapy including active, specific and non-specific, and adoptive mechanisms are discussed. More recent methods of related immunotherapy trials will also be mentioned. As of this writing, the trials of immunochemotherapy have not produced any conclusive results due to the lack of multi-institutional trials and limited quantities of immunotherapeutic agents for these clinical trials.

Immunologic reactivity in patients with nasopharyngeal carcinoma

Immunologic reactivity was measured in 344 patients with nasopharyngeal carcinoma (NPC), before treatment, and in 398 age-matched control subjects. The data recorded suggest that depressed cell-mediated immunity in patients with NPC is a consequence rather than a cause of the disease. In order to reduce tumor burden in patients with NPC, radiation therapy with chemotherapy or immunopotentiation or both is recommended.

Relationships between cervical node histological patterns and rosette test scores: possible prognostic value in laryngeal cancer

In previous research the authors have remarked that some hystological patterns--macrophagic hyperplasia and thymus-dependent areas hyperplasia--when prevailing in cervical nodes of laryngeal cancer patients, possess a positive prognostic value. In this study the possible relationship between the results of E and EAC-rosettes and prevailing hystologic patterns in cervical nodes is investigated. A positive correlation was not found. Conclusively, the inconsistency of aspecific tests for prognostic purposes and the need for a specific immunological monitoring system are outlined.

Comparison of immune derangements in patients with different malignancies

Immune function was evaluated in 109 patients with carcinoma of the breast, bladder, head and neck, and lung. Patients with head and neck cancer showed the most profound derangements of immune function; patients with lung cancer showed no detectable abnormalities. Non-irradiated patients with disseminated head and neck cancer had significantly depressed lymphocyte counts (mean 1357/mm3, P less than .05), E-rosette forming cells (mean 770/mm3, P less than .05), and response to phytohemagglutinin (P less than .05) as compared to controls. This immunodeficiency was detected in patients with localized as well as advanced disease. Although significant differences were noted between patients with head and neck cancer and the other tumors, these differences were minimized by radiation therapy. All irradiated patients showed comparable degrees of immune dysfunction. Absolute Fc-receptor cells were depressed in all irradiated patients and in non-irradiated patients with disseminated breast cancer.

Effect of a bleomycin derivative on oral carcinoma. A clinical and immunologic study of five cases

A new bleomycin derivative NK631 was administered in five cases of advanced recurrent oral carcinoma. The visible improvement of the tumor was noted in three cases, and in the cases of lower lip carcinoma the tumor completely disappeared, however, there was no effective change in cases of cervical metastases of the floor of the mouth and tongue carcinoma. The peripheral lymphocyte counts and serum proteins disclosed a characteristic decrease, serum proteins decreased in the albumin fraction and slightly increased in alpha 2-globlin fraction. Main side effects of NK 631 were skin exanthema, alopecia, anorexia, pyrexia, fatigue and bleeding from the tumor lesion. Regarding the lung function, the vital capacity did not change, but PaO and PaCO in blood gas analysis were together observed to slightly decrease, and it may be supposed that the influence of NK631 on the lung function cannot be neglected. T-cell ratio, lymphocyte blastoformation following PHA stimulation, PPD and DNCB skin tests, and phagocytosis test of peripheral leucocytes were studied. The immuno-suppressive effect of KK631 was the same or weak as bleomycin.

Oral cancer and herpes simplex virus--a review

Numerous studies have suggested that patients with oral cancer have an increased immune response to herpes simplex virus. However, the number of cases has always been small, and essential controls have not always been included. Laboratory experiments have shown that herpes simplex virus can be carcinogenic or cocarcinogenic under certain circumstances and so must be considered as a possible etiologic agent in oral cancer. This article reviews past research and suggests priorities for future investigations.

Immunobiology of head and neck cancer: basic concepts

Patients with squamous cancer of the head and neck have unique perturbations of the immune system. These patients have marked depression of cellular immunity even in the early stages of disease. The known facts about the immunobiology and the immunodeficiencies that commonly occur are discussed. Also reviewed are the relationships of the immunologic deficits to stage of disease, to prognosis, and to the suspected etiologic factors of smoking, alcoholism, and malnutrition. Highlights are given of current immunotherapeutic trials. To date, most of the successful efforts in both immunologic research and immunotherapy of head and neck cancer have dealt with general, rather than specific, immune reactions. Further development in the area of specific immune responses may permit more meaningful measurements of tumor-specific reactions, thus yielding useful tools for immunodiagnosis as well as providing more effective and precise methods of immunotherapy.

Cellular immunity in squamous cell carcinoma of the uterine cervix

The thymus-dependent immunity of 42 patients with SCCC was evaluated by: delayed cutaneous reactions to ubiquitous antigens, DNCB sensitization, and lymphocyte response to PHA. In addition, T and B lymphocytes were detected in peripheral blood and in tumor sections, by adherence to E and HEAC. Depressed CMI was more intense in patients with disseminated disease, although a premature impairment of CMI was observed in some patients with initial-stage tumors. The absolute number of peripheral T lymphocytes showed association with both cutaneous reactions and PHA response. However, there appeared to be no significant correlation between the stage of the tumor and the pattern of adherence of E or HEAC to the biopsies.

The effects of therapeutic irradiation on lymphocytes and immunity

The lymphocytotoxic effect of therapeutic irradiation may lead to immune depression. The significance of such effects is yet to be determined in many malignancies, especially in light of the persistant immune depression in many "cured" patients. The present review examines the effects of age, type of cancer, and stage of disease as well as the results of immune parameters following radiation therapy. Factors to be considered in both the analysis of present day data and in future studies are also reviewed.

Cyclic adenosine monophosphate-phosphodiesterase (cAMP-PDE) in lymphocytes from patients with stage III and IV squamous cell carcinoma of the head and neck

In vivo skin tests using multiple recall and primary antigens such as dinitrochlorobenzine (DNCB) have established that there is decreased cellular-mediated immune response in patients with squamous cell carcinomas of the head and neck. In vitro testing of lymphocytes using blastogenic mitogens as a measure of lymphocyte function has not always shown a statistical difference between patients and controls.cAMP-PDE was assayed in lymphocytes from normal controls-patients with benign conditions in various age groups. No significant difference was found in the specific activity (Vmax) or affinity (Km) in these groups. The mean average was used as a normal control value. In lymphocytes from untreated patients with Stage III and IV squamous cell carcinomas of the head and neck, the Vmax and Km of cAMP-PDE were higher than the controls. This difference was statistically significant. Postoperative values were also determined byt were not statistically different. There were no differences found in blastogenesis in these two groups.