Spontaneous rosette formation and rosette inhibition assays in patients with squamous cell carcinoma of the head and neck

Potential role of melatonin in prevention and treatment of oral carcinoma

Melatonin, a hormone secreted mainly by pineal gland has been found to have antioxidant and anti-inflammatory properties in the oral cavity where it reaches through saliva. These properties have been found to be beneficial in certain oral pathologies including periodontal diseases, herpes viral infections and Candida, local inflammatory processes, xerostomia, oral ulcers and oral cancer. The objective of this review is to discuss the mechanism of action and potential role of melatonin as a preventive and curative agent for oral cancer. an extensive review of databases like pubmed, medline, science direct and Cochrane reviews was conducted to find articles related to beneficial actions of melatonin in human body with focus on cancers. Numerous studies both in-vitro and in-vivo had shown promising results regarding role of melatonin as anti-carcinogenic agent. Melatonin may play a role in protecting the oral cavity from tissue damage caused by oxidative stress. The experimental evidence suggests that melatonin may have utility in the treatment of several common cancers of the body. However, more specific studies are necessary to extend the therapeutic possibilities to oral carcinoma.

Evaluation of adenosine deaminase activity in patients with head and neck cancer

ADA is a key enzyme in the mammalian purine salvage pathway. The lack of ADA activity has been linked to a lack of cellular immunity in various immune and myeloproliferative disorders. Data on its role in patients with solid tumors are scant and inconclusive. In this report, we have evaluated the activity of this enzyme in the peripheral lymphocytes of patients with head and neck squamous cell cancer (HNC). The mean ADA activity in Stage IV patients (0.57 +/- 0.08 SEM, n = 12) was significantly lower than that of controls (1.55 +/- 0.25 SEM, P less than 0.05, n = 14) and also significantly lower that the mean ADA activity in patients with Stages I, II, and III (1.14 +/- 0.10 SEM, P less than 0.05, n = 17). Fourteen out of 19 controls, Stage I, II, and III patients had positive skin tests compared to 7 out of 10 Stage IV patients. These differences were not statistically significant. There was also no correlation between ADA activity and the absolute lymphocyte counts. Our results indicate that ADA activity in lymphocytes of patients with advanced HNC is lower than that of controls or patients with earlier stages of the disease. ADA may be a more sensitive indicator of suppressed cellular immunity than delayed cutaneous hypersensitivity reactions, or monitoring absolute lymphocyte counts.

Immunologic parameters in patients with thyroid cancer

We evaluated various immunologic parameters in patients with papillary and follicular carcinomas of the thyroid gland. Our studies included examinations of peripheral blood lymphocytes and skin reactions to selected antigens. Preoperative peripheral blood tests were found to be normal except for an elevated percentage of IgG X Fc+ T-cells (T gamma). Skin reactions (phytohemagglutinin, purified protein derivative) were greater preoperatively than postoperatively. In postoperative cases without tumor recurrence, absolute numbers of T-cells and lymphocytes were reduced. OK-432 is a biologic response modifier of a streptococcal preparation and was used as immunotherapy in postoperative patients. This therapy seemed to augment the absolute numbers of T-cells and lymphocytes as well as purified protein derivative skin reactions in the patients without tumor recurrences. In the patients with postoperative tumor recurrences, there was an abnormal reduction in the percentage of T-cells and in the absolute numbers of T-cells and lymphocytes. OK-432 treatment was not significantly effective in normalizing this reduction.

In vivo and in vitro observation of cellular immune parameters in squamous cell carcinoma of the oral cavity and its correlation with tumor load and prognosis

In vivo and in vitro observations of cellular immune response in 70 patients with squamous cell cancer of the oral cavity and in 40 age-matched normal controls, were made using delayed hypersensitivity responses to DNCB, PPD, and Candida albicans extract (Dermatophytin 'O'), absolute lymphocyte counts, absolute T-cell numbers, and PHA-induced lymphocyte blastogenesis reactions as parameters. The results were correlated with clinical stage, tumor size, lymph node involvement, tumor differentiation, lymphoreticular responses, and outcome during a one-year follow-up period. A significant degree of impairment of both in vivo and in vitro parameters was found in oral cancer patients compared to normal control. The impairment was more prominent in advanced stages. Lymph node involvement was associated with impaired dermal hypersensitivity to recall antigens as well as a reduced T-cell population and blastogenic response. Only delayed hypersensitivity response to DNCB, PPD, and Candida showed a correlation with histologic features such as tumor differentiation and lymphoreticular response. Although absolute lymphocyte counts and T-cell population were reduced in the primary stage of the disease, the functional capacity of isolated lymphocytes to undergo blast formation was retained. PHA-induced lymphocyte blastogenesis showed a significant impairment only when the tumor was well established and disseminated beyond its local confines. Delayed hypersensitivity responses to DNCB, higher T-cell counts, and blastogenic indices were associated with recurrence-free survival. Immunologic parameters provide prognostic information beyond the clinical stage of the disease. Therefore, it seems that a multiparametric in vivo and in vitro observation of cellular immune response may be useful as an indicator of clinical course and prognosis of patients with squamous cell cancer of the oral cavity.

Pemphigus vulgaris and malignancy

A case of oral squamous cell carcinoma with pemphigus vulgaris is reported and the literature is reviewed. Association between the above entities has essentially been founded upon the specificity of cancer-associated antigen. To date, such an antigen has not been adequately defined, and, therefore, any causal relationship between the 2 processes on the grounds of antigenic-specificity of cancer cells remains unjustified. Hence, pemphigus and malignancy may occur as a coexisting phenomenon.

Specific immunological stimulation induced by cryosurgery in patients with squamous-cell carcinoma of the oral cavity

Following earlier personal studies indicating that cryosurgery stimulates several non-specific immunological parameters, mainly those of the cell-mediated component, in patients with squamous-cell carcinoma of the oral cavity, inhibition of leukocyte migration (evaluated by means of the LIF test) was investigated, using a heterologous squamous-cell tumour extract, before and 7 and 14 days after a single cryotherapy session in 14 patients (11 in stages I and II, 3 in stages III and IV). Increased inhibition was observed after 7 days in 8 subjects (57.2%)-72.7% in stage I-II patients. In two cases, reactivity appeared for the first time. In 7/8 cases, this increase persisted, though at lower levels, until the 14th day. The conclusion is drawn that cryosurgery can stimulate specific delayed hypersensitivity in stage I-II squamous-cell carcinoma of mouth.

Thymus-derived lymphocyte enumeration in patients with uveal malignant melanoma

Thymus-derived lymphocytes (T lymphocytes) were enumerated in patients with uveal malignant melanoma. Two T-lymphocyte subpopulations were determined, the active rosette forming cells (A-RFC) and the total rosette forming cells (T-RFC). Subjects were divided into the following groups: (a) pretreatment patients, (b) patients treated by enucleation, (c) patients treated by photocoagulation, (d) patients treated by cobalt plaque radiotherapy, (e) patients treated by enucleation who developed clinically detectable metastasis, and (f) normal controls. There were no differences in the numbers of A-RFC or T-RFC in the control population, pretreatment patients, and those treated in the different ways. Statistically significant depressions of A-RFC and T-RFC levels were seen in patients with metastatic lesions, suggesting that they had an impairment of immunocompetence, as measured by T-lymphocyte rosette formation.

Observations on immunologic parameters in laryngeal cancer patients

Patients with laryngeal cancer were examined immunologically before treatment and for 1-10 years after treatment. In the pretreatment group, the percentage of T cells, lymphocyte blastoid reaction (PHA, concanavalin A), and skin reactions (PHA) were generally in the normal range, but absolute numbers of T cells and lymphocytes were reduced in most patients. In the group with no recurrence after surgery, the absolute number of T cells and lymphocytes, IgG X FcR+T cells (T gamma), and skin reactions was normal in many cases. The group with recurrence showed reduced percentage of T cells and an absolute number of T cells and lymphocytes. The absolute number of T cells and lymphocytes and the PPD skin reaction increased after surgery in some cases, but reductions in some of the parameters were noted in a few cases long after surgery. Radiation therapy for patients with tumors at early stages did not significantly change the percentage of T cells or the skin reactions.

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).

Effect of postoperative total parenteral nutrition (TPN) as an adjunct to gastrectomy for advanced gastric carcinoma

Clinical staging and immune reactivity were correlated in 39 patients who underwent gastrectomy for primary gastric cancer. Cellular immunity was depressed as the stage of cancer advanced, whereas humoral immunity was unaffected. Gastrectomy for advanced cancer in stage 3 and 4 suppressed cellular immunity. The cellular and humoral immune systems in relation to total parenteral nutrition (TPN) versus non-TPN were evaluated in 57 patients who underwent gastrectomy for stage 3 and 4 advanced cancer. Cell-mediated immunocompetence was restored in all 29 patients who received postoperative TPN, while serum immunoglobulins were unaffected by TPN. Improvement of impaired cell-mediated immunity was also obtained in patients treated with a TPN-5-FU combination as an adjunct to surgery. Treatment with TPN during 5-FU administration restored immunocompetence, increased tolerance for 5-FU and gave a satisfactory 3-year survival rate. There were significant differences in the 3-year survival rates of patients who underwent non-curative gastrectomy (54 per cent for TPN-5-FU v. 0 per cent for non-TPN-5-FU; P less than 0.05). It is concluded that TPN during chemotherapy as an adjunct to surgery leads to diminished morbidity, and possibly to prolonged survival time, in patients undergoing gastrectomy for gastric cancer. A possible mechanism responsible for the gratifying results of TPN treatment may be the increased tolerance for 5-FU resulting from improved nutrition and increased cell-mediated immunity.

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.

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.