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Radin E, Marcuzzo AV, de Groodt J, Degrassi F, Calderan L, Ramella V, Tirelli G, Ukmar M, Cova MA. MRI-based assessment of the mylohyoid muscle in oral squamous cell carcinoma, a 7-point scoring method. Eur Radiol 2024:10.1007/s00330-024-11016-8. [PMID: 39210160 DOI: 10.1007/s00330-024-11016-8] [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: 11/22/2023] [Revised: 07/04/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES To investigate preoperative MRI evaluation of the features of the mylohyoid muscle (MM) predictive of its infiltration in oral squamous cell carcinoma (OSCC) treatment planning, defining the most appropriate sequences to study its deep extension into the floor of the mouth (FOM). MATERIALS AND METHODS We applied a 7-point score to retrospectively evaluate preoperative imaging of patients who underwent surgery for OSCC over 11 years. The results were compared with histopathological findings using Spearman's rank coefficient. Receiver operating characteristic curves were employed to assess the score's ability to predict MM infiltration, determining optimal thresholds for sensitivity, specificity, and predictive values. The Mann-Whitney U-test confirmed that infiltration judgments did not overlap around this threshold. Cohen's K statistical coefficient was used to evaluate the interobserver agreement. RESULTS Fifty-two patients (mean age 66.4 ± 11.9 years, 36 men) were evaluated. Histopathological examination found MM infiltration in 21% of cases (n = 11), with 90% classified in the highest Score categories. A score > 4 proved to be the best cut-off for predicting the risk of MM infiltration, with a sensitivity of 91% (CI: 0.57-0.99), specificity 61% (CI: 0.45-0.76), PPV 38% (CI: 0.21-0.59), and NPV 96% (CI: 0.78-0.99). At the subsequent single-sequence assessment, the TSE-T2wi had the highest diagnostic accuracy, with sensitivity 90% (CI: 0.57-0.99), specificity 70% (CI: 0.53-0.82), PPV 45% (CI: 0.25-0.67), and NPV 96% (CI: 0.80-0.99). CONCLUSION The 7-point score is a promising predictor of safe surgical margins for MM in OSCC treatment, with the particular benefit of T2-weighted sequences. CLINICAL RELEVANCE STATEMENT Our scoring system for tumor infiltration of MM, which is easy to use even for less experienced radiologists, allows for uniformity in radiological language, thereby ensuring crucial preoperative information for the surgeon. KEY POINTS The relationship of the MM to an oral lesion may impact surgical planning. As the score increases, there is a greater incidence of infiltration in the MM. Our score system improves radiologists' reporting for MM involvement by tumor.
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Affiliation(s)
- E Radin
- Department of Radiology, University of Trieste, Trieste, Italy.
| | - A V Marcuzzo
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Trieste, Italy
| | - J de Groodt
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Trieste, Italy
| | - F Degrassi
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Trieste, Italy
| | - L Calderan
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Trieste, Italy
| | - V Ramella
- Department of Plastic, Reconstructive and Aesthetic Surgery, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, University of Trieste, Trieste, Italy
| | - G Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, University of Trieste, Trieste, Italy
| | - M Ukmar
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, University of Trieste, Trieste, Italy
| | - M A Cova
- Department of Radiology, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, University of Trieste, Trieste, Italy
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Tao ZY, Chu G, Su YX. The Prognostic Role of Perineural Invasion for Survival in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:2514. [PMID: 39061154 PMCID: PMC11274576 DOI: 10.3390/cancers16142514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this study was to conduct a comprehensive review of the predictive significance of PNI in HNSCC survival outcomes. A systematic search was conducted across multiple databases, and all studies published in the last decade were screened (Research Registry ID: reviewregistry1853). The included studies were assessed using the Quality in Prognosis Studies tool. Survival outcome data were extracted, combined, and presented as hazard ratios (HR) with a 95% confidence interval (CI). Totally, 74 studies encompassing 27,559 patients were analyzed and revealed a cumulative occurrent rate of 30% for PNI in HNSCC. PNI+ HNSCC patients had a worse overall survival (HR: 1.91, 95% CI: 1.71-2.13), disease-specific survival (HR: 1.79, 95% CI: 1.55-2.07), disease-free survival (HR: 1.82, 95% CI: 1.69-1.96), local recurrence (HR: 2.54, 95% CI: 1.93-3.33), locoregional recurrence (HR: 2.27, 95% CI: 1.82-2.82), locoregional relapse free survival (HR: 1.77, 95% CI: 1.28-2.45), distant metastasis (HR: 1.82, 95% CI: 1.34-2.48), and distant metastasis-free survival (HR: 2.97, 95% CI: 1.82-4.85) compared to those PNI- patients. The available evidence unequivocally establishes PNI as a critical prognostic factor for worse survival in HNSCC patients.
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Affiliation(s)
- Zhuo-Ying Tao
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China;
| | - Guang Chu
- Division of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China;
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China;
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Hohmann M, Kühn D, Ni D, Späth M, Ghosh A, Rohde M, Stelzle F, Klämpfl F, Schmidt M. Relevant parameters for laser surgery of soft tissue. Sci Rep 2024; 14:1263. [PMID: 38218912 PMCID: PMC10787782 DOI: 10.1038/s41598-024-51449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
In recent years, the laser has become an important tool in hospitals. Laser surgery in particular has many advantages. However, there is still a lack of the understanding of the influence of the relevant parameters for laser surgery. In order to fill this gap, the parameters pulse frequency, use of an exhaustion system, air cooling, laser power, laser scan speed, laser line energy and waiting time between cuts were analysed by ANOVA using inter-animal variation as a benchmark. The quality of the cuts was quantized by a previously published scoring system. A total of 1710 cuts were performed with a [Formula: see text] laser. Of the parameters investigated, laser power and scan speed have the strongest influence. Only the right combination of these two parameters allows good results. Other effects, such as the use of pulsed or continuous wave (CW) laser operation, or air cooling, show a small or negligible influence. By modulating only the laser power and scan speed, an almost perfect cut can be achieved with a [Formula: see text] laser, regardless of the external cooling used or the laser pulse duration or repetition rate from CW to nanosecond pulses.
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Affiliation(s)
- Martin Hohmann
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany.
| | - David Kühn
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
| | - Dongqin Ni
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany
| | - Moritz Späth
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany
| | - Anindya Ghosh
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany
| | - Maximilian Rohde
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, 91052, Erlangen, Germany
| | - Florian Stelzle
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, 91052, Erlangen, Germany
| | - Florian Klämpfl
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany
| | - Michael Schmidt
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordon-Straße 6, 91052, Erlangen, Germany
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Binmadi N, Alsharif M, Almazrooa S, Aljohani S, Akeel S, Osailan S, Shahzad M, Elias W, Mair Y. Perineural Invasion Is a Significant Prognostic Factor in Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3339. [PMID: 37958235 PMCID: PMC10649820 DOI: 10.3390/diagnostics13213339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Objectives: This systematic review and meta-analysis aimed to summarize current evidence regarding the prognostic role of perineural invasion (PNI) in patients with oral squamous cell carcinoma (OSCC). (2) Methods: We searched Cochrane Central, ProQuest, PubMed, Scopus, Science Direct, and Web of Science, using relevant keywords to identify eligible articles. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) criteria. All analyses were performed using comprehensive meta-analysis (CMA; version 3.3.070) software. (3) Results: The study included 101 published articles encompassing 26,062 patients. The pooled analyses showed that PNI was associated with significantly worse overall survival (OS; HR = 1.45, 95% CI: 1.32-1.58; p < 0.001), worse disease-specific survival (DSS; HR = 1.87, 95% CI: 1.65-2.12; p < 0.001), and worse disease-free survival (DFS; HR = 1.87, 95% CI: 1.65-2.12; p < 0.001). Similarly, both local recurrence-free survival (LRFS) and regional recurrence-free survival (RRFS) were worse in patients with PNI (HR = 2.31, 95% CI: 1.72-3.10, p < 0.001; and HR = 2.04, 95% CI: 1.51-2.74, p < 0.001), respectively. The random-effect estimate of three studies demonstrated that the presence of PNI was associated with worse failure-free survival (FFS; HR = 2.59, 95% CI: 1.12-5.98, p < 0.001). (4) Conclusions: The current evidence suggests that PNI can be used as an independent predictor of the prognosis for patients with OSCC. The presence of PNI was associated with worse OS, DFS, DSS, FFS, and with recurrence. Asian patients and patients with extra-tumoral or peripheral PNI invasion were associated with worse prognosis.
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Affiliation(s)
- Nada Binmadi
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Maha Alsharif
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Soulafa Almazrooa
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Suad Aljohani
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Sara Akeel
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Samira Osailan
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia
| | - Muhammad Shahzad
- Institute of Basic Medical Sciences, Khyber Medical University, Hayat Abad Phase 5, Peshawar 25110, Pakistan;
- School of Biological Sciences, Health and Life Sciences Building, University of Reading, Reading RG6 6AX, UK
| | - Wael Elias
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
| | - Yasmin Mair
- Department of Oral Diagnostic Sciences, King Abdulaziz University Faculty of Dentistry, Jeddah 21589, Saudi Arabia; (M.A.); (S.A.); (S.A.); (Y.M.)
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Hohmann M, Kühn D, Späth M, Rohde M, Stelzle F, Klämpfl F, Schmidt M. Development and evaluation of a scoring system for assessing incisions in laser surgery. Sci Rep 2022; 12:14741. [PMID: 36042339 PMCID: PMC9427958 DOI: 10.1038/s41598-022-18969-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
The idea of laser surgery is nearly as old as the laser itself. From the first trials to modern laser surgery systems, it was and is the aim to selectively cut the tissue in the focus spot without causing harm to surrounding structures. This is only possible when the correct parameters for the surgical laser are chosen. Usually, this is done by parameter studies. However, the concrete evaluation scheme often differs between groups and more precise approaches require staining and microscopic evaluation. To overcome these issues, a macroscopic scoring system is presented and evaluated. It can be shown that the scoring system works well and, thus, a laser cut can be evaluated within a few seconds. At the same time, the whole cutting front is taken into account. The presented scoring system is evaluated by the intra class correlation (ICC). The final agreement between different raters is more than 0.7. Therefore, the scoring system can be used to optimize and evaluate the cutting process and it should be suitable for comparing the results between different groups. Definitely, it can be applied for scoring within a group to enable e.g., a profound statistical analysis for a parameter study.
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Affiliation(s)
- Martin Hohmann
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany. .,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany.
| | - David Kühn
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany
| | - Moritz Späth
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany
| | - Max Rohde
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Florian Stelzle
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany.,Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Florian Klämpfl
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany
| | - Michael Schmidt
- Institute of Photonic Technologies (LPT), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Konrad-Zuse-Straße 3/5, 91052, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Paul-Gordan-Straße 6, 91052, Erlangen, Germany
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Results of sole postoperative interstitial, high-dose-rate brachytherapy of T1–2 tongue tumours. Strahlenther Onkol 2022; 198:812-819. [PMID: 35157100 PMCID: PMC9402734 DOI: 10.1007/s00066-022-01901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/16/2022] [Indexed: 11/01/2022]
Abstract
Abstract
Purpose
To describe the results of treating tongue cancer patients with single postoperative interstitial, high-dose-rate (HDR) brachytherapy (BT) after resection.
Methods
Between January 1998 and April 2019, 45 patients with squamous cell histology, stage T1–2N0–1M0 tongue tumours were treated by surgery followed by a single HDR BT in case of negative prognostic factors (close or positive surgical margin, lymphovascular and/or perineural invasion). The average dose was 29 Gy (range: 10–45 Gy) and rigid metal needles were used in 11 (24%) and flexible plastic catheters in 34 cases (76%). Survival parameters, toxicities and the prognostic factors influencing survival were analysed.
Results
During a mean follow-up of 103 months (range: 16–260 months) for surviving patients, the 10-year local and regional control (LC, RC), overall survival (OS), and disease-specific survival (DSS) probabilities were 85, 73, 34 and 63%, respectively. The incidence of local grade 1, 2 and 3 mucositis was 23, 73 and 4%, respectively. As a serious (grade 4), late side effect, soft tissue necrosis developed in 3 cases (7%). In a univariate analysis, there was a significant correlation between lymphovascular invasion and RC (p = 0.0118) as well as cervical recurrence and DSS (p < 0.0001).
Conclusion
Sole postoperative HDR brachytherapy can be an effective method in case of negative prognostic factors in the treatment of early, resectable tongue tumours. Comparing the results of patients treated with postoperative BT to those who were managed with surgery or BT alone known from the literature, a slightly more favourable LC can be achieved with the combination therapy, demonstrating the potential compensating effect of BT on adverse prognostic factors, while the developing severe, grade 4 toxicity rate remains low.
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Choi SE, Choudhary A, Huang J, Sonis S, Giuliano AR, Villa A. Increasing HPV vaccination coverage to prevent oropharyngeal cancer: A cost-effectiveness analysis. Tumour Virus Res 2021; 13:200234. [PMID: 34974194 PMCID: PMC8749055 DOI: 10.1016/j.tvr.2021.200234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 11/07/2022] Open
Abstract
The incidence of oropharyngeal cancer (OPC) has been rising, especially among middle-aged men. While Human Papillomavirus (HPV) has been irrevocably implicated in the pathogenesis of oropharyngeal cancer (OPC), the current HPV vaccination uptake rate remains low in the US. The aim of our study was to evaluate the impact of increased HPV vaccination coverage on HPV-associated OPC incidence and costs. A decision analytic model was constructed for hypothetical cohorts of 9-year-old boys and girls. Two strategies were compared: 1) Maintaining the current vaccination uptake rates; 2) Increasing HPV vaccination uptake rates to the Healthy People 2030 target (80%) for both sexes. Increasing HPV vaccination coverage rates to 80% would be expected to prevent 5,339 OPC cases at a cost of $0.57 billion USD. Increased HPV vaccination coverage would result in 7,430 quality-adjusted life year (QALY) gains in the overall population, and it is estimated to be cost-effective for males with an incremental cost-effectiveness ratio of $86,940 per QALY gained under certain conditions. Expanding HPV vaccination rates would likely provide a cost-effective way to reduce the OPC incidence, particularly among males.
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Affiliation(s)
- Sung Eun Choi
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
| | - Abhishek Choudhary
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - Jingyi Huang
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital and Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC) at the Moffitt Cancer Center, Tampa, FL, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
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The CO 2 waveguide laser with flexible fiber in transoral resection of oral and oropharyngeal cancers: a retrospective cohort study on postoperative and quality of life outcomes. Lasers Med Sci 2021; 37:1755-1762. [PMID: 34591217 DOI: 10.1007/s10103-021-03430-x] [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: 04/15/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to evaluate the CO2 waveguide laser (WG CO2 laser) with flexible fiber (Lumenis Ltd., Yokneam, Israel) in the treatment of oral and oropharyngeal cancers, specifically focusing on postoperative outcomes, pain, and quality of life (QoL). Eighty-one patients, 43 women and 38 men, with oral or oropharyngeal cancer who consecutively underwent transoral resection by WG CO2 laser from August 2015 to April 2020 were retrospectively enrolled. Resections were performed in super pulsed mode with a power setting ranging between 3 and 10 W. Data about frozen sections, reconstruction, complication rate, length of hospital stay, tracheostomy rate and time to decannulation, nasogastric feeding tube rate and time to oral feeding, pain, and QoL were reviewed. Continuous variables were presented as mean and standard deviation. Concordance between intraoperative frozen section examination and definitive histology was calculated using Cohen's K test of agreement. The mean length of hospital stay was 13 days. The feeding tube rate was 81%; the tracheostomy rate was 35%; the feeding tube was left in place for 8 days on average, and the time to decannulation was 9 days. The only complication was a postoperative bleeding in 4 patients. The median postoperative pain score measured by the Numeric Pain Rating Scale on postoperative days 1, 3, and 5 was 0 and there was a constant decrease in painkiller use over the days. The overall mean composite QoL score was 77 ± 14, with excellent results in saliva, taste, pain, and speech domains. Frozen section evaluation had a specificity of 99% and a negative predictive value of 98%. WG CO2 laser is a good and safe tool for transoral tailored resection of oral and oropharyngeal cancers. It ensures a good overall QoL and guarantees fast recovery and a very low postoperative pain.
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Rosenthal M, Baser RE, Migliacci J, Boyle JO, Morris LGT, Cohen MA, Singh B, Shah JP, Wong RJ, Patel S, Ganly I. Flexible fiber-based CO 2 laser vs monopolar cautery for resection of oral cavity lesions: A single center randomized controlled trial assessing pain and quality of life following surgery. Laryngoscope Investig Otolaryngol 2021; 6:690-698. [PMID: 34401493 PMCID: PMC8356859 DOI: 10.1002/lio2.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/06/2021] [Accepted: 04/17/2021] [Indexed: 11/05/2022] Open
Abstract
IMPORTANCE This study reports the impact of laser surgery on quality of life in patients with oral cavity lesions. OBJECTIVE To compare postoperative pain and quality of life in patients treated with flexible fiberoptic CO2 laser vs electrocautery in patients with oral cavity precancerous lesions and early stage cancers. DESIGN Randomized controlled trial. SETTING Single center. PARTICIPANTS Patients with premalignant oral cavity lesions and early stage oral cancer. INTERVENTION Patients were randomized to have surgical resection using either flexible fiber carbon dioxide laser (Laser) or electrocautery (EC). The patients were then followed over a period of 28 days to assess for outcomes including pain, quality of life, performance status, return to work, and return to diet. Quality of life was measured by the University of Washington Quality of Life (UWQOL) questionnaire and the performance status score (PSS). MAIN OUTCOME MEASURE The primary endpoint for this study was the numerical pain rating on postoperative day (POD) 7. RESULTS Sixty-two patients were randomized (32 laser and 30 electrocautery). Lesions excised were carcinoma in 30(48%), dysplasia in 31(50%) and benign in 1(2%). There was no difference in the location of lesion, size of lesion, defect size, type of closure, resection time, and blood loss between Laser and EC arms. Patients who had Laser had less pain compared to EC (mean pain score on POD 7 L = 2.84 vs EC = 3.83, P = 0.11). better UW QOL scores and PSS scores, quicker return to normal diet (median days L = 26.0 vs EC = 28.5, P = 0.17) and faster return to work (median days L = 13.0 vs EC = 16.5, P = 0.14). However, these results were not statistically significant. CONCLUSION There was a trend for patients treated with laser to have less pain and better quality of life scores but these result were not statistically significant. Based on the actual observed difference, a large multicenter RCT with 90 patients in each arm is required to determine the clinical relevance of our results.
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Affiliation(s)
- Matthew Rosenthal
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Raymond E. Baser
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jocelyn Migliacci
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jay O. Boyle
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Luc G. T. Morris
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Marc A. Cohen
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Bhuvanesh Singh
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jatin P. Shah
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Richard J. Wong
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Snehal Patel
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Ian Ganly
- Department of SurgeryHead and Neck Service, Memorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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Lee C, Forner D, Noel CW, Taylor V, MacKay C, Rigby MH, Corsten M, Trites JR, Taylor SM. Functional and Oncologic Outcomes of Octogenarians Undergoing Transoral Laser Microsurgery for Laryngeal Cancer. OTO Open 2021; 5:2473974X211046957. [PMID: 34604690 PMCID: PMC8485289 DOI: 10.1177/2473974x211046957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the oncologic and functional outcomes of transoral laser microsurgery (TLM) for glottic cancers in patients ≥80 years. STUDY DESIGN Prospectively collected case series. SETTING QEII Health Sciences Centre, Halifax, Canada. METHODS This case series used a prospectively collected glottic cancer database to examine consecutive elderly patients (≥80 years old) undergoing TLM. Kaplan-Meier analysis was used to evaluate rates of disease-free, disease-specific, and overall survival as the primary end points of oncologic control. Secondary functional outcomes included voice function, length of hospital stay, and time to readmission. RESULTS From 2005 to 2017, 17 octogenarian patients underwent TLM for glottic cancer. Median follow-up was 4.19 years (interquartile range, 0.71-6.95). Kaplan-Meier estimates of 5-year survival were 78.4% (disease free), 92.9% (disease specific), and 81.9% (overall). The median length of hospital stay was 1 day (range, 0-8). There was only 1 readmission within 30 days of surgery. No patients in this study developed significant surgical or postoperative complications requiring unplanned readmissions. Patient-perceived voice function improved to normal after treatment in 62.5% of patients. CONCLUSION The results of this study suggest that TLM is a safe and effective treatment modality for glottic cancer in patients aged ≥80 years, providing good oncologic control and satisfactory functional outcomes.
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Affiliation(s)
- Changseok Lee
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - David Forner
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Christopher W. Noel
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Victoria Taylor
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Colin MacKay
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Matthew H. Rigby
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Martin Corsten
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Jonathan R. Trites
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - S. Mark Taylor
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
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Khunteta N, Katta P, Badwal JS, Ojha T. The Mandible Sparing "POSC Technique" for Management of Middle and Posterior Third Tongue Cancers. Indian J Otolaryngol Head Neck Surg 2021; 73:252-256. [PMID: 34150600 DOI: 10.1007/s12070-021-02535-7] [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: 02/27/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
Cancer of the tongue forms more than 50% of oral cavity cancers. Generally, patients come with locally advanced tongue cancer. The treatment for this cancer is multi-modality. For resectable cancer, multiple surgical approaches are described in the literature. Mandibulotomy for resection of the middle and posterior third oral cancer is a well-established technique but it has its attended morbidity. We present our results of a new surgical technique, called the Peroral and submandibular cervical surgical approach wherein tongue cancer of middle third and posterior third is resected without mandibulotomy. The advantages of this technique are that the complications of malunion or non-union of bone are avoided, no chances of osteoradionecrosis or osteomyelitis, no need of periosteal elevation or damage, the malignancy is removed with wide margin with minimal blood loss, there is no scar on face or chin, morbidity of surgery is minimal. Also, the technique is easily reproducible.
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Affiliation(s)
- Nitin Khunteta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, Rajasthan India
| | - Prakhar Katta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, Rajasthan India
| | - Jaspreet Singh Badwal
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, Rajasthan India
| | - Tarun Ojha
- Department of ENT - Head and Neck Surgery, Mahatma Gandhi Hospital, Mahatma Gandhi University of Medical Sciences and Technology, Sitapura, Jaipur, India
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Carta F, Quartu D, Mariani C, Tatti M, Marrosu V, Gioia E, Gerosa C, Zanda JSA, Chuchueva N, Figus A, Puxeddu R. Compartmental Surgery With Microvascular Free Flap Reconstruction in Patients With T1-T4 Squamous Cell Carcinoma of the Tongue: Analysis of Risk Factors, and Prognostic Value of the 8th Edition AJCC TNM Staging System. Front Oncol 2020; 10:984. [PMID: 32760667 PMCID: PMC7372302 DOI: 10.3389/fonc.2020.00984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
Compartmental surgery and primary reconstruction with microvascular free flaps represent the gold-standard in the treatment of oral tongue squamous cell carcinoma (OTSCC). However, there are still unclear clinical features that negatively affect the outcomes. This retrospective study included 80 consecutive patients with OTSCC who underwent compartmental surgery and primary reconstruction by free flap. The oncologic outcomes, the reliability of the 8th edition American Joint Committee on Cancer (AJCC) staging system and the prognostic factors were evaluated. Fifty-nine males and 21 females (mean age 57.8 years, range 27-81 years) were treated between November 2010 and March 2018 (one patient had two metachronous primaries). Seventy-one patients (88.75%, 52 males, 19 females, mean age of 57.9 years, range of 27-81 years) had no clinical history of previous head and neck radiotherapy and were considered as naive. Histology showed radical surgery on 80/81 lesions (98.8%), with excision margins >0.5 cm, while in 1 case (1.2%), a close posterior margin was found. According to the 8th AJCC classification, 37 patients (45.7%) were upstaged shifting from the clinical to the pathological stage, and 39 (48.1%) showed an upstaging while shifting from the 7th to the 8th AJCC staging system (no tumors were downstaged). Nodal involvement was confirmed in 33 patients (40.7%). Perineural and lymphovascular invasion were present in 9 (11.1%) and 11 (13.6%) cases, respectively. Twenty-two patients (27.1%) underwent adjuvant therapy. The 5-years disease-specific, overall, overall relapse-free, locoregional relapse-free and distant metastasis-free survival rates were 73.2, 66.8, 62.6, 67.4, and 86%, respectively. Patients with a lymph node ratio >0.09 experienced significantly worse outcomes. Univariate analysis showed that patients with previous radiotherapy, stage IV disease, nodal involvement, and lymphovascular invasion had significantly worse outcomes. Multivariate analysis focused naive patients and showed that lymphovascular invasion, advanced stage of disease, and node involvement resulted reliable prognostic factors, and patients with the same tumor stage and histological risk factors who did not undergo adjuvant therapy experienced significantly worse outcomes. In our series, surgery played a major role in the treatment of local extension; adjuvant therapy resulted strictly indicated in patients with advanced-stage disease associated with risk factors.
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Affiliation(s)
- Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Daniela Quartu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Edoardo Gioia
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Jacopo S A Zanda
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Natalia Chuchueva
- ENT Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrea Figus
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
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Tirelli G, Gardenal N, Gatto A, Bonini P, Tofanelli M, Fernández-Fernández MM. Is there a role for ultrasonic surgery in transoral laryngeal cancer resections? Expert Rev Med Devices 2019; 16:275-279. [DOI: 10.1080/17434440.2019.1596795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
| | - Pierluigi Bonini
- ENT Clinic, Head and Neck Department, University of Trieste, Trieste, Italy
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Nader ME, Ginsberg LE, Bell D, Roberts DB, Gidley PW. Evaluating Perineural Spread to the Intratemporal Facial Nerve on Magnetic Resonance Imaging. Otolaryngol Head Neck Surg 2019; 160:1087-1094. [DOI: 10.1177/0194599819827848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To determine the sensitivity and specificity of magnetic resonance imaging (MRI) for the detection of perineural spread (PNS) along the intratemporal facial nerve (ITFN) in patients with head and neck cancers. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods We included 58 patients with head and neck malignancies who underwent sacrifice of the ITFN between August 1, 2002, and November 30, 2015. Demographics, preoperative facial nerve function, prior oncologic treatment, and timing between MRI and surgery were recorded. Histopathology slides and preoperative MRI were reviewed retrospectively by a neuropathologist and a neuroradiologist, respectively, both blinded to clinical data. The mastoid segment of the facial nerve (referred to as the descending facial nerve [DFN]) and stylomastoid foramen (SMF) were evaluated separately. A grading system was devised when radiographically assessing PNS along the DFN. Results Histopathologic evidence of PNS was found in 21 patients (36.2%). The sensitivity and specificity of MRI in detecting PNS to the DFN were 72.7% and 87.8%, respectively. MRI showed higher sensitivity but slightly lower specificity when evaluating the SMF (80% and 82.8%, respectively). Prior oncologic treatment did not affect the false-positive rate ( P = .7084). Sensitivity was 100% when MRI was performed within 2 weeks of surgery and was 62.5% to 73.3% when the interval was greater than 2 weeks. This finding was not statistically significant (SMF, P = .7076; DFN, P = .4143). Conclusion MRI shows fair to good sensitivity and good specificity when evaluating PNS to the ITFN.
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Affiliation(s)
- Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lawrence E. Ginsberg
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dianna B. Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul W. Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Luna-Ortiz K, Hidalgo-Bahena SC, Muñoz-Gutiérrez TL, Mosqueda-Taylor A. Tumors of the oral cavity: CO2 laser management. Med Oral Patol Oral Cir Bucal 2019; 24:e84-e88. [PMID: 30573713 PMCID: PMC6344001 DOI: 10.4317/medoral.22811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cancer of the oral cavity combined with oropharyngeal cancer is the sixth leading cause of death for cancer worldwide. Surgery remains the standard treatment for this disease in early clinical and locally advanced stages. Numerous studies have shown that laser management is useful for premalignant lesions in the oral cavity; however, there is no conclusive evidence that its use is appropriate in cancer of the oral cavity and that results are comparable with traditional surgery. The objective of this study is to determine cancer control after wide local resection with CO2 laser for oral malignant neoplasms. MATERIAL AND METHODS Retrospective study in patients with tumors of the oral cavity who were considered for surgical resection with CO2 laser from January 2006-December 2015. Demographic data, treatment modalities, histopathological diagnosis and clinical stage variables were obtained. All resections were done with the use of the microspot. Patients with cancer of the tongue were not included because a specific protocol for these patients does exist in our institution. RESULTS There were twenty patients, 10 male and 10 female with a average age of 58 years (range: 20-92 years). Mean age was 53.5 years for females and 63 years for males. Twelve (60%) patients are alive and disease free and four (20%) were lost free of disease. CONCLUSIONS CO2 laser is an acceptable surgical method for the management of small lesions in the oral cavity. We cannot rule out that small lesions of the oral cavity with positive neck could be managed in this manner, adding treatment to the neck, producing an adequate local regional control. However, this hypothesis requires additional studies.
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Affiliation(s)
- K Luna-Ortiz
- Department of Head and Neck Surgery, Instituto Nacional de Cancerologia (Mexico), Av. San Fernando #22, Col. Sección XVI, Tlalpan Mexico,
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Practical clinical guidelines for contouring the trigeminal nerve (V) and its branches in head and neck cancers. Radiother Oncol 2018; 131:192-201. [PMID: 30206021 DOI: 10.1016/j.radonc.2018.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE The trigeminal nerve (V) is a major route of tumor spread in several head and neck cancers. However, only limited data are currently available for its precise contouring, although this is absolutely necessary in the era of intensity-modulated radiation therapy (IMRT). The purpose of this article is to present practical clinical guidelines for contouring the trigeminal nerve (V) in head and neck cancers at risk of spread along this nerve. METHOD The main types of head and neck cancers associated with risks of spread along the trigeminal nerve (V) and its branches were comprehensively reviewed based on clinical experience, literature-based patterns of failure, anatomy and radio-anatomy. A consensus for contouring was proposed based on a multidisciplinary approach among head and neck oncology experts including radiation oncologists (JBi, ML, MO, VG and JB), a radiologist (VD) and a surgeon (CS). These practical clinical guidelines have been endorsed by the GORTEC (Head and Neck Radiation Oncology Group). RESULTS We provided contouring and treatment guidelines, supported by detailed figures and tables to help, for the trigeminal nerve and its branches: the ophthalmic nerve (V1), the maxillary nerve (V2) and the manidibular nerve (V3). A CT- and MRI-based atlas was proposed to illustrate the whole trigeminal nerve pathway with its main branches. CONCLUSION Trigeminal nerve (V) invasion is an important component of the natural history of various head and neck cancers. Recognizing the radio-anatomy and potential routes of invasion is essential for optimal contouring, as presented in these guidelines.
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Choi N, Cho JK, Lee EK, Won SJ, Kim BY, Baek CH. Transoral bisected resection for T1-2 oral tongue squamous cell carcinoma to secure adequate deep margin. Oral Oncol 2017; 73:70-76. [PMID: 28939079 DOI: 10.1016/j.oraloncology.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/04/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the clinical usefulness of transoral bisected resection (TBR) asa new method to secure adequate deep resection margin in T1-2 oral tongue squamous cell carcinomas (SCC). METHODS Among 75 patients with cT1-2N0 oral tongue SCCs, 45 (60%) received transoral en-bloc resection (TER) while 30 (40%) received patients underwent TBR. Primary tumor resection was performed with 1.5-cm surgical resection margin for both groups. Mucosal and deep resection margins, adjuvant treatments including re-resection of the tongue and cheomoradiotherapy, local and regional recurrence free survival, and overall survival were compared between the two groups. RESULTS Mean deep resection margin in the TBR group was 9.9mm (95% CI: 8.4-11.4mm), which was significantly (P<0.001) wider than that of the TER group (mean: 5.4mm, 95% CI: 4.5-6.3mm). However, mucosal resection margins were not significantly (P=0.153) different between the two groups. Re-resection of tongue was performed for 6 (13.3%) of 17 (37.8%) patients with inadequate deep resection margin in the TER group and none (0%) in 4 (13.3%) patients with inadequate deep resection margin in the TBR group. Adjuvant radiation due to inadequate deep resection margin was performed for 6.7% of patients in both groups. The TBR group had better local recurrence free survival than the TER group. However, regional recurrence free survival and overall survival were not significantly different between the two groups. CONCLUSION TBR could provide adequate deep resection margin for early stage tongue cancers with better local tumor control than TER. It can decrease the necessity of adjuvant treatment for re-resection of the tongue.
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Affiliation(s)
- Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Eun Kyu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Jun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Bo Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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18
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Graboyes EM, Gross J, Kallogjeri D, Piccirillo JF, Al-Gilani M, Stadler ME, Nussenbaum B. Association of Compliance With Process-Related Quality Metrics and Improved Survival in Oral Cavity Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2017; 142:430-7. [PMID: 26869135 DOI: 10.1001/jamaoto.2015.3595] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Quality metrics for patients with head and neck cancer are available, but it is unknown whether compliance with these metrics is associated with improved patient survival. OBJECTIVE To identify whether compliance with various process-related quality metrics is associated with improved survival in patients with oral cavity squamous cell carcinoma who receive definitive surgery with or without adjuvant therapy. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted at a tertiary academic medical center among 192 patients with previously untreated oral cavity squamous cell carcinoma who underwent definitive surgery with or without adjuvant therapy between January 1, 2003, and December 31, 2010. Data analysis was performed from January 26 to August 7, 2015. INTERVENTIONS Surgery with or without adjuvant therapy. MAIN OUTCOMES AND MEASURES Compliance with a collection of process-related quality metrics possessing face validity that covered pretreatment evaluation, treatment, and posttreatment surveillance was evaluated. Association between compliance with these quality metrics and overall survival, disease-specific survival, and disease-free survival was calculated using univariable and multivariable Cox proportional hazards analysis. RESULTS Among 192 patients, compliance with the individual quality metrics ranged from 19.7% to 93.6% (median, 82.8%). No pretreatment or surveillance metrics were associated with improved survival. Compliance with the following treatment-related quality metrics was associated with improved survival: elective neck dissection with lymph node yield of 18 or more, no unplanned surgery within 14 days of the index surgery, no unplanned 30-day readmissions, and referral for adjuvant radiotherapy for pathologic stage III or IV disease. Increased compliance with a "clinical care signature" composed of these 4 metrics was associated with improved overall survival, disease-specific survival, and disease-free survival on univariable analysis (log-rank test; P < .05 for each). On multivariable analysis controlling for pT stage, pN stage, extracapsular spread, margin status, and comorbidity, increased compliance with these 4 metrics was associated with improved overall survival (100% vs ≤50% compliance: adjusted hazard ratio [aHR], 4.2; 95% CI, 2.1-8.5; 100% vs 51%-99% compliance: aHR, 1.7; 95% CI, 1.0-3.1), improved disease-specific survival (100% vs ≤50% compliance: aHR, 3.9; 95% CI, 1.7-9.0; 100% vs 51%-99%: aHR, 1.3; 95% CI, 0.6-2.9), and improved disease-free survival (100% vs ≤50% compliance: aHR, 3.0; 95% CI, 1.5-5.8; 100% vs 51%-99% compliance: aHR, 1.6; 95% CI, 0.9-2.7). CONCLUSIONS AND RELEVANCE Compliance with a core set of process-related quality metrics was associated with improved survival for patients with surgically managed oral cavity squamous cell carcinoma. Multi-institutional validation of these metrics is warranted.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer Gross
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri2Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Maha Al-Gilani
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Michael E Stadler
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
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Gilmartin M, Ali T, Rogers SN. Patients' experience in the early recovery phase after removal of intraoral squamous cell carcinoma with carbon dioxide laser. Br J Oral Maxillofac Surg 2017; 55:388-390. [PMID: 28320586 DOI: 10.1016/j.bjoms.2016.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/12/2016] [Indexed: 01/10/2023]
Abstract
Laser excision of oral cancer is well established. The aim of this cross-sectional survey was to ask patients about their main symptoms and the severity of them during the first postoperative weeks. We devised a short questionnaire in collaboration with patients, and did a cross-sectional survey of 50 consecutive patients who had laser excision of T1 and T2 oral cancers over a two-year period. The response rate was 76% (38/50). Twenty patients reported that eating was "quite a bit" or "very much of a problem" and 13 reported similar for pain. The main problems were eating (n=27), pain (n=16), numbness (n=14), speech (n=13), and swallowing (n=12). It took 11 patients more than 4 weeks to recover, and 11 of the 20 who were employed needed to take time off work (modal duration 3 or 4 weeks). Thirteen patients sought advice postoperatively from the clinic, ward or secretary's office, general practitioner, or accident and emergency department (or other out-of-hours service). The survey shows that morbidity associated with laser excision is relatively high, and more studies are required to provide a better evidence base that will inform improvements in postoperative recovery and care.
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Affiliation(s)
- M Gilmartin
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, UK.
| | - T Ali
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, UK.
| | - S N Rogers
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, UK; Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St Helens Road, Ormskirk.
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20
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Dietz A, Wichmann G, Wiegand S. Should We De-escalate the Treatment for HPV-Positive Tumors? Recent Results Cancer Res 2017; 206:173-181. [PMID: 27699538 DOI: 10.1007/978-3-319-43580-0_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
De-escalation or de-intensification of therapy is discussed since many retrospective analyses of former trials demonstrated significantly better outcome for patients suffering from p16/HPV16-positive oropharyngeal squamous cell carcinoma of head and neck (OHNSCC). These observations are comprehensively addressed, but the reader has to keep in mind that none of the currently discussed data result from prospective controlled trials addressing the HPV-discrimination in the primary endpoint design. Identification of the true HPV16-related tumors is still challenging and in addition with different clinical reports and lack of data of prospective trials not mature for routine clinical decision making in 2016. Independent of the currently lacking evidence for HPV-dependent treatment de-escalation, there are some relevant arguments to address this question in ongoing and future trials.
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Affiliation(s)
- Andreas Dietz
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany.
- Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany.
| | - Gunnar Wichmann
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
- Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Department Kopf- und Zahnmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
- Clinic of Otolaryngology, Head and Neck Surgery, Department of Head Medicine and Oral Health, University of Leipzig, Leipzig, Germany
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Mehari F, Rohde M, Kanawade R, Knipfer C, Adler W, Klämpfl F, Stelzle F, Schmidt M. Investigation of the differentiation of ex vivo nerve and fat tissues using laser-induced breakdown spectroscopy (LIBS): Prospects for tissue-specific laser surgery. JOURNAL OF BIOPHOTONICS 2016; 9:1021-1032. [PMID: 26790774 DOI: 10.1002/jbio.201500256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/18/2015] [Accepted: 12/19/2015] [Indexed: 05/23/2023]
Abstract
In the present study, the elemental compositions of fat and nerve tissue during their plasma mediated laser ablation are studied in the context of tissue differentiation for laser surgery applications by using Laser-Induced Breakdown Spectroscopy (LIBS). Tissue samples of porcine fat and nerve were prepared as ex vivo experimental objects. Plasma mediated laser ablation is performed using an Nd : YAG laser in open air and under normal stray light conditions. The performed measurements suggest that the two tissue types show a high similarity in terms of qualitative elemental composition while at the same time revealing a distinct difference in the concentration of the constituent elements. Different analysis approaches are evaluated and discussed to optimize the tissue-differentiation performance of the LIBS approach. Plasma mediated laser tissue ablation.
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Affiliation(s)
- Fanuel Mehari
- Clinical Photonics Lab, Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052, Erlangen, Germany.
- Institute of Photonics Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Konrad-Zuse-Str. 3/5, 91052, Erlangen, Germany.
| | - Maximillian Rohde
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstraße 11, 91054, Erlangen, Germany
| | - Rajesh Kanawade
- Clinical Photonics Lab, Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052, Erlangen, Germany
- Institute of Photonics Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Konrad-Zuse-Str. 3/5, 91052, Erlangen, Germany
| | - Christian Knipfer
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstraße 11, 91054, Erlangen, Germany
| | - Werner Adler
- Chair of Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstraße 6, 91054, Erlangen, Germany
| | - Florian Klämpfl
- Institute of Photonics Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Konrad-Zuse-Str. 3/5, 91052, Erlangen, Germany
| | - Florian Stelzle
- Clinical Photonics Lab, Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052, Erlangen, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glückstraße 11, 91054, Erlangen, Germany
| | - Michael Schmidt
- Clinical Photonics Lab, Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052, Erlangen, Germany
- Institute of Photonics Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Konrad-Zuse-Str. 3/5, 91052, Erlangen, Germany
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22
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Will the mininvasive approach challenge the old paradigms in oral cancer surgery? Eur Arch Otorhinolaryngol 2016; 274:1279-1289. [DOI: 10.1007/s00405-016-4221-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023]
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23
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Bur AM, Lin A, Weinstein GS. Adjuvant radiotherapy for early head and neck squamous cell carcinoma with perineural invasion: A systematic review. Head Neck 2015; 38 Suppl 1:E2350-7. [DOI: 10.1002/hed.24295] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/09/2015] [Accepted: 09/12/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Andrés M. Bur
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Gregory S. Weinstein
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Pennsylvania; Philadelphia Pennsylvania
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Melong JC, Rigby MH, Bullock M, Hart RD, Trites JRB, Taylor SM. Transoral laser microsurgery for the treatment of oropharyngeal cancer: the Dalhousie University experience. J Otolaryngol Head Neck Surg 2015; 44:39. [PMID: 26419647 PMCID: PMC4589206 DOI: 10.1186/s40463-015-0093-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The optimal treatment strategy for oropharyngeal squamous cell carcinoma is highly debated. However, growing evidence supports the use of minimally invasive techniques, such as transoral laser microsurgery (TLM), as a first-line treatment modality for these carcinomas. The purpose of our study was to assess the efficacy and safety of TLM for the treatment of primary and recurrent oropharyngeal carcinomas. METHODS All patients with oropharyngeal carcinoma undergoing TLM at the QEII Health Sciences Centre in Halifax, Nova Scotia were identified within a prospective database monitoring TLM outcomes. Kaplan-Meier survival analysis was used to evaluate the following end points at 36 months: local control (LC), disease-specific survival (DSS), and disease-free survival (DFS). Safety endpoints included complications following surgery and long term morbidity related to TLM. RESULTS Between 2003 and 2014, 39 patients with oropharyngeal carcinoma underwent TLM resection. Twenty-eight (72%) patients had primary carcinoma, nine (23%) were radiation/chemoradiation (RT/CRT) failures, and two (5%) had second primaries following previous RT/CRT. Three patients had stage I disease, 8 stage II, 5 stage III, and 23 stage IV disease. HPV status was available for 26 patients, of which 23 (88%) had HPV positive disease. Kaplan-Meier estimates of 36-month LC, DSS, and DFS for primary oropharyngeal carcinomas were 85.5% (SE 10.6%), 85.7% (SE 13.2%) and 77.7% (SE 12.5%) respectively. Thirty-six-month outcomes for RT/CRT failures were 66.76% (SE 15.7%) for LC and 55.6% (SE 16.6%) for DSS and DFS. Three patients developed complications following surgery. CONCLUSIONS Observed 36-month efficacy and safety outcomes support the use of TLM for the treatment of primary and recurrent oropharyngeal carcinoma.
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Affiliation(s)
- Jonathan C Melong
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Matthew H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Martin Bullock
- Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Robert D Hart
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - Jonathan R B Trites
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
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Sakai M, Yokoyama J, Tashiro M, Ishikawa T. A novel procedure combining transoral resection and set-back tongue flap for oropharyngeal cancer. Acta Otolaryngol 2015; 135:736-40. [PMID: 25761449 DOI: 10.3109/00016489.2015.1011790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Seven patients with advanced lateral oropharyngeal cancer (T3N2bM0, or T4N2bM0) underwent transoral lateral oropharyngectomy (TLO) with reconstruction performed through set-back tongue flap and polyglycolic acid (PGA) sheet. TLO was performed following en bloc resection of tumors using endoscopy. To cover the resulting defect in the lateral oropharyngeal wall, the set-back tongue flap was moved posteriorly and laterally to the area of the tongue base and lateral pharyngeal wall. The tip of the set-back tongue flap was sutured to the lateral pharynx to reconstruct the elevated tongue base and altered anterior pillar. The defect on the floor of the mouth was reconstructed using a PGA sheet. Following surgery, the mean observation period was 24 months. The mean operating time was 4 h and 2 min, with an average blood loss of 68.1 ml. All oral intake resumed on the first postoperative day via gastric tube. The mean gastric tube removal time was 1.6 postoperative days as a result of sufficient oral intake. None of the patients received postoperative radiotherapy or displayed evidence of tumor recurrence. We conclude that this novel procedure is highly effective for treating advanced oropharyngeal cancer as it demonstrates good prognostic and functional outcomes.
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Affiliation(s)
- Mizuno Sakai
- Department of Otorhinolaryngology-Head and Neck Surgery, National Hospital Organization Tochigi Medical Center , Utsunomiya
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Perineural growth in head and neck squamous cell carcinoma: a review. Oral Oncol 2014; 51:16-23. [PMID: 25456006 DOI: 10.1016/j.oraloncology.2014.10.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/30/2014] [Accepted: 10/06/2014] [Indexed: 02/07/2023]
Abstract
Perineural growth is a unique route of tumor metastasis that is associated with poor prognosis in several solid malignancies. It is diagnosed by the presence of tumor cells inside the neural space seen on histological or imaging evaluations. Little is known about molecular mechanisms involved in the growth and spread of tumor cells in neural spaces. The poor prognosis associated with perineural growth and lack of targeted approaches necessitates the study of molecular factors involved in communication between tumor and neural cells. Perineural growth rates, shown to be as high as 63% in head and neck squamous cell carcinoma (HNSCC), correlate with increased local recurrence and decreased disease-free survival. Here we describe the literature on perineural growth in HNSCC. In addition, we discuss factors implicated in perineural growth of cancer. These factors include brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), neurotrophin-3 and -4, glial cell-line derived neurotrophic factor (GDNF), the neural cell adhesion molecule (NCAM), substance P (SP), and chemokines. We also explore the literature on membrane receptors, including the Trk family and the low-affinity nerve growth factor receptor. This review highlights areas for further study of the mechanisms of perineural invasion which may facilitate the identification of therapeutic targets in HNSCC.
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Abstract
The striking rise in the incidence of HPV-related oropharyngeal squamous cell carcinomas and their improved prognosis compared to classical oropharyngeal cancer raises the question as to whether this subset of patients could benefit from less aggressive treatment without compromising efficacy. To achieve that goal, it is critically important to advance our understanding of the behavior of HPV-positive tumors. It is necessary to identify relevant clinical risk factors and to refine the current staging system. Several clinical trials studying various deintensification strategies are currently underway. This review presents some of the most valuable evidence in this regard in an attempt to encourage further exploration of risk stratification and risk-based therapy for patients with oropharyngeal cancer.
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Affiliation(s)
- Monica George
- Medway Maritime Hospital, NHS Foundation Trust, Gillingham, UK,
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Sinha P, Mehrad M, Chernock RD, Lewis JS, El-Mofty SK, Wu N, Nussenbaum B, Haughey BH. Histologic and systemic prognosticators for local control and survival in margin-negative transoral laser microsurgery treated oral cavity squamous cell carcinoma. Head Neck 2014; 37:52-63. [PMID: 24430914 DOI: 10.1002/hed.23553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/27/2013] [Accepted: 11/02/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Appreciable local recurrence rates observed in patients with margin-negative, transoral laser microsurgery (TLM)-treated oral cavity squamous cell carcinoma (SCC) necessitate identification of new prognosticators for local control and survival. A histopathologic index (Brandwein-Gensler score [BGS]) and intrinsic/iatrogenic/chronic conditions causing immune compromise are investigated. METHODS From a prospectively assembled database of TLM-treated oral cavity SCC, specimens for 60 patients with a minimum of 2-years follow-up could undergo BGS assignment. Local control, disease-specific survival (DSS), and overall survival (OS) were study endpoints. RESULTS "Low-BGS" was recorded in 28 patients (47%) and "high-BGS" in 32 patients (53%), whereas immune compromise was observed in 18%. In multivariate analyses, immune compromise was the only predictor for local control. T classification and immune compromise were prognostic for DSS and OS. "High-BGS" was prognostic only for OS. CONCLUSION "High-BGS" was associated with recurrences but immune compromise was the most significant predictor of local control and survival in margin-negative, TLM-treated oral cavity SCC. Strategies that maintain/restore tumor-specific immune responses in immune compromised oral cavity SCC hosts need to be developed.
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Affiliation(s)
- Parul Sinha
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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Parikh RA, Appleman LJ, Bauman JE, Sankunny M, Lewis DW, Vlad A, Gollin SM. Upregulation of the ATR-CHEK1 pathway in oral squamous cell carcinomas. Genes Chromosomes Cancer 2013; 53:25-37. [PMID: 24142626 DOI: 10.1002/gcc.22115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/17/2013] [Indexed: 12/30/2022] Open
Abstract
The ATR-CHEK1 pathway is upregulated and overactivated in Ataxia Telangiectasia (AT) cells, which lack functional ATM protein. Loss of ATM in AT confers radiosensitivity, although ATR-CHEK1 pathway overactivation compensates, leads to prolonged G(2) arrest after treatment with ionizing radiation (IR), and partially reverses the radiosensitivity. We observed similar upregulation of the ATR-CHEK1 pathway in a subset of oral squamous cell carcinoma (OSCC) cell lines with ATM loss. In the present study, we report copy number gain, amplification, or translocation of the ATR gene in 8 of 20 OSCC cell lines by FISH; whereas the CHEK1 gene showed copy number loss in 12 of 20 cell lines by FISH. Quantitative PCR showed overexpression of both ATR and CHEK1 in 7 of 11 representative OSCC cell lines. Inhibition of ATR or CHEK1 with their respective siRNAs resulted in increased sensitivity of OSCC cell lines to IR by the colony survival assay. siRNA-mediated ATR or CHEK1 knockdown led to loss of G(2) cell cycle accumulation and an increased sub-G(0) apoptotic cell population by flow cytometric analysis. In conclusion, the ATR-CHEK1 pathway is upregulated in a subset of OSCC with distal 11q loss and loss of the G(1) phase cell cycle checkpoint. The upregulated ATR-CHEK1 pathway appears to protect OSCC cells from mitotic catastrophe by enhancing the G(2) checkpoint. Knockdown of ATR and/or CHEK1 increases the sensitivity of OSCC cells to IR. These findings suggest that inhibition of the upregulated ATR-CHEK1 pathway may enhance the efficacy of ionizing radiation treatment of OSCC.
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Affiliation(s)
- Rahul A Parikh
- Department of Internal Medicine, Division of Hematology-Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA; University of Pittsburgh Cancer Institute, Pittsburgh, PA
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