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Nguyen ML, Hsieh ML, Henson C, Krempl G. Neoadjuvant QUAD shot for downstaging or temporizing locally advanced oral cavity cancer prior to definitive surgery. Oral Oncol 2022; 133:106029. [PMID: 35870330 DOI: 10.1016/j.oraloncology.2022.106029] [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: 04/01/2022] [Revised: 06/22/2022] [Accepted: 07/15/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The mainstay of oral cavity cancer treatment is surgery, often with adjuvant therapies. However, patients often present with locally advanced disease and downstaging would render surgery more feasible. We evaluated hypofractionated radiation therapy (QUAD Shot) prior to definitive surgery for head and neck cancers, with a goal of downstaging. MATERIALS AND METHODS Eighteen patients with primary head and neck malignancy, predominantly locally advanced oral cavity cancers, received QUAD Shot radiation therapy from June 2016 to July 2021. External beam radiation therapy was delivered to the primary lesion in four fractions over two days, two fractions/day at least six hours apart with total dose ranging from 1400 cGy to 1500 cGy. Twelve patients proceeded to definitive surgery. RESULTS Of the twelve patients receiving surgery, one had complete response to radiation therapy with no pathological disease seen at surgery. Four patients had a partial response, defined as downstaging on final pathology. Five patients showed no response, and two had progressive disease defined as upstaging on final pathology. Seven patients had radiographic primary tumor shrinkage ≥ 0.5 cm following Quad Shot. The Quad Shot was tolerated well with no reported adverse effects. CONCLUSION Discrepancies between clinical- and pathological-staging are common and expected. However, ∼40 % of our patients experienced downstaging following QUAD Shot. Thus, neoadjuvant radiation therapy may be viable for temporizing tumor growth while awaiting surgery, or for downstaging and thus facilitating more technically feasible and less morbid surgery for locally advanced head and neck cancers.
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Affiliation(s)
- My-Lien Nguyen
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Meng-Lun Hsieh
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christina Henson
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Greg Krempl
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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2
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von der Grün J, Winkelmann R, Burck I, Martin D, Rödel F, Wild PJ, Bankov K, Weigert A, Kur IM, Brandts C, Filmann N, Issing C, Thönissen P, Tanneberger AM, Rödel C, Ghanaati S, Balermpas P. Neoadjuvant Chemoradiotherapy for Oral Cavity Cancer: Predictive Factors for Response and Interim Analysis of the Prospective INVERT-Trial. Front Oncol 2022; 12:817692. [PMID: 35402268 PMCID: PMC8988145 DOI: 10.3389/fonc.2022.817692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
BackgroundTo study neoadjuvant chemoradiotherapy (nCRT) and potential predictive factors for response in locally advanced oral cavity cancer (LA-OCC).MethodsThe INVERT trial is an ongoing single-center, prospective phase 2, proof-of-principle trial. Operable patients with stage III-IVA squamous cell carcinomas of the oral cavity were eligible and received nCRT consisting of 60 Gy with concomitant cisplatin and 5-fluorouracil. Surgery was scheduled 6-8 weeks after completion of nCRT. Explorative, multiplex immunohistochemistry (IHC) was performed on pretreatment tumor specimen, and diffusion-weighted magnetic resonance imaging (DW-MRI) was conducted prior to, during nCRT (day 15), and before surgery to identify potential predictive biomarkers and imaging features. Primary endpoint was the pathological complete response (pCR) rate.ResultsSeventeen patients with stage IVA OCC were included in this interim analysis. All patients completed nCRT. One patient died from pneumonia 10 weeks after nCRT before surgery. Complete tumor resection (R0) was achieved in 16/17 patients, of whom 7 (41%, 95% CI: 18-67%) showed pCR. According to the Clavien-Dindo classification, grade 3a and 3b complications were found in 4 (25%) and 5 (31%) patients, respectively; grade 4-5 complications did not occur. Increased changes in the apparent diffusion coefficient signal intensities between MRI at day 15 of nCRT and before surgery were associated with better response (p=0.022). Higher abundances of programmed cell death protein 1 (PD1) positive cytotoxic T-cells (p=0.012), PD1+ macrophages (p=0.046), and cancer-associated fibroblasts (CAFs, p=0.036) were associated with incomplete response to nCRT.ConclusionnCRT for LA-OCC followed by radical surgery is feasible and shows high response rates. Larger patient cohorts from randomized trials are needed to further investigate nCRT and predictive biomarkers such as changes in DW-MRI signal intensities, tumor infiltrating immune cells, and CAFs.
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Affiliation(s)
- Jens von der Grün
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- *Correspondence: Jens von der Grün,
| | - Ria Winkelmann
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Daniel Martin
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Peter Johannes Wild
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Katrin Bankov
- Dr. Senckenberg Institute of Pathology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ivan-Maximiliano Kur
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Brandts
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Medicine, Hematology/Oncology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian Issing
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
- Department of Otorhinolaryngology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Philipp Thönissen
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Anna Maria Tanneberger
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt a. M., Goethe-University Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute (FCI), Goethe-University Frankfurt, Frankfurt, Germany
| | - Shahram Ghanaati
- Department of Oral, Maxillofacial and Facial Plastic Surgery, Goethe-University Frankfurt, Frankfurt, Germany
| | - Panagiotis Balermpas
- Department of Radiotherapy and Oncology, Goethe-University Frankfurt, Frankfurt, Germany
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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3
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Silva PGDB, Lemos JVM, Borges MMF, do Rêgo TJR, Dantas TS, Leite CHB, Lima MVA, Cunha MDPSS, Sousa FB. Prognostic factors on surgically and non-surgically treated oral squamous cell carcinoma: Advances in survival in fifteen years of follow up. J Clin Exp Dent 2021; 13:e240-e249. [PMID: 33680326 PMCID: PMC7920565 DOI: 10.4317/jced.57477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Retrospectively to evaluate the influence of radiochemotherapy (RCT) in the treatment of surgically and non-surgically treated Oral Squamous Cell Carcinoma (OSCC).
Material and Methods We analysed 934 patients treated in Hospital Haroldo Juaçaba (2000-2014; 15 years of study) by extraction of data type of cancer, localization of tumour, sex, age, race, education level, risk factors (smoking and alcohol use), year of diagnosis, TNM stage, therapeutic approach, health system used (public or private) and overall survival (OS). Surgically and non-surgically treated OSCC were compared by chi-square and Fisher’s exact tests, and their prognostic factors were analysed by log-rank Mantel-Cox plus Cox regression tests (SPSS 20.0, p<0.05).
Results Non-surgically treated OSCC patients had a lower OS than surgically treated OSCC patients (p<0.001), but an increase in OS was shown in both groups. Although the 2010-2014 period (p=0.003), education level (p=0.032), tongue/mouth floor/palate localization (p=0.023) and TNM stage (p<0.05) were important in non-surgically treated OSCC OS, the major prognostic factors were node metastasis (p=0.003) and non-use of RCT (p=0.039) (multivariate analysis). In surgically treated OSCC patients, higher OS was shown in the 2010-2014 period (p<0.001), females (p=0.012), non-drinkers (p=0.011), non-smokers (p=0.009) and those with lower TNM stage (p<0.05), but the major prognostic factor was the 2010-2014 period (p=0.004) (multivariate analysis), which was directly associated with an increase in RCT indication (p<0.001).
Conclusions The increase in RCT improved the OS in this large cohort of surgically and non-surgically treated OSCC patients. Key words:Mouth neoplasms, neck, radiotherapy, drug therapy, combination.
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Affiliation(s)
- Paulo-Goberlânio-de Barros Silva
- PhD, Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil.,PhD, Department of Oncology Research, Hospital Haroldo Juaçaba, Fortaleza, Ceará, Brazil
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Alzahrani R, Obaid A, Al-Hakami H, Alshehri A, Al-Assaf H, Adas R, Alduhaibi E, Alsafadi N, Alghamdi S, Alghamdi M. Locally Advanced Oral Cavity Cancers: What Is The Optimal Care? Cancer Control 2020; 27:1073274820920727. [PMID: 32339002 PMCID: PMC7218312 DOI: 10.1177/1073274820920727] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patients with oral cavity cancers often present late to seek medical care. Surgery is usually the preferred upfront treatment. However, surgical resection cannot be achieved in many cases with advanced disease without major impact on patient’s quality of life. On the other hand, radiotherapy (RT) and chemotherapy (CT) have not been employed routinely to replace surgery as curative treatment or to facilitate surgery as neoadjuvant therapy. The optimal care of these patients is challenging when surgical treatment is not feasible. In this review, we aimed to summarize the best available evidence-based treatment approaches for patients with locally advanced oral cavity cancer. Surgery followed by RT with or without CT is the standard of care for locally advanced oral cavity squamous cell carcinoma. In the case of unresectable disease, induction CT prior to surgery or chemoradiotherapy (CRT) can be attempted with curative intent. For inoperable patients or when surgery is expected to result in poor functional outcome, patients may be candidates for possibly curative CRT or palliative RT with a focus on quality of life.
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Affiliation(s)
- Rajab Alzahrani
- Department of Surgery, Medical School, Al Baha University, Al Baha, Saudi Arabia
| | - Arwa Obaid
- Department of Surgery, Medical School, Al Baha University, Al Baha, Saudi Arabia
| | - Hadi Al-Hakami
- Otolaryngiology/Head and Neck section, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,King Saud Bin Abdulaziz University, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Alshehri
- King Saud Bin Abdulaziz University, Jeddah, Saudi Arabia.,Medical Oncology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Hossam Al-Assaf
- Radiation Oncology Department, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Reem Adas
- Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Eman Alduhaibi
- Radiation Oncology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Nabil Alsafadi
- Radiation Oncology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Suliman Alghamdi
- King Saud Bin Abdulaziz University, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Radiation Oncology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
| | - Majed Alghamdi
- Radiation Oncology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia.,Department of Medicine, Medical School, Al Baha University, Al Baha, Saudi Arabia
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5
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Mishra S, Tiwari V, Arora A, Gupta S, Anand N, Husain N. Increased Expression of Oct4, Nanog and CD24 Predicts Poor Response to Chemo-Radiotherapy and Unfavourable Prognosis in Locally Advanced Oral Squamous Cell Carcinoma. Asian Pac J Cancer Prev 2020; 21:2539-2547. [PMID: 32986350 PMCID: PMC7779456 DOI: 10.31557/apjcp.2020.21.9.2539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Current study investigates the role of Oct4, Nanog and CD24 in locally-advanced oral squamous cell carcinoma (OSCC), to evaluate whether the expression of these markers can predict efficacy of neoadjuvant-chemo-radiotherapy and survival of patients. Methods: Biomarker expression was evaluated in 50 homogenously treated patients of locally-advanced OSCC. Results: Clinical response was complete in 30% (n=15), partial response in 46% (n=23), no response in 24% (n=12). Pathologically, 74% patents (n=37) were responders and 26% were non-responders (n=13). Biomarker-overexpression was seen in 46% cases for Oct4, 54% cases for Nanog and 58% cases for CD24. Oct4, Nanog and CD24 expression showed significant correlation with clinical and pathological response (p<0.05). Three year recurrence-free survival was 71%, overall survival was 66%. Post-treatment advanced pathological N (ypN), post treatment advanced pathological TNM (ypTNM) stage, clinical non-response, pathologic non-response, positive/high expression of all three biomarkers had a significant negative impact on recurrence-free and overall survival. Conclusions: Expressions of Oct4, Nanog and CD24 have significant association with treatment response and survival in patients with locally advanced OSCC treated with neoadjuvant chemo-radiation. Survival of these patients is significantly affected by ypN stage, ypTNM stage, expression of all three biomarkers, clinical and pathological response to neoadjuvant therapy.
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Affiliation(s)
- Sridhar Mishra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vandna Tiwari
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aditi Arora
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Seema Gupta
- Department of Radiotherapy, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Nidhi Anand
- Department of Radiotherapy, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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6
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Uchiyama Y, Sasai T, Nakatani A, Shimamoto H, Tsujimoto T, Kreiborg S, Murakami S. Distant metastasis from oral cavity-correlation between histopathology results and primary site. Oral Radiol 2020; 37:167-179. [PMID: 32468449 DOI: 10.1007/s11282-020-00440-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 04/19/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Oral cancer is the eighth most common type of cancer worldwide and a significant contributor to the global burden caused by this disease. The principal parameters considered to influence prognosis, and thus treatment selection, are size and location of the primary tumor, as well as assessment of the presence and extent of lymph node and distant metastasis (DM). However, no known report regarding the relationship between the primary site and DM has been presented. For effective treatment selection and good prognosis, the correlation of DM with anatomic site and histopathology results of the primary malignancy is important. In the present study, we performed a systematic review of published reports in an effort to determine the relationship between the anatomic site of various types of oral cavity cancer and DM. METHODS A systematic review of articles published until the end of 2018 was performed using PubMed/MEDLINE. RESULTS A total of 150 studies were selected for this review. The percentage of all cases reported with DM was 6.3%, ranging from 0.6% to 33.1% in the individual studies. The rate of incidence of tongue occurrence was 9.3%. A frequent DM site was the lungs, with adenoid cystic carcinoma the most commonly involved histopathological factor. Malignant melanoma was most frequent (43.4%) in all histopathology findings, whereas there were no cases with an acinic cell carcinoma or cystadenocarcinoma. CONCLUSIONS We found that the occurrence of DM from the primary site as well as rate of incidence was dependent on histopathological factors.
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Affiliation(s)
- Yuka Uchiyama
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tadashi Sasai
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Atsutoshi Nakatani
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomomi Tsujimoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Sven Kreiborg
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.,3D Craniofacial Image Research Laboratory, University of Copenhagen, Copenhagen, Denmark
| | - Shumei Murakami
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, 565-0871, Japan.,3D Craniofacial Image Research Laboratory, University of Copenhagen, Copenhagen, Denmark
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7
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Eder-Czembirek C, Rechinger S, Kornek G, Selzer E, Seemann R. Experience in Intra-arterial Chemotherapy using Two Protocols for the Treatment of OSCC over Two Decades at the University Hospital Vienna. Clinics (Sao Paulo) 2018; 73:e433. [PMID: 30365825 PMCID: PMC6178862 DOI: 10.6061/clinics/2018/e433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/27/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This retrospective study performed a comprehensive analysis of the usage of intra-arterial chemotherapy (iaCh) for locally recurrent UICC stage IV oral squamous cell carcinoma (OSCC) over two decades at the Department of Cranio-Maxillofacial and Oral Surgery at the University Hospital Vienna to assess the utility of its future use. METHODS Between 1994 and 2014, iaCh was indicated in 48 OSCC cases. In these, the two most frequent iaCh schemes, cisplatin/5-fluorouracil (Cis/5-FU) and methotrexate/bleomycin (MTX/Bleo), were chosen for further analysis. The effect on survival of two distinct intra-arterial protocols and their covariates were analyzed with the Kaplan-Meier method as well as univariate and multivariate Cox proportional hazard regression models. RESULTS The mean follow-up period was 29.91 months. The two intra-arterial chemotherapy groups did not differ significantly in sample size, demographic data or therapeutic covariates. The Cis/5-FU iaCh regimen was associated with significantly better overall survival (median OS 2.6 years vs. 1.3 years; p=0.002) and had a beneficial effect on survival (HR=3.62, p=0.015). Side effects occurred at a frequency similar to that described in the literature for intravenous chemotherapy (ivCh). CONCLUSIONS These results suggest a preference for administering Cis/5-FU for iaCh. Nevertheless, due to economic considerations in healthcare expenditures, there is no future for iaCh in the treatment of head and neck carcinomas because ivCh is known to be equivalent.
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Affiliation(s)
- Christina Eder-Czembirek
- Department of Cranio, Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria
- *Corresponding author. E-mail:
| | | | - Gabriela Kornek
- University Clinic of Internal Medicine, Department of Oncology, Medical University Vienna, Vienna, Austria
| | - Edgar Selzer
- University Clinic of Radiotherapy, Medical University Vienna, Vienna, Austria
| | - Rudolf Seemann
- Department of Cranio, Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria
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8
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Eder-Czembirek C, Sulzbacher I, Fuereder T, Selzer E. P16 positivity and regression grade predict survival after neoadjuvant radiotherapy of OSCC. Oral Dis 2018; 24:544-551. [DOI: 10.1111/odi.12814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 12/31/2022]
Affiliation(s)
- C Eder-Czembirek
- Department of Cranio-, Maxillofacial and Oral Surgery; Medical University of Vienna; Vienna Austria
| | - I Sulzbacher
- Clinical Institute of Pathology; Medical University of Vienna; Vienna Austria
| | - T Fuereder
- Department of Internal Medicine I; Division of Oncology & CCC; Medical University of Vienna; Vienna Austria
| | - E Selzer
- University Clinic of Radiotherapy; Medical University of Vienna; Vienna Austria
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9
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Nemeth D, Zaleczna L, Huremovic A, Engelmann J, Poeschl PW, Strasz M, Holawe S, Kornek G, Laskus A, Sacher C, Erovic BM, Perisanidis C. Importance of chewing, saliva, and swallowing function in patients with advanced oral cancer undergoing preoperative chemoradiotherapy: a prospective study of quality of life. Int J Oral Maxillofac Surg 2017; 46:1229-1236. [PMID: 28579265 DOI: 10.1016/j.ijom.2017.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/07/2017] [Accepted: 05/10/2017] [Indexed: 11/26/2022]
Abstract
The primary objective of this study was to investigate the quality of life (QOL) of patients with oral squamous cell carcinoma (OSCC) undergoing curative neoadjuvant chemoradiotherapy followed by radical tumour resection and simultaneous oral cavity reconstruction, using two validated questionnaires. A secondary objective was to assess clinical variables predicting post-treatment dysfunction in chewing, saliva, and swallowing. Thirty-five patients with locally advanced OSCC who underwent preoperative chemoradiotherapy were recruited prospectively. All patients completed both the University of Washington Quality of Life version 4 questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy-Head & Neck version 4 questionnaire (FACT-H&N). UW-QOL and FACT-H&N items were associated with clinical variables. Nearly three-quarters of OSCC patients perceived good to excellent levels of overall QOL after preoperative chemoradiotherapy. Chewing difficulties, decreased salivary function, and swallowing dysfunction were the most frequent complaints of OSCC patients. Items related to food intake were significantly worse in OSCC patients older than 60 years and those with T4 tumours, as well as those without alcohol intake. Chewing, saliva, and swallowing are the most significant issues in patients with OSCC undergoing preoperative chemoradiotherapy. The results of this study may help guide treatment decisions for OSCC patients based on more accurate expectations of adverse effects of cancer treatment.
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Affiliation(s)
- D Nemeth
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | | | - A Huremovic
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - J Engelmann
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - P W Poeschl
- Department of Oral and Maxillofacial Surgery, University Teaching Hospital, Wels, Austria
| | - M Strasz
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - S Holawe
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - G Kornek
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - A Laskus
- Dental Clinic Trio-Dent, Warsaw, Poland
| | - C Sacher
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - B M Erovic
- Department of Otolaryngology - Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - C Perisanidis
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria.
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10
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Holzinger D, Danilovic I, Seemann R, Kornek G, Engelmann J, Pillerstorff R, Holawe S, Psyrri A, Erovic BM, Farwell G, Perisanidis C. Prognostic Impact of Pretreatment Plasma Fibrinogen in Patients with Locally Advanced Oral and Oropharyngeal Cancer. PLoS One 2016; 11:e0158697. [PMID: 27362659 PMCID: PMC4928813 DOI: 10.1371/journal.pone.0158697] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/20/2016] [Indexed: 12/20/2022] Open
Abstract
Background We aimed to determine the prognostic significance of pretreatment plasma fibrinigen in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). Methods A cohort of 183 patients with locally advanced OOSCC receiving preoperative chemoradiotherapy was retrospectively examined. Using ROC curve analysis, a pretreatment plasma fibrinogen cutoff value of 447mg/dL was determined. The primary endpoints were overall survival and recurrence-free survival. A secondary endpoint was to determine whether pretreatment plasma fibrinogen could predict treatment response to neoadjuvant chemoradiotherapy. Cox regression models and Kaplan–Meier curves were used for survival analyses. Results Seventy-one patients had an elevated pretreatment plasma fibrinogen (fibrinogen >447mg/dL). Patients with high fibrinogen showed significantly higher pathologic stages after neoadjuvant treatment than those with low fibrinogen (p = 0.037). In univariate analysis, elevated fibrinogen was associated with poor overall survival (p = 0.005) and recurrence-free survival (p = 0.008) Multivariate analysis revealed that elevated fibrinogen remained an independent risk factor for death (hazard ratio 1.78, 95% CI 1.09–2.90, p = 0.021) and relapse (hazard ratio 1.78, 95% CI 1.11–2.86, p = 0.016). Conclusion Elevated pretreatment plasma fibrinogen is associated with lack of response to neoadjuvant chemoradiotherapy and reduced OS and RFS in patients with OOSCC. Thus, plasma fibrinogen may emerge as a novel prognostic indicator and a potential therapeutic target in OOSCC.
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Affiliation(s)
- Daniel Holzinger
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - Ivan Danilovic
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - Rudolf Seemann
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - Gabriela Kornek
- Department of Medicine I, Medical University of Vienna, Austria
| | - Johannes Engelmann
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - Robert Pillerstorff
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - Simone Holawe
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
| | - Amanda Psyrri
- Division of Oncology, Second Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | - Boban M Erovic
- Department of Otolaryngology-Head and Neck Surgery, Medical University of Vienna, Austria
| | - Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, United States of America
| | - Christos Perisanidis
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Austria
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11
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Eder-Czembirek C, Czembirek C, Selzer E. Neoadjuvant radiotherapy plus radical surgery for locally advanced stage III/IV oral cancer: Analysis of prognostic factors affecting overall survival. Oral Oncol 2016; 60:1-7. [PMID: 27531866 DOI: 10.1016/j.oraloncology.2016.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/19/2016] [Accepted: 06/21/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Preoperative radiotherapy followed by surgery is an effective treatment option for solid tumors including locally advanced squamous cell cancers of the head and neck region. Histopathologic response to radiation has been shown to be associated with survival. However, the relative prognostic importance of regression grade compared to other potential biomarkers has not been established yet. MATERIALS AND METHODS One-hundred forty-four oral squamous cell carcinoma patients with stage III/IV disease were included in this analysis. Patients had received preoperative radiotherapy (RT) up to 50Gy total dose in combination with 5-Fluorouracil (5-FU)/Mitomycin C (MMC) or with Cetuximab, followed by radical surgery six to eight weeks later. Outcome data were obtained from the patient's files. Survival rates were estimated by the Kaplan-Meyer method. Cox-proportional-hazard regression models were used to compare the risk of death among patients stratified according to risk factors. RESULTS Five-year overall survival (OS) was 58% in the presented collective. Regression grade 4 (HR 3.58; p<0.001) was most significantly associated with reduced survival, followed by elevated neutrophils (HR 2.22; p=0.01), the combination of elevated neutrophils plus elevated CRP (HR 2.40; p=0.01), and elevated CRP alone (HR 1.74; p=0.03). In a multivariate analysis, the regression grade remained the most influential predictor of outcome (HR 4.23; p<0.001). CONCLUSION In a comparative analysis, tumor response to pre-operative radiotherapy remains the strongest prognostic factor for treatment outcome, while elevated CRP, as well as neutrophils, were also found to be of significance.
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Affiliation(s)
- Christina Eder-Czembirek
- University Clinic of Cranio, Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Cornelia Czembirek
- Center of Excellence of Cranio, Maxillofacial and Oral Surgery and Pediatric Dentistry, Sozialmedizinisches Zentrum Ost - Donauspital, Langobardenstraße 122, 1220 Vienna, Austria
| | - Edgar Selzer
- University Clinic of Radiotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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12
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Klautke G. [No improvement in results after surgery, postoperative radiation therapy and neoadjuvant chemotherapy with TPF in locally advanced, resectable squamous cell carcinoma of the oral cavity ]. Strahlenther Onkol 2013; 189:702-3. [PMID: 23771678 DOI: 10.1007/s00066-013-0384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G Klautke
- Strahlenklinik, Sozialstiftung Bamberg, Bamberg, Deutschland.
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13
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Wedemeyer I, Kreppel M, Scheer M, Zöller JE, Büttner R, Drebber U. Histopathological assessment of tumour regression, nodal stage and status of resection margins determines prognosis in patients with oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy. Oral Dis 2013; 20:e81-9. [DOI: 10.1111/odi.12137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/30/2013] [Accepted: 05/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- I Wedemeyer
- Department of Pathology; University of Cologne; Cologne Germany
- Center of Integrated Oncology (CIO) Cologne-Bonn; Cologne Germany
| | - M Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery; University of Cologne; Cologne Germany
- Center of Integrated Oncology (CIO) Cologne-Bonn; Cologne Germany
| | - M Scheer
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery; University of Cologne; Cologne Germany
- Center of Integrated Oncology (CIO) Cologne-Bonn; Cologne Germany
| | - JE Zöller
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery; University of Cologne; Cologne Germany
- Center of Integrated Oncology (CIO) Cologne-Bonn; Cologne Germany
| | - R Büttner
- Department of Pathology; University of Cologne; Cologne Germany
- Center of Integrated Oncology (CIO) Cologne-Bonn; Cologne Germany
| | - U Drebber
- Department of Pathology; University of Cologne; Cologne Germany
- Center of Integrated Oncology (CIO) Cologne-Bonn; Cologne Germany
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14
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Perisanidis C, Kornek G, Pöschl PW, Holzinger D, Pirklbauer K, Schopper C, Ewers R. High neutrophil-to-lymphocyte ratio is an independent marker of poor disease-specific survival in patients with oral cancer. Med Oncol 2013; 30:334. [DOI: 10.1007/s12032-012-0334-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/14/2012] [Indexed: 12/19/2022]
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15
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Kreppel M, Dreiseidler T, Rothamel D, Eich HT, Drebber U, Zöller JE, Scheer M. The role of clinical versus histopathological staging in patients with advanced oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy followed by radical surgery. J Craniomaxillofac Surg 2013; 41:22-7. [DOI: 10.1016/j.jcms.2012.05.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 05/11/2012] [Accepted: 05/14/2012] [Indexed: 11/24/2022] Open
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16
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Hoffmann TK. Systemic therapy strategies for head-neck carcinomas: Current status. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc03. [PMID: 23320055 PMCID: PMC3544206 DOI: 10.3205/cto000085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck cancers, most of which are squamous cell tumours, have an unsatisfactory prognosis despite intensive local treatment. This can be attributed, among other factors, to tumour recurrences inside or outside the treated area, and metastases at more distal locations. These tumours therefore require not only the standard surgical and radiation treatments, but also effective systemic modalities. The main option here is antineoplastic chemotherapy, which is firmly established in the palliative treatment of recurrent or metastatic stages of disease, and is used with curative intent in the form of combined simultaneous or adjuvant chemoradiotherapy in patients with inoperable or advanced tumour stages. Neoadjuvant treatment strategies for tumour reduction before surgery have yet to gain acceptance. Induction chemotherapy protocols before radiotherapy have to date been used in patients at high risk of distant metastases or as an aid for decision-making ("chemoselection") in those with extensive laryngeal cancers, prior to definitive chemoradiotherapy or laryngectomy. Triple-combination induction therapy (taxanes, cisplatin, 5-fluorouracil) shows high remission rates with significant toxicity and, in combination with (chemo-)radiotherapy, is currently being compared with simultaneous chemoradiotherapy; the current gold standard with regards to efficacy and long-term toxicity.A further systemic treatment strategy, called "targeted therapy", has been developed to help increase specificity and reduce toxicity. An example of targeted therapy, EGFR-specific antibodies, can be used in palliative settings and, in combination with radiotherapy, to treat advanced head and neck cancers. A series of other novel biologicals such as signal cascade inhibitors, genetic agents, or immunotherapies, are currently being evaluated in large-scale clinical studies, and could prove useful in patients with advanced, recurring or metastatic head and neck cancers. When developing a lasting, individualised systemic tumour therapy, the critical evaluation criteria are not only efficacy and acute toxicity but also (long-term) quality-of-life and the identification of dedicated predictive biomarkers.
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Kreppel M, Eich HT, Brüggenolte C, Dreiseidler T, Rothamel D, Drebber U, Kübler A, Zöller JE, Scheer M. Preoperative vs. postoperative radiochemotherapy in patients with N2 squamous cell carcinoma of the oral cavity. Oral Oncol 2012; 48:1019-1024. [DOI: 10.1016/j.oraloncology.2012.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/01/2012] [Accepted: 04/03/2012] [Indexed: 11/29/2022]
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Neoadjuvant chemoradiation in squamous cell carcinoma of the maxillary sinus: a 26-year experience. CHEMOTHERAPY RESEARCH AND PRACTICE 2012; 2012:413589. [PMID: 23056940 PMCID: PMC3465876 DOI: 10.1155/2012/413589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/21/2012] [Accepted: 09/02/2012] [Indexed: 11/17/2022]
Abstract
Background. The aim of our study was to evaluate the effects of neoadjuvant platinum-based radiochemotherapy (RCT) in patients with maxillary sinus squamous cell carcinoma and to compare the results with other multimodality treatment concepts for advanced-stage maxillary sinus carcinoma in the literature. Methods. In total, 53 patients with squamous cell carcinoma of the maxillary sinus were reviewed retrospectively. All patients received a neoadjuvant RCT containing either cisplatin or carboplatin followed by radical surgery. Overall survival and locoregional control were plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. Results. Five-year overall survival for all patients was 35%. Eleven patients achieved a complete response after radiochemotherapy. The complete response rate was significantly higher for patients treated with cisplatin (P = 0.028); however the 5-year overall survival rates did not differ significantly (P = 0.673) for patients treated with cisplatin (37%) and carboplatin (32%). Orbital invasion (P = 0.005) and complete response to radiochemotherapy (P = 0.021) had a significant impact on overall survival in univariate analysis. Conclusions. Neoadjuvant radiochemotherapy followed by radical surgery is an effective treatment for patients with advanced maxillary sinus squamous cell carcinoma. In terms of treatment response cisplatin seems to be more effective than carboplatin.
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Survival of patients with pathologic T0N+ oral and oropharyngeal cancer after neoadjuvant therapy and surgery: the minority report. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:293-8. [PMID: 22939322 DOI: 10.1016/j.oooo.2012.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/26/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Treatment outcome of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC) achieving complete pathologic response at the primary site (ypT0) but incomplete response in loco-regional lymph nodes after preoperative chemoradiation (ypN+) is poorly described in the literature. This study's objective was to assess the survival of patients with OOSCC with ypT0N+ disease. STUDY DESIGN 176 patients with primary locally advanced OOSCC undergoing preoperative chemoradiotherapy were stratified according to the pathologic TNM classification into 6 groups: ypT0N0M0 (46%), ypT0N+M0 (10%), ypTNM I (24%), ypTNM II (4%), ypTNM III (6%), and ypTNM IV (10%). RESULTS Three-year overall survival (OS) and recurrence-free survival (RFS) rates for the ypT0N+M0 group were both 61.8% and were similar to those of the ypTNM I group (OS 62.4%; RFS rate of 59.2%). CONCLUSIONS Survival analyses showed that patients with OOSCC with ypT0N+ disease have a similar prognosis to those with pathologic TNM stage I.
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20
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Perisanidis C, Savarese-Brenner B, Würger T, Wrba F, Huynh A, Schopper C, Kornek G, Selzer E, Ewers R, Psyrri A, Krainer M, Filipits M. HCRP1 expression status is a significant prognostic marker in oral and oropharyngeal cancer. Oral Dis 2012; 19:206-11. [PMID: 22891969 DOI: 10.1111/j.1601-0825.2012.01972.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/18/2012] [Accepted: 07/03/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The hepatocellular carcinoma-related protein 1 (HCRP1) is a key factor in the degradation of the epidermal growth factor receptor. In this study, we assessed the prognostic significance of HCRP1 expression in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). METHODS HCRP1 expression was determined by immunohistochemistry on tissue biopsy sections of 111 patients with locally advanced OOSCC undergoing neoadjuvant chemoradiotherapy followed by surgery. The Kaplan-Meier method and Cox regression models were used for survival analyses. RESULTS Low HCRP1 expression was associated with poor recurrence-free survival (P = 0.046) and overall survival (P = 0.03). Multivariate analysis revealed that low HCRP1 expression remained an independent risk factor for relapse (HR 2.98, 95% CI 1.19-7.49, P = 0.02) and death (HR 3.04, 95% CI 1.19-7.79, P = 0.02). CONCLUSION Low HCRP1 expression was found to be of adverse prognostic significance in patients with OOSCC who received preoperative chemoradiotherapy.
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Affiliation(s)
- C Perisanidis
- Departments of Cranio-, Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
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Riml S, Böhler F, Larcher L, de Vries A, Elsässer W, Kompatscher P. Neoadjuvant radiotherapy of head and neck carcinoma: an obstacle for plastic reconstruction? Wien Klin Wochenschr 2012; 124:599-604. [PMID: 22850812 DOI: 10.1007/s00508-012-0214-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 07/02/2012] [Indexed: 11/29/2022]
Abstract
Head and neck carcinomas often are at an advanced stage at the time of diagnosis and therefore frequently primarily hardly operable. A downstaging achieved by neoadjuvant radiotherapy can facilitate a radical tumor resection. Because of radiogenic tissue alterations like scarring and impairment of blood supply, elaborate operations, such as microsurgical reconstructions, are aggravated to a degree, and most surgeons consider them impossible. In this paper, we report our experiences with plastic-surgical reconstruction in patients with neoadjuvant pretreated head and neck carcinoma.In the last 6 years, eight patients with an advanced head and neck carcinoma were subjected to neoadjuvant radiotherapy followed by a radical tumor resection and reconstruction within the same session. Therefore, pedicled pectoralis flaps (in three patients), microvascular radialis flaps (two), lateral upper arm flaps (one), parascapular flaps (one), and a microsurgical anastomosed jejunal graft were used. The mean follow-up period was 44.5 months.The surgical postoperative course was uneventful in 75 % of patients (six out of eight). An anastomosis venous thrombose in one patient and a wound dehiscence in another required revision. In the end, a satisfactory result could be achieved in all the patients.Sophisticated reconstructions in irritated patients with ENT carcinoma are challenging; therefore, efficient interdisciplinary cooperation can overcome this obstacle.
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Affiliation(s)
- Stefan Riml
- Department for Plastic, Aesthetic and Reconstructive Surgery, Academic Hospital Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria.
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22
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Perisanidis C, Dettke M, Papadogeorgakis N, Schoppmann A, Mittlböck M, Kyzas PA, Ewers R, Seemann R. Transfusion of allogenic leukocyte-depleted packed red blood cells is associated with postoperative morbidity in patients undergoing oral and oropharyngeal cancer surgery. Oral Oncol 2012; 48:372-8. [DOI: 10.1016/j.oraloncology.2011.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 11/25/2022]
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Kreppel M, Drebber U, Wedemeyer I, Eich HT, Backhaus T, Zöller JE, Scheer M. Podoplanin expression predicts prognosis in patients with oral squamous cell carcinoma treated with neoadjuvant radiochemotherapy. Oral Oncol 2011; 47:873-8. [PMID: 21767977 DOI: 10.1016/j.oraloncology.2011.06.508] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 06/21/2011] [Accepted: 06/26/2011] [Indexed: 10/17/2022]
Abstract
Despite new therapeutic approaches patients with advanced oral squamous cell carcinoma still have a dismal prognosis. The main factor contributing to this problem is locoregional failure due to a lack of response to treatment. Several trials have proven the effect of neoadjuvant radiochemotherapy followed by radical surgery in comparison to primary surgery followed by adjuvant radiochemotherapy. No reliable parameters have been identified so far to predict response to radiochemotherapy. The aim of our study was to assess whether podoplanin expression in pretreatment biopsies could serve as a biomarker to predict the host response to neoadjuvant radiochemotherapy. In this retrospective study, podoplanin expression was examined in a set of 63 patients with oral squamous cell carcinoma by immunohistochemistry. We analyzed associations between the level of podoplanin expression and various clinicopathologic parameters, including response to radiochemotherapy, clinical and histological N-status. Furthermore we evaluated the effects of these parameters on overall survival and on locoregional control in univariate and multivariate analysis. The χ(2)-test revealed that high expression of podoplanin in pretreatment biopsy material was associated with non-regression of the tumor (p=0.013) and poor overall survival (p<0.001). Five-year survival rates of 92.9% for patients with weak expression and 15.0% for high expression were revealed. Podoplanin expression was also significantly associated with ypN status (p=0.004) and ypUICC status (p<0.001). We concluded that podoplanin might serve as a factor to predict treatment response in oral squamous cell carcinoma treated with neoadjuvant platin-based radiochemotherapy as well as a prognostic factor for overall survival and locoregional control.
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Affiliation(s)
- Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Kerpenerstrasse 62, 50937 Cologne, Germany.
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Effectiveness of postoperative radiotherapy in patients with small oral and oropharyngeal squamous cell carcinoma and concomitant ipsilateral singular cervical lymph node metastasis (pN1). Strahlenther Onkol 2011; 187:337-43. [DOI: 10.1007/s00066-011-2206-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 03/16/2011] [Indexed: 01/30/2023]
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Combined-modality treatment in advanced oral squamous cell carcinoma. Strahlenther Onkol 2011; 187:555-60. [DOI: 10.1007/s00066-010-2245-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 12/01/2010] [Indexed: 10/18/2022]
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Bölke E, Schieren G, Gripp S, Steinbach G, Peiper M, Orth K, Matuschek C, Pelzer M, Lammering G, Houben R, Antke C, Rump LC, Mota R, Gerber PA, Schuler P, Hoffmann TK, Rusnak E, Hermsen D, Budach W. Cystatin C - a fast and reliable biomarker for glomerular filtration rate in head and neck cancer patients. Strahlenther Onkol 2011; 187:191-201. [PMID: 21359659 DOI: 10.1007/s00066-010-2203-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/15/2010] [Indexed: 01/08/2023]
Abstract
PURPOSE Determination of renal function is a prerequisite for planning therapy in cancer patients. Limitations of creatinine as marker for the glomerular filtration rate (GFR) led to the proposal of cystatin C as a more accurate biomarker especially in mild renal insufficiency or in patients with low muscle mass. We compared the accuracy of cystatin C- and creatinine-based equations to estimate GFR in head and neck cancer (HNC) patients receiving platinum-based radiochemotherapy. PATIENTS AND METHODS The study population consisted of 52 HNC patients (GFR range, 37-105 mL/min/1.73 m(2) complemented by 17 patients with known renal insufficiency (GFR range, 10-60 mL/min/1.73 m(2)). Intraclass correlation coefficients were calculated between the reference method (51)Cr-EDTA clearance and estimated GFR by creatinine clearance and equations based on creatinine (Cockroft-Gault, modification of diet in renal disease (MDRD), Wright) or cystatin C (Larsson, Dade-Behring, Hoek). In addition, sensitivity and specificity to discriminate GFR > 60 mL/min/1.73 m(2) were evaluated by receiver operating characteristic curve (ROC). RESULTS The highest correlation coefficients were found for the cystatin C-based estimates in comparison with creatinine-based estimates or creatinine clearance, even though Bland-Altman plots revealed GFR overestimation for all equations tested. The cystatin C-based Hoek formula exhibited the highest overall precision and accuracy. GFR of < 60 mL/min/1.73 m(2) was assumed as a cut-off for chemotherapy. ROC analyses revealed the highest AUC to predict a GFR > 60 mL/min/1.73 m(2) for the creatinine-based Wright formula, closely followed by the MDRD formula and cystatin C-based equations of Larsson, Dade-Behring, and Hoek. CONCLUSION Cystatin C-based GFR estimates showed the overall strongest correlation to the reference method. Thus, we recommend cystatin C for GFR estimation in HNC patients as an alternative method to the estimated creatinine clearance in clinical practice.
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Affiliation(s)
- Edwin Bölke
- Department of Radiation Therapy and Radiation Oncology, University of Düsseldorf, Germany.
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Kreppel M, Drebber U, Rothamel D, Eich HT, Kübler A, Scheer M, Zöller JE. Prognostic impact of different TNM-based stage groupings for oral squamous cell carcinoma. Head Neck 2010; 33:1467-75. [PMID: 21928419 DOI: 10.1002/hed.21630] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic significance of different TNM-based stage groupings proposed in the literature. METHODS We conducted a retrospective analysis of 300 patients with primary oral squamous cell carcinoma (T1-4, N0-2, M0). The stage grouping systems of the sixth edition of the Union Internationale Contre le Cancer (UICC), T and N Integer Score (TANIS), the Snyderman scheme, the Hart scheme, and the Berg scheme were tested for their prognostic significance. Disease free survival (DFS) was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. RESULTS On univariate analysis, all systems revealed discriminatory power for DFS; however, on multivariate analysis, only the Hart scheme predicted DFS. The TANIS did not have a better prognostic ability than the UICC stage grouping. CONCLUSION Unlike in previous studies, the UICC stage grouping did perform worse than other TNM-based stage groupings, which may be due to the alterations made in the sixth edition.
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Affiliation(s)
- Matthias Kreppel
- Department for Oral and Cranio-Maxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany.
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Rutkowski T, Wygoda A, Hutnik M, Składowski K, Wydmański J, Maciejewski A, Szymczyk C, Wierzgoń J, Orlef A, Maciejewski B. Intraoperative radiotherapy (IORT) with low-energy photons as a boost in patients with early-stage oral cancer with the indications for postoperative radiotherapy : treatment feasibility and preliminary results. Strahlenther Onkol 2010; 186:496-501. [PMID: 20803185 DOI: 10.1007/s00066-010-2117-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 05/20/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility and preliminary results of intraoperative radiotherapy (IORT) with low-energy photons as a boost in patients with early-stage oral cancer with the indications for postoperative radiotherapy. PATIENTS AND METHODS Between 2003 and 2006, 16 patients with early-stage cancer of mobile tongue (n = 10 [63%]) or floor of the mouth (n = 6 [37%]) treated at Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland, were evaluated for IORT boost with the INTRABEAM®System (Carl Zeiss Surgical GmbH; IORT-PRS) because of the high risk of local recurrence due to positive margins on frozen pathologic section. After tumor resection, the applicator was positioned in the tumor bed. The applicator's diameter (range: 1.5-5 cm) was selected to encompass high-risk area of tumor recurrence. The dose (5 Gy, 7 Gy, or 7.5 Gy) was applied according to tumor volume and bone proximity. External-beam radiotherapy (EBRT) was provided to the tumor bed in all patients (50 Gy) and to the nodal area, when needed. Toxicity and local tumor control were assessed. RESULTS Median follow-up was 36 months. IORT did not increase acute mucosal reaction. Local tumor control was found in all cases. Early mucosal reaction did not exceed 3 according to the RTOG scale and healed in median time of 35 days after completion of EBRT. No late adverse effects were observed. CONCLUSION This preliminary report has demonstrated the feasibility of IORT-PRS for patients with early oral cancer with the indications for postoperative radiotherapy. This method may be considered an alternative boost technique, although additional studies are needed to establish long-term results in a larger group of patients.
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Affiliation(s)
- Tomasz Rutkowski
- Department of Radiation Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
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Uehara M, Shiraishi T, Tobita T, Nonaka M, Asahina I. Antitumor effects on primary tumor and metastatic lymph nodes by superselective intra-arterial concurrent chemoradiotherapy for oral cancer. ACTA ACUST UNITED AC 2010; 110:172-7. [DOI: 10.1016/j.tripleo.2009.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 11/17/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
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