Severity of oral mucositis correlates with the response of oral cancer to preoperative radiochemotherapy

Assessment of gene expressions from squamous cell carcinoma of the head and neck to predict radiochemotherapy-related xerostomia and dysphagia

PURPOSE

We tested the hypothesis that gene expressions from biopsies of locally advanced head and neck squamous cell carcinoma (HNSCC) patients can supplement dose-volume parameters to predict dysphagia and xerostomia following primary radiochemotherapy (RCTx).

MATERIAL AND METHODS

A panel of 178 genes previously related to radiochemosensitivity of HNSCC was considered for nanoString analysis based on tumour biopsies of 90 patients with locally advanced HNSCC treated by primary RCTx. Dose-volume parameters were extracted from the parotid, submandibular glands, oral cavity, larynx, buccal mucosa, and lips. Normal tissue complication probability (NTCP) models were developed for acute, late, and for the improvement of xerostomia grade ≥2 and dysphagia grade ≥3 using a cross-validation-based least absolute shrinkage and selection operator (LASSO) approach combined with stepwise logistic regression for feature selection. The final signatures were included in a logistic regression model with optimism correction. Performance was assessed by the area under the receiver operating characteristic curve (AUC).

RESULTS

NTCP models for acute and late xerostomia and the improvement of dysphagia resulted in optimism-corrected AUC values of 0.84, 0.76, and 0.70, respectively. The minimum dose to the contralateral parotid was selected for both acute and late xerostomia and the minimum dose to the larynx was selected for dysphagia improvement. For the xerostomia endpoints, the following gene expressions were selected: RPA2 (cellular response to DNA damage), TCF3 (salivary gland cells development), GBE1 (glycogen storage and regulation), and MAPK3 (regulation of cellular processes). No gene expression features were selected for the prediction of dysphagia.

CONCLUSION

This hypothesis-generating study showed the potential of improving NTCP models using gene expression data for HNSCC patients. The presented models require independent validation before potential application in clinical practice.

A multidisciplinary approach to squamous cell carcinomas of the head and neck: what is new?

PURPOSE OF REVIEW

The aim of this article is to review progress in the treatment of head and neck squamous cell carcinomas (in the light of the most recent literature). Due to the complexity of the disease the multidisciplinary approach needs also a multidisciplinary knowledge which this review tries to summarize.

RECENT FINDINGS

The multidisciplinary treatment approach to the disease includes predictive and prognostic value of biomolecular and clinical factors, the role of induction chemotherapy and concurrent chemo-radiotherapy, new advances in postoperative treatment, treatment-related side-effects and their impact on patients' quality of life, new targeted therapies and treatment choice for incurable patients. Advances in other disciplines, such as radiation therapy and new imaging techniques, will be considered elsewhere in this journal.

SUMMARY

Major advances derived from the strategic use of different treatment and diagnostic modalities. The importance of a multidisciplinary team and knowledge in the approach of this disease should be stressed. Today, a multidisciplinary diagnostic and treatment philosophy is the tool to guarantee the best treatment plan definition, to prevent and relieve treatment adverse effects with the ultimate goal to improve survival.