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Ueda S, Sonomura T, Okuhira R, Mimura R, Kumamoto A, Minamiguchi H. Usefulness of computed tomography aortography and dye infusion in confirming the feeding arteries for effective treatment of a large squamous cell carcinoma of the lower lip with a single intra-arterial infusion chemotherapy combined with radiotherapy. Radiol Case Rep 2024; 19:5350-5353. [PMID: 39280733 PMCID: PMC11402139 DOI: 10.1016/j.radcr.2024.07.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 09/18/2024] Open
Abstract
A 73-year-old male presented with a lower lip squamous cell carcinoma (SCC) (23 mm in diameter). Systemic imaging, including computed tomography (CT) and positron emission tomography, showed no evidence of distant metastasis. Due to the large size of the tumor, reconstruction after surgical tumor removal was considered to be difficult. Therefore, we decided to initially perform intra-arterial chemotherapy. Under local anesthesia, a catheter was inserted via the femoral artery. CT aortography from the ascending aorta was performed to visualize the precise vascular anatomy. The tumor's feeding arteries were confirmed by injecting indigo carmine dye through the catheter. Then, 87.5 mg of cisplatin was selectively injected through the left and right facial arteries (total dose of 175 mg). The tumor significantly shrank and almost disappeared 1 month after chemotherapy. Although additional intra-arterial chemotherapy was considered, the risks associated with the procedure meant that radiotherapy was performed instead. There were no signs of recurrence at the 2-year follow-up. In this patient, a single intra-arterial infusion chemotherapy combined with radiotherapy achieved complete disappearance of a large SCC of the lower lip. This treatment strategy allowed us to preserve the functional and cosmetic aspects of the patient's lower lip with minimal side effects. CT aortography and dye infusion were important in confirming the tumor's feeding arteries.
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Affiliation(s)
- Shota Ueda
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Ryuta Okuhira
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Ryosuke Mimura
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
| | - Akihiko Kumamoto
- Department of Radiology, Wakayama Medical University, Wakayama, Japan
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Abstract
Oral cancer ranks first among males and is the primary cause of cancer-related deaths in Pakistan. We studied the epidemiology and risk factors associated with this cancer. The main risk factors in the Pakistani population include the usage of chewable and non-chewable tobacco, areca nut, betel leaf, poor dental hygiene practices, oncogenic viral infections, and genetic predispositions. The impact of socioeconomic status and the available health resources on the management of oral cancer is also discussed. It is concluded that being a low-middle economy efforts should be primarily focused on awareness for early screening, diagnosis, and prevention strategies.
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Affiliation(s)
- Naila Malkani
- Department of Zoology, GC University, Lahore, Pakistan
| | - Sara Kazmi
- Department of Zoology, GC University, Lahore, Pakistan
| | - Muhammad Usman Rashid
- Department of Basic Sciences Research, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Lahore, Pakistan
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Lin MH, Sheen YT, Sheen YS, Chen YY, Sheen MC. Squamous cell carcinoma of the auricle treated by intra-arterial infusion chemotherapy. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_48_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sheen YT, Chen YY, Sheen MC. Case report of a huge lower lip cancer successfully treated with intra-arterial infusion chemotherapy. Int J Surg Case Rep 2020; 71:82-84. [PMID: 32446228 PMCID: PMC7242998 DOI: 10.1016/j.ijscr.2020.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/01/2020] [Accepted: 04/20/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We present a difficult case of huge squamous cell carcinoma (SCC) of lower lip that was successfully treated by intra-arterial infusion with methotrexate (MTX). PRESENTATION OF CASE This 42-year-old female patient present with a fungating lower lip SCC of approximately 10 × 5 cm in size. MTX 25 mg was infused continuously to each side of external carotid artery every 24 h using two portable pumps. Totally, MTX 300 mg was given over 6 days. After treatment initiation, the tumor shrank dramatically and disappeared completely 2 months after the therapy. The patient was now recurrence-free at the recent follow-up 4 and half years after therapy. DISCUSSION Intra-arterial infusion chemotherapy has the advantage of delivering a high concentration of anticancer drug to the lesion to induce a rapid shrinkage of the tumor and the side effects are limited. Intra-arterial infusion with MTX achieves good tumor response to lower lip cancer with excellent anatomical and functional preservation. CONCLUSION This therapy may be a treatment option in lower lip cancers with unresectable lesions, or in those patients who are unwilling to undergo resection.
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Affiliation(s)
- Yen Ting Sheen
- Division of Plastic and Reconstructive Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu Yuan Chen
- Department of Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Maw Chang Sheen
- Department of Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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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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Intraarterial chemotherapy as the first-line therapy in penile cancer. Br J Cancer 2014; 111:1089-94. [PMID: 25058350 PMCID: PMC4453844 DOI: 10.1038/bjc.2014.394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/03/2014] [Accepted: 06/18/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Limited literature on the role of intraarterial chemotherapy as first-line therapy for penile squamous cell carcinoma is available. Methods: From 2005 to 2013, a total of 12 patients with various stages of penile squamous cell carcinoma received intraarterial chemotherapy. The chemotherapeutic agents used were methotrexate, mitomycin C, bleomycin, cisplatin, and 5-fluorouracil. Surgery was followed by the tumour responses. Results: An objective tumour response was noted in 10 of 12 patients (83%, 4 complete responders and 6 partial responders). In node-negative patients (n=7), the response rate was 100% (4 complete responders and 3 partial responders). Even in advanced penile squamous cell carcinoma with nodal invasion, a response rate of 60% could be achieved. Grade 2 anorexia was the most frequent chemotherapy-related toxicity and no toxic death was noted. Recurrence-free survival was significantly better in patients without lymph node invasion (log-rank test, P=0.041). Conclusions: Neoadjuvant intraarterial chemotherapy displayed excellent responses for penile squamous cell carcinoma. This therapy could effectively shrink the tumour burden or even achieve complete response before surgery. It could be used as first-line strategy for penile cancer treatment because of low toxicity.
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Interval between intra-arterial infusion chemotherapy and surgery for locally advanced oral squamous cell carcinoma: impacts on effectiveness of chemotherapy and on overall survival. ScientificWorldJournal 2014; 2014:568145. [PMID: 24963509 PMCID: PMC4052512 DOI: 10.1155/2014/568145] [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: 03/20/2014] [Accepted: 04/30/2014] [Indexed: 11/23/2022] Open
Abstract
Background. The interval between intra-arterial infusion chemotherapy (IAIC) and surgery was investigated in terms of its effects on survival in patients with locally advanced oral squamous cell carcinoma (OSCC).
Methods. This retrospective study analyzed 126 patients who had completed treatment modalities for stage IV OSCC. All patients were followed up for 3 years. Kaplan-Meier and Cox regression methods were used to determine how survival was affected by general factors, primary tumor volume, TNM stage, and duration of neoadjuvant chemotherapy. Results. In 126 patients treated for locally advanced OSCC by preoperative induction IAIC using methotrexate, multivariate analysis of relevant prognostic factors showed that an IAIC duration longer than 90 days was significantly associated with poor prognosis (hazard ratio, 1.77; P = 0.0259).
Conclusions. Duration of IAIC is a critical factor in the effectiveness of multimodal treatment for locally advanced OSCC. Limiting the induction course to 90 days improves overall survival.
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WWOX suppresses autophagy for inducing apoptosis in methotrexate-treated human squamous cell carcinoma. Cell Death Dis 2013; 4:e792. [PMID: 24008736 PMCID: PMC3789168 DOI: 10.1038/cddis.2013.308] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 06/18/2013] [Accepted: 07/12/2013] [Indexed: 12/25/2022]
Abstract
Squamous cell carcinoma (SCC) cells refractory to initial chemotherapy frequently develop disease relapse and distant metastasis. We show here that tumor suppressor WW domain-containing oxidoreductase (WWOX) (also named FOR or WOX1) regulates the susceptibility of SCC to methotrexate (MTX) in vitro and cure of SCC in MTX therapy. MTX increased WWOX expression, accompanied by caspase activation and apoptosis, in MTX-sensitive SCC cell lines and tumor biopsies. Suppression by a dominant-negative or small interfering RNA targeting WWOX blocked MTX-mediated cell death in sensitive SCC-15 cells that highly expressed WWOX. In stark contrast, SCC-9 cells expressed minimum amount of WWOX protein and resisted MTX-induced apoptosis. Transiently overexpressed WWOX sensitized SCC-9 cells to apoptosis by MTX. MTX significantly downregulated autophagy-related Beclin-1, Atg12-Atg5 and LC3-II protein expression and autophagosome formation in the sensitive SCC-15, whereas autophagy remained robust in the resistant SCC-9. Mechanistically, WWOX physically interacted with mammalian target of rapamycin (mTOR), which potentiated MTX-increased phosphorylation of mTOR and its downstream substrate p70 S6 kinase, along with dramatic downregulation of the aforementioned proteins in autophagy, in SCC-15. When WWOX was knocked down in SCC-15, MTX-induced mTOR signaling and autophagy inhibition were blocked. Thus, WWOX renders SCC cells susceptible to MTX-induced apoptosis by dampening autophagy, and the failure in inducing WWOX expression leads to chemotherapeutic drug resistance.
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Wave technique for treatment of lower lip cancer. J Craniomaxillofac Surg 2012; 40:e386-91. [PMID: 22440315 DOI: 10.1016/j.jcms.2012.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 02/02/2012] [Accepted: 02/02/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This article reports the authors' experience with treatment of lower lip cancer using the wave technique. PATIENTS AND METHODS Twenty-one patients (16 males, 5 females) were treated using the wave technique between September 2009 and October 2010. Patients undergoing the procedure had tumors that were classified as either T1N0M0 or T2N0M0. Lateral defects less than 2 cm in size are generally treated with unilateral flaps, and median defects are closed with bilateral symmetric flaps. If the defect is paramedian and greater than 2 cm in width, two asymmetric flaps are used. RESULTS No recurrence was observed during a 6- to 32 months follow-up (mean 19 months). All patients showed excellent esthetic results with no microstomia. CONCLUSIONS We modified the straight lines of the staircase technique into round lines of the wave technique, resulting in an esthetic improvement. The goal of the broken lines and round lines is to create less visible scars. The wave technique can be used to close defects of up to two-thirds of the lower lip.
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Behshad R, Garcia-Zuazaga J, Bordeaux JS. Systemic treatment of locally advanced nonmetastatic cutaneous squamous cell carcinoma: a review of the literature. Br J Dermatol 2011; 165:1169-77. [PMID: 21777215 DOI: 10.1111/j.1365-2133.2011.10524.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a small subset of locally advanced nonmetastatic cutaneous squamous cell carcinoma (cSCC) for which local therapy is not curative or feasible, making systemic therapy a possible treatment option. OBJECTIVES To calculate overall response rates (ORR), median time to response (TTR) and median duration of response (DOR) of locally advanced nonmetastatic cSCC to systemic therapy [targeted agents, biological response modifiers (BRM) and chemotherapy]. PATIENTS AND METHODS Medline and PubMed were searched for reports of nonmetastatic locally advanced cSCC treated with systemic therapy from 1970 to 2011. No limits were placed on study design. ORR, TTR and DOR were calculated for systemic therapy overall and for each treatment category. RESULTS Twenty-eight observational studies yielded 119 patients for analysis. The ORR for systemic therapy was 72% (TTR 9 weeks, DOR 42 weeks). Targeted therapy and BRM achieved ORR of 100% (TTR 12 weeks, DOR 20 weeks) and 86% (TTR 10 weeks, DOR 20 weeks), respectively, and oral chemotherapy, intravenous chemotherapy and intra-arterial chemotherapy achieved ORR of 20% (TTR 10 weeks, DOR 24 weeks), 68% (TTR 3 weeks, DOR 44 weeks) and 100% (TTR 15 weeks, DOR 112 weeks), respectively. A limitation of this study was that no controlled data were identified and sample sizes were small. CONCLUSIONS Systemic treatment leads to objective responses in locally advanced cutaneous SCC that are not amenable to local cure.
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Affiliation(s)
- R Behshad
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Lakeside 3500, Cleveland, OH 44106, USA.
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Wu CF, Huang CJ, Chang KP, Chen CM. Continuous intra-arterial infusion chemotherapy as a palliative treatment for oral squamous cell carcinoma in octogenarian or older patients. Oral Oncol 2010; 46:559-63. [PMID: 20538502 DOI: 10.1016/j.oraloncology.2010.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/13/2010] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
Abstract
We intend to determine the potential benefits and analyze the outcomes of regional intra-arterial infusion chemotherapy (IAIC) for the octogenarian and older patients with oral cancer. Eighteen patients with oral squamous cell carcinoma were included. They were 12 males and six females with ages ranging from 80 to 96 years. An implantable port-catheter system was used for catheterization. Using a portable pump, methotrexate was given continuously through the external carotid artery for a mean period of 5.5 days (range, 4-7 days) followed by weekly bolus of low dose (25mg) of methotrexate until the clinical condition was stabilized. During the first week of IAIC, all tumors began to reduce in size. Of them 11 (61%) had a complete clinical response and 7 (39%) achieved a partial clinical response, after a mean follow-up period of 26 months (range, 8-72 months). The one- and three-year survival rates were 87% and 56%, respectively. There were no catheter-related complications. The side effects were mild and tolerable. IAIC might be specially indicated for oral cancer elderly with co-morbidity since a radical surgery or extensive radiotherapy can be avoided, and offers an acceptable palliative treatment in such patients.
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Affiliation(s)
- Chih-Fung Wu
- Department of Surgery, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Liang XH, He YW, Tang YL, Wu JL, Cao XP, Xiao GZ, Mao ZY. Thermochemotherapy of lower lip squamous cell carcinoma without metastases: An experience of 31 cases. J Craniomaxillofac Surg 2010; 38:260-5. [PMID: 19665900 DOI: 10.1016/j.jcms.2009.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 07/03/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022] Open
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Scully C, Bagan JV. Recent advances in Oral Oncology 2007: Imaging, treatment and treatment outcomes. Oral Oncol 2008; 44:211-5. [DOI: 10.1016/j.oraloncology.2008.01.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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MR angiography at 3 T for assessment of the external carotid artery system. AJR Am J Roentgenol 2007; 189:1088-94. [PMID: 17954645 DOI: 10.2214/ajr.07.2235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A number of clinical situations exist in which high-resolution depiction of the external carotid artery system is required, a task not previously addressed by MR angiography. The purpose of this study was to evaluate the extent to which high-spatial-resolution MR angiography at 3 T can be used to map the normal external carotid artery system. SUBJECTS AND METHODS Twenty-three consenting adult patients were prospectively evaluated. Images acquired were evaluated by two independent observers, and each branch vessel was scored with regard to image quality, presence and grade of stenoses, and artifacts. Interobserver agreement regarding image quality and the presence and degree of stenosis was tested using the kappa coefficient. Differences in quality ratings between the two observers were assessed using the paired Student's t test. RESULTS Of 828 vessels analyzed, 92.63% were designated of diagnostic quality with no significant difference between the observers' image quality scores (p = 0.63). Good agreement was determined regarding image quality achieved (kappa = 0.716). All examinations were free of artifact sufficient to interfere with confident interpretation. Excellent correlation was seen with regard to stenosis detection and grading (kappa = 0.857). Of the external carotid artery systems assessed, 82.6% showed conventional anatomic vascular branching. CONCLUSION High-spatial-resolution, 3D contrast-enhanced MR angiography at 3 T using sagittal source data acquisition and an advanced acceleration factor of 6 allows high-quality (92.63% of arterial segments) visualization of the external carotid artery system, with complete head and neck vascular coverage.
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