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Ikeuchi Y, Someya M, Hasegawa T, Saito M, Mafune S, Tsuchiya T, Kitagawa M, Gocho T, Dehari H, Ogi K, Sasaki T, Hirohashi Y, Torigoe T, Hirokawa N, Miyazaki A, Sakata KI. Immunohistological evaluation of patients treated with intra-arterial chemoradiotherapy and surgery for oral cancer. Med Mol Morphol 2023; 56:288-296. [PMID: 37507576 DOI: 10.1007/s00795-023-00367-8] [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: 05/31/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Preoperative intra-arterial chemoradiotherapy (IACRT) can improve the outcome and reduce the extent of surgery in patients with advanced oral cancer. However, the response to this regimen varies among patients, which may be related to the immune status of the tumor. We investigated the effects of proteins involved in tumor immunity on the outcomes of combined IACRT and surgery for oral cancer. We examined CD8 + and FoxP3 + tumor-infiltrating lymphocytes (TILs) and programmed death ligand 1 (PD-L1) expression on immune cells and tumor cells in pretreatment biopsy samples from 69 patients diagnosed with oral cancer treated with IACRT at our institution during 2000-2020. Patients with abundant CD8 + TILs had significantly better 5-year disease-specific survival (DSS) compared to that of patients with less infiltration of these cells (P = 0.016). Patients with higher FoxP3 + T-cells invasion had significantly better DSS compared to that of less FoxP3 (P = 0.005). Patients with high PD-L1 expression in tumor cells and immune cells had significantly better DSS than that of patients with low PD-L1 expression in these cells (P = 0.009 and P = 0.025, respectively). Collectively, these results suggest that the tumor immune microenvironment could affect outcomes of IACRT treatment in oral cancer.
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Affiliation(s)
- Yutaro Ikeuchi
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Masanori Someya
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Tomokazu Hasegawa
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Masato Saito
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shoh Mafune
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takaaki Tsuchiya
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Mio Kitagawa
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Toshio Gocho
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hironari Dehari
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazuhiro Ogi
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takanori Sasaki
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshihiko Hirohashi
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Torigoe
- Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoki Hirokawa
- Department of Diagnostic Radiology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Akihiro Miyazaki
- Department of Oral Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Koh-Ichi Sakata
- Department of Radiology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
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Sakuma K, Kii T, Machida T, Fuwa N, Tanaka A. The ECAS system can superselectively administer anticancer drugs to numerous feeding arteries from the superficial temporal artery: A case report and literature review. Mol Clin Oncol 2023; 19:76. [PMID: 37719043 PMCID: PMC10502795 DOI: 10.3892/mco.2023.2672] [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: 06/25/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Superselective intra-arterial chemoradiotherapy (SSIACRT) is one of the curative treatments for advanced oral cancer. SSIACRT can reportedly treat cervical lymph node metastases in the level I-IIA area by super selectively catheterizing the facial artery (FA) and infusing drugs. However, since advanced oral cancer lesions involve a number of feeding vessels, retrograde treatment requires the placement of catheters from the superficial temporal artery (STA) and occipital artery (OA). Furthermore, in the case of level IIB lymph node metastasis, the catheter must be changed because it is necessary to administer anticancer drugs to more than three routes, including the OA, when the feeding arteries of the primary tumor are combined. The external carotid artery sheath (ECAS) system used in the present study involves the insertion of a microcatheter or steering catheter from one route of the STA, allowing selection of numerous feeding vessels, including the OA. The ECAS system can facilitate the administration of chemotherapy via the STA simultaneously to the maxillary artery, lingual artery, FA and OA. The present study describes cases of maxillary gingival cancer and tongue cancer with cervical lymph node metastasis, which were treated with the ECAS system via the STA; the treatment successfully controlled both the primary tumor and cervical lymph node metastasis. In the two cases described in the present study, metastatic lymph nodes were found in the level ⅠB and ⅡB region, but were successfully treated by administering cisplatin via the OA, in addition to the primary lesion. To date, to the best of our knowledge, there is no case report clearly referring to the treatment of lymph node metastasis using the ECAS system. In conclusion, SSIACRT using ECAS may be considered a useful treatment for oral cancer with cervical lymph node metastasis.
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Affiliation(s)
- Kaname Sakuma
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Tomoyuki Kii
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Toko Machida
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
| | - Nobukazu Fuwa
- Department of Radiation Oncology, Central Japan International Medical Center, Minokamo, Gifu 505-8510, Japan
| | - Akira Tanaka
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Niigata, Niigata 951-8580, Japan
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Chen X, Kioi M, Hayashi Y, Koizumi T, Koike I, Yamanaka S, Hata M, Mitsudo K. Efficacy of concurrent chemoradiotherapy with retrograde super selective intra-arterial infusion combined with cetuximab for synchronous multifocal oral squamous cell carcinomas. Radiat Oncol 2023; 18:90. [PMID: 37237293 DOI: 10.1186/s13014-023-02282-9] [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: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The incidence of multicentric oral cancer is increasing. However, treatment encounters difficulty if each tumor needs to be treated simultaneously. The objective of this clinical case report is to highlight the effect of concurrent chemoradiotherapy with retrograde superselective intra-arterial infusion combined with systemic administration of cetuximab on synchronous multifocal oral squamous cell carcinomas. CASE PRESENTATION A 70-year-old man presented to the hospital with multiple tumors and oral pain. Three independent tumors were found in the right dorsal tongue, left edge of the tongue, and left lower lip. Based on the characteristic appearance of the lesions and further evaluation, clinical diagnoses of right tongue cancer "T3", left tongue cancer "T2" and lower left lip cancer "T1", N2cM0 were made. Treatment was initiated with systemic administration of cetuximab, followed by intra-arterial chemoradiotherapy. Treatment results were complete response on all three local lesions, and left neck dissection was performed following the initial treatment. The patient showed no evidence of recurrence during the 4 years follow-up period. CONCLUSIONS This novel combination treatment seems to be a promising strategy for patients with synchronous multifocal oral squamous cell carcinoma.
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Affiliation(s)
- Xuefei Chen
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Mitomu Kioi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Yuichiro Hayashi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toshiyuki Koizumi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Izumi Koike
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Masaharu Hata
- Department of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
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Nomura M, Fuwa N, Ito S, Toyomasu Y, Takada A, Kobayashi D, Fuke T, Taniguchi M, Ii N, Uraki J, Yamada H. Initial Experience of Intra-Arterial Chemotherapy Using a Novel External Carotid Arterial Sheath System Combined with Radiotherapy and Systemic Chemotherapy for Locally Advanced Tongue Cancer. Cancers (Basel) 2022; 14:cancers14225529. [PMID: 36428625 PMCID: PMC9688766 DOI: 10.3390/cancers14225529] [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: 08/29/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
We retrospectively evaluated the safety and effectiveness of an external carotid arterial sheath (ECAS) for intra-arterial chemotherapy (IACT) for locally advanced tongue cancer. Thirty-one patients with the Union for International Cancer Control's 8th TNM stage III-IV tongue cancer underwent IACT using the ECAS combined with RT and systemic chemotherapy with either cisplatin and fluorouracil (FP) or docetaxel, cisplatin, and fluorouracil (TPF) between October 2015 and February 2021. The ECAS was inserted retrogradely via the superficial temporal artery, and the tip was placed in the external carotid artery between the maxillary and facial arteries. A microcatheter was inserted into each tumor-feeding artery through the ECAS under fluoroscopy, wherein cisplatin 50 mg/m2 was administered. IACT was performed weekly with neutralization using sodium thiosulfate. Complete response of the primary lesion was achieved in 28/31 (90%) patients. The median follow-up for all patients was 39 months. The 3-year overall survival, progression-free survival, and local control rates were 81.6%, 74.2%, and 83.4%, respectively. Grade 3 and greater toxicities included oral mucositis (45%), neutropenia (39%), nausea (13%), anemia (10%), thrombocytopenia (10%), dry mouth (10%), and fever (3%). There were no severe complications associated with IACT. In conclusion, the ECAS is feasible and effective for locally advanced tongue cancer.
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Affiliation(s)
- Miwako Nomura
- Department of Radiation Oncology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
- Correspondence: ; Tel.: +81-596-28-2171; Fax: +81-596-28-2965
| | - Nobukazu Fuwa
- Department of Radiation Oncology, Central Japan International Medical Center, 1-1 Kenkounomachi, Minokamo 505-8510, Japan
| | - Shintaro Ito
- Department of Medical Technology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
| | - Yutaka Toyomasu
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Akinori Takada
- Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu 514-8507, Japan
| | - Daisuke Kobayashi
- Department of Head and Neck Otorhinolaryngology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
| | - Tomohito Fuke
- Department of Head and Neck Otorhinolaryngology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
| | - Masanori Taniguchi
- Department of Medical Oncology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
| | - Junji Uraki
- Department of Radiology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
| | - Hiroyuki Yamada
- Department of Head and Neck Otorhinolaryngology, Ise Red Cross Hospital, 1-471-2 Funae, Ise 516-8512, Japan
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Iwai T, Hirabayashi M, Koizumi T, Mitsudo K. Guidewire Perforation into the Oral Cavity from the Deep Lingual Artery During Retrograde Superselective Intra-Arterial Catheterization for a Tongue Cancer Patient. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Koike K, Ohashi N, Nishiyama K, Okamoto J, Sasaki T, Ogi K, Dehari H, Hirokawa N, Someya M, Saito M, Okuda H, Otani A, Sonoda T, Sugawara T, Hasegawa T, Hiratsuka H, Sakata KI, Miyazaki A. Clinical and histopathological effects of neoadjuvant intra-arterial chemoradiotherapy with cisplatin in combination with oral S-1 on stage III and IV oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:347-353. [DOI: 10.1016/j.oooo.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/02/2022] [Accepted: 04/17/2022] [Indexed: 11/24/2022]
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Ideta Y, Tagawa T, Hayashi Y, Baba J, Takahashi K, Mitsudo K, Sakurai K. Transcriptomic Profiling Predicts Multiple Pathways and Molecules Associated With the Metastatic Phenotype of Oral Cancer Cells. Cancer Genomics Proteomics 2021; 18:17-27. [PMID: 33419893 DOI: 10.21873/cgp.20238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIM Metastasis to cervical lymph nodes of oral squamous cell carcinoma (OSCC) leads to a poor prognosis. The present study aimed at investigating the pathways and molecules associated with OSCC metastasis. MATERIALS AND METHODS The transcriptome between HSC-3 cells and their highly metastatic subline, HSC-3-M3 cells, was examined using gene expression microarray. Gene enrichment analyses and Ingenuity Pathway Analysis were performed. Kaplan-Meier plot analysis using a publicly available dataset was conducted to assess whether candidate molecules are prognosticators. RESULTS A total of 1,018 genes were differentially expressed, and the inflammatory pathway and NF-kB were predicted to be activated in HSC-3-M3 cells. CSF2 was suggested to be an indicator of poor prognosis in head and neck cancers. CONCLUSION Inflammation and NF-kB may be involved in the metastasis of OSCC, and CSF2 is a promising diagnostic and therapeutic molecule. Moreover, HSC-3-M3 cells are a useful cell line model for studying OSCC progression.
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Affiliation(s)
- Yuka Ideta
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan.,Department of Nutrition and Dietetics, School of Family and Consumer Sciences, Kamakura Women's University, Kanagawa, Japan
| | - Takanobu Tagawa
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, U.S.A
| | - Yuichiro Hayashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Junichi Baba
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Kimiko Takahashi
- Department of Nutrition and Dietetics, School of Family and Consumer Sciences, Kamakura Women's University, Kanagawa, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Kouhei Sakurai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan; .,Department of Nutrition and Dietetics, School of Family and Consumer Sciences, Kamakura Women's University, Kanagawa, Japan
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Masuda K, Yamazoe S, Baba A, Mogami T, Ogane S, Nomura T, Ojiri H. Superselective intra-arterial chemoradiotherapy using altered blood flow compared to conventional systemic chemoradiotherapy for locally advanced oral squamous cell carcinoma: a single-center retrospective study. Oral Radiol 2021; 37:700-706. [PMID: 33616818 DOI: 10.1007/s11282-021-00519-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/09/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of superselective intra-arterial (IA) chemoradiotherapy with cisplatin and transcatheter arterial embolization (TAE) on advanced oral cancer, and to compare it with that of systemic chemoradiotherapy. MATERIALS AND METHODS This single-center retrospective study included 23 consecutive patients with locally advanced oral squamous cell carcinoma from November 2011 to November 2019. Of these, 15 received superselective IA cisplatin chemoradiotherapy with altered blood flow in the branches of the external carotid artery, and eight received systemic chemoradiotherapy. Medical charts were reviewed for the evaluation of patient data, drug toxicity, and antitumor efficacy. RESULTS Local control rate for the superselective IA infusion group, who underwent 6-7 cycles was significantly higher than that of the systemic chemotherapy group (11/13, 85% vs 3/8, 38%; p = 0.04). Regional control, locoregional control, disease-free survival, and overall survival rates were not significantly different between the groups (p = 0.15-0.907). Acute toxicity rates of grade 3 or higher were not significantly different between the IA and IV chemotherapy groups (p = 0.221). CONCLUSION Superselective IA chemoradiotherapy with cisplatin using altered blood flow in the branches of the external carotid artery with TAE may be useful for inoperable oral cancer.
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Affiliation(s)
- Koichi Masuda
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichiwaka, Chiba, 272-8513, Japan.
| | - Shinji Yamazoe
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichiwaka, Chiba, 272-8513, Japan
| | - Akira Baba
- Department of Radiology, The Jikei Medical University Hosipital, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takuji Mogami
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichiwaka, Chiba, 272-8513, Japan
| | - Satoru Ogane
- Oral Cancer Center, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichiwaka, Chiba, 272-8513, Japan
| | - Takeshi Nomura
- Oral Cancer Center, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichiwaka, Chiba, 272-8513, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei Medical University Hosipital, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Applicability of a single camera-based catheter navigation system using teeth arch as an anatomical landmark for superselective intraarterial infusion in advanced oral cancer treatment. Med Biol Eng Comput 2021; 59:663-672. [PMID: 33594630 PMCID: PMC7925455 DOI: 10.1007/s11517-021-02326-w] [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: 05/02/2019] [Accepted: 01/18/2021] [Indexed: 11/05/2022]
Abstract
Superselective intraarterial infusion chemoradiotherapy is a modality of oral cancer therapy in which the artery feeding the tumor is catheterized. 3D information about the carotid artery is required to enable the surgeon to judge whether to advance, retract, or rotate the catheter. For this purpose, we proposed and conducted a model experiment to assess a new method of catheterization that applies a tracking system using registration with a monocular camera using the maxillary arch as the anatomical landmark. In this method, the preoperative 3D computer tomography angiographic image of the carotid artery that the catheter will be passed through is overlaid on the 2D video image. The mean TRE was 0.96 ± 0.36 mm and 0.88 ± 0.31 mm and 1.12 ± 0.46 mm when images were registered with the anterior and posterior teeth as the landmarks, respectively; the difference was not significant (p = 0.21). This tracking system that enables markerless registration simply by taking images of the maxillary anterior teeth with a single camera was convenient and effective for catheterization. In this study, we propose the new application of this tracking system and a novel method of catheterization for superselective intraarterial infusion chemoradiotherapy for oral cancer. In retrograde superselective intraarterial catheterization, a catheter is inserted into a tumor-feeding artery originating from the external carotid artery (ECA) (the lingual artery [LA], facial artery [FA], or maxillary artery [MA]). Because the maxillary dentition is located near the external carotid artery, we focused on real-time markerless registration using maxillary dentition fixed to the skull. ![]()
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Mukai Y, Hayashi Y, Koike I, Koizumi T, Sugiura M, Oguri S, Takano S, Kioi M, Sato M, Mitsudo K, Hata M. Impact of superselective intra-arterial and systemic chemoradiotherapy for gingival carcinoma; analysis of treatment outcomes and prognostic factors. BMC Cancer 2020; 20:1154. [PMID: 33243168 PMCID: PMC7691076 DOI: 10.1186/s12885-020-07638-y] [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: 08/07/2020] [Accepted: 11/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background We compared outcomes and toxicities between concurrent retrograde super-selective intra-arterial chemoradiotherapy (IACRT) and concurrent systemic chemoradiotherapy (SCRT) for gingival carcinoma (GC). Methods We included 84 consecutive patients who were treated for non-metastatic GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n = 66; SCRT group: n = 18). Results The median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT: 60 Gy; SCRT: 69 Gy). There were significant differences between the two groups in terms of 3-year overall survival (OS; IACRT: 78.8, 95% confidence interval [CI]: 66.0–87.6; SCRT: 50.4, 95% CI: 27.6–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.6, 95% CI: 62.7–85.2; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.028) and local control rates (LC; IACRT: 77.2, 95% CI: 64.2–86.4; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.015). In univariate analysis, age ≥ 65 years, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with a poor OS rate (P < 0.05). Patients with poorer PS had a significantly worse PFS rate. Regarding acute toxicity, 22 IACRT patients had grade 4 lymphopenia, and osteoradionecrosis was the most common late toxicity in both groups. Conclusions This is the first report to compare outcomes from IACRT and SCRT among patients with GC. ALL therapy related toxicities were manageable. IACRT is an effective and safe treatment for GC.
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Affiliation(s)
- Yuki Mukai
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yuichiro Hayashi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Izumi Koike
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Toshiyuki Koizumi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Madoka Sugiura
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Senri Oguri
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shoko Takano
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mitomu Kioi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mizuki Sato
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kenji Mitsudo
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaharu Hata
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Hu Y, Zheng L, Zhang J, Shen Y, Zhang X, Lin L. LncRNA-MALAT1 is a promising biomarker for prognostic evaluation of tongue squamous cell carcinoma. Eur Arch Otorhinolaryngol 2020; 277:3155-3160. [PMID: 32383096 DOI: 10.1007/s00405-020-06023-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE MALAT1 is recognized as an oncogenic lncRNA in various malignancies. Here, the authors aim to explore the association of MALAT1 expression and prognostic implication in tongue squamous cell carcinoma (SCC). METHODS The tongue tissues of 128 tongue SCC cases satisfying strict follow-up criteria and 28 normal cases were subjected to qRT-PCR assay for monitoring MALAT1 expression. Chi-square test was applied to explore the correlation between MALAT1 expression and clinicopathological features of tongue SCC. Kaplan-Meier analysis was used to calculate survival rates. Cox proportional hazard analysis was adopted to analyze the relationship between prognostic factors and patient survival. RESULTS The expression of MALAT1 was upregulated in tongue SCC, compared to normal tongue tissues. The expression level of MALAT1 was correlated to differentiation and stage of tongue SCC, and high MALAT1 expression was associated with low disease-free survival and overall survival rates. Moreover, advanced tongue SCC patients with high MALAT1 level had lower disease-free survival and decreased overall survival rate than patients with low MALAT1 level. These results revealed that MALAT1 overexpression can be considered as a significant prognostic factor to independently predict the disease-free survival and overall survival rate of tongue SCC. CONCLUSIONS The expression level of MALAT1 is closely related with progression of tongue SCC. Furthermore, MALAT1 can serve as an independent biomarker for prognostic evaluation of tongue SCC.
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Affiliation(s)
- Yuqian Hu
- Institute of Molecular Medicine, Medical College of Eastern Liaoning University, Dandong, 118000, China
| | - Linlin Zheng
- Institute of Molecular Medicine, Medical College of Eastern Liaoning University, Dandong, 118000, China
| | - Jinhui Zhang
- Institute of Molecular Medicine, Medical College of Eastern Liaoning University, Dandong, 118000, China
| | - Yue Shen
- Institute of Molecular Medicine, Medical College of Eastern Liaoning University, Dandong, 118000, China
| | - Xiaoyan Zhang
- Department of Pathology, Fifth People's Hospital of Shenyang City, Shenyang Tumor Hospital, Shenyang, 110023, China.
| | - Lijuan Lin
- Institute of Molecular Medicine, Medical College of Eastern Liaoning University, Dandong, 118000, China.
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12
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Huang Y, Wu LL, Xiang RL, Yu GY. Efficacy and Safety of Intro-Arterial Chemotherapy Combined with Radiotherapy on Head and Neck Cancer: A Systematic Review and Meta-Analysis. J Cancer 2019; 10:6233-6243. [PMID: 31772656 PMCID: PMC6856744 DOI: 10.7150/jca.36478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives: Intro-arterial chemotherapy combined with radiotherapy (IACRT) for the treatment of head and neck cancer (HNC) underwent a revival in recent years. Although many clinical trials have reported favorable outcomes, the effect of IACRT for HNC is still controversial. Therefore, this study was designed to evaluate the efficacy and safety of IACRT for HNC. Methods: The relevant articles published before August 2019 were searched from PubMed, Embase, Cochrane Library, Web of Science and PMC databases. Data were extracted and the combined complete response (CR), overall survival (OS) and toxicity incidence with 95% credible interval (CI) were examined from eligible studies. Results: Thirty-four studies comprising 1890 patients were included. IACRT achieved high CR (0.81, 95% CI: 0.76-0.86, P < 0.001), 3-year OS (0.75, 95% CI: 0.68-0.82, P < 0.001) and 5-year OS (0.68, 95% CI: 0.61-0.75, P < 0.001). The 3-year OS rate of stage III cancer (0.75, 95% CI: 0.53-0.97, P< 0.001) was higher than stage IV (0.52, 95% CI: 0.37-0.66, P = 0.025). Meanwhile, the 5-year OS of T3 cancer (0.87, 95% CI: 0.73-1.01, P = 0.028) was higher than T4 (0.53, 95% CI: 0.42-0.63, P = 0.286). Additionally, oral diseases, mucositis, leukopenia and dermatitis were the major toxicities of IACRT, which were all reversible. Conclusion: IACRT is an efficient and safe modality for HNC, which could achieve favorable cancer response and higher survival rate with acceptable toxicities, even for advanced HNC.
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Affiliation(s)
- Yan Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Li-Ling Wu
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Ruo-Lan Xiang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, 100191, China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
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13
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Deng Y, Zhong Z, Tan X, Wang S, Qian K. Satisfactory short-term outcome after anlotinib and docetaxel chemotherapy in tongue cancer with N3 cervical lymph node metastasis: A case report. Clin Case Rep 2019; 7:1923-1927. [PMID: 31624610 PMCID: PMC6787789 DOI: 10.1002/ccr3.2390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/31/2019] [Accepted: 08/08/2019] [Indexed: 01/21/2023] Open
Abstract
Patients with tongue squamous cell carcinoma (TSCC) and cervical lymph node metastasis are particularly difficult to treat. This is the first report of about anlotinib combined with docetaxel chemotherapy for chemotherapy-refractory TSCC with cervical lymph node metastasis, may provide a new, suitable therapeutic option for these patients.
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Affiliation(s)
- Yi Deng
- Department of OncologyInstitute of Surgery Research, Daping Hospital, Army Medical UniversityChongqingChina
| | - Zhao‐Yang Zhong
- Department of OncologyInstitute of Surgery Research, Daping Hospital, Army Medical UniversityChongqingChina
| | - Xiao‐Rong Tan
- Department of OncologyInstitute of Surgery Research, Daping Hospital, Army Medical UniversityChongqingChina
| | - Shuai Wang
- Department of OncologyInstitute of Surgery Research, Daping Hospital, Army Medical UniversityChongqingChina
| | - Kai Qian
- Department of Thoracic SurgeryInstitute of Surgery Research, Daping Hospital, Army Medical UniversityChongqingChina
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14
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Takayama K, Kato T, Nakamura T, Azami Y, Ono T, Suzuki M, Takada A, Yamaguchi H, Seto I, Nakasato T, Wada H, Kikuchi Y, Mitsudo K, Fuwa N, Murakami M. Proton Beam Therapy Combined with Intra-Arterial Infusion Chemotherapy for Stage IV Adenoid Cystic Carcinoma of the Base of the Tongue. Cancers (Basel) 2019; 11:cancers11101413. [PMID: 31546728 PMCID: PMC6826952 DOI: 10.3390/cancers11101413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 01/06/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is a very rare epithelial tumor of the salivary glands. Surgical resection is considered to be a standard therapy. However, the optimal treatment strategy for managing advanced cases has not yet been established. This study evaluated the efficacy and toxicity of proton beam therapy (PBT) combined with selective intra-arterial infusion chemotherapy (IAIC) using weekly cisplatin for locally advanced ACC of the base of the tongue. Between March 2009 and February 2018, 15 patients were treated. The median follow-up duration was 56 (range: 15–116) months. The 5-year local control and overall survival rates were 89% and 76%, respectively. With regard to late toxicities, grade 2 osteoradionecrosis was found in one patient and grade 5 pharyngeal necrosis was observed in one patient. Considering most cases were significantly advanced and inoperable, this therapy was effective in controlling the primary tumor, preserving function and maintaining the quality of life. Although improvements are needed to reduce adverse events, PBT in combination with IAIC can be a treatment option for locally advanced ACC of the base of the tongue.
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Affiliation(s)
- Kanako Takayama
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Takahiro Kato
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Akinori Takada
- Department of Radiation Oncology, Mie University Hospital, 2-174, Edobashi Tsu, Mie 514-8507, Japan.
| | - Hisashi Yamaguchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Ichiro Seto
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Tatsuhiko Nakasato
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Nobukazu Fuwa
- Department of Radiation Oncology, Ise red cross hospital, 1-471-2, Funae, Ise, Mie 516-8512, Japan.
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan.
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15
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Hayashi Y, Osawa K, Nakakaji R, Minamiyama S, Ohashi N, Ohya T, Iida M, Iwai T, Ozawa T, Oguri S, Koizumi T, Hirota M, Kioi M, Hata M, Mitsudo K. Prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma treated by intra-arterial infusion chemotherapy concurrent with radiotherapy. Head Neck 2019; 41:1777-1784. [PMID: 30694002 DOI: 10.1002/hed.25607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/20/2018] [Accepted: 12/10/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma (SCC) treated with intra-arterial infusion chemotherapy concurrent with radiotherapy. METHODS A total of 46 patients were reviewed retrospectively in this study. The treatment schedule comprised intra-arterial chemotherapy (total, 60 mg/m2 docetaxel and 150 mg/m2 cisplatin) and three-dimensional computed tomography based, daily conventional radiotherapy (total, 60 Gy/30 fr) for 6 weeks. RESULTS The median follow-up period was 40 months (range, 3-110 months). The 3-year overall survival and locoregional control rates for all patients were 64.3% and 84.3%, respectively. The OS rate of the patients with N0-1 was significantly higher than that of the patients with N ≥ 2 (P < .05). No grade 5 toxicities were observed. CONCLUSIONS Intra-arterial infusion chemotherapy concurrent with radiotherapy was effective for advanced maxillary gingival SCC.
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Affiliation(s)
- Yuichiro Hayashi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Kohei Osawa
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Rina Nakakaji
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Shuhei Minamiyama
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Nobuhide Ohashi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Takashi Ohya
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Masaki Iida
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Toshinori Iwai
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Tomomichi Ozawa
- Department of Dentistry and Oral Surgery, Yamato Municipal Hospital, Yamato City, Kanagawa, Japan
| | - Senri Oguri
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Toshiyuki Koizumi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Makoto Hirota
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Mitomu Kioi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Masaharu Hata
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
| | - Kenji Mitsudo
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan
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16
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Hayashi Y, Minamiyama S, Ohya T, Iida M, Iwai T, Koizumi T, Oguri S, Hirota M, Kioi M, Hata M, Taguri M, Mitsudo K. Daily Cisplatin and Weekly Docetaxel versus Weekly Cisplatin Intra-Arterial Chemoradiotherapy for Late T2-3 Tongue Cancer: A Pilot and Feasibility Trial. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E52. [PMID: 30344283 PMCID: PMC6174343 DOI: 10.3390/medicina54040052] [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] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022]
Abstract
Background and objectives: The aim of present study was to compare the treatment results of daily cisplatin (CDDP), weekly docetaxel (DOC) intra-arterial infusion chemotherapy combined with radiotherapy (DIACRT) regimen and weekly CDDP intra-arterial infusion chemotherapy combined with radiotherapy (WIACRT) for patients with tongue cancer. Materials and Methods: Between January 2007 and December 2016, a total of 11 patients treated with WIACRT and 45 patients treated with DIACRT were enrolled in the present study. In the DIACRT group, 25 patients had late T2, and 20 patients had T3. A total of nine patients had late T2 and two had T3 in WIACRT (p = NS). In DIACRT, the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m²; CDDP, total 150 mg/m²) and daily concurrent radiotherapy (RT) (total, 60 Gy). In WIACRT, the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m²) and daily concurrent RT (total, 60 Gy). Results: The median follow-up periods for DIACRT and WIACRT were 61 and 66 months, respectively. The five-year local control (LC) and overall survival (OS) rate were 94.5% and 89.6% for the DIACRT group, and 60.6% and 63.6% for the WIACRT group, respectively. The LC rate and OS of the DIACRT group were significantly higher than those of the WIACRT group. As regards toxicities, no treatment-related deaths were observed during the follow-up periods in both groups. Conclusions: DIACRT was found to be feasible and effective for patients with tongue cancer and could become a new treatment modality.
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Affiliation(s)
- Yuichiro Hayashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Shuhei Minamiyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Takashi Ohya
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masaki Iida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Toshiyuki Koizumi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Mitomu Kioi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masaharu Hata
- Department of Radiation Oncology, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masataka Taguri
- Department of Biostatistics, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
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