Comparison between computed tomography and clinical evaluation in tumour/node stage and follow-up of oral cavity and oropharyngeal cancer

Outcomes of 3-year follow up with induction vs first line chemotherapy in oral cancer patients: An observational hospital-based study

OBJECTIVE

Our study aims to analyse and compare the efficacy, adverse effect profile and survival among the Paclitaxel/Cisplatin/5-Flurouracil (TPF) induction chemotherapy and Paclitaxel/carboplatin (PC) first line or cisplatin chemotherapy in a high-volume tertiary care cancer centre.

MATERIALS AND METHODS

215 patients with oral cavity cancer were recruited in this study. Patients with stages I-IIc underwent surgical resection or radiation therapy 66-74 GY/fraction. Patients of Stages III-IV were administered with either induction chemotherapy TPF or PC or cisplatin regimen. Treatment responses were assessed by CT and MRI. Response rates, survival and adverse effects data were tabulated and analysed.

RESULTS

The mean age was 49.2 ± 11.68 years. Symptoms were ulceration (33.5%), growth (20.5%), pain (13%), ulcer-proliferative growth (8.4%) and swelling (13, 6%). The tumour site was found at the base of the tongue, C01 (42.2%) followed by C06 (35.8%), C08 (6.5%), C07 (5.2%) and C05 (4.6%). There were no significant differences ( P > 0.05) in efficacy and survival outcomes between the different groups of treatment. Median survival was achieved within 36 months. The major side effect observed were anaemia (15.81%), diarrhoea (36.2%), dyspepsia (28.8%), fever (33.95%), mucositis (28.85%), myalgia (33.95%) and nausea (7.9%). Survival among the responder categories (CR, PR and NR) was significantly different as per Log-rank analysis ( P = 0.015).

CONCLUSIONS

TPF induction therapy and PC first line chemotherapy showed similar efficacy, safety profile and survival whereas cisplatin shows poor efficacy and safety and survival in Indian oral cancer patients.

Clinical practice guidelines for radiographic assessment in management of oral cancer

In recent years, oral cancer has become a huge solicitude in oncology with its accelerating incidence and has accounted for nearly 50% of cancers seen in India. Screening of patients and lack of awareness among people about the early signs and symptoms are the major factors for a late diagnosis. Although examination of the lesion clinically and diagnosis has a paramount role in early detection, different imaging techniques are required to accurately gauge the extent to local regions. Imaging plays a pivotal role in deciding the apt treatment strategy, assessing the resectability of the tumor, and gauging exact margins for resection. Thus, this study aims to describe a new clinical guideline using various available imaging systems and their importance in oral cancer management.

Oral cancer diagnosis and perspectives in India

Globally, oral cancer is the sixth most common type of cancer with India contributing to almost one-third of the total burden and the second country having the highest number of oral cancer cases. Oral squamous cell carcinoma (OSCC) dominates all the oral cancer cases with potentially malignant disorders, which is also recognized as a detectable pre-clinical phase of oral cancer. Tobacco consumption including smokeless tobacco, betel-quid chewing, excessive alcohol consumption, unhygienic oral condition, and sustained viral infections that include the human papillomavirus are some of the risk aspects for the incidence of oral cancer. Lack of knowledge, variations in exposure to the environment, and behavioral risk factors indicate a wide variation in the global incidence and increases the mortality rate. This review describes various risk factors related to the occurrence of oral cancer, the statistics of the distribution of oral cancer in India by various virtues, and the socio-economic positions. The various conventional diagnostic techniques used routinely for detection of the oral cancer are discussed along with advanced techniques. This review also focusses on the novel techniques developed by Indian researchers that have huge potential for application in oral cancer diagnosis.

Contribution of cone-beam computed tomography in the decision of surgical management for bone lesions of the maxillofacial region

The aim of this study was to evaluate the contribution of cone-beam computed tomography (CBCT) in the decision of surgical management for bone lesions of the maxillofacial region. It is a retrospective cross-sectional observational study that includes a sample of panoramic radiography (PR) and CBCT from patients with some type of bone lesion in the maxillofacial region. PR and CBCT images were evaluated by three previously assessed examiners, specialists in oral and maxillofacial surgery. Each image was evaluated randomly, and a surgical procedure was suggested, initially in PR and then in CBCT. The obtained results were submitted to the McNemar test to evaluate the frequencies of changes in the surgical management between the first and the second evaluation in PR and CBCT, and intra-examiner and inter-examiner agreements were analyzed by the Cohen's kappa test. The level of significance was set at 5% (p < 0.05). Intra-examiner agreement increases when CBCT is used. Inter-examiner agreement was low, independently of the evaluated exam, which shows that the choice of treatment plan is examiner-dependent and not exam-dependent. CBCT increases the certainty of the professional in the evaluation of the bone lesions of the maxillofacial region; however, it does not change the indication of the treatment type.

Magnetic resonance imaging based radiomics signature for the preoperative discrimination of stage I-II and III-IV head and neck squamous cell carcinoma

PURPOSE

This study aimed to investigate the predictive ability of magnetic resonance imaging (MRI) based radiomics signature for the preoperative staging in HNSCC.

METHODS

This study involved127 consecutive patients (training cohort: n = 85; testing cohort, n = 42) with stage I-IV HNSCC. A total of 970 radiomics features were extracted from T2-weighted (T2W) (n = 485) and contrast-enhanced T1-weighted (ceT1W) (n = 485) MRI for each case. Radiomics signatures were constructed with least absolute shrinkage and selection operator (LASSO) logistic regression. Associations between radiomics signatures and HNSCC staging were explored. Areas under the receiver operating characteristic curve (AUC) and classification performance of radiomics signatures were determined and compared with those of the visual assessment.

RESULTS

Ten features from T2W images, six from ceT1W images, and six from combined T2W and ceT1W images were selected by LASSO logistic regression. The three radiomics signatures of stage III-IV HNSCC were significantly higher than that for stage I-II in both cohorts (all P < 0.05). The radiomics signatures from ceT1W and combined images performed well in the discrimination of stage I-II and III-IV HNSCC, with AUCs of 0.828 and 0.850 in the training cohort, and AUCs of 0.853 and 0.849 in the testing cohort. Based on the cut-off value of the training cohort, the radiomics signature from combined images achieved best classification performance in both cohorts, with accuracies of 0.788 and 0.857, sensitivities of 0.836 and 0.885, and specificities of 0.700 and 0.813. Significant differences in accuracy and sensitivity were found between the radiomics signature from combined images and the visual assessment of the radiologists in the training cohort.

CONCLUSION

Radiomics signature based on MRI could discriminate stage I-II from stage III-IV HNSCC, which may serve as a complementary tool for preoperative staging.

Loco-regional recurrence after surgical treatment of oral squamous cell carcinoma: Proposals for follow-up imaging based on literature, national guidelines and institutional experience

The recurrence rate following the treatment of oral squamous cell carcinoma (OSCC) by primary surgery is about 10%-26%. The earliest possible diagnosis of residual tumour, recurrence of local tumour disease, and subsequent metastasis is essential for an improvement of the overall survival and of the survival period for affected patients. No international consensus exists for a post-therapeutic surveillance schedule for OSCCs. Based on a review of the literature, existing guidelines, and our institutional experience, we have established an algorithm for the follow-up of these patients regarding the timing and techniques of postoperative imaging. We recommend a follow-up interval of 6 weeks during the first half-year after discharge from hospital by single clinical and alternating clinical check-ups combined with computed tomography (CT) or magnetic resonance imaging (MRI), followed by an interval of 3 months in the second half-year, with clinical and radiological check-ups. In year 2, we recommend a follow-up interval of 3 months with single clinical and alternating clinical check-ups combined with CT or MRI. In year 3, we recommend screening every 6 months, both clinically and via imaging, because of the decreased risk of recurrence. From year 5 onwards, our recommendation is a clinical and imaging-based examination every 6-12 months, depending on patient risk factors and disease progression. Four standard imaging techniques, namely positron emission tomography (PET), CT, MRI, and ultrasound (US), are discussed concerning their range of application, sensitivity, and specificity. Furthermore, the technical aspects of our institutional protocols are described in detail. In highly frequented head and neck cancer centres, PET and US are of secondary importance, since CT and MRI are nowadays highly efficient tools in primary diagnostic and post-therapeutic surveillance.

Contrast-enhanced CT and MRI for detecting neck metastasis of oral cancer: comparison between analyses performed by oral and medical radiologists

OBJECTIVES

The aim of the study was to verify the concordance of contrast-enhanced CT (CECT) and MRI evaluation among four radiologists in detecting metastatic cervical lymph nodes of oral cancer patients.

METHODS

Ten patients underwent clinical and imaging examinations (CECT and MRI). Four radiologists, two oral and maxillofacial radiologists (OMRs) and two medical radiologists (MRs), independently analysed the images twice. Cohen's kappa index and Wilcoxon signed-rank test were used to verify the concordance between all analyses.

RESULTS

Regarding the interobserver agreement, the OMRs presented excellent kappa values for determining the regional lymph nodes (N-stage) in both CECT and MRI. The MRs presented moderate agreement for CECT evaluation at the first reading, but no concordance was found for the other analyses. When each imaging modality was analysed separately, kappa values were higher between all examiners. Greater variability was demonstrated between N-stage evaluation using different examinations. All radiologists were able to identify a greater number of metastatic lymph nodes in CECT than in MRI, except one MR, but no significant difference was found for all readers. The differences between the number of metastatic lymph nodes among all radiologists were not statistically significant. Moderate intraobserver agreement was observed for CECT and MRI evaluation, except for one MR.

CONCLUSIONS

The differences found between the N-stage performed by OMRs and MRs support the necessity of a multidisciplinary approach in the imaging evaluation of metastatic nodes. Further studies are necessary to confirm which imaging modality should be employed when evaluating neck areas.