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van de Ven S, Bugter O, Hardillo JA, Bruno MJ, Baatenburg de Jong RJ, Koch AD. Screening for head and neck second primary tumors in patients with esophageal squamous cell cancer: A systematic review and meta-analysis. United European Gastroenterol J 2019; 7:1304-1311. [PMID: 31839955 PMCID: PMC6893998 DOI: 10.1177/2050640619856459] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/20/2019] [Indexed: 12/18/2022] Open
Abstract
Background Esophageal squamous cell carcinomas (ESCCs) are often accompanied by head and neck second primary tumors (HNSPTs). The prognosis of patients with an additional HNSPT is worse compared with patients with only ESCC. Therefore, early detection of HNSPTs may improve the overall outcome of patients with ESCC. The purpose of this study was to investigate the yield of endoscopic screening for HNSPTs in patients with primary ESCC. Methods We conducted a systematic literature search of all available databases. Studies were included if ESCC patients were endoscopically screened for HNSPT. The primary outcome was the pooled prevalence of HNSPTs. Results Twelve studies, all performed in Japan, were included in this systematic review with a total of 6483 patients. The pooled prevalence of HNSPTs was 6.7% (95% confidence interval: 4.9–8.4). The overall heterogeneity was high across the studies (I2 = 89.0%, p < 0.001). Most HNSPTs were low stage (85.3%) and located in the hypopharynx (60.3%). The proportion of synchronous (48.2%) and metachronous (51.8%) HNSPTs was comparable. Conclusion Based on our results, HNSPT screening could be considered in patients with primary ESCC. All studies were performed in Japan; it is therefore not clear whether this consideration applies to the Western world.
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Affiliation(s)
- Sem van de Ven
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - O Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Amar A, Rapoport A, Curioni OA, Dedivitis RA, Cernea CR, Brandão LG. Prognostic value of regional metastasis in squamous cell carcinoma of the tongue and floor of mouth. Braz J Otorhinolaryngol 2014; 79:734-7. [PMID: 24474486 PMCID: PMC9442422 DOI: 10.5935/1808-8694.20130134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 08/01/2013] [Indexed: 11/20/2022] Open
Abstract
The presence of metastatic nodes is a survival-limiting factor for patients with mouth tumors. Objective To evaluate the causes of treatment failure in carcinomas of the tongue and floor of the mouth due to staging. Method This study included 365 patients with squamous cell carcinoma of the mouth treated from 1978 to 2007; 48 were staged as T1, 156 as T2, 98 as T3, and 63 as T4, of which 193 were pNo and 172 pN+. Results Among the pN+ cases, 17/46 (36.9%) of the patients not treated with radiation therapy had relapsing tumors, against 46/126 (36.5 %) of the patients who underwent radiation therapy. Success rates in the group of subjects submitted to salvage procedures were 16/51 (31.3%) for pN0 patients and 3/77 (3.9%) for pN+ patients. Conclusion Salvage procedure success and survival rates are lower for pN+ patients; pN+ individuals also have more relapsing local disease.
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Affiliation(s)
- Ali Amar
- Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, Hospital Heliópolis, São PauloSP
| | | | - Otávio Alberto Curioni
- Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, Hospital Heliópolis, São Paulo
| | - Rogério Aparecido Dedivitis
- Departamento de Cirurgia de Cabeça e Pescoço, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo
| | - Claudio Roberto Cernea
- Departamento de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina, Universidade de São Paulo
| | - Lenine Garcia Brandão
- Departamento de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina, Universidade de São Paulo
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Swellam M, El-Arab LRE, Adly A. Prognostic value of cell-cycle regulators and cellular biomarkers in laryngeal squamous cell carcinoma. Clin Biochem 2008; 41:1059-66. [DOI: 10.1016/j.clinbiochem.2008.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 05/01/2008] [Accepted: 06/01/2008] [Indexed: 10/22/2022]
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Chedid HM, Franzi SA. Avaliação de fatores demográficos e estadiamento clínico nos pacientes submetidos a resgate cirúrgico por carcinomas epidermóides de orofaringe. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0034-72992008000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O tratamento clássico do carcinoma epidermóide das vias aéreas digestivas superiores (VADS) é a cirurgia, associada ou não à radioterapia pós-operatória. As recidivas loco-regionais constituem a principal falha no tratamento inicial e o diagnóstico precoce favorece a indicação de cirurgia de resgate. OBJETIVO: Análise descritiva dos dados demográficos e de estadiamento no resgate cirúrgico dos tumores de orofaringe. CASUÍSTICO E MÉTODOS: Estudo retrospectivo de 78 pacientes, submetidos à cirurgia em todos os casos e a radioterapia complementar em 37 destes. RESULTADOS: Predomínio do gênero masculino em 70 casos, com idade média de 54,2 anos e etnia branca em 54 pacientes. O pacientes foram estadiados em T3 e T4 em 38 casos. Dos 78 pacientes, 40 eram pescoço N0. Trinta e cinco pacientes desenvolveram recidiva loco-regional e à distância. Das recidivas loco-regionais, 17 deles foram submetidos ao resgate cirúrgico, sendo que 12 pacientes foram reestadiados na recidiva em T1; 2 em T2 e quanto ao N, 2 eram N2a e 2 eram N2b. A idade média dos pacientes submetidos ao resgate foi de 52,8 anos, com predomínio na etnia branca e gênero masculino. CONCLUSÃO: O resgate predominou em estádios I e II com controle da doença em 58,8%.
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Assessment of demographics factors and clinical staging in patients submitted to salvage surgery for oropharyngeal squamous cell carcinoma. Braz J Otorhinolaryngol 2008; 74:532-6. [PMID: 18852978 PMCID: PMC9442088 DOI: 10.1016/s1808-8694(15)30599-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 07/30/2007] [Indexed: 11/22/2022] Open
Abstract
The usual management of upper aero digestive tract squamous cell carcinoma is surgery associated or not to post surgical radiotherapy. Loco-regional relapses constitute the main failure of the initial treatment and early diagnosis justifies the indication of salvage surgery. Aim Descriptive analysis of demographic data and staging for salvage surgery of oropharynx tumors. Material and methods We studied retrospectively 78 patients submitted to surgery in all cases; however, just 37 patients received post surgical radiotherapy. Results There was a predominance of males in 70 cases, with mean age of 54.2 years, and 54 patients were Caucasian. The patients were classified as T3 and T4 in 38 cases and 40 patients were classified as N0 neck. 35 patients developed loco-regional distant relapses. 17 patients were submitted to salvage surgery and 12 patients were reclassified as T1; 2 patients T2 and in relation to the clinical stage N, 2 patients were N2a and 2 patients N2b. The average age of the patients submitted to salvage surgery was 52.8 years, with predominance of male Caucasians. Conclusion Clinical stage I and II were accorded salvage surgery.
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Michaluart P, Abdallah KA, Lima FD, Smith R, Moysés RA, Coelho V, Victora GD, Socorro-Silva A, Volsi EC, Zárate-Bladés CR, Ferraz AR, Barreto AK, Chammas MC, Gomes R, Gebrim E, Arakawa-Sugueno L, Fernandes KP, Lotufo PA, Cardoso MR, Kalil J, Silva CL. Phase I trial of DNA-hsp65 immunotherapy for advanced squamous cell carcinoma of the head and neck. Cancer Gene Ther 2008; 15:676-84. [PMID: 18535616 DOI: 10.1038/cgt.2008.35] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Considering that mycobacterial heat-shock protein 65 (hsp65) gene transfer can elicit a profound antitumoral effect, this study aimed to establish the safety, maximum-tolerated dose (MTD) and preliminary efficacy of DNA-hsp65 immunotherapy in patients with advanced head and neck squamous cell carcinoma (HNSCC). For this purpose, 21 patients with unresectable and recurrent HNSCC were studied. Each patient received three ultrasound-guided injections at 21-day intervals of: 150, 600 or 400 microg of DNA-hsp65. Toxicity was graded according to CTCAE directions. Tumor volume was measured before and after treatment using computed tomography scan. The evaluation included tumor mass variation, delayed-type hypersensitivity response and spontaneous peripheral blood mononuclear cell proliferation before and after treatment. The MTD was 400 microg per dose. DNA-hsp65 immunotherapy was well tolerated with moderate pain, edema and infections as the most frequent adverse effects. None of the patients showed clinical or laboratory alterations compatible with autoimmune reactions. Partial response was observed in 4 out of 14 patients who completed treatment, 2 of which are still alive more than 3 years after the completion of the trial. Therefore, DNA-hsp65 immunotherapy is a feasible and safe approach at the dose of 400 microg per injection in patients with HNSCC refractory to standard treatment. Further studies in a larger number of patients are needed to confirm the efficacy of this novel strategy.
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Affiliation(s)
- P Michaluart
- HSP65 Clinical Trial Group, University of São Paulo, São Paulo, Brazil
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Rapoport A, Ortellado DK, Amar A, Lehn CN, Dedivitis RA, Perez RS, Rodrigues HM. Radical versus supraomohyoid neck dissection in the treatment of squamous cell carcinoma of the inferior level of the mouth. Braz J Otorhinolaryngol 2007; 73:641-6. [PMID: 18094805 PMCID: PMC9445703 DOI: 10.1016/s1808-8694(15)30124-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 08/26/2006] [Indexed: 12/04/2022] Open
Abstract
The therapeutic paradigm for neck metastasis of squamous cell carcinoma (SCC) in the lower level of the mouth has changed due to survival. Aim: A comparative study between radical (RND) versus selective neck dissection (SND). Material and Method: An analysis of mouth SCC in the lower level of the mouth in 460 files from the Head & Neck and ORL Department of the Heliopolis Hospital, from 1978 to 2002. In the RND the metastathic rate in levels IV and V was assessed; in the SND the presence and site of recurrence was identified. The chi square test with the Yates correction was the chosen statistical method. Results: In the RND the metastatic rates were 5.8% (level IV) and 4.6% (level V) for cNO cases, and 9.9% (level IV) and 5.9%(level V) for cN+ cases; for level I only the rates were 11,0% for cNO cases and 5.5% for cN+ cases. In the SND the number of recurrences was 4 (4.1%) in 97 neck dissections (pNO) and 2 (10%) in 20 neck dissections (pN+). There was no advantage in using radiation compared to non-irradiated cases (5.6% and 5.7%). Conclusion: The SND may be used for SCC of the lower level of the mouth.
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Affiliation(s)
- Abrão Rapoport
- Head & Neck Surgery Department, Heliopolis Hospital, Hosphel/SP, Brazil
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Lung T, Tăşcău OC, Almăşan HA, Mureşan O. Head and neck cancer, epidemiology and histological aspects - Part 1: a decade's results 1993-2002. J Craniomaxillofac Surg 2007; 35:120-5. [PMID: 17449259 DOI: 10.1016/j.jcms.2007.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 02/02/2007] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Studies prior to 1990 showed an incidence of 5% for oral and maxillofacial cancer in Romania. In this paper (Part 1) an evaluation of malignant tumour cases, covering a 10-year period is made regarding histological forms, the relationships of malignant tumours to patients' geographic origin, environment, age, gender of patients and lymph node involvement. PATIENTS AND METHODS From 1485 patients with malignant oral and maxillofacial tumours, 1072 cases fulfilled the criteria for inclusion in this study. The following data were examined: patients' charts and medical records as well as pathology reports. RESULTS From 16,315 patients admitted to this hospital between 1993 and 2002, 9% presented with primary ('de novo') malignant tumours; 2/3 were male patients; average age at presentation was 61 years for males and 59 years for females; 47% presented with stage IV tumours; out of the 'de novo' tumours, 93% were carcinomas and 4% sarcomas; 56% of patients had positive lymph nodes at presentation. CONCLUSIONS The number of head and neck cancer cases increased in the last 15 years; almost half of the patients presented with tumours in stage IV.
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Affiliation(s)
- Teofil Lung
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
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Lung T, Tăşcău OC, Almăşan HA, Mureşan O. Head and neck cancer, treatment, evolution and post therapeutic survival – Part 2: A decade's results 1993–2002. J Craniomaxillofac Surg 2007; 35:126-31. [PMID: 17449258 DOI: 10.1016/j.jcms.2007.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Accepted: 02/02/2007] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES In the second part of an analysis of a 10-year period of treating oral cancer patients, the focus was the efficiency of treatment, recurrence rates and survival. PATIENTS AND METHODS From 1485 patients with oral and maxillofacial malignant tumours, 1072 cases could be evaluated. The following data were analyzed statistically: patients' charts and medical records including the follow-up reports. RESULTS From all patients studied, 811 underwent surgical treatment alone, the mean recurrence rate was 23%. The recurrence rate after surgery plus radiotherapy was 38%; after surgical treatment alone it was 23%; the survival rate at 3 and 5 years post-therapeutically was 49% and 31%, respectively. CONCLUSIONS The first choice therapy for carcinomas is surgical. The recurrence rate increased with lymph node involvement and tumour size.
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Affiliation(s)
- Teofil Lung
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
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Amar A, Curioni OA, Franzi SA, Ortelado DK, Rapoport A. Neck dissection in squamous cell carcinoma of the tongue. Braz J Otorhinolaryngol 2006; 71:29-31. [PMID: 16446888 PMCID: PMC9443495 DOI: 10.1016/s1808-8694(15)31281-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim The purpose of this study was to assess the prognosis of patients with tonsillar squamous cell carcinoma with different stages of lymph node involvement and to determine the best elective neck dissection for those cases. Study design Case series. Material and Method 51 patients with tonsillar tumors were treated between 1992 and 2001. The incidence of different tumor-node-metastasis stages was evaluated according to primary tumor extension. Results cN0 patients had metastases in stages I and II only. Among pN+ subjects with stage I metastases, 6/7 had primary tumor extending to oral cavity. Conclusion Supraomohyoid neck dissection (stages I, II and III) is the elective treatment of choice when tonsillar primary tumor extends to oral cavity. When primary tumors are limited to the oropharynx, selective neck dissection of stages II and III proved to be more adequate.
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Affiliation(s)
- Ali Amar
- Department of Head and Neck Surgery and Otorhinolaryngology, Hospital Heliópolis, Hosphel, Sao Paulo, Brazil
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Amar A, Ortellado DK, Franzi SA, Curioni OA, Rapoport A. Sobrevida após recidiva intratável do carcinoma epidermóide de cabeça e pescoço. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000500009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a sobrevida em pacientes com câncer de cabeça e pescoço recidivado e sem possibilidade de tratamento curativo. MÉTODO: Foram revisados os prontuários dos pacientes com carcinoma epidermóide de boca, orofaringe, hipofaringe e laringe tratados cirurgicamente (tumor primário e esvaziamento cervical) entre 1978 e 2001, e selecionados 140 com recidiva da doença acompanhados até o óbito pelo câncer. Após 1999, 30 pacientes receberam cuidados paliativos de uma equipe multidisciplinar. Foi avaliado o intervalo de tempo entre a recidiva não resgatável e o óbito, considerando o sítio primário, estadiamento inicial, sobrevida livre de doença e cuidados paliativos. Os resultados foram expressos em medianas e médias, com os respectivos quartis e percentis. RESULTADOS: A sobrevida livre de doença apresentou média de 30 semanas. A sobrevida média após a recidiva foi de 17 semanas (Q25-75% = 8 a 34 semanas). Dezessete pacientes (12%) sobreviveram por mais de 12 meses após a recidiva. O sítio primário, estadiamento inicial, local da recidiva, sobrevida livre de doença e os cuidados paliativos não influenciaram a sobrevida após a recidiva. CONCLUSÃO: A sobrevida após uma recidiva não resgatável é similar ao relatado para os pacientes não tratados. Os cuidados paliativos não aumentaram a sobrevida destes pacientes.
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Amar A, Curioni OA, Franzi SA, Rapoport A. Recidivas locais após tratamento cirúrgico do carcinoma epidermóide de cabeça e pescoço em estágio avançado. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000200003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar os resultados do tratamento de resgate das recidivas locais nos pacientes com carcinoma epidermóide das vias aerodigestivas superiores submetidos a tratamento cirúrgico. MÉTODO: Foram revisados os prontuários de 943 pacientes submetidos à ressecção do tumor primário e esvaziamento cervical entre 1977 e 1996, e selecionados 107 pacientes com recidiva no sítio primário. Foram avaliados os resultados do tratamento de resgate, bem como os motivos para a não realização do mesmo. RESULTADOS: A principal queixa no diagnóstico da recidiva foi dor. O tratamento de resgate foi realizado em 45% dos pacientes e o principal motivo para a não realização do mesmo foi a extensão da recidiva. Foram resgatados 54% dos pacientes com recidiva no estádio rT1T2 em comparação com 31% dos pacientes rT3T4 (p = 0,04). Apenas quatro (8%) dos pacientes resgatados estavam assintomáticos por período superior a 12 meses após o re-tratamento, todos resgatados com cirurgia. O intervalo de tempo entre o tratamento inicial e a recidiva apresentou mediana de oito meses e as novas recidivas ocorreram na mediana de cinco meses. CONCLUSÃO: As recidivas locais após tratamento cirúrgico extenso apresentam prognóstico reservado.
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