[Epidemiology and anatomy of head and neck cancers]

Head and neck cancer patients under radiotherapy undergoing skin application of hydrogel dressing or hyaluronic acid: results from a prospective, randomized study

PURPOSE

Acute radiodermatitis (ARD) is a frequent side effect of radiotherapy, a therapeutic option for head and neck squamous cell carcinoma (HNSCC). It is responsible for pain, quality of life (QoL) impairment, and increased risk of treatment discontinuation, which may compromise the prognosis for patients. Local therapies to prevent or alleviate ARD have been proposed without providing any high level of evidence to establish recommendations.

METHODS

We implemented a prospective multicenter randomized study on patients with HNSCC treated with definitive radiotherapy to assess the impact on ear, nose, and throat (ENT) pain of the application of a hydrogel-based skin dressing (HydroTac®) compared with the application of hyaluronic acid (Ialuset®) during radiotherapy.

RESULTS

Out of 130 enrolled patients, 48 patients per group were assessable for the main endpoint. No difference between groups was found: a worsening of ENT pain of 3 points or more on a visual analog scale from the initiation to 1 month after the end of the radiotherapy was observed for 8 patients (16.7%) who received HydroTac® compared to 13 patients (27%) who received Ialuset® (p = 0.342). The proportion of patients who experienced ARD and grades of ARD (CTCAE v4.0 criteria) were similar between groups. Patient compliance with radiodermatitis treatment was poor, with 56.1% of patients in the HydroTac® group having their treatment temporarily stopped.

CONCLUSION

The application of a hydrogel dressing to prevent ARD during radiotherapy for HNSCC patients has failed to demonstrate a benefit. These results may be limited by the difficulties of applying the dressing.

Function of gold nanoparticles in oral cancer beyond drug delivery: Implications in cell apoptosis

OBJECTIVES

Gold nanoparticles (AuNPs) are used to deliver drugs and therapeutic small molecule inhibitors to cancer cells. Evidence shows that AuNPs coated with nuclear localization sequence can cross the nuclear membrane and induce cellular apoptosis. To determine the therapeutic role of AuNPs, we compared two nanoconstructs conjugated to doxorubicin (DOX) through pH-sensitive and pH-resistant linkers.

MATERIALS AND METHODS

We tested DOX nanoconjugates' cytotoxicity, cellular and nuclear uptake in oral squamous cell carcinoma cell line. Furthermore, we evaluated the therapeutic effect of pH-sensitive and pH-resistant DOX bioconjugates in hamster buccal pouch carcinoma model.

RESULTS

Our data indicate that pH-resistant and pH-sensitive DOX-nanoconjugates were equally localized in cancer cells, but the pH-resistant DOX nanoparticles were more localized in the nuclei inducing a 2-fold increase in the apoptotic effect compared with the pH-sensitive DOX nanoparticles. Our in vivo results show significantly higher tumor shrinkage and survival rates in animals treated with DOX pH-resistant AuNPs compared with pH-sensitive ones.

CONCLUSION

Our findings suggest that AuNPs enhance the cytotoxic effect against cancer cells in addition to acting as drug carriers. DOX pH-resistant AuNPs enhanced accumulation of AuNPs in cancer cells' nuclei inducing a significant cellular apoptosis which was confirmed using in vitro and in vivo experiments without deleterious effects on blood cell count.

Predictive Value of Early Post-Treatment Diffusion-Weighted MRI for Recurrence or Tumor Progression of Head and Neck Squamous Cell Carcinoma Treated with Chemo-Radiotherapy

Aims: To investigate the predictive capacity of early post-treatment diffusion-weighted magnetic resonance imaging (MRI) for recurrence or tumor progression in patients with no tumor residue after chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma, and, to assess the predictive capacity of pre-treatment diffusion-weighted MRI for persistent tumor residue post-CRT. Materials and Method: A single center cohort study was performed in one French hospital. All patients with squamous cell carcinoma receiving CRT (no surgical indication) were included. Two diffusion-weighted MRI were performed: one within 8 days before CRT and one 3 months after completing CRT with determination of median tumor apparent diffusion coefficient (ADC). Main outcome: The primary endpoint was progression-free survival. Results: 59 patients were included prior to CRT and 46 (78.0%) completed CRT. A post-CRT tumor residue was found in 19/46 (41.3%) patients. In univariate analysis, initial ADC was significantly lower in patients with residue post CRT (0.56 ± 0.11 versus 0.79 ± 0.13; p < 0.001). When initial ADC was dichotomized at the median, initial ADC lower than 0.7 was significantly more frequent in patients with residue post CRT (73.7% versus 11.1%, p < 0.0001). In multivariate analysis, only initial ADC lower than 0.7 was significantly associated with tumor residue (OR = 22.6; IC [4.9–103.6], p < 0.0001). Among 26 patients without tumor residue after CRT and followed up until 12 months, 6 (23.1%) presented recurrence or progression. Only univariate analysis was performed due to a small number of events. The only factor significantly associated with disease progression or early recurrence was the delta ADC (p = 0.0009). When ADC variation was dichotomized at the median, patients with ADC variation greater than 0.7 had time of disease-free survival significantly longer than patients with ADC variation lower than 0.7 (377.5 [286–402] days versus 253 [198–370], p < 0.0001). Conclusion and relevance: Diffusion-weighted MRI could be a technique that enables differentiation of patients with high potential for early recurrence for whom intensive post-CRT monitoring is mandatory. Prospective studies with more inclusions would be necessary to validate our results.

Neutrophil-to-lymphocyte ratio as a prognostic factor for pharyngocutaneous fistula after total laryngectomy

SUMMARY

The role of systemic inflammatory response as a prognostic factor has been proposed in a variety of cancers. The purpose of this study was to investigate the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the incidence of pharyngocutaneous fistula (PCF) in patients who underwent total laryngectomy. We conducted a retrospective cohort analysis of 141 patients with squamous cell carcinoma of larynx who underwent total laryngectomy from 2009 to 2015. The incidence of PCF was 49.6%. A higher risk of 23% was observed among patients with NLR > 2.5 for the occurrence of PCF (p = 0.007). Patients with laryngeal squamous cell carcinoma who present elevated values in the ration > LR> (> 2.5) presented a higher risk of developing pharyngocutaneous fistula in the postoperative setting of total laryngectomy.

Cancer des VADS et comportements à risque

Les cancers des voies aérodigestives supérieures (VADS) sont majoritairement des cancers masculins. Ils sont associés avant tout à une consommation excessive d'alcool et de tabac. Ils apparaissent comme des sociopathologies. Les répercussions psychosociales de ces cancers se manifestent par des trajectoires de vie difficiles et une dégradation des relations au sein du couple. Ces constatations incitent à mettre en œuvre des politiques de santé contre le tabagisme et à proposer des recherches pour réduire l'incidence de ces cancers.

Epidemiological Aspects in Lip Tumors in Oltenia Region of Romania During 2012-2016

Purpose. The objective of this study was to review lip tumor diagnosed subjects from Oltenia region, in the past 5 years according to gender, age, home environment, profession, geographic area, smoking habit, associated diseases, tumor location, macroscopic aspect and histological type. Material and Methods. The study was done at the Oral and Maxillo-Facial Clinic of the Emergency Clinical County Hospital of Craiova, and involved the analysis of patient file records, surgical registers, histopathological bulletins, from 2012-2016. Results. Of the 175 subjects included in this study, all of them diagnosed with lip tumor pathology, 109 (62.29%) were men, and 66 (37.71%) were women, all of them with ages between 6 and 92 years, with a mean age of 61 years. Distribution of study participants according to the home residence showed that majority of the subjects lived in rural area. The most frequently localization of lip tumors in study participants was at the lower lip-140 cases (80%), than at the upper lip-35 cases (20%).According to histological characteristics, distribution of the malignant lip tumors was 87.39%-squamous cell carcinoma (SCC), 5.41%-basal cell carcinoma (BCC) and 7.20%-other type of tumors. Conclusions. The lower lip was the most affected, by lip cancer, and squamous cell carcinoma represents the most frequently histological type of these tumors.

Locally advanced paranasal sinus carcinoma: A study of 30 patients

Sinonasal carcinomas (SNcs) are rare neoplasms arising from the paranasal sinuses and nasal cavity. Although these tumours have a heterogeneous histology, they are commonly diagnosed as a locally advanced disease and are associated with a poor prognosis. The present retrospective study reviewed 30 patients with locally advanced SNc, who were treated with surgery followed by chemoradiotherapy or radiotherapy, or radiotherapy with or without concomitant chemotherapy between January 1999 and January 2013 at the Department of Radiation Therapy, University of Naples 'Federico II' (Naples, Italy). A total of 19 patients were treated with upfront surgery followed by adjuvant radio- or chemoradiotherapy (group A), while the remaining 11 patients received exclusive radiotherapy with or without concomitant chemotherapy (group B). Concurrent cisplatin-based chemotherapy (100 mg/m2, days 1, 22 and 43 for 3 cycles) was administered to 34% of patients in group A and 55% of patients in group B. At a median follow-up of 31 months, 33.3% of patients were alive. Cause-specific survival (CSS) and progression-free survival (PFS) times were 32 and 12 months, respectively. No difference in CSS rate was observed between the two treatment groups. Univariate analysis determined that disease stage was the only factor that significantly affected CSS (P=0.002) and PFS (P=0.0001) rates. Acute and chronic toxicities were mild, with only 23.3% of patients reporting G1-2 side effects and no treatment-related blindness. The present study reported moderate activity and efficacy of surgery followed by adjuvant radio- or chemoradiotherapy, and exclusive radiotherapy with or without chemotherapy in this poor prognosis category of patients.

[Primitive oto-rhino-laryngology and cervico-maxillofacial tumors: epidemiological and histological aspects]

Introduction

Notre objectif a été d'établir le panorama des cancers primitifs oto-rhino-laryngologiques et cervico-maxillo-faciaux dans un service de référence au Togo.

Méthodes

Il s’est agi d’une étude rétrospective descriptive, portant sur les cancers diagnostiqués dans le service d’ORL et de chirurgie cervico-maxillo-faciale du CHU Sylvanus Olympio de Lomé. Elle a été réalisée sur une période de 10 ans (1^er Janvier 2005 au 31 Décembre 2014).

Résultats

Les cancers ORL et cervico-maxillo-faciaux représentaient 0,48% des consultations et 15,3% de l’ensemble des tumeurs ORL. L’âge moyen des patients était de 47 ans, avec des extrêmes de 3 mois et 86 ans. On notait une prédominance masculine; la sex-ratio était de 1,45. L’alcoolotabagisme prédominait dans le cancer du larynx. Les cancers des voies aérodigestives supérieures (VADS) ont représenté 64,8%, avec une prédominance des cancers de la cavité buccale (36,2% des VADS), suivi des cancers de l’oropharynx (18,5% des VADS) puis des cancers du larynx (18,1% des VADS). Les adénopathies cervicales malignes primitives représentaient 18%. Les lésions les plus rares étaient les cancers de l’oreille et du tissu osseux maxillo-mandibulaire (2,24% chacun). L’histologie était dominée par le carcinome épidermoïde (61,4%) suivi du lymphome non hodgkinien (23,2%).

Conclusion

Les cancers ORL et cervico-maxillo-faciaux sont fréquents au Togo et diagnostiqués à tout âge. Les cancers prédominants sont ceux de la cavité buccale, du pharynx et les adénopathies cervicales malignes primitives.

[Psychological care of patients with head and neck cancer]

Treatments for head and neck cancers are generally complex and debilitating. Surgery, often mutilating, profoundly affects the relationship between oneself and others and causes verbal communication, breathing and swallowing difficulties. The functional and aesthetic sequelae are a constant reminder to the patient of the disease and make them conscious of their appearance.

[Radioresistance parameters in head and neck cancers and methods to radiosensitize]

Head and neck cancers have been widely studied concerning their sensitivity to radiation therapy. Several parameters affect tumour response to radiation therapy. Some parameters are linked to the tumour. Large or invasive tumours, localization, such as oral cavity or adenopathy, are factors of radioresistance. Others parameters are linked to the patients themselves. Tobacco intoxication during radiotherapy and a low hemoglobin level contribute to radioresistance. More recently, a positive human papilloma virus (HPV) status has been reported to positively affect radiosensitivity. Finally, other parameters are related to tumour biology. Hypoxia, intrinsic radiosensitivity of tumour cells, tumour differentiation and repopulation (provided by Ki-67 index or EGFR level) are components of radiosensitivity. Currently, concurrent chemoradiotherapy is one of the gold standard treatments to overcome clinical outcome of locally advanced head and neck cancer. This combination increases locoregional control and survival. Taxane-based induction chemotherapy can also be an alternative. Another validated approach is the association of radiotherapy with cetuximab (EGFR targeting) but only one randomized study has been published. Fractionation modifications, especially hyperfractionation, have given positive results on both tumour control and survival. Strategies targeting hypoxia improve locoregional control but have less clinical impact.

Treatment improvement and better patient care: which is the most important one in oral cavity cancer?

Due to substantial improvement in diagnosis and treatment of oral cavity cancer, a better understanding of the patient care needs to be revised. We reviewed literature related to OCC and discussed current general management approaches and related long-term radiation toxicities to emphasize the multidisciplinary team involvement. New technical modalities and patient quality of life parameters should be an integral and paramount state in the clinical evaluation to significantly contribute to reduce secondary side effects.