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Arboleda LPA, de Carvalho GB, Santos-Silva AR, Fernandes GA, Vartanian JG, Conway DI, Virani S, Brennan P, Kowalski LP, Curado MP. Squamous Cell Carcinoma of the Oral Cavity, Oropharynx, and Larynx: A Scoping Review of Treatment Guidelines Worldwide. Cancers (Basel) 2023; 15:4405. [PMID: 37686681 PMCID: PMC10486835 DOI: 10.3390/cancers15174405] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Head and neck cancer (HNC) treatments have been based on single or multimodal therapies with surgery, radiotherapy (RT), chemotherapy, and immunotherapy. However, treatment recommendations among countries may differ due to technological/human resources and usual local practices. This scoping review aims to identify, compare, and map the clinical practice guidelines (CPGs) for treating squamous cell carcinoma (SCC) of the oral cavity, oropharynx, and larynx worldwide. A search strategy on global CPGs for HNC was performed by using five electronic databases and grey literature. CPGs were selected for inclusion using EndNote-20 and Rayyan online software. No language or publication date restrictions were applied. The results were analyzed descriptively considering the most updated CPG version. In total, 25 CPGs covering the head and neck region (10), the larynx (7), the oral cavity (5), and the oropharynx (3), were found in 13 geographical regions, and 19 were developed by medical societies from 1996 to 2023. Surgery and RT remain the main modalities for early-stage HNC, with surgery preferred in low-resource countries, and RT in selected cases, especially in the larynx/oropharynx aiming to achieve a cure with organ preservation. Human papillomavirus infection for oropharyngeal SCC is not tested in some Asian countries and there is still no consensus to treat p16-positive cases differently from p16-negative. Recommendations for larynx preservation vary according to facilities in each country, however, individualized choice is emphasized. Inequality across countries/continents is evident, with a similar pattern of recommendations among developed as well as developing ones. No CPGs were found in Latin America as well as Oceania countries, where the incidence of HNC is high and limitations of access to treatment may be encountered.
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Affiliation(s)
| | - Genival Barbosa de Carvalho
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, Sao Paulo 01508-020, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, Brazil
| | - Gisele Aparecida Fernandes
- Group of Epidemiology and Statistics on Cancer, A.C.Camargo Cancer Center, Rua Tagua, 440, Liberdade, Sao Paulo CEP 01508-020, Brazil
| | - Jose Guilherme Vartanian
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, Sao Paulo 01508-020, Brazil
| | - David I. Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow G2 3JZ, UK
| | - Shama Virani
- Genomic Epidemiology Group, International Agency for Research on Cancer (IARC/WHO), G2 3JZ Lyon, France
| | - Paul Brennan
- Genomic Epidemiology Group, International Agency for Research on Cancer (IARC/WHO), G2 3JZ Lyon, France
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C.Camargo Cancer Center, Sao Paulo 01508-020, Brazil
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 05403-000, Brazil
| | - Maria Paula Curado
- Group of Epidemiology and Statistics on Cancer, A.C.Camargo Cancer Center, Rua Tagua, 440, Liberdade, Sao Paulo CEP 01508-020, Brazil
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Outcome Analysis of Advanced Oral Cancers Requiring Large Composite Fibular Osteocutaneous Flap Reconstruction: Experience From a Tertiary Care Cancer Hospital. Ann Plast Surg 2022; 88:635-640. [PMID: 35502967 DOI: 10.1097/sap.0000000000003217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Advanced oral cancer entailing extensive resection of large parts of the mucosa, bone, and skin require reconstructions with composite free flaps. Our aim was to analyze the outcomes of those oral squamous cell carcinomas requiring fibular osteocutaneous free flaps with large skin defects. METHODS Perioperative course and histopathological and survival outcomes of 246 consecutive patients warranting composite fibular flaps from January 2010 to June 2015 at Tata Memorial Hospital, Mumbai, India, were retrospectively analyzed. RESULTS Despite majority of T4 disease (88.2%) and stage IV disease (92%) patients, the 5-year overall survival was 52.1% and the 5-year recurrence-free survival was 48.6% with a median follow-up of 42 months with minimal complications. CONCLUSIONS Reconstruction with composite fibular osteocutaneous flaps has comparable outcomes of survival with acceptable complications in mega oral squamous cell carcinomas requiring extensive resection.
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De Felice F, Lei M, Oakley R, Lyons A, Fry A, Jeannon JP, Simo R, Guerrero Urbano T. Risk stratified follow up for head and neck cancer patients - An evidence based proposal. Oral Oncol 2021; 119:105365. [PMID: 34058702 DOI: 10.1016/j.oraloncology.2021.105365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) has a significant impact on patients' quality of life and treatment can be associated with severe morbidity. Following completion of treatment, patients are followed up in order to detect potentially salvageable recurrences and to manage long-term toxicities. In recent years, a growing interest has been given to risk stratified follow-up interventions to prevent and detect recurrences and manage treatment toxicities in other tumour sites as well as to transfer some of that care to community services. We review the literature for HNSCC and propose a risk stratified follow up protocol to address these issues and assist clinicians in decision making. A shift in patterns of care is suggested in order to provide a basis to improve care for HNSCC patients after complete response to primary treatment.
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Affiliation(s)
- Francesca De Felice
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK; Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Mary Lei
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK
| | - Richard Oakley
- Department of Head and Neck Surgery Guys and St Thomas' NHS Trust, London, UK
| | - Andrew Lyons
- Department of Head and Neck Surgery Guys and St Thomas' NHS Trust, London, UK
| | - Alastair Fry
- Department of Head and Neck Surgery Guys and St Thomas' NHS Trust, London, UK
| | - Jean-Pierre Jeannon
- Department of Head and Neck Surgery Guys and St Thomas' NHS Trust, London, UK; King's College London, UK
| | - Ricard Simo
- Department of Head and Neck Surgery Guys and St Thomas' NHS Trust, London, UK
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Thakar A, Thakur R, Kakkar A, Malhotra RK, Singh CA, Sikka K, Kumar R, Pramanik R, Biswas A, Bhalla AS, Bhaskar S, Sharma A. Oral Cancer in the Indian Subcontinent-Survival Outcomes and Risk Factors with Primary Surgery. Laryngoscope 2021; 131:2254-2261. [PMID: 33797083 DOI: 10.1002/lary.29537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the oncological outcome and prognostic factors for primary Oral Squamous Cell Cancer (OSCC) staged as per AJCC 8th pTNM, and treated by the contemporary standard of primary surgery and pathology directed adjuvant radiation-chemoradiation. METHODS A single institution cohort from a tertiary care academic institution in North India. Case inclusion 2013 to 2016; n = 218, median follow-up 35 months. All patients were restaged as per the AJCC 8th pTNM classification. Analysis for Overall Survival (OS), Disease-free Survival(DFS), and factors impacting outcome (Cox proportionate model Multivariate analysis). RESULTS AJCC pTNM 7th to 8th edition conversion led to upstaging in 16.5%. Stage-II demonstrated greatest stage migration and apparent improvement in OS and DFS (P < .09). Discordance was noted between the presurgical (clinico-radiologic) and postsurgical (pathological) nodal status in 40.3% (88/218; 54 pathologically upstaged;34 downstaged). Pathological downstaging was particularly significant with advanced stage Gingivo-Buccal Cancers (25/73-34.7%). Stage-I-II early cancers had 3 years. OS-86.7% and DFS-78.8%; Stage-III-IV advanced cancers had 3 years. OS-56.7% and DFS-46.6%. Multivariate analysis identified poorer OS and DFS for age < 40 years (HR-1.8; 2.0), skin involvement (HR-2.1; 2.6) and pN+ status (HR-2.4; 3.5). Bone involvement did not compromise survival in this surgically treated set of patients. CONCLUSION Age < 45 is newly identified as significantly compromising DFS and OS in Oral Cancer. Established factors of skin involvement and pN+ are confirmed as impacting DFS-OS. An apparent improvement in survival in Stage II Cancers is noted as consequent to adoption of AJCC 8th edition staging. LEVEL OF EVIDENCE II (OCEBM 2011-Inception Cohort Study for Prognosis) Laryngoscope, 2021.
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Affiliation(s)
- Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rishikesh Thakur
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar Malhotra
- Delhi Cancer Registry, BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Pramanik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhaskar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Thakur R, Thakar A, Malhotra RK, Sharma A, Kakkar A. Tumor-host interface in oral squamous cell carcinoma: Impact on nodal metastasis and prognosis. Eur Arch Otorhinolaryngol 2021; 278:5029-5039. [PMID: 33743065 DOI: 10.1007/s00405-021-06756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate tumor-host interface in oral squamous cell carcinoma (OSCC) by the Brandwein-Gensler histological risk score (BG risk score); to assess its association with clinicopathological features and impact on survival outcomes in a contemporary cohort staged as per AJCC 8th edition pTNM classification. METHODS This retrospective cohort study at a tertiary care centre included 178 cases of OSCC treated by primary surgical resection from 2013 to 2016. Pathological lymph node status, disease-free survival (DFS), overall survival (OS) were assessed. RESULTS BG risk score assessment categorized 25 (14%) cases as low-risk, 93 (52%) as intermediate-risk, and 60 (34%) as high-risk. BG risk score category progression from low to intermediate to high risk was associated with an incremental risk of worsening pN status, DFS, and OS. BG risk score categories significantly demarcated 2-year DFS (96% in low-risk, 51.6% in intermediate-risk, 15% in high-risk; p < 0.001) and OS (96% in low-risk, 66.7% in intermediate-risk, 31.3% in high-risk; p < 0.001). On stratified analysis, BG risk score could further demarcate prognosis in early (I/II) and late (III/IV) stage subgroups (p < 0.001). Multivariate analysis indicated the prognostic impact of BG risk score categories to be additional to, and of equal magnitude to, impact of pTNM stage. CONCLUSIONS BG risk score is a powerful prognostic tool in OSCC additional to pTNM staging. It can enable risk stratification and inform decisions regarding post-surgical adjuvant treatment. It is undertaken with routine histopathological evaluation, with no increased expense or turnaround time. A case is made for its inclusion in OSCC reporting guidelines.
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Affiliation(s)
- Rishikesh Thakur
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Rajeev K Malhotra
- Delhi Cancer Registry, BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Rajan S, Prakash P, Akhtar N, Kumar V, Gupta S, Chaturvedi A, Mahajan D, Srivastava R, Qayoom S, Chakrabarti D, Parveen S. Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients: An institutional experience. Natl J Maxillofac Surg 2021; 12:72-77. [PMID: 34188404 PMCID: PMC8191556 DOI: 10.4103/njms.njms_114_20] [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: 06/17/2020] [Revised: 07/28/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUNDS Oral squamous cell cancer (SCC) is one of the most common cancers. The most common age of presentation is fifth to sixth decade. Management of this disease is dictated by stage, age, and related comorbidities. Elderly patients have their own set of limitations as far as their management is concerned. Carcinoma involving central mandibular arch is a challenging disease for surgeons, especially in the elderly. This article describes our experience with the surgical treatment of oral cancer involving the central arch of the mandible in elderly patients. METHODS Forty elderly (≥60 years) patients with histologically proven SCC of the oral cavity in which disease was involving the central arch of the mandible, were included in our study. Demographic, clinical, and treatment-related factors were recorded. The outcome was assessed in terms of postoperative complications, recurrence, and patient survival. RESULTS The median age of the patients was 63 years. The male:female ratio was 7:3. A history of oral tobacco use was present in 95% of patients. The most common site of disease was lower alveolus (80%) followed by carcinoma of the lower lip (20%). Majority of our patients (77.3% [30]) were having Stage IV disease. Mandibulectomy was either segmental (62.5%) or marginal (37.5%). Bilateral neck dissection (37/40, 92.5%) was done in most patients. Among all patients, 62.5% (25) received adjuvant radiotherapy. The local recurrence rate after a median follow-up of 30 months was 15% (6). Two-year disease-free survival and overall survival were 89% and 90%, respectively. CONCLUSION Central arch of the mandible is a difficult disease to treat. It needs a complex and lengthy reconstructive procedure. Comorbidities such as extreme age, diabetes, and pulmonary and cardiac illnesses make it more challenging to manage. With the proper evaluation of comorbidities and avoiding long, cumbersome procedures, we can provide patients a fairly good chance of survival.
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Affiliation(s)
- Shiv Rajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Puneet Prakash
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sameer Gupta
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Arun Chaturvedi
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Dhruv Mahajan
- Department of Surgical Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Resham Srivastava
- Department of Radiation Oncology, MPMMCC and HBCH, Varanasi, Uttar Pradesh, India
| | - Sumaira Qayoom
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deep Chakrabarti
- Department of Radiation Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shirin Parveen
- Department of Anesthesiology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Chatterjee A, Laskar SG, Chaukar D. Management of early oral cavity squamous cancers. Oral Oncol 2020; 104:104627. [PMID: 32169747 DOI: 10.1016/j.oraloncology.2020.104627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 12/11/2022]
Abstract
Early oral cavity cancers comprise a favorable entity, amenable to clinical staging and single modality treatment. Surgery typically forms the mainstay of treatment and should ideally address both the primary and the neck in all cases. Careful attention must be paid to reconstruction and rehabilitation of such patients. Radical radiotherapy mainly in the form of brachytherapy can achieve excellent disease related and functional outcomes in a carefully chosen subset of patients. Increasingly, a subset of patients is being recognized, who harbor single or multiple adverse features on histopathology and may therefore benefit from escalation of adjuvant therapy. This review discusses the management of early oral cavity squamous carcinomas (Early OSCCs) in detail and highlights the dilemmas and controversies faced in the management of the same.
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Affiliation(s)
- Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National University (HBNI), Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National University (HBNI), Mumbai, India.
| | - Devendra Chaukar
- Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National University (HBNI), Mumbai, India
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Grover S, Gudi S, Gandhi AK, Puri PM, Olson AC, Rodin D, Balogun O, Dhillon PK, Sharma DN, Rath GK, Shrivastava SK, Viswanathan AN, Mahantshetty U. Radiation Oncology in India: Challenges and Opportunities. Semin Radiat Oncol 2016; 27:158-163. [PMID: 28325242 DOI: 10.1016/j.semradonc.2016.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Rising cancer incidence and mortality in India emphasize the need to address the increasing burden of this disease and the stark inequities in access to radiotherapy and other essential medical treatments. State-of-the-art technology is available within the private sector and a few hospitals in the public sector, but 75% of patients in the public sector in India do not have access to timely radiotherapy. This inequity in access to radiotherapy in the public sector is amplified in rural areas, where most of India׳s population lives. A long-term government commitment to machine purchase and human resource development in the public sector is needed to improve access. A number of innovative initiatives to improve cancer treatment and access have emerged that could support such an investment. These include local production of equipment, twinning programs between institutions in high- and low-income countries to exchange knowledge and expertise, and nongovernmental and state-sponsored schemes to sponsor and support patients in their cancer journey. Strengthening of cancer registries and regulatory bodies with authority to enforce minimum standards is also required to improve care. The more uniform and frequent availability of high-quality radiotherapy can improve cancer outcomes and may be regarded as a marker of a comprehensive and equitable system of health care delivery.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
| | | | - Ajeet Kumar Gandhi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Priya M Puri
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Adam C Olson
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC; Hubert Yeargan Center for Global Health, Duke University, Durham, NC
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Onyi Balogun
- Department of Radiation Oncology, Weill Cornell Medical College, NY
| | - Preet K Dhillon
- Public Health Foundation of India, National Capital Region, India
| | | | | | | | - Akila N Viswanathan
- Johns Hopkins Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD
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