Head and neck cancer: causes, prevention and treatment

Relationship between ERCC1 and XPC polymorphisms and the susceptibility to head and neck carcinoma: A systematic review, meta-analysis, and trial sequential analysis

OBJECTIVE

This meta-analysis was conducted to investigate the relationship between ERCC1 and XPC polymorphisms and the risk of head and neck cancer (HNC), incorporating more studies and additional analyses.

DESIGN

An exhaustive search of various databases, including PubMed/Medline, Web of Science, Scopus, and Cochrane Library was carried out, up until November 18, 2023, to identify pertinent studies. The Review Manager 5.3 software was employed to calculate the effect sizes, which were presented as the odds ratio (OR) along with a 95% confidence interval (CI).

RESULTS

The study found that the T allele (OR = 1.11; p-value = 0.02; 95%CI: 1.02, 1.22) and the TT genotype rs2228000 polymorphism in both the homozygous model (OR = 1.61, p-value = 0.02; 95%CI: 1.07, 2.42) and the recessive model (OR = 1.53; p-value = 0.02; 95%CI: 1.06, 2.22) had statistically significant associations. However, no significant associations were found for rs11615, rs3212986, rs735482, rs2228001, and PAT polymorphisms in any genetic models.

CONCLUSIONS

The meta-analysis revealed significant associations for the T allele and TT genotype rs2228000 polymorphism, but not for rs11615, rs3212986, rs735482, rs2228001, and PAT polymorphisms. The results highlight the impact of factors such as ethnicity, cancer subtype, and control source on these associations, emphasizing the intricate nature of genetic interactions in disease risk.

Multi-organ segmentation of organ-at-risk (OAR's) of head and neck site using ensemble learning technique

INTRODUCTION

This paper presents a novel approach to automate the segmentation of Organ-at-Risk (OAR) in Head and Neck cancer patients using Deep Learning models combined with Ensemble Learning techniques. The study aims to improve the accuracy and efficiency of OAR segmentation, essential for radiotherapy treatment planning.

METHODS

The dataset comprised computed tomography (CT) scans of 182 patients in DICOM format, obtained from an institutional image bank. Experienced Radiation Oncologists manually segmented seven OARs for each scan. Two models, 3D U-Net and 3D DenseNet-FCN, were trained on reduced CT scans (192 × 192 x 128) due to memory limitations. Ensemble Learning techniques were employed to enhance accuracy and segmentation metrics. Testing was conducted on 78 patients from the institutional dataset and an open-source dataset (TCGA-HNSC and Head-Neck Cetuximab) consisting of 31 patient scans.

RESULTS

Using the Ensemble Learning technique, the average dice similarity coefficient for OARs ranged from 0.990 to 0.994, indicating high segmentation accuracy. The 95% Hausdorff distance (mm) ranged from 1.3 to 2.1, demonstrating precise segmentation boundaries.

CONCLUSION

The proposed automated segmentation method achieved efficient and accurate OAR segmentation, surpassing human expert performance in terms of time and accuracy.

IMPLICATIONS FOR PRACTICE

This approach has implications for improving treatment planning and patient care in radiotherapy. By reducing manual segmentation reliance, the proposed method offers significant time savings and potential improvements in treatment planning efficiency and precision for head and neck cancer patients.

Mu and Kappa opioid receptor immunolabeling indicates the prognosis of oropharyngeal squamous cell carcinoma: A cross-sectional observational study

BACKGROUND

Opioids are the most effective drugs currently available for cancer pain management. The administration of morphine, in addition to its analgesic effect, can alter tumor development.

OBJECTIVE

To characterize the immunoexpression of opioid receptors µ and κ in oropharyngeal squamous cell carcinoma, and correlate it with prognostic factors, proliferation markers, and cell death.

MATERIALS AND METHODS

A retrospective, cross-sectional observational study was carried out with 50 patients diagnosed at Haroldo Juaçaba Hospital. Sociodemographic, clinicopathological, and overall survival data were collected, and excisional biopsies were taken for immunohistochemistry using tissue microarrays for opioid receptors µ and κ, Ki-67, and caspase-3. Immunolabeling was evaluated and correlated with other variables using Mann-Whitney, Kruskal-Wallis, Spearman correlation, log-rank (Mantel-Cox), and Cox regression tests.

RESULTS

Immunoexpression of opioid receptors µ and κ, Ki-67, and caspase-3 was significantly higher in p16+ and p16- primary tumors and lymph node metastases than in surgical resection margins. The overall survival of patients with p16- tumors was 57.53 ± 8.43 months and that of patients with p16+ tumors was slightly higher at 75.92 ± 11.14 months. Multivariate analysis showed that the expression of opioid receptors µ and κ in the nucleus was directly associated with a lower and higher risk of death, respectively.

CONCLUSION

We found increased expression of opioid receptors µ and κ in tumor tissues. The nuclear expression of opioid receptors µ and κ influences overall survival and may be a prognostic factor of oropharyngeal squamous cell carcinoma.

Impact of weight loss on treatment interruption and unplanned hospital admission in head and neck cancer patients undergoing curative (chemo)-radiotherapy in Hong Kong

PURPOSE

Malnutrition is highly prevalent in head and neck cancer (HNC) patients, with weight loss being one of the major nutritional indicators. The objective of this study was to investigate the impact of weight loss on treatment interruptions and unplanned hospital admissions in HNC patients undergoing radiotherapy (RT) with or without chemotherapy.

METHODS

In this retrospective cohort study, consecutive HNC patients who started RT between January 2011 and December 2019 were included. Data from a total of 1086 subjects with 747 (68.8%) nasopharyngeal carcinomas (NPCs) and 31.2% (N=339) non-NPC patients were analysed. Body weight (BW) was measured before, during, and after RT treatment. Factors associated with ≥10% weight loss, treatment interruption, and unplanned admissions were analysed using multivariate logistic regression.

RESULTS

The prevalence of ≥10% weight loss was 26.8% (N=288), with 32.7% (N=243) in NPC and 13.5% (N=45) in non-NPC patients. The prevalence of RT delay in patients with ≥10% vs. <10% weight loss was 6.2% vs. 7.0% (p=0.668) in NPC patients and 42.2% vs. 50.5% (p=0.300) in non-NPC patients. The prevalence of unplanned admissions in patients with ≥10% vs. <10% weight loss was 51.9% vs. 25.3% (p<0.001) in NPC patients and 68.9% vs. 27.0% (p<0.001) in non-NPC patients.

CONCLUSION

In our study, ≥10% weight loss was found to be associated with a higher rate of unplanned admissions but not with RT delay or chemotherapy interruption.

CLINICAL IMPLICATIONS

With the knowledge of the impact of weight loss on hospital admissions and the characteristics of patients with weight loss, nutritional intervention can be effectively focused on the stratification of patients for intensive nutritional support to reduce weight loss.

Effectiveness of zinc supplementation on the incidence of oral mucositis during chemotherapy and radiation: A meta‑analysis

Oral mucositis (OM) is a commonly observed and debilitating side effect of chemotherapy and radiation therapy in patients with cancer, especially head and neck cancer. Although there is no proven therapy for the prevention and treatment of OM, zinc supplementation effectively decreases the incidence of OM. This paper provides a current and comprehensive meta-analysis of the efficacy of zinc compared with placebo/control in OM. A systematic literature review was conducted using MEDLINE and Central databases for randomized control trials (RCTs) comparing zinc supplementation (oral or rinse) with placebo/control in patients with various types of cancer undergoing chemotherapy, radiation therapy or combined chemo-radiation. The outcome was OM incidence, independent of the severity. A random-effects model was used to calculate the pooled risk ratio and subgroup analyses were performed. A total of 12 RCTs were included, containing information from 783 patients. A decrease in OM incidence was observed overall when all cancer therapies were considered. However, subgroup analyses showed that zinc did not significantly decrease the incidence of OM when studies were stratified by cancer therapy or scale/criteria used to assess OM. The results of the meta-analysis support the use of zinc supplementation in decreasing OM incidence in patients with cancer receiving chemotherapy or radiation therapy. However, the high heterogeneity between studies and the small number of studies are limitations of the meta-analysis.

Immuno-oncology in head and neck squamous cell carcinoma - a narrative review

Immuno-oncology studies the immune system in cancer. In recent decades, immunotherapy has shown a good response to the treatment of various locally advanced and metastatic cancers. The main mechanisms of action include stimulation of the patient's own immune system to enhance immune responses acting in tumor escape pathways. This review examined the literature related to immune system mechanisms in head and neck squamous cell carcinoma (HNSCC) and their application in immunotherapy using biomarkers. The PUBMED, LILACS, MEDLINE, WHOLIS, and SCIELO databases were searched using the terms squamous cell carcinoma, head and neck, immuno-oncology, immunotherapy, and immunology. The main drugs currently available for clinical use in patients diagnosed with HNSCC include pembrolizumab and nivolumab, both classified as check-point inhibitors. These immunobiological agents improve patient survival and quality of life. Many authors and clinical trials point out that the recommendation of these agents is linked to the dose of PD-L1 (ligand expressed primarily by tumor cells), which proved to be an unreliable biomarker in the patient selection. Recommendation of immunotherapy depends on reliable biomarkers that must be identified in order to achieve good therapeutic results.

Current Insights and Progress in the Clinical Management of Head and Neck Cancer

Head and neck cancer (HNC), also known as the cancer that can affect the structures between the dura mater and the pleura, is the 6th most common type of cancer. This heterogeneous group of malignancies is usually treated with a combination of surgery and radio- and chemotherapy, depending on if the disease is localized or at an advanced stage. However, most HNC patients are diagnosed at an advanced stage, resulting in the death of half of these patients. Thus, the prognosis of advanced or recurrent/metastatic HNC, especially HNC squamous cell carcinoma (HNSCC), is notably poorer than the prognosis of patients diagnosed with localized HNC. This review explores the epidemiology and etiologic factors of HNC, the histopathology of this heterogeneous cancer, and the diagnosis methods and treatment approaches currently available. Moreover, special interest is given to the novel therapies used to treat HNC subtypes with worse prognosis, exploring immunotherapies and targeted/multi-targeted drugs undergoing clinical trials, as well as light-based therapies (i.e., photodynamic and photothermal therapies).

Overexpression of Laminin 5γ2 Chain Correlates with Tumor Cell Proliferation, Invasion, and Poor Prognosis in Laryngeal Squamous Cell Carcinoma

Objective

Laryngeal squamous cell carcinoma (LSCC) is a common malignant tumor. Laminin 5γ2 chain (LAMC2) was reported to be associated with tumorigenesis. This study explored the role of LAMC2 on LSCC progression by regulating the integrinβ1/FAK/Src/AKT pathway.

Methods

The level of LAMC2 in 46 LSCC patients was detected by qRT-PCR and western blot. Then the relationship between LAMC2 expression and LSCC malignancy as well as prognosis was analyzed, and the effect of LAMC2 expression on LSCC patient survival was also analyzed using the Kaplan–Meier survival curves. Afterwards, the LSCC cells were transfected with LAMC2 overexpression and knockdown vectors, the effect of LAMC2 on LSCC cell viability, proliferation ability, cell cycle, cell migration, and invasion were detected by CCK-8, colony formation, flow cytometry, wound healing, and Transwell assays. The expression of EMT-related biomarkers and integrin β1/FAK/Src/AKT signaling-related proteins was detected by western blot. Moreover, the effect of LAMC2 on LSCC tumor growth was evaluated by in vivo xenograft experiments and western blot.

Results

LAMC2 was expressed at high level in LSCC tissues and associated with poor prognosis. LAMC2 overexpression increased TU177 cell viability, proliferation ability, promoted cell cycle, cell migration, and invasion capacity. The expression of N-cadherin, vimentin, and integrinβ1/FAK/Src/AKT related proteins was increased, while the expression of E-cadherin protein was decreased. When the LAMC2 knockdown in AMC-HN-8 cells had opposite effects. Furthermore, shLAMC2 decreased tumor volume and the expression of LAMC2, Ki-67 and integrinβ1, but increased the expression of E-cadherin in LSCC tumor-bearing mice.

Conclusion

The findings suggested that LAMC2 was overexpressed in LSCC and correlated with poor prognosis. LAMC2 knockdown inhibited LSCC progression by regulating the integrinβ1/FAK/Src/AKT signaling pathway. Therefore, LAMC2 could be a target for LSCC therapy.

Cumulative Coffee Consumption as a Protective Factor for Head and Neck Cancer in Brazil

There is still no consensus in the literature regarding the role of coffee in head and neck cancer. Thus, we sought to analyze the cumulative consumption of coffee as a protective factor in the genesis of head and neck cancer in Brazil, one of the main coffee producing countries, from January 2011 to February 2017. We carried out a case-control study in 5 referral centers for head and neck cancer with 839 cases and 842 non-cancer hospital controls matched by sex, data collection center and age group. The results of logistic regression analysis showed that the cumulative consumption of >2 cups of coffee per day is an important protective factor (OR: 0.73, 95% CI: 0.5-0.9) against head and neck cancer. Smoking increased the risk by 22 times (OR: 22.19; 95% CI: 13.7-35.8) in individuals who smoke more than 50 packs per year, and the habit of ingesting more than 155 ml of alcohol per day represented approximately twice as high risk (OR: 2.20; 95% CI: 1.4-3.4). In summary, this study suggests that coffee consumption is associated with a lower chance of head and neck cancer.

Emerging roles of PIWI-interacting RNAs (piRNAs) and PIWI proteins in head and neck cancer and their potential clinical implications

Head and neck squamous cell carcinoma (HNSCC) are among the well-known neoplasms originating in the oral cavity, pharynx, and larynx. Despite advancements in chemotherapy, radiotherapy, and surgery, the survival rates of the patients are low, which has posed a major therapeutic challenge. A growing number of non-coding RNAs (ncRNAs), for instance, microRNAs, have been identified whose abnormal expression patterns have been implicated in HNSCC. However, more recently, several seminal research has shown that piwi-interacting RNAs (piRNAs), a promising and young class of small ncRNA, are linked to the emergence and progression of cancer. They can regulate transposable elements (TE) and gene expression through multiple mechanisms, making them potentially more powerful regulators than miRNAs. Hence, they can be more promising ncRNAs candidates for cancer therapeutic intervention. Here, we surveyed the roles and clinical implications of piRNAs and their PIWI proteins partners in tumorigenesis and associated molecular processes of cancer, with a particular focus on HNSCC, to offer a new avenue for diagnosis, prognosis, and therapeutic interventions for the malignancy, improving patient's outcomes.

Quality of Life of the Patient with Head and Neck Cancer Submitted to Radiotherapy and the Overload of Their Caregivers

Introduction  Esthetic and functional changes are frequent in patients with head and neck cancer, and they can be caused by both tumor and treatment. Physical and functional impairment often requires the need of a caregiver, who may feel overwhelmed with the tasks of care.

Objective  This study aims to evaluate the quality of life of patients with head and neck cancer submitted to radiotherapy and the overload of their caregivers.

Method  This is a quantitative cross-sectional study with 42 patients with head and neck cancer and 17 caregivers evaluated during the radiotherapy treatment. Patients responded to the following questionnaires: Functional Assessment of Cancer Therapy for Head and Neck Cancer (FACT-H&N) and Shame and Stigma Scale (SSS), while the caregivers responded to the Zarit Burden Interview Scale (ZBI) and Palliative Performance Scale (PPS).

Results  Head and neck cancer patients showed a decline in the quality of life in all FACT-H&N domains, with the domain of additional concerns having the worst outcome. Among the feelings reported by patients, the most important was penitence. Less than half of the patients needed caregivers. It was observed that the greater the degree of commitment of the patient, the greater the degree of overload of the caregiver.

Conclusion  Therefore, the quality of life of the patient with head and neck cancer is an important aspect to be considered during the therapeutic choice and in the follow-up of the patient, since it has influenced both the patient and his caregiver.

Head and Neck Cancers Are Not Alike When Tarred with the Same Brush: An Epigenetic Perspective from the Cancerization Field to Prognosis

Simple Summary

Squamous cell carcinomas affect different head and neck subsites and, although these tumors arise from the same epithelial lining and share risk factors, they differ in terms of clinical behavior and molecular carcinogenesis mechanisms. Differences between HPV-negative and HPV-positive tumors are those most frequently explored, but further data suggest that the molecular heterogeneity observed among head and neck subsites may go beyond HPV infection. In this review, we explore how alterations of DNA methylation and microRNA expression contribute to head and neck squamous cell carcinoma (HNSCC) development and progression. The association of these epigenetic alterations with risk factor exposure, early carcinogenesis steps, transformation risk, and prognosis are described. Finally, we discuss the potential application of the use of epigenetic biomarkers in HNSCC.

Abstract

Head and neck squamous cell carcinomas (HNSCC) are among the ten most frequent types of cancer worldwide and, despite all efforts, are still diagnosed at late stages and show poor overall survival. Furthermore, HNSCC patients often experience relapses and the development of second primary tumors, as a consequence of the field cancerization process. Therefore, a better comprehension of the molecular mechanisms involved in HNSCC development and progression may enable diagnosis anticipation and provide valuable tools for prediction of prognosis and response to therapy. However, the different biological behavior of these tumors depending on the affected anatomical site and risk factor exposure, as well as the high genetic heterogeneity observed in HNSCC are major obstacles in this pursue. In this context, epigenetic alterations have been shown to be common in HNSCC, to discriminate the tumor anatomical subsites, to be responsive to risk factor exposure, and show promising results in biomarker development. Based on this, this review brings together the current knowledge on alterations of DNA methylation and microRNA expression in HNSCC natural history, focusing on how they contribute to each step of the process and on their applicability as biomarkers of exposure, HNSCC development, progression, and response to therapy.

Analysis of Risk Factors Associated with Squamous Cell Carcinoma in the Indian Population

BACKGROUND

Squamous cell carcinoma (SCC) describes the carcinomatous growth in the oral cavity. Recently, various authors have described increased SCC incidence in the young population. The distribution of SCC shows varied geographic spread, with the highest distribution in Asian countries.

AIMS

The present trial was carried out to assess the associated factors that could lead to increased risk of developing oral cancer.

MATERIALS AND METHODS

Oral examination was carried out for 21 participants by a dentist and any significant oral lesion or deleterious habit if present, was recorded. The data collected were analyzed.

RESULTS

Areca nut was chewed by 47.61% participants (n = 10), smoking tobacco by 76.19% (n = 16), chewing tobacco by 38.09% (n = 8), and consuming alcohol in 9 participants (42.85%). No significant difference was seen concerning age for any factor except alcohol which showed higher intake in the older group where six participants depicted alcohol intake as compared to three participants in the younger group. In participants who chewed areca nuts, 6 participants also smoked tobacco and 1 consumed alcohol. For tobacco chewing, 5 consumed alcohol and 6 also took tobacco as smoke.

CONCLUSION

The present study showed that areca nut and tobacco chewing along with alcohol consumption and tobacco smoking increase the risk of developing SCC in the Indian population.

Late radiation effects in survivors of head and neck cancer: State of the science

Head and neck squamous cell carcinoma is one of the most common neoplasms. Radiotherapy (RT) plays an essential role in the management of such cases. Despite advances in the technique, hyposalivation, xerostomia, dysphagia, trismus, radiation caries, and osteoradionecrosis remain significant late complications of RT. The aim of this narrative review was to summarize and update the main findings related to late side effects of radiotherapy in survivors of head and neck cancer (HNC). Such effects limit the ability to speak, ingest food and medications, and breathe and also exert a negative impact on social well-being and quality of life. This review highlights research in the field for both researchers and clinicians, assisting in the prevention and management of these adverse conditions. The findings can contribute to improving preventive management and multidisciplinary interventions for HNC patients.

Arterial lactate as a predictor of postoperative complications in head and neck squamous cell carcinoma

INTRODUCTION

Surgery is one of the most frequently used options in the treatment of head and neck squamous cell carcinoma. In surgical patients, the use of arterial lactate to assess hypoxemia and severe inflammatory states is well-founded. However, there are few studies on its use in patients with head and neck squamous cell carcinoma. The aim of this study was to investigate whether the serum arterial lactate level on the 1st postoperative day would be a predictor of postoperative complications in head and neck squamous cell carcinoma surgeries.

METHODS

This is a prospective cohort, which evaluated 44 adult patients of both genders, with HNSCC, who underwent surgery associated with monobloc neck dissection as an initial treatment. Patients were divided into two groups, according to the presence or absence of postoperative complications: with complication (Clavien-Dindo II-V) and without complications (Clavien-Dindo 0-I). Student's t-test and its variants were used to compare continuous data. Pearson's or Spearman's test was used to correlate the data and p values ​​<0.05 were considered statistically significant.

RESULTS

A total of 59% of the patients (n=26/44) developed postoperative complications. Serum lactate was significantly higher in the group with complications when compared to patients without complications, respectively 2.15mmoL/L (1.10-3.90) and 1.59 mmoL/L (0.70-3.44); p=0.03. The prognostic accuracy of arterial lactate was 69% (95% CI: 54%-82%; p=0.03), estimated by the ROC curve. A cut-off >1.7mmoL/L was identified, with a sensitivity of 65.38% and specificity of 66.67%.

CONCLUSION

Arterial lactate measured on the first postoperative day is a good predictor of postoperative complications in patients with head and neck squamous cell carcinoma.

Epidemiological Characteristics and Survival Analysis of Patients With Nasopharyngeal Cancer in Western Greece

Purpose The purpose of this study is to assess the overall survival (OS) of patients with nasopharyngeal cancer and the factors affecting the survival rates. Methods A retrospective cohort study was performed, including 77 patients with nasopharyngeal cancer diagnosed and treated in the Otorhinolaryngology Clinic of the University Hospital of Patras during 1990-2017. The prognostic impact of age, gender, occupation, smoking/alcohol, and TNM staging were evaluated using Kaplan-Meier analysis. Results During the last 28 years, nasopharyngeal cancer (NPC) was higher in men (80.5% of patients) than women (19.5%) (mean age 56-years). Most patients were smokers (64.9%, mean 70 pack-years) and 35 (45.5%) of them were alcohol users. Postoperative staging indicated 39% stage-III, 26% stage-IV, and 26% stage-I. Histologically, 70.1% of the volumes were WHO-III, 20.8% WHO-II, and 5.2% WHO-I. Also, 98.7% of patients received radiotherapy, 85.7% chemotherapy, and 20.8% surgery. More than half were farmers (26%), self-employed (16.9%), and workers (14.3). During the follow-up (mean 66 months), 38 (49.5%) patients died, 88.9% from disease-related causes. The 5-year survival was 58.8%, 74.5% for non-smokers, and 49.1% for smokers, and 10-year survival was 43.6%, 63.4%, and 31.6%, respectively (p=0.016). Moreover, significant statistical differences were observed in age (p=0.054), time period of diagnosis and treatment (p=0.002), cause of death (p=0.033), and metastatic disease (p=0.023). Conclusions Age, stage in disease detection, tumor characteristics, treatment, and tobacco abuse are important factors that affect the OS of patients with NPC during the three last decades.

Head–Neck Cancer Delineation

Head–Neck Cancer (HNC) has a relevant impact on the oncology patient population and for this reason, the present review is dedicated to this type of neoplastic disease. In particular, a collection of methods aimed at tumor delineation is presented, because this is a fundamental task to perform efficient radiotherapy. Such a segmentation task is often performed on uni-modal data (usually Positron Emission Tomography (PET)) even though multi-modal images are preferred (PET-Computerized Tomography (CT)/PET-Magnetic Resonance (MR)). Datasets can be private or freely provided by online repositories on the web. The adopted techniques can belong to the well-known image processing/computer-vision algorithms or the newest deep learning/artificial intelligence approaches. All these aspects are analyzed in the present review and comparison among various approaches is performed. From the present review, the authors draw the conclusion that despite the encouraging results of computerized approaches, their performance is far from handmade tumor delineation result.

An Approach Toward Assessing Head-and-Neck Lymphedema Using Tissue Dielectric Constant Ratios: Method and Normal Reference Values

Background: There are multiple methods to quantitatively assess limb lymphedema, but quantitative methods to assess external lymphedema in persons with head-and-neck lymphedema are quite limited. Quantification in this difficult condition currently uses multiple time-consuming head, face, and neck metric measurements, the accuracy of which is unclear. Thus, there is an important need for a new approach that is sufficiently convenient yet accurate to quantify head-and-neck lymphedema. The approach adopted was to use tissue dielectric constant (TDC) measurements that depend on tissue water, at neck and a submental area, and normalize these to TDC values at the forearm as a way to develop subject-independent indices. Methods and Results: TDC was measured in 60 self-reported healthy nonlymphedematous adults (34 female, 18-81 years, 18.5-45.7 Kg/m²) at two neck sites and one arm site bilaterally and at a submental area. Neck-to-arm-index (NAI) and submental-to-arm-index (SAI) ratios were calculated. TDC values (mean ± standard deviation [SD]) for neck, submental, and arm were, respectively, 37.4 ± 6.9, 35.9 ± 7.7, and 30.1 ± 4.6. Mean NAI and SAI values were 1.253 ± 0.222 and 1.214 ± 0.296 respectively. Head-and-neck lymphedema thresholds calculated as mean + 2.5 SD were for NAI and SAI 1.80 and 1.95, respectively. Conclusions: An approach to help quantify and track head-and-neck lymphedema using TDC neck and/or submental values normalized to a person's forearm TDC values indicates threshold values between 1.80 and 1.95. These ratios, denoted as NAI and SAI, are suggested for use to detect and track changes in lymphedema status based on a patient's changing indices associated with lymphedema treatment.

Human Papilloma Virus: Current Knowledge and Focus on Oral Health

The human papilloma virus (HPV) is responsible for different pathological manifestations in humans. This agent gives rise to lesions of different types and in different areas of the organism, including the oral cavity. The aim of this study is to show which are the main diseases for which HPV is responsible and to bring to light some of the interceptive and therapeutic strategies. The analysis was conducted by consulting the major scientific databases with the aim of obtaining information on the characteristics of oral HPV and its management; furthermore, the literature was supported by some clinical cases proposed by the authors. The role of dentistry is essential in the early diagnosis of this type of pathologies and above all in knowing how to direct patients towards a path that can lead to patient management, especially in the event that these lesions have a malignant potential. Enhancing the knowledge and role of dentistry can lead to early diagnosis of this type of injury, intercepting a pathology that could have multiorgan implications.

Immunonutrition in head and neck cancer: Systematic review and metanalysis of its clinical and nutritional effects

BACKGROUND AND AIMS

A systematic review was conducted to assess the effects of glutamine, arginine and omega-3 supplementation on the tolerance to treatment, nutritional status and immune function of head and neck cancer (HNC) patients undergoing chemoradiotherapy.

METHODS

Randomized clinical trials were searched in MEDLINE, EMBASE, CENTRAL, LILACS, ClinicalTrials.gov, OpenGrey and Proquest. Tolerance to treatment, nutritional status, immune function and mortality rate were the primary outcomes investigated. Secondary outcomes comprised functional status, weight loss and body composition. Risk of bias of individual studies and the overall quality of the evidence were assessed using the Cochrane and the GRADE tools, respectively.

RESULTS

Nineteen articles met the inclusion criteria and nine were included in the meta-analyses, which assessed mucositis severity, weight loss and handgrip strength. Ten studies were evaluated as high risk of bias. Glutamine supplementation has significantly reduced the risk of grade 2-4 mucositis (RR: 0.76, IC95% [0.63; 0.92], P = 0.006, I² = 0%; P = 0.792; 4 studies). Omega-3 supplementation did not show statistically significant results on weight loss (SMD: -0.042, 95% CI [-0.322; 0.238], P = 0.769, I² = 33.4%; P = 0.212; 4 studies). The overall quality of the evidence ranged from low to very low.

CONCLUSIONS

These results must be interpreted with caution due to differences between supplementations regimen, lack of methodological rigor in most studies and due to the possible role of glutamine in tumor metabolism. Studies focused on elucidating the contribution of each immunonutrient to HNC patients undergoing chemoradiotherapy deserve further investigation.

Mining TCGA database for prognostic genes in head and neck squamous cell carcinoma microenvironment

Background/purpose

Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignant tumors. The aim of this study was to elucidate the effect of tumor microenvironment-related genes on the prognosis of HNSCC and to obtain tumor microenvironment-related genes that can predict poor prognosis in HNSCC patients.

Materials and methods

The ESTIMATE algorithm was applied to the HNSCC transcriptomic data downloaded from the TCGA (The cancer genome atlas), and then the samples were divided into two groups: high and low immune scoring groups, and high and low basal scoring groups to screen for differentially expressed genes (DEGs) associated with poor patient outcomes. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was performed to explore the potential functions of DEGs, and then to explore the potential prognostic value of individual DEGs. The results of survival analysis between DEGs and overall survival (OS) to explore tumor microenvironment-related genes relevant to the prognosis of HNSCC patients.

Results

Fifty-nine tumor microenvironment-related genes were screened for association of OS with HNSCC (P < 0.05). The GO and KEGG enrichment analysis showed that the selected DEGs may mediate immune response, extracellular matrix, and immunoglobulin binding via neutrophil activation in HNSCC. Six of these DEGs, GIMAP6, SELL, TIFAB, KCNA3, P2RY8 and CCR4 were most significantly associated with OS (P < 0.001).

Conclusion

We identified six tumor microenvironment-related genes that were significantly associated with poor prognosis in HNSCC. These genes may inspire researchers to discover new targets and approaches for HNSCC treatment.

OSA in patients with head and neck cancer is associated with cancer size and oncologic outcome

Purpose

Obstructive sleep apnea (OSA) is associated with severe daytime sleepiness and reduced quality of life. These symptoms are also present in patients with squamous cell carcinoma of the head and neck (SCCHN) before, during and after treatment, so that comorbidity cannot be excluded. The aim was to evaluate the prevalence of OSA and its impact on the quality of life in patients with oropharyngeal, hypopharyngeal and lateral tongue SCCHN in a prospective study.

Methods

We performed cardiorespiratory home sleep apnea testing and recorded sleep-related patient-reported outcomes in 33 patients with confirmed oropharyngeal, hypopharyngeal and lateral tongue SCCHN. We correlated the sleep-related variables to oncologic variables and endpoints.

Results

Five female and 28 male patients with SCCHN (aged 46–77 years) were recruited. Thirty patients (90%) had OSA as defined by an Apnea/Hypopnea Index (AHI) > 5 /h before treatment. Evaluation after treatment, which was possible in 17 patients, showed OSA in 16 patients (94%). Radiologic primary tumor size showed significant positive correlation with AHI and apnea-index. Tumor recurrence and tumor-related mortality showed significant positive association with AHI. PSQI of these patients showed at least a moderate sleep disturbance. EORTC QLQ c30 questionnaire showed reduced values for all tested qualities, in particular for fatigue, insomnia, pain and financial distress.

Conclusion

Obstructive sleep apnea is a significant comorbidity in patients with SCCHN. Pre-interventional AHI may be correlated with the oncologic outcome. Further research is needed to further describe the course of OSA and its treatment before, during and after therapy.

Glutathione S-transferase Polymorphisms in Head and Neck Squamous Cell Carcinoma Treated with Chemotherapy and/or Radiotherapy

BACKGROUND/AIM

The Glutathione S-transferases (GSTs) are important carcinogen-metabolizing enzymes. Polymorphisms involved in these enzymes can modulate the development and treatment of head and neck cancer. To investigate the association of GSTs polymorphisms with head and neck cancer and risk factors, clinical-pathological features, and survival time of the patients treated with chemotherapy and/or radiotherapy.

METHODS

The GST gene polymorphisms were evaluated in 197 cases and 514 controls by PCR-RFLP-Polymerase Chain Reaction Restriction Fragment Length Polymorphism.

RESULTS

The GSTP-313 was associated with a decreased risk for HNSCC (p=0.050). The GSTP1 haplotype analysis revealed a higher frequency of the AC and AT haplotypes in the case group than in the control group (p=0.013 and p=0.019, respectively), and the opposite for G-C haplotype (p = 0.015). Yet, the different combinations between the genotypes were associated with an increased risk of cancer. The study showed no association between the polymorphisms and primary tumor site, clinical-pathological characteristics, treatment (chemotherapy and/or radiotherapy) and survival time of the patients.

CONCLUSION

The GST polymorphisms combination showed an increased risk for carcinogenesis, and studies with larger casuistry can contribute to the clarification of the role in individual patient differences for the response to chemotherapy and/or radiotherapy and identify biomarkers of susceptibility.

Epidermal growth factor receptor (EGFR) involvement in epithelial-derived cancers and its current antibody-based immunotherapies

The epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein that is part of the family of tyrosine kinase receptors. The binding of EGFR to its cognate ligands leads to its autophosphorylation and subsequent activation of the signal transduction pathways involved in regulating cellular proliferation, differentiation, and survival. Accordingly, this receptor carries out both redundant and restricted functions in the germline development of mammals and in the maintenance of various adult tissues. Correspondingly, the loss of EGFR regulation results in many human diseases, with the most notable cancer. This receptor is overexpressed and/or mutated in multiple epithelial-derived tumors, and associated with poor prognosis and survival in cancer patients. Here, we discuss in detail the role of EGFR in specific epithelial-derived cancer pathologies; these include lung cancer, colorectal cancer, and squamous cell carcinomas. The development of multiple anticancer agents against EGFR diminished the progression and metastasis of tumors. Some of the most versatile therapeutic anti-EGFR agents include the monoclonal antibodies (mAbs), demonstrating success in clinical settings when used in combination with cytotoxic treatments, such as chemotherapy and/or radiation. We thus discuss the development and application of two of the most notable therapeutic mAbs, cetuximab, and panitumumab, currently utilized in various EGFR-related epithelial cancers.

Quercetin Inhibits Cell Survival and Metastatic Ability via the EMT-mediated Pathway in Oral Squamous Cell Carcinoma

This study aimed to investigate whether quercetin exerts anticancer effects on oral squamous cell carcinoma (OSCC) cell lines and to elucidate its mechanism of action. These anticancer effects in OSCC cells were assessed using an MTT assay, flow cytometry (to assess the cell cycle), wound-healing assay, invasion assay, Western blot analysis, gelatin zymography, and immunofluorescence. To investigate whether quercetin also inhibits transforming growth factor β1 (TGF-β1)-induced epithelial-mesenchymal transition (EMT) in human keratinocyte cells, HaCaT cells were treated with TGF-β1. Overall, our results strongly suggest that quercetin suppressed the viability of OSCC cells by inducing cell cycle arrest at the G2/M phase. However, quercetin did not affect cell viability of human keratinocytes such as HaCaT (immortal keratinocyte) and nHOK (primary normal human oral keratinocyte) cells. Additionally, quercetin suppresses cell migration through EMT and matrix metalloproteinase (MMP) in OSCC cells and decreases TGF-β1-induced EMT in HaCaT cells. In conclusion, this study is the first, to our knowledge, to demonstrate that quercetin can inhibit the survival and metastatic ability of OSCC cells via the EMT-mediated pathway, specifically Slug. Quercetin may thus provide a novel pharmacological approach for the treatment of OSCCs.

Nutrition impact symptoms and weight loss in head and neck cancer during radiotherapy: a longitudinal study

OBJECTIVE

Patients with head and neck cancer (HNC) receiving radiotherapy (RT) are at high risk of weight loss (WL) due to a variety of nutrition impact symptoms (NIS). This study aimed to describe the NIS through the Head and Neck patient Symptom Checklist and body weight over time and further explore the impact of NIS on WL in patients with HNC undergoing RT.

METHODS

This was a prospective, longitudinal observational study. NIS and body weight of 117 participants were assessed at baseline, mid-treatment and post-treatment of RT. Generalised estimation equations (GEE) were used to conduct repeated measures analysis of NIS interference score and body weight at each time point and estimate the impact of NIS interference score on WL.

RESULTS

All participants experienced a substantial increase in the mean number of NIS during RT, with each patient having eight to nine NIS at mid-treatment and post-treatment. Marked increases were noted in almost each NIS score during RT. Compared with their baseline body weight, 97 (82.9%) and 111 (94.9%) participants experienced WL at mid-treatment and post-treatment, with the mean WL of 2.55±1.70 kg and 5.31±3.18 kg, respectively. NIS of dry mouth (β=-0.681, p=0.002, 95% CI -1.116 to -0.247), difficulty swallowing (β=-0.410, p=0.001, 95% CI -0.651 to -0.169) and taste change (β=-0.447, p=0.000, 95% CI -0.670 to -0.225) impacted WL significantly in GEE multivariate model.

CONCLUSIONS

Patients with HNC experience a variety of NIS which have significant impact on WL during RT. Assessment of NIS, especially dry mouth, difficulty swallowing and taste change, should be given more considerable attention in the supportive care of patients with HNC.

Immunotherapy orchestrates radiotherapy in composing abscopal effects: A strategic review in metastatic head and neck cancer

The treatment of metastatic head and neck squamous cell carcinoma (HNSCC) with a combination of radiotherapy (RT) and immunotherapy can augment treatment response and symptomatic relief. Combination therapy can also trigger a non-targeted tumor control event called the abscopal effect. This effect can be demonstrated by treatment with anti-programmed death 1/programmed death ligand 1 (PD-L1) and anti-cytotoxic T-lymphocyte-associated antigen 4 antibodies in combination with hypofractionated RT. Individual studies and clinical trials have revealed that combination radio-immunotherapy improves overall treatment response by successful initiation of the abscopal effect, which extends the treatment effects to non-targeted lesions. Growing attention to the abscopal effect may inspire innovations in current RT toward more effective and less toxic radiobiological treatment modalities for advanced HNSCC. We review the latest findings on the abscopal effect with emphases on therapeutic modalities and potential applications for treating metastatic HNSCC.

SEVERE RADIODERMATITIS AND RISK FACTORS ASSOCIATED IN HEAD AND NECK CANCER PATIENTS

ABSTRACT Objective: To evaluate the association between sociodemographic, clinical, and treatment factors in the outcome of severe radiodermatitis in patients with head and neck cancer seen at the nursing consultation; and to analyze the impact of severe radiodermatitis cases on therapeutic follow-up. Method: A quantitative, documentary research conducted with medical records of 167 patients with head and neck cancer submitted to radiotherapy with curative indication followed in the nursing consultation in 2016. A structured form was used for data collection and analytical and descriptive statistics were used for its analysis. Results: Of the 99.4% patients who had radiodermatitis, 11.4% were severe cases. Severe radiodermatitis was associated with the type of equipment, treatment technique and presence of comorbidities. Of the patients who presented grade three, 53% had temporary discontinuation of treatment. Conclusion: Head and neck cancer patients who undergo radiotherapy with curative indication are at risk for severe radiodermatitis. Nursing consultation is important to minimize the severity of this event and the reduction of temporary treatment interruption due to this adverse reaction.

Validation of a simple diet self-assessment tool (SDSAT) in head and neck cancer patients undergoing radiotherapy

PURPOSE

The simple diet self-assessment tool (SDSAT) is a simple instrument for estimating the cancer patients' dietary intake. This study aimed to evaluate its reliability and validity among head and neck (HNC) cancer patients undergoing radiotherapy (RT).

METHODS

Two studies were conducted at the department of radiation oncology of a University-affiliated hospital, where HNC patients were assessed at baseline, mid-treatment and post-treatment of RT. In the first study, 25 patients (a total of 60 cases) were recruited by convenience sample method to estimate the interrater reliability of SDSAT. Then, 304 patients (a total of 912 cases) were involved in a prospective, longitudinal observational study. The criterion validity was confirmed by the agreement rate between SDSAT and 24-h dietary recall (24HR). The predictive validity was established by exploring the impact of the score of SDSAT on weight loss among HNC patients during RT.

RESULTS

The estimation of interrater reliability of SDSAT showed that weighted kappa was 0.82 (95%CI = 0.74-0.90, p < 0.001), suggesting a high level of agreement between two raters. The overall agreement rate between SDSAT and 24HR was 62.9% (574/912) and weighted kappa was 0.66 (95%CI = 0.63-0.70, p < 0.001), which indicated good criterion validity. Generalized estimating equation (GEE) showed that the score of SDSAT had a significant impact on weight loss (β = 1.40, 95%CI = 1.21-1.59, p < 0.001), which demonstrated good predictive validity.

CONCLUSIONS

The SDSAT demonstrated favorable reliability and validity. It is appropriate for estimation of dietary intake among HNC patients.

Head and neck cancer awareness: a survey of young people in international communities

INTRODUCTION

Head and neck cancer (HNC) is killing young people yearly. The knowledge of HNC risk factors and its symptoms among this population group may go a long way in HNC prevention among them. This study aims to: determine the level of awareness of HNC; determine the prevalence of HNC risk factors; and explore the knowledge of HNC risk factors, HNC symptoms, as well as family history of HNC among youth in the international communities (with focus on the Canadian and Nigerian youth).

METHODS

A sample of 801 youth were surveyed using an e-questionnaire. The questionnaire obtained information from each participant about their: socio-demographic information; knowledge of HNC, its risk factors, and its manifestations; and family history of HNC. Data obtained from the participants were analyzed using the Statistical Analysis Software (SAS Version 9.4 for Windows).

RESULTS

The majority (73%) of the surveyed youth (n=801) were residing in Nigeria, seven-tenths of them were between the age 18 and 24 years, and 53% were females. Less than 10% had a history of smoking, 7% were active smokers, and 24% had history of oral sex (of which 57% (108/109) of them had a lifetime history of more than one oral sexual partner). Around half (51%) of the participants had never heard of HNC before. Only 4% knew of a family member who had suffered/is suffering from HNC. Half of the participants were not sure whether HNC can manifest without initial complaint, pain, or symptoms. Only 9% of the participants erroneously believed that HNC is a contagious disease. Comparative analyses among subgroups revealed that a higher proportion of those participants who were: from Canada; young adults; and males generally knew about HNC when compared with the proportions recorded among those in the adolescents; females, and Nigerian participants' categories. Lastly, 76% of the participants showed interest in knowing more about HNC.

CONCLUSION

The majority of the surveyed youth demonstrated poor knowledge of HNC. Also, a significant proportion of them are at risk of developing HNC disease in future, if they keep indulging in HNC risky behaviors. There exists the need to conduct community health education programs on HNC among youth in these surveyed communities.

Mortality due to oral and oropharyngeal cancer in Uruguay from 1997 to 2014

Oral and oropharyngeal cancer is considered a public health problem in several countries due to its high incidence and mortality rate.

Expression of MMR system genes is correlated to NF-kB in patients with oral squamous cell carcinoma

AIMS

The aim of this study was to evaluate the mismatch repair gene expression and their correlation with NF-kB in patients with oral squamous cell carcinoma (SCC).

METHODS

Total RNA was isolated from 28 biopsy samples. A control group was composed of 20 volunteers. Differential expression of hMSH2, hMSH6 and NF-kB genes was accessed by quantitative PCR.

RESULTS

There is increased expression of all the analysed genes when the patients were smokers and alcoholics. In addition, there is increased expression of hMSH2 when SCC was removed from the base of the tongue. There was a correlation between NF-kB and hMSH2 and hMSH6 as well as between repair genes hMSH2 and hMSH6 expression levels. There is increased expression of the hMSH2 gene in patients with SCC, especially in the alcoholics.

CONCLUSIONS

There is a strong indication that NF-kB gene was expressed along with the studied repair genes, evidencing the possibility that this system can be activated by the inflammatory pathway.

Fatigue in patients with head and neck cancer undergoing radiation therapy: a prospective study

Objective

to identify the frequency of fatigue and domains affected in patients with head and neck cancer undergoing radiation therapy, at the beginning, middle and end of treatment.

Method

longitudinal and prospective study of quasi-experimental design, involving 60 patients with head and neck cancer. It should be highlighted that this article will address only the data of the Control Group. The dependent variables were collected through interview, using the revised Piper Fatigue Scale, which is a multidimensional instrument that assesses global, behavioral, affective and sensory/psychological domains. Data analysis was based on absolute and relative frequencies.

Results

there was a predominance of males, age group between 41-60 years, low level of education and in regular use of alcohol and cigarettes. All domains in the fatigue scale had their scores increased, presenting median values of greater magnitude in Time 2 and Time 3, when compared to the Time 1 values, indicating an increase in fatigue levels during radiation therapy.

Conclusion

fatigue increased in the course of the radiation therapy, having all domains affected. Therefore, its evaluation throughout the treatment is important, as fatigue is a common and debilitating symptom on cancer patients.

Smokeless tobacco use and oral neoplasia among urban Indian women

OBJECTIVES

Oral cavity cancers are fourth most common cancers among Indian women. The objectives were to create cancer awareness (CA) and screen tobacco-using women for oral cavity cancers.

MATERIALS AND METHODS

A community-based CA and screening programme was conducted among women in Mumbai, India. The tobacco-using women participated in CA and oral cavity screening by oral visual inspection (OVI). All screen-positive women were referred to nodal hospital and assisted for diagnostic confirmation and treatment completion.

RESULTS

Twelve slum clusters comprising of 138,383 population and 13,492 tobacco-using women have been covered. Among them, 11,895 (88.2%) participated in CA and 11,768 (87.2%) in OVI. A total of 377 (3.2%) women were screened positive, 275 (72.9%) complied with referral and 207 oral precancers [173 leukoplakia, 9 erythroplakia, 3 erythroleukoplakia and 41 sub-mucus fibrosis (SMF) including 35 women with multiple precancers] and 7 oral cancers were diagnosed. The detection rate of oral precancerous lesions and oral cancers was 17.6 and 0.6 per 1,000 screened women. Thirty-five women had multiple oral precancerous lesions. The results of multivariate analysis indicate dose-response relationship between tobacco use and risk of oral precancers.

CONCLUSION

Good participation rates (>85%) for cancer awareness and OVI were seen among urban slum women in India. Many oral precancer and cancer cases were detected and were managed at the nodal hospital.

Assessment of tumor-associated immune cells in laryngeal squamous cell carcinoma

PURPOSE

This study investigated the characteristics of tumor-associated immune cells (TAICs) in laryngeal squamous cell carcinoma (LSCC) and their correlation with clinicopathological variables.

METHODS

The immune cell infiltrates of 71 specimens of stages I-IV LSCC were examined. The density of TAICs expressing CD3, CD4, CD8, CD68, and CD163 was assessed using immunohistochemical staining and image analysis in peritumoral and intratumoral regions.

RESULTS

Higher densities of CD3+ and CD8+ cell and lower densities of CD68+ and CD163+ cell infiltrations were found in early tumor stages than in late tumor stages. A higher percentage of patients with strong CD3+ and CD8+ immune cell infiltration and weak CD68+ cell infiltration in both tumor regions presented with T1 stage tumors compared with T4 stage tumors. Further, strong CD68+ cells infiltration in both regions was observed in a greater number of patients who had a relapse, while a weak CD3+ cells infiltration in both regions was found in a greater number of patients with nodal lymphatic metastasis. The univariate analysis showed that a high density of peritumoral CD3+ and CD8+ immune cells in both regions was significantly associated with a favorable overall survival (OS) (P = 0.004; P = 0.006; P = 0.042). In contrast, a high density of intratumoral CD68+ cells and peritumoral CD163+ cells was significantly associated with poor OS durations (P = 0.026; P = 0.030). The multivariate analysis demonstrated that a high density of peritumoral CD163+ cells correlated with poor OS after adjusting for tumor stage, recurrence, and nodal lymphatic metastasis (P = 0.034). This study found different patterns of TAIC infiltration in LSCC. The density and location of TAICs infiltration correlated with the clinicopathological characteristics of LSCC.

CONCLUSION

A combined analysis of the density of TAICs and their location may help predict patient survival and response to checkpoint inhibitors.

Relationship of human papillomavirus with diseases of the oral cavity

Over the last few decades, the human papillomavirus (HPV) infection has emerged as a new epidemic and become a health issue due to its involvement in several cancers affecting the cervix, the anogenital region and the oropharynx. In this review, we aim to understand and explain the distinctive features of HPV-related oropharyngeal squamous cell carcinoma based on its epidemiological data, risk factors, specific topography, HPV subtypes most frequently involved, HPV-status diagnosis, clinical behaviour, prognosis, treatment, and preventive measures. In addition, the relationship of HPV with the development of other head and neck carcinomas and benign lesions of the oral cavity will also be discussed.

[Aetiopathology and prevention of oropharyngeal cancer]

Oropharyngeal cancer is in the sixth position of cancer incidence in the world (after colorectal, breast, prostate, bladder, and cervix uteri cancer). More than 90% of them are squamous cell carcinoma. This type of cancer can originate on the lip, oral cavity, pharynx, and larynx. The risk factors associated with oropharyngeal cancer are tobacco, alcohol, and poor oral hygiene. However, other conditions, such as infection with human papilloma virus (HPV) and oral dysbiosis, are gaining prominence. Pre-malignant and malignant lesions are related to diverse factors that can be monitored by the health professional. These professionals are also in an ideal position to influence and advise patients on healthy life habits that contribute to prevent or treat metabolic-endocrine syndromes associated with the development of pre-cancerous disease and cancer located in different organs.

Loss of TP63 Promotes the Metastasis of Head and Neck Squamous Cell Carcinoma by Activating MAPK and STAT3 Signaling

TP63 is frequently amplified or overexpressed in primary head and neck squamous cell carcinomas (HNSCC). Nevertheless, the role of TP63 in the initiation and progression of HNSCCs is not known. Using archival HNSCC tissue sections, we found that TP63 expression is often downregulated in late-stage human HNSCCs. To establish a causal link between TP63 loss and HNSCC tumorigenesis, we developed a genetically engineered mouse model in which Trp63 (the mouse homolog of human TP63) was ablated from head and neck epithelia. Upon exposure of the mice to a chemical carcinogen, we found that Trp63 ablation accelerated HNSCC initiation and progression. To determine whether these findings are relevant for human HNSCCs, we generated TP63 knockdown HNSCC cell lines. These cells were implanted into the tongue of athymic nude mice to generate orthotopic xenografts. We found that loss of TP63 promoted HNSCC progression and metastasis. Furthermore, we determined that tumor metastasis is dependent on MAPK activation in TP63 knockdown HNSCCs. The significance of these findings is underscored by our finding that pharmacologic inhibition of MAPK activity by trametinib drastically impaired HNSCC metastasis mediated by TP63 loss. In conclusion, our data provide novel mechanistic insights into the role of TP63 loss in HNSCC initiation and progression, and provide a rationale for the development of new therapeutic approaches specifically targeting TP63-dependent tumor pathways. IMPLICATIONS: Our findings uncover a novel functional role for TP63 loss in HNSCC metastasis and identify MAPK signaling as a potential therapeutic target for treating HNSCCs with low TP63 expression.

Head and neck cancer: validation of a data collection instrument

OBJECTIVE

construct and validate the content of an instrument to collect data from patients with head and neck cancer (HNC) served in a specialty clinic.

METHOD

methodological study consisting of four steps. The first step consisted in the preparation of the instrument using databases and the theoretical model of Marjory Gordon. In the second and third steps the content was validated by eight nursing judges. The evaluation used the Content Validity Index (CVI). The fourth step consisted in a pilot test with seventeen HNC patients.

RESULTS

of the 88 questions formulated and organized on the dimensions of structure and process submitted to validation, items with CVI lower than 0.80 were excluded. The final instrument was composed of 56 items, with global CVI calculated as 0.87.

CONCLUSION

the final instrument presented content validity for data collection in head and neck clinic.

Modulators of Redox Metabolism in Head and Neck Cancer

SIGNIFICANCE

Head and neck squamous cell cancer (HNSCC) is a complex disease characterized by high genetic and metabolic heterogeneity. Radiation therapy (RT) alone or combined with systemic chemotherapy is widely used for treatment of HNSCC as definitive treatment or as adjuvant treatment after surgery. Antibodies against epidermal growth factor receptor are used in definitive or palliative treatment. Recent Advances: Emerging targeted therapies against other proteins of interest as well as programmed cell death protein 1 and programmed death-ligand 1 immunotherapies are being explored in clinical trials.

CRITICAL ISSUES

The disease heterogeneity, invasiveness, and resistance to standard of care RT or chemoradiation therapy continue to constitute significant roadblocks for treatment and patients' quality of life (QOL) despite improvements in treatment modality and the emergence of new therapies over the past two decades.

FUTURE DIRECTIONS

As reviewed here, alterations in redox metabolism occur at all stages of HNSCC management, providing opportunities for improved prevention, early detection, response to therapies, and QOL. Bioinformatics and computational systems biology approaches are key to integrate redox effects with multiomics data from cells and clinical specimens and to identify redox modifiers or modifiable target proteins to achieve improved clinical outcomes. Antioxid. Redox Signal.

Relationship between subjective taste alteration and weight loss in head and neck cancer patients treated with radiotherapy: A longitudinal study

PURPOSE

To conduct a dynamic and comprehensive evaluation of subjective taste alteration (STA)and identify the association between STA and weight loss in patients with head and neck cancer (HNC) who were treated with radiotherapy.

METHODS

STA and weight of 114 patients were recorded at baseline, mid-treatment, post-treatment, and one to two months after radiotherapy (follow-up). Generalized estimating equations (GEE) were used to conduct repeated measures analyses of STA and weight loss at four time-points and assess the relationship between them.

RESULTS

The prevalence of STA was 13.2% (baseline), 83.3% (mid-treatment), 92.1% (post-treatment), and 77.9% (follow-up), respectively; the prevalence of ≥10% weight loss increased from 1.8% (mid-treatment) to 44.2% (follow-up). The severity of STA was increasingly poor with radiation therapy and did not return to the baseline level at the follow-up. Meanwhile, the weight of patients did not increase at the follow-up. Among the four subscales of STA (decline in basic taste, general taste alterations, phantogeusia and parageusia, and discomfort), only the discomfort score (β = -2.988; p = 0.005; 95%confidence interval: -5.084-0.891) had a significant effect on weight loss.

CONCLUSIONS

The main finding of this study was that STA, particularly the discomfort symptom associated with dietary intake, as a common and persistent symptom among HNC patients during and after radiotherapy, might promote weight loss in patients, which should be afforded greater attention from medical staff.

Relationship between CD44high/CD133high/CD117high cancer stem cells phenotype and Cetuximab and Paclitaxel treatment response in head and neck cancer cell lines

Recent evidence suggests that cancer stem cells (CSCs), a small population of cancer cells that are highly tumourigenic, capable of self-renewal and have the ability to differentiate into cells that constitute the tumor, are the "drivers" of local recurrence and metastatic spread and may be associated with resistant to conventional therapy. The objectives of the study are to identify and characterize two head and neck cancer cell lines with regard CD44high/CD133high/CD117high profile (CSCs) and CD44low/CD133low/CD117low profile (Non-CSCs); to investigate the influence of chemotherapy treatment in CSCs and compare with Non-CSCs; to evaluate CD44 and EGFR gene expression in CSCs. Fluorescent-activated cell sorting (FACS) using specific cell surface marker combination (CD44, CD117 and CD133) was performed to isolate CSCs of Non-CSCs from cell lines. The Wound Healing assay was performed to confirm the presence of CSCs. After, the CSCs subpopulation and Non-CSCs were cultured and exposed for 24 h to Cetuximab and Paclitaxel treatment, separately. Cell proliferation was determined by MTS assay. CD44 and EGFR gene expression was quantified by quantitative real time PCR (qPCR) using TaqMan® Assay in both subpopulations. CSCs subpopulation untreated were considered as relative expression control. We firstly characterized CSCs in HN13 and HEP-2 cell lines with CD44, CD133 and CD117 biomarkers. We treated CSCs and Non-CSCs subpopulations with Cetuximab and Paclitaxel treatment and found that CSCs subpopulations demonstrated more resistance to Paclitaxel chemoterapy, when compared with Non-CSCs subpopulations of oral cancer cell line. These CSCs subpopulations presented up-regulation of CD44 gene and down-regulation of EGFR gene in oral cancer cell line, and down-regulation of CD44 gene and up-regulation of EGFR gene in laryngeal cancer cell line when compared with Non-CSCs subpopulations. We conclude that the combination of CD44, CD133 and CD117 biomarkers have stem cell properties in both cell lines. CSCs has ability to resist to Paclitaxel treatment in oral cancer cell line. CSCs present high expression of CD44 gene and down expression of EGFR gene in oral cancer cell line. CSCs in laryngeal cell line present down expression of CD44 gene and high expression of EGFR gene when compared with cells without characteristics of cancer stem cells.

Correlation between the Voice Handicap and Swallowing Quality of Life in patients with laryngeal cancer submitted to chemoradiotherapy

Purpose To verify the correlation between the voice handicap and swallowing quality of life in individuals submitted to chemoradiotherapy for laryngeal cancer treatment. Methods Cross-sectional, observational and quantitative study. Fourteen male individuals diagnosed with laryngeal cancer were submitted to exclusive chemoradiotherapy treatment. The individuals completed the Voice Handicap Index (VHI) and the Swallowing Quality of Life (SWAL-QOL) questionnaires. Data were submitted to descriptive and inferential analysis using Spearman's Correlation Test to verify possible correlations among the scores of these instruments. Values of p ≤ 0.05 were considered statistically significant. Results No significant correlation was found between the total VHI and overall SWAL-QOL scores. However, there was significant correlation between the domain Functional of the VHI and the domains Fatigue and Social of the SWAL-QOL, between the domain Organic in the VHI and the SWAL-QOL domain Social, and total VHI score and SWAL-QOL domain Swallowing as a burden. Furthermore, chemoradiotherapy treatment had a greater impact on the voice than on the swallowing for the studied individuals. Conclusion The data showed a significant correlation between voice handicap and the impact of quality of life involving swallowing in individuals with laryngeal cancer submitted to chemoradiotherapy. This may affect individuals' emotional and social aspects, impacting their overall quality of life.

Quercetin induced apoptosis of human oral cancer SAS cells through mitochondria and endoplasmic reticulum mediated signaling pathways

Oral cancer is a cause of cancer-associated mortality worldwide and the treatment of oral cancer includes radiation, surgery and chemotherapy. Quercetin is a component from natural plant products and it has been demonstrated that quercetin is able to induce cytotoxic effects through induction of cell apoptosis in a number of human cancer cell lines. However, there is no available information to demonstrate that quercetin is able to induce apoptosis in human oral cancer cells. In the present study, the effect of quercetin on the cell death via the induction of apoptosis in human oral cancer SAS cells was investigated using flow cytometry, Annexin V/propidium iodide (PI) double staining, western blotting and confocal laser microscopy examination, to test for cytotoxic effects at 6–48 h after treatment with quercetin. The rate of cell death increased with the duration of quercetin treatment based on the results of a cell viability assay, increased Annexin V/PI staining, increased reactive oxygen species and Ca²⁺ production, decreased the levels of mitochondrial membrane potential (ΔΨ_m), increased proportion of apoptotic cells and altered levels of apoptosis-associated protein expression in SAS cells. The results from western blotting revealed that quercetin increased Fas, Fas-Ligand, fas-associated protein with death domain and caspase-8, all of which associated with cell surface death receptor. Furthermore, quercetin increased the levels of activating transcription factor (ATF)-6α, ATF-6β and gastrin-releasing peptide-78 which indicated an increase in endoplasm reticulum stress, increased levels of the pro-apoptotic protein BH3 interacting-domain death antagonist, and decreased levels of anti-apoptotic proteins B-cell lymphoma (Bcl) 2 and Bcl-extra large which may have led to the decreases of ΔΨ_m. Additionally, confocal microscopy suggested that quercetin was able to increase the expression levels of cytochrome c, apoptosis-inducing factor and endonuclease G, which are associated with apoptotic pathways. Therefore, it is hypothesized that quercetin may potentially be used as a novel anti-cancer agent for the treatment of oral cancer in future.

The neuropeptide genes SST, TAC1, HCRT, NPY, and GAL are powerful epigenetic biomarkers in head and neck cancer: a site-specific analysis

Background

Staging and pathological grading systems are convenient but imperfect predictors of recurrence in head and neck squamous cell carcinoma (HNSCC). Identifying biomarkers for HNSCC that will progress and cause death is a critical research area, particularly if the biomarker can be linked to selection of patients. Therefore, to identify potential alternative prognostic markers, we investigated the methylation status of five neuropeptide gene promoters. The promoter methylation status was determined by quantitative methylation-specific PCR in 230 cases of HNSCC; 58 hypopharynx, 45 larynx, 56 oropharynx, and 71 oral cavity tumor samples were studied.

Results

The somatostatin (SST), tachykinin precursor 1 (TAC1), hypocretin neuropeptide precursor (HCRT), neuropeptide Y (NPY), and galanin (GAL) promoters were methylated in 84.3, 63.5, 32.6, 28.3, and 20.0%, respectively, of the samples. The mean number of methylated genes per sample was 2.29 (range, 0–5). Disease-free survival was lower in patients with 3–5 methylated genes than in those with 0–2 methylated genes (log-rank test, P = 0.007). In multivariate Cox proportional hazards analysis, TAC1 and GAL promoter methylation independently predicted recurrence (odds ratios 1.620, 95% confidence interval [CI] 1.018–2.578, P = 0.042, and odds ratios 1.692, 95% CI 1.063–2.694, P = 0.027, respectively). In patients with oral cancer, TAC1 methylation showed the best correlation with poor survival (odds ratio 4.427, 95% CI 1.634–12.00, P = 0.003). Similar findings were observed for HCRT and GAL in patients with laryngeal cancer and oropharyngeal cancer, respectively.

Conclusion

In this study, we demonstrated the methylation status of the neuropeptide-encoding genes SST, TAC1, HCRT, NPY, and GAL and its relationship with recurrence and survival in HNSCC. These methylation changes may serve as potential molecular markers for defining the risk and prognosis of HNSCC.

Electronic supplementary material

The online version of this article (10.1186/s13148-018-0485-0) contains supplementary material, which is available to authorized users.

Emerging and re-emerging infectious disease in otorhinolaryngology

SUMMARY

Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

Comparative assessment of HPV, alcohol and tobacco etiological fractions in Algerian patients with laryngeal squamous cell carcinoma

Background

Despite the increasing incidence of laryngeal squamous cell carcinoma (LSCC) in Algeria, scarce information is available on the importance of the preventable etiological factors which may drive the disease. Remarkably, a significant number of cases occur in nonsmoker and nondrinker patients; hence, suggesting that alternative risk factors, like Human papillomavirus (HPV), might be etiologically involved. To gain more insight on the risk factors associated with the disease in the country, we evaluated the etiological fraction of HPV in comparison to tobacco and alcohol intake in LSCC patients.

Methods

To evaluate the etiopathologic fraction (EF) for HPV compared to history of tobacco and alcohol in LSCC, HPV DNA presence in 46 invasive and 3 non-invasive formalin-fixed paraffin-embedded laryngeal tumors was screened using the SPF10-DEIA-LiPA25 Assay. Demographic data and information related to exposure to the risk factors were gathered through interviewer-assisted questionnaires.

Results

We observed that 40.8% of all LSCC cases were associated with smoking, 40.8% had combined tobacco and alcohol exposure history, and 14.3% did not show prior exposure to either risk factor. 1 out of 3 in-situ carcinoma cases was positive for HPV-6. HPV prevalence was null in the invasive tumors. HPV DNA was detected in 2.38% for all studied cases. 10.2% of LSCC patients did not associate with any of the studied risk factors.

Conclusion

Here we show that HPV etiological fraction in LSCC Algerian patients is low and smoking and alcohol remain the principal etiopathologic risk for LSCC burden in Algeria.

Construction and validation of clinical contents for development of learning objects

OBJECTIVE

to describe the process of construction and validation of clinical contents for health learning objects, aimed at patients in the treatment of head and neck cancer.

METHOD

descriptive, methodological study. The development of the script and the storyboard were based on scientific evidence and submitted to the appreciation of specialists for validation of content. The agreement index was checked quantitatively and the suggestions were qualitatively evaluated.

RESULTS

The items described in the roadmap were approved by 99% of expert experts. The suggestions for adjustments were inserted in their entirety in the final version. The free-marginal kappa statistical test, for multiple evaluators, presented value equal to 0.68%, granting a substantial agreement.

CONCLUSION

The steps taken in the construction and validation of the content for the production of educational material for patients with head and neck cancer were adequate, relevant and suitable for use in other subjects.