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Izumi T, Rychahou P, Chen L, Smith MH, Valentino J. Copy Number Variation That Influences the Ionizing Radiation Sensitivity of Oral Squamous Cell Carcinoma. Cells 2023; 12:2425. [PMID: 37887269 PMCID: PMC10605269 DOI: 10.3390/cells12202425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
Genome instability in cancer cells causes not only point mutations but also structural variations of the genome, including copy number variations (CNVs). It has recently been proposed that CNVs arise in cancer to adapt to a given microenvironment to survive. However, how CNV influences cellular resistance against ionizing radiation remains unknown. PRMT5 (protein arginine methyltransferase 5) and APE1 (apurinic/apyrimidinic endonuclease 1), which enhance repair of DNA double-strand breaks and oxidative DNA damage, are closely localized in the chromosome 14 of the human genome. In this study, the genomics data for the PRMT5 and APE1 genes, including their expression, CNVs, and clinical outcomes, were analyzed using TCGA's data set for oral squamous cell carcinoma patients. The two genes were found to share almost identical CNV values among cancer tissues from oral squamous cell carcinoma (OSCC) patients. Levels of expression of PRMT5 and APE1 in OSCC tissues are highly correlated in cancer but not in normal tissues, suggesting that regulation of PRMT5 and APE1 were overridden by the extent of CNV in the PRMT5-APE1 genome region. High expression levels of PRMT5 and APE1 were both associated with poor survival outcomes after radiation therapy. Simultaneous down-regulation of PRMT5 and APE1 synergistically hampered DNA double-strand break repair and sensitized OSCC cell lines to X-ray irradiation in vitro and in vivo. These results suggest that the extent of CNV in a particular genome region significantly influence the radiation resistance of cancer cells. Profiling CNV in the PRMT5-APE1 genome region may help us to understand the mechanism of the acquired radioresistance of tumor cells, and raises the possibility that simultaneous inhibition of PRMT5 and APE1 may increase the efficacy of radiation therapy.
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Affiliation(s)
- Tadahide Izumi
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY 40536, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Piotr Rychahou
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Surgery, University of Kentucky, Lexington, KY 40536, USA
| | - Li Chen
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Internal Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Molly H. Smith
- Oral Pathology, University of Kentucky, Lexington, KY 40536, USA
- Pathology and Cytology Laboratory, University of Kentucky, Lexington, KY 40506, USA
| | - Joseph Valentino
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
- Department of Otorhinolaryngology, University of Kentucky, Lexington, KY 40536, USA
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Borger T, Shelton BJ, Valentino J, Ostroff JS, Cummings KM, Studts JL, Carpenter MJ, Burris JL. A Daily Assessment Study of Smoking Cessation After a Head and Neck Cancer Diagnosis. Nicotine Tob Res 2022; 24:1781-1788. [PMID: 35486923 PMCID: PMC9597003 DOI: 10.1093/ntr/ntac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/03/2022] [Accepted: 04/26/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This intensive longitudinal study describes key events in the process of smoking cessation after a new head and neck cancer (HNC) diagnosis. Prior longitudinal studies show some cancer patients quit, while others continue to smoke, but details about the pattern in which these discrete outcomes arise are scarce. This study is meant to help rectify this gap in the literature. AIMS AND METHODS Participants were 42 HNC patients who reported current smoking at enrollment. Participants were recruited from an outpatient oncology clinic and completed a baseline questionnaire prior to begin a 30-day daily assessment. RESULTS Few participants (9.52%) achieved 30-day continuous abstinence from smoking. On average, participants reported 9.64 ± 11.93 total days of abstinence. Nearly, all (94.44%, n = 34) participants made at least one quit attempt, with an average of 16.94 ± 11.30 quit attempt days. Fewer participants were able to achieve a 24-hour quit attempt (52.78%, n = 19), with a corresponding average of 5.50 ± 8.69 24-hour days. The median time to first 24-hour quit attempt was 13 days after enrollment. Based on smoking behavioral patterns, participants were categorized into five groups, the most common being "persistent attempters," which involved unsuccessful quit attempts throughout the study. Only 45% of participants (n = 19) used evidence-based treatment, the most common being cessation medication. CONCLUSIONS This intensive longitudinal study found that cancer diagnosis can spur a lot of efforts to quit smoking. Unfortunately, this study suggests that many quit attempts are short lived, possibly a result of an absence or insufficient use of evidence-based treatments. IMPLICATIONS For adults who are current smokers at the time of cancer diagnosis, there is a high likelihood of persistent cigarette smoking and use of other tobacco products in the weeks and months after a cancer diagnosis. Furthermore, this study shows that while a lot of quit attempts may occur, few are successful, which may be partly attributable to the low use of evidence-based tobacco treatment. Future research with cancer patients should aim to identify predictors of quit attempts and abstinence as well as treatment utilization.
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Affiliation(s)
- Tia Borger
- University of Kentucky, Department of Psychology, Lexington, KY, USA
- University of Kentucky, Markey Cancer Center, Lexington, KY, USA
| | - Brent J Shelton
- University of Kentucky, Markey Cancer Center, Lexington, KY, USA
- University of Kentucky, Department of Biostatistics, Lexington, KY, USA
| | - Joseph Valentino
- University of Kentucky, Markey Cancer Center, Lexington, KY, USA
- University of Kentucky, Department of Otolaryngology—Head and Neck Surgery, Lexington, KY, USA
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY, USA
| | - Kenneth Michael Cummings
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Charleston, SC, USA
| | - Jamie L Studts
- University of Colorado School of Medicine, Department of Medicine, Aurora, CO, USA
| | - Matthew J Carpenter
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences and Hollings Cancer Center, Charleston, SC, USA
| | - Jessica L Burris
- University of Kentucky, Department of Psychology, Lexington, KY, USA
- University of Kentucky, Markey Cancer Center, Lexington, KY, USA
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Burris JL, Borger TN, Shelton BJ, Darville AK, Studts JL, Valentino J, Blair C, Davis DB, Scales J. Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute-Designated Cancer Center. JCO Oncol Pract 2022; 18:e261-e270. [PMID: 34185570 PMCID: PMC9213199 DOI: 10.1200/op.20.01095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute-designated cancer center. METHODS AND MATERIALS The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.
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Affiliation(s)
- Jessica L. Burris
- Department of Psychology, University of Kentucky, Lexington, KY
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Tia N. Borger
- Department of Psychology, University of Kentucky, Lexington, KY
| | - Brent J. Shelton
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Biostatistics, University of Kentucky, Lexington, KY
| | | | - Jamie L. Studts
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Joseph Valentino
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, KY
| | - Courtney Blair
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - D. Bront Davis
- Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Joan Scales
- Markey Cancer Center, University of Kentucky, Lexington, KY
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Wicker CA, Takiar V, Suganya R, Arnold SM, Brill YM, Chen L, Horbinski CM, Napier D, Valentino J, Kudrimoti MR, Yu G, Izumi T. Evaluation of antioxidant network proteins as novel prognostic biomarkers for head and neck cancer patients. Oral Oncol 2020; 111:104949. [PMID: 32801084 DOI: 10.1016/j.oraloncology.2020.104949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Recurrence rates for head and neck squamous cell carcinoma (HNSCC) approach 50% at 5 years. Current staging fails to identify patients with a worse prognosis who might benefit from intensified treatment, which warrants improved prognostic biomarkers. The purpose of this retrospective case study is to identify potential prognostic biomarkers in patients with HNSCC including APE1 (DNA repair/redox gene regulator), NRF2 and PPARGC1A (redox gene regulators), SOD3 and DCN (antioxidant proteins). MATERIALS AND METHODS Differential protein expression between benign, carcinoma in situ (CIS), and invasive HNSCC tissue specimens from 77 patients was assessed using immunohistochemistry. Protein expression was analyzed with multivariate, pair-wise, and Kaplan-Meier survival analyses to identify potential prognostic biomarkers. Utilizing The Cancer Genome Atlas's transcriptome database, pair-wise and survival analysis was performed to identify potential prognostic biomarkers. RESULTS APE1, NRF2, PPARGC1A, SOD3, and DCN expression in HNSCC in relation to, lymph node invasion, and patient survival were examined. Elevated APE1 protein expression in CIS corresponded with reduced survival (p = 0.0243). Increased APE1 gene expression in stage T4a HNSCC was associated with reduced patient survival (p < 0.015). Increased PPARGC1A in invasive tumor correlated with reduced survival (p = 0.0281). Patients with lymph node invasion at diagnosis had significantly increased APE1 protein in the primary sites (p < 0.05). Patients with poorly differentiated invasive tumors had reduced PPARGC1A in CIS proximal to the invasive tumor and had elevated DCN and SOD3 in proximal benign tissue (p < 0.05). CONCLUSIONS The expression of APE1, DCN, and SOD3 is a potential prognostic signature that identifies patients with worsened survival.
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Affiliation(s)
- Christina A Wicker
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, United States
| | - Rangaswamy Suganya
- Houston Eye Associates, Clinical Research Department, Houston, TX, United States
| | - Susanne M Arnold
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States; Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Yolanda M Brill
- Department of Pathology, University of Kentucky, Lexington, KY, United States
| | - Li Chen
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States; Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Craig M Horbinski
- Department of Pathology, Northwestern University, Chicago, IL, United States
| | - Dana Napier
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Joseph Valentino
- Department of Otolaryngology, University of Kentucky, Lexington, KY, United States
| | - Mahesh R Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Lexington, KY, United States
| | - Guoqiang Yu
- F. Joseph Halcomb III M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States
| | - Tadahide Izumi
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, United States.
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5
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Huang Y, Zhao J, Mao G, Lee GS, Zhang J, Bi L, Gu L, Chang Z, Valentino J, Li GM. Author Correction: Identification of novel genetic variants predisposing to familial oral squamous cell carcinomas. Cell Discov 2020; 6:46. [PMID: 32685192 PMCID: PMC7358213 DOI: 10.1038/s41421-020-00189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yaping Huang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Jizhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Guogen Mao
- Department of Toxicology and Cancer Biology, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - Grace Sanghee Lee
- Department of Toxicology and Cancer Biology, University of Kentucky College of Medicine, Lexington, KY, 40536, USA
| | - Jia Zhang
- Insititute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
| | - Lijun Bi
- Insititute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
| | - Liya Gu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Zhijie Chang
- Department of Basic Medical Sciences, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Joseph Valentino
- Department of Otolaryngology, Head & Neck Surgery, University of Kentucky College of Medicine, Lexington, KY, 40536, USA.
| | - Guo-Min Li
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA. .,Department of Toxicology and Cancer Biology, University of Kentucky College of Medicine, Lexington, KY, 40536, USA.
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Huang Y, Zhao J, Mao G, Lee GS, Zhang J, Bi L, Gu L, Chang Z, Valentino J, Li GM. Identification of novel genetic variants predisposing to familial oral squamous cell carcinomas. Cell Discov 2019; 5:57. [PMID: 31798960 PMCID: PMC6877579 DOI: 10.1038/s41421-019-0126-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/06/2019] [Indexed: 12/13/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a common subtype of head and neck squamous cell carcinoma (HNSCC), but the pathogenesis underlying familial OSCCs is unknown. Here, we analyzed whole-genome sequences of a family with autosomal dominant expression of oral tongue cancer and identified proto-oncogenes VAV2 and IQGAP1 as the primary factors responsible for oral cancer in the family. These two genes are also frequently mutated in sporadic OSCCs and HNSCCs. Functional analysis revealed that the detrimental variants target tumorigenesis-associated pathways, thus confirming that these novel genetic variants help to establish a predisposition to familial OSCC.
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Affiliation(s)
- Yaping Huang
- 1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Jizhi Zhao
- 4Department of Stomatology, Peking Union Medical College Hospital, Beijing, 100730 China
| | - Guogen Mao
- 2Department of Toxicology and Cancer Biology, University of Kentucky College of Medicine, Lexington, KY 40536 USA
| | - Grace Sanghee Lee
- 2Department of Toxicology and Cancer Biology, University of Kentucky College of Medicine, Lexington, KY 40536 USA
| | - Jia Zhang
- 5Insititute of Biophysics, Chinese Academy of Sciences, Beijing, 100101 China
| | - Lijun Bi
- 5Insititute of Biophysics, Chinese Academy of Sciences, Beijing, 100101 China
| | - Liya Gu
- 1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Zhijie Chang
- 6Department of Basic Medical Sciences, Tsinghua University School of Medicine, Beijing, 100084 China
| | - Joseph Valentino
- 3Department of Otolaryngology, Head & Neck Surgery, University of Kentucky College of Medicine, Lexington, KY 40536 USA
| | - Guo-Min Li
- 1Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA.,2Department of Toxicology and Cancer Biology, University of Kentucky College of Medicine, Lexington, KY 40536 USA
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Angadi V, Dressler E, Kudrimoti M, Valentino J, Aouad R, Gal T, Stemple J. Efficacy of Voice Therapy in Improving Vocal Function in Adults Irradiated for Laryngeal Cancers: A Pilot Study. J Voice 2019; 34:962.e9-962.e18. [PMID: 31235195 DOI: 10.1016/j.jvoice.2019.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiation therapy (XRT) for laryngeal cancers causes acute and chronic vocal dysfunction. Although these deleterious effects of XRT are well-established, there is a dearth of research with respect to effective voice rehabilitation following XRT for laryngeal cancers. OBJECTIVE To obtain preliminary data on the efficacy of voice rehabilitation, using vocal function exercises (VFEs) in improving vocal function in adults irradiated for laryngeal cancer. The comparison treatment group (VH) received vocal hygiene counseling. STUDY DESIGN Randomized clinical trial. METHODS Participants were randomized to the VFE + VH or VH group. Both interventions lasted 6 weeks. The primary outcome measure was improvement in VHI scores. Secondary outcome measures included auditory-perceptual assessments, acoustic and aerodynamic measures, and laryngeal imaging. RESULTS Ten participants were recruited for the study. The VFE + VH (n = 6) group demonstrated a statistically significant improvement in the primary outcome measure (P = 0.03), as well as select parameters of all secondary outcome measures. The VH (n = 4) group did not demonstrate a statistically significant improvement in primary or secondary outcome measures. CONCLUSIONS This study offers preliminary data for the utility of VFEs in the irradiated laryngeal cancer population. However, findings in the VFE + VH group lack generalizability, secondary to sample heterogeneity, and limited sample size.
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Affiliation(s)
- Vrushali Angadi
- Division of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky.
| | - Emily Dressler
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mahesh Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Chandler Medical Center, Lexington, Kentucky
| | - Joseph Valentino
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Rony Aouad
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Thomas Gal
- Department of Otolaryngology-Head and Neck surgery, University of Kentucky, Lexington, Kentucky
| | - Joseph Stemple
- Division of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky
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Roy BC, Ahmed I, Ramalingam S, Jala V, Haribabu B, Ramamoorthy P, Ashcraft J, Valentino J, Anant S, Sampath V, Umar S. Co-localization of autophagy-related protein p62 with cancer stem cell marker dclk1 may hamper dclk1's elimination during colon cancer development and progression. Oncotarget 2019; 10:2340-2354. [PMID: 31040926 PMCID: PMC6481322 DOI: 10.18632/oncotarget.26684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/01/2019] [Indexed: 12/16/2022] Open
Abstract
Autophagy may play a critical role in colon cancer stem cells (CCSCs)-related cancer development. Here, we investigate whether accumulation of infection/injury-induced CCSCs due to impaired autophagy influences colon cancer development and progression. When Apc++ mice were infected with Citrobacter rodentium (CR; 109CFUs), we discovered presence of autophagosomes with increases in Beclin-1, LC3B and p62 staining during crypt hyperplasia. Apc1638N/+ mice when infected with CR or subjected to CR+AOM treatment, exhibited increased colon tumorigenesis with elevated levels of Ki-67, β-catenin, EZH2 and CCSC marker Dclk1, respectively. AOM/DSS treatment of Apc1638N/+ mice phenocopied CR+AOM treatment as colonic tumors exhibited pronounced changes in Ki-67, EZH2 and Dclk1 accompanied by infiltration of F4/80+ macrophages, CD3+ lymphocytes and CD3/β-catenin co-localization. Intestinal and colonic tumors also stained positive for migrating CSC markers CD110 and CDCP1 wherein, colonic tumors additionally exhibited stromal positivity. In tumors from CR-infected, CR+AOM or AOM/DSS-treated Apc1638N/+ mice and surgically-resected colon tumor/metastatic liver samples, significant accumulation of p62 and it's co-localization with LC3B and Dclk1 was evident. ApcMin/+ mice when infected with CR and BLT1−/−;ApcMin/+ mice, exhibited similar co-localization of p62 with LC3B and Dclk1 within the tumors. Studies in HCT116 and SW480 cells further confirmed p62/Dclk1 co-localization and Chloroquin/LPS-induced increases in Dclk1 promoter activity. Thus, co-localization of p62 with Dclk1 may hamper Dclk1's elimination to impact colon cancer development and progression.
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Affiliation(s)
- Badal Chandra Roy
- Departments of Surgery and Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ishfaq Ahmed
- Departments of Surgery and Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Satish Ramalingam
- Department of Genetic Engineering, School of Bio-Engineering, SRM Institute of Science and Technology, Kattankulathur, Kanchipuram, Tamil Nadu, India
| | - Venkatakrishna Jala
- James Graham Brown Cancer Center and Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA
| | - Bodduluri Haribabu
- James Graham Brown Cancer Center and Department of Microbiology and Immunology, University of Louisville, Louisville, KY, USA
| | - Prabhu Ramamoorthy
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - John Ashcraft
- Departments of Surgery and Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joseph Valentino
- Departments of Surgery and Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shrikant Anant
- Departments of Surgery and Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Venkatesh Sampath
- Division of Neonatology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shahid Umar
- Departments of Surgery and Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
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9
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Mouw TJ, Lu J, Woody-Fowler M, Ashcraft J, Valentino J, DiPasco P, Mammen J, Al-Kasspooles M. Morbidity and mortality of synchronous hepatectomy with cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). J Gastrointest Oncol 2018; 9:828-832. [PMID: 30505581 DOI: 10.21037/jgo.2018.06.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Liver resection in conjunction with partial colectomy for colon cancer is considered acceptable treatment for isolated metastasis to the liver. This method is unstudied in patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for carcinomatosis due to colon cancer and high grade appendiceal cancer. Methods A retrospective chart review included patients from 2005 to 2016 undergoing CRS/HIPEC. Cancers other than colorectal adenocarcinoma and high grade appendiceal carcinoma were excluded. Patients were divided into hepatectomy and non-hepatectomy groups. Data was collected by chart review from electronic medical records to assess morbidity and mortality, as well as oncologic outcomes of included patients. Results The average patient age, length of stay, and sex were similar between groups. For those in the hepatectomy group, 80% underwent minor hepatectomy, and 20% underwent major hepatectomy. The comprehensive complication index (CCI) scores ranged from 0 (no complications), to 100 (death). The average CCI between study groups was similar (27.29 vs. 17.41, P=0.09). Hepatectomy was associated with a higher rate of Clavien-Dindo classifications (CDCs) of III or greater. Complications included pressor requirement, renal failure, blood transfusions, TPN, pleural effusions and leaks requiring drain placement, respiratory failure, UTI, new onset atrial fibrillation, wound infections, and death. Conclusions Patients who underwent CRS/HIPEC and hepatectomy for colorectal and high grade appendiceal carcinomatosis had more severe complications at similar rates to non-hepatectomy patients. Complication rates should be considered when selecting patients for aggressive surgical intervention.
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Affiliation(s)
- Tyler J Mouw
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jennifer Lu
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Meghan Woody-Fowler
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - John Ashcraft
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joseph Valentino
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Peter DiPasco
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joshua Mammen
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mazin Al-Kasspooles
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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10
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Dean M, Valentino J, Ritter K, Church J. A novel endoscopic grading system for prediction of disease-related outcomes in patients with diverticulosis. Am J Surg 2018; 216:926-931. [PMID: 29792278 DOI: 10.1016/j.amjsurg.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/29/2018] [Accepted: 05/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND We describe a simple endoscopic grading system of diverticular disease for the assessment of disease severity and prediction of outcomes. METHODS A retrospective analysis of prospectively maintained colonoscopy database was conducted. A single endoscopist prospectively graded disease severity according to the number and size of diverticula, the degree of muscular hypertrophy and rigidity of the sigmoid colon. RESULTS 762 patients were included in the analysis. Mean patient age was 70 years (range 37-97). Endoscopic severity of diverticulosis was predictive of the need for surgery, with 2% in the mild-moderate, 12% in the severe and 33% in the acute group (p < 0001). Time to surgery showed correlation to severity grade, with mean periods of 107.5 months in the moderate group vs. 3 and 2.5 months in the severe and acute group (p < 0001). The mean follow up was 11 years. CONCLUSION Surgeons should consider using endoscopic grading as an adjunct to clinical management decisions.
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Affiliation(s)
- Meara Dean
- Department of Colorectal Surgery, Cleveland Clinic Foundation, 2049 East 100th Street, 44195, Cleveland, OH, USA
| | - Joseph Valentino
- University of Kansas Health System, 1450 Jayhawk Blvd, Lawrence, 66045, Kansas City, USA
| | - Kaitlin Ritter
- Department of Colorectal Surgery, Cleveland Clinic Foundation, 2049 East 100th Street, 44195, Cleveland, OH, USA
| | - James Church
- Department of Colorectal Surgery, Cleveland Clinic Foundation, 2049 East 100th Street, 44195, Cleveland, OH, USA.
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Wolf GT, Patel M, Erman A, Newman JG, Krempl G, Nieva J, Bell RB, Kaplan M, Kraus D, Moyer J, Panwar A, Valentino J. Abstract 31: The INSPIRE trial: A randomized trial of neoadjuvant and adjuvant therapy with the IRX-2 regimen in patients with newly diagnosed stage II, III, or IVa squamous cell carcinoma of the oral cavity. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.aacrahns17-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: IRX-2 is a primary-cell-derived immune-restorative biologic consisting of a well-defined set of human cytokines that act on multiple immune system cell types to overcome tumor-mediated immunosuppression. The IRX-2 biologic stimulates T cells and natural killer cells and turns immature or defective dendritic cells into mature antigen-presenting cells. The IRX-2 biologic is provided as part of the IRX-2 regimen, which contains cyclophosphamide, indomethacin, and zinc to support an anticancer immune response. In a phase 2a clinical trial in 27 patients with therapy-naïve head and neck squamous cell carcinoma (HNSCC), treatment with the IRX-2 regimen was well tolerated and associated with immunologically mediated antitumor effects. The new multicenter randomized IRX-2 Neoadjuvant Therapy in Head and Neck SCC to Provide Immune Response Enhancement (INSPIRE) trial (NCT02609386) is designed to evaluate the safety and effectiveness of combined neoadjuvant and adjuvant therapy with the IRX-2 regimen in patients with oral cavity HNSCC, a disease known to have a disordered immune function.
Study Design: Patients enrolled in INSPIRE must be at least 18 years of age; have previously untreated Stage II, III, or IVa SCC of the oral cavity that is surgically resectable with curative intent; and have a Karnofsky Performance status ≥70%. Up to 200 patients will be randomized 2:1 to either the IRX-2 biologic regimen arm or the IRX-2 regimen control arm (the IRX regimen minus the IRX-2 biologic).
The neoadjuvant stage of INSPIRE begins 21 days before resection, when patients in both treatment arms will receive the IRX-2 regimen each day until resection. This regimen consists of the immunomodulatory chemotherapeutic agent cyclophosphamide, provided as a low-dose intravenous infusion, as well as two oral drugs, a zinc-containing multivitamin and indomethacin, a nonselective COX-1/COX-2 inhibitor. During this period, patients in the IRX-2 biologic regimen arm will also receive 10 days of the IRX-2 biologic subcutaneously injected into their bilateral sternocleidomastoid insertion regions.
After resection, patients receive standard adjuvant radiation or chemoradiation therapy followed by adjuvant IRX-2 booster regimens at 3, 6, 9, and 12 months. During each 10-day booster period, patients in the IRX-2 biologic regimen arm also receive, for 5 consecutive days, the IRX-2 biologic subcutaneously injected into their bilateral deltoid regions.
Study Endpoints: INSPIRE is now enrolling patients at 12 selected institutions in the United States. The primary endpoint of INSPIRE is event-free survival (EFS). Secondary endpoints include overall survival (OS) and safety as assessed by the incidence and severity of adverse events. Exploratory endpoints include changes in tumor size and histologic differences between pre- and post-treatment specimens in lymphocytic infiltration, assessed by both cell-surface marker expression (Perkin Elmer multiplex IHC) and immune cell gene signatures (NanoString).
Conclusion: With enrollment of up to 200 patients, the randomized INSPIRE trial provides the opportunity to assess the ability of the IRX-2 regimen to improve EFS and OS by inhibiting tumor-mediated immunosuppression. Analysis of the exploratory endpoints will generate data to better describe the mechanism of action of the IRX-2 regimen and provide insight into the differences between inflammatory and non-inflammatory responses to SCCs of the oral cavity.
Citation Format: Gregory T. Wolf, Mihir Patel, Audrey Erman, Jason G. Newman, Greg Krempl, Jorge Nieva, R. Bryan Bell, Michael Kaplan, Dennis Kraus, Jeffrey Moyer, Aru Panwar, Joseph Valentino. The INSPIRE trial: A randomized trial of neoadjuvant and adjuvant therapy with the IRX-2 regimen in patients with newly diagnosed stage II, III, or IVa squamous cell carcinoma of the oral cavity [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 31.
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Affiliation(s)
| | - Mihir Patel
- 2Emory University Winship Cancer Institute, Atlanta, GA,
| | - Audrey Erman
- 3University of Arizona Medical Center, Tucson, AZ,
| | - Jason G. Newman
- 4Hospital of the University of Pennsylvania, Philadelphia, PA,
| | - Greg Krempl
- 5University of Oklahoma Health Sciences Center, Oklahoma City, OK,
| | - Jorge Nieva
- 6University of Southern California, Los Angeles, CA,
| | | | | | - Dennis Kraus
- 9Northwell Health/Lenox Hill Hospital, New York, NY,
| | | | - Aru Panwar
- 10University of Nebraska Medical Center, Omaha, NE,
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Burnett N, Dhanireddy B, Ain K, Valentino J, Gal T, Kudrimoti M. External Beam Radiation Therapy in Radioactive Iodine Refractory Thyroid Carcinoma: Long-Term Outcomes and Side Effects. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fletcher KT, Gal TJ, Ebelhar AJ, Valentino J, Brill YM, Dressler EV, Aouad RK. Prognostic indicators and survival in salvage surgery for laryngeal cancer. Head Neck 2017; 39:2021-2026. [DOI: 10.1002/hed.24860] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/28/2016] [Accepted: 05/18/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Kyle T. Fletcher
- Department of Otolaryngology; University of Kentucky Medical Center; Lexington Kentucky
| | - Thomas J. Gal
- Department of Otolaryngology; University of Kentucky Medical Center; Lexington Kentucky
| | - Andrew J. Ebelhar
- Department of Otolaryngology; University of Kentucky Medical Center; Lexington Kentucky
| | - Joseph Valentino
- Department of Otolaryngology; University of Kentucky Medical Center; Lexington Kentucky
| | - Yolanda M. Brill
- Department of Pathology; University of Kentucky Medical Center; Lexington Kentucky
| | - Emily V. Dressler
- Division of Cancer Biostatistics; University of Kentucky Medical Center; Lexington Kentucky
| | - Rony K. Aouad
- Department of Otolaryngology; University of Kentucky Medical Center; Lexington Kentucky
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Wicker CA, Scott TL, Suganya R, Arnold SM, Brill YM, Horbinski CM, Napier D, Valentino J, Kudrimoti MR, Yu G, Izumi T. Abstract 4142: Regulation of tumor suppressor decorin by APE1 in head and neck squamous cell carcinoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Oral cancers have a high rate of recurrence, and a tendency to develop treatment resistance. From 2009 to 2013, Kentucky had a disproportionately higher incidence of invasive oral cancers and resultant higher mortality compared to the national average (SEER & NPCR, Kentucky Cancer Registry).
Apurinic/Apyrimidinic endonuclease (APE1) is a key protein in DNA repair, and an important transcriptional regulator. Gene array analysis in pMEFs expressing wild-type APE1 and extremely low levels of APE1 showed an eight-fold reduction of tumor suppressor decorin (DCN), with wild-type APE1.
Decorin is a known tumor suppressor and extracellular matrix protein, which can suppress tumor proliferation, migration and angiogenesis. Tumors with decreased decorin are associated with increased mortality.
These studies aim to elucidate APE1’s role in decorin regulation in oral cancer and identify biomarkers, which may aid in diagnosis, treatment, or predicting prognosis.
Immunohistochemistry studies of head and neck squamous cell carcinoma from Kentuckians were analyzed aided by Aperio’s high resolution scanning capabilities, and software. Analysis showed a significant decrease in decorin in both tumor and carcinoma in situ compared to benign tissue. Whereas, APE1 was significantly increased in tumors. Additionally there was a significant negative correlation between APE1 and decorin total protein in carcinoma in situ. This data supports that increased APE1 may deplete decorin. Superoxide Dismutase 3, which is important in detoxifying extracellular ROS, was also significantly decreased in tumor and in carcinoma in situ. This along with previous research showing increased ROS in the tumor microenvironment and APE1 activation by ROS may explain the origination of decorin suppression.
We hypothesize that the overexpression of APE1 in early stages of oral cancer leads to diminished decorin translation, which may drive cancer progression and increase mortality. Better understanding how APE1 influences tumor suppressors may eventually aid in development of therapeutics that would increase patient survival.
Citation Format: Christina A. Wicker, Timothy L. Scott, Rangaswamy Suganya, Susan M. Arnold, Yolanda M. Brill, Craig M. Horbinski, Dana Napier, Joseph Valentino, Mahesh R. Kudrimoti, Guoqiang Yu, Tadahide Izumi. Regulation of tumor suppressor decorin by APE1 in head and neck squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4142. doi:10.1158/1538-7445.AM2017-4142
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Abstract
Problem Dietary flavonoids are being investigated as chemopreventative agents for many cancers. The objective of this study was to determine whether the dietary flavonoids apigenin and kaempferol inhibit growth of malignant oral keratinocytes. Methods FaDu cells were treated with increasing concentrations of apigenin and kaempferol. After 24 and 48 hours cell growth was determined using the WST-1 assay. Three groups of nude mice (group 1-kaempferol, group 2-apigenin, group 3-controls) were treated by gavage for one week prior to inoculation with FaDu cells (1 × 105 cells) Following inoculation, treatments were continued until sacrifice. Tumor volumes were calculated from three dimensional tumor measurements. Results In vitro cell growth decreased with increasing concentrations of apigenin and kaempferol (p<0.001). In vivo tumor volume was significantly higher than controls for the apigenin group (p<0.03) but was marginally higher in kaempferol group (p=0.09) with an average volume of 3024mm3, 2610 mm3, and 1858 mm3 respectively. Conclusion Apigenin and kaempferol inhibited tumor cell growth in culture. However, in vivo results show that these substances increased tumor burden. This is in contrast to previous in vivo and in vitro prostate cell line models showing apigenin inhibition of tumor growth. Further studies are needed to better evaluate the effect these dietary flavonoids exert on squamous cell carcinoma of the head and neck. Significance The role of these agents as chemopreventative agents for oral carcinoma is not supported by our data. Support University of Kentucky Department of Surgery Research Grant and NIH R-01 grant.
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Abstract
The management of patients with head and neck cancer can be complicated by massive carotid artery hemorrhage, often requiring ligation owing to the emergent conditions and scarring from previous surgery and radiation. A case of emergent endovascular management of carotid artery hemorrhage in a patient treated for pharyngeal carcinoma is described. Hemorrhage was controlled, but on follow-up the patient developed a carotid-cutaneous fistula with exposure of the coils. Further management required the use of autogenous vein to replace the involved vessels. This case demonstrates that endovascular control of carotid hemorrhage can be successful, but close follow-up is necessary to identify potential subsequent complications.
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Affiliation(s)
- Jeffrey A Hertz
- Division of Vascular Surgery, University of Kentucky School of Medicine, Lexington, KY 40536, USA
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Arnold SM, Kudrimoti M, Dressler EV, Gleason JF, Silver NL, Regine WF, Valentino J. Using low-dose radiation to potentiate the effect of induction chemotherapy in head and neck cancer: Results of a prospective phase 2 trial. Adv Radiat Oncol 2016; 1:252-259. [PMID: 28740895 PMCID: PMC5514161 DOI: 10.1016/j.adro.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022] Open
Abstract
Purpose Low-dose fractionated radiation therapy (LDFRT) induces effective cell killing through hyperradiation sensitivity and potentiates effects of chemotherapy. We report our second investigation of LDFRT as a potentiator of the chemotherapeutic effect of induction carboplatin and paclitaxel in locally advanced squamous cell cancer of the head and neck (SCCHN). Experimental design Two cycles of induction therapy were given every 21 days: paclitaxel (75 mg/m2) on days 1, 8, and 15; carboplatin (area under the curve 6) day 1; and LDFRT 50 cGy fractions (2 each on days 1, 2, 8, and 15). Objectives included primary site complete response rate; secondary included overall survival, progression-free survival (PFS), disease-specific survival, and toxicity. Results A total of 24 evaluable patients were enrolled. Primary sites included oropharynx (62.5%), larynx (20.8%), oral cavity (8.3%), and hypopharynx (8.3%). Grade 3/4 toxicities included neutropenia (20%), leukopenia (32%), dehydration/hypotension (8%), anemia (4%), infection (4%), pulmonary/allergic rhinitis (4%), and diarrhea (4%). Primary site response rate was 23/24 (95.8%): 15/24 (62.5%) complete response, 8/24 (33.3%) partial response, and 1/24 (4.2%) stable disease. With median follow-up of 7.75 years, 9-year rates for overall survival were 49.4% (95% confidence interval [CI], 30.5-79.9), PFS was 72.2% (CI, 55.3-94.3), and disease-specific survival was 65.4% (44.3-96.4). Conclusion Chemopotentiating LDFRT combined with paclitaxel and carboplatin is effective in SCCHN and provided an excellent median overall survival of 107.2 months, with median PFS not yet reached in this locally advanced SCCHN cohort. This compares favorably to prior investigations and caused fewer grade 3 and 4 toxicities than more intensive, 3-drug induction regimens. This trial demonstrates the innovative use of LDFRT as a potentiator of chemotherapy.
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Affiliation(s)
- Susanne M Arnold
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | - Mahesh Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | - Emily V Dressler
- Division of Cancer Biostatistics, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | | | | | - William F Regine
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Joseph Valentino
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
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Silver NL, Arnold SM, Gleason JF, Kudrimoti M, Brill Y, Dressler EV, Valentino J. p16INK4a Status and Response to Induction Low-Dose Fractionated Radiation in Advanced Head and Neck Cancer. Ann Otol Rhinol Laryngol 2015; 124:714-20. [PMID: 25810339 PMCID: PMC5555599 DOI: 10.1177/0003489415579220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the impact of p16INK4a (p16) expression on clinical efficacy of induction low-dose fractionated radiation therapy (LDFRT) with concurrent chemotherapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). STUDY DESIGN Historical cohort study. SETTING Tertiary medical center. METHODS A total of 66 Patients with locally advanced SCCHN were enrolled in 2 clinical trials using paclitaxel, carboplatin, and concurrent LDFRT induction therapy. Patients were evaluated for response to induction by a multidisciplinary team and then were given definitive treatment. Adequate tissue samples from the pretreatment biopsies of 42 individuals were identified and analyzed for p16 expression. Expression was correlated with clinical outcomes. RESULTS Of 42 tumors, 15 (35.7%) were positive for p16. Patients with p16-positive tumors had improved response to induction, but this was not statistically significant (P = .06). Five-year overall survival was 80% in p16-positive patients and 58% in p16-negative patients (P = .025). CONCLUSIONS p16 Expression affects treatment response in patients treated with induction LDFRT with concurrent chemotherapy. This is similar to results reported for standard induction chemotherapy.
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Affiliation(s)
- Natalie L Silver
- Department of Otolaryngology HNS, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Susanne M Arnold
- Division of Medical Oncology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - John F Gleason
- Department of Radiation, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Mahesh Kudrimoti
- Department of Radiation, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Yolanda Brill
- Department of Pathology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Emily V Dressler
- Division of Cancer Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky, USA
| | - Joseph Valentino
- Department of Otolaryngology HNS, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Huang C, Radabaugh JP, Aouad RK, Lin Y, Gal TJ, Patel AB, Valentino J, Shang Y, Yu G. Noncontact diffuse optical assessment of blood flow changes in head and neck free tissue transfer flaps. J Biomed Opt 2015; 20:075008. [PMID: 26187444 PMCID: PMC4696658 DOI: 10.1117/1.jbo.20.7.075008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/23/2015] [Indexed: 05/18/2023]
Abstract
Knowledge of tissue blood flow (BF) changes after free tissue transfer may enable surgeons to predict the failure of flap thrombosis at an early stage. This study used our recently developed noncontact diffuse correlation spectroscopy to monitor dynamic BF changes in free flaps without getting in contact with the targeted tissue. Eight free flaps were elevated in patients with head and neck cancer; one of the flaps failed. Multiple BF measurements probing the transferred tissue were performed during and post the surgical operation. Postoperative BF values were normalized to the intraoperative baselines (assigning "1") for the calculation of relative BF change (rBF). The rBF changes over the seven successful flaps were 1.89 ± 0.15, 2.26 ± 0.13, and 2.43 ± 0.13 (mean ± standard error), respectively, on postoperative days 2, 4, and 7. These postoperative values were significantly higher than the intraoperative baseline values (p<0.001), indicating a gradual recovery of flap vascularity after the tissue transfer. By contrast, rBF changes observed from the unsuccessful flaps were 1.14 and 1.34, respectively, on postoperative days 2 and 4, indicating less flow recovery. Measurement of BF recovery after flap anastomosis holds the potential to act early to salvage ischemic flaps.
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Affiliation(s)
- Chong Huang
- University of Kentucky, Department of Biomedical Engineering, 143 Graham Avenue, Lexington, Kentucky 40506, United States
| | - Jeffrey P. Radabaugh
- University of Kentucky College of Medicine, Department of Otolaryngology–Head and Neck Surgery, 800 Rose Street, Lexington, Kentucky 40536, United States
| | - Rony K. Aouad
- University of Kentucky College of Medicine, Department of Otolaryngology–Head and Neck Surgery, 800 Rose Street, Lexington, Kentucky 40536, United States
| | - Yu Lin
- University of Kentucky, Department of Biomedical Engineering, 143 Graham Avenue, Lexington, Kentucky 40506, United States
| | - Thomas J. Gal
- University of Kentucky College of Medicine, Department of Otolaryngology–Head and Neck Surgery, 800 Rose Street, Lexington, Kentucky 40536, United States
| | - Amit B. Patel
- University of Kentucky College of Medicine, Department of Otolaryngology–Head and Neck Surgery, 800 Rose Street, Lexington, Kentucky 40536, United States
| | - Joseph Valentino
- University of Kentucky College of Medicine, Department of Otolaryngology–Head and Neck Surgery, 800 Rose Street, Lexington, Kentucky 40536, United States
| | - Yu Shang
- University of Kentucky, Department of Biomedical Engineering, 143 Graham Avenue, Lexington, Kentucky 40506, United States
| | - Guoqiang Yu
- University of Kentucky, Department of Biomedical Engineering, 143 Graham Avenue, Lexington, Kentucky 40506, United States
- Address all correspondence to: Guoqiang Yu,
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Rychahou P, Haque F, Shu Y, Zaytseva Y, Weiss HL, Lee EY, Mustain W, Valentino J, Guo P, Evers BM. Delivery of RNA nanoparticles into colorectal cancer metastases following systemic administration. ACS Nano 2015; 9:1108-16. [PMID: 25652125 PMCID: PMC4613746 DOI: 10.1021/acsnano.5b00067] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The majority of deaths from all cancers, including colorectal cancer (CRC), is a result of tumor metastasis to distant organs. To date, an effective and safe system capable of exclusively targeting metastatic cancers that have spread to distant organs or lymph nodes does not exist. Here, we constructed multifunctional RNA nanoparticles, derived from the three-way junction (3WJ) of bacteriophage phi29 motor pRNA, to target metastatic cancer cells in a clinically relevant mouse model of CRC metastasis. The RNA nanoparticles demonstrated metastatic tumor homing without accumulation in normal organ tissues surrounding metastatic tumors. The RNA nanoparticles simultaneously targeted CRC cancer cells in major sites of metastasis, such as liver, lymph nodes, and lung. Our results demonstrate the therapeutic potential of these RNA nanoparticles as a delivery system for the treatment of CRC metastasis.
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Affiliation(s)
- Piotr Rychahou
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, United States
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
| | - Farzin Haque
- Nanobiotechnology Center, University of Kentucky, Lexington, KY 40536, United States
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, United States
| | - Yi Shu
- Nanobiotechnology Center, University of Kentucky, Lexington, KY 40536, United States
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, United States
| | - Yekaterina Zaytseva
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, United States
| | - Heidi L. Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, United States
| | - Eun Y. Lee
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, United States
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
- Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY 40536, United States
| | - William Mustain
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
| | - Joseph Valentino
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
| | - Peixuan Guo
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, United States
- Nanobiotechnology Center, University of Kentucky, Lexington, KY 40536, United States
- Department of Pharmaceutical Sciences, University of Kentucky, Lexington, KY 40536, United States
| | - B. Mark Evers
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, United States
- Department of Surgery, University of Kentucky, Lexington, KY 40536, United States
- Corresponding Author: B. Mark Evers, M.D., Markey Cancer Center, University of Kentucky, 800 Rose Street, CC140, Lexington, KY 40536, Phone: 859-323-6556, Fax: 859-323-2074,
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Spring PM, Arnold SM, Shajahan S, Brown B, Dey S, Lele SM, Valentino J, Jones R, Mohiuddin M, Ahmed MM. Low Dose Fractionated Radiation Potentiates the Effects of Taxotere in Nude Mice Xenografts of Squamous Cell Carcinoma of Head and Neck. Cell Cycle 2014. [DOI: 10.4161/cc.3.4.786] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wooten CE, Wilson A, Arnold SM, Gal T, Aouad R, Valentino J, Kudrimoti MR. Surgery and definitive chemoradiation (CRT) for locally advanced oropharyngeal cancer and impact of transoral robotic surgery (TORS). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Alex Wilson
- Department of Radiation Medicine, University of Kentucky, Lexington, KY
| | - Susanne M. Arnold
- Department of Medical Oncology, Department of Radiation Oncology, University of Kentucky, Lexington, KY
| | - Thomas Gal
- Department of Otolaryngology, University of Kentucky, Lexington, KY
| | - Rony Aouad
- Department of Otolaryngology, University of Kentucky, Lexington, KY
| | - Joseph Valentino
- Department of Otolaryngology, University of Kentucky, Lexington, KY
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Zaytseva YY, Elliott VA, Rychahou P, Mustain WC, Kim JT, Valentino J, Gao T, O'Connor KL, Neltner JM, Lee EY, Weiss HL, Evers BM. Cancer cell-associated fatty acid synthase activates endothelial cells and promotes angiogenesis in colorectal cancer. Carcinogenesis 2014; 35:1341-51. [PMID: 24510238 DOI: 10.1093/carcin/bgu042] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Upregulation of fatty acid synthase (FASN), a key enzyme of de novo lipogenesis, is associated with metastasis in colorectal cancer (CRC). However, the mechanisms of regulation are unknown. Since angiogenesis is crucial for metastasis, we investigated the role of FASN in the neovascularization of CRC. The effect of FASN on tumor vasculature was studied in orthotopic CRCs, the chick embryo chorioallantoic membrane (CAM) and Matrigel plug models using immunohistochemistry, immunofluorescent staining and confocal microscopy. Cell secretion was evaluated by ELISA and antibody arrays. Proliferation, migration and tubulogenesis of endothelial cells (ECs) were assessed in CRC-EC coculture models. In this study, we found that stable knockdown of FASN decreased microvessel density in HT29 and HCT116 orthotopic CRCs and resulted in 'normalization' of tumor vasculature in both orthotopic and CAM models. Furthermore, FASN regulated secretion of pro- and antiangiogenic factors, including vascular endothelial growth factor-A (VEGF-A). Mechanisms associated with the antiangiogenic activity noted with knockdown of FASN included: downregulation of VEGF(189), upregulation of antiangiogenic isoform VEGF(165b) and a decrease in expression and activity of matrix metalloproteinase-9. Furthermore, conditioned medium from FASN knockdown CRC cells inhibited activation of vascular endothelial growth factor receptor-2 and its downstream signaling and decreased proliferation, migration and tubulogenesis of ECs as compared with control medium. Together, these results suggest that cancer cell-associated FASN regulates tumor vasculature through alteration of the profile of secreted angiogenic factors and regulation of their bioavailability. Inhibition of FASN upstream of VEGF-A and other angiogenic pathways can be a novel therapeutic strategy to prevent or inhibit metastasis in CRC.
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Affiliation(s)
| | | | | | | | - Ji Tae Kim
- Markey Cancer Center, Department of Surgery
| | | | - Tianyan Gao
- Department of Molecular and Cellular Biochemistry
| | | | | | - Eun Y Lee
- Markey Cancer Center, Department of Surgery, Department of Pathology and Laboratory Medicine and
| | - Heidi L Weiss
- Markey Cancer Center, Department of Biostatistics, University of Kentucky, Lexington, KY 40536, USA
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Swanson HI, Choi EY, Helton WB, Gairola CG, Valentino J. Impact of apigenin and kaempferol on human head and neck squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:214-20. [PMID: 24439916 DOI: 10.1016/j.oooo.2013.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/27/2013] [Accepted: 10/17/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Apigenin and kaempferol are plant flavonoids with reported chemopreventive activities. This study aimed to determine the effect of apigenin and kaempferol on cell viability in cultured cells derived from the pharynx (FaDu cell line), an oral cavity carcinoma (PCI-13 cell line), and a metastatic lymph node (PCI-15B cell line) and in explanted FaDu cells. STUDY DESIGN The in vitro viability of FaDu, PCI-13, and PCI-15B cells treated with apigenin and kaempferol was determined. Tumor growth of FaDu explants was evaluated in athymic mice that were gavaged with either apigenin or kaempferol. RESULTS Although apigenin and kaempferol treatment decreased viability of cells in vitro, cell-type-dependent differences in responsiveness were observed. In vivo apigenin treatment significantly increased the tumor size of FaDu explants. Results obtained using kaempferol were similar. CONCLUSIONS The in vitro decrease in FaDu cell viability by apigenin and kaempferol was not observed in in vivo tumor explants using the conditions described in this study.
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Affiliation(s)
- Hollie I Swanson
- Professor, Department of Molecular and Biomedical Pharmacology, University of Kentucky College of Medicine, Lexington, KY, USA.
| | - Eun-Young Choi
- Professor, Department of Molecular and Biomedical Pharmacology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - W Brian Helton
- Partner, Mark Veronneau Plastics and ENT, Prestonsburg, KY, USA
| | - C Gary Gairola
- Professor, Graduate Center for Toxicology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Joseph Valentino
- Professor, Division of Otolaryngology-Head and Neck Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
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Xenos ES, Orr N, Valentino J. Internal carotid pseudoaneurysm associated with tortuosity after tonsillectomy: a case report. Int J Angiol 2013; 21:159-62. [PMID: 23997561 DOI: 10.1055/s-0032-1324737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
We present a patient who was found to have an internal carotid pseudoaneurysm 3 years after tonsillectomy and chemoradiation for tonsillar cancer. Ha also had severe tortuosity of both internal carotid arteries. The lesion was in an anatomically challenging location, but an endoluminal approach was not feasible because of the extreme tortuosity. He underwent open repair with resection of the pseudoaneurysm and direct anastomosis with good results.
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Valentino J, Helton WB, Unnikrishnan R, Kudrimoti M, Arnold SM, Gal TJ. Microvascular reconstruction after intra-arterial chemotherapy with concomitant radiation. Otolaryngol Head Neck Surg 2013; 149:541-6. [PMID: 23894148 DOI: 10.1177/0194599813497923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE While the success of microvascular reconstruction is well established, even in the setting of prior radiotherapy, the outcomes in the setting of prior chemoradiation are less well documented. We present our experience with microvascular reconstruction in a unique cohort of patients previously treated with concomitant hyperfractionated radiation and intra-arterial chemotherapy (HYPERRADPLAT). Despite the observation in prior studies of minimal vessel damage in this setting, the hypothesis of this study is that in the late setting of most salvage surgical therapy, either for recurrence or osteoradionecrosis, a different, progressive level of vessel injury may be encountered. STUDY DESIGN Case series with chart review. SETTING Tertiary referral academic medical center practice. SUBJECTS AND METHODS Eighty-four patients received primary treatment for advanced head and neck squamous cell carcinoma with HYPERRADPLAT. Of these, 8 patients (10%) underwent free tissue transfer reconstruction and a total of 11 free flaps. RESULTS Wound breakdown, fistula, or both occurred postoperatively in 50% (4/8) of these patients. No complications of the venous anastomoses occurred. Fifty percent (4/8) of patients required return to surgery for arterial failure due to thrombosis of the anastomosis. Two cases of these flaps could not be salvaged. CONCLUSION Microvascular reconstruction following HYPERRADPLAT appears to result in a high number of arterial related complications. This experience implies an important delayed treatment effect of HYPERRADPLAT occurs upon recipient arteries. The manner in which this effect may occur in recipient arteries in the setting of more conventional chemoradiation requires further study.
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Affiliation(s)
- Joseph Valentino
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Abstract
BACKGROUND External beam radiotherapy (XRT) has an established role in the management of recurrent or advanced well-differentiated thyroid carcinoma (WDTC). The goal of this study was to investigate the impact of this additional intervention on the quality of life (QOL) compared with total thyroidectomy (TT), with or without adjuvant radioactive iodine (RAI). METHODS A cross-sectional analysis using validated QOL instruments was performed. Patients receiving XRT between 1992 and 2008 for WDTC were identified and offered study participation. The Quality of Life Radiation Therapy Instrument and the Head and Neck Companion Module were administered retrospectively (N=13). For a comparison, patients previously treated with TT (N=11) alone as well as TT with postoperative RAI (N=11) for WDTC were also evaluated. RESULTS Thirty-four patients were included in the analysis. The XRT group reported significant decreases in chewing, swallowing, and appetite, and significant increase in pain, compared with both the RAI group and the TT group. Significant differences were reported for questions with regard to peace of mind, feeling discouraged, saliva, taste, ability to eat regular food, and concerns for the appearance of the neck in both RAI and XRT groups compared with TT patients. Subscale analysis of head and neck specific questions demonstrated significant overall differences for both RAI and XRT groups compared with thyroidectomy alone, with no differences observed between RAI and XRT groups in a direct comparison. CONCLUSIONS RAI therapy results in a measurable decrease in head and neck specific QOL measures compared with TT alone. The addition of XRT results in additional measurable morbidity secondary to pain and dysphagia.
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Affiliation(s)
- Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
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Alexander D, Alexander K, Valentino J. Intranasal hydrocodone-acetaminophen abuse induced necrosis of the nasal cavity and pharynx. Laryngoscope 2012; 122:2378-81. [PMID: 22965281 DOI: 10.1002/lary.23542] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Two million new users will abuse prescription narcotics this year, most commonly hydrocodone. The most commonly prescribed form is hydrocodone-acetaminophen (HA). Many individuals crush the tablets and snort the product to take advantage of the rapid transmucosal delivery of narcotics. The resultant pathology of intranasal hydrocodone acetaminophen abuse (INHAA) has been described only in a few case studies. STUDY DESIGN Retrospective chart review. METHODS Two private and one academic otolaryngology practices in Kentucky searched their patient charts for patients with morbidity from intranasal abuse of hydrocodone acetaminophen tablets. We identified thirty-five patients who presented for treatment between 2004 and 2011. RESULTS The majority of patients will initially deny the behavior, frequently delaying diagnosis. Physical exam findings of white powder covering an underlying nasal mucosal necrosis are characteristic of this condition during active INHAA. Follow up was limited as only 26% returned for follow-up care. Patients commonly presented with orofacial-nasal pain (43%) and sino-nasal congestion and discharge (43%). Active necrosis or prior tissue loss was noted in 77% of patients. Fifty-one percent of patients presented with septal perforations, and 26% with palatal perforations. Two cases of invasive fungal sinusitis were clearly documented, with one resulting in death. CONCLUSIONS The vast majority of cases presented with characteristic physical findings that included acute necrosis of soft tissue, which can progress to destroy oronasal structures. In the absence of invasive fungal disease, the condition is self-limited after cessation of INHAA and performance of local nasal debridement and nasal hygiene.
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Affiliation(s)
- David Alexander
- Department of Otolaryngology, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0084, USA
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Silver N, Brill Y, Baffi J, Albuquerque R, Ambati J, Valentino J. Soluble VEGFR-2 Expression in Head and Neck Malignant Tumors. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451426a173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: 1) Define the spatial pattern of expression of soluble vascular endothelial growth factor receptor 2 (sVEGFR-2), a recently discovered receptor that has an important role in tumor lymphangiogenesis, in head and neck malignant tumors. 2) Examine the relationship between sVEGFR-2 expression and lymphatic vessel density in head and neck malignant tumors. Method: One hundred ten paraffin-embedded tissue samples from patients with malignant tumors were stained using immunohistochemistry for sVEGFR-2 and podoplanin, a marker for lymphatic vessels. Tissues studied included: squamous cell carcinoma of the larynx (61), oral cavity (16), oropharynx (20), hypopharynx (5), nasopharynx (1). Papillary (4), medullary (2), and follicular (1) thyroid cancers were also examined. Results: sVEGFR-2 expression was identified in all squamous cell carcinomas of the head and neck. Expression was specific to the endothelial cells in blood vessels of both malignant tissue as well as adjacent normal tissues. sVEGFR-2 was not expressed in lymphatic vessels. This secreted protein was also expressed in tissue stroma. Decreased expression of sVEGFR-2 was correlated with increased lymphatic vessel density in tumors, as measured by podoplanin expression. sVEGFR-2 was minimally expressed in normal thyroid tissue but was abundant in the basement membrane of papillary thyroid cancer cells. Conclusion: We have provided the first evidence of sVEGFR-2 expression in head and neck malignant tumors. Its expression correlates with lymphatic vessel density in head and neck malignant tumors and ongoing studies will reveal the precise function of sVEGFR-2 in nodal metastasis and disease progression.
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Wilson WA, Valentino J, Gal T, Sloan D, Ain KB, Arnold SM, Brill Y, Kudrimoti MR. Excellent long-term control in locoregionally recurrent radioactive iodine-refractory papillary thyroid cancer with the addition of external beam radiation therapy to maximal surgical resection. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e16035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16035 Background: Locoregionally recurrent radioactive iodine (RAI) refractory papillary thyroid cancer represents a small percentage of papillary thyroid cancers but is an aggressive disease with significantly lower survival rates. This retrospective review is our experience with these cancers treated with maximal surgical resection followed by external beam radiotherapy. Methods: 26 patients treated from 2001-2011 were eligible for review. After obtaining IRB approval, medical records were reviewed for clinical outcome. All patients had histologically proven recurrences that were negative on I-131 scans. All patients were maximally resected. All patients received external radiotherapy to the thyroid bed, bilateral cervical lymph node levels II-IV, level VI, and superior mediastinal nodes. 15/26 patients received intensity modulated, 9/26 patients received 3-D conformal, and 2/26 patients received Tomotherapy radiation treatment. The mean dose was 5790 cGy (range 5280-6800 cGy). Results: All histologies were papillary thyroid cancer with 4/26 exhibiting tall cell features and 1/26 diffuse sclerosing features. All patients had locoregional relapse in the cervical nodes (16/26) or in the mediastinum (5/26) or both areas (5/26). The mean pre-treatment thyroglobulin was 5.2 (range <0.1 to 599.1). The mean post-treatment thyroglobulin was 1.0 (range <0.1-5.2). Median follow-up was 55 months (range 7-123 months). 0/26 patients failed locoregionally. 2/26 patients failed distantly (lungs). 20/26 patients (77%) of patients had undetectable thyroglobulin at last follow-up. 4/26 patients had detectable thyroglobulin (2.5-16.9), but had not recurred on imaging. 2/26 required PEG placement during treatment, but 0/26 patients were PEG-dependent on long-term follow-up. 1/26 patients experienced grade III osteoradionecrosis of the mandible. Conclusions: External beam radiotherapy provides excellent locoregional control for locoregionally recurrent radioactive iodine-refractory papillary thyroid cancers. Long-term grade III and IV toxicities are uncommon.
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Affiliation(s)
- William A. Wilson
- University of Kentucky Department of Radiation Medicine, Lexington, KY
| | - Joseph Valentino
- University of Kentucky Department of Otolaryngology, Lexington, KY
| | - Thomas Gal
- University of Kentucky Department of Otolaryngology, Lexington, KY
| | - David Sloan
- University of Kentucky Department of Surgery, Lexington, KY
| | - Kenneth B. Ain
- University of Kentucky Department of Internal Medicine Division of Endocrinology, Lexington, KY
| | - Susanne M. Arnold
- University of Kentucky Department of Internal Medicine Division of Hematology/Oncology, Lexington, KY
| | - Yolanda Brill
- University of Kentucky Department of Pathology, Lexington, KY
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Affiliation(s)
- Joseph Valentino
- Department of Surgery, Markey Cancer Center, The University of Kentucky, 800 Rose Street, CC140, Lexington, KY 40536-0093, USA
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Gal TJ, Sokoya F, Valentino J. Percutaneous Gastrostomy Complications and the Management of Head and Neck Cancer. Otolaryngol Head Neck Surg 2011. [DOI: 10.1177/0194599811415823a131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: 1) Understand the surgical site morbidity of percutaneous gastrostomy (PEG) in the head and neck cancer population. 2) Understand the implications of PEG morbidity on the therapy for head and neck cancer. Method: A retrospective review was performed on patients with head and neck cancer undergoing PEG in a tertiary care center. Patients treated between 1998 and 2008 were eligible for inclusion. Demographic and oncologic data were recorded. Primary outcome measures were surgical complications and complication type arising from the gastrostomy itself. Results: A total of 153 patients were identified with sufficient data available for review. A total of 61.6% of patients were male. Mean age was 58.1 years. Complications were observed in 28.1% of patients. The most common documented complication was leakage around the gastrostomy site (9.2%). Other observed complications included cellulitis of the abdominal wall (8.5%), abdominal wall abscess (1%), buried or extruded bumper (8%), and non-patent tubes (2.3%). Major complications were documented in 4 patients (2.6%) and included hemorrhage, perforated viscus, and peritonitis. No association of complications of any type with age, gender, tumor site, stage, or surgical service were observed. Conclusion: Complications resulting from PEG in the head and neck cancer population are for the most part minor, self limited, and likely underreported. Major complications are infrequent but can be significant. Management and treatment implications with regards to head and neck cancer are discussed.
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Abstract
The characteristics of facial nerve electromyography at various levels of neuromuscular blockade are unclear. Partial blockade is well known to facilitate anesthetic safety and management. However, the use of neuromuscular blockage in many skull base procedures is avoided to allow intraoperative facial nerve monitoring.We studied the influence of various levels of neuromuscular blockade on facial nerve stimulation in the New Zealand white rabbit. The facial nerve was exposed in the middle ear of six rabbits. Using electromyographic-type facial nerve monitor, we recorded the facial electromyography signals in these rabbits at increasing levels of vecuronium-induced neuromuscular blockade. All animals demonstrated reliable facial electromyography response at all levels of partial neuromuscular blockade (P < .02). Five of the six animals could be monitored throughout complete blockade. These results clearly demonstrate that rabbit facial electromyography monitoring is possible under neuromuscular blockade. The effect of neuromuscular blockers on facial electromyography monitoring deserves further study, as partial blockade would greatly facilitate the management of anesthesia in otologic, neurotologic, and skull base surgery.
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Kudrimoti MR, Arnold SM, Valentino J, Gal T, Hyland A, Singh A, Rangnekar V, Cummings KM, Marshall JR, Warren GW. The accuracy of tobacco assessment during definitive radiotherapy or chemoradiotherapy in patients with head and neck cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kudrimoti MR, Arnold SM, Valentino J, Randall M, Warren GW. Longitudinal self-reported and serum-based assessment of tobacco or nicotine use in head and neck cancer patients during definitive radiotherapy or chemoradiotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Warren GW, Arnold SM, Valentino J, Randall M, Kudrimoti MR. A rationale and model for tobacco and nicotine assessment during cancer treatment. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kudrimoti M, Arnold S, Valentino J, Rangnekar V, Randall M, Warren G. Assessment of Nicotine Exposure in Head and Neck Cancer Patients during Treatment with Radiotherapy or Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yoo GH, Moon J, Leblanc M, Lonardo F, Urba S, Kim H, Hanna E, Tsue T, Valentino J, Ensley J, Wolf G. A phase 2 trial of surgery with perioperative INGN 201 (Ad5CMV-p53) gene therapy followed by chemoradiotherapy for advanced, resectable squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx: report of the Southwest Oncology Group. ACTA ACUST UNITED AC 2009; 135:869-74. [PMID: 19770418 DOI: 10.1001/archoto.2009.122] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the feasibility of treating patients with high-risk stage III and IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx with perioperative adenovirus-p53 (INGN 201) gene therapy along with surgery and chemoradiotherapy. DESIGN AND SETTING A phase 2 study in a multi-institutional setting within the Southwest Oncology Group. PATIENTS Thirteen individuals who met the following entry criteria: newly diagnosed, previously untreated squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx; selected stage III or IV disease without distant metastases; and surgically resectable disease. INTERVENTIONS Surgery, perioperative INGN 201 gene therapy, and postoperative chemoradiotherapy. MAIN OUTCOME MEASURES Overall patient status, tumor status, adverse effects, accrual rate, and percentage of patients successfully receiving the required doses of INGN 201. RESULTS All 13 patients received surgery and perioperative INGN 201 injections in the primary tumor bed and the ipsilateral neck. In addition, 3 patients received injections in the contralateral neck. Three patients did not receive chemoradiotherapy. One patient had a grade 2 fistula of the oral cavity. Of the 10 patients with evaluable data, 2 experienced grade 4 adverse events, 1 owing to hypokalemia, hyponatremia, vomiting, leukopenia, and neutropenia and 1 owing to increased aspartate aminotransferase and alanine aminotransferase levels. Seven other patients experienced grade 3 adverse events. The estimate of 1-year progression-free survival is 92%. CONCLUSIONS This trial demonstrated the feasibility of handling and delivering a very complex gene vector safely in multiple cooperative group institutions without significant incident. Intraoperative INGN 201 gene therapy is technically feasible, but it has many logistical problems when performed in a multi-institutional setting. Regulatory requirements might have hindered accrual in this multi-institutional setting. Disease control seems to be promising; however, no definitive conclusion can be made with this small sample size. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00017173.
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Affiliation(s)
- George H Yoo
- Department of Otolaryngology, Head and Neck Surgery, Wayne State University, University Health Center 5-E, 4201 St Antoine, Detroit, MI 48201, USA
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Warren G, Rangnekar V, McGarry R, Arnold S, Valentino J, Kudrimoti M. Pathways of Resistance: Potential Effects of Nicotine on Cancer and Treatment Response. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Payne G, Warren G, Valentino J, Gal T, Arnold S, Ain K, Kenady D, Sloan D, Kudrimoti M. External Beam Radiotherapy in the Management of Recurrent I-131 Refractory Thyroid Cancer. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jones K, Gal TJ, Valentino J. S140 – The Fibula Flap for Through and Through Oral Cavity Defects. Otolaryngol Head Neck Surg 2008. [DOI: 10.1016/j.otohns.2008.05.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives 1) Understand the complexity of through and through osteocutaneous defects of the oral cavity and face. 2) Appreciate that extensive bone requirements preclude the use of other single flap reconstructive options such as scapula or iliac crest. 3) Understand the use of the fibula osteocutaneous flap in these circumstances. Methods A retrospective review was performed of patients undergoing fibula osteocutaneous flap reconstruction of through and through oral cavity defects between August 2006 and December 2007 at a tertiary care referral center. Size and type of defects as well as success rates were examined. Results 7 patients underwent reconstruction of composite through and through mandibular defects of the oral cavity. There were 4 patients with complications of prior reconstructions, 2 with primary oral cancer, and 1 gunshot wound to the face. All patients had successful restoration of mandibular continuity. Soft tissue defects were successfully closed using the perforator-based skin paddle with a de-epithelialized segment to create a double skin paddle. 1 skin paddle from an otherwise viable flap was found to be unusable and was replaced with a pectoralis major(PM) flap. A second flap succumbed to delayed venous congestion but had healed uneventfully prior to postop day 8, and was closed post-debridement with a PM flap. Conclusions While the usual foibles of the fibula osteocutaneous flap still apply, its versatility in the setting of through and through defects of the oral cavity is underestimated. In the setting of extensive bony defects, it is appropriate to reserve second flaps for salvage reconstruction.
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Huang B, Valentino J, Wyatt SW, Gal TJ. Incidence of oral cavity and pharynx cancer in Kentucky. J Ky Med Assoc 2008; 106:355-360. [PMID: 18783038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Oral cavity and pharyngeal (OCOP) cancer is strongly associated with tobacco use and alcohol consumption. Kentucky consistently has one of the highest rates of tobacco use in the United States. The purpose of this study was to examine the differences in incidence rates in Kentucky as compared to nationwide data as well as regional differences within the state. METHOD Oral and pharyngeal cancer incidence data for the years 1995-2004 in Kentucky were obtained from Kentucky Cancer Registry (KCR). Data for the same time period for the United States were approximated using SEER*Stat 6.3.5 provided by the Surveillance, Epidemiology, and End Results (SEER) Program. Age-adjusted incidence rates and smoothed incidence rates by county were examined. RESULTS The overall incidence of oral cavity and pharyngeal cancer in Kentucky was 12.1/100,000. This was significantly higher than the rate seen in the SEER data of 11.3/100,000 population (p < 0.05). This difference was more pronounced for males in Kentucky, where a 20% higher rate (19.2 vs 16.3/100,000 SEER) was observed. The vast majority of cases (62.1%) had a documented smoking history, and this number was higher in advanced stage disease (73%). Rates were lower in Appalachian regions (11.4/100,000) compared to non-Appalachian regions (12.4/10/ 100,000), p < 0.01, with additional geographic variations observed. CONCLUSION Kentucky has a higher incidence rate for oral cavity and pharyngeal cancer than the national average. The high prevalence of tobacco use in the state is likely a strong contributing factor. The etiology of regional patterns of incidence rates statewide requires further study.
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Affiliation(s)
- Bin Huang
- Division of Otolaryngology, Department of Surgery, University of Kentucky, Chandler Medical Center RM C236, 800 Rose St., Lexington, KY 40536-0084, USA
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Payne GA, Warren GW, Valentino J, Gal TJ, Arnold SM, Ain KB, Given CA, Brill YM, Kudrimoti MR. Locoregional control following external beam radiotherapy for recurrent, I-131 refractory thyroid 26061 cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sorial E, Valentino J, Given CA, Endean ED, Minion DJ. The emergency use of endografts in the carotid circulation to control hemorrhage in potentially contaminated fields. J Vasc Surg 2007; 46:792-8. [PMID: 17903657 DOI: 10.1016/j.jvs.2007.05.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 05/29/2007] [Indexed: 11/18/2022]
Abstract
We report our experience with the use of endoluminal grafts to control emergency bleeding in two patients with tracheoinnominate fistulas and three patients with carotid blowouts. Systemic infectious complications were not seen. However, rebleeding occurred in one patient, and extensive stent coverage to control bleeding was required in a second. Survival was usually limited by the patient's cancer. There was one long-term survivor without cancer whose tracheostomy was placed for neurologic compromise. A review of the literature for similar cases identified 18 additional endografts placed for carotid blowout and 3 placed for tracheoinnominate fistulas. Overall, infectious complications occurred in only two patients, whereas rebleeding occurred in eight patients. On the basis of these findings, we believe that endografts are useful to control emergency hemorrhage in these two pathologies because treatment is usually palliative, given the poor survival secondary to the underlying disease. However, more extensive graft coverage may be necessary considering the erosive nature of these processes.
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Affiliation(s)
- Ehab Sorial
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY 40536, USA
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Warren G, Arnold S, Valentino J, Brill Y, Regine W, Spring P, Given C, Mohiuddin M, Meigooni A, Kudrimoti M. Long Term Results of a Phase II Trial of Hyperfractionated Radiation and Intraarterial Cisplatin (HYPERRADPLAT) on Stage III-IV Head and Neck Cancer With Bulky Primary Tumors. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Agrawal A, Moon J, Davis RK, Sakr WA, Giri SPG, Valentino J, LeBlanc M, Truelson JM, Yoo GH, Ensley JF, Schuller DE. Transoral Carbon Dioxide Laser Supraglottic Laryngectomy and Irradiation in Stage I, II, and III Squamous Cell Carcinoma of the Supraglottic Larynx. ACTA ACUST UNITED AC 2007; 133:1044-50. [PMID: 17938330 DOI: 10.1001/archotol.133.10.1044] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amit Agrawal
- Southwest Oncology Group, Operations Office, 14980 Omicron Dr, San Antonio, TX 78245-3217, USA
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Zhang L, Wu R, Dingle RWC, Gairola CG, Valentino J, Swanson HI. Cigarette smoke condensate and dioxin suppress culture shock induced senescence in normal human oral keratinocytes. Oral Oncol 2007; 43:693-700. [PMID: 17070097 PMCID: PMC1995564 DOI: 10.1016/j.oraloncology.2006.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 08/24/2006] [Accepted: 08/29/2006] [Indexed: 11/24/2022]
Abstract
The aryl hydrocarbon receptor is a ligand activated transcription factor which regulates biological responses to a variety of environmental pollutants, such as dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin, TCDD) and cigarette smoke. The purpose of this study was to determine whether cigarette smoke condensate (CSC) is capable of activating the AHR in normal human oral keratinocytes (NHOK) and inhibiting their ability to senesce. Towards this end, NHOK were isolated from human subjects and were cultured in the presence or absence of either TCDD or CSC. While neither TCDD nor CSC treatments altered the lifespan of NHOK in culture, both were capable of suppressing a culture induced premature senescence as indicated by their ability to decrease the mRNA and protein levels of the senescence markers p16(INK4a), p53 and p15(INK4b). A role of the AHR in mediating these events is indicated by the observations that the TCDD and CSC-induced decreases in p15(INK4b), p16(INK4a) and p53 expression was accompanied by a corresponding increase in the expression levels of the AHR target gene, CYP1A1. In addition, cotreatment with the AHR antagonist, 3'-methoxy-4'-nitroflavone (MNF) blocked the effects of TCDD and CSC on p53 and CYP1A1 expression. The findings of this study indicate that in NHOK, CSC is capable of altering a key cell fate decision, i.e., commitment to premature senescence, that is in part, dependent on the AHR. These results support the idea that progression of CSC-induced tumorigenesis may include an AHR-mediated inhibition of senescence that contributes to immortalization and agents that block the actions of the AHR may be effective components of novel cancer therapeutics.
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Affiliation(s)
- Li Zhang
- Department of Molecular and Biomedical Pharmacology, University of Kentucky College of Medicine, Lexington, KY 40536, USA
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Affiliation(s)
- Joseph Valentino
- Division of Otolaryngology, University of Kentucky, Lexington, Kentucky, USA.
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Dasgupta S, Tripathi PK, Qin H, Bhattacharya-Chatterjee M, Valentino J, Chatterjee SK. Identification of molecular targets for immunotherapy of patients with head and neck squamous cell carcinoma. Oral Oncol 2006; 42:306-16. [PMID: 16321566 DOI: 10.1016/j.oraloncology.2005.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 08/10/2005] [Indexed: 01/15/2023]
Abstract
To identify molecular targets for immunotherapy of head and neck squamous cell carcinoma (HNSCC) patients, we analyzed gene expression profile in matched tumor (HN) and normal fibroblast (FB) cell lines established from a HNSCC patient using microarray technique followed by real-time RT-PCR. Screening against a series of established normal and malignant cell lines followed by screening against a panel of normal human tissues led to the identification of 7 genes (AREG, CDH3, KLK10, NmU, SLPI, ANAX3 and MAL2), which were over-expressed at least 10-fold in tumors over any of the normal tissues. We determined the expression of mRNA encoding these genes against a panel of 15 HNSCC primary tumor samples. Relative expression of these genes was at least 20-fold. Expression of AREG, CDH3, KLK10, NmU and SLPI at the protein level was determined by immunohistochemistry in seven supraglottic laryngeal cancer specimens. All five proteins were expressed in these tumor samples with high intensity. We conclude that these molecules are potential targets for immunotherapy of HNSCC patients.
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Affiliation(s)
- Santanu Dasgupta
- Department of Internal Medicine, the Barrett Cancer Center, University of Cincinnati, Cincinnati, OH 45267, USA
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Kudrimoti M, Warren G, Valentino J, Spring P, Brill Y, Given C, St.Clair W, Mohuddin M, Regine W, Arnold S. 2417. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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