Beneath the rind: A review on the remarkable health benefits and applications of the wood apple fruit

Limonia acidissima Groff, commonly referred to as the Wood apple, is a tropical fruit belonging to Rutaceae family. Indigenous to Sri Lanka, India, and Myanmar, it is extensively cultivated throughout Southeast Asia. This fruit holds a profound historical significance in traditional medicine due to its exceptional nutritional and therapeutic attributes. Wood apple pulp is significantly abundant in β-carotene, a precursor to vitamin A, and contains a substantial amount of vitamin B, including riboflavin and thiamine, as well as trace amounts of ascorbic acid (vitamin C). Moreover health-benefitting properties associated with L. acidissima, such as, antioxidant, hepatoprotective, antimicrobial, neuroprotective, antidiabetic, anti-inflammatory, anti-spermatogenic, analgesic, antiulcer, and antihyperlipidemic properties, are attributed to a diverse range of phytochemicals. These encompass polyphenolic compounds, saponins, phytosterols, tannins, triterpenoids, coumarins, amino acids, tyramine derivatives, and vitamins. From the findings of the various studies, it was observed that wood apple fruit shows significant anticancer activity by inhibiting the proliferation of cancer. Furthermore, wood apple finds wide-ranging commercial applications in the formulation of ready-to-serve beverages, syrups, jellies, chutneys, and various other food products. In summary, this review highlights the nutritional and phytochemical constituents of wood apple, depicts its antioxidant, anti-inflammatory, and anti-diabetic capabilities, and explores its potential in value-added product development. Nevertheless, it is crucial to acknowledge that the molecular mechanisms supporting these properties remain an underexplored domain. To ensure the safe integration of wood apple fruit into the realms of the food, cosmetics, and pharmaceutical sectors, rigorous clinical trials, including toxicity assessments, are required. These endeavors hold the potential to promote innovation and contribute significantly to both research and industrial sectors.

Neuroprotective and anti-inflammatory effects of curcumin in Alzheimer's disease: Targeting neuroinflammation strategies

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by the accumulation of amyloid-beta plaques and neurofibrillary tangles, leading to neuronal loss. Curcumin, a polyphenolic compound derived from Curcuma longa, has shown potential neuroprotective effects due to its anti-inflammatory and antioxidant properties. This review aims to synthesize current preclinical data on the anti-neuroinflammatory mechanisms of curcumin in the context of AD, addressing its pharmacokinetics, bioavailability, and potential as a therapeutic adjunct. An exhaustive literature search was conducted, focusing on recent studies within the last 10 years related to curcumin's impact on neuroinflammation and its neuroprotective role in AD. The review methodology included sourcing articles from specialized databases using specific medical subject headings terms to ensure precision and relevance. Curcumin demonstrates significant neuroprotective properties by modulating neuroinflammatory pathways, scavenging reactive oxygen species, and inhibiting the production of pro-inflammatory cytokines. Despite its potential, challenges remain regarding its limited bioavailability and the scarcity of comprehensive human clinical trials. Curcumin emerges as a promising therapeutic adjunct in AD due to its multimodal neuroprotective benefits. However, further research is required to overcome challenges related to bioavailability and to establish effective dosing regimens in human subjects. Developing novel delivery systems and formulations may enhance curcumin's therapeutic potential in AD treatment.

Unlocking the potential of cotton stalk as a renewable source of cellulose: A review on advancements and emerging applications

Cotton stalk (CS) is a global agricultural residue, with an annual production of approximately 50 million tons, albeit with limited economic significance. The utilization of cellulose derived from CS has gained significant attention in green nanomaterial technologies. This interest stems from its unique properties, including biocompatibility, low density, minimal thermal expansion, eco-friendliness, renewability, and its potential as an alternative source for chemicals, petroleum, and biofuels. In this review, we delve into various extraction and characterization methods, the physicochemical attributes, recent advancements, and the applications of cellulose extracted from CS. Notably, the steam explosion method has proven to yield the highest cellulose content (82 %) from CS. Moreover, diverse physicochemical properties of cellulose can be obtained through different extraction techniques. Sulfuric acid hydrolysis, for instance, yields nanocrystalline cellulose fibers measuring 10-100 nm in width and 100-850 nm in length. Conversely, the steam explosion method yields cellulose fibers with dimensions of 10.7 μm in width and 1.2 mm in length. CS-derived products, including biochar, aerogel, dye adsorbents, and reinforcement fillers, find applications in various industries, such as environmental remediation and biodegradable packaging. This is primarily due to their ready availability, cost-effectiveness, and sustainable nature.

Innovations in textile wastewater management: a review of zero liquid discharge technology

Zero liquid discharge (ZLD) technology emerges as a transformative solution for sustainable wastewater management in the textile industry, emphasizing water recycling and discharge minimization. This review comprehensively explores ZLD's pivotal role in reshaping wastewater management practices within the textile sector. With a primary focus on water recycling and minimized discharge, the review thoroughly examines the economic and environmental dimensions of ZLD. Additionally, it includes a comparative cost analysis against conventional wastewater treatment methods and offers a comprehensive outlook on the global ZLD market. Presently valued at US $0.71 billion, the market is anticipated to reach US $1.76 billion by 2026, reflecting a robust annual growth rate of 12.6%. Despite ZLD's efficiency in wastewater recovery, environmental challenges, such as heightened greenhouse gas emissions, increased carbon footprint, elevated energy consumption, and chemical usage, are discussed. Methodologies employed in this review involve an extensive analysis of existing literature, empirical data, and case studies on ZLD implementation in the textile industry worldwide. While acknowledging existing adoption barriers, the review underscores ZLD's potential to guide the textile industry toward a more sustainable and environmentally responsible future.

Exploring apple pectic polysaccharides: Extraction, characterization, and biological activities - A comprehensive review

Apple (Malus domestica) is a popular and ancient fruit of the Myrtaceae family. Apple fruit is well-known for its great nutritional and phytochemical content consisted of beneficial compounds such as polyphenols, polysaccharides, sterols, and organic acids. Polysaccharides extracted from different parts of the apple fruit, including the peel, pomace, or the whole fruit, have been extensively studied. Researchers have investigated the structural characteristics of these polysaccharides, such as molecular weight, type of monosaccharide unit, type of linkage and its position and arrangement. Besides this, functional properties and physicochemical and of apple polysaccharides have also been studied, along with the effects of extraction procedures, storage, and processing on cell wall polysaccharides. Various extraction techniques, including hot water extraction, enzymatic extraction, and solvent-assisted extraction, have been studied. From the findings, it was evident that apple polysaccharides are mainly composed of (1 → 3), (1 → 6): α-β-glycosidic linkage. Moreover, the apple polysaccharides were demonstrated to exhibit antioxidant, hepatoprotective, anti-cancer, hypoilipidemic, and enzyme inhibitory properties in vitro and in vivo. The potential applications of apple polysaccharides in the food, cosmetic, pharmaceutical, nutraceutical industries have also been explored in the present review. Overall, the research on apple polysaccharides highlights their significant potential as a source of biologically active compounds with various health benefits and practical applications.

Phytochemicals, therapeutic benefits and applications of chrysanthemum flower: A review

Chrysanthemum is a flowering plant belonging to a genus of the dicotyledonous herbaceous annual flowering plant of the Asteraceae (Compositae) family. It is a perpetual flowering plant, mostly cultivated for medicinal purposes; generally, used in popular drinks due to its aroma and flavor. It is primarily cultivated in China, Japan, Europe, and United States. These flowers were extensively used in various healthcare systems and for treating various diseases. Chrysanthemum flowers are rich in phenolic compounds and exhibit strong properties including antioxidant, antimicrobial, anti-inflammatory, anticancer, anti-allergic, anti-obesity, immune regulation, hepatoprotective, and nephroprotective activities. The main aim of the present review was to investigate the nutritional profile, phytochemistry, and biological activities of flowers of different Chrysanthemum species. Also, a critical discussion of the diverse metabolites or bioactive constituents of the Chrysanthemum flowers is highlighted in the present review. Moreover, the flower extracts of Chrysanthemum have been assessed to possess a rich phytochemical profile, including compounds such as cyanidin-3-O-(6″-O-malonyl) glucoside, delphinidin 3-O-(6" -O-malonyl) glucoside-3', rutin, quercetin, isorhamnetin, rutinoside, and others. These profiles exhibit potential health benefits, leading to their utilization in the production of supplementary food products and pharmaceutical drugs within the industry. However, more comprehensive research studies/investigations are still needed to further discover the potential benefits for human and animal utilization.

Exploring the Chemical and Biological Potential of Jamun (Syzygium cumini (L.) Skeels) Leaves: A Comprehensive Review

Leaves of jamun collected as agro by-produce during the cultivation of jamun is traditionally used as ayurvedic medicine to treat diabetes, gall bladder stones and other ailments. Most of the beneficial effects of jamun leaves are associated with phytochemicals found in jamun leaves such as gallic acid, tannins, mallic acid, flavonoids, essential oils, jambolin, ellagic acid, jambosine, antimellin and betulinic acid. Jamun possess curative activities like anticancer, antidiabetic, antifertility, anti-inflammatory, antidiarrheal, antimicrobial, antinociceptive, antioxidant, antiradiation, chemotherapeutic, and gastroprotective. The main goal of this review article is to provide information on the nutritional content, phytochemical composition and health promoting properties of jamun leaves. The review of literature based on the phytochemical composition and health promoting benefits of the jamun leaves, suggests that leaves can be used as potential constituent in the formulation of pharmacological drugs. From the review literature it is found that clinical, in-vivo, in-vitro studies are still required to check the health promoting effects of jamun leaves extracts on humans.

Tea (Camellia sinensis (L.) Kuntze) as an emerging source of protein and bioactive peptides: A narrative review

Tea residues represent one of the major agricultural wastes that are generated after the processing of tea. They account for 21-28% of crude protein and are often discarded without the extraction of valuable proteins. Due to various bioactivity and functional properties, tea proteins are an excellent alternative to other plant-based proteins for usage as food supplements at a higher dosage. Moreover, their good gelation capacity is ideal for the manufacturing of dairy products, jellies, condensation protein, gelatin gel, bread, etc. The current study is the first to comprehend various tea protein extraction methods and their amino acid profile. The preparation of tea protein bioactive peptides and hydrolysates are summarized. Several functional properties (solubility, foaming capacity, emulsification, water/oil absorption capacity) and bioactivities (antioxidant, antihypertensive, antidiabetic) of tea proteins are emphasized.

The resilient cotton plant: uncovering the effects of stresses on secondary metabolomics and its underlying molecular mechanisms

Cotton is an important fiber crop cultivated around the world under diverse climate conditions and generates billions of dollars in annual revenue globally. Biotic and abiotic stresses have caused reduction in yield and productivity of cotton crops. In this review, we comprehensively analyzed and summarized the effect of biotic and abiotic stress on secondary metabolite production in cotton. The development of cotton varieties with improved tolerance against abiotic and biotic stress can play an important role in sustainable cotton production. Under stress conditions, plants develop a variety of defense mechanisms such as initiating signaling functions to upregulate defense responsive genes and accumulation of secondary metabolites. Understanding the impact of stress on secondary metabolite production in cotton is crucial for developing strategies to alleviate the negative effects of stress on crop yield and quality. Further, the potential industrial applications of these secondary metabolites in cotton, such as gossypol, could provide new opportunities for sustainable cotton production and the development of value-added products. Additionally, transgenic and genome-edited cotton cultivars can be developed to provide tolerance to both abiotic and biotic stress in cotton production.

Tinospora cordifolia (Willd.) Hook.f. & Thomson polysaccharides: A review on extraction, characterization, and bioactivities

Human awareness of the need for health and wellness practices that enhance disease resilience has increased as a result of recent health risks. Plant-derived polysaccharides with biological activity are good candidates to fight diseases because of their low toxicity. Tinospora cordifolia (Willd.) Hook.f. & Thomson polysaccharides extract from different plant parts have been reported to possess significant biological activity such as anti-oxidant, anti-cancer, immunomodulatory, anti-diabetic, radioprotective and hepatoprotective. Several extraction and purification techniques have been used to isolate and characterize T. cordifolia polysaccharides. Along with hot-water extraction (HWE), other novel techniques like microwave-assisted extraction (MAE), ultrasound-assisted extraction (UAE), pulsed electric field (PEF), supercritical-fluid extraction (SFE), and enzyme-assisted extraction (EAE) are used to extract T cordifolia polysaccharides. SFE is a revolutionary technology that gives the best yield and purity of low-molecular-weight polysaccharides. According to the findings, polysaccharides extracted and purified from T. cordifolia have a significant impact on their structure and biological activity. As a result, the methods of extraction, structural characterization, and biological activity of T. cordifolia polysaccharides are covered in this review. Research on T. cordifolia polysaccharides and their potential applications will benefit greatly from the findings presented in this review.

Guava (Psidium guajava L.) seed: A low-volume, high-value byproduct for human health and the food industry

Guava processing industries generate peel and seeds as primary waste fractions. Guava seeds obtained after fruit processing possess untapped potential in the field of food science due to the presence of a diversity of nutritional and bioactive compounds. Along with offering a detailed understanding of the nutritional attributes of guava seeds, the present review comprehensively elaborates on the therapeutic activities of their bioactive compounds, their techno-functional properties, and their other edible and nonedible applications. The limited molecular and biochemical mechanistic studies outlining the antioxidant, immunomodulatory, anticancer, antimicrobial, neuroprotective and antidiabetic activities of guava seeds available in the literature are also extensively discussed in this review. The use of guava seed constituents as food additives and food functional and structural modulators, primarily as fat reducers, emulsifiers, water and oil holding agents, is also conceptually explained. Additional human intervention and molecular mechanistic studies deciphering the effects of guava seeds on various diseases and human health are warranted.

Onion and garlic polysaccharides: A review on extraction, characterization, bioactivity, and modifications

Allium cepa (onion) and Allium sativum (garlic) are important members of the Amaryllidaceae (Alliaceae) family and are being used both as food and medicine for centuries in different parts of the world. Polysaccharides have been extracted from different parts of onion and garlic such as bulb, straw and cell wall. The current literature portrays several studies on the extraction of polysaccharides from onion and garlic, their modification and determination of their structural (molecular weight, monosaccharide unit and their arrangement, type and position of glycosidic bond or linkage, degree of polymerization, chain conformation) and functional properties (emulsifying property, moisture retention, hygroscopicity, thermal stability, foaming ability, fat-binding capacity). In this line, this review, summarizes the various extraction techniques used for polysaccharides from onion and garlic, involving methods like solvent extraction method. Furthermore, the antioxidant, antitumor, anticancer, immunomodulatory, antimicrobial, anti-inflammatory, and antidiabetic properties of onion and garlic polysaccharides as reported in in vivo and in vitro studies is also critically assessed in this review. Different studies have proved onion and garlic polysaccharides as potential antioxidant and immunomodulatory agent. Studies have implemented to improve the functionality of onion and garlic polysaccharides through various modification approaches. Further studies are warranted for utilizing onion and garlic polysaccharides in the food, nutraceutical, pharmaceutical and cosmetic industries.

Moringa (Moringa oleifera Lam.) polysaccharides: Extraction, characterization, bioactivities, and industrial application

Owing to numerous biological activities of different parts of Moringa oleifera Lam., various studies have been carried out to isolate and explore the activities of its various bioactive compounds including polysaccharides. Polysaccharides of M. oleifera have been reported to possess a variety of biofunctionalities including antihyperlipidemic, anti-diabetic, immunomodulatory, antihypertensive and gastrointestinal protection. In addition to bioactive polysaccharides, the gum exudated by stem of this plant is of commercial importance with wide range of applications in pharmaceutical industries. Various extraction and purification methods as well as combination of methods have been used to isolate and purify moringa polysaccharides. Studies suggest that extraction methods influence the structure of polysaccharides and thus their biological activity. This review summarizes all the available literature to provide updated information related to extraction, purification, modification, structural characterization, bioactivities and potential applications of moringa polysaccharides. This review will provide novel insights for future research and applications of moringa polysaccharides.

Black soybean (Glycine max (L.) Merr.): paving the way toward new nutraceutical

Black soybean (BS) is a nutritious legume that is high in proteins, essential amino acids, dietary fiber, vitamins, minerals, anthocyanins, phenolic acids, isoflavones, and flavones. Traditional approaches for extracting BS bioactive compounds are commonly employed because they are simple and inexpensive, but they use toxic solvents and have lower yields. As a result, new extraction techniques have been developed, such as microwave, ultrasound, and enzyme-assisted extraction. Modern approaches are less harmful to the environment, are faster, and produce higher yields. The major anthocyanin in the BS seed coat was discovered as cyanidin-3-O-glucoside, accounting for nearly 75% of the total anthocyanins. BS and its seed coat also contains phenolic acids (p-hydroxybenzoic, gallic, vanillin, syringic acid), isoflavones (daidzein, glycitein and genistein), flavones, flavonols, flavanones, and flavanols. Bioactive compounds present in BS exhibit antioxidant, anti-cancerous, anti-diabetic, anti-obesity, anti-inflammatory, cardio and neuroprotective activities. The characterization and biological activity investigation of these bioactive compounds has provided researchers and food manufacturers with valuable information for developing functional food products and nutraceutical ingredients. In this review, the nutritional makeup of BS is reviewed, and the paper seeks to provide an insight of bioactive compound extraction methods as well as bioactive compounds identified by various researchers. The biological activities of BS extracts and their potential applications in food products (noodles), biodegradable films (pH sensitive film), and therapeutic applications (wound healing and anti-inflammation) are also discussed in the study. Therefore, BS have enormous potential for use in developing functional foods and nutraceutical components. This is the first review of its sort to describe and explain various extraction methodologies and characterization of bioactives, as well as their biological activity recorded in diverse works of literature, making it possible for food manufacturers and scientists to get a quick overview.

Onion (Allium cepa L.) peels: A review on bioactive compounds and biomedical activities

Huge quantities of byproducts/wastes generated in onion processing are usually discarded, but they are excellent sources of bioactive compounds and phytochemicals. However, with growing interest in the sustainable use of resources and the circular economy to reduce adverse impacts on the environment, food processing wastes such as onion peel/skin can be extracted and employed as inputs in developing or reformulating nutrient supplements, and pharmacological drugs. This review highlights major bioactive components, especially total phenolics, total flavonoid, quercetin and its derivatives present in onion peel/skin and their therapeutic applications as cardioprotective, neuroprotective, antiobesity, antidiabetic, anticancer and antimicrobial agents. The present review emphasized that onion peel is one of the important agricultural by-products which is rich in bioactive compounds and can be utilized as health promoting ingredient especially in pharmacological and biomedical fields. Thus, with increasing burden of life style disorders/non-communicable diseases, finding suitable natural alternative for their treatment is one major concern of the researchers and onion peel and its extract can be exploited as a prime ingredient.

Ethnomedicinal Plants Used in the Health Care System: Survey of the Mid Hills of Solan District, Himachal Pradesh, India

The study was performed in the mid hills of the Dharampur region in Solan district of Himachal Pradesh, India. At the study site, a total of 115 medicinal plants were documented (38 trees, 37 herbs, 34 shrubs, 5 climbers, 1 fern, and 1 grass). In the study region, extensive field surveys were performed between March 2020 and August 2021. Indigenous knowledge of wild medicinal plants was collected through questionnaires, discussions, and personal interviews during field trips. Plants with their correct nomenclature were arranged by botanical name, family, common name, habitat, parts used, routes used, and diseases treated. In the present study, the predominant family was Rosaceae, which represented the maximum number of plant species, 10, followed by Asteraceae and Lamiaceae, which represented 8 plant species. The rural inhabitants of the Dharampur region in the Solan district have been using local plants for primary health care and the treatment of various diseases for a longer time. However, information related to the traditional knowledge of medicinal plants was not documented. The rural inhabitants of the Dharampur region reported that the new generation is not so interested in traditional knowledge of medicinal plants due to modernization in society, so there is an urgent need to document ethnomedicinal plants before such knowledge becomes inaccessible and extinct.

Plant-Based Antioxidant Extracts and Compounds in the Management of Oral Cancer

Oral cancer continues to be a leading cause of death worldwide, and its prevalence is particularly high in developing countries, where people chew tobacco and betel nut on a regular basis. Radiation-, chemo-, targeted-, immuno-, and hormone-based therapies along with surgery are commonly used as part of a treatment plan. However, these treatments frequently result in various unwanted short- to long-term side effects. As a result, there is an urgent need to develop treatment options for oral cancer that have little or no adverse effects. Numerous bioactive compounds derived from various plants have recently attracted attention as therapeutic options for cancer treatment. Antioxidants found in medicinal plants, such as vitamins E, C, and A, reduce damage to the mucosa by neutralizing free radicals found in various oral mucosal lesions. Phytochemicals found in medicinal plants have the potential to modulate cellular signalling pathways that alter the cellular defence mechanisms to protect normal cells from reactive oxygen species (ROS) and induce apoptosis in cancer cells. This review aims to provide a comprehensive overview of various medicinal plants and phytoconstituents that have shown the potential to be used as oral cancer therapeutics.

Evaluation of Nutritional, Phytochemical, and Mineral Composition of Selected Medicinal Plants for Therapeutic Uses from Cold Desert of Western Himalaya

The aim of this study was to determine the elemental and nutritive values of leaf parts of 10 selected wild medicinal plants, Acer pictum, Acer caecium, Betula utilis, Oxalis corniculata, Euphorbia pilosa, Heracleum lanatum, Urtica dioica, Berberis lycium, Berberis asiaticaand, and Quercus ilex, collected from the high hills of the Chitkul range in district Kinnaur, Western Himalaya. The nutritional characteristics of medicinal plant species were analyzed by using muffle furnace and micro-Kjeldahl methods, and the mineral content in plants was analyzed through atomic absorption spectrometry. The highest percentage of used value was reported in Betula utilis (0.42) and the lowest in Quercus ilex (0.17). In this study, it was found that new generations are not much interested in traditional knowledge of ethnomedicinal plants due to modernization in society. Therefore, there is an urgent need to document ethnomedicinal plants along with their phytochemical and minerals analysis in study sites. It was found that rural people in western Himalaya are dependent on wild medicinal plants, and certain steps must be taken to conserve these plants from extinction in the cold desert of Himalayan region. They are an alternative source of medicine because they contain saponin, alkaloid, and flavonoid etc. as well as minerals. The leaves used for analysis possesses good mineral content, such as Na, N, K, P, Zn, Fe, Cu, Mn, Ca, Mg, and S. Hence, in the current study it was observed that medicinal plants are not only used for therapeutic purposes, but they can also be used as nutritional supplements.

Delineating the inherent functional descriptors and biofunctionalities of pectic polysaccharides

Pectin is a plant-based heteropolysaccharide macromolecule predominantly found in the cell wall of plants. Pectin is commercially extracted from apple pomace, citrus peels and sugar beet pulp and is widely used in the food industry as a stabilizer, emulsifier, encapsulant, and gelling agent. This review highlights various parameters considered important for describing the inherent properties and biofunctionalities of pectins in food systems. These inherent descriptors include monosaccharide composition, galacturonic acid content, degree of esterification, molecular weight, structural morphology, functional group analysis, and functional properties, such as water and oil holding capacity, emulsification, foaming capacity, foam stability, and viscosity. In this study, we also delineate their potential as a nutraceutical, prebiotic, and carrier for bioactive compounds. The biofunctionalities of pectin as an anticancer, antioxidant, lipid-lowering, and antidiabetic agent are also conceptually elaborated in the current review. The multidimensional characteristics of pectin make it a potential candidate for use in food and biomedical science.

Mango (Mangifera indica L.) Leaves: Nutritional Composition, Phytochemical Profile, and Health-Promoting Bioactivities

Mangifera indica L. belongs to the family of Anacardiaceae and is an important fruit from South and Southeast Asia. India, China, Thailand, Indonesia, Pakistan, Mexico, Brazil, Bangladesh, Nigeria, and the Philippines are among the top mango producer countries. Leaves of the mango plant have been studied for their health benefits, which are attributed to a plethora of phytochemicals such as mangiferin, followed by phenolic acids, benzophenones, and other antioxidants such as flavonoids, ascorbic acid, carotenoids, and tocopherols. The extracts from mango leaves (MLs) have been studied for their biological activities, including anti-cancer, anti-diabetic, anti-oxidant, anti-microbial, anti-obesity, lipid-lowering, hepato-protection, and anti-diarrheal. In the present review, we have elaborated on the nutritional and phytochemical profile of the MLs. Further, various bioactivities of the ML extracts are also critically discussed. Considering the phytochemical profile and beneficial effects of the MLs, they can be used as a potential ingredient for the development of functional foods and pharmaceutical drugs. However, more detailed clinical trials still needed to be conducted for establishing the actual efficacy of the ML extracts.

Predictivity of human papillomavirus positivity in advanced oral cancer

BACKGROUND AND OBJECTIVE

Human papillomavirus (HPV) is a known prognostic factor world over in patients of carcinoma oropharynx. The role of HPV in oral cancers has not been investigated adequately. We tried to identify standard clinicopathological features in oral cancer, which would predict HPV-positivity.

METHODS

This was a retrospective analysis of 124 cases of T4 oral cancer patients at our center. HPV-positive was defined in accordance with positive p16 immunohistochemistry done on pretreatment local tumor site biopsy. Age, sex, habits (smoking history and oral tobacco), Eastern Cooperative Oncology Group performance status (ECOG PS), T stage, N stage, grade, and site were selected, for testing of prediction for HPV-positivity. The analysis was performed by R studio version 3.1.1. Two-sample test for equality of proportions with continuity correction was used to identify factors predicting for HPV-positivity. P = 0.05 was considered as significant.

RESULTS

Of 124 patients, 16 patients (12.9%) were HPV-positive. The median age of the whole cohort was 43 years (interquartile range 37-52 years) with 15 females (12.1%). All had squamous cell carcinoma (100%). The grade of the tumor was well differentiated in 9 patients (7.2%), moderately differentiated in 98 patients (79.1%), and poorly differentiated in 17 patients (13.7%). The ECOG PS 0 in 19 patients (15.3%), 1 in 104 patients (83.9%), and 2 in 1 patient (0.8%). The subsite of the tumor was buccal mucosa in 74 patients (59.7%), anterior two-third of tongue in 33 patients (26.6%), and others in 17 patients (13.7%). None of the tested factors except the use of oral tobacco were statistically significantly associated with HPV-positivity. History of tobacco usage had a statistical trend toward ability to predict HPV-positivity. The proportion of patients with HPV-positive oral cancer in patients without history usage of oral tobacco was 31.3% while it was 10.2% in patients with previous history of tobacco use (P = 0.03).

CONCLUSION

Standard clinicopathological variables could not predict for HPV-positivity. Negative history of tobacco (smokeless) usage showed statistical trends toward ability to predict HPV-positivity in oral cancer patients.

Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers

BACKGROUND

The median survival of technically unresectable oral-cavity cancers (T4a and T4b) with non surgical therapy is 2-12 months. We hypothesized that neoadjuvant chemotherapy (NACT) could reduce the tumour size and result in successful resection and ultimately improved outcomes. We present a retrospective analysis of consecutive patients who received NACT at our centre between January 2008 and August 2012.

PATIENTS AND METHODS

All patients with technically unresectable oral cancers were assessed in a multidisciplinary clinic and received 2 cycles of NACT. After 2 cycles, patients were reassessed and planned for either surgery with subsequent CTRT or nonsurgical therapy including CT-RT, RT or palliation. SPSS version 16 was used for analysis of locoregional control and overall survival (OS). Univariate and multivariate analysis was done for factors affecting the OS.

RESULTS

721 patients with stage IV oral-cavity cancer received NACT. 310 patients (43%) had sufficient reduction in tumour size and underwent surgical resection. Of the remaining patients, 167 received chemoradiation, 3 radical radiation and 241 palliative treatment alone The locoregional control rate at 24 months was 20.6% for the overall cohort, 32% in patients undergoing surgery and 15% in patients undergoing non surgical treatment (p=0.0001). The median estimated OS in patients undergoing surgery was 19.6 months (95% CI, 9.59-25.21 months) and 8.16 months (95%, CI 7.57-8.76) in patients treated with non surgical treatment (p=0.0001).

CONCLUSION

In our analysis, NACT led to successful resection and improved overall survival in a significant proportion of technically unresectable oral-cancer patients.

Referral pattern for neoadjuvant chemotherapy in the head and neck cancers in a tertiary care center

BACKGROUND

Use of any treatment modality in cancer depends not only on the effectiveness of the modality, but also on other factors such as local expertise, tolerance of the modality, cost and prevalence of the disease. Oropharyngeal and laryngeal cancer are the major subsites in which majority of neoadjuvant chemotherapy (NACT) literature in the head and neck cancers is available. However, oral cancers form a major subsite in India.

MATERIALS AND METHODS

This is an analysis of a prospectively maintained data on NACT in the head and neck cancers from 2008 to 2012. All these patients were referred for NACT for various indications from a multidisciplinary clinic. Descriptive analysis of indications for NACT in this data base is presented.

RESULTS

A total of 862 patients received NACT within the stipulated time period. The sites where oral cavity 721 patients (83.6%), maxilla 41 patients (4.8%), larynx 33 patients (3.8%), laryngopharynx 8 patients (0.9%) and hypopharynx 59 patients (8.2%). Out of oral cancers, the major indication for NACT was to make the cancer resectable in all (100%) patients. The indication in carcinoma of maxilla was to make the disease resectable in 29 patients (70.7% of maxillary cancers) and in 12 patients (29.3% of maxillary cancers) it was given as an attempt to preserve the eyeball. The indication for NACT in laryngeal cancers was organ preservation in 14 patients (42.4% of larnyngeal cancer) and to achieve resectability in 19 patients (57.6% of larnyngeal cancer). The group with laryngopharynx is a cohort of eight patients in whom NACT was given to prevent tracheostomy, these patients had presented with early stridor (common terminology criteria for adverse events Version 4.02). The reason for NACT in hypopharyngeal cancers was for organ preservation in 24 patients (40.7% of hypopharyngeal cancer) and for achievement of resectability in 35 patients (59.3% of hypopharyngeal cancer).

CONCLUSION

The major indication for NACT is to make disease resectable at our center while cases for organ preservation are few.