Estimating LOCP cancer mortality rates in small domains in Spain using its relationship with lung cancer

The distribution of lip, oral cavity, and pharynx (LOCP) cancer mortality rates in small domains (defined as the combination of province, age group, and gender) remains unknown in Spain. As many of the LOCP risk factors are preventable, specific prevention programmes could be implemented but this requires a clear specification of the target population. This paper provides an in-depth description of LOCP mortality rates by province, age group and gender, giving a complete overview of the disease. This study also presents a methodological challenge. As the number of LOCP cancer cases in small domains (province, age groups and gender) is scarce, univariate spatial models do not provide reliable results or are even impossible to fit. In view of the close link between LOCP and lung cancer, we consider analyzing them jointly by using shared component models. These models allow information-borrowing among diseases, ultimately providing the analysis of cancer sites with few cases at a very disaggregated level. Results show that males have higher mortality rates than females and these rates increase with age. Regions located in the north of Spain show the highest LOCP cancer mortality rates.

Global patterns and trends in cancers of the lip, tongue and mouth

OBJECTIVES

Global descriptions of international patterns and trends in oral cancer are informative in providing insight into the shifting epidemiologic patterns and the potential prevention of these tumours. We present global statistics on these cancers using the comprehensive set of national estimates and recorded data collated at the International Agency for Research on Cancer (IARC).

METHODS

The estimated number of lip and oral cavity cases and deaths in the 185 countries for the year 2018 was extracted from IARC's GLOBOCAN database of national estimates. To examine trends, recorded data series on lip and oral cavity cancers, as well as corresponding population-at-risk data were extracted from successive volumes of Cancer Incidence in Five Continents.

RESULTS

Globally, the highest incidence was found in South-Central Asia and parts of Oceania, with the highest estimated incidence rates in Papua New Guinea, Pakistan and India. The highest observed rates of lip cancer were in Australia, while India had the highest incidence rates of mouth and oral tongue cancer. Trends are diverse, with lip cancer incidence rates continuing to decrease for both sexes; the incidence rates of mouth cancer are also in decline in males, although increasing rates among females were observed in some populations.

CONCLUSION

There are some grounds for optimism given the prospects for control of these cancers. Primary prevention should however focus on the reduction of the main causes, namely, tobacco and alcohol consumption.

Nomogram predicting long-term overall survival and cancer-specific survival of lip carcinoma patients based on the SEER database: A retrospective case-control study

Our study was designed to construct nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of lip carcinoma patients.A search of the Surveillance, Epidemiology, and End Results (SEER) database provided us with detailed clinical data of the 1780 lip carcinoma patients. On the basis of the credible random split-sample method, the 1780 patients were placed into 2 groups, with 890 patients in the modeling group and 890 patients in the counterpart's group (proportion = 1:1). By employing Kaplan-Meier univariate and Cox multivariate survival analyses based on the modeling cohort, the nomograms were developed and then used to divide the modeling cohort into low-risk cohort and high-risk cohort. The survival rates of the 2 groups were calculated. Internal and external evaluation of nomogram accuracy was performed by the concordance index (C-index) and calibration curves.With regard to 5- and 8-year OS and CSS, the C-indexes of internal validation were 0.762 and 0.787, whereas those of external validation reached 0.772 and 0.818, respectively. All the C-indexes were higher than 0.7. The survival curves of the low-risk cohort were obviously better than those of the high-risk cohort.Credible nomograms have been established based on the SEER large-sample population research. We believe these nomograms can contribute to the design of treatment plans and evaluations of individual prognosis.

Association of Nodal Metastasis and Mortality With Vermilion vs Cutaneous Lip Location in Cutaneous Squamous Cell Carcinoma of the Lip

Importance

Although the lip is considered a high-risk location in cutaneous squamous cell carcinoma (cSCC), it has not been established whether this risk stems from vermilion or cutaneous locations or both.

Objective

To compare differences in risks of recurrence, metastasis, and death from cSCCs on the vermilion vs cutaneous lip.

Design, Setting, and Participants

Retrospective cohort study of 303 patients with 310 primary cSCCs of the lip (138 cutaneous, 172 vermilion) diagnosed between 2000 and 2015 at 2 academic tertiary care centers in Boston, Massachusetts.

Main Outcomes and Measures

Development of local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death.

Results

Of the 303 study participants with 310 SCCs of the lip, 153 (50.5%) were men, and 150 (49.5%) were women; median age at diagnosis, 68 years (range, 27-93 years). Outcomes were as follows for vermilion vs cutaneous locations: local recurrence, 6.4% (11 of 172) vs 2.9% (4 of 138); nodal metastasis, 7.6% (13 of 172) vs 1.5% (2 of 138); distant metastasis, 0.6% (1 of 172) vs 0.7% (1 of 138); disease-specific death, 3.5% (6 of 172) vs 2.9% (4 of 138); and all-cause death, 26.7% (46 of 172) vs 29.0% (40 of 138). The difference was statistically significant for nodal metastasis (P = .01). In multivariable analysis, nodal metastasis was associated with vermilion lip location (subhazard ratio, 5.0; 95% CI, 1.1-23.8) and invasion beyond fat (fascia or beyond for vermilion lip) (subhazard ratio, 4.4; 95% CI, 1.3-14.9).

Conclusions and Relevance

The risk of nodal metastasis is 5-fold greater for cSCCs on the vermilion lip compared with those on the cutaneous lip. Squamous cell carcinomas of the cutaneous lip have a nodal metastasis risk similar to cSCCs in general (1.5%). Thus, vermilion involvement appears responsible for the increased risk associated with cSCC of lip. Vermilion involvement may merit radiologic nodal staging and inclusion in future tumor staging, since it was independently associated with higher-risk cSCC of the lip region.

Interstitial Brachytherapy for Carcinomas of the Lower Lip. Results of Treatment

From 1973 to 1988 47 patients with previously untreated T1 and T2 squamous cell carcinomas of the lower lip received a definitive course of interstitial brachytherapy by iridium 192 wires. The disease stage was T1 in 21 cases (44.7 %) and T2 in 26, and NO in all cases except 2 of N1. Radiation therapy dose ranged between 6000 and 8000 cGy. Local control was obtained in 44 patients (93.6 %). Treatment failure in the neck was observed in 3 patients (6.7 %) The 5- and 10-year actuarial disease-free survival rates were 92% and 85%, respectively. A surgical salvage was attempted in 3 patients, with postoperative definitive control of the disease in 2. The 10-year actuarial overall survival was 95 %. The incidence of complications was acceptable (10.6% of mucosal necrosis). An excellent or good cosmetic result was obtained in 91.7% of patients.

Prognostic factors in squamous cell carcinoma of the lower lip - an immunohistochemical study

Squamous cell carcinoma (SCC) of the lip represents 15-30% of SCC of cephalic extremity, located on the lower lip in about 90% of cases. The present paper aimed to define the profile of SCC of the lip with major risk factors. The study included 20 selected cases diagnosed with lower lip SCC, using a panel of antibodies which addressed cell proliferation (Ki67), perturbation of the cell cycle (p53), angiogenesis (VEGF - vascular endothelial growth factor), factors related to tumor cell interaction with the extracellular matrix (CD44). Ki67 immunoexpression was identified in all the cases. Poorly differentiated (PD) SCC presented a mean value of Ki67 positivity index (PI) significantly higher compared to well-differentiated (WD) and moderately differentiated (MD) SCC. We found significantly higher mean values of Ki67 PI in pT3 lesion, compared with pT2 and pT lesions, and with no statistically significant differences in lip SCC with associated lymph node metastasis (pN1), compared to those with no lymph node metastasis (pN0). PD SCC presented a higher mean value of p53 PI compared to WD and MD SCC, but without significant differences. Analysis indicated significantly higher values in pT3 lesions and in pT2 and pT1 and in pN1 SCC. In WD SCC, CD44 immunoexpression had a higher intensity. For PD and MD SCC the immunolabelings presented low÷moderate heterogeneous intensity. WD lip SCC presented a statistically significant higher mean value for CD44 PI compared to MD and PD SCC, and not statistically significant higher in pT1, pT2 then in pT3 and in pN0 cases then in pN1. WD lip SCC presented statistically significant higher mean value of VEGF PI related to those with MD and PD SCC. VEGF PI values were higher in pT1, pT2 then in pT3 and in the pN0 SCC, but without statistically significant differences. We found a positive linear correlation for Ki67÷p53, although statistically not significant and for CD44÷VEGF statistically significant (p=0.001). Also, the analysis identified negative a linear statistically significant correlation for Ki67÷CD44 and for Ki67÷VEGF statistically significant as well (p=0.001). Immunohistochemical investigations in lip SCC, regarding the expression of p53, Ki67, CD44 and VEGF, revealed results that suggest their ability to assess the prognosis and progression of tumor evolution.

Impact of recurrence interval on survival of oral cavity squamous cell carcinoma patients after local relapse

OBJECTIVE: The aim of this study was to investigate whether the recurrence interval influenced the survival of oral cavity squamous cell carcinoma patients after relapse.

STUDY DESIGN AND SETTING: Retrospective charts were reviewed at a medical center.

METHODS: We retrospectively reviewed 1687 chart records of oral cancer patients. Statistical methods included descriptive statistics, bivariate analyses, Kaplan-Meier survival analyses, and Cox proportional hazard models for investigating the relationship between the recurrence interval and survival of oral cancer patients after relapse.

RESULTS: Local recurrence rate was 31.3 percent. Kaplan-Meier survival analyses showed the 5-year overall survival after recurrence was 31.56 percent. Cox proportional hazard model revealed that those with recurrence interval less than 18 months tended to have a higher probability of death than those with recurrence interval greater than or equal to 18 months (relative risk, 1.743; 95% confidence interval, 1.298–2.358).

CONCLUSION: The interval from initial treatment to recurrence is an independent prognostic factor for oral squamous cell carcinoma patients. Those with a shorter disease-free interval tend to have a less favorable outcome.

© 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

Mortality rate of lip, oral cavity and pharynx malignant tumors in Serbia within a period 1991-2009

BACKGROUND/AIM

Lip, oral cavity and pharynx malignant tumors account for 3.7% of all cancer deaths worldwide, with significant geographic variations in frequency and distribution. The aim of this descriptive epidemiologic study was to analyze the mortality rate of lip, oral cavity and pharynx malignant tumors in Serbia proper within a period 1991-2009.

METHODS

Mortality rates standardized directly using the world population as the standard were used in data analysis. Linear trend and regression analyses were used to analyze rate trends in mortality.

RESULTS

The Serbian population demonstrated an increase in the mortality of lip, oral cavity and pharynx malignant tumors (y = 3.32 + U.03x; p = 0.002; average annual percent change = + 0.8). The male population showed a significant increase in mortality trend (y = 5.90 + 0.03x; p = 0.020; % change = + 0.9), while the female population did not show a significant increase in mortality. The male/female cancer mortality ratio was 5.5:1. Mortality rates for lip, oral cavity and pharynx cancer increased with age in both genders, with rates being the highest in the population aged 85 and older. Increasing trends of lip, oral cavity and pharynx cancer mortality were observed in males aged 50-54; the average annual percent change was + 7.4% (95% CI, 6.2-9.0). The population of both genders aged 55-59 demonstrated an increase in lip, oral cavity and pharynx cancer mortality, the increase being + 1.8% (95% CI, 1.4-2.2) in men and + 34.30% (95% CI, 28.4-40.2) in women.

CONCLUSION

The increasing trend in lip, oral cavity and pharynx cancer mortality points to the necessity to investigate etiology and improve primary and secondary prevention measures.

[Management of recurrent lower lip carcinomas]

OBJECTIVES

In this study patients who had locoregional recurrence of lower lip carcinomas after therapies such as surgery, electrocoagulation, cryotherapy or traditional local therapies are discussed.

PATIENTS AND METHODS

The records of 16 cases (1 female, 15 males; mean age 58 years; range 30 to 83 years) with recurrent lower lip carcinoma admitted between March 2002 and September 2007 to Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ear, Nose and Throat Department were retrospectively reviewed.

RESULTS

Fourteen patients had been treated in other institutions, while two had been treated in our center. Four of the patients had recurrence in the lip, four patients had recurrence only in the neck, and the remaining eight patients had both lip and neck recurrence. Ten patients received modified radical or radical neck dissection because of their palpable lymphadenopathies, three patients received supraomohyoid neck dissection due to non palpable lymphadenopathies, and the remaining three patients did not have neck dissection because of co-morbid diseases. Seven patients (43%) died in the first postoperative year because of lower lip carcinomas and three patients died because of other reasons. Six patients survived for the first two years without any evidence of disease.

CONCLUSION

Patient survival will be affected by the applied treatment. For patients with primary lower lip cancers, otolaryngologists experienced in oncology must plan surgery rather than local treatments. In case of locoregional recurrence, immediate treatment should be planned.

Trends in the survival of patients diagnosed with cancers of the lip, oral cavity, and pharynx in the Nordic countries 1964-2003 followed up to the end of 2006

BACKGROUND

This is the first comprehensive population-based study on relative survival of lip, oral cavity and pharyngeal cancer in the Nordic countries.

MATERIAL AND METHODS

Relative survival of patients with cancers of the lip, oral cavity, and pharynx diagnosed in the Nordic countries in 1964-2003 and followed up to the end of 2006 was studied and contrasted with trends in incidence and mortality.

RESULTS

There are marked differences in incidence between countries and over time. The stability of the relative survival ratios gives support to the hypothesis that the incidence differences are more likely to be real and not materially affected by differences in definitions and coding. Of particular note are the steep rises in pharyngeal cancer incidence in Denmark in both sexes. Survival has only moderately improved over time and has tended to be slightly higher in females than males.

CONCLUSIONS

Co-morbidity caused by smoking and high alcohol consumption are likely to be partially responsible for differences between countries. Advances in therapy and standards of care are also likely to have played a role in the increasing survival trends.

Clinical Parameters in T1N0M0 Lower Lip Squamous Cell Carcinoma

This retrospective study was carried out to asses the clinical outcome of T1 (i.e., tumor 2 cm or less at greatest dimension) squamous cell carcinoma of the lower lip (SCCLL) and verify the impact of some clinical parameters on prognosis. Fifty-seven patients with histologically proven T1 SCCLL were analyzed. Fifty-two patients were never treated before admission, whereas five (8.8%) had a second radical resection of the primary tumor location; none had neck nodes (i.e., N0) or distant metastasis (i.e., M0). The global disease-specific survival rate at 32 months was 100%, irrespective of grading and type of surgery, and thus no differences were statistically detected. Therefore, we concluded that radical tumor resection is a viable procedure for T1 SCCLL, irrespectively of grading. In addition, a second surgery on the primary tumor location is possible and has effectiveness on survival. Finally, neck dissection is not necessary in cases of T1 SCCLL.

Breast malignant phyllodes tumour metastasising to soft tissues of oral cavity

Metastases from infraclavicular neoplasms to the oral cavity are rare, and the anatomical structures most frequently affected are the maxillae. The primary sites that develop metastases to head and neck include lung, breast, liver, thyroid gland, kidney and melanomas, among others. The breast is one of the usual primary regions that can present them. In the literature, most metastases to these regions correspond to squamous cell carcinomas and adenocarcinomas; few studies report other type of neoplasms such as phyllodes tumour (PT) that present this behaviour. The importance of identifying metastatic disease to the oral cavity, be it as the first manifestation of a neoplasm from unknown origin or as a development in the course of the disease, is that it allows determination of adequate treatment, which has an effect on the patient's prognosis. The usual behaviour of PT is frequent recurrence and, when metastases are present, these are to lungs and bone. Two cases of malignant PT metastasising to tongue and lip are presented, as well as a review of the literature.

Cluster detection diagnostics for small area health data: with reference to evaluation of local likelihood models

The focus of this paper is the development of a range of cluster detection diagnostics that can be used to assess the degree to which a clustering method recovers the true clustering behaviour of small area data. The diagnostics proposed range from individual region specific diagnostics to neighbourhood diagnostics, and assume either individual region risk as focus, or concern areas of maps defined to be clustered and the recovery ability of methods. A simulation-based comparison is made between a small set of count data models: local likelihood, BYM and Lawson and Clark. It is found that local likelihood has good performance across a range of criteria when a CAR prior is assumed for the lasso parameter.

A study of squamous cell carcinoma of the lip at West Virginia University Hospitals from 1980-2000

The goal of this study was to review the patterns of relapse and outcome for patients with squamous cell carcinoma of the lip treated at West Virginia University Hospitals, and to assess the tumor factors that may influence the prognosis of patients. A total of 52 patients were identified in a retrospective review of all lip cancer patients referred to West Virginia University Hospitals between 1980 and 2000. Relevant data was extracted from the medical records of each patient, as well as information from the Cancer Registry. Most patients were men (86%) with T1N0 cancers (52%) of the lower lip. Less than 10% had nodal disease at diagnosis. Following treatment, 31% of patients relapsed, 7 at the primary site and 9 at regional lymph nodes. The relapse rate was 15% for T1 lesions, whereas it increased to 44% for T2 lesions. The overall crude 5-year survival rate was 69%. These findings highlight an increased relapse rate and mortality for a subgroup of patients diagnosed with a more aggressive form of lip cancer. Treatment and follow up of these patients should accordingly be more aggressive.

Oral cancer at a Tasmanian tertiary referral clinic, the Royal Hobart Hospital 1996-2002

BACKGROUND

The Holman Clinic at the Royal Hobart Hospital includes a multi-disciplinary head and neck clinic which functions as a tertiary referral centre for Southern Tasmania and involves Ear Nose and Throat surgeons, Oral and Maxillofacial Surgeons, Plastic and Reconstructive Surgeons, Radiation Oncologists and Medical Oncologists.

METHODS

The aim of this study was to examine retrospectively the number, gender distribution, age, site of lesion, histology, mortality and treatment modalities of the oral cancers referred to the Holman clinic at the Royal Hobart Hospital. The medical histories and a database of the Holman clinic were used as the sources of data for this study. A total of 101 patients were treated for oral cancer in the Holman clinic at the Royal Hobart Hospital from 1996 to 2002. There were 64 males and 37 females.

RESULTS

The distribution of anatomical sites of the oral cancers in this study was as follows: 36 oral tongue lesions, 17 floor of mouth, 13 lip, five retromolar trigone, five mandibular alveolus, six buccal mucosa, nine palatal and 10 minor and major salivary gland cancers. The most common site of oral cancer was the tongue (35.6 per cent), followed by the floor of mouth (16.8 per cent) and lip (12.9 per cent).

CONCLUSIONS

The majority of oral cancers were squamous cell carcinoma, except for the salivary gland cancers. The incidence of squamous cell carcinoma was between 67 and 100 per cent, depending upon the site involved. The trends found in this study are similar to those previously documented over the past 20 years.

Cancer risks in a historical UK cohort of benzene exposed workers

AIMS

To examine mortality from different causes and cancer incidence among a cohort of benzene workers in England and Wales.

METHODS

A cohort of 5514 workers who had been occupationally exposed to benzene in 1966/67 or earlier was assembled by the former Factory Inspectorate and the Medical Research Council from details provided by 233 employers in England and Wales. The cohort was followed up for mortality (1968-2002) and cancer registrations (1971-2001). National mortality rates and cancer registration (incidence) rates were used to calculate standardised mortality ratios and standardised registration ratios.

RESULTS

Mortality was close to expectation for all causes and significantly increased for cancer of the lip, cancer of the lung and bronchus, secondary and unspecified cancers, acute non-lymphocytic leukaemia (ANLL), and all neoplasms. Significant deficits were shown for three non-malignant categories (mental disorders, diseases of the digestive system, accidents). SMRs for other leukaemia, lymphomas, and multiple myeloma were close to or below expectation. There was some evidence of under-ascertainment of cancer registrations, although significantly increased SRRs were shown for lung cancer and cancer of the pleura (mesothelioma).

CONCLUSIONS

Many study subjects would have been exposed to carcinogens other than benzene (for example, asbestos, rubber industry fumes, foundry fumes, polycyclic aromatic hydrocarbons), and the excesses of lung cancer and mesothelioma are likely to reflect exposures to these other carcinogens. The carcinogenic effects of benzene exposure on the lymphohaematopoietic system were limited to ANLL.

[Reconstruction after tumour's excision in lip's cancer: report of 100 cases]

OBJECTIVE

Cancer of the lips is a frequent pathology, it represents 1/5 of cancers of the upper aerodigestive tract. Its objectives are to present the experience of the plastic and reconstructive surgery unit of the universitary hospital of Casablanca.

MATERIAL AND METHOD

The authors present a retrospective study about 100 cases of lips cancer treated between January 1999 and December 2002.

RESULTS

The average age is 59 years. The sex-ratio is 7.3. Eighty-five percent of our patients were smokers and 22% were alcoholics, the association alcoholic and smoker was found in 20%. In our study 71% were classified T1-T2 and 29% as T3-T4. The tumoral location was the lower lip in 82% and the upper lip in 10%. The histological study showed a squamous cell carcinoma type in 85% and a basal-cell carcinoma type in 14% of cases. After the tumour's excision, the reparation was done by cross-lip flap in 25%, the naso-lateral flap in 16% and the Gillies flap in 8%. The functional result was good in 92% of cases and the aesthetic result was excellent in 60% of cases and good in 30% of cases. The survival rate at 2 year was 90%.

CONCLUSION

Actually, lip's cancer treatment is essentially surgical. The reconstructive techniques are various, depending on the size and location of the loss of substance.

Important prognostic factors of long-term oropharyngeal carcinoma survivors in Taiwan

In Taiwan, a clear gender difference emerges for rates of oropharyngeal carcinoma incidence. The purpose of this study was to identify the gender differences and clinical factors associated with oropharyngeal carcinoma survival rates in Taiwan. We analyzed the 5-year survival rates of 8114 subjects diagnosed with oropharyngeal carcinoma between 1987 and 1994. The Cox proportional-hazards model identified clinical characteristics for gender according to oropharyngeal carcinoma death and all-cause death outcomes. The 5-year survival rates were significantly lower for males than females (p < 0.0001). The adjusted hazard ratio of males versus females was 1.54 (95% CI: 1.36-1.74) for oropharyngeal carcinoma death and 1.44 (95% CI: 1.31-1.58) for all-cause death. Gender and other clinical characteristics (i.e. diagnostic age, anatomic site, morphologic type, and treatment modality) play important roles in oropharyngeal carcinoma survival. We suggested that Taiwanese males have high proportion of betel quid chewing and that this is associated with the gender differences.

Management of lower lip cancer: a retrospective analysis of 118 patients and review of the literature

In this current study, the clinical data and postoperative follow-up findings of 118 patients with a primary lower lip carcinoma who were treated between 1983 and 1999 in the Department of Plastic and Reconstructive Surgery are presented. Medical records were reviewed retrospectively and data were collected concerning age, gender, followup period, location of lesion on the lip, cervical metastasis at presentation, preoperative biopsy results, histological grade, initial treatment, reconstruction type, pathological outcome, local recurrence, regional lymph node metastasis, treatment of local recurrence and regional lymph node metastasis, and postoperative treatment. The prognostic value of clinical stages in relation with recurrence and mortality from disease was investigated. The overall rate of recurrence was calculated as being 39.8%, and the determinate survival rate was found to be 72.9% at 5-year follow-up. The data concerning the above-mentioned parameters, together with risk factors that might play a role in the development of lip cancer, are discussed in light of the current literature.

Supraomohyoid neck dissection in the management of cervical lymph node metastases of squamous cell carcinoma of the lower lip

BACKGROUND

Supraomohyoid neck dissection (SOHND) is generally considered an adequate staging procedure in selected patients with squamous cell carcinoma (SCC) of the lip and oral cavity, with clinically negative nodes in the neck that are at increased risk for occult metastatic disease. The potential role of SOHND as a therapeutic surgical procedure for cervical metastasis limited to level I is controversial.

METHODS

A series of 44 patients with clinical cervical lymph node metastases at level I from SCC of the lower lip is reported to evaluate the results of a treatment protocol consisting of therapeutic SOHND on indication followed by radiotherapy.

RESULTS

Regional recurrences were observed in four (9%) patients. All recurrences developed within the SOHND dissected area only.

CONCLUSIONS

A therapeutic SOHND, on indication followed by radiotherapy, can be an oncologically sound and effective procedure in the management of regional lymph node metastases at level I from SCC of the lower lip.

Desmoplastic melanoma of the lip

BACKGROUND

This retrospective study looks at the prognosis of desmoplastic melanoma of the lip, correlating it with the clinical course, treatment, and patterns of failure.

METHOD

Twenty-two patients with desmoplastic melanoma of the lip were seen at the University of Texas M. D. Anderson Cancer Center from 1965 to 1998.

RESULTS

Three disease groups: (I) untreated tumor (3 patients), (II) excisional scar (10 patients), and (III) locoregional recurrence (9 patients). Group I had two cures and one failure. In group II six had no recurrences, and there were four failures. In group III, all patients failed. Ten patients (45%) had no evidence of disease, of which three (30%) had an initial misdiagnosis. Twelve patients (55%) died of disease or were living with disease, of which eight (67%) had an initial misdiagnosis.

CONCLUSIONS

Desmoplastic melanoma of the lip is often misdiagnosed and, therefore, inappropriately treated with multiple recurrences and poor prognosis. Accurate diagnosis and combined treatment may improve local control and survival.

[Lip, oral cavity and pharynx cancers in France: incidence, mortality and trends (period 1975-1995)]

With 10,882 estimated new cases in 1995 in France, lip, oral cavity and pharynx tumours rank 4th, representing 8.1% of all cancers in men. They are less frequent in women, with a sex ratio of 7. Based on the French cancer registries data which cover 13% of the metropolitan territory in 2000, both incidence and mortality increased until early 1980s to decrease thereafter. The main hypothesis proposed to explain the French leadership world-wide for these tumours deals with alcohol and tobacco consumption. Important differences observed between several areas within Europe, for some subsites, in connection with age or sex, are pointing toward the need of new studies about environment and/or genetics. Until now, comparisons between countries were made at the level of lip, oral cavity and pharynx category as a whole or by large subgroups. In this work we attempt to establish more accurate statistics, in order to comply with the situation of this cancer in France. Present results should encourage the scientific community to conduct site specific epidemiological studies.

Basal cell carcinoma of the lip treated with radiotherapy

Basal cell carcinoma (BCC) of the lip is uncommon relative to other cutaneous sites for BCC, such as the central face or scalp. A female predisposition and predilection for the upper lip have been previously documented. A retrospective analysis of patients treated for BCC of the lip was undertaken within the department of Radiation Oncology, Westmead Hospital, Sydney. Twenty patients were identified; 12 women and 8 men. The majority (15/20) had T1 lesions of the upper lip (17/20). Eleven patients were referred for radiotherapy alone and nine for adjuvant radiotherapy following either incomplete excision or local recurrence. With a mean follow up of 36 months no patient has recurred following either definitive or adjuvant radiotherapy. Despite the majority of BCCs of the lip being amenable to surgery fractionated external beam radiotherapy remains an option especially when functional and/or cosmetic concerns are an issue. We present the findings from this small case series and use our findings to illustrate the role of radiotherapy in treating BCC of the lip.

P53 protein expression in oral squamous cell carcinoma. survival analysis

BACKGROUND

The present study aimed to analyze the pattern of p53 expression and its influence on survival in patients with oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

An immunohistochemical technique with BP53-12 antibody was performed on stored tissue from 78 patients with OSCC (intraoral cancer n=40; lip cancer n=38). The nuclear and cytoplasmic extension of p53 staining was assessed. Clinical and histopathological data were gathered and the patient survival was analyzed.

RESULTS

57.7% (n=45) of the OSCCs expressed p53, with nuclear expression in 52.6% (n=41) of cases and cytoplasmic expression in 24.4% (n=19). The OSCCs with extensive nuclear expression of p53 showed dissociated patterns of invasion of adjacent tissues (p<0.05). A greater extension of cytoplasmic expression of p53 most commonly appeared in tumors that were better-differentiated (p<0.005), more keratinized (p<0.01) and with less nuclear atypia (p<0.05). The parameters that significantly influenced survival of patients were tumor localization (p<0.01), size (p<0.0001), lymph node invasion (p<0.0001), clinical stage (p<0.0001), differentiation degree (p<0.01) and nucleargrade (p<0.01).

CONCLUSION

The expression of p53 protein did not behave as a marker of prognostic value in patients with OSCC.

Squamous cell carcinoma of the lip. Patterns of relapse and outcome: Reporting the Westmead Hospital experience, 1980-1997

Australia has one of the highest rates of squamous cell carcinoma of the lip in the world. Despite a high cure rate, many studies report relapse rates of between 5% and 20% with an associated mortality of 5-10%. The aim of this study was to review the patterns of relapse and outcome for patients treated at Westmead Hospital, Sydney. Ninety-three eligible patients were identified in a retrospective review of all lip cancer patients referred to Westmead Hospital between 1980 and 1997. Relevant data were extracted from the treatment files and included contact with referring doctors and utilizing the Cancer Council Registry. Equal numbers of patients were treated with radiotherapy alone or surgery (+/- adjuvant radiotherapy). The majority of patients were male (78.5%) with T1N0 cancers (64.5%) of the lower lip. A minority (5.4%) had nodal disease at diagnosis. Following treatment, 31 (33.3%) patients relapsed, 11 at the primary site, 18 at the regional nodes and two at both sites simultaneously. Patients treated with a combined approach (RTx/Sx) experienced a better outcome. Overall cancer-specific survival at 5 years was 85%. These findings highlight a disturbing relapse rate and mortality for a subgroup of patients diagnosed with a more aggressive form of lip cancer. Treatment and follow up of these patients should accordingly be more aggressive.

Surgical treatment of squamous cell carcinoma of the lower lip

INTRODUCTION

A controversy still exists regarding the preferable mode of treatment - surgical treatment or radiotherapy of 1st stage squamous cell carcinoma of the lower lip. That is why we have set as a

PURPOSE

To compare the two methods of treatment and to propose a therapeutic approach.

METHODS

A retrospective longitudinal study of patients with squamous cell carcinoma (SCC) of the lower lip from three regions in South Bulgaria (Plovdiv, Pazardjik and Smolian), who have been treated primarily with surgical operation (n=184) or by radiotherapy (n=592) was performed.

RESULTS

Following up 184 patients who have undergone surgical treatment (vermilionectomy) as a primary therapeutic method for a period of 15 years, we have observed favourable results in 92.5% of the cases (n=170). We found local recurrences in 3.1% of the cases (n=6) and regional lymph-node metastases in 4.4% of the cases (n=8). Five-year overall survival rates was 81% and 10-year survival rates - 64%. The corresponding relapse-free five-year survival was 89% and ten-year survival - 82%. The results from the 592 patients treated with radiotherapy are: therapeutically cured - 90.5% of the cases (n=536), local recurrences - 4.3% of the cases (n=25) and regional lymph-node metastases (n=31.)

CONCLUSIONS

Vermilionectomy is a suitable method for surgical treatment of 1st-stage SCC of the lower lip with a thickness of the tumour up to 3 mm and a size of the primary tumour up to 1.5 cm.

Disease mapping models: an empirical evaluation. Disease Mapping Collaborative Group

The analysis of small area disease incidence has now developed to a degree where many methods have been proposed. However, there are few studies of the relative merits of the methods available. While many Bayesian models have been examined with respect to prior sensitivity, it is clear that wider comparisons of methods are largely missing from the literature. In this paper we present some preliminary results concerning the goodness-of-fit of a variety of disease mapping methods to simulated data for disease incidence derived from a range of models. These simulated models cover simple risk gradients to more complex true risk structures, including spatial correlation. The main general results presented here show that the gamma-Poisson exchangeable model and the Besag, York and Mollie (BYM) model are most robust across a range of diverse models. Mixture models are less robust. Non-parametric smoothing methods perform badly in general. Linear Bayes methods display behaviour similar to that of the gamma-Poisson methods.

The temporal and spatial epidemiology of lip cancer in England and Wales

OBJECTIVE

To examine trends in lip cancer mortality and incidence during the 20th century, and its geographical distribution, in England and Wales as a prerequisite to establishing any essential differences in the aetiology of lip and intra-oral cancer.

METHOD

Age-standardised rates for lip cancer mortality by gender from 1901 to 1991 were derived from archived OPCS data. Standardised incidence rates from 1962 to 1986 were also calculated. Registrations of lip cancer between 1979 and 1983 in the 15 RHAs covering England and Wales were obtained from the same source and standardised incidence ratios (SIR) computed.

RESULTS

Progressive and sustained falls in lip cancer mortality and incidence were recorded in the period covered. In males, these related particularly to cohorts born after 1856. In addition, the incidence of lip cancer in both genders was found to be raised in a band stretching from East Anglia to the South West and also in the Trent and Wales RHAs.

CONCLUSIONS

The findings support an hypothesis that employment in the agriculture, forestry and fishing industries, and also pipe smoking, were the major risk factors for lip cancer in the 20th century. Further research is required to differentiate between the aetiological risk factors for lip and intra-oral cancer.

Comparing the performance of two indices for spatial model selection: application to two mortality data

The statistical analysis of spatially correlated data has become an important scientific research topic lately. The analysis of the mortality or morbidity rates observed at different areas may help to decide if people living in certain locations are considered at higher risk than others. Once the statistical model for the data of interest has been chosen, further effort can be devoted to identifying the areas under higher risks. Many scientists, including statisticians, have tried the conditional autoregressive (CAR) model to describe the spatial autocorrelation among the observed data. This model has greater smoothing effect than the exchangeable models, such as the Poisson gamma model for spatial data. This paper focuses on comparing the two types of models using the index LG, the ratio of local to global variability. Two applications, Taiwan asthma mortality and Scotland lip cancer, are considered and the use of LG is illustrated. The estimated values for both data sets are small, implying a Poisson gamma model may be favoured over the CAR model. We discuss the implications for the two applications respectively. To evaluate the performance of the index LG, we also compute the Bayes factor, a Bayesian model selection criterion, to see which model is preferred for the two applications and simulation data. To derive the value of LG, we estimate its posterior mode based on samples derived from the BUGS program, while for Bayes factor we use the double Laplace-Metropolis method, Schwarz criterion, and a modified harmonic mean for approximations. The results of LG and Bayes factor are consistent. We conclude that LG is fairly accurate as an index for selection between Poisson gamma and CAR model. When easy and fast computation is of concern, we recommend using LG as the first and less costly index.

Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88

BACKGROUND

Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective.

METHODS

A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause-specific mortality, and the incidence of metachronous lesions.

RESULTS

Recurrence-free survival at 10 years was estimated to be 92.5%, and cause-specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period.

CONCLUSIONS

Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced.

Cervical lymph node metastases and squamous cell carcinoma of the lip

BACKGROUND

Squamous cell carcinoma of the lip generally has a favorable outcome. The chance of long-term survival is significantly reduced if lymph node metastases develop. Any features that could identify patients having increased risks of occult lymph node metastases would allow more aggressive treatment and, possibly, a better outcome.

METHODS

A chart review of lip cancer from this institution identified 1001 patients with squamous cell carcinoma of the lip. This database was used to identify the characteristics that are associated with occult lymph node metastases.

RESULTS

Delayed cervical lymph node metastases developed in 40 patients. No significant differences were noted in the frequency of delayed lymph node metastases according to gender, lip subsite, or age less than 40 years. Significant differences were noted in association with the tumor size, tumor differentiation, and local recurrence.

CONCLUSIONS

Elective cervical lymphadenectomy is justifiable for higher grade tumors and for locally recurrent tumors. An increase in delayed metastases was observed in patients with tumors greater than 3 cm, but the proportion is not great enough to justify elective neck dissections.

Trends in oral cancer mortality in Japan: 1950-1993

OBJECTIVES

To investigate trends in mortality rates of oral cancer patients in Japan between 1950 and 1993 by sex, age and cancer site, and compare the results with previous studies to determine whether there are any common characteristics of oral cancer patterns between Japan and European countries.

MATERIAL AND METHODS

The mortality data obtained from the Japanese Vital Statistics were analyzed using the 5-year moving average method, and the mortality rates were adjusted to the 1990 world population by age and sex. Age-specific mortality rates were analyzed by birth cohort.

RESULTS

The age-standardized mortality rates among the males increased from 1.14 per 100,000 person--years in 1952 to 1.84 in 1991, whereas the corresponding rate among females changed little over the same period. Cancer of the tongue was the most common cause of death in Japan among the five studied oral regions: lip, tongue, floor of the mouth, major salivary glands and oropharynx, males aged under 54 born in 1920 or later were found to have an increased risk of such disease.

CONCLUSION

Further epidemiological investigations are necessary to clarify the etiology of oral cancer in Japan.

[Suprahyoid lymphangiectomy in patients treated for lip cancer]

Bilateral suprahyoid lymphangiectomy have been made in 95 patients because of suspicion of submandibular lymph nodes metastases. The patients with lip carcinoma have been previously treated with surgery, surgery and radiotherapy or with radiotherapy followed by surgery. Histological examinations have revealed lymph node metastases in 62 (65.3%) patients, in 31 (32.6%) patients histology has been negative and in 2 (2.2%) patients lymphonodular tuberculosis has been stated. Authors have analyzed 3, 5 and 10 years survivals in 65 patients after suprahyoid lymphangiectomy during lip cancer treatment.

[Results of treatment for lip carcinoma]

233 patients with lip carcinoma were treated in ENT Department of County Hospital No 1 in Rzeszów from 1974 to 1990. Analysing the kind of surgery according to clinical stage of the disease it was stated that the most patients with advanced tumors required reconstruction operations-125 (53.6%). Authors analyzed 3, 5 and 10 years survivals, separately for patients treated either surgically or with combined method and for patients who were treated with radiotherapy followed by surgery because of local recurrence of the disease.

Applications of brachytherapy in head and neck cancer

Brachytherapy offers the radiation oncologist the opportunity to deliver high doses of radiation to the tumor, with minimal doses to the surrounding normal tissue. This combination enhances the therapeutic ratio. It allows for enhanced tumor control, with minimal toxicity. When utilized, it often allows for tumor control without the need for resection. This is especially important in the head and neck. Resection of organs such as the lip, oral tongue, base-of-tongue, and other sites can cause significant functional and cosmetic morbidity. The ability to save these structures, using radiation therapy instead of surgery, can provide excellent tumor control and optimal quality-of-life outcome. In situations of recurrent disease, especially when prior radiation has been given, brachytherapy is often the only way to re-irradiate certain areas. This can be done alone, or in combination with surgery. Therefore, brachytherapy becomes an important component of the treatment of recurrent disease. This broad overview of the use of brachytherapy in head and neck cancer will include applications in the primary as well as the recurrent disease setting.

[A retrospective assessment of spinocellular carcinomas of the lip treated by roentgenotherapy]

From December 1965 to December 1987 (22 years), 279 patients with histologically confirmed squamous cell carcinoma of the lip were treated in this Department with roentgenotherapy. All the patients that had completed the treatment were evaluated with a follow-up time of 5 years (n=255). Distribution by age, sex, occupation, residence, evolution time of the lesion, localization (upper lip, lower lip and commissure), tumoral size and histological grade were analysed. Concerning technical conditions and fractionation, we evaluated the type and which dose of radiation elicit acute reactions as well as the results of radiotherapy (local and cosmetic control). A relation is made between the size of the lesion and outcome after treatment. The survival rate at 3 years was 76,6% and at 5 years (the usual follow-up period for these patients) was 66%. Disease-free survival rate at 3 years was 79% and at 5 years was 77,6%.

Squamous-cell carcinoma of the lower lip: a retrospective study of 58 patients

The charts of 58 patients with squamous-cell carcinomas of the lower lip, treated at the General Hospital of the University of São Paulo Medical School from January 1980 to December 1989, were retrospectively analyzed. In addition to regular demographic data, all available information was collected regarding: smoking and drinking habits; sun exposure; clinical stage; macroscopic features of the primary lesions; type of treatment; and follow-up. A meticulous pathological analysis, comprising the histologic differentiation grade, maximal tumor thickness, sun elastosis, perineural spread, vascular and muscular invasion, surgical margins, peritumoral inflammatory infiltrate, and positive lymph nodes, with or without extracapsular spread, was undertaken as well. The evaluation of the overall 5-year survival showed significant statistical differences, with prognostic implications, for the following variables: maximal tumor thickness, T-stage and positive nodes.

Outcome analysis for lip carcinoma

Carcinoma of the lip is a relatively common malignancy of the head and neck region, accounting for approximately one quarter of oral cavity cancers. Although this form of cancer is generally readily curable compared with malignancies at other head and neck sites, regional metastases, local recurrence, and even death from this disease may occasionally occur. A review of 1252 patients who were diagnosed with lip cancer from 1940 to 1987 was undertaken to identify and rank prognostic variables, clarify differential incidences of site predilection between male and female patients, and examine the correlation between tumor site and histopathologic diagnoses. Large tumor size, high tumor grade, the presence of adenopathy, a subsite other than the lower lip, and inadequate surgical margins were found to have a negative impact on determinate survival of patients with lip carcinoma. Twenty-one percent of lip cancers in female patients arose on the upper lip, whereas only 3% of lip cancers in male patients developed on the upper lip. Basal cell carcinomas comprised 13% of upper lip cancers and only less than 1% of lower lip cancers. Recurrence developed in 15.1% of the patients reviewed and was strongly associated with large tumor size and poor differentiation. Local recurrence was associated with a determinate survival of 78%, whereas patients having regional recurrences had a survival rate of 52%. These data support aggressive treatment of lip cancers greater than 3 cm in diameter, high-grade tumors, tumors associated with cervical lymphadenopathy, and upper lip and commissure tumors. Lip cancer in women seems to be slightly more aggressive than in men.

Lymph-node metastasis in squamous cell carcinoma of the lip. A retrospective analysis of 105 cases

During 1975-87, 105 patients with squamous cell carcinoma (SCC) of the lip were surgically treated. All patients underwent radical resection of the tumor. Only the patients with palpable lymph nodes had a simultaneous neck dissection. All patients were followed up for at least 5 years. Of the 80 patients without palpable lymph nodes, only three developed lymph-node metastasis. Of the 25 patients with palpable lymph nodes who underwent modified neck dissection, four had recurrence of lymph-node metastasis at a different level. The over-all 5-year survival rate was 97%. The survival rate for patients with lymph-node metastasis was 88%.

Brachytherapy for lower lip epidermoid cancer: tumoral and treatment factors influencing recurrences and complications

From 1972 to 1991, 237 patients with squamous cell carcinoma of the lower lip were treated by exclusive LDR brachytherapy (192Ir). There were 158 T1, 61 T2, 17 T3 and 1 T4 with 231 N0, 3 N1 and 3 N2 patients. The actuarial values at 5 years for local and regional controls, overall and specific survivals were 95%, 91%, 74% and 91%. Salvage treatment increased local control up to 99% and regional control to 94%. No heterolabial recurrence has been observed since the entire lip is treated, even for small tumors. The regional control depends closely on the thickness of the labial tumor (> or = 1 cm, p < 0.0001). The healing of treatment-induced mucositis is sometimes delayed for thick tumors (> or = 1 cm, p = 0.015). Late complications are not related to tumoral thickness but to the treated thickness (> 1.4 cm, p = 0.018) and particularly to the thickness of normal tissue included in the 85% isodose (treated thickness - tumoral thickness > 0.4 cm, p = 0.025). The use of a leaded protection and low linear radioactivity wires (< 2 mCi/cm, < 8.6 muGy/h.m2/cm) especially for large target volumes is required to lessen late complications. Based on this review, we advocate exclusive brachytherapy for small and intermediate tumors, with elective bilateral submaxillary and submental dissection for thick, high grade or commissure tumors. Simple recommendations are made to assure quality of the brachytherapy treatment.

[Interstitial brachytherapy in carcinoma of the lip. Case histories and results]

Squamous cell carcinomas of the lip can be treated by surgery or radiation therapy. Since local control rates exceed 90% with both treatment modalities, therapy is chosen according to functional and cosmetic results, to the patient's wishes and to the physician's medical policy. This study was aimed at retrospectively reviewing our local control results and patterns of failure relative to survival as well as evaluating the results according to technical surgical variables. From 1982 to 1991, sixty-nine patients with squamous cell carcinoma of the lip received a course of interstitial brachytherapy with 192Ir. The disease stage was T1 in 36 cases, T2 in 12 cases and T3 in 2 cases and 19 recurrences; 3 patients only had clinically detectable lymph nodes at diagnosis. Interstitial brachytherapy was used as postoperative treatment, at a dose of 60 Gy, in 47 cases. As an exclusive curative approach brachytherapy was given at a reference dose of 65 Gy, with a medium dose rate of 62.88 cGy; a single plane was used in 55 cases, a triangular plane in 11 and a double plane in 3 cases. In one patient only the disease persisted and no local failures were observed. Overall actuarial survival at 5 years is 76.81% (91.3% when corrected for disease). In fact, 6 patients died of disease progression: 3 with lung metastases, 1 with bone metastases and 3 with lymph node metastases. Five patients died of cancer in other sites--i.e., ovary, lung, prostate, hypopharynx, stomach--and 4 of non-neoplastic diseases. Tolerance rates were excellent, with only one mucosal necrosis which resolved spontaneously; no sequelae were observed in gums, teeth and jaws. The cosmetic result was also excellent in most of the cases with a worsening trend for multiplanar disposition. In conclusion, interstitial brachytherapy can be considered the treatment of choice for early lip cancer.

Carboplatin plus ftorafur as a palliative treatment in locally advanced cancer of the oral cavity and lip

Forty consecutive patients with local advanced cancer of the oral cavity and lip, heavily pretreated, were palliated with two courses of carboplatin, 400 mg/m2 intravenously once a month plus ftorafur, 500 mg/m2 daily per os for 30 days. Previous treatment consisted of surgery (17 patients), radiation therapy (23 patients), and chemotherapy with cisplatin plus bleomycin (15 patients). The main sites of primary tumor were the tongue (12 patients), hard palate (6 patients), retromolar area (6 patients), tonsils (6 patients), perioral skin and lip (5 patients), and floor of the mouth (5 patients). Complete response was observed in 3 patients, and partial response in 7. Symptomatic improvement was observed in 56% of the cases. Median duration of response was 9 months. Median survival was 7 months. The main toxic effects were nausea (39 cases), vomiting (35 cases), and thrombocytopenia (4 cases). We conclude that carboplatin plus ftorafur has a role as palliative chemotherapy in cancer of the oral cavity and lip in heavily pretreated patients when local therapies are not suitable.

Epidemiological aspects of lip cancer in Scotland

The purpose of this paper is to present the descriptive epidemiology of lip cancer in Scotland. The incidence and mortality of lip cancer are found to be higher in men than in women and to have fallen remarkably among men. This decline has been the result of cohort effects indicating that the risk of lip cancer is decreasing among successively younger people.

[The cryodestruction of cancer of the lower lip]

The authors review the results of cryogenic treatment of the lower lip cancer and its recurrences in 212 patients for 1973-1989. The technique of cryodestruction is analysed. It is found that the best results were achieved at the disease stage I-II and local cancer relapses after radiation treatment. The responses were also satisfactory in stage III cancer without extensive spread in the region.

Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection

We reviewed all studies since 1940 on the prognosis of squamous cell carcinoma (SCC) of the skin and lip. The following variables are correlated with local recurrence and metastatic rates: (1) treatment modality, (2) prior treatment, (3) location, (4) size, (5) depth, (6) histologic differentiation, (7) histologic evidence of perineural involvement, (8) precipitating factors other than ultraviolet light, and (9) host immunosuppression. Local recurrences occur less frequently when SCC is treated by Mohs micrographic surgery. This local recurrence rate differential in favor of Mohs micrographic surgery holds true for primary SCC of the skin and lip (3.1% vs 10.9%), for ear SCC (5.3% vs 18.7%), for locally recurrent (previously treated) SCC (10% vs 23.3%), for SCC with perineural involvement (0% vs 47%), for SCC of size greater than 2 cm (25.2% vs 41.7%), and for SCC that is poorly differentiated (32.6% vs 53.6%).

Computer-aided individual prognoses of squamous cell carcinomas of the lips, oral cavity and oropharynx

Computer-aided individual prognoses (CIP) is a software-package developed on the basis of an empirical study and can be installed on any IBM-compatible personal computer. The project which went into the making of CIP was called "Prospective DOSAK-study on squamous cell carcinomas of the lips, oral cavity and oropharynx". In the course of the study 1485 patients were treated between 1977 and 1982, and followed up through 1985. CIP facilitates individual prognoses and comparisons of independent patient groups with parallel groups from the data of the above-mentioned study. In practical clinical work individual prognoses allow exact and reliable judgements on individual patients. In clinical cancer research it provides the information about prognostic factors required for controlled clinical studies. The comparison of independent patient populations allows for an ongoing qualitative control of the patients in each clinical institution. In clinical cancer research such a comparison means that certain characteristics of the patient, the tumor and of the disease can be given higher prognostic value. The same is true of the clinical testing of therapeutic measures which is typically carried out during phase-II-studies. Due to its menu-based organization CIP does not presuppose any specialist knowledge on the part of its users and can be regarded as particularly user-friendly.

[Treatment of tumors of the oral cavity. Long-term follow up of 1223 cases. Clinico-experimental computerized processing using BMDP program]

The study assesses a series of 1223 patients treated for oral cavity neoplasm at the Institute of Oncology of Turin. It confirms the proportional deterioration of the survival rate in correlation with the advanced stage of the carcinoma. It shows the influence of the different types of treatment on survival, particularly referring to tumor site and stage at the time of first treatment.

[Angiosarcoma of the oral cavity. A clinical case report and review of the literature]

The authors describe a case of lip angiosarcoma. Angiosarcoma occurs rarely in the oral cavity, and in a recent review of the literature only 14 cases of such a localisation were found. Angiosarcomas are tumors with a very malignant biologic behavior and the 5-year survival is very low.