Raman spectroscopy to discriminate laryngeal squamous cell carcinoma from non-cancerous surrounding tissue

As for many solid cancers, laryngeal cancer is treated surgically, and adequate resection margins are critical for survival. Raman spectroscopy has the capacity to accurately differentiate between cancer and non-cancerous tissue based on their molecular composition, which has been proven in previous work. The aim of this study is to investigate whether Raman spectroscopy can be used to discriminate laryngeal cancer from surrounding non-cancerous tissue. Patients surgically treated for laryngeal cancer were included. Raman mapping experiments were performed ex vivo on resection specimens and correlated to histopathology. Water concentration analysis and CH-stretching region analysis were performed in the high wavenumber range of 2500-4000 cm-1. Thirty-four mapping experiments on 22 resection specimens were used for analysis. Both laryngeal cancer and all non-cancerous tissue structures showed high water concentrations of around 75%. Discriminative information was only found to be present in the CH-stretching region of the Raman spectra of the larynx (discriminative power of 0.87). High wavenumber region Raman spectroscopy can discriminate laryngeal cancer from non-cancerous tissue structures. Contrary to the findings for oral cavity cancer, water concentration is not a discriminating factor for laryngeal cancer.

Transcriptomics of Epstein-Barr virus aids to the classification of T-cell evasion in nasopharyngeal carcinoma

Epstein-Barr virus (EBV) contributes to oncogenesis and immune evasion in nasopharyngeal carcinoma (NPC). At present, an aggregated, higher-level view on the impact of EBV genes toward the immune microenvironment of NPC is lacking. To this end, we have interrogated tumor-derived RNA sequences of 106 treatment-naive NPC patients for 98 EBV transcripts, and captured the presence of 10 different immune cell populations as well as 23 different modes of T-cell evasion. We discovered 3 clusters of EBV genes that each associate with distinct immunophenotypes of NPC. Cluster 1 associated with gene sets related to immune cell recruitment, such as those encoding for chemoattractants and their receptors. Cluster 2 associated with antigen processing and presentation, such as interferon-related genes, whereas cluster 3 associated with presence of M1-like macrophages, absence of CD4+ T cells, and oncogenic pathways, such as the nuclear factor kappa light-chain enhancer of activated B-cell pathway. We discuss these 3 EBV clusters regarding their potential for stratification for T-cell immunity in NPC together with the next steps needed to validate such therapeutic value.

The observational clinical registry (cohort design) of the European Reference Network on Rare Adult Solid Cancers: The protocol for the rare head and neck cancers

INTRODUCTION

Care for head and neck cancers is complex in particular for the rare ones. Knowledge is limited and histological heterogeneity adds complexity to the rarity. There is a wide consensus that to support clinical research on rare cancer, clinical registries should be developed within networks specializing in rare cancers. In the EU, a unique opportunity is provided by the European Reference Networks (ERN). The ERN EURACAN is dedicated to rare adults solid cancers, here we present the protocol of the EURACAN registry on rare head and neck cancers (ClinicalTrials.gov Identifier: NCT05483374).

STUDY DESIGN

Registry-based cohort study including only people with rare head and neck cancers.

OBJECTIVES

to help describe the natural history of rare head and neck cancers;to evaluate factors that influence prognosis;to assess treatment effectiveness;to measure indicators of quality of care.

METHODS

Settings and participants It is an hospital based registry established in hospitals with expertise in head and neck cancers. Only adult patients with epithelial tumours of nasopharynx; nasal cavity and paranasal sinuses; salivary gland cancer in large and small salivary glands; and middle ear will be included in the registry. This registry won't select a sample of patients. Each patient in the facility who meets the above mentioned inclusion criteria will be followed prospectively and longitudinally with follow-up at cancer progression and / or cancer relapse or patient death. It is a secondary use of data which will be collected from the clinical records. The data collected for the registry will not entail further examinations or admissions to the facility and/or additional appointments to those normally provided for the patient follow-up. Variables Data will be collected on patient characteristics (eg. patient demographics, lifestyle, medical history, health status); exposure data (eg. disease, procedures, treatments of interest) and outcomes (e.g. survival, progression, progression-free survival, etc.). In addition, data on potential confounders (e.g. comorbidity; functional status etc.) will be also collected. Statistical methods The data analyses will include descriptive statistics showing patterns of patients' and cancers' variables and indicators describing the quality of care. Multivariable Cox's proportional hazards model and Hazard ratios (HR) for all-cause or cause specific mortality will be used to determine independent predictors of overall survival, recurrence etc. Variables to include in the multivariable regression model will be selected based on the results of univariable analysis. The role of confounding or effect modifiers will be evaluated using stratified analysis or sensitivity analysis. To assess treatment effectiveness, multivariable models with propensity score adjustment and progression-free survival will be performed. Adequate statistical (eg. marginal structural model) methods will be used if time-varying treatments/confounders and confounding by indication (selective prescribing) will be present.

RESULTS

The registry initiated recruiting in May 2022. The estimated completion date is December 2030 upon agreement on the achievement of all the registry objectives. As of October 2022, the registry is recruiting. There will be a risk of limited representativeness due to the hospital-based nature of the registry and to the fact that hospital contributing to the registry are expert centres for these rare cancers. Clinical Follow-up could also be an issue but active search of the life status of the patients will be guaranteed.

Salivary gland cancer: ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-up

•This ESMO–EURACAN Clinical Practice Guideline provides key recommendations for managing salivary gland cancer. •The guideline covers clinical and pathological diagnosis, staging and risk assessment, treatment and follow-up. •Treatment algorithms for parotid, submandibular, sublingual and minor salivary gland cancer are provided. •The author group encompasses a multidisciplinary group of experts from different institutions and countries in Europe. •Recommendations are based on available scientific data and the authors’ collective expert opinion.

Early Upper Aerodigestive Tract Cancer Detection Using Electron Microscopy to Reveal Chromatin Packing Alterations in Buccal Mucosa Cells

A profound characteristic of field cancerization is alterations in chromatin packing. This study aimed to quantify these alterations using electron microscopy image analysis of buccal mucosa cells of laryngeal, esophageal, and lung cancer patients. Analysis was done on normal-appearing mucosa, believed to be within the cancerization field, and not tumor itself. Large-scale electron microscopy (nanotomy) images were acquired of cancer patients and controls. Within the nuclei, the chromatin packing of euchromatin and heterochromatin was characterized. Furthermore, the chromatin organization was quantified through chromatin packing density scaling. A significant difference was found between the cancer and control groups in the chromatin packing density scaling parameter for length scales below the optical diffraction limit (200 nm) in both the euchromatin (p = 0.002) and the heterochromatin (p = 0.006). The chromatin packing scaling analysis also indicated that the chromatin organization of cancer patients deviated significantly from the control group. They might allow for novel strategies for cancer risk stratification and diagnosis with high sensitivity. This could aid clinicians in personalizing screening strategies for high-risk patients and follow-up strategies for treated cancer patients.

B-cell clusters at the invasive margin associate with longer survival in early-stage oral-tongue cancer patients

In oral-cancer, the number of tumor-infiltrating lymphocytes (TILs) associates with improved survival, yet the prognostic value of the cellular composition and localization of TILs is not defined. We quantified densities, localizations, and cellular networks of lymphocyte populations in 138 patients with T1-T2 primary oral-tongue squamous cell carcinoma treated with surgical resections without any perioperative (chemo)radiotherapy, and correlated outcomes to overall survival (OS). Multiplexed in-situ immunofluorescence was performed for DAPI, CD4, CD8, CD20, and pan-cytokeratin using formalin-fixed paraffin-embedded sections, and spatial distributions of lymphocyte populations were assessed in the tumor and stroma compartments at the invasive margin (IM) as well as the center of tumors. We observed a high density of CD4, CD8, and CD20 cells in the stroma compartment at the IM, but neither lymphocyte densities nor networks as single parameters associated with OS. In contrast, assessment of two contextual parameters within the stroma IM region of tumors, i.e., the number of CD20 cells within 20 µm radii of CD20 and CD4 cells, termed the CD20 Cluster Score, yielded a highly significant association with OS (HR 0.38; p = .003). Notably, the CD20 Cluster Score significantly correlated with better OS and disease-free survival in multivariate analysis (HR 0.34 and 0.47; p = .001 and 0.019) as well as with lower local recurrence rate (OR: 0.13; p = .028). Taken together, our study showed that the presence of stromal B-cell clusters at IM, in the co-presence of CD4 T-cells, associates with good prognosis in early oral-tongue cancer patients.

Raman spectroscopy for cancer detection and cancer surgery guidance: translation to the clinics

Oncological applications of Raman spectroscopy have been contemplated, pursued, and developed at academic level for at least 25 years. Published studies aim to detect pre-malignant lesions, detect cancer in less invasive stages, reduce the number of unnecessary biopsies and guide surgery towards the complete removal of the tumour with adequate tumour resection margins. This review summarizes actual clinical needs in oncology that can be addressed by spontaneous Raman spectroscopy and it provides an overview over the results that have been published between 2007 and 2017. An analysis is made of the current status of translation of these results into clinical practice. Despite many promising results, most of the applications addressed in scientific studies are still far from clinical adoption and commercialization. The main hurdles are identified, which need to be overcome to ensure that in the near future we will see the first Raman spectroscopy-based solutions being used in routine oncologic diagnostic and surgical procedures.

Differences in cancer gene copy number alterations between Epstein-Barr virus-positive and Epstein-Barr virus-negative nasopharyngeal carcinoma

BACKGROUND

Nasopharyngeal carcinoma (NPC) treatment is mainly based on clinical staging. We hypothesize that better understanding of the molecular heterogeneity of NPC can aid in better treatment decisions. Therefore, the purpose of this study was to present our exploration of cancer gene copy-number alterations (CNAs) of Epstein-Barr virus (EBV)-positive and EBV-negative NPC.

METHODS

Multiplex ligation-dependent probe amplification was applied to detect CNAs of 36 cancer genes (n = 103). Correlation between CNAs, clinicopathological features, and survival were examined.

RESULTS

The CNAs occurred significantly more in EBV-negative NPC, with PIK3CA and MCCC1 (P < .001) gain/amplification occurring more frequently. Gain/amplification of cyclin-L1 (CCNL1) and PTK2 (P < .001) predict worse disease-free survival (DFS) in EBV-positive NPC.

CONCLUSION

The EBV-positive and EBV-negative NPC show some similarities in cancer gene CNAs suggesting a common pathogenic route but also important differences possibly indicating divergence in oncogenesis. Copy number gain/amplification of CCNL1 and PTK2 are possibly good predictors of survival in EBV-positive NPC.

Molecular profile of nasopharyngeal carcinoma: analysing tumour suppressor gene promoter hypermethylation by multiplex ligation-dependent probe amplification

Aims

To assess differences in methylation profiles, and thus pathogenesis, between Epstein-Barr virus (EBV)-positive and negative nasopharyngeal carcinomas (NPCs). Also, promoter hypermethylation is a common phenomenon in early carcinogenesis to inactivate tumour suppressor genes. Since epigenetic changes are reversible, the therapeutic application of methylation inhibitors could provide treatment options.

Methods

We evaluated promoter hypermethylation profiles of 22 common tumour suppressor genes in 108 NPCs using methylation-specific multiplex ligation-dependent probe amplification. Correlation between methylation, clinicopathological features (including EBV) and survival was examined. Cluster analysis was also performed.

Results

Hypermethylation of RASSF1A and ESR1 was significantly more frequent in EBV-positive NPC, while hypermethylation of DAPK1 was more frequent in EBV-negative NPC. In logistic regression, age, with EBV-positive NPC occurring at earlier age, and RASSF1, with RASSF1 hypermethylation being more frequent in EBV-positive NPC, remained significant. In EBV-positive NPC, hypermethylation of RASSF1A predicted worse overall survival (OS) (HR 3.058,95% CI 1.027 to 9.107). In EBV-negative NPC, hypermethylated adenomatous polyposis coli (APC) was a predictor of poor disease-free survival (DFS) (HR 6.868, 95% CI 2.142 to 22.022).

Conclusion

There are important epigenetic differences between EBV-negative and EBV-positive NPCs, with EBV-negative NPC having a more similar hypermethylation profile to other head and neck squamous cell carcinomas than EBV-positive NPC. Hypermethylation of RASSF1A might contribute to worse OS in EBV-positive NPC, and may be an important event in the pathogenesis of EBV-infected NPC. Hypermethylation of APC might contribute to worse DFS in EBV-negative NPC.

Heat-induced BRCA2 degradation in human tumours provides rationale for hyperthermia-PARP-inhibitor combination therapies

PURPOSE

Hyperthermia (40-44 °C) effectively sensitises tumours to radiotherapy by locally altering tumour biology. One of the effects of heat at the cellular level is inhibition of DNA repair by homologous recombination via degradation of the BRCA2-protein. This suggests that hyperthermia can expand the group of patients that benefit from PARP-inhibitors, a drug exploiting homologous recombination deficiency. Here, we explore whether the molecular mechanisms that cause heat-mediated degradation of BRCA2 are conserved in cell lines from various origins and, most importantly, whether, BRCA2 protein levels can be attenuated by heat in freshly biopted human tumours.

EXPERIMENTAL DESIGN

Cells from four established cell lines and from freshly biopsied material of cervical (15), head- and neck (9) or bladder tumours (27) were heated to 42 °C for 60 min ex vivo. In vivo hyperthermia was studied by taking two biopsies of the same breast or cervical tumour: one before and one after treatment. BRCA2 protein levels were measured by immunoblotting.

RESULTS

We found decreased BRCA2-levels after hyperthermia in all established cell lines and in 91% of all tumours treated ex vivo. For tumours treated with hyperthermia in vivo, technical issues and intra-tumour heterogeneity prevented obtaining interpretable results.

CONCLUSIONS

This study demonstrates that heat-mediated degradation of BRCA2 occurs in tumour material directly derived from patients. Although BRCA2-degradation may not be a practical biomarker for heat deposition in situ, it does suggest that application of hyperthermia could be an effective method to expand the patient group that could benefit from PARP-inhibitors.

Tubes of Vascularized Cartilage Used for Replacement of Rabbit Cervical Trachea

This study was performed to evaluate the healing process of vascularized cartilage tubes after reconstruction of circumferential tracheal defects in rabbits. Vascularized cartilage was obtained by applying ear cartilage to a vascularized fascia flap in the lateral thoracic area in 10 animals. Five animals (control group) were used to evaluate the viability of the vascularized cartilage after 2 weeks. Circumferential tracheal defects were reconstructed in 5 animals by means of tubes of vascularized cartilage with preservation of the established blood supply around the grafts. The experimental animals were followed until signs of dyspnea became apparent. After follow-up and euthanasia, cartilage viability and regeneration of respiratory epithelium were evaluated. A viable plate of cartilage that was intensely attached to the vascularized fascia flap was found in the control animals. The animals from the experimental group showed dyspnea after a mean follow-up period of 22.6 days because of cartilage necrosis with loss of airway support. Cartilage graft revascularization and remucosalization were limited to 18.1% of the initial surface area of the cartilage tube. Mucosal coverage was seen at the anastomoses, whereas the middle part of the cartilage tube underwent necrosis. We conclude that tubes of autologous cartilage show problematic healing when placed inside the airway. Migration of vascularized connective tissue, migration of respiratory epithelium, and preservation of the viability of the cartilaginous graft were limited to a short segment at the anastomotic sites.

Prefabrication of composite tissue for improved tracheal reconstruction

Tracheal repair tissues were evaluated experimentally to provide an evidence-based choice for decision-making in clinical tracheal reconstruction. Tracheal reconstructive tissue was characterized as providing for vascularization, support, and/or lining. A tissue equivalent was developed in the rabbit for each of the individual tissues. The individual tissues consisted of nonepithelialized soft tissue (vascularized fascia), epithelialized tissue (vascularized fascia grafted with buccal mucosa), and supportive tissue (ear cartilage). The 3 reconstructive tissues were evaluated in 30 rabbits after repair of an anterior laryngotracheal defect. Morphometric and histologic analysis was applied to the reconstructions. After a 1-month follow-up period, defects repaired with nonepithelialized soft tissue showed healing by secondary intention and a wound that was contracted to 44% of the initial surface area of the defect. Mucosa-lined soft tissue flaps and cartilage grafts showed a less than 10% wound contraction. Compared to cartilage grafts, mucosalined soft tissue (vascularized fascia grafted with buccal mucosa) seemed preferable for clinical use, because it showed healing by primary intention. A mucosa-lined radial forearm fascia flap was used successfully in cases of restenosis after tracheal resection. One deficiency of the mucosa-lined soft tissue was the absence of supportive tissue. In cases of extensive stenosis, it might be useful to obtain additional expansion of the airway lumen by creating a convexity at the site of reconstruction. In a second set of experiments, we attempted to improve the mucosa-lined soft tissue concept by adding elastic cartilage. A composite tissue consisting of vascularized fascia, buccal mucosa, and auricular cartilage was developed. Heterotopic prefabrication of the composite tissue was essential for survival of the cartilaginous component. Additional airway lumen expansion could be obtained after heterotopic flap prefabrication. After experimental evaluation, the concept of the prefabricated composite tissue was successfully applied in a clinical case of long-segment stenosis. Experimental and clinical evidence suggests that the combination of buccal mucosa and fascia form an optimized tissue combination for tracheal reconstruction. This combination can be improved by adding strips of autologous ear cartilage.

An investigation of airway wound healing using a novel in vivo model

OBJECTIVE

To study the amount of wound contraction and reepithelialization occurring in the healing process of full-thickness mucosal defects treated with and without mitomycin.

STUDY DESIGN

A new wound healing model was developed in which the tracheal mucosa was exteriorized without interference with the blood supply or with the cartilage support of the trachea. This was done by: 1) orthotopic tracheal revascularization in vascularized fascia; 2) isolation of revascularized segment after 14 days; 3) posterior longitudinal incision of revascularized segment; 4) exteriorization of tracheal mucosa with formation of anterior full-thickness mucosal defect; and 5) closure of posterior tracheal incision and reimplantation in the airway. This model was used to study airway wound healing in three groups of animals: 1) controls (revascularization, exteriorization, reimplantation) (N = 6); 2) full-thickness mucosal defect: patch defect (N = 5), circumferential defect (N = 3); and 3) full-thickness mucosal defect after topical mitomycin application: patch defect (N = 7), circumferential defect (N = 3). The animals were followed for periods varying from 2 to 4 weeks or until signs of dyspnea. The surface areas of the wounds before and after follow-up were measured. Wound healing was studied histologically on axial and longitudinal sections.

RESULTS

Group 1: All the animals survived for 1 month. No significant difference existed between surface area of isolated trachea and of reimplanted trachea after follow-up. Group 2: Five animals (patch defects) survived for 1 month. Full-thickness mucosal defects healed by reepithelialization and by a surface area reduction of 58.9% (mean - standard deviation = 10.5). The animals with the circumferential defects showed dyspnea after an average follow-up of 14 days as a result of excessive granulation tissue formation. Group 3: Mitomycin reproducibly inhibited wound closure, yielding wounds that on average closed 56% less than controls by day 14 (P <.001). Histologic comparisons showed that mitomycin blocks angiogenesis during wound healing.

CONCLUSIONS

A wound healing model based on tracheal revascularization, isolation, and reimplantation was developed in rabbits. This model allowed us to study the healing of full-thickness mucosal defects inside the airway.