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Zhai TT, Wesseling F, Langendijk JA, Shi Z, Kalendralis P, van Dijk LV, Hoebers F, Steenbakkers RJHM, Dekker A, Wee L, Sijtsema NM. External validation of nodal failure prediction models including radiomics in head and neck cancer. Oral Oncol 2021; 112:105083. [PMID: 33189001 DOI: 10.1016/j.oraloncology.2020.105083] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To externally validate the previously published pre-treatment prediction models for lymph nodes failure after definitive radiotherapy in head and neck squamous cell carcinoma (HNSCC) patients. MATERIALS AND METHODS This external validation cohort consisted of 143 node positive HNSCC patients treated between July 2007 and June 2016 by curative radiotherapy with or without either cisplatin or cetuximab. Imaging and pathology reports during follow-up were analyzed to indicate persisting or recurring nodes. The previously established clinical, radiomic and combined models were validated on this cohort by assessing the concordance index (c-index) and model calibration. RESULTS Overall 113 patients with 374 pLNs were suitable for final analysis. There were 20 (5.3%) nodal failures from 15 patients after a median follow-up of 36.1 months. Baseline characteristics and radiomic features were comparable to the training cohort. Both the radiomic model (Least-axis-length of lymph node (LALLN) and correlation of gray level co-occurrence matrix (Corre-GLCM)) and the combined model (T stage, gender, WHO performance score, LALLN and Corre-GLCM) showed good agreement between predicted and observed nodal control probabilities. The radiomic (c-index: 0.71; 95% confidence interval (CI): 0.59-0.84) and combined (c-index: 0.71; 95% CI: 0.59-0.82) models performed better than the clinical model (c-index: 0.57; 95% CI: 0.47-0.68) on this cohort, with a significant difference between the combined and clinical models (z-score test: p = 0.005). CONCLUSION The combined model including clinical and radiomic features was externally validated and proved useful to predict nodal failures and could be helpful to guide treatment choices before and after curative radiation treatment for node positive HNSCC patients.
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Affiliation(s)
- Tian-Tian Zhai
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
| | - Frederik Wesseling
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Zhenwei Shi
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Petros Kalendralis
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Chen YH, Lin CR, Liang WA, Huang CY. Motor control integrated into muscle strengthening exercises has more effects on scapular muscle activities and joint range of motion before initiation of radiotherapy in oral cancer survivors with neck dissection: A randomized controlled trial. PLoS One 2020; 15:e0237133. [PMID: 32760097 PMCID: PMC7410307 DOI: 10.1371/journal.pone.0237133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Accessory nerve shoulder dysfunction is common after neck dissection in oral cancer survivors. This study aimed to investigate the short-term effects of scapular muscle strengthening exercises with motor-control techniques on neck dissection-related shoulder dysfunction in oral cancer survivors before the initiation of radiotherapy. Methods Thirty-eight participants were randomly allocated into the motor-control and regular-exercise groups. Each group received conventional physical therapy and specific scapular muscle strengthening exercises for 1 month immediately after neck dissection. Motor control techniques were integrated with scapular strengthening exercises for the motor-control group. Shoulder pain, active range of motion (AROM) of shoulder abduction, and scapular muscle activities including upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) when performing maximal voluntary isometric contraction (MVIC) and scapular muscle exercises were evaluated at baseline and after 1 month of training. Results Both groups reduced shoulder pain and increased muscle activity of maximum voluntary isometric contraction (MVIC) of each muscle after the intervention. Increased AROM of shoulder abduction was only observed in the motor-control group (95% CI 3.80 to 20.51, p = 0.004). Relative to baseline evaluation, muscle activities of UT decreased in the motor-control group when performing shoulder shrug with 1-kg weight (95% CI -33.06 to -1.29, p = 0.034). Moreover, the SA activity decreased in the motor-control group (95% CI -29.73 to -27.68, p<0.001) but increased in the regular-exercise group (95% CI 28.16 to 30.05, p<0.001) when performing shoulder horizontal adduction and flexion. Conclusion Early strengthening exercise with motor control techniques has greater benefits for improving AROM of shoulder abduction, muscle economy, and reducing compensatory scapular muscle activities in patients with neck dissection-related shoulder dysfunction before the initiation of radiotherapy.
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Affiliation(s)
- Yueh-Hsia Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Chi-Rung Lin
- Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Wei-An Liang
- Rehabilitation Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Cheng-Ya Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Hague C, Aznar M, Dong L, Fotouhi-Ghiam A, Lee LW, Li T, Lin A, Lowe M, Lukens JN, McPartlin A, O'Reilly S, Slevin N, Swisher-Mcclure S, Thomson D, Van Herk M, West C, Zou W, Teo BKK. Inter-fraction robustness of intensity-modulated proton therapy in the post-operative treatment of oropharyngeal and oral cavity squamous cell carcinomas. Br J Radiol 2020; 93:20190638. [PMID: 31845816 PMCID: PMC7066971 DOI: 10.1259/bjr.20190638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate dosimetric consequences of inter-fraction setup variation and anatomical changes in patients receiving multifield optimised (MFO) intensity modulated proton therapy for post-operative oropharyngeal (OPC) and oral cavity (OCC) cancers. METHODS Six patients receiving MFO for post-operative OPC and OCC were evaluated. Plans were robustly optimised to clinical target volumes (CTVs) using 3 mm setup and 3.5% range uncertainty. Weekly online cone beam CT (CBCT) were performed. Planning CT was deformed to the CBCT to create virtual CTs (vCTs) on which the planned dose was recalculated. vCT plan robustness was evaluated using a setup uncertainty of 1.5 mm and range uncertainty of 3.5%. Target coverage, D95%, and hotspots, D0.03cc, were evaluated for each uncertainty along with the vCT-calculated nominal plan. Mean dose to organs at risk (OARs) for the vCT-calculated nominal plan and relative % change in weight from baseline were evaluated. RESULTS Robustly optimised plans in post-operative OPC and OCC patients are robust against inter-fraction setup variations and range uncertainty. D0.03cc in the vCT-calculated nominal plans were clinically acceptable across all plans. Across all patients D95% in the vCT-calculated nominal treatment plan was at least 100% of the prescribed dose. No patients lost ≥10% weight from baseline. Mean dose to the OARs and max dose to the spinal cord remained within tolerance. CONCLUSION MFO plans in post-operative OPC and OCC patients are robust to inter-fraction uncertainties in setup and range when evaluated over multiple CT scans without compromising OAR mean dose. ADVANCES IN KNOWLEDGE This is the first paper to evaluate inter-fraction MFO plan robustness in post-operative head and neck treatment.
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Affiliation(s)
| | | | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | | | - Lip Wai Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Taoran Li
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Matthew Lowe
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Andrew McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Shannon O'Reilly
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | | | | | | | | | | | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
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Khan T, Relitti N, Brindisi M, Magnano S, Zisterer D, Gemma S, Butini S, Campiani G. Autophagy modulators for the treatment of oral and esophageal squamous cell carcinomas. Med Res Rev 2019; 40:1002-1060. [PMID: 31742748 DOI: 10.1002/med.21646] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/16/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
Oral squamous cell carcinomas (OSCC) and esophageal squamous cell carcinomas (ESCC) exhibit a survival rate of less than 60% and 40%, respectively. Late-stage diagnosis and lack of effective treatment strategies make both OSCC and ESCC a significant health burden. Autophagy, a lysosome-dependent catabolic process, involves the degradation of intracellular components to maintain cell homeostasis. Targeting autophagy has been highlighted as a feasible therapeutic strategy with clinical utility in cancer treatment, although its associated regulatory mechanisms remain elusive. The detection of relevant biomarkers in biological fluids has been anticipated to facilitate early diagnosis and/or prognosis for these tumors. In this context, recent studies have indicated the presence of specific proteins and small RNAs, detectable in circulating plasma and serum, as biomarkers. Interestingly, the interplay between biomarkers (eg, exosomal microRNAs) and autophagic processes could be exploited in the quest for targeted and more effective therapies for OSCC and ESCC. In this review, we give an overview of the available biomarkers and innovative targeted therapeutic strategies, including the application of autophagy modulators in OSCC and ESCC. Additionally, we provide a viewpoint on the state of the art and on future therapeutic perspectives combining the early detection of relevant biomarkers with drug discovery for the treatment of OSCC and ESCC.
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Affiliation(s)
- Tuhina Khan
- Department of Biotechnology, Chemistry, and Pharmacy, Department of Excellence 2018-2022, University of Siena, Siena, Italy
| | - Nicola Relitti
- Department of Biotechnology, Chemistry, and Pharmacy, Department of Excellence 2018-2022, University of Siena, Siena, Italy
| | - Margherita Brindisi
- Department of Pharmacy, Department of Excellence 2018-2022, University of Napoli Federico IL, Napoli, Italy
| | - Stefania Magnano
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160, Pearse Street, Dublin, Dublin 2, Ireland
| | - Daniela Zisterer
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, 152-160, Pearse Street, Dublin, Dublin 2, Ireland
| | - Sandra Gemma
- Department of Biotechnology, Chemistry, and Pharmacy, Department of Excellence 2018-2022, University of Siena, Siena, Italy
| | - Stefania Butini
- Department of Biotechnology, Chemistry, and Pharmacy, Department of Excellence 2018-2022, University of Siena, Siena, Italy
| | - Giuseppe Campiani
- Department of Biotechnology, Chemistry, and Pharmacy, Department of Excellence 2018-2022, University of Siena, Siena, Italy
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Dias-Polak D, Kra-Oz Z, Szwarcwort-Cohen M, Barzilai A, Bergman R. A Case of Oral Florid Papillomatosis (Verrucous Carcinoma) With Lack of Evidence for Human Papillomavirus Involvement. Am J Dermatopathol 2019; 41:617-619. [PMID: 31335422 DOI: 10.1097/dad.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- David Dias-Polak
- Department of Dermatology, Rambam Health Care Campus and The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Zipi Kra-Oz
- Laboratory of Virology, Rambam Health Care Campus and The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Moran Szwarcwort-Cohen
- Laboratory of Virology, Rambam Health Care Campus and The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus and The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Kim BY, Cho KR, Sohn JH, Kim JY. Sarcomatoid carcinoma after radiotherapy for early-stage oral squamous cell carcinoma: Case report. Medicine (Baltimore) 2019; 98:e16003. [PMID: 31277093 PMCID: PMC6635294 DOI: 10.1097/md.0000000000016003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Sarcomatoid carcinoma is a rare variant of squamous cell carcinoma (SCC) with poor prognosis. Previous radiation has been reported as one of the etiologic factors. PATIENT CONCERNS We describe a case of a 57-year-old man presented with a painless mass in the left supraclavicular area. Five years before, he was diagnosed with SCC in floor of mouth (FOM) and underwent radiotherapy (RT). DIAGNOSES Sonography-guided biopsy on the supraclavicular lymph node revealed diffuse spindle cell proliferation with a focus of squamous differentiation. Local recurrence on primary site or distant metastasis was not obvious on both computed tomography (CT) of the neck and F-fluorodeoxyglucose positron emission tomography CT. The final diagnosis was confirmed as sarcomatoid carcinoma via surgery. INTERVENTIONS The patient underwent surgery including explorative resection of the mouth floor, excision of the submandibular gland, and modified radical neck dissection. Following surgery, the patient received adjuvant radiation therapy. OUTCOMES There were no complications according to the surgery. Six months after adjuvant therapy, distant metastasis to liver was identified. The patient is currently undergoing palliative chemotherapy. LESSONS This may be the first reported case of sarcomatoid carcinoma arising from early-stage SCC in FOM that was previously treated with RT alone. When RT is performed as a single modality for oral SCC, even in an early stage, rigorous follow-up should be performed.
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Affiliation(s)
- Bo Young Kim
- Departments of Otorhinolaryngology—Head and Neck Surgery, Sanggye Paik Hospital
| | - Kyoung Rai Cho
- Departments of Otorhinolaryngology—Head and Neck Surgery, Sanggye Paik Hospital
| | - Jung Heob Sohn
- Departments of Otorhinolaryngology—Head and Neck Surgery, Sanggye Paik Hospital
| | - Jung Yeon Kim
- Department of Pathology, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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Cramer JD, Samant S, Heron DE, Ferris RL, Kim S. Impact of postoperative radiation therapy for deeply invasive oral cavity cancer upstaged to stage III. Head Neck 2019; 41:1178-1183. [PMID: 30773733 PMCID: PMC6533633 DOI: 10.1002/hed.25498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This article is about the eighth edition staging guidelines for upstaged patients with oral cavity squamous cell carcinoma (OCSCC) with >10 mm depth to pT3. This upstages some patients from stage I-II to stage III, a point at which patients are traditionally considered for postoperative radiation therapy (PORT). The role of PORT in patients upstaged for >10 mm depth is unknown. METHODS We identified patients with surgically resected stage I-II OCSCC with >10 mm depth who were upstaged to stage III. We used Cox proportional hazard modeling to compare patients who received PORT to those who did not (median follow-up 38.6 months). RESULTS We observed that 3.6% of patients with OCSCC were upstaged to stage III for depth >10 mm including 823 eligible patients. On adjusted analyses, PORT was associated with improved overall survival in patients upstaged to stage III (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI] 0.30-0.73). CONCLUSION PORT is associated with improved survival for patients with OCSCC upstaged to stage III for >10 mm depth.
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Affiliation(s)
- John D. Cramer
- Department of Otolaryngology—Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sandeep Samant
- Department of Otolaryngology—Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dwight E. Heron
- Department of Otolaryngology—Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert L. Ferris
- Department of Otolaryngology—Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Seugwon Kim
- Department of Otolaryngology—Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Patil V, Baad R, Gudur A, Vibhute N, Belgaumi U, Kadashetti V. Evaluation of Radiation-induced Cytological Changes in Lesional Oral Cancer Cells and Adjacent Normal Mucosal Cells. J Contemp Dent Pract 2018; 19:1474-1479. [PMID: 30713176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To assess various cytological changes for predicting radiosensitivity of oral squamous cell carcinoma by exfoliative cytology. MATERIALS AND METHODS Histologically proven 30 cases of oral squamous cell carcinoma who underwent fractionated radiotherapy in a dose of 45-60 Gy in 5 fractions/week were enrolled in the study. The exfoliative cytology smear was evaluated on lesional and adjacent oral mucosa before radiotherapy, during radiotherapy (8 and 11th fraction) and post radiotherapy (4, 6 and 8 weeks). Various parameters like multinucleation, cellular enlargement, nuclear enlargement, cytoplasmic vacuolation, cytoplasmic granulation, leukocytic infiltration were evaluated. RESULTS Statistical significant values were seen in the inter-group comparison of all the parameters when compared adjacent mucosa and normal mucosa for leukocytic infiltration in pretreatment smear. CONCLUSION The study showed that radiation-induced cytological changes in oral squamous cell carcinoma have a significant dose-related increase. This dose-response relationship and the high intratumoral variations suggest that serial assay of these changes has potential use for radiosensitivity prediction. CLINICAL SIGNIFICANCE Radiosensitivity prediction can be evaluated by means of cytological smears in one stop crisis centre (OSCC) individuals subjected to fractionated radiotherapy by evaluating the cytological parameters.
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Affiliation(s)
- Vinit Patil
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Telangana, India, e-mail:
| | - Rajendra Baad
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Telangana, India
| | - Anand Gudur
- Department of Oncology, Krishna Institute of Medical Sciences Deemed University, Karad, Telangana, India
| | - Nupura Vibhute
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Telangana, India
| | - Uzma Belgaumi
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Telangana, India
| | - Vidya Kadashetti
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, Telangana, India
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Subramaniam N, Balasubramanian D, Murthy S, Rathod P, Vidhyadharan S, Thankappan K, Iyer S. Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition. Int J Oral Maxillofac Surg 2018; 48:152-156. [PMID: 30243830 DOI: 10.1016/j.ijom.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022]
Abstract
According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10mm and a tumour diameter >4cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10mm and a tumour diameter <4cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10mm with tumour diameter below or above 4cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10mm may not be warranted in the absence of other risk features such as nodal disease or close margins.
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Affiliation(s)
- N Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - D Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India.
| | - S Murthy
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - P Rathod
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - S Vidhyadharan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - K Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
| | - S Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Edappally, Kochi, Kerala, India
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Elango S, Samuel S, Khashim Z, Subbiah U. Selenium Influences Trace Elements Homeostasis, Cancer Biomarkers in Squamous Cell Carcinoma Patients Administered
with Cancerocidal Radiotherapy. Asian Pac J Cancer Prev 2018; 19:1785-1792. [PMID: 30049188 PMCID: PMC6165669 DOI: 10.22034/apjcp.2018.19.7.1785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 06/16/2018] [Indexed: 11/27/2022] Open
Abstract
In the perspective of selenium as an antioxidant and anti-carcinogen, so far no strong intervention trials with selenium over radiation-treated oral squamous cell carcinoma cases have been conducted, to examine the response of the disease and the subsequent biochemical alterations. In the present study, untreated oral cancer cases (Gp II) were compared with radiation-treated groups with and without selenium (Gp IIa, IIb), forward to find the trace elements and cancer biomarkers status, at a follow-up of 6 months. Severe alteration in the trace elements levels of Se, Cu, Fe, Zn, Na, K, Ca, Cl, were noticed in Gp II. Though Gp IIa showed slight improvement, administration of selenium (Gp IIb) improved the level of all these elements to a greater extent (p<0.001). GpII and IIa showed increased level of bio markers 5’-nucleotidase, PschE, LAP, γ-GTP, LDH, SGOT, SGPT, ACP, ALP, CPK, TNF, CEA, AFP, Scc-Ag. The greater extent of restitution to near normalcy was observed in patients given selenium (Gp IIb) (p<0.001). Owing to the fact that selenium scavengers oxidants and hence decelerate carcinogenesis by eliminating tumors, so the tumor released constituents into the systemic circulation declined significantly. Therefore, the outcome of the study suggests selenium as a valuable therapeutic measure as adjuvant for oral cancer patients undergoing cancerocidal radiotherapy.
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Affiliation(s)
- Sonaa Elango
- Department of Life Science,School of Natural Sciences,Suwon University,312, Wau-ri, Bongdam -eup,Hwaseong-si,Gyeonggi - do, 445- 743., Republic of Korea.
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Seyedmahmoud R, Wang Y, Thiagarajan G, Gorski JP, Reed Edwards R, McGuire JD, Walker MP. Oral cancer radiotherapy affects enamel microhardness and associated indentation pattern morphology. Clin Oral Investig 2018; 22:1795-1803. [PMID: 29151196 PMCID: PMC5908727 DOI: 10.1007/s00784-017-2275-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study is to determine the effects of in vitro and in vivo high-dose radiotherapy on microhardness and associated indentation pattern morphology of enamel. MATERIALS AND METHODS The inner, middle, and outer microhardness of enamel was evaluated using three experimental groups: control (non-radiated); in vitro irradiated; in vivo irradiated. In vitro specimens were exposed to simulated radiotherapy, and in vivo specimens were extracted teeth from oral cancer patients previously treated with radiotherapy. Indentations were measured via SEM images to calculate microhardness values and to assess the mechanomorphological properties of enamel before and after radiotherapy. RESULTS Middle and outer regions of enamel demonstrated a significant decrease in microhardness after in vitro and in vivo irradiation compared to the control group (p < 0.05). Two indentation patterns were observed: pattern A-presence of microcracks around indent periphery, which represents local dissipation of deformation energy; pattern B-clean, sharp indents. The percentage of clean microindentation patterns, compared to controls, was significantly higher following in vitro and in vivo irradiation in all enamel regions. The highest percentage of clean microindentations (65%) was observed in the in vivo irradiated group in the inner region of enamel near the dentin-enamel junction. CONCLUSIONS For the first time, this study shows that in vitro and in vivo irradiation alters enamel microhardness. Likewise, the indentation pattern differences suggest that enamel may become more brittle following in vitro and in vivo irradiation. CLINICAL RELEVANCE The mechanomorphological property changes of enamel following radiation may be a contributory component of pathologic enamel delamination following oral cancer radiotherapy.
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Affiliation(s)
- R Seyedmahmoud
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - Y Wang
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
- Center of Excellence in Musculoskeletal and Dental Tissues, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
| | - G Thiagarajan
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
- Department of Civil and Mechanical Engineering, School of Computing and Engineering, University of Missouri-Kansas City, Kansas City, MO, USA
| | - J P Gorski
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
- Center of Excellence in Musculoskeletal and Dental Tissues, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - R Reed Edwards
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - J D McGuire
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA
| | - M P Walker
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
- Center of Excellence in Musculoskeletal and Dental Tissues, University of Missouri-Kansas City, 650 East 25th St, Kansas City, MO, 64108, USA.
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62
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Abstract
RATIONALE Although an ototoxicity is well-known as adverse event of the radiotherapy, it is not widely known that immunosuppressed patients who underwent radiotherapy in head and neck region have risk of malignant external otitis. PATIENT CONCERNS A 68-year-old man with diabetes, who had been diagnosed as intraosseous squamous cell carcinoma of the right mandible, underwent surgical resection. He received a total of 60 Gy/30Fr postoperative radiation. Four months after the course of radiation, he suffered from right aural fullness, otalgia and otorrhea. DIAGNOSES Clinical examination revealed granulation and existence of Pseudomonas aeruginosa in the external auditory canal. Computed tomography showed expansive inflammation and erosion in the temporal bone. The patient is elderly and diabetes. These findings led to the diagnosis of malignant external otitis. INTERVENTIONS The ear irrigation and administration of quinolones were started. Afterwards, fistula was formed in the oral cavity, and connected to the right external auditory canal. Therefore, irrigations were performed not only from ear but also from the oral fistula. OUTCOMES Eight weeks after starting treatment, the malignant external otitis was completely healed. LESSONS Physicians should raise awareness of malignant external otitis in immunosuppressed patients with oral cancer after radiotherapy.
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Affiliation(s)
| | | | - Ikuyo Kanai
- Department of Oral and Maxillofacial Surgery
| | | | - Tomomitsu Nasuno
- Department of Otorhinolaryngology, Toshiba Rinkan Hospital, Sagamihara
| | - Yoshiki Hamada
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, Yokohama, Japan
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63
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Volterrani F, Severini A, Chiesa F, Acerbi G, Mantero M, Uslenghi C. Results of Radiotherapy in a Series of 250 Carcinomas of the Mucosal Surface of the Cheek. Tumori 2018; 62:673-86. [PMID: 1030865 DOI: 10.1177/030089167606200611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents the results of a retrospective clinical study of 250 cases of mono-centric carcinoma of the mucosal surface of the cheek, i. e. all the primaries treated by radiotherapy at our Institute between January 1948 and December 1965. Neoplastic lesions found at follow-up were regarded as marginal recurrences if in the proximity of the treated area and as secondary tumors in other cases. From 1948 to 1957 conventional radium therapy was the usual treatment for the primary tumor whereas from 1958 to 1965 cobalt teletherapy was given most frequently. Surgery was reserved for lymph node metastases when present on clinical examination. In our experience radiotherapy is effective in cancers of the mucosal surface of the cheek, for it checked local spread in 50.9 % of cases, however treated and regardless of initial clinical appearance, whereas in the T1-T2 cases the local failure rate dropped to 35.8 %. The higher the T level the greater are the difficulties confronting radiotherapy; for more extensive lesions appropriate combination therapy (radiosurgical) in line with the well-defined rules explained in the text is useful. In our experience radiotherapy yields good long term results regardless of T level and even in the more unfavorable cases. Our study confirms the low rate of lymph spread of these carcinomas: over half of the patients were NO before treatment; only 56.7 % of the patients receiving surgical treatment on the neck had histologically positive lymph nodes; there were very few neck recurrences at follow-up; the presence of suspect or frankly metastatic nodes on clinical examination, being movable and homolateral (N1), did not worsen the prognosis. However, considering the techniques used for irradiation of the primary, some patients received a substantial dose to the neck; hence radiotherapy probably played its part in the low rate of neck metastases.
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64
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Kolotas C, Tonus C, Baltas D, Cernea M, Vogt HG, Martin T, Strassmann G, Zamboglou N. Clinical Relevance of Tumor Ploidy and Micronucleus Formation for Oral Cavity Cancer. Tumori 2018; 85:253-8. [PMID: 10587027 DOI: 10.1177/030089169908500408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background To study the clinical relevance of tumor ploidy and micronucleus formation as prognostic factors. Methods and Study Design Twenty-eight patients with squamous cell carcinoma of the oral cavity were treated with primary radiochemotherapy consisting of irradiation up to 70 Gy in combination with cisplatin. Cell cycle distribution, micronucleus formation and ploidy were evaluated by flow cytometry of biopsies taken before treatment and after irradiation to 10 Gy (5 × 2 Gy). Sexteen out of 28 patients relapsed after a minimum follow-up period of two years. Results Flow cytometry of the recurrence biopsy showed hyperpentaploid (5c exceeding) cells in 13/16 (81%) of the relapsed patients. In 7 patients the hyperploid clone was not present in the flow cytometry of the primary tumors. Ploidy could retrospectively be determined also by image cytometry in archival tumor material of the pretreatment specimens. Patients with a level below 100 5c cells per 10,000 cell nuclei were shown to have a significantly better prognosis than patients with more than 100 hyperpentaploid tumor cells. The micronucleus formation was 2-5 times higher in tumors showing a good response to treatment than in carcinomas relapsing within two years. Conclusions The 5c-exceeding ratio measured by image cytometry and micronucleus formation proved to be good prognostic parameters for the clinical outcome of patients with locally advanced head and neck carcinomas.
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Affiliation(s)
- C Kolotas
- Department of Radiation Medicine, Staedtische Kliniken Offenbach, Germany.
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65
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Abstract
A report of the results obtained in 194 cases of epithelial tumors of the oral cavity subjected to telecobalt therapy between June 1958 and December 1964 at the Institute of Radiology, University of Milan, and the Radiology Division of the National Cancer Institute. The criteria for establishing whether the treatment was indicated and the principles of selection of cases are specified. In the majority of cases the tumors were no longer circumscribed (T3-T4) and in over half the cases regional lymph node metastases were present when treatment commenced. Thirty-six patients had previously been subjected to radiotherapy or surgery. Telecobalt therapy was given almost exclusively to stationary fields using one or two portals of entry. Tumors of the floor of the mouth were often irradiated through wedges of lead. In 80% of the cases a tumor-dose of between 5000 and 6000 r was given over 6–8 weeks. At the end of treatment the tumor had completely disappeared in 22.7% of the patients, regressed to some extent in 40.6% and was unchanged or had deteriorated in 36.7%. The survival curves show that 2/3 of the patients died within two years of starting treatment; the five-year survival rate was 10.9%. This case-series confirmed that the prognosis is poorer in cases with regional lymph node metastases at the start of treatment and in patients subjected to telecobalt therapy for relapse after radiotherapy or surgery. The results obtained with telecobalt therapy proved to be considerably inferior to those obtained with curietherapy and so the latter is recommended in cancers of the oral cavity whenever it is feasible. Telecobalt therapy may be indicated, mainly as a symptomatic palliative, in very extensive infiltrating tumors adhering to the bone structures and in patients with inoperable lymph node metastases.
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Abstract
According to previous personal experience with conventional 226-Ra sources, in T2 oral carcinomas treated with curietherapy alone the incidence of local failures was 23%. Moreover, 50% of the local relapses were marginal with respect to the treated volume. From May 1980 to November 1981, 29 T2 oral carcinomas suitable for correct curietherapy received 3 weekly courses of VBM chemotherapy: i.e., vincristine, 1 mg i.v.; bleomycin, 15 mg i.m. after 6 and 24 h; and methotrexate, 30 mg p.o. after 48 h. A full dose curietherapy was performed 2 weeks after the completion of VBM. Twenty-seven patients have had a minimum follow-up of 12 months. The overall treatment was well tolerated and immediate results were encouraging. However, the local failure rate does not seem to have decreased by the combined treatment in comparison with curietherapy alone in historical series.
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Abstract
This work concerns 406 oral carcinomas treated with curietherapy (interstitial applications and surface molds) from January 1959 to December 1970. There were 65 (16.0%) carcinomas of the mucosal surface of cheeks, 15 of the retromolar areas, alveolus and gingiva, and hard palate (3.7%), 211 of the mobile tongue (51.9%), and 115 of the floor of mouth (28.4%). There were 132 (32.5%) T1 cases, 245 (60.3%) T2 and 29 (7.2%) T3. In 376 cases with adequate follow-up (92.6%) there were 93 (24.7%) local relapses: 83 isolated and 10 associated with a lymph nodal relapse; 49.5% of the local relapses were peripheral with respect to the treated volume (46/93). The incidence of local relapses only slightly differed for initially T1 and T2 cases (respectively 21.8% and 22.7%), whereas it was more than twice as much for initially T3 cases (53.6%). The overall incidence of radionecrotic complications was 22.0% (83/376 cases with adequate follow-up). Altogether the disease-free survival was 41.1% and 31.4% at 5 and 10 years, respectively. We think that local control of practically all treatable oral carcinomas can be obtained with a combined treatment.
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Abstract
The results of a retrospective clinical evaluation concerning 434 cases of oral carcinomas treated with radiotherapy from January 1959 to December 1967 are presented. The analysis of the results obtained shows that radiotherapy alone may offer a reasonable possibility of success in limited lesions (68.3% 5-year survival of Stage I patients). In more advanced local cases, and especially those with regional adenopathies, radiotherapy alone cannot consistently control the disease for a long period of time; 5-year survival from the onset of treatment was respectively 36.5% and 24.5% for Stage II and III cases. Moreover, if controlateral or bilateral metastatic adenopathies or fixed lymph nodes are present, the prognosis becomes dramatic (2.6% 5-year survival of Stage IV patients). Among the irradiation techniques currently available, curietherapy (interstitial applications or surface molds) presumably offers the best possibility of success, since the observed failures, both overall and stage by stage, are inferior. Radiotherapy alone may generally be of proven efficacy if the local or locoregional extension is limited. In more advanced cases a combined surgery-chemotherapy treatment method is recommended. The criteria for a combined therapeutic approach for these tumors are also discussed.
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69
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Uslenghi C, Volterrani F, Chiesa F, Cozzi G, Lombardi F, Kenda R, Bulgheroni A. Cobalt Therapy in the Treatment of Carcinoma of the Oropharynx. Tumori 2018; 62:263-74. [PMID: 1014122 DOI: 10.1177/030089167606200303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A clinical retrospective evaluation of 177 cases of carcinoma of the oropharynx treated with Cobalt therapy from 1959 to 1965 has been made. The analysis of long term results has shown that Cobalt therapy alone does not satisfactorily control carcinomas of oropharynx. In fact, less than 30% of the patients is still alive after 3 years. Survival is directly affected by the local extent of disease since, while the 5-year survival of Tl and T2 cases is respectively 26.8% and 21.5%, only 6.5% of patients with T3 carcinomas is still alive after 5 years. Particularly disappointing is the survival rate in cases with mono- or bilateral involvement of neck nodes, since none of these cases are alive 2 years after the initial therapy. In 69.4% of the cases, treatment failure has to be attributed to minimal response or early recurrence of primary tumor, while lymph node relapses have been observed in more than 25% of the cases. To allow a detailed clinical evaluation of the results, the different regions of the oropharynx should be considered separatly, since differences in clinical evolution of various carcinomas would call for a different therapeutic approach. The results of this study in oropharyngeal carcinomas, indicate that improvement of long term results may only be obtained through a multidisciplinary therapeutic approach.
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70
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Orlandi E, Zonca G, Pignoli E, Stucchi C, Borroni M, Collini P, Cantù G, Casali PG, Grosso F, Cerrotta A, Fallai C, Olmi P. Postoperative Radiotherapy for Synovial Sarcoma of the Head and Neck during Pregnancy: Clinical and Technical Management and Fetal Dose Estimates. Tumori 2018; 93:45-52. [PMID: 17455871 DOI: 10.1177/030089160709300109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background In vivo and phantom dosimetry is reported to estimate the fetal dose and evaluate the effectiveness of a special shielding device to reduce fetal exposure in a woman undergoing postoperative radiation therapy for synovial oral cavity sarcoma at the 30th week of pregnancy. Methods In vivo measurements were performed by placing thermoluminescent dosimeters on 3 points for fetal dose estimation: uterine fundus, umbilicus and pubis. A Rando anthropomorphic phantom was used to simulate radiotherapy. We also performed off-axis dose measurements for wedged beams to estimate the dose contribution of this accessory used in the treatment. Results The special shielding device reduced the fetal dose by 70% on average, despite the presence of wedges, which increased the dose by a factor of about 2.5. Before delivery the patient received 48 Gy, and from the in vivo measurements a fetal dose of 8.5, 1.7 and 0.7 cGy was estimated to the uterine fundus, umbilicus and pubis, respectively. Conclusions Pre-treatment simulation in the same irradiation conditions is the only reliable approach to predict the fetal dose. By using a special shielding device, radiotherapy can be optimized while keeping the fetal exposure below the risk of deterministic damage.
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Affiliation(s)
- Ester Orlandi
- Department of Radiation Oncology I, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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71
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Lilja M, Markkanen-Leppänen M, Viitasalo S, Saarilahti K, Lindford A, Lassus P, Mäkitie A. Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study. Eur Arch Otorhinolaryngol 2018; 275:959-966. [PMID: 29380039 DOI: 10.1007/s00405-018-4883-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population. PATIENTS AND METHODS This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland. Thirty-nine (89%) of them also received radiotherapy. The senses of smell (odour detection, identification and threshold test) and taste (electrogustometry) and quality of life (UW-QOL) were evaluated preoperatively, and at 6 weeks, 3 months, 6 months and 12 months, postoperatively. RESULTS There were higher scores in the odour detection values in the 6-week and 3-month tests compared with preoperative values for the tumour side. Other detection scores did not differ statistically from the preoperative values neither in the tumour nor the contralateral side. However, in the odour identification test, all posttreatment values were statistically significantly higher than pretreatment ones. In the olfactory threshold test, no statistically significant differences were found between pre- and posttreatment values. Electrogustometry values for the taste on the tumour side were statistically significantly impaired at 6 weeks (p < 0.05) and at 3 months (p < 0.01) compared with the pretreatment results. They were also impaired at 6 months and at 12 months, although the differences were not statistically significant. The quality of life was impaired after treatment in this patient series. However, the correlation between quality of life and sense of taste was found only at one time point (3 months) and only with contralateral side measurements. CONCLUSIONS We conclude that in oral and pharyngeal cancer patients the postoperative taste problems are related to the impairment on the taste sensation in the tongue but not with the sense of smell. Moreover, the impairment in the quality of life is not clearly related to the impaired sense of taste.
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Affiliation(s)
- Markus Lilja
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland
| | - Mari Markkanen-Leppänen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland
| | - Sanna Viitasalo
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland
| | - Kauko Saarilahti
- Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andrew Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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72
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Abstract
The use of chemotherapy, including immunotherapy, in oral squamous cell carcinoma has expanded considerably in the past several years. Its use mirrors that in the treatment of squamous cell carcinoma affecting other structures in the head and neck. This article summarizes the current evidence that guides use of chemotherapy both in combination with radiation and as monotherapy for patients with advanced disease. It also addresses the expanding role of immunotherapy, particularly use of programmed cell death-ligand 1 inhibitors, in the treatment of advanced disease.
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Affiliation(s)
- Lee Hartner
- Abramson Cancer Center at Pennsylvania Hospital, 230 West Washington Square, Philadelphia, PA 19106, USA.
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73
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Doležalová H, Blechová N, Petera J. [Quality of Life After High-dose Brachytherapy in Patients with Early Oral Carcinoma]. Klin Onkol 2018; 31:125-129. [PMID: 29708355 DOI: 10.14735/amko2018125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The prevalence of head and neck tumors has continually increased over the past decades, which is a serious medical and social problem. This study retrospectively assessed the quality of life of patients with early-stage oral cavity tumors after high-dose rate (HDR) brachytherapy. MATERIAL AND METHODS Quality of life was evaluated in 14 patients with early-onset oral cavity tumors who underwent HDR brachytherapy at the Department of Oncology and Radiotherapy, University Hospital Hradec Kralove. The standardized EORTC QLQ-C30 and EORTC QLQ-H&N 35 questionnaires were used. Patients completed these questionnaires at 12 months after treatment. RESULTS The general health status was scored 70 points using the EORTC QLQ-C30 questionnaire. Fatigue, insomnia, loss of appetite, dyspnea, and financial problems were the most severe problems reported. The main problems identified by the EORTC QLQ-H&N 35 questionnaire were weight gain, coughing, pain, sticky saliva, and difficulties eating in public. On the contrary, patients did not significantly suffer weight loss, speech impairments, difficulties in mouth opening or swallowing, or sensory problems. CONCLUSION HDR brachytherapy is an effective treatment for early oral cancer that leaves patients with an acceptable quality of life. A prospective, multicentric study focused on the quality of life of patients with head and neck tumors is required.Key worlds: oral cancer - brachytherapy - quality of life This article was supported by grant PROGRES Q 40/13. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 17. 1. 2018Accepted: 4. 2. 2018.
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74
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Abstract
This paper introduces the individual design of oral radiotherapy stent based on 3D printing technology, and expounds its design principle. The modeling of the device is based on CT images and Mimics software, which builds a set of 3D printing oral stent technology. The instrument has more advantage in high precision, fast modeling, individualized production and digital storage. The results show that the construction of 3D printed dental stent is feasible, which provides a new idea and method for the production of oral stents.
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Affiliation(s)
- Jiping Ding
- Shanghai the Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, 201999
| | - Wenyong Tu
- Shanghai the Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, 201999
| | - Haisheng Hu
- Shanghai the Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, 201999
| | - Huifeng Shi
- Shanghai the Ninth People's Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, 201999
| | - Yuehong Kong
- The Second Affiliated Hospital of Soochow University, Suzhou, 215004
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75
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Ramesh G, Chaubey S, Raj A, Seth RK, Katiyar A, Kumar A. Micronuclei assay in exfoliated buccal cells of radiation treated oral cancer patients. J Exp Ther Oncol 2017; 12:121-128. [PMID: 29161779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Micronuclei are suitable internal dosimeters for revealing tissue-specific genotoxic damage in individuals exposed to carcinogenic mixtures. Evaluation of radiation-induced cellular changes to predict radiosensitivity has invested many investigators since such changes were first found in biopsy material. AIM The aim of the present study was to assess the relationship of with histopathological grade and number of radiation therapy sittings with the frequency of micronuclei and nuclear anomalies among oral cancer patients. MATERIAL & METHOD Thirty male patients with histologically proven cases of oral cancer undergoing radiation therapy and age and sex matched 20 healthy controls were included in the study. Scrape cytology smears of exfoliated buccal cells were prepared and stained using Feulgen stain and frequency of micronuclei and other nuclear anomalies counts were evaluated with the help of light microscope expressed as per 1000 buccal cells. RESULTS The mean values of the micronuclei and nuclear anomalies were 14.03 and 21.30 respectively. There was a significant association and strong positive correlation of Radiation exposure and grades of squamous cell carcinoma with micronuclei and nuclear anomalies. There was no statistically significant association and correlation between nuclear anomalies in well differentiated and moderately differentiated carcinomas. CONCLUSION With increase number of radiation therapy sittings, there was increase in number of micronuclei and nuclear anomalies. Hence the result of this study highlights that increased number of micronuclei and nuclear anomalies provides information regarding radiosensitivity of epithelial cells.
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Affiliation(s)
- Gayathri Ramesh
- Rama Dental College Hospital and Research Centre, Department of Oral and Maxillofacial Pathology, Kanpur 208024, Uttar Pradesh, India
| | - Smriti Chaubey
- Rama Dental College Hospital and Research Centre, Department of Oral and Maxillofacial Pathology, Kanpur 208024, Uttar Pradesh, India
| | - Amrita Raj
- Rama Dental College Hospital and Research Centre, Department of Oral and Maxillofacial Pathology, Kanpur 208024, Uttar Pradesh, India
| | - Ravi Kumar Seth
- Rama Dental College Hospital and Research Centre, Department of Oral and Maxillofacial Pathology, Kanpur 208024, Uttar Pradesh, India
| | - Anuradha Katiyar
- Rama Dental College Hospital and Research Centre, Department of Oral and Maxillofacial Pathology, Kanpur 208024, Uttar Pradesh, India
| | - Amit Kumar
- Rama Dental College Hospital and Research Centre, Department of Oral and Maxillofacial Pathology, Kanpur 208024, Uttar Pradesh, India
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Nariai Y, Akutsu J, Okuma S, Odawara S, Kanno T, Sekine J. [A Contrivance for Closure and Dressing of Orocutaneous Fistula Developed in Advanced Oral Cancer]. Gan To Kagaku Ryoho 2017; 44:1287-1289. [PMID: 29394609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Orocutaneous fistula sometimes occurs in locallyadvanced unresectable or recurrent oral squamous cell carcinoma. The developed orocutaneous fistula results in constant leakage of saliva, ingested foods and liquids and decline in patients' quality of life(QOL). A 47-year-old Japanese man had received treatment for tongue carcinoma. At the routine follow-up, a cystic lesion in the right submandibular region was detected. Biopsyof the specimen of the cystic lesion revealed squamous cell carcinoma. After chemotherapy, an orocutaneous fistula between the right oropharyngeal and the right submandibular region developed and graduallyincreased. Although closure and dressing of the orocutaneous fistula with various materials was attempted, it was ultimatelyunsuccessful. Finally, application of a rubber film and silicone adhesive agent to the skin was successful for closure and dressing of the fistula. Orocutaneous fistula is one of major contributors to decline in patients' QOL. The sharing of information regarding effective methods or materials for closure and dressing of orocutaneous fistula is necessaryto maintain patients' QOL.
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Affiliation(s)
- Yoshiki Nariai
- Dept. of Oral and Maxillofacial Surgery, Matsue City Hospital
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Lai TY, Hu YW, Liu YM, Chen YW, Shiau CY, Chu PY, Tai SK, Lo WL, Wu CH, Wang LW. The pattern of failure and predictors of locoregional control in lateralized buccogingival cancer after postoperative radiation therapy. J Chin Med Assoc 2017; 80:569-574. [PMID: 28687157 DOI: 10.1016/j.jcma.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To evaluate the failure pattern and identify predictors of locoregional control in lateralized buccogingival cancer after postoperative radiotherapy (RT) at a single institution. METHODS We retrospectively reviewed the clinical data of 150 patients with lateralized oral squamous cell carcinoma, including carcinoma of the buccal mucosa, gingiva and retromolar trigone. All patients underwent radical surgery followed by postoperative RT with or without concurrent chemotherapy. We registered planning computer tomography images with images obtained at recurrence and categorized the failure pattern as in-field, marginal, or out-field recurrence. RESULTS The median follow-up duration was 47 months (range, 2-131 months). Twenty-eight patients (19%) experienced locoregional failure, including 20 local failure, 5 regional failure and 3 with both. Among the 24 patients who had image studies at recurrence, 15 patients had in-field recurrence, 5 were marginal recurrence and 4 were out-field recurrence. Seven patients (5%) had contralateral neck failure. Four of 5 patients with marginal failure had recurrent tumors in the infratemporal fossa. In multivariate analysis, extracapsular spread and positive or close surgical margin were associated with poor locoregional control. CONCLUSION Local in-field recurrence is the most common failure pattern in lateralized buccogingival cancer after postoperative RT. The infratemporal fossa is a risk area for marginal failure and should be encompassed adequately in the postoperative RT field. Extracapsular spread and positive or close margin are predictors of locoregional control for lateralized oral cancer. Patients exhibiting such adverse features require more aggressive treatment.
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Affiliation(s)
- Tzu-Yu Lai
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Wen Hu
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Ming Liu
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Wei Chen
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Cheng-Ying Shiau
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pen-Yuan Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shyh-Kuan Tai
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wen-Liang Lo
- Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Hsien Wu
- Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Wei Wang
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Naganawa K, Koto M, Takagi R, Hasegawa A, Ikawa H, Shimozato K, Kamada T, Okamoto Y. Long-term outcomes after carbon-ion radiotherapy for oral mucosal malignant melanoma. J Radiat Res 2017; 58:517-522. [PMID: 28028129 PMCID: PMC5570020 DOI: 10.1093/jrr/rrw117] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/12/2016] [Accepted: 12/20/2016] [Indexed: 06/06/2023]
Abstract
Oral mucosal malignant melanoma (OMM) is extremely rare and has a poor prognosis. Owing to its rarity, it has not yet been possible to establish an optimal treatment modality. The objective of this study was to evaluate the long-term efficacy of carbon-ion radiotherapy (C-ion RT) for OMM. Between 1997 and 2013, 19 patients with OMM were treated with C-ion RT alone. Patient ages ranged from 44 to 84 years (median, 69 years). Nine men and 10 women were included. OMMs were restaged in accordance with the seventh edition of the tumour/node/metastasis (TNM) Staging System of the International Union Against Cancer. Before treatment, 14 patients had T3 disease and 5 had T4a disease. Three patients were classified as having N1 disease. All patients were classified as having M0. The hard palate was the most frequently involved oral subsite. All patients were treated with 57.6 Gy (relative biological effectiveness) in 16 fractions. The median follow-up period was 61 months (range, 8-190 months). The 5-year local control, overall survival and progression-free survival rates were 89.5%, 57.4% and 51.6%, respectively. For local control and overall survival, T classification was found to be a significant prognostic factor. Grade 2 and 3 osteoradionecrosis was observed in three and four patients, respectively. The presence of teeth within the planning target volume was a significant risk factor for developing osteoradionecrosis. C-ion RT was an effective treatment option with acceptable toxicity for OMM.
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Affiliation(s)
- Kensuke Naganawa
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
- Department of Oral and Maxillofacial Surgery, Aichi Gakuin University, School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
| | - Masashi Koto
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Ryo Takagi
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Azusa Hasegawa
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hiroaki Ikawa
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Kazuo Shimozato
- Department of Oral and Maxillofacial Surgery, Aichi Gakuin University, School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
| | - Tadashi Kamada
- National Institute of Radiological Sciences Hospital, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Yoshitaka Okamoto
- Department of Otolaryngology, Chiba University Graduate School of Medicine, 1-8-1 Inohara, Chuo-ku, Chiba 260-8677, Japan
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Ozaki Y, Watanabe H, Kaida A, Miura M, Nakagawa K, Toda K, Yoshimura R, Sumi Y, Kurabayashi T. Estimation of whole-body radiation exposure from brachytherapy for oral cancer using a Monte Carlo simulation. J Radiat Res 2017; 58:523-528. [PMID: 28339846 PMCID: PMC5570130 DOI: 10.1093/jrr/rrx002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/23/2016] [Accepted: 12/18/2016] [Indexed: 06/06/2023]
Abstract
Early stage oral cancer can be cured with oral brachytherapy, but whole-body radiation exposure status has not been previously studied. Recently, the International Commission on Radiological Protection Committee (ICRP) recommended the use of ICRP phantoms to estimate radiation exposure from external and internal radiation sources. In this study, we used a Monte Carlo simulation with ICRP phantoms to estimate whole-body exposure from oral brachytherapy. We used a Particle and Heavy Ion Transport code System (PHITS) to model oral brachytherapy with 192Ir hairpins and 198Au grains and to perform a Monte Carlo simulation on the ICRP adult reference computational phantoms. To confirm the simulations, we also computed local dose distributions from these small sources, and compared them with the results from Oncentra manual Low Dose Rate Treatment Planning (mLDR) software which is used in day-to-day clinical practice. We successfully obtained data on absorbed dose for each organ in males and females. Sex-averaged equivalent doses were 0.547 and 0.710 Sv with 192Ir hairpins and 198Au grains, respectively. Simulation with PHITS was reliable when compared with an alternative computational technique using mLDR software. We concluded that the absorbed dose for each organ and whole-body exposure from oral brachytherapy can be estimated with Monte Carlo simulation using PHITS on ICRP reference phantoms. Effective doses for patients with oral cancer were obtained.
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Affiliation(s)
- Y. Ozaki
- Department of Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - H. Watanabe
- Department of Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - A. Kaida
- Department of Oral Radiation Oncology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - M. Miura
- Department of Oral Radiation Oncology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - K. Nakagawa
- Department of Radiation Therapeutics and Oncology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - K. Toda
- Department of Radiation Therapeutics and Oncology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - R. Yoshimura
- Department of Radiation Therapeutics and Oncology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Y. Sumi
- Center of Advanced Medicine for Dental and Oral Diseases, National Center for Geriatrics and Gerontology, Moriokacho 7-430, Obu-shi, Aichi, Obu, 474-8511, Japan
| | - T. Kurabayashi
- Department of Oral and Maxillofacial Radiology, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8549, Japan
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Rehman A, Allaudin Z, Nisar H, Khan IU, Fatima I, Shami A, Masood M, Shahid A. Efficacy and Toxicity of Concurrent Chemoradiation in Inoperable Oral Carcinoma in Pakistani Population. J Coll Physicians Surg Pak 2017; 27:342-347. [PMID: 28689522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 07/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy of concurrent chemoradiation in patients with locally advanced inoperable squamous cell carcinoma of oral cavity in terms of local control and toxicity. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from January 2008 to December 2013. METHODOLOGY Sixty-nine patients with locally advanced inoperable oral cavity cancer, registered in INMOL hospital from January 2008 to December 2013 who fulfilled a pre-defined eligibility criteria, were enrolled in the study. Concurrent chemoradiation protocol consisted of conventional fractionation delivering 70 Gy with weekly Cisplatin (50 mg/m2) during the course of radiation. Tumor response was calculated by RECISTcriteria version 1.1 along with the median overall survival and disease-free survival. Acute treatment related toxicities were graded as (G). RESULTS Thirty-six (52.17%) patients showed complete response; while 19 (27.54%), 8 (11.59%) and 6 (8.7%) were observed with partial response, stable and progressive disease, respectively. Treatment response was significant (p<0.001) in terms of responders vs. non responders to treatment. Median overall survival was 18.00 months; whereas, median disease-free survival remained 14.00 months. Main toxicities included mucositis (G3 and G4, 71%), xerostomia (G2 and G3, 82.5%), vomiting (G3 and G4, 51%), myelosuppression (G3 and G4, 26.2%), dermatitis (G3 and G4, 49.2%), and fatigue (G3 and G4, 57.9%). CONCLUSION Platinum based CCR Tremained effective for inoperable oral cancer patients.
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Affiliation(s)
- Abdul Rehman
- Department of Radiation Oncology, Centre of Nuclear Medicine and Radiotherapy (CENAR), Quetta
| | - Zafar Allaudin
- Department of Radiation Oncology Institute of Nuclear Medicine and Oncology (INMOL), Lahore
| | - Hasan Nisar
- Faculty of Medical Science, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad
| | - Irfan Ullah Khan
- Department of Radiopharmacy Institute of Nuclear Medicine and Oncology (INMOL), Lahore
| | - Ismat Fatima
- Department of Radiation Oncology Institute of Nuclear Medicine and Oncology (INMOL), Lahore
| | - Amira Shami
- Department of Radiation Oncology Institute of Nuclear Medicine and Oncology (INMOL), Lahore
| | - Misbah Masood
- Department of Radiation Oncology Institute of Nuclear Medicine and Oncology (INMOL), Lahore
| | - Abubaker Shahid
- Department of Radiation Oncology Institute of Nuclear Medicine and Oncology (INMOL), Lahore
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81
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Güll FD, Deppe H, Kesting M, Schwarzer C. Periodontal disease-like bone loss after
adjuvant radiotherapy in the head and neck region:
A case report and review of the literature. Quintessence Int 2017; 48:451-457. [PMID: 28462407 DOI: 10.3290/j.qi.a38161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to present a rare case of periodontal disease-like bone loss and possible treatment options. This paper discusses the pros and cons of conservative treatment and radical surgical intervention and summarizes possible complications. It focuses also on the individual situation of the patient and provides a review of literature. METHOD AND MATERIALS A 32-year-old patient presented with widening of the periodontal spaces and apical translucencies at every tooth after adjuvant radiotherapy of an oral squamous cell carcinoma (OSCC) of the tongue. In addition, the patient suffers from slight mental retardation. The following periodontal parameters were examined: Bleeding Index, Plaque Index, tooth mobility, and clinical attachment loss. Panoramic radiography and computed tomography were used for diagnosis and follow-up purposes. The literature review was carried out systematically combined with individual searching. RESULTS This study presents a distinct case of rarely mentioned periodontal-disease-like bone loss, most likely radiation-induced. This resulted in complete devitalization of the entire dentition and will eventually lead to a loss of all teeth. The review of the literature summarizes the incidence of post-radiogenic periodontitis, bone loss, and possible risk-factors of unwanted events after radiotherapy in the oral cavity and dentoalveolar structures. CONCLUSION The combination of the patient's history and individual situation makes this a special case with regard to decision making and further therapy. After carefully considering the possible options, a conservative treatment with minimal surgical interventions and close surveillance was followed. The intention was the preservation of the patient's natural dentition as long as possible as well as the prevention of an osteonecrosis of the jaw. Taking the literature review into account this article presents a patient with an unusually distinct extent of periodontal disease-like bone loss, which is not to be compared to periodontal disease.
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82
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Nolan M, Courtney R, Sexton P, Barry T, McCann PJ. Aggressive Recurrence of Oral Squamous Cell Carcinoma in a patient with Fanconi's Anaemia (FA). Ir Med J 2017; 110:533. [PMID: 28657246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Fanconi's Anaemia is a rare autosomal recessive disease for which the incidence of head and neck cancer can be increased 700-fold1. We report a case of a 31-year old Caucasian male with FA who initially presented in July 2007 with oral squamous cell carcinoma for which he received radical surgery and radiotherapy. He was disease-free until August 2015 when he presented with an extremely aggressive recurrence.
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Affiliation(s)
- M Nolan
- Oral & Maxillofacial Department, Galway University Hospitals, Galway
| | - R Courtney
- Oral & Maxillofacial Department, Galway University Hospitals, Galway
| | - P Sexton
- Oral & Maxillofacial Department, Galway University Hospitals, Galway
| | - T Barry
- Oral & Maxillofacial Department, Galway University Hospitals, Galway
| | - P J McCann
- Oral & Maxillofacial Department, Galway University Hospitals, Galway
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83
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Jie Z, Jian M, Qianwei Z, Zhiping L. Dosimetry study on radioactive particle brachytherapy in oral carcinoma. J BUON 2017; 22:519-523. [PMID: 28534379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the therapeutic effects of different doses of 125I radioactive particle brachytherapy on oral cancer. METHODS Between September 2012 and September 2015, 78 patients with oral cancer who received 125I radioactive particle brachytherapy for the first time in our hospital were enrolled in this study. Patients were divided into high dose (≥3) and low dose (<3) groups. The treatment outcome, serum tumor marker levels and the expression levels of autophagy and apoptotic genes in tumor cells were compared between groups. RESULTS Complete remission (CR)+partial remission (PR) ratio in the high dose group was significantly higher than that of the low dose group. Stable disease (SD)+ progressive disease (PD) ratio was significantly lower in the high dose group. The serum levels of TSGF, SCCA, CEA, CA125, CA15.3, CA19.9 and PSA oral cancer markers were significantly lower than those of the low dose group. In the high dose group, the expression levels of Beclin-1 and MAP1LC3 (autophagic genes) mRNAs were significantly higher than those of the low dose group, while the expression levels of EMMPRIN and MMP-14 (invasive genes) mRNAs were significantly lower in the high dose group. Also survival rates in the responsive patients were significantly better in comparison to non-responsive patients. CONCLUSION High dose particle brachytherapy with radioactive 125I is a safe and effective treatment and its clinical results were more beneficial than the low dose therapy.
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Affiliation(s)
- Zhang Jie
- Department of Stomatology, Xuzhou Central Hospital, Xhuzhou City, China
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84
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Chen B, Hu H, Li D, Shi H. [Influence on thyroid function postperative racriotherapy in patients with oral cancer]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31:72-73. [PMID: 29774691 DOI: 10.13201/j.issn.1001-1781.2017.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Indexed: 06/08/2023]
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85
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Carneiro-Neto JN, de-Menezes JDS, Moura LB, Massucato EMS, de-Andrade CR. Protocols for management of oral complications of chemotherapy and/or radiotherapy for oral cancer: Systematic review and meta-analysis current. Med Oral Patol Oral Cir Bucal 2017; 22:e15-e23. [PMID: 27918734 PMCID: PMC5217492 DOI: 10.4317/medoral.21314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Considering the high possibility of dentist consult a patient with oral complications of chemotherapy and/or radiotherapy for oral cancer because of the advances in this area, this study aims to systematically review the literature to identify and suggest effective and safe protocols for the managements of oral complications in oncology patients. MATERIAL AND METHODS The systematic review was designed by PICO and PRISMA including eligibility and exclusion criteria; the source of information and search strategy in PubMed according MeSH: "Mouth Neoplasms and Radiotherapy" and "Mouth Neoplasms and Drug Therapy" the period from 2010 to 2015; selection and data collection of study was carried form blind and independently by two researchers; risk of bias and methodological quality: ensured by the PEDro scale; synthesis of data: of oral complications were evaluated by adapted version of associative direction classification proposed by Costigan and collaborators; and data analysis was performed by the meta-analysis of BioEstat program (5.0) in the included studies. RESULTS 2,700 articles found, 2,371 were selected after removal of duplicate and elected 40 full-text articles. Of these, only 06 articles were included in the systematic review with exclusion of others, per obtain punctuation ≥ 7 with high methodological quality for synthesis of the managements of oral complications. Since 05 articles were associated with low risk of bias composing the protocols suggestive for managements and the meta-analysis in odds ratio (0.916) to cure and relative risk (1.049) for the development of oral mucositis and pain. CONCLUSIONS The protocols suggestive for managements of oral mucositis and pain with MuGard - mucoadhesive hydrogel; PerioAid Tratamiento® antiseptic mouthrinse with chlorhexidine and cetylpyridinium chloride; Episil® plus benzydamine - bioadhesive oromucosal gel; 0,03% of Triclosan mouthwash Colgate Plax; and Diode Laser Therapy of low-level are safe for oncology patients applied according to adopted clinical parameters.
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Affiliation(s)
- J-N Carneiro-Neto
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Odontologia de Araraquara, Departamento de Diagnóstico e Cirurgia, Rua Humaita, 1680, Centro, 14801903 - Araraquara, SP - Brasil - Caixa-postal: 331
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Dias Schalch T, Porta Santos Fernandes K, Costa-Rodrigues J, Pereira Garcia M, Agnelli Mesquita-Ferrari R, Kalil Bussadori S, Fernandes MH. Photomodulation of the osteoclastogenic potential of oral squamous carcinoma cells. J Biophotonics 2016; 9:1136-1147. [PMID: 27089455 DOI: 10.1002/jbio.201500292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
The treatment for oral cancer usually involves surgical excision followed by chemotherapy and/or radiotherapy. The combination of these therapies generally promotes a serious inflammation of the mucosa of the digestive tract, denominated mucositis, which compromises continuity of treatment. Photobiomodulation (PBM) therapy has been used successfully to reduce the oral mucositis, however there is still some controversy regarding the effects of this therapy on unintentionally irradiated tumor cells that may remain after cancer treatment. The aim of this study was to analyze the effect of PBM therapy (using parameters for mucositis) on the modulation of osteoclastogenic potential of a cell line derived from human lingual squamous cell carcinoma (SCC9). Previously irradiated SCC9 cells were co-cultured with human osteoclast precursors. Co-cultures performed with non-irradiated SCC9 cells served as control. After 7, 14 and 21 days the co-cultures were evaluated for the tartrate-resistant acid phosphatase (TRAP) activity, an osteoclastogenic marker. Additionally, the monocultures of SCC9 cells (non-irradiated and irradiated) were analyzed for cell viability/proliferation and for the expression of IL-11 and PTHrP. The irradiation of SCC9 cells with PBM with an energy density of 4 J/cm2 decreased the pro-osteoclastogenic potential of those cells. This may represent a potential useful side effect of PBM therapy. PBM (using recommended parameters for mucositis treatment) decreases the osteoclastogenic potential of oral squamous carcinoma cells.
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Affiliation(s)
- Tatiana Dias Schalch
- Biophotonics Applied to Health Sciences Postgraduate Program, Nove de Julho University - UNINOVE, 235/249 Vergueiro Street, 01504-001, São Paulo, Brazil
| | - Kristianne Porta Santos Fernandes
- Biophotonics Applied to Health Sciences Postgraduate Program, Nove de Julho University - UNINOVE, 235/249 Vergueiro Street, 01504-001, São Paulo, Brazil
| | - João Costa-Rodrigues
- Laboratory for Bone Metabolism and Regeneration, Faculdade de Medicina Dentária, Universidade do Porto, Portugal, Dr. Manuel Pereira da Silva Street, 4200-393, Porto, Portugal
| | - Mônica Pereira Garcia
- Laboratory for Bone Metabolism and Regeneration, Faculdade de Medicina Dentária, Universidade do Porto, Portugal, Dr. Manuel Pereira da Silva Street, 4200-393, Porto, Portugal
| | - Raquel Agnelli Mesquita-Ferrari
- Biophotonics Applied to Health Sciences Postgraduate Program, Nove de Julho University - UNINOVE, 235/249 Vergueiro Street, 01504-001, São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Biophotonics Applied to Health Sciences Postgraduate Program, Nove de Julho University - UNINOVE, 235/249 Vergueiro Street, 01504-001, São Paulo, Brazil
| | - Maria Helena Fernandes
- Laboratory for Bone Metabolism and Regeneration, Faculdade de Medicina Dentária, Universidade do Porto, Portugal, Dr. Manuel Pereira da Silva Street, 4200-393, Porto, Portugal
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Ding L, Wang S, Qu X, Wang J. Tanshinone IIA sensitizes oral squamous cell carcinoma to radiation due to an enhanced autophagy. Environ Toxicol Pharmacol 2016; 46:264-269. [PMID: 27521571 DOI: 10.1016/j.etap.2016.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/14/2016] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Tanshinone IIA (TanIIA), which is derived from the roots of Salvia miltiorrhiza (Danshen), has multiple pharmacological activities. However, the radiosensitivezing activity of TanIIA in oral cancer cells has not been studied extensively. The purpose of this study is to investigate the radiosensitizing effects of TanIIA in human oral squamous cell carcinoma SCC090 and examined the underlying mechanisms. METHODS Clonogenic assay was used to investigate the radiosensitizing effect of TanIIA on SCC090. And then, apoptosis and reactive oxygen species (ROS) induced by the combination of TanIIA with radiation were analyzed by Flow cytometry. Finally, autophagy was detected by monodansylcadervarine (MDC) staining. RESULTS TanIIA could significantly sensitize SCC090 to radiation. Meanwhile, an increase ROS generation after exposed to the combination treatment was found. In addition, the protein levels of Beclin 1, Atg5 and LC3-II, three important proteins involved in autophagy were increased in cells. CONCLUSIONS TanIIA exerted a strong radiosensitizing effect on SCC090 comparing with the simple drug or single radiation treatment, which was due to an enhanced ROS generation and autophagy.
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Affiliation(s)
- Lijuan Ding
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, China
| | - Shudong Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun 130021, China
| | - Xiaozhang Qu
- Department of Endocrinology, The Second Part of the First Hospital, Jilin University, Changchun 130021, China
| | - Jiafeng Wang
- Department of Endodontics, School and Hospital of Stomatology, Jilin University, Changchun 130021, China.
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Eder-Czembirek C, Czembirek C, Selzer E. Neoadjuvant radiotherapy plus radical surgery for locally advanced stage III/IV oral cancer: Analysis of prognostic factors affecting overall survival. Oral Oncol 2016; 60:1-7. [PMID: 27531866 DOI: 10.1016/j.oraloncology.2016.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/19/2016] [Accepted: 06/21/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Preoperative radiotherapy followed by surgery is an effective treatment option for solid tumors including locally advanced squamous cell cancers of the head and neck region. Histopathologic response to radiation has been shown to be associated with survival. However, the relative prognostic importance of regression grade compared to other potential biomarkers has not been established yet. MATERIALS AND METHODS One-hundred forty-four oral squamous cell carcinoma patients with stage III/IV disease were included in this analysis. Patients had received preoperative radiotherapy (RT) up to 50Gy total dose in combination with 5-Fluorouracil (5-FU)/Mitomycin C (MMC) or with Cetuximab, followed by radical surgery six to eight weeks later. Outcome data were obtained from the patient's files. Survival rates were estimated by the Kaplan-Meyer method. Cox-proportional-hazard regression models were used to compare the risk of death among patients stratified according to risk factors. RESULTS Five-year overall survival (OS) was 58% in the presented collective. Regression grade 4 (HR 3.58; p<0.001) was most significantly associated with reduced survival, followed by elevated neutrophils (HR 2.22; p=0.01), the combination of elevated neutrophils plus elevated CRP (HR 2.40; p=0.01), and elevated CRP alone (HR 1.74; p=0.03). In a multivariate analysis, the regression grade remained the most influential predictor of outcome (HR 4.23; p<0.001). CONCLUSION In a comparative analysis, tumor response to pre-operative radiotherapy remains the strongest prognostic factor for treatment outcome, while elevated CRP, as well as neutrophils, were also found to be of significance.
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Affiliation(s)
- Christina Eder-Czembirek
- University Clinic of Cranio, Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Cornelia Czembirek
- Center of Excellence of Cranio, Maxillofacial and Oral Surgery and Pediatric Dentistry, Sozialmedizinisches Zentrum Ost - Donauspital, Langobardenstraße 122, 1220 Vienna, Austria
| | - Edgar Selzer
- University Clinic of Radiotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Nayar S, Brett R, Clayton N, Marsden J. The Effect of a Radiation Positioning Stent (RPS) in the Reduction of Radiation Dosage to the Opposing Jaw and Maintenance of Mouth opening after Radiation Therapy. Eur J Prosthodont Restor Dent 2016; 24:71-77. [PMID: 27424338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The effect of a radiation positioning stent (RPS) in radiation dosage reduction to the opposing jaw and maintenance of mouth opening was audited. 55 Head and Neck cancer patients who received radiotherapy were reviewed. Radiation dosages at similar points in the primary/opposing jaws were measured along with the mouth opening. Results showed a significant reduction in the radiation dosage to the opposing jaw in patients given the RPS. Mouth opening was generally maintained in patients given the RPS (77.7% improvement in mouth opening) compared to patients without RPS. Patients undergoing radiotherapy who had an RPS showed a significant reduction in radiation dosage to the opposing jaw and maintained their mouth opening in the short-term.
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Abstract
PURPOSE: Curcumin, a potential chemopreventive agent, was found to inhibit cancer cells in S/G2M phases of the cell cycle, when radiation is more effective. The purpose of the current study was to investigate whether curcumin can sensitize squamous cell carcinoma (SCC) cells to the ionizing effects of irradiation.METHODS: Curcumin (3.5 μM) was added for 48 hours to an SCC cell line prior to irradiation. Cell growth (counts) and colony-formation (colonogenic assay) were examined after radiation.RESULTS: Incubation with curcumin only (3.75 μM) for 48 hours did not decrease the number of cells or the ability to form colonies in the absence of radiation. However, in plates that were exposed to 1–5 Gy of radiation, cell counts dropped significantly if pretreated with curcumin with a maximal effect at 2.5 Gy (where the cell counts dropped from 1240 to 1017, P < 0.001). The colonogenic assay revealed a significant decrease in the ability to form colonies following pretreatment with curcumin in all radiation doses ( P < 0.05).CONCLUSIONS: Given the appropriate doses, curcumin exhibits radio-sensitizing effects on SCC cells in vitro.
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Affiliation(s)
- Avi Khafif
- Department of Otolaryngology, Tel-Aviv Sourasky Medical Center, Israel.
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91
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Lo WC, Cheng PW, Wang CT, Shueng PW, Hsieh CH, Chang YL, Liao LJ. The Effect of Radiotherapy on Ultrasound-Guided Fine Needle Aspiration Biopsy and the Ultrasound Characteristics of Neck Lymph Nodes in Oral Cancer Patients after Primary Treatment. PLoS One 2016; 11:e0149346. [PMID: 26954569 PMCID: PMC4783113 DOI: 10.1371/journal.pone.0149346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/29/2016] [Indexed: 02/07/2023] Open
Abstract
Objectives To investigate the effect of radiotherapy (RT) on ultrasound-guided fine needle aspiration (USgFNA) and sonographic characteristics in the assessment of cervical lymph nodes (LNs) in oral squamous cell carcinoma (OSCC) patients after primary treatment. Materials and Methods 88 treated OSCC patients underwent 111 USgFNAs of the neck LNs after US evaluation. Among them, 48 USgFNAs were performed on 40 patients following RT and 63 USgFNAs on 48 patients without previous RT. The results of USgFNA and the US characteristics were compared between these two groups. Results USgFNA had a sensitivity of 88.0%, specificity of 91.4%, positive predictive value (PPV) of 88.0%, negative predictive value (NPV) of 91.4% and accuracy of 90.0% in patients without previous RT, and a sensitivity of 97.1%, specificity of 83.3%, PPV of 94.3%, NPV of 90.9% and accuracy of 93.5% in those with previous neck RT. The ranges of the short-axis and long-axis length were 13.3 ± 8.0 mm (mean ± SD) versus 17.8 ± 9.1 mm, and 18.6 ± 9.0 mm versus 24.4 ± 10.9 mm for recurrent LNs from patients with, versus without, previous RT (both ps < 0.05), respectively. 76.5% (26/34) of the recurrent nodes after RT and 48% (12/25) of the recurrent nodes without previous RT exhibited an irregular margin (p < 0.05). Additionally, irradiated recurrent LNs had a significantly decreased percentage of discernable calcification compared with non-irradiated recurrent nodes (48% versus 20.6%, p < 0.05). Conclusions RT had influence on sonographic characteristics but no influence on USgFNA in diagnosing recurrent LNs in treated OSCC patients.
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Affiliation(s)
- Wu-Chia Lo
- Department and Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Oriental Institute of Technology, Taipei, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Oriental Institute of Technology, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Yih-Leong Chang
- Department and Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail: (YLC); ; (LJL)
| | - Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
- * E-mail: (YLC); ; (LJL)
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Abstract
Targeting and inhibiting DNA repair pathways is a powerful strategy of controlling malignant growth. One such strategy includes the inhibition of PARP1, a central element in the intracellular DNA damage response. To determine and visualize the expression and intercellular distribution of PARP1 in vivo, and to monitor the pharmacokinetics of PARP1 targeted therapeutics, fluorescent small probes were developed. To date, however, it is unclear how these probes behave in a more realistic clinical setting, where DNA damage has been induced through one or more prior lines of therapy. Here, we use one such imaging agent, PARPi-FL, in tissues both with and without prior DNA damage, and investigate its value as a probe for PARP1 imaging. We show that PARP1 expression in oral cancer is high, and that the uptake of PARPi-FL is selective, irrespective of whether cells were exposed to irradiation or not. We also show that PARPi-FL uptake increases in response to DNA damage, and that this increase is reflected in higher enzyme expression. Our findings provide a framework for measuring exposure of cells to external beam radiation, and could help to elucidate the effects of such treatments non-invasively in mouse models of cancer.
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Affiliation(s)
- Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, United States of America
| | - Wolfgang A. Weber
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, United States of America
- Department of Radiology, Weill Cornell Medical College, New York, New York, 10065, United States of America
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, 10065, United States of America
- Department of Radiology, Weill Cornell Medical College, New York, New York, 10065, United States of America
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93
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Zheng L, Lv X, Shi Y, Zhang Y, Yu G, Zhang J. (125)I interstitial brachytherapy for the treatment of myoepithelial carcinoma of the oral and maxillofacial region. Brachytherapy 2016; 15:240-5. [PMID: 26778756 DOI: 10.1016/j.brachy.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE This study evaluated the treatment of myoepithelial carcinoma (MC) of the oral and maxillofacial region with radioactive iodine ((125)I) seed implantation. METHODS AND MATERIALS Twenty-seven patients with MC in the oral and maxillofacial region were treated with (125)I seed implantation between March 2006 and October 2012. Thirteen of the 27 patients (8/8 patients with primary disease and 5/19 patients with recurrent disease) were treated on an adjuvant setting after resections, and the other 14 patients were treated by brachytherapy after a recurrence precluding a surgical resection for salvage. The sites of the MC were the parotid for 18 patients, oral cavity for 2 patients, and base of skull for 7 patients. Recurrence-free survival (RFS), overall survival (OS) rates, and side effects were retrospectively reviewed. RESULTS Patients were followed for 6-105 months (median 37 months). The 3- and 5-year RFS rates were 51.9% and 46.1%, respectively. The 3- and 5-year OS rates were 68.6% and 51.5%, respectively. The OS and RFS were significantly better among the 8 patients treated upfront in comparison with the 19 patients treated for salvage at relapse. The OS was worst for the 7 patients with base of skull region disease. No severe complications were observed during followup. CONCLUSIONS This study showed (125)I brachytherapy is a feasible and effective modality for the treatment of MC. These findings should be interpreted cautiously due to the small number of patients and the relatively short followup.
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Affiliation(s)
- Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R.China
| | - Xiaoming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R.China
| | - Yan Shi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R.China
| | - Yi Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R.China
| | - Guangyan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R.China
| | - Jianguo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, P.R.China.
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Alhazzazi TY, Kamarajan P, Xu Y, Ai T, Chen L, Verdin E, Kapila YL. A Novel Sirtuin-3 Inhibitor, LC-0296, Inhibits Cell Survival and Proliferation, and Promotes Apoptosis of Head and Neck Cancer Cells. Anticancer Res 2016; 36:49-60. [PMID: 26722027 PMCID: PMC5417072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The survival rate of patients with head and neck squamous cell carcinoma (HNSCC) stands at approximately 50% and this has not improved in decades. This study developed a novel sirtuin-3 (SIRT3) inhibitor (LC-0296) and examined its role in altering HNSCC tumorigenesis. MATERIALS AND METHODS The effect of the SIRT3 inhibitor, LC-0296, on cell survival, proliferation, and apoptosis, and reactive oxygen species levels in HNSCC cells were studied. RESULTS LC-0296 reduces cell proliferation and promotes apoptosis of HNSCC cells but not of normal human oral keratinocytes. This inhibitory effect is mediated, in part, via modulation of reactive oxygen species levels. Additionally, LC-0296 works synergistically to increase the sensitivity of HNSCC cells to radiation and cisplatin treatment. CONCLUSION Development of novel SIRT3 inhibitors, such as LC-0296, might enable the development of new targeted therapies to treat and improve the survival rate of patients with head and neck cancer.
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Affiliation(s)
- Turki Y Alhazzazi
- Department of Oral Biology, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, U.S.A
| | - Pachiyappan Kamarajan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, U.S.A
| | - Yanli Xu
- Center for Drug Design, Academic Health Center, University of Minnesota, Minneapolis, MN, U.S.A
| | - Teng Ai
- Center for Drug Design, Academic Health Center, University of Minnesota, Minneapolis, MN, U.S.A
| | - Liqiang Chen
- Center for Drug Design, Academic Health Center, University of Minnesota, Minneapolis, MN, U.S.A
| | - Eric Verdin
- Gladstone Institute of Virology and Immunology, University of California, San Francisco, CA, U.S.A
| | - Yvonne L Kapila
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, U.S.A.
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95
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Richard P, Sandison G, Dang Q, Johnson B, Wong T, Parvathaneni U. Dental amalgam artifact: Adverse impact on tumor visualization and proton beam treatment planning in oral and oropharyngeal cancers. Pract Radiat Oncol 2015; 5:e583-8. [PMID: 26419441 DOI: 10.1016/j.prro.2015.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/17/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the incidence and impact of dental filling artifacts on the definition of clinical target volume (CTV) for oropharyngeal/oral cavity cancers receiving radiation therapy. We performed phantom proton beam dosimetric analyses using a low-density composite filling to investigate artifact reduction and dose distribution. METHODS AND MATERIALS We reviewed oral cavity/oropharynx radiation treatment plans between 2010 and 2012. Plans were evaluated for artifacts and impact on CTV visualization. We constructed a head and neck phantom, obtaining planning computed tomography images at baseline (native tooth) and for each filling (composite and metal amalgam) interchanged into a tooth adjacent to the tumor. We performed uniform scanning proton plans with each filling, evaluating for planning target volume (PTV) coverage and overall dose distribution. RESULTS A total of 110 treatment plans were reviewed (71 oropharynx, 39 oral cavity). Artifacts were identified in 81 plans (73.6%), including 53 oropharynx (74.6%) and 28 oral cavity (71.8%). Artifacts obscured the CTV in 77 cases (95%), including 49 of 53 oropharynx cases (92.5%) and all 28 oral cavity cases. On phantom testing, the metal amalgam obscured the tumor while the composite did not. Hounsfield unit (HU) values (range, mean) for the tumor were: baseline (-484.0 to 700.0 HU, 104 HU), composite (-728.5 to 1038.0 HU, 105 HU), metal amalgam (-1023.0 to 807.0 HU, 90.74 HU). The percent of planning target volume receiving 95% of prescription dose of the PTV was baseline (100%), composite (100%), and metal amalgam (92.3%). PTV dose ranges were baseline (98%-106%), composite (98%-107%), and metal amalgam (66%-111%). PTV coverage and dose distributions of the composite and native tooth plans were identical. CONCLUSIONS A high incidence of artifacts was found on the planning scans of oral/oropharyngeal cancer patients, adversely impacting CTV visualization. In our phantom model, metal amalgam impacted tumor and tissue density. The PTV was underdosed with the metal amalgam compared with the composite filling. A potential solution involves exchanging metal fillings with composite before proton treatment planning for improved tumor visualization and dosimetry.
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Affiliation(s)
- Patrick Richard
- University of Washington, Department of Radiation Oncology, Seattle, Washington.
| | - George Sandison
- University of Washington, Department of Radiation Oncology, Seattle, Washington
| | - Quang Dang
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Bart Johnson
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Tony Wong
- Seattle Special Care Dentistry, Seattle, Washington
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96
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Schrijen-Floor JM, Fennis WMM, Abbink JH, de Putter C, Koole R, van den Braber W. Tooth loss prior to radiation in relation to tumor location in patients with head and neck cancer. INT J PROSTHODONT 2015; 28:252-7. [PMID: 25965639 DOI: 10.11607/ijp.4097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE This study aimed to investigate the impact of preradiation tooth loss in patients with head and neck cancer. MATERIALS AND METHODS Records of 397 (partially) dentate patients who were referred for preradiation oral screening were included. Number and location of teeth lost and occluding pairs lost were determined for different tumor locations. RESULTS The majority of patients (54%) were affected by tooth loss. Proportion of teeth lost, their location, and proportion of occluding pairs lost were not evenly distributed across tumor locations. The highest proportions of teeth were removed with oral tumors (maxilla: 25%; mandible: 47%). For preradiation preventive extractions only, ie, not taking into account teeth that were lost due to ablative surgery, tooth loss in the mandible was still not evenly distributed across tumor locations, but tooth loss in the maxilla and occluding pairs lost were. CONCLUSIONS Tumor location affects preradiation tooth loss, though this is primarily a consequence of ablative surgery rather than a consequence of preradiation dental extraction decisions. Since patients with oral cavity tumors are affected most by preradiation tooth loss, treatment planning with regard to functional rehabilitation is desirable for this patient group in particular.
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97
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Inhestern J, Oertel K, Stemmann V, Schmalenberg H, Dietz A, Rotter N, Veit J, Görner M, Sudhoff H, Junghanß C, Wittekindt C, Pachmann K, Guntinas-Lichius O. Prognostic Role of Circulating Tumor Cells during Induction Chemotherapy Followed by Curative Surgery Combined with Postoperative Radiotherapy in Patients with Locally Advanced Oral and Oropharyngeal Squamous Cell Cancer. PLoS One 2015; 10:e0132901. [PMID: 26186556 PMCID: PMC4505900 DOI: 10.1371/journal.pone.0132901] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/22/2015] [Indexed: 12/11/2022] Open
Abstract
Background The prognostic role of circulating tumor cells (CTCs) after induction chemotherapy using docetaxel, cisplatin and fluorouracil (TPF) prior to surgery and adjuvant (chemo)radiation in locally advanced oral squamous cell cancer (OSCC) was evaluated. Methods In this prospective study, peripheral blood samples from 40 patients of the phase II study TISOC-1 (NCT01108042) with OSCC before, during, and after treatment were taken. CTCs were quantified using laser scanning cytometry of anti– epithelial cell adhesion molecule–stained epithelial cells. Their detection was correlated with clinical risk factors, recurrence-free (RFS) and overall survival (OS). Results Before starting the treatment CTCs were detected in 32 of 40 patients (80%). The median number at baseline was 3295 CTCs/ml. The median maximal number of CTCs during treatment was 5005 CTCs/ml. There was a significant increase of CTCs before postoperative radiotherapy compared to baseline before 1st cycle of IC (p = 0.011), 2nd cycle of IC (p = 0.001), 3rd cycle of IC (p = 0.004), and before surgery (p = 0.002), but not compared to end of therapy (p = 0.118). CTCs at baseline >median was also associated to risk of recurrence (p = 0.014). Maximal CTCs during therapy >median was more frequently observed in tumors of the oral cavity (p=0.022) and related to higher risk of death during follow-up (p = 0.028). Patients with CTCs at baseline >median value had significant lower RFS than patients with CTCs at baseline <median value (p = 0.025). Patients with maximal CTCs values >median during the complete course of therapy had a significantly lower OS than patients with values <median (p = 0.049). Finally, the multivariate analysis revealed that OS was significantly lower in patients with maximal CTCs during treatment higher than the median value (HR=6.151; CI: 1.244-30.420). Conclusions Baseline CTCs and maximal CTCs during therapy both seem to be good prognostic markers for OSCC when treated by TPF induction chemotherapy, surgery, and postoperative (chemo)radiation.
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Affiliation(s)
- Johanna Inhestern
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Katrin Oertel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Viola Stemmann
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | | | - Andreas Dietz
- Department of ENT Surgery, University Medical Center Leipzig, Leipzig, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Johannes Veit
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Martin Görner
- Department of Hematology and Oncology, Academic Teaching Hospital Bielefeld, Bielefeld, Germany
| | - Holger Sudhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, Academic Teaching Hospital Bielefeld, Bielefeld, Germany
| | - Christian Junghanß
- Division of Medicine, Department of Hematology, Oncology and Palliative Medicine, University of Rostock, Rostock, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Katharina Pachmann
- Clinic of Internal Medicine II, Division of Hematology and Internal Oncology, Jena University Hospital, Erlanger Allee 101, Jena, Germany
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98
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Affiliation(s)
- C C Wang
- Department of Radiation Medicine, Massachusetts General Hospital Cancer Center, Boston
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99
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Zeng D, Li X, Sun R, Jiang H, Fan Y, Yang J. [Factors for oral infections in patients with oral cancer undergoing radiotherapy]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:295-299. [PMID: 26081083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the factors associated with oral infections in patients with oral cancer undergoing radiotherapy. METHODS Clinical data of 241 patients with oral cancer undergoing radiotherapy between March 2012 and May 2014 in sichuan cancer hospital were reviewed. Univariate and multivariate analyses were performed to determine the factors related to oral infection occurring in the patients. SPSS 17.0 software was used to analyze the data. RESULTS Ninety-three (38.59%) of 241 cases had oral infection. Among the 93 cases, 49 (52.69%) cases presented with fungal infections, 44 (47.31%) cases with bacterial infection, and 38 (40.86%) cases with mixed infection. Oral infection occurred since the fifth week after radiotherapy in 55 (59.14%) patients. Multivariate Logistic regression analysis showed that the risk factors for oral infection after radiotherapy were the late stage of cancer, poor oral health habits, the coexistence of multiple treatments, city dwellers and surgical history (all P<0.05). CONCLUSIONS Oral infections commonly occur in the late period of radiotherapy. The late stage of cancer, poor oral health habits, the coexistence of multiple treatments, city dwellers and surgical history are key risk factors for oral infection in patients with oral cancer undergoing radiotherapy.
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Affiliation(s)
- Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu 610041, China;
| | - Xiaoxia Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Ronghao Sun
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Hua Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Yuxia Fan
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Jing Yang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital, Chengdu 610041, China
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100
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Mobit PN, Rajaguru P, Brewer M, Baird M, Packianathan S, Yang CC. Radiation safety consideration during intraoperative radiation therapy. Radiat Prot Dosimetry 2015; 164:376-382. [PMID: 25267855 DOI: 10.1093/rpd/ncu292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 08/24/2014] [Indexed: 06/03/2023]
Abstract
Using in-house-designed phantoms, the authors evaluated radiation exposure rates in the vicinity of a newly acquired intraoperative radiation therapy (IORT) system: Axxent Electronic Brachytherapy System. The authors also investigated the perimeter radiation levels during three different clinical intraoperative treatments (breast, floor of the mouth and bilateral neck cancer patients). Radiation surveys during treatment delivery indicated that IORT using the surface applicator and IORT using balloons inserted into patient body give rise to exposure rates of 200 mR h(-1), 30 cm from a treated area. To reduce the exposure levels, movable lead shields should be used as they reduce the exposure rates by >95%. The authors' measurements suggest that intraoperative treatment using the 50-kVp X-ray source can be administered in any regular operating room without the need for radiation shielding modification as long as the operators utilise lead aprons and/or stand behind lead shields.
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Affiliation(s)
- Paul N Mobit
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA
| | - Priyadarshini Rajaguru
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA
| | - Michael Brewer
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA
| | - Michael Baird
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA
| | - Satyaseelan Packianathan
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA
| | - Claus Chunli Yang
- Department of Radiation Oncology, University of Mississippi Medical Center, 350 West Woodrow Wilson Drive, Suite 1600, Jackson, MS 39213, USA
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