Concurrent platinum-based chemotherapy and simultaneous modulated accelerated radiation therapy for locally advanced squamous cell carcinoma of the tongue base

BACKGROUND

Randomized data support use of chemotherapy concurrently with radiation in treatment of advanced squamous cell carcinoma (SCC) of the oropharynx. Intensity modulated radiation therapy (IMRT) is increasingly being used to deliver such radiotherapy; no published reports specifically describe results of chemotherapy with IMRT for SCC of the base of tongue (BOT). We present outcomes data using simultaneous modulated accelerated radiation therapy (SMART) combined with platinum-based chemotherapy in treatment of locally advanced SCC of the BOT METHODS: The records of the Otolaryngology/Head and Neck Surgery Department of Emory University were screened for patients undergoing definitive chemoradiotherapy for SCC of the BOT. Radiation Oncology records were reviewed for dosimetry and prescription data. Hospital and clinic records were reviewed for control and toxicity data. All patients were treated definitively with platinum-based chemotherapy and once-daily RT. Median dose and dose per fraction to sites of gross primary or nodal disease, clinically involved neck, and clinically uninvolved neck were 70.29 Gy (2.13 Gy/fx), 63.03 Gy (1.91 Gy/fx), and 57.75 Gy (1.75 Gy/fx), respectively.

RESULTS

Between January 2003 and August 2005, 34 patients underwent definitive therapy for SCC of the BOT using SMART and chemotherapy. Follow-up was documented in all cases (median, 20.1 months). There have been 3 distant failures and 3 locoregional failures.

CONCLUSION

With moderate follow-up, chemotherapy and SMART contributes to excellent results, with 24-month actuarial overall survival and local control of 90% and 92%, respectively. Toxicity may be increased, however, with 15% of patients developing esophageal stricture or stenosis. .

Dental treatment planning and management in the patient who has cancer

The oral cavity has the potential to be a major source of short-term and long-term complications from cancer therapy. Appropriate evaluation and elimination of potential sources of oral infection before cancer therapy is vital because oral bacteria are a known source of bacteremia and septicemia during cancer therapy. Cancer diagnosis with previous and planned treatment, past medical history, past dental history, current medications, drug allergies, social history, family history, laboratory values, extraoral findings, intraoral findings, and radiographic findings must all be evaluated in planning dental treatment for these complex cases.

Correlation of clinical, histological, and cytokeratin profiles of squamous cell carcinoma of the oral tongue with prognosis

The aim of the present study was to clinically, morphologically, and immunohistochemically correlate the expression of cytokeratins (CKs) 7, 10, 13, 14, 16, and 19 in 30 cases of tongue squamous cell carcinoma (SCC) with disease outcome, metastases, clinical stage (tumor, node, metastasis [TNM]), and histological grade of malignancy proposed by Bryne. Statistical analysis (chi2 test) showed that only histological grading was not significantly correlated with the clinical variables. CK expression varied in the samples analyzed. CK 10 expression was significantly correlated with the presence of metastases, and the expression of CK 16 was related to disease outcome and also to TNM stages III and IV. These results indicate that metastases and TNM are effective prognostic indicators. The histological grading proposed by Bryne did not reflect the biological behavior of the tongue SCC cases studied. Analysis of some intermediate CK filaments can reflect the biological behavior and aggressiveness of some tongue SCCs.

Clinicopathologic significance of EpCAM expression in squamous cell carcinoma of the tongue and its possibility as a potential target for tongue cancer gene therapy

Epithelial adhesion molecule (EpCAM) is a transmembrane glycoprotein involved in intercellular adhesion. In particular, EpCAM appears to be overexpressed by the majority of human epithelial carcinomas, including colorectal, breast, head and neck, and hepatic carcinomas. We therefore hypothesized that EpCAM would be a good molecular target for cancer gene therapy. EpCAM protein expression in 48 primary tongue cancers and 10 normal oral mucosa was evaluated using anti-EpCAM immunohistochemistry, and correlation was examined with the clinicopathologic factors. In four human tongue cancer cell lines (SAS, HSC-2, OSC19 and OSC20), we investigated EpCAM expression by reverse transcription-polymerase chain reaction (RT-PCR). The invasive potential of cancer cells was evaluated using Matrigel invasion assay. Moreover, the effect of EpCAM inhibition was analyzed using RNA interference (RNAi). EpCAM overexpression was detected in 30 of 48 tongue cancers (62.5%), and was significantly higher in primary squamous cell carcinoma (SCC) of the tongue than in normal oral mucosa. The expression of EpCAM was significantly associated with tumor size, regional lymph node metastasis, histological differentiation and invasion pattern. Cancer cell lines with higher EpCAM expression had more invasive potential. Moreover, RNAi-mediated EpCAM reduction decreased the invasion potential and proliferation activity. These results indicated that the overexpression of EpCAM was correlated with a more aggressive phenotype of tongue cancer. Moreover, we suggested that EpCAM could be a molecular target, and that RNAi targeting EpCAM could be useful for tongue cancer gene therapy.

Oral tongue cancer in young patients: A matched analysis

Previous studies on squamous cell carcinoma of the tongue have reported conflicting results with respect to age and prognosis. The aim of this study is to elucidate if any differences in outcome exist between patients younger and older than 40 years. A case-control study was performed. Patients recorded in the head and neck cancer registry of Milano-Bicocca School of Medicine between January 1981 and December 1998 were reviewed. Cases were patients with squamous cell carcinoma of the tongue aged 40 years or less. Controls were patients older than 40 who were matched to cases for diagnosis, sex and TNM classification. Two controls were matched for each case, thus forty-six cases and 92 controls were selected. The frequency of recurrences was found to be significantly higher in younger patients. The survival analysis further supports this conclusion (log-rank test, p=0.002). The number of cancer-related deaths in patients younger and older than 40 years were 23 (50%) and 31 (34%), respectively (p=0.10). A statistical significant difference emerged when the number of deaths was compared using survival curves (log-rank test, p=0.05). In conclusion, in patients with squamous cell carcinoma of the tongue, young age is an independent predictor of worse survival.

Hyalinizing clear cell carcinoma of the base of tongue

Hyalinizing clear cell carcinoma is a rare, low-grade neoplasm of the minor salivary glands. It is composed exclusively of epithelial cells with optically clear cytoplasm. There are only a few isolated cases reported in the literature involving the base of tongue. The treatment of choice is wide excision and selective neck dissection, with or without radiotherapy. The prognosis of these tumours is good. A 57-year-old male patient presented with a lesion in the base of tongue, which was well enhanced on contrast computerized tomography scan. Once confirmed by biopsy, the hyalinizing clear cell carcinoma was resected via a transcervical approach. The patient underwent postoperative radiotherapy. There was no evidence of locoregional recurrence or distant metastasis at 18 months of follow up.

Deep lingual arterial chemoembolization of tongue carcinoma with microcapsuled anticancer drug

OBJECTIVE

Microcapsule chemoembolism is a promising treatment of tumors. We describe a deep lingual arterial embolization of tongue carcinoma with microcapsuled carboplatinum.

METHODS

Lingual artery cast specimens from cadavers were microscopically examined, and 78 patients with tongue cancer were recruited and treated with the deep lingual arterial embolization therapy.

RESULTS

Microcapsule embolism occurred approximately at the fifth or sixth level of the deep lingual artery branches. The five-year survival rate was 88.5% (69 out of 78), and the ten-year survival rate 52.6% (41 out of 78).

CONCLUSION

The deep lingual arterial embolization of tongue carcinoma with microcapsuled carboplatinum is an effective therapy to treat carcinoma in mid-margin or mid-body of the tongue.

Treatment of early tongue carcinoma with brachytherapy: results over a 25-year period

BACKGROUND

Brachytherapy for patients with early tongue cancer is an accepted method of treatment.

PATIENTS AND METHODS

The records of 409 patients with T1/2N0M0 tongue cancer treated with brachytherapy between 1978 and 2004 were reviewed.

RESULTS

The overall and disease-free 5-year survival rates were 82.3% and 64.6% for patients with T1 disease, and 72.2% and 56.0% for patients with T2 disease, respectively. The 5-year nodal metastasis-free survival rates for patients treated between 1978 and 1986, 1987 and 1996, and 1997 and 2004 were 64.8%, 74.8% and 81.3% for patients with T1 disease (p=0.22), and 47.4%, 70.4% and 76.4% for patients with T2 disease (p=0.0011), respectively. The 5-year local recurrence-free survival rates for patients treated between 1978 and 1986, 1987 and 1996, and 1997 and 2004 were 91.0%, 84.0% and 96.9% for patients with T1 disease (p=0.31), and 87.6%, 83.3% and 85.8% for patients with T2 disease (p=0.90), respectively.

CONCLUSION

The incidence rate of nodal metastasis in patients with early tongue cancer improved over the 25-year period studied, while the local recurrence-free survival rates remained stable.

[Removing illness changes related with ORL in laser-clinic in 2005]

INTRODUCTION

For 13 years now we use neodine - laser in our clinic. In 2005 we treated 463 patients using this laser with local anesthesia. There are 47 cases presented in article (28 women and 19 men) from who pieces of nasal cavity, oral cavity or throat were taken or illness changes have been curing. Those patients were 9,93% among all patients who were cured by laser ND-YAG.

MATERIAL AND METHODS

[corrected] 47 patients were splited into 4 groups. Group No 1 containing 11 men and 10 women with removing changes in nasal cavity. Group No 2 with 7 patients who had removing changes on palatine tonsils and 5 on tongue radix. Group No 3 in which changes in oral cavity were removed where were 4 men and 8 women. Last Group No 4 contained 2 women, from who changes in chin were removed. All operations were under local anesthesia.

RESULTS

Among majority patients removed pices were proliferation of neoplasm - benign type (20 patients). In 2 cases were papilloma and 4 causes were malignant neoplasm. 8 patients had chronic state with metaplasia and displasia within nose. 5 patients had bleeding granuloma (septum nasi) removed. 6 cases cyst epidermid, next seborrheic in chin. In 2 cases there were no patologic changes. Control visits did not show the increase of illness (except malignant neoplasm).

CONCLUSIONS

Laser ND-YAG may be used to remove egzofitical changes and to take some pices in case of neoplasm. Bloodless operation with laser allow to control the time. Operations may be taken under local anesthesia. Using laser technology high precision is possible and deep penetration of laser make the operations safer in case of neoplasm.

Combined effects of soluble vascular endothelial growth factor receptor FLT-1 gene therapy and cisplatin chemotherapy in human tongue carcinoma xenografts

The aim of the present study was to assess the anti-tumor effect of a defective adenovirus that expresses soluble vascular endothelial growth factor (VEGF) receptor FLT-1 (AdsFLT-1) in combination with cisplatin (cis-diamminedichloroplatinum, DDP) on human tongue carcinoma Tca8113 cell xenografts that had been pre-established in nude mice. In vitro, Tca8113 cells secreted soluble FLT-1 (sFLT-1) after infection with AdsFLT-1, and the conditioned medium from AdsFLT-1-treated Tca8113 cells seemed to inhibit VEGF-induced proliferation of human umbilical vein endothelial cells. The combined effects of sFLT-1 gene therapy and DDP chemotherapy was then studied in well-established Tca8113 xenografts. The concentration of sFLT-1 in serum reached a peak 8 days after intratumoral injection of AdsFLT-1. In these tumors, AdsFLT-1 intratumoral injections had only a small effect. Interestingly, when the cells were also exposed to DDP chemotherapy, significantly higher (P<0.05), and possibly synergistic, anti-tumoral effects were observed that were highly correlated to a marked reduction in intratumoral vascularization and an increase in tumor-cell apoptosis. Together, these data emphasize the potential of combining an anti-angiogenic gene therapy strategy with a destructive approach directed against the tumor cells to fight human tongue carcinoma.

Spinal cord compression in patients with oral squamous cell carcinoma

Squamous cell carcinoma (SCC) is the most common malignancy arising in the oral cavity. It can cause severe morbidity and mortality due to its propensity to metastasis. Despite the likelihood of distant metastases, commonly to the lungs, there is little report in the literature of metastatic spread to the spinal vertebrae from oral SCC with secondary spinal cord compression. We report 2 patients with advanced SCC in the tongue who developed signs of spinal cord compression due to metastasis to lumbar vertebrae. The clinical impression of metastasis causing spinal cord compression was confirmed by magnetic resonance imaging.

[Construction of antisense human tankyrase-1 RNA retroviral vector and its inhibition on tongue cancer cells]

OBJECTIVE

To investigate the inhibition of telomerase activity and cellular proliferation in tongue cancer TCCA-8113 cell lines by antisense human tankyrase-1 RNA treatment, and explore the possibility of the tankyrase-1 as a target of gene therapy for tongue cancer.

METHODS

The replication deficient retrovirus expressing tankyrase-1 antisense RNA was constructed to infect the TCCA-8113 cells. Tankyrase-1 expression was examined by RT-PCR. Telomerase activity was assayed by telomerase repeat amplification protocol (TRAP). Cell proliferation was investigated by cellular growth curve. Cellular apoptosis was detected by flow cytometry method and invert microscope.

RESULTS

Tankyrase-1 expression and telomerase activity of tongue cancer TCCA-8113 cells were significantly inhibited. There was G(1)-S phase arrest when TCCA-8113 cells were treated with antisense tankyrase-1 transduction. Cellular proliferation was arrested, and cellular apoptosis occurred after antisense tankyrase transduction.

CONCLUSIONS

The transduction of antisense tankyrase-1 by retroviral vector can significantly inhibit the tankyrase-1 expression and telomerase activity of tongue cancer TCCA-8113 cell lines, and arrest the cellular proliferation and promote cellular apoptosis. The tankyrase may be a potential target of gene therapy for tongue cancer.

Malignant peripheral primitive neuroectodermal (pPNET) of tongue

Primitive neuroectodermal tumors (PNETs) are relatively rare tumors. Tumors that once would have been diagnosed as Ewing's sarcoma are now often designated as peripheral neuroepithelioma or synonymously PNET. This paper reports a case of PNET located orally on the tongue, which is, to our knowledge, the first case reported in medical literature. The patient was treated with postoperative radiotherapy and chemotherapy. Multiple liver metastases occurred 5 months after the initial diagnosis and following extensive chemotherapy the patient was only able to survive for a further 10 months.

Retrospective study of survival and treatment pattern in a cohort of patients with oral and oropharyngeal tongue cancers from 1987 to 2004

This is a retrospective study of patients with oral and oropharyngeal tongue cancers who presented to the Royal Adelaide Hospital (RAH) from 1987 to 2004. The aims of this study were to determine sociodemographic and tumour characteristics, treatment patterns and five-year disease-specific survival of the disease. All cases of tongue cancers, including untreated and palliative cases, were identified through the Royal Adelaide Hospital Cancer Registry and were included in statistical analysis. A total of 212 cases of tongue cancer were identified. Patients less than 45 years of age accounted for 15% of cases and had a tendency to present with advanced stage disease. Squamous cell carcinoma was the most common histological type. Almost 30% of recorded cases were oropharyngeal or base of tongue cancers. Nearly half of the patients had advanced stage (III and IV) disease at presentation, which was significantly associated with rural area of residence, base of tongue sub-site and early diagnostic period. Treatment involved a multidisciplinary approach and majority of patients were treated with a curative intent. Palliative treatment was more likely to be given to patient with oropharyngeal tongue cancers or advance stage disease. There was no significant improvement of five-year disease-specific survival over the 18-year period. Poorer survival was significantly associated with age 45 years or older, oropharyngeal tongue cancers and advanced stage disease. Tongue cancer is an important health issue associated with poor survival. Early detection and diagnosis is important in order to improve survival rate for this malignancy.

Tongue Cancer: Is There a Difference in Survival Compared With Other Subsites in the Oral Cavity?

PURPOSE

Advances in the management of patients with oral squamous cell carcinoma (OSCC) have confounded the importance of site in predicting overall prognosis. The purpose of this retrospective study was to review the outcome of patients with OSCC and to determine if site is a significant predictor of survival or disease-free survival.

PATIENTS AND METHODS

The records of 233 patients that underwent surgery for resectable OSCC treated at a single institution from 1993 to 2003 were identified. Patients with positive surgical margins, high grade histology, aggressive biologic behavior, or advanced stage disease underwent adjuvant radiotherapy or chemoradiotherapy. The demographics, site, stage, pathologic, treatment, and survival data were collected and statistically analyzed in an attempt to identify predictors of loco-regional control and disease-free survival. Descriptive statistics were calculated for each variable and survival was calculated using the Kaplan-Meier method. For purposes of comparison, patients were divided into 2 groups: those with tongue lesions (n = 73) and all other sites (n = 152). The Cox proportional hazards model was used to distinguish different survival rates between the groups.

RESULTS

Two hundred fifteen patients consisting of 104 males (48%) and 111 females (52%) met the criteria for inclusion in the study. Overall and disease-free survival rates were 56% and 58%, respectively. Stage and grade were identified as having a statistically significant effect on survival (P = .0014, likelihood ratio chi2 = 0.04, 1 degree of freedom; and P = .026, chi2 = 5, 1 degree of freedom, respectively). There was no significant difference in survival between patients with tongue cancer and other sites in the oral cavity (P = .8, chi2 = .04, 1 degree of freedom).

CONCLUSIONS

Grade and stage are significant predictors of overall and disease-free survival for patients with OSCC. In this study, however, there was no survival difference between patients with tongue cancer and cancers located at other sites in the oral cavity.

Imaging of tongue carcinoma

The tongue enables taste and plays a critical role in formation of food bolus and deglutition. The tongue is also crucial for speech and the earliest sign of tongue paresis is a change in the quality of speech. Given the importance of the tongue, tongue carcinoma should be accurately staged in order to optimise treatment options and preserve organ function. The intent of this review is to familiarise radiologists with the pertinent anatomy of the tongue and the behaviour of tongue carcinoma so as to map malignant infiltration accurately.

A case report: Epstein-Barr virus-associated undifferentiated carcinoma of the tongue base

Outside the nasopharynx, undifferentiated carcinomas occur only rarely at other head and neck locations. Although the association between undifferentiated nasopharyngeal carcinoma and Epstein-Barr virus (EBV) is consistent, there is conflicting evidence as to the association of EBV with undifferentiated carcinomas outside the nasopharynx. Here, we report on a case of undifferentiated carcinoma of the tongue base. A 71-year-old male, who had been treated with irradiation for primary unknown right neck metastatic EBV-positive undifferentiated carcinoma 9 years previously, was referred to our clinic with masses at the tongue base and right neck. The lesion at the tongue base was revealed to be an EBV-positive undifferentiated carcinoma. He was treated with resection of tongue base tumor and bilateral-neck dissection, and the defect at the tongue base was reconstructed with a free rectus abdominis myocutaneous flap. Re-irradiation was added post-operatively because of a positive surgical margin at the tongue base. The patient is presently alive without recurrence or distant metastasis 20 months after treatment. Although it is unclear whether our case is recurrent or newly developed EBV-latently infected undifferentiated carcinoma, we propose that EBV-associated tumors should be carefully observed after treatment at least for more than 10 years.

[Comparison of primary tongue carcinoma with second primary tongue carcinoma after radiotherapy for nasopharynx cancer]

OBJECTIVE

To investigate the clinical characteristics and prognosis of second primary tumor of tongue (SPTr) after nasopharyngeal carcinoma (NPCR) treated with radiotherapy.

METHODS

Clinical data of 53 patients with SP7T after NPCR (group A) and 252 patients with primary tongue carcinoma (group B) were analyzed retrospectively with regard to clinical characteristics and survival rate (Kaplan-Meier); and multivariate analysis was performed using Cox proportional hazards model.

RESULTS

There was no significant difference between group A and group B ( P > 0. 05) in the presenting age, sex, tumor size, cTNM stage, tumor differentiation and the rate of distant metastasis. The overall 5-year survival rates were 41.6% in group A and 56.3% in group B (chi2 = 4.40, P = 0.0359) with a statistically significant difference between two groups. The differences of tumor location (chi2 = 61.18, P = 0.000) and rate of clinical (cN+, chi2 = 6.846, P = 0.009) or pathological lymph node metastasis (pN+, X2 = 3.993, P = 0.046) were also statistically significant between group A and group B, respectively. Multivariate analysis showed that age at presence, cTNM stage and with or without neck lymph node dissection were independent risk factors affecting survival.

CONCLUSION

Second primary tongue carcinoma after radiotherapy for nasopharyngeal carcinoma is likely to occur on the dorsal aspect of the tongue with worse prognosis but with a lower rate of lymph node metastasis than that of primary tongue carcinoma. However, radiotherapy history is not an independent influencing factor on prognosis. Surgical resection or combined modality therapy may give a better prognosis.

[Treatment and prognostic analysis of 92 cases with advanced mobile tongue squamous cell carcinoma]

OBJECTIVE

To compare the results of different treatment modalities for the advanced tongue squamous cell carcinoma and investigate the factors that influence its prognosis.

METHODS

Ninety-two patients with advanced tongue squamous cell carcinoma without distant metastasis, treated in our hospital from Jan. 1990 to Dec. 1999 were retrospectively reviewed. Survival rate was estimated by Kaplan-Meier method, and multivariate analysis was performed by the Cox Proportional hazard model.

RESULTS

The overall 3-year and 5-year survival rates were 52.40% and 37.23% respectively. There was a significant difference in the overall between the two groups survival rate (chemotherapy only and radiotherapy after induced chemotherapy) and the three groups (operation only, operation after induced chemotherapy, radiotherapy after operation) cTNM stage, operation for the primary lesion and local recurrence were the independent factors that influenced the prognosis.

CONCLUSIONS

Risk factors that independently influence the survival of patients with advanced tongue squamous cell carcinoma were the local recurrence, cTNM and receiving operation or not for the primary lesion. Operation only or comprehensive therapy including operation could give a better prognosis, but the results of chemotherapy only or radiotherapy after chemotherapy were poor.

Intratumoral injection of herpes simplex virus HF10 in recurrent head and neck squamous cell carcinoma

We have developed a novel replication-competent, oncolytic herpes simplex virus (HSV), named HF10, and have evaluated its anticancer efficacy in a variety of animal models. We report a pilot study of intratumoral injection of HF10 into subcutaneous nodules in patients with head and neck squamous cell carcinoma (HNSCC). HF10 efficiently infected human HNSCC cells and caused extensive tumor cell death without any significant adverse effects, suggesting that HF10 represents a promising therapy for HNSCC in humans. To assess the therapeutic potential of HF10 in human HNSCC, we performed a preliminary study of toxicity and efficacy in two patients with recurrent metastatic HNSCC. For each patient, a metastatic skin nodule was injected with HF10 once a day for 3 days. They were monitored for systemic adverse effects, and the injected nodules were excised at day 13 (patient 1) or day 15 (patient 2) after injection for histochemical examination. HF10 replicated, spread well in the tumor nodules, and caused cell death in a considerable population of tumor cells without any significant adverse effects.

Concomitant chemo-radio-immunotherapy has a lethal therapeutic effect on tongue carcinomas independent of the clinical stage and histological characteristics of the tumor

We examined the effect of concomitant chemo-radio-immunotherapy on 80 patients with tongue carcinoma. Disappearance of the tumor without recurrence was observed in 21 patients (38.9%) in intravenous infusion chemotherapy group (A) and in 20 patients (76.9%) in intra-arterial infusion chemotherapy group (B) (P<0.005). A total of 41 patients (51.3%) were free from the tumor after the combined therapy. Along with the good therapeutic effect, oral function was preserved with minimal impairment of speech and mastication. Tumor stage, the mode of tumor cell invasion and tumor cell differentiation were not correlated with the therapeutic effect. In addition, the expression of p53, p21(Cip1/WAF1) and proliferating cell nuclear antigen did not differ between the patients with lethal and non-lethal effects. The 5-year-survival rate was 56.8% in Group A, 76.9% in Group B and 59.6% overall. Thus, combined chemo-radio-immunotherapy, especially intra-arterial infusion, may bring a universal therapeutic effect in tongue carcinoma regardless of the tumor stage and the expression of cell phase-regulating proteins.