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Gonzalez-Astudillo V, Mete A, Navarro MA, Uzal FA, Asin J. Alimentary squamous cell carcinoma in psittacines: 12 cases and review of the literature. J Vet Diagn Invest 2021; 33:906-912. [PMID: 34078200 DOI: 10.1177/10406387211021480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Squamous cell carcinoma (SCC), which is a neoplasm that usually arises from the integument, is reported uncommonly in pet birds. Only a few reports of SCCs in the alimentary tract of birds, including psittacines, have been published, and a detailed description of the pathology is not available in the literature. We present here 12 cases of alimentary SCC in psittacines. The average age of the birds was 22.2 y (range: 15-29 y), and affected species included 4 Amazon parrots (Amazona sp.), 3 cockatiels (Nymphicus hollandicus), 3 macaws (Ara sp.), 1 conure (Eupsittula sp.), and 1 Senegal parrot (Poicephalus sp.). Frequent clinical complaints included regurgitation, dysphagia, dyspnea, lethargy, and/or weight loss. SCC primarily affected the oral cavity in 6 of 12 cases, the crop alone in 2 of 12 cases, the crop and esophagus in 1 of 12 cases, the proventriculus alone in 1 of 12 cases, and the crop, esophagus, and proventriculus in 2 of 12 cases. Histologically, alimentary SCCs were locally invasive and often resulted in mucosal ulceration. Although there were no metastases in any of our cases, poor clinical outcomes were frequent and associated most commonly with complete effacement of the alimentary segment and severe inflammation with opportunistic bacterial infection. Our review of the literature records commonly affected species, variability of gross presentations and clinical signs, plausible etiologies, and current diagnostic developments.
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Affiliation(s)
- Viviana Gonzalez-Astudillo
- California Animal Health and Food Safety Laboratory, San Bernardino, University of California-Davis, Davis, CA, USA
| | - Aslı Mete
- Davis branches, University of California-Davis, Davis, CA, USA
| | - Mauricio A Navarro
- California Animal Health and Food Safety Laboratory, San Bernardino, University of California-Davis, Davis, CA, USA
| | - Francisco A Uzal
- California Animal Health and Food Safety Laboratory, San Bernardino, University of California-Davis, Davis, CA, USA
| | - Javier Asin
- California Animal Health and Food Safety Laboratory, San Bernardino, University of California-Davis, Davis, CA, USA
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Chen YW, Chen IL, Lin IC, Kao SY. Prognostic value of hypercalcaemia and leucocytosis in resected oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2014; 52:425-31. [DOI: 10.1016/j.bjoms.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/17/2014] [Indexed: 12/20/2022]
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Ryu Y, Shibuya H, Hayashi K. 198Au grain implantation for early tongue cancer in patients of advanced age or poor performance status. JOURNAL OF RADIATION RESEARCH 2013; 54:1125-1130. [PMID: 23685669 PMCID: PMC3823781 DOI: 10.1093/jrr/rrt060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 04/11/2013] [Accepted: 04/11/2013] [Indexed: 06/02/2023]
Abstract
Brachytherapy using (198)Au grains is minimally invasive and the only curative treatment for early tongue cancer in patients of advanced age or poor performance status available in our institution. From March 1993 to February 2008, (198)Au grains were used to treat a group of 96 Stage I-II tongue cancer patients who could not undergo surgery or brachytherapy using (192)Ir pins because of an advanced age (≥75 years) or poor performance status (≥2). The patients were followed for 3.9 ± 3.3 years, and the cause-specific survival and local control rates were determined. Survival analyses were performed using the Kaplan-Meier method, and univariate and multivariate analyses were performed using the Cox proportional hazard model. The results were compared with those for a group of 193 early tongue-cancer patients who underwent treatment using iridium pins. The 5-year cause-specific survival and local control rates of the (198)Au grains group were 71% and 68%, respectively, both of which were 16% lower than the corresponding rates for the (192)Ir pins group. Our study demonstrated that as the last curative treatment available, (198)Au grain implantation could be used to achieve moderate treatment results for early tongue cancer in patients of advanced age or poor performance status.
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Affiliation(s)
- Yoshiharu Ryu
- Corresponding author. Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan. Tel: +81-3-5803-5311; Fax: +81-3-3980-2991;
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Manskikh VN. Phenoptosis hypothesis as a concept of evolutionary oncology. RUSS J GEN CHEM+ 2010. [DOI: 10.1134/s1070363210070406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Toro C, Rinaldo A, Silver CE, Politi M, Ferlito A. Paraneoplastic syndromes in patients with oral cancer. Oral Oncol 2009; 46:14-8. [PMID: 19932048 DOI: 10.1016/j.oraloncology.2009.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 12/15/2022]
Abstract
The diagnosis of a paraneoplastic syndrome (PNS) may precede, follow or be concurrent with the diagnosis of a malignant tumor. There is increasing knowledge of association between PNS and head and neck cancers, but the relationship between oral cancer and paraneoplastic disease has not been previously investigated. PNS associated with head and neck cancer can be divided into six main groups: endocrine, cutaneous or dermatologic, hematologic, osteoarticular or rheumatologic, neurologic, and ocular syndromes. We have comprehensively reviewed the literature to evaluate the incidence of occurrence of PNS with oral cancer, and conclude that only endocrine and dermatologic PNS have been associated with oral cancer. Humoral hypercalcemia is the most frequent PNS related to oral cancer, and has a negative prognostic significance. Dermatologic PNS are less common, but when they occur, they may precede the diagnosis of the oral tumor. Awareness of these conditions is important for clinicians who deal with cancer.
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Affiliation(s)
- C Toro
- Department of Surgical Sciences, Maxillofacial Surgery Clinic, University-Hospital of Udine, Udine, Italy.
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Ihara N, Shibuya H, Yoshimura R, Oota S, Miura M, Watanabe H. Interstitial brachytherapy and neck dissection for Stage III squamous cell carcinoma of the mobile tongue. Acta Oncol 2006; 44:709-16. [PMID: 16227161 DOI: 10.1080/02841860500267881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to describe the cause-specific survival rate, local control rate, salvage rate of neck metastasis, and post-treatment eating and speaking conditions for stage III mobile tongue squamous cell carcinomas and its subgroups. Between 1968 and 1999, 117 previously untreated patients with stage III mobile tongue carcinomas underwent mainly brachytherapy with external beam irradiation (EBRT) and neck dissection. A multivariate analysis was performed for the cause-specific survival rate on the various factors. The 1-, 3- and 5-year cause-specific survival rates for all patients were 76%, 54% and 54%, respectively. The 1-, 3- and 5-year primary control rates for all patients were 67.6%, 63.4% and 59.2%, respectively. There were statistically significant differences in cause-specific survival rates among stage III subgroups of T3N0, T1-2N1 and T3N1 (p = 0.0002). Our treatment method for patients with stage III mobile tongue squamous cell carcinoma was effective and acceptable.
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Affiliation(s)
- Nobumaro Ihara
- Department of Radiology, Graduate School, Tokyo Medical and Dental University, 5-45 Yushima 1-Chome, Bunkyo-ku, Tokyo 113-8519, Japan.
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Iwase M, Takemi T, Manabe M, Nagumo M. Hypercalcemic complication in patients with oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2003; 32:174-80. [PMID: 12729778 DOI: 10.1054/ijom.2002.0261] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hypercalcemia is one of the metabolic complications associated with cancer. To assess the frequency of hypercalcemia in patients with squamous cell carcinoma (SCC), 242 patients who were evaluated as having SCC in the oral cavity between July 1995 and June 2001 were investigated. All patients were periodically monitored for their serum level of calcium (Ca). Hypercalcemia was defined as a serum Ca concentration higher than 11 mg/dl. By this definition, hypercalcemia was detected in 12 of the 242 patients (5.0%). All 12 patients were at an advanced stage of oral SCC. In these 12 patients, the serum level of parathyroid hormone-related protein (PTH-rP) was also significantly elevated. Therefore, we diagnosed these diseases as humoral hypercalcemia of malignancy (HHM). Moreover, we studied the efficacy of anti-hypercalcemic therapy on the quality of life (QOL). The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 was used for estimation of QOL. The patients with HHM who were administrated drugs such as bisphosphonate and calcitonin showed a reduction in their Ca and PTH-rP levels, and the six of ten EORTC QLQ-C30 subscales (emotional functioning, cognitive functioning, fatigue, dyspnoea, nausea/vomiting and appetite loss) were also improved after the anti-hypercalcemic therapy. However, these suppressive effects were temporary. The median survival time after the diagnosis of HHM was only 54.9+/-18.3 days (range 27-86 days). Therefore, HHM in SCC appears to be an ominous prognostic sign. Although anti-hypercalcemic therapy has a palliative role, the patients may be in less discomfort during the terminal stage of their illness.
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Affiliation(s)
- M Iwase
- Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, 2-1-1 Kitasenzoku, Ota-ku, Tokyo 145-8515, Japan.
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Papp-Szabó E, Douglas GR, Coomber BL, Josephy PD. Mutagenicity of the oral carcinogen 4-nitroquinoline-1-oxide in cultured BigBlue rat tongue epithelial cells and fibroblasts. Mutat Res 2003; 522:107-17. [PMID: 12517416 DOI: 10.1016/s0027-5107(02)00285-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Environmental carcinogen exposures contribute to the development of oral cancer and improved test systems for the analysis of such carcinogens are needed. We have previously isolated and characterized an epithelial cell line from the tongue of a BigBlue rat. Now, we have established an immortalized fibroblast cell line from the same organ. We exposed these cells to 4-nitroquinoline-1-oxide (NQO), a well-known experimental oral carcinogen in the rat and other species, and measured its cytotoxic and genotoxic (cII transgene mutagenesis) effects. Both cell lines were very sensitive to NQO toxicity and showed dose-dependent mutant frequency responses. At the highest NQO dose tested, 70 ng/ml, the mutant frequency was elevated more than eight-fold above background for the epithelial cells and more than 25-fold for the fibroblast cells. We examined cellular parameters which could affect glutathione-dependent detoxication of mutagens. Glutathione (GSH) contents of the two cell lines were similar. Glutathione transferase (GST) activities were measured with several substrates and were generally higher in the epithelial cells. Although multiple biochemical and biological characteristics of individual cell lines are likely to determine responses to mutagens, the greater sensitivity of the fibroblast cells to NQO mutagenicity is in accord with the lower GST activity and the lower DNA content of these cells. These new cell lines are suitable for in vitro testing of chemicals as possible oral mutagens and for studies of their biochemical mechanisms of action.
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Affiliation(s)
- Erzsēbet Papp-Szabó
- Department of Chemistry and Biochemistry, University of Guelph, Guelph, Ont, Canada N1G 2W1
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Hannen EJ, van der Laak JA, Manni JJ, Pahlplatz MM, Freihofer HP, Slootweg PJ, Koole R, de Wilde PC. Improved prediction of metastasis in tongue carcinomas, combining vascular and nuclear tumor parameters. Cancer 2001; 92:1881-7. [PMID: 11745261 DOI: 10.1002/1097-0142(20011001)92:7<1881::aid-cncr1705>3.0.co;2-m] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Predicting the presence of metastasis, based on tumor or tumor-related characteristics is of utmost importance. The authors studied the significance of tumor DNA features and tumor-related angiogenesis to predict the occurrence of metastasis in squamous cell carcinomas (SCCs) of the tongue. METHODS Paraplast blocks from resection specimens of 20 metastasized and 20 nonmetastasized SCCs of the tongue with a minimum follow-up of 24 months were used. Tissue sections were stained with anti-CD34 monoclonal antibodies for vessel visualization, and according to Feulgen to stain DNA. Using image analysis, data from both stainings were computed for each of the 40 carcinomas. A logistic regression model to predict the presence of metastasis, based on vascular and nuclear morphology features, was developed. RESULTS The intratumor variation of chromatin condensation and the percentage vessels smaller than 5 microm in diameter were selected for the model. The model correctly predicted metastasis in 90% of patients and excluded metastasis correctly in 75% of nonmetastasized tumors. Taking into account the prevalence of metastasis in SCC of the tongue of between 30% and 60%, this means a predictive value for a negative outcome of between 95% and 83%. CONCLUSIONS The proposed model shows an improvement of predictive values compared with previous models with single parameters. Therefore, a multiparameter model appears to predict the multiparameter process of metastasis better.
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Affiliation(s)
- E J Hannen
- Department of Pathology, University Medical Centre St. Radboud Nijmegen, Nijmegen, The Netherlands.
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El-Husseiny G, Kandil A, Jamshed A, Khafaga Y, Saleem M, Allam A, Al-Rajhi N, Al-Amro A, Rostom AY, Abuzeid M, Otieschan A, Flores AD. Squamous cell carcinoma of the oral tongue: an analysis of prognostic factors. Br J Oral Maxillofac Surg 2000; 38:193-9. [PMID: 10864725 DOI: 10.1054/bjom.1999.0235] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To identify the prognostic significance of different factors in patients with squamous cell carcinoma of the tongue. PATIENTS AND METHODS Seventy-seven patients with carcinoma of the tongue were treated radically at the King Faisal Specialist Hospital and Research Centre between 1980 and 1989. Twenty patients (26%) were treated by resection alone, 11 (14%) with radiotherapy alone, and 46 (60%) with combined resection and radiotherapy. RESULTS Forty-seven patients (61%) had T(1-2), 28 (36%) T(3-4), and two T(x) tumours. The regional nodes were clear in 53 (69%) and contained metastases in 24 patients (31%). Thirty patients (39%) developed recurrences, which were local in 9, regional in 14, locoregional in 5, and locoregional with metastatic disease in 2. The five and 10-year overall actuarial survival for all patients were 65% and 53%, respectively, and the corresponding relapse-free survival 56% and 50%. Univariate and multivariate analyses were done of seven variables - age (<40 compared with >/=40 years), sex, chewing tobacco use, smoking, TNM stage, surgical margins (clear or invaded), and treatment (resection, radiotherapy, or the combination). On univariate analysis chewing tobacco (P=0.04), smoking (P=0.01), invaded resection margins (P=0.04), involved regional lymph nodes (P=0.009), T4 tumours, and patients treated with radiotherapy alone (P=0.001) were associated with poor overall survival. Factors associated with shorter relapse-free survival were age >40 (P=0.03), chewing tobacco (P=0.04), invaded resection margins (P=0.01), and smoking (P=0.01). On multivariate analysis, invaded resection margins and smoking (P=0.04)(P=0.02) were associated with shorter overall survival and relapse-free survival (P=0.03 and (P=0.01), while chewing tobacco independently influenced relapse-free survival only (P=0.03). CONCLUSION Invaded resection margins and smoking were the only independent prognostic factors that affected both overall and relapse-free survival. Those who chewed tobacco were at high risk of locoregional failure.
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Affiliation(s)
- G El-Husseiny
- Section of Radiation Oncology, Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Yoshida K, Koizumi M, Inoue T, Yamazaki H, Imai A, Shiomi H, Yoshioka Y, Tanaka E, Shimizutani K, Furukawa S, Inoue T. Radiotherapy of early tongue cancer in patients less than 40 years old. Int J Radiat Oncol Biol Phys 1999; 45:367-71. [PMID: 10487557 DOI: 10.1016/s0360-3016(99)00164-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the results of treatment for early mobile tongue cancer in patients less than 40 years. METHODS AND MATERIALS Between January 1967 and September 1992, 70 patients less than 40 years old (young age group) with early tongue cancer (T1-2N0M0) were treated with low-dose-rate (LDR) interstitial radiotherapy at the Osaka University Hospital (OUH). All patients had a minimum 2-year follow-up (median: 13 years). External radiotherapy (median: 30 Gy) was combined in 25 cases. The treatment results were compared with those for two older age groups (middle age: 40-64 years old; old age: 65 years old or more). RESULTS The 5-year probability of cause-specific survival (CSS) rate for the young age group was 80%, which was not significantly different from the two older groups: 81% for middle age and 71% for old age. However, male patients of young age showed significantly worse rates than those of middle and old age (p = 0.02). The 5-year local control rate for the young age group was 78%. It was not significantly different from the two older groups: 81% for middle age and 70% for old age. The incidence of regional lymph node metastasis was 32% for T1, 48% for T2, 56% for males, and 24% for females. The regional failure rate of young males was significantly higher than those of the two older groups: 32% for middle and 22% for old age (p = 0.001). CONCLUSION The overall treatment results for patients with early tongue cancer less than 40 years old were not worse than those of older age groups. However, male gender was a risk factor for lymph node metastasis and CSS.
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Affiliation(s)
- K Yoshida
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Japan
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Califano L, Zupi A, Mangone GM, Longo F, Coscia G, Piombino P. Surgical management of the neck in squamous cell carcinoma of the tongue. Br J Oral Maxillofac Surg 1999; 37:320-3. [PMID: 10475657 DOI: 10.1054/bjom.1999.0076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
If the nodes are involved, survival of patients with squamous cell carcinoma of the tongue is considerably reduced. Surgery remains the treatment of choice and, to define its role, we have reviewed 82 consecutive cases. Sixty-two cases (76%) were T1-2, and 46 patients (56%) had involved nodes. The cervical region II was the most often involved (n=26). Occult nodal metastases were present in 12 cases. The extent of nodal spread and prognosis varies according to whether the body or the base of the tongue is involved. Lesions of the base with involved node should be treated by a selective posterolateral neck dissection, whilst in the case of a lesion of the body of the tongue, the dissection should be selective anterolateral. In lesions of the base, when there are no nodes involved, a prophylactic selective posterolateral neck dissection is recommended, whilst in the case of the lesions of the body, selective supraomohyoid neck dissection in T2-4 lesions is recommended.
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Affiliation(s)
- L Califano
- School of Medicine and Surgery, Department of Maxillofacial Surgery, Federico II University of Naples, Italy.
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Abstract
Carcinoma of the tongue is a common condition treated by oral and maxillofacial surgeons. The tongue is a complex anatomical site at the entrance of the oropharynx, bounded by the floor of mouth and lingual mandibular cortex; its form and mobility are crucial for efficient swallowing; speech, and the appreciation of taste. Single and multiple treatments have been used, but the tongue remains a difficult area to assess and treat. In this paper, we have attempted to review some of the papers published over the last 20 years with particular reference to prognosis and functional outcome. We have dealt exclusively with squamous cell carcinoma of the tongue and its management by surgery, radiotherapy, brachytherapy, photodynamic therapy, and chemotherapy.
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Affiliation(s)
- S Prince
- Department of Oral and Maxillofacial Surgery, Queen Mary's University Hospital, Roehampton, London, UK
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Ramis A, Gibert X, Majó N, Grifols J. Metastatic oral squamous cell carcinoma in a Montagu's harrier (Circus pigargus). J Vet Diagn Invest 1999; 11:191-4. [PMID: 10098697 DOI: 10.1177/104063879901100218] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Ramis
- Department of Pathology, School of Veterinary Medicine, Universitat Autònoma de Barcelona, Spain
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Sun LM, Leung SW, Su CY, Wang CJ. The relapse patterns and outcome of postoperative recurrent tongue cancer. J Oral Maxillofac Surg 1997; 55:827-31. [PMID: 9251610 DOI: 10.1016/s0278-2391(97)90342-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The relapse patterns and salvage treatment results for patients who developed locoregional recurrence after surgery for squamous cell carcinoma of the tongue were retrospectively analyzed. MATERIALS AND METHODS Between April 1986 and January 1995, 77 cases with recurrent squamous cell carcinoma of the tongue were evaluated. Most of them were males in the early stages of initial disease. Although the surgical margins were negative in most cases (67 of 77), relapse eventually occurred. The relapse patterns showed 15 patients with primary recurrence, 45 patients with regional neck lymph node (LN) relapse, and 17 patients with relapse in both sites. RESULTS Salvage treatment was given to most of the patients, but their median survival time was only 9 months. Survival data were analyzed and compared with different types of relapse patterns, salvage treatments, disease-free intervals, age, and sex. In univariate analysis, the neck LN relapse and shorter relapse-free interval (< 6 months) were poor prognostic factors (P < .05), and surgical treatment showed a trend for better salvage results (P = .0575). In multivariate analysis, patients with neck LN relapse had the worst outcome (P < .05). CONCLUSIONS Recurrence of tongue cancer is not uncommon, but there are little data in literature regarding the prognosis. Although this study showed poor salvage results, various prognoses could be predicted on the bases of the different relapse patterns and salvage methods.
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Affiliation(s)
- L M Sun
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 19-1997. A 57-year-old man with a bloody pericardial effusion. N Engl J Med 1997; 336:1812-9. [PMID: 9187073 DOI: 10.1056/nejm199706193362508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Affiliation(s)
- D J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, IL 60637, USA
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