Radiotherapy alone or combined with chemotherapy for base of tongue squamous cell carcinoma

Functional outcomes and survival after total glossectomy with laryngectomy: a systematic review

Total glossectomy with laryngectomy (TGL) is a procedure with high morbidity/mortality risks reserved for cases of advanced tongue cancer with laryngeal invasion. This technique is controversial as there are significant impacts on quality of life, including loss of functional speech and swallowing. A systematic review was performed following the PRISMA guidelines with the primary goal of quantifying the functional outcomes and overall survival of patients undergoing TGL. The initial search resulted in 748 studies; seven of these met the inclusion criteria. Five studies evaluated functional speech postoperatively, and 12.1% (8/66) of patients in these studies achieved a form of functional speech. Most studies did not refer to the use of specific postoperative voice rehabilitation. Regarding swallowing function, 53.3% (32/60) of patients in five studies regained their ability to swallow. In six studies reporting gastrostomy tube dependence, 37.7% (29/77) of patients were tube-dependent. Recurrence within 1-year was reported in three studies; 52% (26/50) of the patients had recurrence within 1 year, and the 1-year disease-free survival rate was 48%. TGL is a highly invasive surgery; postoperatively, most patients do not regain the ability to speak, while only half are able to swallow. Despite these extreme efforts and sacrifices by the patient, approximately half of patients have a recurrence within the first year. The decision to perform a TGL should be made only in select and motivated patients after carefully explaining and weighing the oncological and quality of life risks and benefits.

Ultrasound-guided microwave ablation in the treatment of early-stage tongue cancer

Background

Tongue cancer is a common malignant tumor of the head and neck. Its treatment methods include surgery, radiotherapy, and chemotherapy. However, these treatments have serious side effects and poor cosmetic effect, so it is urgent to find new treatment methods. We pioneered the use of microwave ablation (MWA) in the treatment of early tongue cancer and achieved good results.

Case Presentation

A 67-year-old woman (Han nationality) was admitted to the hospital because of progressive aggravation of tongue pain. She had a history of tongue pain of more than 1 year. Pathological biopsy showed squamous cell carcinoma; following this, radical operation of the tongue cancer was planned. The preoperative examination showed thyroid occupation in the upper mediastinum region compressing the airway; hence, the risk of general anesthesia was high. Consent was obtained from the patient and her family. Ultrasound-guided MWA was successfully performed under the lingual nerve block. The patient was followed for 1 year. She recovered well with no dysphagia and unclear articulation symptoms, and the cosmetic effect was excellent.

Conclusion

To our knowledge, this is the first case of using MWA for the treatment of early-stage tongue cancer (ESTC). Ultrasound-guided MWA may be used for ESTC that can completely ablate the tumor and retain the function of the tongue, further improving the quality of life of the patient. However, it is only a case report and needs more research to verify the use of MWA in ESTC.

Larynx-preserving reconstruction after extended base of the tongue resection

BACKGROUND

As the base of the tongue (BOT) plays essential roles in speech and swallowing, surgical resection of BOT cancer is typically avoided. Moreover, standard reconstructive procedures for larynx-preserving BOT defects have not yet been established. We performed immediate flap reconstruction after wide resection of BOT cancer with laryngeal preservation. Herein, the functional and oncological results of our strategy were analysed.

METHODS

We retrospectively evaluated patients who underwent extended BOT resection (including the oral tongue, upper/lateral oropharyngeal wall, epiglottis and false vocal cord) with laryngeal preservation between April 2006 and April 2016. We classified defects involving the oral tongue or upper/lateral oropharyngeal wall as the lateral extension type and those involving the epiglottis or false vocal cord as the laryngeal extension type. Lateral extension-type defects were closed primarily and filled with a deepithelialised skin or muscle flap. Laryngeal extension-type defects were reconstructed using a bulky skin flap plus hyo-thyroid-pexy to create a neo-epiglottis. Postoperative functional and oncologic outcomes were assessed.

RESULTS

We enrolled 18 patients with extended BOT defects. Of them, 11 had a history of irradiation. The tracheal cannula was removed in all cases, although laryngeal extension defects were associated with a longer duration to removal. All patients achieved complete oral intake and retained intelligible speech, with preservation of laryngeal function. There was no local recurrence, and the 5-year overall survival was 88.9%.

CONCLUSIONS

Following wide BOT resection, reconstruction with laryngeal preservation is feasible even in cases involving irradiated tumours with laryngeal extension.

Radiation treatment of soft palate squamous cell carcinoma

BACKGROUND

To report our institution's experience treating soft palate squamous cell carcinoma with radiotherapy alone or combined with adjuvant chemotherapy and/or neck dissection for residual disease.

METHODS

We analyzed 159 patients treated curatively between 1963 and 2016. Median follow-up was 4 years.

RESULTS

The 5-year local control rates were T1, 90%; T2, 90%; T3, 70%; and T4, 59%. The 5-year cause-specific survival (CSS) rate was nearly identical for patients with stage I-III disease (88%, 86%, and 88%, respectively) compared to stage IVA/B (58%). Five-year overall survival was similar between patients with stage I-III disease (50%, 57%, and 54%, respectively) and approximately double that of patients with stage IVA/B disease (26%). Thirteen patients (8%) had severe complications related to radiotherapy.

CONCLUSIONS

The likelihood of cure after definitive radiotherapy is relatively high in patients with stage I-III disease with soft palate carcinoma. Patients with stage IVA/B disease have a lower cure rate but with a 5-year CSS exceeding 50%.

lncRNA MALAT1 potentiates the progression of tongue squamous cell carcinoma through regulating miR-140-5p-PAK1 pathway

BACKGROUND

Tongue squamous cell carcinoma (TSCC) is the second most common malignancy in oral carcinoma. lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) was regarded as an oncogenic factor in various carcinomas. However, its underlying molecular mechanisms in the development and progression of TSCC have not been well featured till now.

METHODS

The expressions of MALAT1, miR-140-5p and p21 (RAC1)-activated kinase 1 (PAK1) mRNA were measured by RT-qPCR assay. The protein level of PAK1 was determined by western blot analysis. Cell viability was detected by Cell Counting Kit-8 assay. Transwell chamber was used to detect cell migratory and invasive capability. Luciferase reporter assay, RNA-binding protein immunoprecipitation (RIP) assay and biotin pull-down assay were applied to evaluate the relationship between MALAT1, miR-140-5p and PAK1. Xenograft experiments were performed to assess the effect and mechanism of MALAT1 in TSCC tumor growth.

RESULTS

The expression of MALAT1 and p21 (RAC1)-activated kinase 1 (PAK1) was upregulated and microRNA-140-5p (miR-140-5p) expression was downregulated in TSCC tissues and cells. MALAT1 knockdown induced miR-140-5p expression by direct interaction. Moreover, MALAT1 knockdown inhibited proliferation, migration, and invasion by upregulating miR-140-5p expression in TSCC cells. Additionally, PAK1 was identified as a direct target of miR-140-5p. Also, MALAT1 knockdown inhibited PAK1 expression by upregulating miR-140-5p in TSCC cells. Furthermore, miR-140-5p overexpression curbed the proliferation, migration, and invasion of TSCC cells by targeting PAK1. Finally, MALAT1 knockdown inhibited tumor growth by upregulating miR-140-5p and downregulating PAK1 in mouse xenograft models of TSCC.

CONCLUSION

MALAT1 contributed to TSCC progression via miR-140-5p-PAK1 regulatory axis, highlighting a potential target for TSCC management.