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Bello IO, Qannam A. Gingival and Alveolar Ridge Overgrowths: A Histopathological Evaluation from Saudi Arabia. Saudi Dent J 2022; 34:509-515. [PMID: 36092522 PMCID: PMC9453526 DOI: 10.1016/j.sdentj.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background Focal tissue overgrowths on the gingiva and edentulous alveolar ridge are occasionally perplexing to periodontists, owing to the wide variety of differential diagnoses that may be responsible. As such, biopsy and microscopy are often required to establish a definitive diagnosis. The present study aimed to retrospectively evaluate focal gingival and alveolar ridge overgrowths at a single institution in Saudi Arabia. Materials and Methods Histopathology reports and slides from patients presenting to King Saud University Hospital between 1984 and 2016, particularly those with focal gingival enlargements other than those due to gingivitis and periodontitis, were collected and analyzed based on age, sex, and location. Results A total of 624 patient records were evaluated, with a mean age of 35 years (range, 1 week–91 years), peak incidence in the third decade of life, male-to-female ratio of 1:1.4, and a slightly higher prevalence of lesions in the mandible. The majority (88%) of the lesions were reactive or hyperplastic, followed by malignant (10%) and benign (2%) tumors. A total of 24 distinct histological entities were diagnosed across the three groups. The most common histologically diagnosed lesions were pyogenic granulomas (38%), fibromas (33%), peripheral ossifying fibromas (9%), squamous cell carcinomas (7%), peripheral giant cell granulomas (6%), neurofibromas (1%), and non-Hodgkin lymphomas (1%). Conclusion Similar to what has been reported by most previous studies, reactive hyperplastic lesions were the most prevalent focal overgrowths found in the gingival and alveolar mucosae. Carcinomas at these sites, however, may be an understated but significant clinical and epidemiological problem in Saudi Arabia. Gingival and alveolar ridge lumps can serve as a nexus for cooperation between periodontologists and oral pathologists to improve diagnosis, disease classification, and patient management.
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Affiliation(s)
- Ibrahim Olajide Bello
- Corresponding author at: Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, 11545, Saudi Arabia.
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Jalali E, Mago J, Tadinada A. Gingival Squamous Cell Carcinoma Masquerading as Localized Periodontal Disease in the Maxilla: A Case Report. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2112220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives:
Squamous cell carcinoma is a malignant neoplasm of epithelium. In the U.S., carcinoma of the gingiva constitutes 4% to 16% of all oral carcinomas. This case report highlights such a case in maxillary gingiva and emphasizes the vital role of dental professionals, especially periodontists and endodontists, in being cognizant that an inflammatory lesion can mimic a serious condition like squamous cell carcinoma.
Case Presentation:
A patient who visited the screening clinic for an ulcerated lesion in the gingiva was otherwise healthy with no associated history of tobacco or any traumatic/persistent traumatic events.
The patient was treated for pseudoepitheliomatous hyperplasia based on the current condition and negative history of malignancy. On three months of follow-up, computed tomography radiographic evaluation and a biopsy were done, which were positive for the malignancy. Follow-up after six months includes PET, Head MRI, and chest X-ray examinations to rule out any metastatic entity.
Results:
A six-month follow-up radiographic examination revealed metastasis of the entity. Additional findings include pleural effusion and underlying infections.
Conclusion:
Early diagnosis is the key to the treatment plan. It further highlights the role of advanced imaging as a vital tool in determining the extent of the disease. Therefore, any persistent lesion exhibiting features that are not responding to conventional gingival and periodontal treatment options for more than two weeks should be referred for further evaluation to rule out cancer.
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Lee C, Jenkins G, Lee-Warder L, Kennedy M, Iqbal M, Adams J. The role of adjuvant radiotherapy in locally advanced T4 mandible squamous cell carcinoma in the N0 patient: a single centre experience. Int J Oral Maxillofac Surg 2022; 51:1251-1256. [DOI: 10.1016/j.ijom.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/20/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
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Yu D, Huang J, Yu C, Liu J, Yong CW, Zhu H. Use of anterior ramus bone graft for mandibular reconstruction in elderly patients. J Plast Surg Hand Surg 2021; 56:208-216. [PMID: 34602014 DOI: 10.1080/2000656x.2021.1953045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this study, we investigated the feasibility of using a geometrically designed anterior ramus graft to reconstruct lateral mandibular defects. This was achieved by assessing the anatomical dimensions of the mandibular ramus on computed-tomographies. The design sequence and application of the graft was also demonstrated using one of our cases. The following dimensions were measured; a and b - horizontal length from mid-ramus to the posterior and anterior ramus border respectively, c - longest length of the graft, Mp - width at the centre of the ramus, h - vertical length of the angle at its cross-section, w - horizontal length of the angle at its cross-section, x - cross-sectional area along the mandible angle. A total of 80 mandibular rami were examined. The mean length of a, b, c were 17.3 ± 1.8 mm, 15.9 ± 1.2 mm, 54.6 ± 3.8 mm, respectively. The mean width of Mp was 9.8 ± 1.1 mm. The mean cross section area of Eo-Md (x) was 326.7 ± 67.8 mm2. The average length of h and w were 26.5 ± 3.2 and 15.6 ± 2.1 mm, respectively. The use of virtual surgical planning (VSP) to geometrically design the graft was also described. Together with VSP, the anterior ramus bone graft will allow for reconstruction of the mandible with greater surgical efficiency, reduced complexity and without the need for extra-oral bone harvest. This may be an useful alternative in situations where simpler reconstructive procedures are preferred.
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Affiliation(s)
- Dan Yu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jianyao Huang
- Department of Stomatology, Fourth Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Changyang Yu
- 6D Dental Tech Co., Ltd., Hangzhou, People's Republic of China
| | - Jianhua Liu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chee Weng Yong
- Faculty of Dentistry, Discipline of Oral Maxillofacial Surgery, National University Centre for Oral Health Singapore, Singapore, Singapore
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Enomoto A, Kinoshita Y, Matsunaga K, Sukedai M, Shimoide T, Ehara H, Hamada S. Lateral Approach With a Mouth Corner Incision for the Molar Part of Mandibulectomy. J Craniofac Surg 2021; 32:e141-e144. [PMID: 33705053 DOI: 10.1097/scs.0000000000006876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the present study was to evaluate the functional and esthetic results of marginal mandibulectomy for mandibular cancer using a lateral approach with a simple, straightforward mouth corner incision. STUDY DESIGN Six mandibular cancer patients (2 men, 4 women; age range: 65-80 years; mean age, 73.1 years; all stage I) were treated using this approach. With this approach, the surgical field was widely exposed, and mandibulectomy was performed with sufficient surgical margins. Intraoperative frozen specimens of remaining tissues showed no malignancy in all cases. In all 6 patients, follow-up imaging assessments were obtained, with no local recurrence after 12 to 78 months. RESULTS AND CONCLUSIONS An overall functional, physical, and esthetic assessment of oral behavior and oral appearance was made of all patients by the FACT-H&N questionnaire, which showed that functional lip behavior and esthetic lip appearance were not much affected by the present surgical approach, and good quality of life was maintained. Thus, the lateral approach with the mouth corner incision is an effective and useful alternative for the molar part of mandibulectomy.
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Affiliation(s)
- Akifumi Enomoto
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
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Jacobs CD, Williamson H, Barak I, Rocke DJ, Kahmke RR, Suneja G, Mowery YM. Postoperative radiotherapy is associated with improved overall survival for alveolar ridge squamous cell carcinoma with adverse pathologic features. Head Neck 2021; 43:203-211. [PMID: 32969107 PMCID: PMC9113753 DOI: 10.1002/hed.26475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Alveolar ridge squamous cell carcinoma (ARSCC) is poorly represented in randomized trials. METHODS Adults in the National Cancer Database diagnosed with ARSCC between 2010 and 2014 who should be considered for postoperative radiotherapy (PORT) based on National Comprehensive Cancer Network (NCCN)-defined risk factors were identified. RESULTS Eight hundred forty-five (58%) of 1457 patients meeting the inclusion criteria received PORT. PORT was associated with improved overall survival (OS) on unadjusted (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.70-0.98, P = .02) and multivariable (HR 0.78, 95% CI 0.64-0.94, P = .002) analyses. PORT was associated with significantly improved 5-year OS for patients with 1 (68% vs 58%, P < .001), 2 (52% vs 31%, P < .001), and ≥3 (38% vs 24%, P < .001) NCCN-defined risk factors. Prognostic variables significantly associated with worse OS on multivariable analysis included advanced age, primary tumor size ≥3 cm, high grade, positive margin(s), stage N2-3, level IV/V nodal metastasis, and extranodal extension. CONCLUSION PORT for resected ARSCC with adverse pathologic features is associated with significantly improved OS.
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Affiliation(s)
- Corbin D. Jacobs
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Hannah Williamson
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Ian Barak
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Daniel J. Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Russel R. Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Gita Suneja
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Yvonne M. Mowery
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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Arduino PG, Carbone M, Gambino A, Cabras M, Cannarsa F, Macciotta A, Conrotto D, Broccoletti R. Challenging management of gingival squamous cell carcinoma: a 10 years single-center retrospective study on Northern-Italian patients. Med Oral Patol Oral Cir Bucal 2021; 26:e21-e27. [PMID: 32851989 PMCID: PMC7806350 DOI: 10.4317/medoral.23913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background Aim of this study was to describe the outcome of patients with gingival squamous cell carcinoma (GSCC), and to recognize aspects affecting clinical course and to consider survival rate.
Material and Methods The case records of patients, over a 10-year period, were retrospectively examined. Differences in distribution of the potential risk factors by prognosis were investigated through non-parametrical tests (Wilcoxon Rank-Sum and Fisher’s Exact). Survival curves for age, therapy and stage were built by the Kaplan-Meier method and compared with Log-Rank test.
Results 79 patients were analysed. Significant increase in mortality for patients older than 77 and for those with advanced stages was found. Cumulative survival rate 5 years after the diagnosis was 43%, while at 10 years was of 11%.
Conclusions With a statistical relationship between age and tumour stage with survival rates, and 70% of GSCC cases identified as stage IV, early GSCC diagnosis remains challenging. Key words:Gingival cancer, clinical appearance, treatment, retrospective study.
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Affiliation(s)
- P-G Arduino
- Department of Surgical Sciences CIR-Dental School, University of Turin Via Nizza 230, 10126 Turin, Italy
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Mukai Y, Hayashi Y, Koike I, Koizumi T, Sugiura M, Oguri S, Takano S, Kioi M, Sato M, Mitsudo K, Hata M. Impact of superselective intra-arterial and systemic chemoradiotherapy for gingival carcinoma; analysis of treatment outcomes and prognostic factors. BMC Cancer 2020; 20:1154. [PMID: 33243168 PMCID: PMC7691076 DOI: 10.1186/s12885-020-07638-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background We compared outcomes and toxicities between concurrent retrograde super-selective intra-arterial chemoradiotherapy (IACRT) and concurrent systemic chemoradiotherapy (SCRT) for gingival carcinoma (GC). Methods We included 84 consecutive patients who were treated for non-metastatic GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n = 66; SCRT group: n = 18). Results The median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT: 60 Gy; SCRT: 69 Gy). There were significant differences between the two groups in terms of 3-year overall survival (OS; IACRT: 78.8, 95% confidence interval [CI]: 66.0–87.6; SCRT: 50.4, 95% CI: 27.6–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.6, 95% CI: 62.7–85.2; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.028) and local control rates (LC; IACRT: 77.2, 95% CI: 64.2–86.4; SCRT: 42.0, 95% CI: 17.7–70.9; P = 0.015). In univariate analysis, age ≥ 65 years, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with a poor OS rate (P < 0.05). Patients with poorer PS had a significantly worse PFS rate. Regarding acute toxicity, 22 IACRT patients had grade 4 lymphopenia, and osteoradionecrosis was the most common late toxicity in both groups. Conclusions This is the first report to compare outcomes from IACRT and SCRT among patients with GC. ALL therapy related toxicities were manageable. IACRT is an effective and safe treatment for GC.
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Affiliation(s)
- Yuki Mukai
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yuichiro Hayashi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Izumi Koike
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Toshiyuki Koizumi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Madoka Sugiura
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Senri Oguri
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shoko Takano
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mitomu Kioi
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mizuki Sato
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kenji Mitsudo
- Departments of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaharu Hata
- Departments of Radiation Oncology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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A Study on Neck Nodes in Oral Cancers, with Special Reference to Skip Metastasis. Indian J Otolaryngol Head Neck Surg 2019; 71:474-481. [PMID: 31742006 DOI: 10.1007/s12070-018-1360-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 04/10/2018] [Indexed: 11/26/2022] Open
Abstract
To analyse the distribution of Neck metastases (NM) and to study frequency of skip metastases in oral squamous cell carcinoma (SCC) of oral cavity. From September 2012 to April 2013, 30 previously untreated patients with SCC of oral cavity underwent primary surgical treatment in our institution. From pathological report of Neck dissection specimen prevalence and distribution of NM were ascertained. All patients were classified according to American Joint Committee on Cancer 2005 TNM classification. Overall frequency of NM was 36.7%. Frequency of occult metastases was 33.3%. N+ metastases found in 37% cases. The overall frequency of NM in level IV and V was 9.5%. Isolated level III involvement was found in 3.3%. No isolated level IV and V involvement was found. Skip metastases to level III LN was 6.7%. We did not find any skip metastases to level IV in our study. Neck nodes at greater risk for metastases were level I and II (50 and 28.6%). Level III (11.9%), IV (7.14%), V (2.38%). The risk of skip metastases to level IV was nil in our study.
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What Is a Safe Distance for Preservation of the Inferior Alveolar Nerve in Lower Gingival Squamous Cell Carcinoma? A Radiographic and Histopathological Study. J Craniofac Surg 2019; 30:e327-e330. [PMID: 31166277 DOI: 10.1097/scs.0000000000005280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Involvement of the inferior alveolar nerve (IAN) is important in the prognosis and treatment of gingival squamous cell carcinoma (SCC). METHODS In this cross sectional study, patients with gingival SCC (T4a), undergoing hemimandibulectomy or subtotal hemimandibulectomy, were examined. The distance between the lesion and inferior alveolar canal (IAC) was measured, using axial computed tomography scans before resection. Following that, histopathological evaluation of IAN was conducted. The receiver operating characteristic curve was plotted to determine the association of IAN involvement in histopathological evaluation with various distances between the lesion and IAC. RESULTS A total of 29 patients were examined in this study. The mean distance between the lesion and IAC was 9.40 ± 2.21 mm. Nerve involvement was documented in 9 (45%) out of 20 males, while 11 (55%) men showed no involvement. Thirteen (44.82%) patients showed IAN involvement. The receiver operating characteristic curve demonstrated a cut-off point of 9.75 mm for the lesion-IAN distance. The possibility of IAN involvement was 23.33 times higher in patients who reported paresthesia, compared with patients without nerve involvement (odds ratio, 23.33; 95% CL; P = 0.001) CONCLUSION:: It seems that in a CT scan view, a 9.75-mm safe margin is associated with high accuracy for preserving IAN in patients with gingival SCC. Also, neurosensory disturbance can be considered a strong predictor of IAN involvement.
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Okuyama K, Fukushima H, Naruse T, Yanamoto S, Tsuchihashi H, Umeda M. CD44 Variant 6 Expression and Tumor Budding in the Medullary Invasion Front of Mandibular Gingival Squamous Cell Carcinoma Are Predictive Factors for Cervical Lymph Node Metastasis. Pathol Oncol Res 2018; 25:603-609. [DOI: 10.1007/s12253-018-0529-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
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12
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Shibasaki M, Iwai T, Oguri S, Koizumi T, Hirota M, Mitsudo K, Ozawa Y, Tohnai I. Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in predicting pathological response to preoperative super-selective intra-arterial chemoradiotherapy for advanced squamous cell carcinoma of the mandible. J Bone Oncol 2018; 11:33-37. [PMID: 29552462 PMCID: PMC5852282 DOI: 10.1016/j.jbo.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Although chemoradiotherapy (CRT) for oral squamous cell carcinoma (SCC) has been shown to preserve organ function and improve cosmetic results, site-specific data, especially mandible, are limited. The aim of this study was to evaluate the predictability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) on response to super-selective intra-arterial CRT for advanced SCC of the mandible. Methods Fifteen patients with advanced SCC of the mandible underwent super-selective intra-arterial CRT followed by radical resection. Maximum standardized uptake value (SUVmax) of the mandibular lesion was evaluated with FDG-PET/CT before and after CRT. The SUVmax before and after CRT was defined as pre-SUVmax and post-SUVmax, respectively. The difference between pre- and post-SUVmax was calculated as SUVmax reduction rate to evaluate treatment response of the mandibular lesion. Each SUVmax reduction rate and surgical specimen of the corresponding lesion was analyzed to evaluate an accuracy of the modality for predicting pathological response. Results The median of pre-SUVmax was significantly lower than that of post-SUVmax (p = 0.001). Of the 15 patients, 6 had a pathological complete response (pCR) and 9 had a non-pCR. Neither pCR patients nor non-pCR patients showed significant difference of the median of SUVmax between pre- and post-CRT (pre-CRT p = 0.099 post-CRT p =0.074). The SUVmax reduction rate in patients with pCR was significantly higher than that with non-pCR (p = 0.002). Receiver operating characteristic analysis revealed that the optimal cut-off point of the reduction rate was 64.7%, with 83% sensitivity and 100% specificity. Conclusions These results concluded that SUVmax reduction rate can predict pathological complete response of preoperative super-selective intra-arterial CRT for advanced SCC of the mandible.
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Affiliation(s)
- Maiko Shibasaki
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Toshiyuki Koizumi
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
| | - Yukihiko Ozawa
- Yuai Clinic, 1-6-2 Kitashinyokohama, Kohoku-ku, Yokohama 223-0059, Japan
| | - Iwai Tohnai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Lubek JE, Magliocca KR. Evaluation of the Bone Margin in Oral Squamous Cell Carcinoma. Oral Maxillofac Surg Clin North Am 2017; 29:281-292. [DOI: 10.1016/j.coms.2017.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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14
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Niu LX, Feng ZE, Wang DC, Zhang JY, Sun ZP, Guo CB. Prognostic factors in mandibular gingival squamous cell carcinoma: A 10-year retrospective study. Int J Oral Maxillofac Surg 2016; 46:137-143. [PMID: 28029423 DOI: 10.1016/j.ijom.2016.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 07/22/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
The mandibular gingiva is the second most common site of oral cavity squamous cell carcinoma. This retrospective study was designed to determine the clinicopathological features of squamous cell carcinoma of the mandibular gingiva (MGSCC) and to establish a new risk model to predict overall survival. The study included 207 patients with primary MGSCC from January 2000 to September 2009. The medical charts were reviewed and data related to clinical characteristics, treatment provided, histopathological analysis, and follow-up were recorded. All patients underwent surgery as the first-line therapy; follow-up ranged from 1 to 171 months (median 63 months). Clinical characteristics and pathological outcomes were analyzed with respect to the 5-year overall survival rate. A survival risk model was established, and patients were classified into low-, moderate-, and high-risk groups based on the prognostic index designed in this study. The 5-year overall survival rates for the low-, moderate-, and high-risk groups were 92.3%, 76.9%, and 34.2%, respectively. Pathological node metastasis, perineural invasion, and extracapsular spread were the most significant predictive factors for 5-year overall survival. MGSCC is not aggressive, and the survival outcomes of MGSCC are better than those of squamous cell carcinoma (SCC) at other sites. It is suggested that patients with T2-T4 tumours undergo elective neck dissection and those with T1 tumours be followed up without addressing the neck.
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Affiliation(s)
- L X Niu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Z E Feng
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Capital Medical University, Beijing, China
| | - D C Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Peking University, Beijing, China
| | - J Y Zhang
- Department of Oral Pathology, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Z P Sun
- Department of Oral and Maxillofacial Radiology, School and Hospital of Stomatology, Peking University, Beijing, China
| | - C B Guo
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Peking University, Beijing, China.
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15
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Correlation of BMI1 and ZEB1 expression with epithelial–mesenchymal transition in gingiva squamous cell carcinoma. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2016. [DOI: 10.1016/j.ajoms.2016.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Li C, Lin J, Men Y, Yang W, Mi F, Li L. Does Medullary Versus Cortical Invasion of the Mandible Affect Prognosis in Patients With Oral Squamous Cell Carcinoma? J Oral Maxillofac Surg 2016; 75:403-415. [PMID: 27621147 DOI: 10.1016/j.joms.2016.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Whether mandibular involvement by oral squamous cell carcinoma (OSCC) could be identified as a factor for cancer staging and prognosis prediction remains a subject of debate. In addition, the influence of different types of mandibular invasion (cortical or medullary invasion) on patients' prognosis remains unclear. The aim of this systematic review was to establish whether mandibular invasion or its subset should be considered an independent prognostic factor for patients with OSCC. MATERIALS AND METHODS The search for eligible studies was performed according to the predesigned inclusion criteria for a systematic review. Mandibular invasion and invasion depth were considered the primary and secondary predictor variables, respectively. The electronic search was performed using 12 databases. Manual searching covered 14 related journals and references of the included studies were scanned. The risk of bias assessment was evaluated by 2 reviewers using risk-of-bias assessment tools recommended by Saltaji et al (Angle Orthod 82:1115, 2012). Two reviewers extracted the data in duplicate. RevMan 5.2 was used for meta-analysis to assess the primary outcomes (disease-free survival and overall survival) and the secondary outcomes (2- and 5-year survival rate and local control). RESULTS Eighteen studies (total, 3,756 participants) were included and used as the study sample. Among these included studies, 7 had an unclear risk of bias and the remaining showed a high risk. The results of the meta-analyses showed a significant relation between mandibular invasion and overall survival (P = .04) and, most importantly, that medullary involvement (P = .0001), but not cortical involvement (P = .66), could decrease overall survival. When focusing on disease-specific survival, mandibular medullary involvement predicted a poor disease-specific survival (P < .0001), but cortical involvement showed no effect (P = .66). CONCLUSION This review showed that OSCC mandibular medullary invasion, and not mandibular invasion or mandibular cortical invasion, could be an independent prognostic factor for patients.
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Affiliation(s)
- Chunjie Li
- Associate Professor, Departments of Head and Neck Oncology and Evidence-Based Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Jie Lin
- Attending Physician, Department of Dental Anesthesiology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Yi Men
- Attending Physician and Lecturer, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Wenbin Yang
- PhD Candidate, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Fanglin Mi
- Professor and Department Head, Department of Stomatology, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Longjiang Li
- Professor and Department Director, Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
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Cheng CS, Chang CM, Hsiao YL, Chan MY, Lee CY, Lee LT, Wong YK. Clinical implications of recent exodontia before diagnosis of gingival squamous cell carcinoma: A new classification. Head Neck 2015; 38:339-46. [PMID: 25331819 DOI: 10.1002/hed.23896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to clarify the clinical implications of cases with recent dental extractions to establish a new classification of gingival squamous cell carcinoma (SCC). METHODS A total of 156 patients were enrolled in this study. The subjects were divided into 3 groups: type I (dentate; n = 46), type II (edentulous; n = 55), and type III (dental extraction; n = 55). Continuous clinical and treatment variables were analyzed by 1-way analysis of variance (ANOVA) or t test, and categorical variables were evaluated by chi-square tests. Assessment of 5-year survival rates were carried out by the Kaplan-Meier analysis, and the influence of related factors was evaluated by the log-rank test. RESULT The 55 type III patients showed a high probability of bony invasion (80%) and a lower 5-year survival rate (48%) than the other 2 groups. CONCLUSION Our proposed classification may help clinicians to identify patients with gingival SCC who present with more advanced disease status.
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Affiliation(s)
- Chi-Sheng Cheng
- Department of Stomatology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Chien-Ming Chang
- Department of Stomatology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Ying-Lyung Hsiao
- Department of Stomatology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Man-Yee Chan
- Department of Oral and Maxillofacial Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,Chung Shan University, Taichung, Taiwan, Republic of China
| | - Chun-Yin Lee
- Department of Stomatology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Li-Tzu Lee
- Department of Stomatology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Yong-Kie Wong
- Department of Oral and Maxillofacial Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.,School of Dentistry, National Yang-Ming University, Taipei, Taiwan
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Bark R, Mercke C, Munck-Wikland E, Wisniewski NA, Hammarstedt-Nordenvall L. Cancer of the gingiva. Eur Arch Otorhinolaryngol 2015; 273:1335-45. [PMID: 25649283 DOI: 10.1007/s00405-015-3516-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
Cancer of the gingiva is a rare disease in the Western World. It most commonly affects elderly population. Because of its rarity, the reporting on the disease is sparse and often grouped with other subsites of oral cancer, which makes conclusions difficult to interpret. The aim of this paper is to review the literature on gingival cancer as a specific subsite of oral cancer and report on published prognostic factors as well as treatment of local and regional disease. We also present differences between gingival cancer subgroups, mandibular and maxillary gingival cancer. In addition, both surgical and oncological treatments are reviewed. It seems that surgery is the preferred initial treatment approach for the majority of patients with gingival cancer, although adjuvant radiation, with or without chemotherapy, is commonly recommended to increase locoregional control.
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Affiliation(s)
- Rusana Bark
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, S-171 76, Stockholm, Sweden. .,Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Karolinska University Hospital, 17176, Stockholm, Sweden.
| | - Claes Mercke
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | - Eva Munck-Wikland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, S-171 76, Stockholm, Sweden
| | | | - Lalle Hammarstedt-Nordenvall
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, S-171 76, Stockholm, Sweden
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Mukai Y, Hata M, Mitsudo K, Koike I, Koizumi T, Oguri S, Kioi M, Omura M, Tohnai I, Inoue T. Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy for gingival carcinoma. Strahlenther Onkol 2013; 190:181-5. [PMID: 24264464 DOI: 10.1007/s00066-013-0468-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma. METHODS AND MATERIALS In all, 34 patients (21 men and 13 women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60 Gy in 30 fractions was delivered to tumors. RESULTS Of the 34 patients, 29 (85 %) achieved a complete response (CR) and 5 had residual tumors. Of the 29 patients with a CR, 2 had local recurrences and 1 had distant metastasis 1-15 months after treatment. Twenty-six of the 36 patients had survived at a median follow-up time of 36 months (range 12-79 months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5 years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1 patient after treatment. CONCLUSION Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma.
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Affiliation(s)
- Y Mukai
- Department of Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, 236-0004, Kanazawa-ku, Yokohama, Kanagawa, Japan,
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Singh T, Schenberg M. Delayed diagnosis of oral squamous cell carcinoma following dental treatment. Ann R Coll Surg Engl 2013; 95:369-73. [PMID: 23838503 DOI: 10.1308/003588413x13629960045599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Oral squamous cell carcinoma (SCC) can present with a wide range of clinical appearances. Consequently, an oral SCC, particularly in its early stage, may not be considered suspicious by a clinician, thereby delaying diagnosis. Delayed diagnosis of an oral SCC could result in more advanced disease at the time of treatment, leading to more extensive and costly treatment, greater morbidity and poorer survival. The aim of this study was to identify cases of oral SCC treated at Southern Heath (Melbourne, Australia) with a history of prediagnosis dental treatment, and to determine the delay between dental treatment and appropriate surgical assessment of the oral SCC. METHODS Patients were identified from the head and neck tumour database at Southern Health who met the inclusion criteria and relevant data were recorded. RESULTS Twelve patients met the inclusion criteria and 83% of cases involved the mandible. Dental extraction was the most common prediagnosis treatment performed (75%). The average delay from dental treatment to surgical assessment was just over eight weeks and all patients were found to have stage IV disease. Most patients had received extensive surgical resections (83%), neck dissections (75%) and adjunctive therapy (83%). CONCLUSIONS Oral SCC can sometimes be difficult to diagnose, which can result in more extensive treatment and greater morbidity. Health professionals and patients need to be aware that non-healing oral lesions, even after dental treatment such as a dental extraction, need to be considered as suspicious and an appropriate surgical referral should be made.
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Affiliation(s)
- T Singh
- Maxillofacial Surgery Unit, Dandenong Hospital, Melbourne, Australia.
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Yamagata K, Ito H, Onizawa K, Yamatoji M, Yanagawa T, Bukawa H. Prognosis for gingival carcinomas with a delayed diagnosis after dental extraction. J Oral Maxillofac Surg 2013; 71:2189-94. [PMID: 23871315 DOI: 10.1016/j.joms.2013.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE In gingival squamous cell carcinoma (GSCC), the association between survival and previous dental extraction (DE) is controversial. The purpose of this study was to investigate the prognosis for patients in whom GSCC was detected after DE was performed. PATIENTS AND METHODS DE for GSCC tumor symptoms was performed in 19 patients before diagnosis (DE group) and not in 58 patients (non-DE group). The clinical features, characteristics, and prognosis were evaluated statistically between the 2 groups. RESULTS The interval from DE to the first hospital visit was 1.1 to 97 weeks (median, 7.3 weeks). There was no significant difference in tumor status, node status, local recurrence, pathologically positive lymph nodes, or distant metastasis between the DE and non-DE groups. Bone invasion was observed radiographically in 6 patients with mandibular GSCC in the DE group (100%) and 13 in the non-DE group (68.4%). There was a significant difference in bone invasion between the DE and non-DE groups (P < .01). Segmental mandibulectomy was performed in 11 patients (84.6%) in the DE group and 21 patients (61.8%) in the non-DE group. Extent of resection tended to be larger for the DE group. The 5-year overall survival rate was 84.6% for the DE group and 65.8% for patients with mandibular GSCC in the non-DE group. For maxillary GSCC, the survival rates differed significantly between groups (33.3% in DE group and 73.7% in non-DE group). CONCLUSIONS For mandibular GSCC, the resection field was appropriate for the extent of bone invasion after DE and the prognosis was similar to that in the non-DE group. For maxillary GSCC, a broad surgical field is suggested because of the potential for rapid spread in cancellous bony trabeculae.
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Affiliation(s)
- Kenji Yamagata
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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Fitzpatrick SG, Neuman AN, Cohen DM, Bhattacharyya I. The clinical and histologic presentation of gingival squamous cell carcinoma: a study of 519 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 114:509-15. [PMID: 22986247 DOI: 10.1016/j.oooo.2012.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/08/2012] [Accepted: 06/11/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Gingival squamous cell carcinoma (SCCA) often presents with benign features, which may lead to delay in treatment. This study describes the clinical and histologic characteristics of a series of gingival SCCA cases. STUDY DESIGN A retrospective consecutive case review was performed using the University of Florida College of Dentistry Biopsy service's database, which yielded clinical and histologic information on 519 cases of gingival SCCA. RESULTS The average age of affected patients was 72.3 years. The most common site was the mandibular posterior gingiva. Approximately 72% of lesions were present for >2 months at biopsy. The majority of clinicians considered a malignancy in their differential diagnosis (64%), although 15% considered only reactive lesions. Most of the carcinomas presented as exophytic masses and, histologically, were moderately differentiated. CONCLUSIONS Gingival SCCA may present with varied clinical and histologic appearances and should be considered in the differential diagnosis of benign appearing lesions of the gingiva.
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Affiliation(s)
- Sarah G Fitzpatrick
- Department of Oral Pathology, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
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Lubek JE, Clayman L. An update on squamous carcinoma of the oral cavity, oropharynx, and maxillary sinus. Oral Maxillofac Surg Clin North Am 2012; 24:307-16, x. [PMID: 22341511 DOI: 10.1016/j.coms.2012.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
There are more than 45,000 new cancer cases involving the head and neck diagnosed each year within the United States. Squamous cell carcinoma accounts for the majority of cases, often occurring within the oral cavity and oropharynx. This article reviews current literature and various controversial topics involving the diagnosis and treatment strategies for patients with oral cavity/oropharyngeal cancers. Although not considered cancer within the oral cavity, maxillary sinus squamous cell carcinoma is discussed.
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Affiliation(s)
- Joshua E Lubek
- Maxillofacial Oncology/Microvascular Surgery, Department of Oral & Maxillofacial Surgery, University of Maryland, Baltimore, MD 21201, USA.
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Prognostic Significance of Bone or Cartilage Invasion of Locally Advanced Head and Neck Cancers. Am J Clin Oncol 2010; 33:591-4. [PMID: 20065851 DOI: 10.1097/coc.0b013e3181bead63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen YL, Kuo SW, Fang KH, Hao SP. Prognostic impact of marginal mandibulectomy in the presence of superficial bone invasion and the nononcologic outcome. Head Neck 2010; 33:708-13. [PMID: 21117177 DOI: 10.1002/hed.21530] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Treatment of oral cavity cancer may require variable extent of mandibular resection. Marginal mandibulectomy is a controversial technique in providing oncologic resection margin. This study analyzes the efficacy of local oncologic control and the morbidity of marginal mandibulectomy in oral cavity carcinoma. Nononcologic complication of osteoradionecrosis is discussed. METHODS A retrospective cohort study analyzed clinicopathologic features of 43 patients with oral cavity cancer who underwent marginal mandibulectomy. Histologic mandibular invasion was examined as a function of local control and contribution to osteoradionecrosis. RESULTS Bone invasion was present in 16.3% of patients with marginal mandibulectomy. Local control rates were 85.7% in the bone invasion group and 77.8% in the no bone invasion group (p = .7). Osteoradionecrosis rates were 16.7% and 17.6%, respectively (p = .96). There was no significant difference between the 2 groups. CONCLUSIONS Marginal mandibulectomy is oncologically sound in providing a safe resection margin in oral cavity cancer abutting or superficially invading the mandible.
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Affiliation(s)
- Yih-Long Chen
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
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26
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Lubek J, El-Hakim M, Salama AR, Liu X, Ord RA. Gingival carcinoma: retrospective analysis of 72 patients and indications for elective neck dissection. Br J Oral Maxillofac Surg 2010; 49:182-5. [PMID: 20462676 DOI: 10.1016/j.bjoms.2010.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 04/11/2010] [Indexed: 11/27/2022]
Abstract
Gingival squamous cell carcinoma (SCC) is relatively uncommon, and little is known about its metastatic pattern. We retrospectively reviewed 864 consecutive patients with oral SCC who were seen at the University of Maryland Department of Oral and Maxillofacial Surgery (1991-2005), and identified 111 cases of gingival SCC. Inclusion criteria were fulfilled in 72 patients (mean duration of follow up 49 (1-153) months). Mean (range) age was 72 (45-93) years; 41 patients were women and 31 men. Distribution was almost equal: mandible 35 and maxilla 37. Forty (56%) were in the early stages (pI/II) and 32 (44%) in the later stages (pIII/IV). Twenty-nine patients had primary neck dissections, of whom 7/21 had clear, and 6/8 invaded, cervical nodes. The total number of occult nodal metastases was 9/29 (31%) in the mandible and 14/35 in the maxilla (one patient with initially clear nodes had both invaded nodes at neck dissection and a recurrence in the neck). The number of early compared with late stage occult metastases was 4 of 20 patients (20% T1/T2) and 5 of 9 patients (55% T3/T4) in the mandible and 2 of 22 patients (9% T1/T2) and 2 of 13 patients (15% T3/T4) in the maxilla. Two of 9 patients developed occult nodes within T2 maxillary gingival SCC. Bony invasion was identified in 17 patients (24%) occurring in 8 of 19 patients (42%) with invaded nodes compared with 9 of 53 patients (17%) with clear nodes. Overall survival at 2 and 5 years was 53 of 72 patients (74%) and 27 of 72 patients (38%) respectively. Elective neck dissection is indicated for all stages of mandibular gingival tumours and T3/T4 carcinomas of the maxillary gingiva. T2 maxillary SCC should be considered for elective neck dissection. Overall disease-free survival was worse among those with cervical metastases (p=0.004) and those who had had marginal resections (p=0.04).
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Affiliation(s)
- Joshua Lubek
- Oregon Health & Science University, Head & Neck Surgical Associates, Portland, USA.
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Pandey M, Rao L, Das S, Shukla M. Tumor stage and resection margins not the mandibular invasion determines the survival in patients with cancers of oro-mandibular region. Eur J Surg Oncol 2009; 35:1337-42. [DOI: 10.1016/j.ejso.2009.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 07/02/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022] Open
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Treatment Outcomes of T4 Locally Advanced Head and Neck Cancers With Soft Tissue Invasion or Bone and Cartilage Invasion. Am J Clin Oncol 2009; 32:477-82. [PMID: 19506456 DOI: 10.1097/coc.0b013e31819380a8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jegoux F, Bedfert C, Alno N, Godey B, Le Clech G. [Mandibular involvement and resection in management of oral carcinomas]. ACTA ACUST UNITED AC 2009; 126:149-54. [PMID: 19473650 DOI: 10.1016/j.aorl.2009.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 04/26/2009] [Indexed: 11/15/2022]
Affiliation(s)
- F Jegoux
- Service d'ORL et chirurgie maxillo-faciale, CHU Pontchaillou, rue Henri-Le-Guillou, 35033 Rennes cedex 9, France.
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Hirano C, Nagata M, Noman AA, Kitamura N, Ohnishi M, Ohyama T, Kobayashi T, Suzuki K, Yoshizawa M, Izumi N, Fujita H, Takagi R. Tetraspanin gene expression levels as potential biomarkers for malignancy of gingival squamous cell carcinoma. Int J Cancer 2009; 124:2911-6. [PMID: 19330835 DOI: 10.1002/ijc.24297] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Accurate assessment of malignancy in oral squamous cell carcinoma is essential to optimize treatment planning. To detect a biomarker related to malignant propensity in gingival squamous cell carcinoma (GSCC), quantitative gene expression analysis of tetraspanin family genes was conducted. In 73 cases of GSCC, total RNA was extracted from carcinoma tissues, and gene expression was analyzed by quantitative real time-PCR. Six tetraspanin family genes (CD9, CD63, CD81, CD82, CD151, NAG-2) were investigated. Housekeeping genes (ACTB and GAPDH), anchor protein genes (JUP and PXN) and an integrin gene (ITGA3) were used as reference genes. Forty-five gene expression ratios were calculated from these 11 gene expression levels and were analyzed with clinical parameters using multivariate statistical methods. According to the results of the logistic regression analysis subjecting cervical lymph node metastasis as a target variable, CD9/ACTB (p = 0.013) or CD9/CD82 (p = 0.013) in addition to tumor size (p = 0.028) were detected as significant factors. In Cox proportional hazards regression analysis, delayed cervical lymph node metastasis (p = 0.039) and tumor cell positive surgical margin (p = 0.032) in addition to CD151/GAPDH (p = 0.024) were detected as significant factors for death outcome. A Kaplan-Meier survival curve presented a significantly lower survival rate of the group with a CD151/GAPDH value of 10 or more (log rank and generalized Wilcoxon tests: p = 0.0003). Results of this study present the usefulness of CD9 and CD151 expression levels as biomarkers for assessment of malignancy in GSCC. They also indicate that detection of residual tumor cells at the surgical margin and the biological malignancy of a tumor interdependently affects prognosis.
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Affiliation(s)
- Chizuru Hirano
- Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences, Gakkocho-dori, Niigata, Japan
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Marginal mandibulectomy: 11 years of institutional experience. J Oral Maxillofac Surg 2009; 67:962-7. [PMID: 19375004 DOI: 10.1016/j.joms.2008.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/24/2008] [Accepted: 08/20/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE Literature on marginal mandibulectomy deals mainly with floor of mouth cancers. The purpose of the present study was to evaluate the oncologic outcome of marginal mandibulectomy in buccal sulcus cancer as compared with floor of mouth cancer. PATIENTS AND METHODS Chart review of 179 patients who underwent marginal mandibulectomy during 1993 to 2003 at Tata Memorial Hospital yielded 161 marginal mandibulectomies done for squamous cell carcinoma (SCC). Oncologic outcomes in terms of disease control and cause-specific survival for the gingival buccal and tongue/floor of mouth cancers were compared. Independent impact of various prognostic factors on the local control and cause-specific survival was evaluated using Cox proportional hazards model. RESULTS A total of 137 marginal mandibulectomies were done for SCC in gingival buccal complex and 24 for floor of mouth SCC. Bone was microscopically involved in 13 (8.1%) cases and mucosal margin of excision showed tumor in 12 (7.5%) cases. However, they had no influence on locoregional failure or cause-specific survival. Cause-specific survival at 2 and 5 years was 85.6% and 72.2%, respectively. Cause-specific survival at 5 years was significantly better for buccal cancer than floor of mouth cancer (P = .041). On multivariate analysis patients with floor of mouth cancer were at a 3 times higher risk of dying of disease than those with buccal cancer. CONCLUSION In carefully selected patients, marginal mandibulectomy in buccal sulcus cancer achieves at least as good local control and survival as compared with the floor of mouth cancer.
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Seoane J, Varela-Centelles PI, Walsh TF, Lopez-Cedrun JL, Vazquez I. Gingival Squamous Cell Carcinoma: Diagnostic Delay or Rapid Invasion? J Periodontol 2006; 77:1229-33. [PMID: 16805687 DOI: 10.1902/jop.2006.050408] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The similarity between gingival squamous cell carcinoma (GSCC) and more common periodontal lesions may lead to a delay in diagnosis or misdiagnosis. Neoplastic lesions of gingival tissues are frequently diagnosed at an advanced stage. METHODS To assess the relative time from when patients first become aware of the problem to histopathologic diagnosis (total diagnostic time), 59 consecutive oral cancer cases were examined in this study. The following variables were considered: age, gender, smoking habits, tumor stage at diagnosis, and total diagnostic time. The median of the patients' total diagnostic time (1.5 months) was used as a cutoff point to distinguish between delayed and non-delayed cases. Analysis of the variables was undertaken using the Student t test and chi2 test, with a 95% confidence interval (CI). RESULTS The total diagnostic time was <1.5 months for 75% of gingival carcinomas, 50% of tongue carcinomas, and 78% of floor-of-the-mouth carcinomas. It was >1.5 months for 25% of gingival carcinomas, 50% of tongue carcinomas, and 21% of floor-of-the-mouth carcinomas. No significant differences in time before diagnosis were found when gingival cancers were compared to other oral tumors (chi2=0.21; 95% CI=-0.40 to 0.26). However, by the time of diagnosis, gingival cancers had invaded adjacent structures more frequently than other oral cancers (chi2=13.51; 95% CI=0.18 to 0.85). CONCLUSIONS The gingival location of oral squamous cell carcinoma (OSCC) was associated with advanced stages at the time of diagnosis, due to early invasion of contiguous bone tissue (T4-primary tumor). This would indicate that even earlier referral and diagnosis are necessary.
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Affiliation(s)
- Juan Seoane
- Stomatology Department, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, A Coruña, and Primary Care Clinics, Galician Health Service, Burela, Lugo, Spain.
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Genden EM, Rinaldo A, Jacobson A, Shaha AR, Suárez C, Lowry J, Urquhart AC, Werner JA, Gullane PJ, Ferlito A. Management of mandibular invasion: When is a marginal mandibulectomy appropriate? Oral Oncol 2005; 41:776-82. [PMID: 16109354 DOI: 10.1016/j.oraloncology.2004.12.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 12/06/2004] [Indexed: 11/30/2022]
Abstract
There has been a great deal of controversy regarding the appropriate method of management of oral cavity and oropharyngeal tumors that invade the mandible. The inability to acquire intraoperative bone margins can make the decision process complex. Preoperative imaging offers several advantages, however, there is no single modality that has proven accurate. Intraoperative assessment has been suggested as a method of evaluation, however, this approach does not allow for preoperative planning. The following is a review of the current literature regarding mandibular invasion and the indications for a marginal mandibulectomy.
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Affiliation(s)
- Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Ampil FL, Ghali GE, Caldito G, Hardin JC. Treatment of head and neck cancer with bone or cartilage invasion by surgery and postoperative radiotherapy. J Oral Maxillofac Surg 2004; 62:408-11. [PMID: 15085504 DOI: 10.1016/j.joms.2003.05.014] [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: 11/17/2022]
Abstract
PURPOSE The study goal was to review our experience with patients with bone or cartilage invasion (BCI) by adjacent head and neck cancer (HNC) who were treated with curative surgery and postoperative radiotherapy (SPR). PATIENTS AND METHODS Thirty-eight individuals treated with SPR for HNC with BCI were identified after review of the radiation oncology charts and pathology reports for the period 1981 through 2000. RESULTS The thyroid cartilage and mandible were predominantly invaded by HNC. The follow-up time for the surviving patients was 65.5 months (range, 17 to 106 months). The local, regional, and distant relapse rates were 5%, 11%, and 13%, respectively. The overall disease-free survival rates at 3 and 5 years were 54% and 41%, respectively. CONCLUSION Although these results were not obtained from a randomized trial, the present observations may be beneficial in clinical decision making concerning patients with HNC and contiguous invasion of bone or cartilage.
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Affiliation(s)
- Federico L Ampil
- Louisiana State University Health Sciences Center, Shreveport, LA, USA.
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Abstract
There is little evidence that the tumor enters the mandible preferentially through the occlusal surface, the periodontal membrane, or named foramina. Tumor enters the mandible at the point of contact, which is often at the junction of the attached and reflected mucosa, which lies below the crest of the ridge in all but grossly resorbed mandibles. Angulation of the bone cut in rim or marginal resection of the mandible is advised. The erosive pattern of disease is associated with shallow mandibular invasion and smaller tumors in the soft tissue. This finding supports the principle of marginal resection in such cases. There is little evidence to support the principle that the tumor spreads preferentially along the inferior alveolar nerve or the bone marrow. The inclusion of the neurovascular bundle in marginal resections of the mandible is not necessary. Preoperative assessment should include plain radiography combined with a sensitive scan (bone scintigraphy, single photon emission computerized tomography, or MRI) and inspection of the bone surface after periosteal stripping at the time of the resection.
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Affiliation(s)
- James Brown
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 7AL, UK.
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