Role of hypoxia-related proteins in adenoid cystic carcinoma invasion

Are hypoxia-related proteins associated with the invasiveness of glandular odontogenic cysts? A multicenter study

OBJECTIVE

The study aimed to investigate the expression of hypoxia markers associated with invadopodia in glandular odontogenic cysts and to explore an association between this expression with the aggressive biological behaviour of this odontogenic cyst.

DESIGN

Immunohistochemistry was employed to assess the expression of hypoxia-inducible factor 1 alpha (HIF-1α), notch homologous protein of the neurogenic locus 1 (NOTCH-1), disintegrin and metalloproteinase-12 (ADAM-12), and heparin-binding epidermal growth factor (HB-EGF) in 17 samples of glandular odontogenic cysts, 10 samples of calcifying odontogenic cysts, and 10 samples of dental follicles.

RESULTS

The glandular odontogenic cyst samples exhibited increased expression of HIF-1α, NOTCH-1, ADAM-12 and HBEGF proteins compared with calcifying odontogenic cyst and dental follicle samples. HIF-1α demonstrated localization primarily within the nuclei of cystic epithelial cells of the glandular odontogenic cyst. NOTCH-1 and ADAM-12 exhibited expression in the cytoplasm and nuclei of epithelial and mucous cells of the glandular odontogenic cyst, of whereas HB-EGF was predominantly expressed in the cytoplasm. Weak labeling of these proteins was observed in the odontogenic epithelium of the calcifying odontogenic cyst and dental follicle samples.

CONCLUSIONS

The hypoxia-related signaling proteins are overexpressed in glandular odontogenic cyst when compared with calcifying odontogenic cyst and dental follicle. The reported aggressiveness of glandular odontogenic cyst can be partially explained by the expression of these proteins.

Radioresistant, Rare, Recurrent, and Radioinduced: 4Rs of Hadrontherapy for Patients Selections

Purpose

To describe the role of hadrontherapy (HT) in treating radioresistant, rare, recurrent, and radio-induced tumors, which can be defined, in assonance with the 4Rs of radiobiology, the "4Rs" of HT indications.

Materials and Methods

This is a narrative review written by a multidisciplinary team consisting of radiation oncologists, radiobiologists, and physicists on the current literature on HT, particularly carbon ion radiation therapy. To refine HT indications within the context of the "4Rs" framework, we evaluated tumor histologies across different clinical indication settings and emphasized the radiobiological mechanisms contributing to the effectiveness of HT.

Results

For rare, radioresistant, recurrent, and radio-induced tumors, HT has proven to be effective and safe, achieving high rates of local response with mild toxicity. The current review shows that the biological parameters can assist clinicians in identifying appropriate cases for HT treatment.

Conclusion

Biological characteristics of the tumor support the administration of HT in radioresistant, rare, recurrent, and radio-induced tumors and should be considered during multidisciplinary discussions.

Adenoid Cystic Carcinoma of Salivary Glands: A Ten-Year Review and an Assessment of the Current Management, Surgery, Radiotherapy, and Chemotherapy

Adenoid cystic carcinoma (ACC) is a rare cancer that arises from the salivary glands and other sites in the body, such as the lung and breast. Although the tumor accounts for 10% of all salivary gland malignancies, it only accounts for 1% of head and neck malignancies. It can affect both major and minor salivary glands; here, it is called salivary gland adenoid cystic carcinoma or SACC, with a slight predilection to the latter, and commonly manifests between the 6_th and 7_th decades of life. The disease also shows a slight female predilection, with a reported female to male ratio of 3 : 2. Lesions of SACC are often insidious and slow-growing, and symptoms such as pain and altered sensation are frequently associated with advanced stages of the disease. Salivary adenoid cystic carcinoma is characterized by perineural invasion (PNI), a distinctive feature that potentially plays a significant role in the tumor's relapse and recurrence, which is approximately 50%. The disease is not prevalent, and its etiopathogenesis is poorly understood, although several genetic patterns and biomarkers have been linked to its initiation and/or progression. The discovery of these mutations and biomarkers has encouraged several clinical studies to use therapeutic agents to target the specific receptors on the cancer cells to potentially prevent further proliferation of the tumor cells and metastasis of the disease. Diagnosis of SACC is often challenging and frequently requires a combination of clinical examination, imaging, and histopathology. Management of SACC is primarily surgical excision, while radiotherapy has shown to be effective in improving local control in cases with microscopic residual disease. However, treatment of recurrent or metastatic tumors by radiotherapy with or without chemotherapy has so far shown limited success. The aim of this thesis is to provide an update of literature on SACC with a particular focus on the latest management approaches and future trends.

Exploring the role of neutrophil-to-lymphocyte ratio and blood chemistry in head and neck adenoid cystic carcinomas treated with carbon ion radiotherapy

BACKGROUND AND PURPOSE

In recent years, there is an emerging interest in the prognostic role of chemistry blood biomarkers in oncological patients but their role in adenoid cystic carcinomas (ACCs) is still unknown. This study aims to assess the prognostic significance of baseline neutrophil-to-lymphocyte ratio (NLR) and blood chemistry in a series of head and neck ACC patients treated with carbon ion radiotherapy (CIRT).

MATERIAL AND METHODS

We retrospectively retrieved the data of 49 consecutive head and neck ACC patients treated with CIRT. Univariable and multivariable Cox proportional hazard regression (Cox-ph) analyses were performed to look for a potential association of NLR, and other blood biomarker values, with disease-free survival (DFS), Local Control (LC), Metastasis Free Survival (MFS) and overall survival (OS).

RESULTS

No significant association between NLR > 2,5 and DFS, LC, MFS and OS was found with univariable analysis although a trend was reported for DFS (Hazard ratio [HR]: 2,10, 95 % CI: 0,85 - 5,08, p-value = 0,11). Patients with hemoglobin (hb) ≤ 14 g/dL showed significantly better DFS, MFS and OS. Multivariable regression Cox-ph analysis for DFS, adjusted for margin status, clinical target volume and Absolute Number of Monocytes, reported the following statistically significant HRs, for both NLR > 2,5 and hb > 14 g/dL respectively: 4,850 (95 % CI = 1,408 - 16,701, p = 0,012) and 3,032 (95 % CI = 1,095 - 8,393, p = 0,033). Moreover, hb > 14 with HR = 3,69 (95 % CI: 1,23 - 11,07, p-value = 0,02), was a negative independent prognostic predictor for MFS.

CONCLUSIONS

Pre-treatment NLR and hb values seem to be independent prognostic predictor for clinical outcomes in head and neck ACC patients. If their role will be validated in a larger prospective cohort, they might be worthwhile for a pre-treatment risk stratification in patients treated with CIRT.

Biological Rationale and Clinical Evidence of Carbon Ion Radiation Therapy for Adenoid Cystic Carcinoma: A Narrative Review

Adenoid cystic carcinoma (ACC) is a rare, basaloid, epithelial tumor, arising mostly from salivary glands. Radiation therapy can be employed as a single modality for unresectable tumors, in an adjuvant setting after uncomplete resection, in case of high-risk pathological features, or for recurrent tumors. Due to ACC intrinsic radioresistance, high linear energy transfer (LET) radiotherapy techniques have been evaluated for ACC irradiation: while fast neutron therapy has now been abandoned due to toxicity concerns, charged particle beams such as protons and carbon ions are at present the beams used for hadron therapy. Carbon ion radiation therapy (CIRT) is currently increasingly used for ACC irradiation. The aim of this review is to describe the immunological, molecular and clinicopathological bases that support ACC treatment with CIRT, as well as to expose the current clinical evidence that reveal the advantages of using CIRT for treating ACC.

Quantitative ubiquitylomics reveals the ubiquitination regulation landscape in oral adenoid cystic carcinoma

Adenoid cystic carcinoma (ACC) is an extremely rare salivary gland tumor with a poor prognosis and needs attention on molecular mechanisms. Protein ubiquitination is an evolutionarily conserved post-translational modification (PTM) for substrates degradation and controls diverse cellular functions. The broad cellular function of ubiquitination network holds great promise to detect potential targets and identify respective receptors. Novel technologies are discovered for in-depth research and characterization of the precise and dynamic regulation of ubiquitylomics in multiple cellular processes during cancer initiation, progression and treatment. In the present study, 4D label-free quantitative techniques of ubiquitination proteomics were used and we identified a total of 4152 ubiquitination sites in 1993 proteins. We also performed a systematic bioinformatics analysis for differential modified proteins and peptides containing quantitative information through the comparation between oral ACC (OACC) tumor with adjacent normal tissues, as well as the identification of eight protein clusters with motif analysis. Our findings offered an important reference of potential biomarkers and effective therapeutic targets for ACC.