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Inoue K, Ito H, Iwai M, Tanaka M, Mori Y, Todo T. Neoadjuvant use of oncolytic herpes virus G47Δ prevents local recurrence after insufficient resection in tongue cancer models. Mol Ther Oncolytics 2023; 30:72-85. [PMID: 37583387 PMCID: PMC10423690 DOI: 10.1016/j.omto.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
A complete resection of tongue cancer is often difficult. We investigate the usefulness of administering G47Δ (teserpaturev), a triple-mutated oncolytic herpes simplex virus type 1, prior to resection. G47Δ exhibits good cytopathic effects and replication capabilities in all head and neck cancer cell lines tested. In an orthotopic SCCVII tongue cancer model of C3H/He mice, an intratumoral inoculation with G47Δ significantly prolongs the survival. Further, mice with orthotopic tongue cancer received neoadjuvant G47Δ (or mock) therapy with or without "hemilateral" resection, the maximum extent avoiding surgical deaths. Neoadjuvant G47Δ and resection led to 10/10 survival (120 days), whereas the survivals for G47Δ alone and resection alone were 6/10 and 5/10, respectively: all control animals died by day 11. Furthermore, 100% survival was achieved with neoadjuvant G47Δ therapy even when the resection area was narrowed to "partial," providing insufficient resection margins, whereas hemilateral resection alone caused death by local recurrence in half of the animals. G47Δ therapy caused increased number of tumor-infiltrating CD8+ and CD4+ cells, increased F4/80+ cells within the residual tongues, and increased expression of immune-related genes in and around the tumor. These results imply that neoadjuvant use of G47Δ is useful for preventing local recurrence after tongue cancer surgery.
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Affiliation(s)
- Kosuke Inoue
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
- Department of Oral and Maxillofacial Surgery, Jichi Medical University Hospital, Tochigi 329-0498, Japan
| | - Hirotaka Ito
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Miwako Iwai
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Minoru Tanaka
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
- Project Division of Oncolytic Virus Development, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Yoshiyuki Mori
- Department of Oral and Maxillofacial Surgery, Jichi Medical University Hospital, Tochigi 329-0498, Japan
| | - Tomoki Todo
- Division of Innovative Cancer Therapy, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
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An Update on Surgical Margins in the Head Neck Squamous Cell Carcinoma: Assessment, Clinical Outcome, and Future Directions. Curr Oncol Rep 2020; 22:82. [PMID: 32601821 DOI: 10.1007/s11912-020-00942-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Failure to achieve tumor-free margins is the single largest cause of death for head neck cancer patients. At the same time, it is the only factor that is in complete control of the surgeon. This review summarizes evidence for the definition, clinical implications, and methods to achieve optimal margins. RECENT FINDINGS The previous universally followed definition of adequate margin (5 mm in final histopathology) has been disputed. Various biological, optical, and imaging adjuncts can aid in achieving optimal margins. Extent of resection and margins in human papilloma virus (HPV)-positive oropharyngeal cancers and following induction chemotherapy remain controversial. Though practiced widely, frozen section-guided margin revision has not conclusively shown improved local control rates. The role of molecular assessment of margins is promising but not established. The definition of adequate margin differs according to the site in the head neck region. Currently, the 5-mm margin at final histopathology is the most commonly accepted definition of an "adequate" margin.
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Malik A, Qayyumi BN, Mair M, Singhavi H, Mathur Y, Nair D, Ghosh-Laskar S, Agrawal JP, Prabash K, Chaturvedi P. Outcome of patients following neo-adjuvant chemotherapy for unresectable cervical nodes in head and neck squamous cell carcinomas. Eur Arch Otorhinolaryngol 2018; 276:567-574. [PMID: 30556102 DOI: 10.1007/s00405-018-5253-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was undertaken to assess the effects of neo-adjuvant chemotherapy (NACT) on patients with head and neck squamous cell carcinoma (HNSCC) having advanced unresectable cervical nodal metastasis. METHODOLOGY A retrospective cohort study was conducted to assess the response of unresectable nodes to NACT in a pragmatic manner. Patients were grouped according to the response noted and the treatment offered after chemotherapy. The median survival amongst the patients in these groups was compared. RESULTS The study included 51 patients. Oral cavity was the commonest site (67.2%). Favourable nodal response was seen in 64.7% of the patients. Up to 87.9% of the nodal responders were amenable to curative intent therapy. The overall survival of patients undergoing surgery, definitive chemoradiotherapy, palliative chemotherapy and palliative radiotherapy was 24, 13, 10 and 9 months, respectively. CONCLUSION NACT may be utilized in HNSCC with advanced inoperable nodal disease to make them amenable to definitive therapy.
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Affiliation(s)
- Akshat Malik
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Burhanuddin N Qayyumi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Manish Mair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Hitesh Singhavi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Yash Mathur
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Deepa Nair
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Jai Prakash Agrawal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Kumar Prabash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai, 400012, India.
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Pandey M, Kannepali KK, Dixit R, Kumar M. Effect of neoadjuvant chemotherapy and its correlation with HPV status, EGFR, Her-2-neu, and GADD45 expression in oral squamous cell carcinoma. World J Surg Oncol 2018; 16:20. [PMID: 29386013 PMCID: PMC5793383 DOI: 10.1186/s12957-018-1308-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 01/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Head and neck cancers are the commonest cancer in Southeast Asia. Despite being a surface cancer, it is associated with significant morbidity as despite early detection by the patients they often report for treatment late and hence are associated with poor prognosis. The role of neoadjuvant chemotherapy in head and neck cancer is still under evaluation; there is a large subgroup of population that does not respond to chemotherapy, and hence, most studies have failed to show any survival benefit. This study evaluated the role of neoadjuvant therapy with docetaxel and carboplatin in patients with oral cancer and correlated the response to human papilloma virus, EGFR1, EGFR2, and GADD45 expression. Methods A total of 24 locally advanced, non-metastatic oral cancer patients were included in the study. Tumor biopsies were taken prior to the start of neoadjuvant therapy for expression of EGFR, Her-2-Neu, and GADD45 by immunohistochemistry and for HPV by PCR. The response was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) criteria after three cycles of chemotherapy. Statistical analysis was performed using correlation and Kaplan–Meier analysis; the difference in survival was calculated with log rank test. Results A total of 21 male and 3 female with a mean age of 53.12 years were enrolled. Sixty-five percent of these received three cycles of chemotherapy. Five patients were positive for HPV 16 and none for HPV 18. Twenty-two of 24 patients showed GADD45 expression, 3 showed expression of Her-2-Neu while all 24 showed expression for EGFR1 protein. Two-year overall survival was 81%; GADD45 expressions were found to significantly affect the overall and disease-free survival, while any of the other protein expression studied and HPV status was not significant. Conclusion The result of the present study shows significant downgrading of the oral cancers with neoadjuvant chemotherapy suggesting its utility in borderline operable cases. However, the response of chemotherapy does not appear to be related to the expression of EGFR, Her-2-Neu, and GADD45 protein or presence of HPV. Bone involvement, perineural invasion, and GADD45 expression significantly predict OS and DFS. All patients who did not express Gadd45 died before 2 years. Study with more subjects and longer follow-up should be carried out to elucidate this relation further.
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Affiliation(s)
- Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India.
| | - Krishna Kiran Kannepali
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
| | - Ruhi Dixit
- Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
| | - Mohan Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
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