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Neumann F, Straub X, Mrosk F, Rubarth K, Wolfsberg J, Piwonski I, Doll C, Voss J, Heiland M, Kreutzer K, Koerdt S. Resection status and margin control in intraoperative frozen sectioning analysis of oral squamous cell carcinoma. Oral Maxillofac Surg 2024:10.1007/s10006-024-01238-x. [PMID: 38532169 DOI: 10.1007/s10006-024-01238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Intraoperative frozen section analysis (IFSA) is a well-established procedure for determining the intraoperative soft tissue resection status in patients with oral squamous cell carcinoma (OSCC). Margin status is a major predictor of the patient´s outcome, histologically free margins of ≥ 5 mm are demanded. This study evaluates the accuracy of IFSA, the impact of margin status and the impact of intraoperative margin revision on disease-free survival (DFS) and overall survival (OS). METHODS This retrospective study included 213 patients with OSCC. IFSA results were compared with definitive histopathological reports, Kaplan-Meier analysis was performed. Cut-off values were calculated for resection margins considering known risk factors. RESULTS IFSA showed positive margins in 8 cases (3.8%). Kaplan-Meier analysis revealed no significant differences for OS or DFS if R0-status was achieved by initial resection or immediate re-resection. Final histopathological evaluation revealed false-positive IFSA in 3/8 cases (37.5%) and false-negative IFSA in 1/205 cases (0.5%). Sensitivity was 83.3% and specificity was 98.6%. Analysis of optimal cut-off values showed no general need for larger resection margins in patients with risk factors. Cut-off values were slightly higher for patients with the risk factor alcohol consumption (7 mm for OS and DFS) or pN + ECS- disease (7 mm for DFS). Optimal cut-off values for tumour-margin-distance were around 6 mm. CONCLUSION IFSA provides a valuable assessment method for intraoperative soft tissue resection margins. Risk factors seemingly do not significantly influence the extent of tumour resection.
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Affiliation(s)
- Felix Neumann
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Xenia Straub
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedrich Mrosk
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kerstin Rubarth
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117, Berlin, Germany
| | - Johanna Wolfsberg
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117, Berlin, Germany
| | - Iris Piwonski
- Department of Pathology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan Voss
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Memberember of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Melchior C, Isfort P, Braunschweig T, Witjes M, Van den Bosch V, Rashad A, Egger J, de la Fuente M, Röhrig R, Hölzle F, Puladi B. Development and validation of a cadaveric porcine Pseudotumor model for Oral Cancer biopsy and resection training. BMC Med Educ 2024; 24:250. [PMID: 38500112 PMCID: PMC10949621 DOI: 10.1186/s12909-024-05224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The gold standard of oral cancer (OC) treatment is diagnostic confirmation by biopsy followed by surgical treatment. However, studies have shown that dentists have difficulty performing biopsies, dental students lack knowledge about OC, and surgeons do not always maintain a safe margin during tumor resection. To address this, biopsies and resections could be trained under realistic conditions outside the patient. The aim of this study was to develop and to validate a porcine pseudotumor model of the tongue. METHODS An interdisciplinary team reflecting various specialties involved in the oncological treatment of head and neck oncology developed a porcine pseudotumor model of the tongue in which biopsies and resections can be practiced. The refined model was validated in a final trial of 10 participants who each resected four pseudotumors on a tongue, resulting in a total of 40 resected pseudotumors. The participants (7 residents and 3 specialists) had an experience in OC treatment ranging from 0.5 to 27 years. Resection margins (minimum and maximum) were assessed macroscopically and compared beside self-assessed margins and resection time between residents and specialists. Furthermore, the model was evaluated using Likert-type questions on haptic and radiological fidelity, its usefulness as a training model, as well as its imageability using CT and ultrasound. RESULTS The model haptically resembles OC (3.0 ± 0.5; 4-point Likert scale), can be visualized with medical imaging and macroscopically evaluated immediately after resection providing feedback. Although, participants (3.2 ± 0.4) tended to agree that they had resected the pseudotumor with an ideal safety margin (10 mm), the mean minimum resection margin was insufficient at 4.2 ± 1.2 mm (mean ± SD), comparable to reported margins in literature. Simultaneously, a maximum resection margin of 18.4 ± 6.1 mm was measured, indicating partial over-resection. Although specialists were faster at resection (p < 0.001), this had no effect on margins (p = 0.114). Overall, the model was well received by the participants, and they could see it being implemented in training (3.7 ± 0.5). CONCLUSION The model, which is cost-effective, cryopreservable, and provides a risk-free training environment, is ideal for training in OC biopsy and resection and could be incorporated into dental, medical, or oncologic surgery curricula. Future studies should evaluate the long-term training effects using this model and its potential impact on improving patient outcomes.
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Affiliation(s)
- Claire Melchior
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, RWTH Aachen University, 52074, Aachen, Germany
- Institute of Pathology, Faculty of Medicine, Ludwig Maximilians University (LMU), 80337, Munich, Germany
| | - Max Witjes
- Department of Oral and Maxillofacial Surgery, UMCG Groningen, 9713, GZ, Groningen, The Netherlands
| | - Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Ashkan Rashad
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jan Egger
- Cancer Research Center Cologne Essen (CCCE), University Medicine Essen (AöR), 45147, Essen, Germany
- Institute of Artificial Intelligence in Medicine, Essen University Hospital, 45131, Essen, Germany
| | - Matías de la Fuente
- Chair of Medical Engineering, RWTH Aachen University, 52074, Aachen, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Behrus Puladi
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Ferrari L, Cariati P, Zubiate I, Martínez-Sahuquillo Rico Á, Arroyo Rodriguez S, Pulgar Encinas RM, Ferrari S, Martínez Lara I. Controversies in the treatment of early-stage oral squamous cell carcinoma. Curr Probl Cancer 2024; 48:101056. [PMID: 38096653 DOI: 10.1016/j.currproblcancer.2023.101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/27/2023] [Accepted: 11/29/2023] [Indexed: 03/10/2024]
Abstract
The treatment of early-stage oral squamous cell carcinoma (OSCC) is still a controversial issue. Thanks to the 8th edition of TNM by AJCC there is a better distinction between the stages of OSCC. However, Stages I and II still share the same treatment protocol, even if the prognosis is radically different. A retrospective study has been conducted including 70 previously untreated patients with Stage I or II OSCC, treated with tumorectomy and selective neck dissection. The study focuses on the link between pT1/2 and various other factors, particularly histological grading, vascular and perineural invasion, local and cervical recurrence, surgical margins and overall survival. These data reveal significant differences between pT1 and pT2 in histological grade, perineural invasion, cervical recurrence, surgical margins, and overall survival, emphasizing the necessity of different treatment protocols for T1 and T2 OSCC. Distinct strategies should be proposed to treat Stage I and II OSCC, with Stage II patients possibly benefitting from more aggressive treatments: following these data, a wait-and-see strategy should only be considered in Stage I, while certain treatments at the cervical level - such as prophylactic neck dissection and sentinel node biopsy - should always be considered for Stage II tumors.
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Affiliation(s)
| | - Paolo Cariati
- Maxillofacial Surgeon, Virgen de las Nieves University Hospital, Granada, Spain
| | - Imanol Zubiate
- Resident in Oral and Maxillofacial Surgery, Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | | | - Silvano Ferrari
- Professor, Department of Maxillofacial Surgery, University of Parma, Italy
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O’Meara CH, Nguyen TV, Jafri Z, Boyer M, Shonka DC, Khachigian LM. Personalised Medicine and the Potential Role of Electrospinning for Targeted Immunotherapeutics in Head and Neck Cancer. Nanomaterials (Basel) 2023; 14:6. [PMID: 38202461 PMCID: PMC10780990 DOI: 10.3390/nano14010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
Advanced head and neck cancer (HNC) is functionally and aesthetically destructive, and despite significant advances in therapy, overall survival is poor, financial toxicity is high, and treatment commonly exacerbates tissue damage. Although response and durability concerns remain, antibody-based immunotherapies have heralded a paradigm shift in systemic treatment. To overcome limitations associated with antibody-based immunotherapies, exploration into de novo and repurposed small molecule immunotherapies is expanding at a rapid rate. Small molecule immunotherapies also have the capacity for chelation to biodegradable, bioadherent, electrospun scaffolds. This article focuses on the novel concept of targeted, sustained release immunotherapies and their potential to improve outcomes in poorly accessible and risk for positive margin HNC cases.
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Affiliation(s)
- Connor H. O’Meara
- Department of Otorhinolaryngology, Head & Neck Surgery, The Canberra Hospital, Garran, ACT 2605, Australia
- ANU School of Medicine, Australian National University, Canberra, ACT 0200, Australia
| | - Thanh Vinh Nguyen
- School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Zuhayr Jafri
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (Z.J.)
| | - Michael Boyer
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia;
| | - David C. Shonka
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Levon M. Khachigian
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (Z.J.)
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Obermeier KT, Liokatis P, Smolka W. Comparison of histopathological margins after resection of oral squamous cell carcinoma using sharp dissection versus mono-polar electrocautery in T1 and T2 tumors. Surg Oncol 2023; 51:102010. [PMID: 37907044 DOI: 10.1016/j.suronc.2023.102010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/25/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
The study aims to compare histopathological margins after resection of oral squamous cell carcinoma (OSCC) with different surgical techniques: conventional sharp resection (SR) with scalpel versus monopolar electrocautery (ME). Hence, the question arises whether thermal damage by performing monopolar electrocautery surgery will lead to close margins more frequently than by using scalpels. 152 patients were included in this study. All patients received a primary tumor resection either performed with SR or with ME. Surgical margins were distributed into two groups: ≥5 mm (clear margins) and < 5 mm (close or involved margins). For comparing homogeneous groups, we considered tumor localizations, diameter and depth of invasion. The results were statistically analyzed by applying the Wilcoxon-Mann-Whitney-U-Test. The distribution of tumor diameter and depth of invasion was equal in both groups. There was no statistically significant difference between the amount of free surgical margins using SR or ME (p = 0.884). According to this study, the use of the monopolar electrocautery for tumor resection in the oral cavity does not increase the rate of compromised resection margins compared to the conventional scalpel.
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Affiliation(s)
| | - Paris Liokatis
- Department of Oral & Maxillofacial Surgery, University of Munich, LMU, Germany
| | - Wenko Smolka
- Department of Oral & Maxillofacial Surgery, University of Munich, LMU, Germany.
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Williamson A, Moen CM, Slim MAM, Warner L, O'Leary B, Paleri V. Transoral robotic surgery without adjuvant therapy: A systematic review and meta-analysis of the association between surgical margins and local recurrence. Oral Oncol 2023; 147:106610. [PMID: 37951118 DOI: 10.1016/j.oraloncology.2023.106610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Transoral robotic surgery (TORS) is increasingly employed in the management of oropharyngeal cancer without adjuvant treatment. Attaining safe surgical margins is paramount to preventing local recurrence (LR), but the necessary surgical margin dimension remains contentious. METHODS Systematic review and meta-analysis of studies reporting margin status and LR following TORS without adjuvant therapy for primary OPSCC. RESULTS The search identified 269 articles and 11 were selected for inclusion, with 406 patients included in the meta-analysis. Heterogeneity was noted in the definition of "close" margins. Random-effects pooled rate of positive margins was 7 % (95 % CI 0.04-0.12, I2 = 54 %, p = 0.02) and close margins was 7 % (95 % CI 0.02-0.27, I2 = 86 %, p=<0.01). The random-effects overall rate of LR was 6 % (95 % CI 0.04-0.10, I2 = 11 %, p = 0.35), 13 % (95 % CI 0.02-0.620, I2 = 0 %, p = 1.0) after a positive margin, and 3 % (95 % CI 0.03-0.24, I2 = 23 %, p = 0.26) after a close margin. Odds ratio (OR) for LR indicated higher risk of LR for positive compared to close margins (7.5; 95 % CI 1.31-42.91, I2 = 0 %, p = 0.51), and a slightly lower risk of LR between close and negative margins (2.22; 95 % CI 0.67-7.38, I2 = 0 %, p = 0.8). A lack of frozen-section analysis (OR 2.91, p = 0.36) and HPV-negative disease (OR 1.68, p = 0.03) were associated with an elevated risk of LR. CONCLUSIONS TORS as a standalone treatment is associated with low rates of LR; however, the literature is hampered by considerable heterogeneity in margin definitions. Larger multicentre studies are required to determine the precise margin cut-off required for oropharyngeal tumours managed with TORS alone.
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Affiliation(s)
- Andrew Williamson
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK; Institute for Cancer Research, London, UK.
| | | | | | - Laura Warner
- Department of Head and Neck Surgery, The Freeman Hospital, Newcastle, UK
| | - Ben O'Leary
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK; Institute for Cancer Research, London, UK
| | - Vinidh Paleri
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK; Institute for Cancer Research, London, UK.
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Ooms M, Ponke L, Winnand P, Heitzer M, Peters F, Steiner T, Hölzle F, Modabber A. Predictive factors and repetition numbers for intraoperative additional resection of initially involved soft tissue resection margins in oral squamous cell carcinoma: a retrospective study. World J Surg Oncol 2023; 21:308. [PMID: 37752503 PMCID: PMC10523667 DOI: 10.1186/s12957-023-03192-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Intraoperative additional resection (IAR) of initially microscopically involved soft tissue resection margins negatively impacts tumor recurrence in oral squamous cell carcinoma (OSCC). Increasing the selected initial macroscopic resection margin distance beyond the tumor tissue may help prevent IAR; however, the existence of predictive factors for IAR and IAR repetition numbers remains unclear. This study aimed to identify predictive factors for IAR and to evaluate the IAR repetition numbers in soft tissue for surgically treated OSCC. METHODS A cohort of 197 patients surgically treated for OSCC between 2008 and 2019 was retrospectively reviewed (44 patients with IAR and 153 patients without IAR). Clinical parameters (tumor location, midline involvement, clinical T-status, time between staging imaging and surgery, bone resection, monopolar use, and reconstruction flap size) and histopathological parameters (pathologic T-status [pT-status], grading, vascular invasion, and lymphatic invasion) of the two groups were compared. RESULTS Patients with and without IAR differed in their histopathological parameters, such as pT-status above 2 (47.7% vs. 28.1%, p = 0.014) and lymphatic invasion (13.6% vs. 4.6%, p = 0.033); however, their clinical parameters were similar (all p > 0.05). Only pT-status above 2 was predictive for IAR in a multivariable regression analysis (odds ratio 2.062 [confidence interval 1.008-4.221], p = 0.048). The IAR repetition numbers varied from zero to two (zero = 84.4%, one = 11.4%, and two = 2.3%). CONCLUSIONS Only postoperative available pT-status was identified as a predictive factor for IAR, underscoring the importance of improving preoperative or intraoperative tumor visualization in OSCC before selecting the initial macroscopic resection margin distance to avoid IAR.
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Affiliation(s)
- Mark Ooms
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Lisa Ponke
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Winnand
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Peters
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Tim Steiner
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Hegde S, Reghunadhan P, Thakur S, Subash A, Rao V. Ultrasound-guided resection for squamous cell carcinoma of the buccal mucosa: A feasibility study. Head Neck 2023; 45:2478-2479. [PMID: 37417649 DOI: 10.1002/hed.27445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Smita Hegde
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India
| | - Parvathy Reghunadhan
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India
| | - Shalini Thakur
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India
| | - Anand Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India
| | - Vishal Rao
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka, India
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Dannhorn A, Doria ML, McKenzie J, Inglese P, Swales JG, Hamm G, Strittmatter N, Maglennon G, Ghaem-Maghami S, Goodwin RJA, Takats Z. Targeted Desorption Electrospray Ionization Mass Spectrometry Imaging for Drug Distribution, Toxicity, and Tissue Classification Studies. Metabolites 2023; 13:metabo13030377. [PMID: 36984817 PMCID: PMC10060000 DOI: 10.3390/metabo13030377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
With increased use of mass spectrometry imaging (MSI) in support of pharmaceutical research and development, there are opportunities to develop analytical pipelines that incorporate exploratory high-performance analysis with higher capacity and faster targeted MSI. Therefore, to enable faster MSI data acquisition we present analyte-targeted desorption electrospray ionization–mass spectrometry imaging (DESI-MSI) utilizing a triple-quadrupole (TQ) mass analyzer. The evaluated platform configuration provided superior sensitivity compared to a conventional time-of-flight (TOF) mass analyzer and thus holds the potential to generate data applicable to pharmaceutical research and development. The platform was successfully operated with sampling rates up to 10 scans/s, comparing positively to the 1 scan/s commonly used on comparable DESI-TOF setups. The higher scan rate enabled investigation of the desorption/ionization processes of endogenous lipid species such as phosphatidylcholines and a co-administered cassette of four orally dosed drugs—erlotininb, moxifloxacin, olanzapine, and terfenadine. This was used to enable understanding of the impact of the desorption/ionization processes in order to optimize the operational parameters, resulting in improved compound coverage for olanzapine and the main olanzapine metabolite, hydroxy-olanzapine, in brain tissue sections compared to DESI-TOF analysis or matrix-assisted laser desorption/ionization (MALDI) platforms. The approach allowed reducing the amount of recorded information, thus reducing the size of datasets from up to 150 GB per experiment down to several hundred MB. The improved performance was demonstrated in case studies investigating the suitability of this approach for mapping drug distribution, spatially resolved profiling of drug-induced nephrotoxicity, and molecular–histological tissue classification of ovarian tumors specimens.
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Affiliation(s)
- Andreas Dannhorn
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, UK
| | - Maria Luisa Doria
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - James McKenzie
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Paolo Inglese
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - John G. Swales
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, UK
| | - Gregory Hamm
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, UK
| | - Nicole Strittmatter
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, UK
| | - Gareth Maglennon
- Pathology, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, UK
| | - Sadaf Ghaem-Maghami
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Richard J. A. Goodwin
- Imaging and Data Analytics, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge CB4 0WG, UK
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
- Correspondence:
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Chen Y, Streeter SS, Hunt B, Sardar HS, Gunn JR, Tafe LJ, Paydarfar JA, Pogue BW, Paulsen KD, Samkoe KS. Fluorescence molecular optomic signatures improve identification of tumors in head and neck specimens. Front Med Technol 2023; 5:1009638. [PMID: 36875185 PMCID: PMC9975724 DOI: 10.3389/fmedt.2023.1009638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background Fluorescence molecular imaging using ABY-029, an epidermal growth factor receptor (EGFR)-targeted, synthetic Affibody peptide labeled with a near-infrared fluorophore, is under investigation for surgical guidance during head and neck squamous cell carcinoma (HNSCC) resection. However, tumor-to-normal tissue contrast is confounded by intrinsic physiological limitations of heterogeneous EGFR expression and non-specific agent uptake. Objective In this preliminary study, radiomic analysis was applied to optical ABY-029 fluorescence image data for HNSCC tissue classification through an approach termed "optomics." Optomics was employed to improve tumor identification by leveraging textural pattern differences in EGFR expression conveyed by fluorescence. The study objective was to compare the performance of conventional fluorescence intensity thresholding and optomics for binary classification of malignant vs. non-malignant HNSCC tissues. Materials and Methods Fluorescence image data collected through a Phase 0 clinical trial of ABY-029 involved a total of 20,073 sub-image patches (size of 1.8 × 1.8 mm2) extracted from 24 bread-loafed slices of HNSCC surgical resections originating from 12 patients who were stratified into three dose groups (30, 90, and 171 nanomoles). Each dose group was randomly partitioned on the specimen-level 75%/25% into training/testing sets, then all training and testing sets were aggregated. A total of 1,472 standardized radiomic features were extracted from each patch and evaluated by minimum redundancy maximum relevance feature selection, and 25 top-ranked features were used to train a support vector machine (SVM) classifier. Predictive performance of the SVM classifier was compared to fluorescence intensity thresholding for classifying testing set image patches with histologically confirmed malignancy status. Results Optomics provided consistent improvement in prediction accuracy and false positive rate (FPR) and similar false negative rate (FNR) on all testing set slices, irrespective of dose, compared to fluorescence intensity thresholding (mean accuracies of 89% vs. 81%, P = 0.0072; mean FPRs of 12% vs. 21%, P = 0.0035; and mean FNRs of 13% vs. 17%, P = 0.35). Conclusions Optomics outperformed conventional fluorescence intensity thresholding for tumor identification using sub-image patches as the unit of analysis. Optomics mitigate diagnostic uncertainties introduced through physiological variability, imaging agent dose, and inter-specimen biases of fluorescence molecular imaging by probing textural image information. This preliminary study provides a proof-of-concept that applying radiomics to fluorescence molecular imaging data offers a promising image analysis technique for cancer detection in fluorescence-guided surgery.
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Affiliation(s)
- Yao Chen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Samuel S. Streeter
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Department of Orthopaedics, Dartmouth Health, Lebanon, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Brady Hunt
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Hira S. Sardar
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Jason R. Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Laura J. Tafe
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Pathology, Dartmouth Health, Lebanon, NH, United States
| | - Joseph A. Paydarfar
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Surgery, Dartmouth Health, Lebanon, NH, United States
- Department of Otolaryngology, Dartmouth Health, Lebanon, NH, United States
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Kimberley S. Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
- Department of Surgery, Dartmouth Health, Lebanon, NH, United States
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11
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Lawaetz M, Christensen A, Juhl K, Karnov K, Lelkaitis G, Kanstrup Fiehn AM, Kjaer A, von Buchwald C. Potential of uPAR, αvβ6 Integrin, and Tissue Factor as Targets for Molecular Imaging of Oral Squamous Cell Carcinoma: Evaluation of Nine Targets in Primary Tumors and Metastases by Immunohistochemistry. Int J Mol Sci 2023; 24:ijms24043853. [PMID: 36835265 PMCID: PMC9962929 DOI: 10.3390/ijms24043853] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
No clinically approved tumor-specific imaging agents for head and neck cancer are currently available. The identification of biomarkers with a high and homogenous expression in tumor tissue and minimal expression in normal tissue is essential for the development of new molecular imaging targets in head and neck cancer. We investigated the expression of nine imaging targets in both primary tumor and matched metastatic tissue of 41 patients with oral squamous cell carcinoma (OSCC) to assess their potential as targets for molecular imaging. The intensity, proportion, and homogeneity in the tumor and the reaction in neighboring non-cancerous tissue was scored. The intensity and proportion were multiplied to obtain a total immunohistochemical (IHC) score ranging from 0-12. The mean intensity in the tumor tissue and normal epithelium were compared. The expression rate was high for the urokinase-type plasminogen activator receptor (uPAR) (97%), integrin αvβ6 (97%), and tissue factor (86%) with a median total immunostaining score (interquartile range) for primary tumors of 6 (6-9), 12 (12-12), and 6 (2.5-7.5), respectively. For the uPAR and tissue factor, the mean staining intensity score was significantly higher in tumors compared to normal epithelium. The uPAR, integrin αvβ6, and tissue factor are promising imaging targets for OSCC primary tumors, lymph node metastases, and recurrences.
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Affiliation(s)
- Mads Lawaetz
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence:
| | - Anders Christensen
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Karina Juhl
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kirstine Karnov
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Giedrius Lelkaitis
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Anne-Marie Kanstrup Fiehn
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Copenhagen University Hospital-Rigshospitalet & Department of Biomedical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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12
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de Kleijn BJ, Heldens GTN, Herruer JM, Sier CFM, Piazza C, de Bree R, Guntinas-Lichius O, Kowalski LP, Vander Poorten V, Rodrigo JP, Zidar N, Nathan CA, Tsang RK, Golusinski P, Shaha AR, Ferlito A, Takes RP. Intraoperative Imaging Techniques to Improve Surgical Resection Margins of Oropharyngeal Squamous Cell Cancer: A Comprehensive Review of Current Literature. Cancers (Basel) 2023; 15. [PMID: 36765858 DOI: 10.3390/cancers15030896] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Inadequate resection margins in head and neck squamous cell carcinoma surgery necessitate adjuvant therapies such as re-resection and radiotherapy with or without chemotherapy and imply increasing morbidity and worse prognosis. On the other hand, taking larger margins by extending the resection also leads to avoidable increased morbidity. Oropharyngeal squamous cell carcinomas (OPSCCs) are often difficult to access; resections are limited by anatomy and functionality and thus carry an increased risk for close or positive margins. Therefore, there is a need to improve intraoperative assessment of resection margins. Several intraoperative techniques are available, but these often lead to prolonged operative time and are only suitable for a subgroup of patients. In recent years, new diagnostic tools have been the subject of investigation. This study reviews the available literature on intraoperative techniques to improve resection margins for OPSCCs. A literature search was performed in Embase, PubMed, and Cochrane. Narrow band imaging (NBI), high-resolution microendoscopic imaging, confocal laser endomicroscopy, frozen section analysis (FSA), ultrasound (US), computed tomography scan (CT), (auto) fluorescence imaging (FI), and augmented reality (AR) have all been used for OPSCC. NBI, FSA, and US are most commonly used and increase the rate of negative margins. Other techniques will become available in the future, of which fluorescence imaging has high potential for use with OPSCC.
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13
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Fernandes JR, Dos Santos LCF, Lamers ML. Applicability of autofluorescence and fluorescent probes in the trans-surgical of oral carcinomas: A systematic review. Photodiagnosis Photodyn Ther 2022; 41:103238. [PMID: 36509404 DOI: 10.1016/j.pdpdt.2022.103238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
Oral cancer represents an important health problem, as it is the sixth most common type of cancer in the world and is associated with high rates of morbidity and mortality. The treatment considered the gold standard for this type of tumor is surgical resection with negative margins, with a distance of at least 5 mm from the tumor. This procedure is strongly associated with local control and disease-specific survival, however, in many cases, large amounts of healthy tissue are removed, resulting in surgical defects, compromising various functions and directly affecting the individual's quality of life. From this perspective, this systematic review aimed to evaluate the use of autofluorescence and fluorescent probes as potential adjuvant techniques to facilitate the delineation of surgical margins for oral cancers. A comprehensive search was performed in Pubmed, Scopus, Web of Science, LIVIVO, Embase, ProQuest Open Access Dissertations & Theses, Open Access Theses and Dissertations, and DART Europe databases, where 1948 articles were found. After the different stages of critical evaluation, 15 articles were selected, eligible for the inclusion criteria. Of these, 7 articles used autofluorescence, 7 used fluorescent probes and 1 article used both methods. As for autofluorescence, the most used device was the VELScope, and indocyanine green was the most used probe. Compared to histopathology, autofluorescence did not obtain significant and/or superiors results. In contrast to fluorescent probes that, most articles showed a good performance of margins during surgical resection, making them a promising alternative. However, it is still necessary to carry out the analysis of more articles, with more significant samples and sensitivity and specificity data to qualify the results.
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Affiliation(s)
- Julia Rodrigues Fernandes
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Marcelo Lazzaron Lamers
- Department of Morphological Sciences, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2600, Porto Alegre, RS CEP 90035-003, Brazil.
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14
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Liao CT, Lee LY, Lee SR, Ng SH, Liu TW, Chien CY, Lin JC, Wang CP, Terng SD, Hua CH, Chen TM, Chen WC, Tsai YT, Kang CJ, Tsai CY, Chu YH, Lin CY, Fan KH, Wang HM, Hsieh CH, Yeh CH, Lin CH, Tsao CK, Yen TC, Cheng NM, Fang TJ, Huang SF, Lee LA, Fang KH, Wang YC, Lin WN, Hsin LJ, Wen YW. Optimizing margin status for improving prognosis in patients with oral cavity squamous cell carcinoma: A retrospective study from the two highest-volume Taiwanese hospitals. Front Oncol 2022; 12:1019555. [DOI: 10.3389/fonc.2022.1019555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/20/2022] [Indexed: 11/15/2022] Open
Abstract
BackgroundIn the treatment of oral cavity squamous cell carcinoma (OCSCC), surgical quality measures which are expected to affect outcomes, including the achievement of a clear margin, are surgeon-dependent but might not be invariably associated with hospital volume. Our objective was to explore surgical margin variations and survival differences of OCSCC between two highest-volume hospitals in Taiwan.Materials and methodsA total of 2009 and 1019 patients with OCSCC who were treated at the two highest-volume Taiwanese hospitals (termed Hospital 1 and Hospital 2, respectively) were included. We examined how a pathological margin <5 mm impacted patient outcomes before and after propensity score (PS) matching.ResultsThe prevalence of margins <5 mm was markedly lower in Hospital 1 than in Hospital 2 (34.5%/65.2%, p<0.0001). Compared with Hospital 2, tumor severity was higher in Hospital 1. On univariable analysis, being treated in Hospital 2 (versus Hospital 1; hazard ratio [HR] for 5-year disease-specific survival [DSS] = 1.34, p=0.0002; HR for 5-year overall survival [OS] = 1.17, p=0.0271) and margins <5 mm (versus ≥5 mm; HR for 5-year DSS = 1.63, p<0.0001; HR for 5-year OS = 1.48, p<0.0001) were identified as adverse factors. The associations of treatment in Hospital 2 and margins <5 mm with less favorable outcomes remained significant after adjustment for potential confounders in multivariable analyses, as well as in the PS-matched cohort. The 5-year survival differences between patients operated in Hospital 1 and Hospital 2 were even more pronounced in the PS-matched cohort (before PS matching: DSS, 79%/74%, p=0.0002; OS, 71%/68%, p=0.0269; after PS matching: DSS, 84%/72%, p<0.0001; OS, 75%/66%, p<0.0001). In the entire cohort, the rate of adjuvant therapy was found to be lower in patients with margins ≥5 mm than in those with margins <5 mm (42.7%/57.0%, p<0.0001).ConclusionsWithin the two highest-volume hospitals in Taiwan, patients with OCSCC with a clear margin status (≥5 mm) achieved more favorable outcomes. These results have clinical implications and show how initiatives aimed at improving the margin quality can translate in better outcomes. A clear margin status can reduce the need for adjuvant therapy, ultimately improving quality of life.
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15
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MacKay C, Turner B, Bullock M, Taylor SM, Trites J, Corsten M, Geldenhuys L, Rigby MH. Margin Sampling and Survival Outcomes in Oral Cavity and p16-Positive Oropharyngeal Squamous Cell Carcinoma. OTO Open 2022; 6:2473974X221101024. [PMID: 36160933 PMCID: PMC9500292 DOI: 10.1177/2473974x221101024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the association of margin sampling technique on survival outcomes in surgically treated cT1-2 oral cavity and oropharyngeal squamous cell carcinoma. Study Design A prospective longitudinal cohort study. Setting Tertiary care academic teaching hospital in Halifax, Nova Scotia. Methods All cases of surgically treated cT1-2 oral cavity and oropharyngeal cancer undergoing specimen-oriented margin analysis between January 1, 2017, and December 31, 2018 were analyzed. The specimen-oriented cohort was compared with a cohort of patients from January 1, 2009, to December 31, 2014, where a defect-oriented margin sampling protocol was used. Kaplan-Meier survival curves were used to estimate 2-year overall survival, disease-specific survival, local control, and recurrence-free survival rates in oral cavity and p16-positive oropharyngeal squamous cell carcinoma. Cox proportional hazards models were used to assess the effect of margin sampling method on disease-specific survival and local control. Results There was no significant association between margin sampling technique and 2-year survival outcomes for surgically treated cT1-2 oral cavity and oropharyngeal squamous cell carcinoma. In the multivariate Cox proportional hazard model, the hazard ratio (HR) of specimen-oriented sampling was not significantly different for disease-specific survival (HR, 1.32; 95% CI, 0.3032-5.727; P = .713) or local control (HR, 0.4087; 95% CI, 0.0795-2.099; P = .284). Conclusion Intraoperative margin sampling method was not associated with a significant change in 2-year survival outcomes. Despite no effect on survival outcomes, implementation of a specimen-oriented sampling method has potential for cost avoidance by decreasing the number of re-resections for positive or close margins.
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Affiliation(s)
- Colin MacKay
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
| | - Brooke Turner
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
| | - Martin Bullock
- Division of Anatomical Pathology, Department of Pathology, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
| | - S. Mark Taylor
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
| | - Jonathan Trites
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
| | - Martin Corsten
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
| | - Laurette Geldenhuys
- Division of Anatomical Pathology, Department of Pathology, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
| | - Matthew H. Rigby
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, Canada
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16
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Bhandari C, Fakhry J, Eroy M, Song JJ, Samkoe K, Hasan T, Hoyt K, Obaid G. Towards Photodynamic Image-Guided Surgery of Head and Neck Tumors: Photodynamic Priming Improves Delivery and Diagnostic Accuracy of Cetuximab-IRDye800CW. Front Oncol 2022; 12:853660. [PMID: 35837101 PMCID: PMC9273965 DOI: 10.3389/fonc.2022.853660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Fluorescence image-guided surgery (IGS) using antibody conjugates of the fluorophore IRDye800CW have revolutionized the surgical debulking of tumors. Cetuximab, an anti-epidermal growth factor receptor (EGFR) monoclonal antibody, conjugated to IRDye800CW (Cet-IRDye800) is the first molecular targeted antibody probe to be used for IGS in head and neck cancer patients. In addition to surgical debulking, Cetuximab-targeted photodynamic therapy (photoimmunotherapy; PIT) is emerging in the clinic as a powerful modality for head and neck tumor photodestruction. A plethora of other photoactivable agents are also in clinical trials for photodynamic-based therapies of head and neck cancer. Considering the vascular and stromal modulating effects of sub-therapeutic photodynamic therapy, namely photodynamic priming (PDP), this study explores the potential synergy between PDP and IGS for a novel photodynamic image-guided surgery (P-IGS) strategy. To the best of our knowledge, this is the first demonstration that PDP of the tumor microenvironment can augment the tumor delivery of full-length antibodies, namely Cet-IRDye800. In this study, we demonstrate a proof-of-concept that PDP primes orthotopic FaDu human head and neck tumors in mice for P-IGS by increasing the delivery of Cet-IRDye800 by up to 138.6%, by expediting its interstitial accumulation by 10.5-fold, and by increasing its fractional tumor coverage by 49.5% at 1 h following Cet-IRDye800 administration. Importantly, PDP improves the diagnostic accuracy of tumor detection by up to 264.2% with respect to vicinal salivary glands at 1 h. As such, PDP provides a time-to-surgery benefit by reducing the time to plateau 10-fold from 25.7 h to 2.5 h. We therefore propose that a pre-operative PDP regimen can expedite and augment the accuracy of IGS-mediated surgical debulking of head and neck tumors and reduce the time-to-IGS. Furthermore, this P-IGS regimen, can also enable a forward-looking post-operative protocol for the photodestruction of unresectable microscopic disease in the surgical bed. Beyond this scope, the role of PDP in the homogenous delivery of diagnostic, theranostic and therapeutic antibodies in solid tumors is of considerable significance to the wider community.
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Affiliation(s)
- Chanda Bhandari
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - John Fakhry
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Menitte Eroy
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Jane Junghwa Song
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Kimberley Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, United States
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Division of Health Sciences and Technology, Harvard University and Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Kenneth Hoyt
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
| | - Girgis Obaid
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX, United States
- *Correspondence: Girgis Obaid,
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17
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Brinkman D, Callanan D, Jawad H, O'Sullivan R, O'Shea R, Dias A, Feeley L, Sheahan P. Comparison of royal college of pathologists and college of american pathologists definition for positive margins in oral cavity squamous cell carcinoma. Oral Oncol 2022; 127:105797. [PMID: 35272227 DOI: 10.1016/j.oraloncology.2022.105797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/13/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathological margin assessment is an essential component of surgical management of oral cavity squamous cell carcinoma (OCSCC), however, in many studies, variable definitions of involved margins have been used. The purpose of the present study was to compare the prognostic ability of involved margins according to Royal College of Pathologists (RCPath) and College of American Pathologists (CAP) guidance. METHODS Retrospective study of 300 patients with previously untreated OCSCC undergoing definitive surgical management. Main specimen margin status was defined according to RCPath guidance and CAP guidance. "Final margin status", incorporated the results of frozen sections and extra tumour bed resections. The prognostic impact of each margin definition was studied using univariate analysis, and in multivariate models including T-stage (AJCC 8th edition), nodal status (pN+), extranodal extension (ENE), and use of adjuvant radiotherapy. RESULTS Both RCPath and CAP positive margins were associated with local recurrence (LR), disease-specific survival (DSS), and overall survival (OS) on univariate analysis, while final margin status was associated with LR and DSS, but not OS. On multivariate analysis, only CAP positive main specimen margin status was independently associated with LR (odds ratio 2.44, 95% CI 1.37, 4.34), DSS (odds ratio 2.28, 95% CI 1.31, 3.82), and OS (odds ratio 1.59, 95% CI 1.04, 2.42). CONCLUSIONS Involved main specimen margin as defined by CAP guidance has the advantage of being an independent prognosticator of LR and survival in our cohort.
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Affiliation(s)
- David Brinkman
- Dept of Otolaryngology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Deirdre Callanan
- Dept of Otolaryngology, South Infirmary Victoria University Hospital, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Ireland
| | - Hadeel Jawad
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - Ryan O'Sullivan
- Dept of Otolaryngology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Ross O'Shea
- Dept of Otolaryngology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Andrew Dias
- Dept of Otolaryngology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Linda Feeley
- Department of Pathology, Cork University Hospital, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Ireland
| | - Patrick Sheahan
- Dept of Otolaryngology, South Infirmary Victoria University Hospital, Cork, Ireland; Department of Surgery, University College Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Ireland.
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18
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Lauwerends LJ, Abbasi H, Bakker Schut TC, Van Driel PBAA, Hardillo JAU, Santos IP, Barroso EM, Koljenović S, Vahrmeijer AL, Baatenburg de Jong RJ, Puppels GJ, Keereweer S. The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles. Eur J Nucl Med Mol Imaging 2022; 49:2364-2376. [PMID: 35102436 PMCID: PMC9165240 DOI: 10.1007/s00259-022-05705-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/23/2022] [Indexed: 01/09/2023]
Abstract
A clear margin is an important prognostic factor for most solid tumours treated by surgery. Intraoperative fluorescence imaging using exogenous tumour-specific
fluorescent agents has shown particular benefit in improving complete resection of tumour tissue. However, signal processing for fluorescence imaging is complex, and fluorescence signal intensity does not always perfectly correlate with tumour location. Raman spectroscopy has the capacity to accurately differentiate between malignant and healthy tissue based on their molecular composition. In Raman spectroscopy, specificity is uniquely high, but signal intensity is weak and Raman measurements are mainly performed in a point-wise manner on microscopic tissue volumes, making whole-field assessment temporally unfeasible. In this review, we describe the state-of-the-art of both optical techniques, paying special attention to the combined intraoperative application of fluorescence imaging and Raman spectroscopy in current clinical research. We demonstrate how these techniques are complementary and address the technical challenges that have traditionally led them to be considered mutually exclusive for clinical implementation. Finally, we present a novel strategy that exploits the optimal characteristics of both modalities to facilitate resection with clear surgical margins.
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Affiliation(s)
- L J Lauwerends
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - H Abbasi
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands.,Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - T C Bakker Schut
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - P B A A Van Driel
- Department of Orthopedic Surgery, Isala Hospital, Zwolle, Netherlands
| | - J A U Hardillo
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - I P Santos
- Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | | | - S Koljenović
- Department of Pathology, Antwerp University Hospital/Antwerp University, Antwerp, Belgium
| | - A L Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - G J Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - S Keereweer
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
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19
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Kang CJ, Wen YW, Lee SR, Lee LY, Hsueh C, Lin CY, Fan KH, Wang HM, Hsieh CH, Ng SH, Yeh CH, Lin CH, Tsao CK, Fang TJ, Huang SF, Lee LA, Fang KH, Yen TC, Cheng NM, Tsai TY, Tai SF, Tsai CY. Surgical Margins Status and Prognosis after Resection of Oral Cavity Squamous Cell Carcinoma: Results from a Taiwanese Nationwide Registry-Based Study. Cancers (Basel) 2021; 14:cancers14010015. [PMID: 35008181 PMCID: PMC8749941 DOI: 10.3390/cancers14010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary While the prognostic role of surgical margins in oral cavity squamous cell carcinoma is well-established, the optimal cutoff values for margin status remain controversial. This study addressed this issue in a large sample of 13,768 patients included in a nationwide registry in Taiwan. The identification of the most suitable cutoff value for surgical margins was conducted using 5-year local control as the outcome of interest. On analyzing the margin status—categorized as 0, 0.1–4 and > 4 mm—the 5-year outcomes were as follows: local control, 87, 89 and 92%; disease-specific survival, 57, 76 and 81%; overall survival, 47, 67 and 74%, respectively. Collectively, these data indicate that a margin status >4 mm can be considered as adequate. Abstract (1) Background: The optimal cutoff value that maximizes the prognostic value of surgical margins in patients with resected oral cavity squamous cell carcinoma has not yet been identified. (2) Methods: Data for this study were retrieved from the Taiwan Cancer Registry Database. A total of 13,768 Taiwanese patients with oral cavity squamous cell carcinoma were identified and stratified according to different margin statuses (0, 0.1–4 and > 4 mm). The five-year local control, disease-specific survival and overall survival rates were the main outcome measures. (3) Results: The 5-year local control, disease-specific survival and overall survival rates of patients with close margins (0 and 0.1–4 mm) were significantly lower than those observed in patients with clear margins (> 4 mm; all p values < 0.001). In multivariate analysis, margin status, depth of invasion and extra-nodal extension were identified as independent adverse prognostic factors for 5-year local control. (4) Conclusions: A thorough assessment of surgical margins can provide a reliable prognostic prediction in patients with OCSCC. This has potential implications for treatment approaches tailored to the individual level. The achievement of clear margins (>4 mm) should be considered a key surgical goal to improve outcomes in this patient group.
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Affiliation(s)
- Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-J.K.); (T.-J.F.); (S.-F.H.); (L.-A.L.); (K.-H.F.); (T.-Y.T.); (S.-F.T.)
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Medical College of Chang Gung University, Taoyuan 333, Taiwan;
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shu-Ru Lee
- Research Service Center for Health Information, Chang Gung University, Taoyuan 333, Taiwan;
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (L.-Y.L.); (C.H.)
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (L.-Y.L.); (C.H.)
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.L.); (K.-H.F.)
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-Y.L.); (K.-H.F.)
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (H.-M.W.); (C.-H.H.)
| | - Chia-Hsun Hsieh
- Department of Medical Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (H.-M.W.); (C.-H.H.)
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (S.-H.N.); (C.-H.Y.)
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (S.-H.N.); (C.-H.Y.)
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-K.T.)
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-K.T.)
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-J.K.); (T.-J.F.); (S.-F.H.); (L.-A.L.); (K.-H.F.); (T.-Y.T.); (S.-F.T.)
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-J.K.); (T.-J.F.); (S.-F.H.); (L.-A.L.); (K.-H.F.); (T.-Y.T.); (S.-F.T.)
| | - Li-Ang Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-J.K.); (T.-J.F.); (S.-F.H.); (L.-A.L.); (K.-H.F.); (T.-Y.T.); (S.-F.T.)
| | - Ku-Hao Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-J.K.); (T.-J.F.); (S.-F.H.); (L.-A.L.); (K.-H.F.); (T.-Y.T.); (S.-F.T.)
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (T.-C.Y.); (N.-M.C.)
| | - Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (T.-C.Y.); (N.-M.C.)
| | - Tsung-You Tsai
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-J.K.); (T.-J.F.); (S.-F.H.); (L.-A.L.); (K.-H.F.); (T.-Y.T.); (S.-F.T.)
| | - Shiao-Fwu Tai
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan; (C.-J.K.); (T.-J.F.); (S.-F.H.); (L.-A.L.); (K.-H.F.); (T.-Y.T.); (S.-F.T.)
| | - Chi-Ying Tsai
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan 333, Taiwan
- Correspondence:
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20
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Ferrari M, Taboni S, Carobbio ALC, Buffoli B, Rampinelli V, Mattavelli D, Schreiber A, Verzeletti V, Ravanelli M, Daly MJ, Chan HHL, Sahovaler A, Franz L, Gualtieri T, Rezzani R, Maroldi R, Signoroni A, Deganello A, Irish JC, Nicolai P. Development of a cadaveric head and neck cancer model and three-dimensional analysis of margins in surgical navigation-aided ablations. Eur J Surg Oncol 2021; 48:1235-1242. [PMID: 34916084 DOI: 10.1016/j.ejso.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The adequacy of the surgical resection is the main controllable variable that is in the hands of the surgical team. There exists an unmet need to increase the rate of negative margins, particularly in cancers invading the craniofacial area. The study aimed 1) at developing a gross tumor model to be utilized for research, educational, and training purposes and 2) establishing the 3-dimensional relationship between the outer surface of the surgical specimen and tumor surface and test the effect of guiding ablations on cadavers with surgical navigation (SN). MATERIAL AND METHODS Seven cadaver heads were employed to create 24 craniofacial tumor models. Simulation of tumor resections was performed by 8 surgeons. Fourteen and 10 resections were performed with and without SN-guidance, respectively. Gross specimens underwent computed tomography and 3-dimensional analysis through dedicated software. Task load was assessed through a validated questionnaire. Tumor model reliability was studied based on visual analogue scale rate by surgeons and radiologists. RESULTS SN reduced the rate of margin involvement, particularly by decreasing the percentage of the gross specimen outer surface involvement in areas uncovered by normal bony structures. The workload of SN-aided ablations was found to be medium-to-somewhat-high. Tumor model reliability was deemed satisfactory except for the extension to bony structures. CONCLUSIONS A gross tumor model for head and neck cancers involving the craniofacial area was developed and resulted satisfactorily reliable from both a surgical and radiologic standpoint. SN reduced the rate of margin involvement, particularly by improving delineation of bone-uncovered areas.
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Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea L C Carobbio
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Vincenzo Verzeletti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Head & Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Leonardo Franz
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Tommaso Gualtieri
- Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Alberto Signoroni
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy
| | - Jonathan C Irish
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy
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21
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Liao CT, Wen YW, Lee SR, Ng SH, Liu TW, Tsai ST, Tsai MH, Lin JC, Chien CY, Lou PJ, Wang CP, Chu PY, Leu YS, Tsai KY, Terng SD, Chen TM, Wang CH, Chen WC, Lee LY, Lin CY, Wang HM, Fang TJ, Huang SF, Kang CJ, Chang KP, Yen TC, Yang LY, Lin CH. Clinical Outcomes of Taiwanese Patients with Resected Oral Cavity Squamous Cell Carcinoma Who Underwent Reconstruction with Free Versus Local Flaps. Ann Surg Oncol 2021; 29:1130-1140. [PMID: 34668119 DOI: 10.1245/s10434-021-10524-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 07/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND We sought to compare the clinical outcomes of Taiwanese patients with resected oral cavity squamous cell carcinoma (OCSCC) who underwent reconstruction with free versus local flaps. METHODS From 2011 to 2017, we examined 8646 patients with first primary OCSCC who received surgery either with or without adjuvant therapy. Of these patients, 7297 and 1349 received free and local flap reconstruction, respectively. Two propensity score-matched groups of patients who underwent free versus local flap (n = 1268 each) reconstructions were examined. Margin status was not included as a propensity score-matched variable. RESULTS Compared with local flaps, patients who received free flaps had a higher prevalence of the following variables: male sex, age < 65 years, pT3-4, pN1-3, p-Stage III-IV, depth ≥ 10 mm, margin > 4 mm, extranodal extension (ENE), and adjuvant therapy (all p < 0.0001). Multivariable analysis identified the reconstruction method (local vs. free flaps, only overall survival [OS]), age ≥ 65 years, pT3-4, pN1-3, p-Stage III-IV, depth ≥ 10 mm (only OS), margins ≤ 4 mm, and ENE as independent adverse prognosticators for disease-specific survival (DSS) and OS. The results of propensity score-matched analyses revealed that, compared with free flaps, patients who underwent local flap reconstruction showed less favorable 5-year DSS (hazard ratio [HR] 1.26, 82%/77%; p = 0.0100) and OS (HR 1.21, 73%/68%; p = 0.0079). CONCLUSIONS After adjusting for covariates using multivariate models, and also by propensity score modeling, OCSCC patients who underwent free flap reconstruction showed a higher frequency of clear margins and a significant survival advantage compared with those who received local flaps.
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Affiliation(s)
- Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Ru Lee
- Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
| | - Sen-Tien Tsai
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Shing Leu
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Yang Tsai
- Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Shyuang-Der Terng
- Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Tsung-Ming Chen
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Hsu Wang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wen-Cheng Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
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22
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Patel V, Galloway TJ, Liu JC. The impact of positive margin on survival in oral cavity squamous cell carcinoma. Oral Oncol 2021; 122:105499. [PMID: 34509101 DOI: 10.1016/j.oraloncology.2021.105499] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/21/2021] [Accepted: 08/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Positive margins are known to impact survival in oral cavity squamous cell carcinoma (OCSCC). We aimed to determine the impact of positive margins on survival and whether radiation improves survival following positive margins. METHODS Data was obtained from the National Cancer Database and included patients with cT1T2N0 OCSCC. Survival outcomes were assessed via log-rank test. Cox-regression analysis was performed to determine if positive margins or radiation, when applicable, correlated with survival after accounting for covariates. RESULTS Positive margin patients had worse overall survival compared to negative margin control (HR = 1.76, p < 0.001) and reduced survival by 13%. On multivariate analysis, positive margins correlated with survival (HR = 1.60, p < 0.001). Radiation did not improve survival in positive margin patients (HR = 0.99, p = 0.55). CONCLUSIONS Patients with positive margins have an 11-15% worse overall survival. Radiation does not appear to impact survival in patients with a positive margin.
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23
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Kang CJ, Tsai CY, Lee LY, Lin CY, Yang LY, Cheng NM, Hsueh C, Fan KH, Wang HM, Hsieh CH, Ng SH, Yeh CH, Lin CH, Tsao CK, Fang TJ, Huang SF, Lee LA, Fang KH, Wang YC, Lin WN, Hsin LJ, Yen TC, Liao CT. Prognostic stratification of patients with AJCC 2018 pStage IVB oral cavity cancer: Should pT4b and pN3 disease be reclassified? Oral Oncol 2021; 119:105371. [PMID: 34174527 DOI: 10.1016/j.oraloncology.2021.105371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES pStage IVB oral cavity squamous cell carcinoma (OCSCC) is defined as either pT4b or pN3 disease. We sought to devise an improved prognostic stratification of this patient group. METHODS Between December 2003 and January 2018, we retrospectively reviewed the clinical records of 1331 consecutive patients with OCSCC who received tumor excision and neck dissection. The number of patients with pT4a/pT4b, pT1N3b/pT2N3b/pT3N3b/pT4N3b, and pStage IVA/IVB was 370/83, 3/49/42/142, and 332/295, respectively. RESULTS The 5-year rates of disease-free survival (DFS) and disease-specific survival (DSS) for patients with pT4a/pT4b disease were 64%/63% (p = 0.973) and 72%/69% (p = 0.672), respectively. The 5-year DFS and DSS rates for patients with pT1N3b/pT2N3b/pT3N3b/pT4N3b disease were 67%/65%/40%/42% (p < 0.001; pT1-2N3b versus pT3-4N3b, p = 0.002) and 100%/68%/45%/49% (p < 0.001; pT1-2N3b versus pT3-4N3b, p = 0.002), respectively. We devised a new definition for pStage IV by considering patients with pT4bN0-2 and pT1-2N3b diseases as pStage-IVA. The number of patients with pStage IVA/IVB (pT3-4N3b) was 443/184. The 5-year rates of AJCC pStage IVA/IVB and the newly proposed pStage IVA/IVB (pT3-4N3b) were as follows: DFS, 74%/52% and 72%/42%; DSS, 83%/58% and 81%/47%; respectively, all p value < 0.001. CONCLUSIONS The clinical outcomes of pT4b and pT4a OCSCC are similar. However, patients with pT3-4N3b disease have a less favorable 5-year prognosis compared with cases with pT1-2N3b. In light of the unfavorable outcomes, pT3-4N3b disease should continue to be classified as pStage IVB. Conversely, pT4bN0-2 and pT1-2N3b diseases portend a less adverse prognosis and should therefore be downstaged to pStage IVA.
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Affiliation(s)
- Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chi-Ying Tsai
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Particle Physics and Beam Delivery Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Lan-Yan Yang
- Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Ang Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ku-Hao Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Chien Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wan-Ni Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Jen Hsin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
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Steele P, McMahon J, Dickson K, Zubair F, Puglia F, McMahon G, Wales C, McCaul J, Ansell M, Hislop S, Thomson E, Subramaniam S. Applying the British Association of Oral and Maxillofacial Surgeons quality outcomes metrics to a UK oncology and reconstructive surgery service - benchmarking the data. Br J Oral Maxillofac Surg 2021; 59:1079-1084. [PMID: 34275677 DOI: 10.1016/j.bjoms.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/15/2022]
Abstract
The British Association of Oral and Maxillofacial Surgery is soon to implement the Quality Outcomes in Oral in Maxillofacial Surgery (QOMS) to provide a platform for quality management across the specialty in the UK. The initial oncology and reconstruction audits for QOMS involves data collection on specific procedures and metrics. The aim of this report is to determine their appropriateness using extant audit datasets in our institution that overlap substantially with the QOMS audits. Pre-existing datasets comprising information on patients treated for oral cavity SCC with curative intent were analysed. Data on surgical margins, lymphadenectomy lymph node yield, delay between surgery and adjuvant radiotherapy, duration of hospital stay, and complications including flap failures were analysed. All statistical analyses were performed with SPSS 25. Run charts describing longitudinal data were generated using SPC for Excel version 6. Twenty three patients (3.1%) of 701 resections had a positive surgical margin reported. Seventeen (4.3%) of patients had less than 18 LNs in the ND specimen analysed. Mean time to start date of adjuvant therapy was 62 days. Only 9% of patients commenced adjuvant therapy within 6 weeks. The median duration of stay was 18 days. In 1153 free flaps a failure rate of 4.3% was identified. A total of 1349 complications (CD I-V) were recorded in the 1111 patients undergoing major surgery with free flap reconstruction. The QOMS selected metrics for oncology and reconstruction are clinically relevant, readily measurable, and likely to be actionable by the surgical team.
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Affiliation(s)
- P Steele
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - J McMahon
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - K Dickson
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - F Zubair
- University of Glasgow Medical School, Faculty of Life Sciences, United Kingdom.
| | - F Puglia
- BAOMS Royal College of Surgeons of England, 35/43 Lincoln's Inn Fields, London, United Kingdom.
| | - G McMahon
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - C Wales
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - J McCaul
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - M Ansell
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - S Hislop
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - E Thomson
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
| | - S Subramaniam
- Oral and Maxillofacial Surgery Department, Queen Elizabeth University Hospital Glasgow, United Kingdom.
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25
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Lyu S, Wu Z, Xie D, Long Z, Zhong R, Lei W, Cheng W, Hu J, Liu X, Xie C, Su Y. Clinical target volume design of postoperative intensity-modulated radiotherapy for major salivary gland tumours according to surgical principles: an innovative method. J Cancer Res Clin Oncol 2021; 148:921-930. [PMID: 33970299 DOI: 10.1007/s00432-021-03646-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND No international consensus has been reached regarding delineation of postoperative intensity-modulated radiotherapy (PO-IMRT) clinical target volumes (CTV) for major salivary gland carcinoma (SGC). The purpose of this article was to report our experience according to surgical principles. METHODS Between June 2010 and June 2018, 54 consecutive patients were enrolled. Reserved tissues around the margin of resection that were less than 5 mm from the invasive tumour edge before surgery were defined as high-risk clinical target volumes (CTV-HD), those less than 10 mm away were defined as medium-risk CTV (CTV1), and those 10-20 mm away were defined as low-risk CTV (CTV2), and were irradiated with 63-65 Gy, 59.5-61 Gy, and 45-54 Gy, respectively. Target volume distributions of reserved tissues were analysed and actuarial estimates of overall survival (OS), recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) were obtained with the Kaplan-Meier method. RESULTS In parotid gland tumours, the percentages of defined CTV-HD in the styloid process, mandibular ramus, posterior venter of the digastric muscle, carotid sheath and stylomastoid foramen reached 34.29%, 25.71%, 54.29%, 40.00%, and 37.10%, respectively. The median follow-up was 33 months (range, 5-98 months). The 3-year and 5-year Kaplan-Meier estimates of OS, RFS and DMFS were 85.4% and 77.8%, 97.4%, and 97.4%, and 82.0% and 82.0%, respectively. CONCLUSIONS It is feasible to delineate CTVs according to distances between various reserved tissues and the primary tumour edge before operation.
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Affiliation(s)
- Shaowen Lyu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zheng Wu
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Dehuan Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiqing Long
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rui Zhong
- Department of Radiation Oncology, Hainan General Hospital, Hainan Clinical Medicine Research Institution, Haikou, China
| | - Wang Lei
- VIP Department, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wanqin Cheng
- Department of Radiation Oncology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Jiang Hu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xuekui Liu
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chuanmiao Xie
- Department of Medical Imaging and Interventional Radiology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, People's Republic of China
| | - Yong Su
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Nentwig K, Unterhuber T, Wolff KD, Ritschl LM, Nieberler M. The impact of intraoperative frozen section analysis on final resection margin status, recurrence, and patient outcome with oral squamous cell carcinoma. Clin Oral Investig 2021; 25:6769-6777. [PMID: 33956217 PMCID: PMC8602179 DOI: 10.1007/s00784-021-03964-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
Background The objective of this study was to evaluate the diagnostic value of intraoperative frozen section analysis (IFSA) of tumor bed margins in patients with oral squamous cell carcinoma (OSCC). Methods This retrospective study includes 194 primary OSCC cases. The impact of intraoperative information by IFSA on final margin status, local recurrence, and disease-specific survival were analyzed. Results IFSA revealed a 50% sensitivity and a 100% specificity, with a positive and negative predictive value of 100% and 89.1%, respectively. In 19 cases, margins were rated positive by IFSA and remained positive in eight cases (42.1%), despite immediate re-resection. This constellation led to higher recurrence and lower survival rates than in cases with consecutive R0 status (each p = 0.046). Positive margins in IFSA were associated with closer final margins (p = 0.022) and early recurrences (p = 0.050). Conclusions Achieving instant R0 status has a crucial impact on disease recurrence and patient survival. IFSA falls short to ensure secure definite surgical margins. Thus, improved intraoperative diagnostic information on the location and extent of OSCC could support patient treatment. Clinical relevance Considering that patient survival has not improved despite progress in surgical and adjuvant therapy, the process and outcome of IFSA was scrutinized as one part of the treatment concept.
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Affiliation(s)
- Katharina Nentwig
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Tobias Unterhuber
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Nieberler
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
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Tomblinson CM, Fletcher GP, Hu LS, Mi L, Howard BE, Nagel TH, Hinni ML, Hoxworth JM. Determination of posterolateral oropharyngeal wall thickness and the potential implications for transoral surgical margins in tonsil cancer. Head Neck 2021; 43:2185-2192. [PMID: 33780072 DOI: 10.1002/hed.26693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Margins in transoral surgery for tonsil cancer can be limited by oropharyngeal wall thickness (OWT), but the normal range is not well established. METHODS In 240 noncancer subjects, OWT was measured bilaterally in the vicinity of the tonsils with MRI. Statistical analysis was performed to assess for interaction of age, sex, location, and obesity. RESULTS Mean(SD) OWT measured 3.4(0.6) mm posteriorly, 3.7(2.0) mm between the styloglossus and stylopharyngeus, and 5.3(0.8) mm laterally. OWT was greater in men, correlated with obesity, decreased posteriorly and laterally in the 60-80 versus 40-59 year age groups, and increased when styloglossus/stylopharyngeus were closer. OWT was <5 mm in 36.7%-97.9% of locations, with the largest percentage below this threshold located posteriorly. CONCLUSIONS OWT is frequently <5 mm, particularly in the posterior and intermuscular areas, suggesting that a smaller surgical margin may need to be accepted in transoral tonsil cancer surgery for anatomic reasons.
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Affiliation(s)
| | | | - Leland S Hu
- Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
| | - Lanyu Mi
- Department of Biostatistics, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Thomas H Nagel
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
| | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Phoenix, Arizona, USA
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28
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Lee YJ, Krishnan G, Nishio N, van den Berg NS, Lu G, Martin BA, van Keulen S, Colevas AD, Kapoor S, Liu JTC, Rosenthal EL. Intraoperative Fluorescence-Guided Surgery in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2021; 131:529-534. [PMID: 33593036 DOI: 10.1002/lary.28822] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023]
Abstract
The rate of positive margins in head and neck cancers has remained stagnant over the past three decades and is consistently associated with poor overall survival. This suggests that significant improvements must be made intraoperatively to ensure negative margins. We discuss the important role of fluorescence imaging to guide surgical oncology in head and neck cancer. This review includes a general overview of the principles of fluorescence, available fluorophores used for fluorescence imaging, and specific clinical applications of fluorescence-guided surgery, as well as challenges and future directions in head and neck surgical oncology. Laryngoscope, 131:529-534, 2021.
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Affiliation(s)
- Yu-Jin Lee
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Giri Krishnan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A.,Department of Otolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Naoki Nishio
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Nynke S van den Berg
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Guolan Lu
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Stan van Keulen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Alexander D Colevas
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Shrey Kapoor
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Jonathan T C Liu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, U.S.A.,Department of Bioengineering, University of Washington, Seattle, WA, U.S.A.,Department of Pathology, University of Washington, Seattle, WA, U.S.A
| | - Eben L Rosenthal
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, U.S.A.,Department of Radiology, Stanford University School of Medicine, Stanford, CA, U.S.A
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29
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Lwin TM, Hoffman RM, Bouvet M. Unique Benefits of Tumor-Specific Nanobodies for Fluorescence Guided Surgery. Biomolecules 2021; 11:311. [PMID: 33670740 DOI: 10.3390/biom11020311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 12/11/2022] Open
Abstract
Tumor-specific fluorescence labeling is promising for real-time visualization of solid malignancies during surgery. There are a number of technologies to confer tumor-specific fluorescence. Antibodies have traditionally been used due to their versatility in modifications; however, their large size hampers efficient fluorophore delivery. Nanobodies are a novel class of molecules, derived from camelid heavy-chain only antibodies, that have shown promise for tumor-specific fluorescence labeling. Nanobodies are ten times smaller than standard antibodies, while maintaining antigen-binding capacity and have advantageous features, including rapidity of tumor labeling, that are reviewed in the present report. The present report reviews special considerations needed in developing nanobody probes, the status of current literature on the use of nanobody probes in fluorescence guided surgery, and potential challenges to be addressed for clinical translation.
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Abe A, Hayashi H, Ishihama T, Furuta H. Prognostic impact of the prognostic nutritional index in cases of resected oral squamous cell carcinoma: a retrospective study. BMC Oral Health 2021; 21:40. [PMID: 33482792 PMCID: PMC7821535 DOI: 10.1186/s12903-021-01394-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The systemic inflammatory response and nutritional status of patients with malignant tumors are related to postoperative results. We examined the usefulness of the prognostic nutritional index (PNI) as a prognostic tool in patients with oral squamous cell carcinoma who underwent radical surgery. METHODS From 2008 to 2019, 102 patients (73 males, 29 females; age, 65.6 ± 9.8 years) who visited our hospital and underwent surgical therapy were included in this study. The endpoint was the total survival period, and the evaluation markers included the lymphocyte count and albumin level in peripheral blood obtained 4 weeks preoperatively, age, sex, alcohol consumption, smoking history, site of the tumor, pathological stage, and surgery status. The PNI was calculated using serum albumin levels and the peripheral blood lymphocyte count. The relationship between the PNI and patient characteristics were analyzed using Fisher's exact test. The Kaplan-Meier method was used to evaluate the survival rate. The survival periods were compared using the log-rank method. We evaluated the prognostic factors for overall survival (OS) and disease-free survival (DFS) in a logistic regression model. RESULTS The tumor sites included the maxilla (n = 12), buccal mucosa (n = 11), mandible (n = 17), floor of the mouth (n = 9), and tongue (n = 53). The number of patients with stage I, II, III, and IV oral cancers was 28 (27.5%), 34 (27.5%), 26 (33.3%), and 14 (13.7%), respectively. During the observation period, 21 patients died of head and neck cancer. The optimal cut-off PNI value was 42.9, according to the receiver operating characteristic analysis. The proportion of patients with a short OS was lower in those with PNI higher than 42.9, and the 5-year OS in patients with PNI higher and lower than the cut-off value was 62.3% and 86.0%, respectively (P = 0.0105). CONCLUSIONS The OS of patients with PNI < 42.9 was lower than that of patients with PNI ≥ 42.9. The PNI, which is a preoperative head-to-foot inflammatory marker, can help in estimating the prognosis of oral cancer.
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Affiliation(s)
- Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Syounen-cho Nakagawa-ku, Nagoya, 454-8502, Japan.
| | - Hiroki Hayashi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Syounen-cho Nakagawa-ku, Nagoya, 454-8502, Japan
| | - Takanori Ishihama
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Syounen-cho Nakagawa-ku, Nagoya, 454-8502, Japan
| | - Hiroshi Furuta
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, 4-66 Syounen-cho Nakagawa-ku, Nagoya, 454-8502, Japan
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Nishio N, van den Berg NS, van Keulen S, Martin BA, Fakurnejad S, Zhou Q, Lu G, Chirita SU, Kaplan MJ, Divi V, Colevas AD, Rosenthal EL. Optimal Dosing Strategy for Fluorescence-Guided Surgery with Panitumumab-IRDye800CW in Head and Neck Cancer. Mol Imaging Biol 2020; 22:156-64. [PMID: 31054001 DOI: 10.1007/s11307-019-01358-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify the optimal dosing strategy for fluorescence-guided surgery in patients with head and neck squamous cell carcinoma, we conducted a dose-ranging study evaluating the anti-epidermal growth factor receptor (EGFR) therapeutic antibody, panitumumab, that was fluorescently labeled with the near-infrared dye IRDye800CW. PROCEDURES Patients (n = 24) received either 0.5 or 1.0 mg/kg panitumumab-IRDye800CW in the weight-based dosing group or 25 or 50 mg panitumumab-IRDye800CW in the fixed dosing group. Following surgery, whole primary specimens were imaged in a closed-field device and the mean fluorescence intensity (MFI) and tumor-to-background ratio (TBR) were assessed. Clinical variables, including dose, time of infusion-to-surgery, age, unlabeled dose, gender, primary tumor site, and tumor size, were analyzed to evaluate the factors affecting the fluorescence intensity in order to identify the optimal dose for intraoperative fluorescence imaging. RESULTS A total of 24 primary tumor specimens were imaged and analyzed in this study. Although no correlations between TBR and dose of panitumumab-IRDye800CW were found, there were moderate-strong correlations between the primary tumor MFI and panitumumab-IRDye800CW dose for fixed dose (mg) (R2 = 0.42) and for dose/weight (mg/kg) (R2 = 0.54). Results indicated that the optimal MFI was at approximately 50 mg for fixed dose and 0.75 mg/kg for dose/weight. No significant differences were found for the primary tumor MFI and TBRs between the weight-based dosing and the fixed dosing groups. MFIs significantly increased when the infusion-to-surgery window was reduced to within 2 days (vs. 3 days or more, p < 0.05). CONCLUSIONS Antibody-based imaging for surgical resection is under investigation in multiple clinical trials. Our data suggests that a fixed dose of 50 mg is an appropriate diagnostic dose for successful surgical fluorescence imaging.
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Algadi HH, Abou-Bakr AA, Jamali OM, Fathy LM. Toluidine blue versus frozen section for assessment of mucosal tumor margins in oral squamous cell carcinoma. BMC Cancer 2020; 20:1147. [PMID: 33238944 DOI: 10.1186/s12885-020-07644-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When the resected specimen is sent for intraoperative margin assessment, all margins are grossly checked, and selected margins undergo a frozen section (FS) examination. Therefore, there is a possibility of sampling error. This study evaluated the effectiveness of using toluidine blue (TB) as an intraoperative triage screening tool to detect positive mucosal margins of the resected specimens of oral squamous cell carcinoma (OSCC) and serve as a guide for FS sampling. METHODS Surgical samples of 30 consecutive patients with biopsy-proven OSCC were included in the study. A total of 140 mucosal margins were analyzed intraoperatively by TB and FS, the results were compared with the final histopathology. RESULTS Of the 140 examined mucosal tumor margins, 14 stained positives with TB, six were true-positives, eight were false-positives, and there were no false-negatives, as confirmed by final histopathology of the same margins. The diagnostic performance measures were sensitivity 100.0%; specificity 94.0%; positive predictive value (PPV) 42.9%; negative predictive value (NPV) 100.0%; and accuracy 94.3% (95% CI: 89.0-97.5%). For FS, there were three true-positives, three false-negatives, and no false-positives. The diagnostic performance measures were sensitivity 50.0%; specificity 100.0%; PPV 100.0%; NPV 97.8%; and accuracy 97.9% (95% CI: 93.9-99.6%). CONCLUSION TB is less specific but more sensitive than FS for detecting positive mucosal margins of resected OSCC. Screening the tumor mucosal margins with TB before FS sampling may help identify more tumor-bearing margins. TRIAL REGISTRATION This trial was registered at ClinicalTrials.gov. Registration number: NCT03554967 . Registration date: June 13, 2018.
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McMahon J, Steele P, Kyzas P, Pollard C, Jampana R, MacIver C, Subramaniam S, Devine J, Wales C, McCaul J. Operative tactics in floor of mouth and tongue cancer resection - the importance of imaging and planning. Br J Oral Maxillofac Surg 2020; 59:5-15. [PMID: 33143945 DOI: 10.1016/j.bjoms.2020.08.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
Complete tumour resection (R0 margin) is an axiom of surgical oncology. Oral cancer ablation is challenging, due to anatomical, functional, and aesthetic considerations. R0 margin is strongly linked to better survival outcomes with great variation in the R0 % across units. This is commonly attributed to disease biology. Without disputing the importance of biological characteristics, we contend that image-based anatomical surgical planning has an important role to play in achieving complete resection. Here, we present our approach utilising cross-sectional imaging, anatomical characteristics and spatial awareness in planning resections for floor of mouth (FOM) and oral tongue cancers. We highlight the challenge of controlling the deep tumour margin lingual to mandible due to anterior vector constraints and emphasise the importance of resecting the genial muscles in a planned fashion and that any rim resection should be obliquely sagittal. In resecting lateral FOM tumours, assessing extension to the parapharyngeal fat is crucial; and mandibular rim resection at a sagittal plane below the mylohyoid line is often required. Assessing the proximity of the contralateral neurovascular pedicle, pre-epiglottic space and hyoid bone are crucial parameters to determine the extent of tongue tumour resection. Our cohort included 173 patients with FOM SCC and 299 patients with tongue SCC. Six patients (3.5%) from the FOM group and eight patients (3%) from the tongue group had involved (R1) margins following surgery. This was associated with local relapse (p<0.05). In conclusion, we demonstrate that image-based planning can aid achieving R0 resections and reduce disease relapse.
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Affiliation(s)
- J McMahon
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - P Steele
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - P Kyzas
- Dept of OMFS/H&N Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals Trust, BB2 3HH.
| | - C Pollard
- Dept of Neuroradiology, Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF.
| | - R Jampana
- Dept of Neuroradiology, Institute of Neurosciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF.
| | - C MacIver
- Maxillofacial/Head and Neck Unit, SSMC Hospital in partnership with Mayo Clinic, Abu Dhabi.
| | - S Subramaniam
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - J Devine
- Maxillofacial/Head and Neck Unit, SSMC Hospital in partnership with Mayo Clinic, Abu Dhabi.
| | - C Wales
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
| | - J McCaul
- Dept of Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF.
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Bungum A, Jensen JS, Jakobsen KK, Christensen A, Grønhøj C, von Buchwald C. Impact of surgical resection margins less than 5 mm in oral cavity squamous cell carcinoma: a systematic review. Acta Otolaryngol 2020; 140:869-875. [PMID: 32564643 DOI: 10.1080/00016489.2020.1773532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: The width of the surgical resection margin impacts recurrence and survival in oral cavity squamous cell carcinoma (OSCC). The most commonly used definition of a clear margin is one larger than 5 mm, although due to anatomical restrictions to e.g. bone or vessels, this size is not always feasible. Margins less than 5 mm affect postsurgical strategies and prognoses, and further knowledge of margins smaller than 5 mm is needed.Aims/objectives: We aimed to systematically review the literature on the impact of surgical resection margins less than 5 mm addressing recurrence and survival in OSCC.Methods/materials: A systematic literature search was performed in the PubMed and EMBASE databases identifying studies regardless of publication date that examined margin less than 5 mm, with or without a comparison to size of 5 mm or greater, in patients with OSCC. We assessed the impact on recurrence and survival.Results: We identified six studies (n = 1514 patients); all studies, investigated recurrence, and three (n = 768 patients) evaluated survival. The studies had noteworthy variability in, e.g. follow-up times, anatomical sublocations, T- and N-stage classifications, and outcome measures. Five studies (n = 1387 patients) reported that margins smaller than 5 mm would be safe and would not affect survival or recurrence negatively compared to their own data on larger margins. One study reported that a clear resection margin greater than five mm was necessary to ensure optimal outcomes.Conclusion/significance: The literature showed significant bias and risk issues. In five of the included studies with 1387 patients, we found in selected cases, where margins larger than 5 mm are not possible, a tendency regarding resection margins less than 5 mm to be sufficient for the surgical treatment of patients with primary OSCC. However, the data is insufficient to enable altered recommendations of resection margins in patients with primary OSCC.
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Affiliation(s)
- Alexandra Bungum
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Schmidt Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Christensen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Lau L, Eu D, Loh T, Ahmed Q, Lim CM. Histopathologic prognostic indices in tongue squamous cell carcinoma. Eur Arch Otorhinolaryngol 2021; 278:2461-71. [PMID: 32897441 DOI: 10.1007/s00405-020-06329-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Consistent prognosticators are needed to guide adjuvant treatment in tongue squamous cell carcinoma (SCC). We validate the prognostic significance of histopathologic parameters in surgically treated tongue SCC. METHODS Archival specimens of 88 consecutive patients who were treated surgically for tongue SCC from 2003 to 2016 were re-analyzed by one pathologist. Patient records were retrospectively reviewed. Prognosticators of recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) were identified using multivariate analysis. RESULTS Tumor depth of invasion (DOI) > 6 mm (OR 4.76; 95%CI 1.22-18.5; p = 0.024) and lymphovascular invasion (OR 5.61; 95%CI 1.00-31.5; p = 0.05) were independent predictors of nodal metastases. The overall 5-year RFS, OS and DSS were 70%, 82% and 84% respectively. Positive margins predicted poor RFS (HR 3.91; 95%CI 1.58-9.65; p = 0.003) and local recurrence-free survival (HR 4.96; 95%CI 1.36-18; p = 0.015). Presence of nodal metastases (HR 5.03; 95%CI 1.73-14.6; p = 0.003), tumor DOI > 6 mm (HR 9.91; 95%CI 1.26-78.0; p = 0.029) and positive margins (HR 8.26; 95%CI 2.75-24.8; p < 0.001) were independent predictors of poor OS. Presence of nodal metastases (HR 3.87; 95%CI 1.17-12.8; p = 0.027) and positive margins (HR 12.3; 95%CI 3.54-42.9; p < 0.001) also independently predicted poor DSS. CONCLUSION Margins' status was the only independent predictor of local recurrence. Tumor DOI, nodal and margin status were key prognosticators of survival and may determine the necessity for adjuvant therapy.
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Singh A, Mishra A, Singhvi H, Sharin F, Bal M, Laskar SG, Prabhash K, Chaturvedi P. Optimum surgical margins in squamous cell carcinoma of the oral tongue: Is the current definition adequate? Oral Oncol 2020; 111:104938. [PMID: 32739791 DOI: 10.1016/j.oraloncology.2020.104938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the impact of progressively increasing margin distances on locoregional recurrence-free survival (LFRS) and determine an optimum margin distance for tongue cancers. METHODS We retrospectively reviewed the records of patients with squamous carcinoma of oral tongue, surgically treated between January 2012 and December 2013. The patients were divided based on ROC derived optimal distance and differences in LRFS per millimeter: margin distances with no significant difference in LRFS starting from 0 mm onwards (Group-I), from upper limit of Group-I to ROC cut-off (Group-II), and all values above it (Group-III). Group-II and III were matched for clinicopathologic factors and type of adjuvant therapy received. RESULTS 451 patients had a median LRFS of 29.4 months that included 32.1% of Stage I/II and 51.7% of Stage III/IV. Group-I consisted of 0--2.0 mm (2.0-2.1 mm (p-0.029)), Group-II form 2.1 to 7.5 (7.5-7.6 mm (p-0.042)) and Group-III were ≥ 7.6 mm. In the matched group, each millimeter increase in margin provided a 3.67 months survival advantage from 2.1 mm to 7.5 mm while a substantial advantage of 15 months was seen from 7.5 to 7.6 mm. No significant advantage was gained in LRFS when the margin was increased by a millimeter from the cut-off value (p-0.602). Among the patients that were not prescribed any adjuvant therapy, a significantly better LRFS was observed in Group III than Group II (HR-3.01, p-value = 0.002). CONCLUSION Based on these results, adequacy of surgical margins should be re-considered for oral tongue cancers.
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Affiliation(s)
- Arjun Singh
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, India
| | - Aseem Mishra
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, India
| | - Hitesh Singhvi
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, India
| | - Florida Sharin
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre and HBNI, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre and HBNI, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, India.
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Stepan KO, Li MM, Kang SY, Puram SV. Molecular margins in head and neck cancer: Current techniques and future directions. Oral Oncol 2020; 110:104893. [PMID: 32702629 DOI: 10.1016/j.oraloncology.2020.104893] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
Complete tumor extirpation with clear surgical margins remains a central tenet of oncologic head and neck surgery. Rates of locoregional recurrence and survival are both significantly worse when clear margins are unable to be obtained. Current clinical practice relies on the use of frozen sections intra-operatively, followed by traditional histopathologic analysis post-operatively to assess the surgical margin. However, with improved understanding of tumor biology and advances in technology, new techniques have emerged to analyze margins at a molecular level. Such molecular margin analysis interrogates tissue for genetic, epigenetic, or proteomic changes that may belie tumor presence or aggressive features not captured by standard histopathologic techniques. Intra-operatively, this information may be used to guide resection, while post-operatively, it may help to stratify patients for adjuvant treatment. In this review, we summarize the current state of molecular margin analysis and describe directions for future research.
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Affiliation(s)
- Katelyn O Stepan
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, 4921 Parkview Pl, St. Louis, MO 63110, USA
| | - Michael M Li
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University Wexner Medical Center, 410 W. 10(th) Ave, Columbus, OH, USA
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University Wexner Medical Center, 410 W. 10(th) Ave, Columbus, OH, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, 4921 Parkview Pl, St. Louis, MO 63110, USA; Department of Genetics, Washington University School of Medicine, 4921 Parkview Pl, St. Louis, MO 63110, USA.
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Fendt L, Fazzini F, Weissensteiner H, Bruckmoser E, Schönherr S, Schäfer G, Losso JL, Streiter GA, Lamina C, Rasse M, Klocker H, Kofler B, Kloss-Brandstätter A, Huck CW, Kronenberg F, Laimer J. Profiling of Mitochondrial DNA Heteroplasmy in a Prospective Oral Squamous Cell Carcinoma Study. Cancers (Basel) 2020; 12:E1933. [PMID: 32708892 PMCID: PMC7409097 DOI: 10.3390/cancers12071933] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 01/25/2023] Open
Abstract
While a shift in energy metabolism is essential to cancers, the knowledge about the involvement of the mitochondrial genome in tumorigenesis and progression in oral squamous cell carcinoma (OSCC) is still very limited. In this study, we evaluated 37 OSCC tumors and the corresponding benign mucosa tissue pairs by deep sequencing of the complete mitochondrial DNA (mtDNA). After extensive quality control, we identified 287 variants, 137 in tumor and 150 in benign samples exceeding the 1% threshold. Variant heteroplasmy levels were significantly increased in cancer compared to benign tissues (p = 0.0002). Furthermore, pairwise high heteroplasmy frequency difference variants (∆HF% > 20) with potential functional impact were increased in the cancer tissues (p = 0.024). Fourteen mutations were identified in the protein-coding region, out of which thirteen were detected in cancer and only one in benign tissue. After eight years of follow-up, the risk of mortality was higher for patients who harbored at least one ∆HF% > 20 variant in mtDNA protein-coding regions relative to those with no mutations (HR = 4.6, (95%CI = 1.3-17); p = 0.019 in primary tumor carriers). Haplogroup affiliation showed an impact on survival time, which however needs confirmation in a larger study. In conclusion, we observed a significantly higher accumulation of somatic mutations in the cancer tissues associated with a worse prognosis.
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Affiliation(s)
- Liane Fendt
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Federica Fazzini
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Hansi Weissensteiner
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Emanuel Bruckmoser
- Oral and Maxillofacial Surgeon, Private Practice, A-5020 Salzburg, Austria;
| | - Sebastian Schönherr
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Georg Schäfer
- Institute for Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, A-6020 Innsbruck, Austria;
| | - Jamie Lee Losso
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Gertraud A. Streiter
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Claudia Lamina
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Michael Rasse
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University of Innsbruck, A-6020 Innsbruck, Austria;
- Clinic for Maxillofacial Surgery, Sechenov University, Trubetskaya Str. 8 b.2, 119992 Moscow, Russia
| | - Helmut Klocker
- Division of Experimental Urology, Department of Urology, Medical University of Innsbruck, A-6020 Innsbruck, Austria;
| | - Barbara Kofler
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria;
| | - Anita Kloss-Brandstätter
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
- Carinthia University of Applied Sciences, A-9524 Villach, Austria
| | - Christian W. Huck
- Institute of Analytical Chemistry and Radiochemistry, CCB-Center for Chemistry and Biomedicine, Leopold Franzens University Innsbruck, A-6020 Innsbruck, Austria;
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, A-6020 Innsbruck, Austria; (L.F.); (F.F.); (H.W.); (S.S.); (J.L.L.); (G.A.S.); (C.L.); (A.K.-B.); (F.K.)
| | - Johannes Laimer
- University Hospital for Craniomaxillofacial and Oral Surgery, Medical University of Innsbruck, A-6020 Innsbruck, Austria;
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Baart VM, van Duijn C, van Egmond SL, Dijckmeester WA, Jansen JC, Vahrmeijer AL, Sier CFM, Cohen D. EGFR and αvβ6 as Promising Targets for Molecular Imaging of Cutaneous and Mucosal Squamous Cell Carcinoma of the Head and Neck Region. Cancers (Basel) 2020; 12:E1474. [PMID: 32516897 DOI: 10.3390/cancers12061474] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/24/2022] Open
Abstract
R0 resection is paramount in cutaneous squamous cell carcinoma (CSCC) and head and neck squamous cell carcinoma (HNSCC). However, in the setting of recurrence, immunocompromised patients, or non-keratinizing squamous cell carcinoma (SCC) with a spindle growth pattern, tumor borders are difficult, if not impossible, to determine. Fluorescence-guided surgery (FGS) aids in this differentiation. Potential targets for FGS of CSCC and HNSCC were evaluated. Most sections stained intensely for αvβ6 and epidermal growth factor receptor (EGFR) on tumor cells. Normal epithelium stained less for αvβ6 than for EGFR. In addition, soft tissue and stroma stained negative for both, allowing for clear discrimination of the soft tissue margin. Tumor cells weakly expressed urokinase plasminogen activator receptor (uPAR) while expression on stromal cells was moderate. Normal epithelium rarely expressed uPAR, resulting in clear discrimination of superficial margins. Tumors did not consistently express integrin β3, carcinoembryonic antigen, epithelial cell adhesion molecule, or vascular endothelial growth factor A. In conclusion, αvβ6 and EGFR allowed for precise discrimination of SSC at the surgically problematic soft tissue margins. Superficial margins are ideally distinguished with uPAR. In the future, FGS in the surgically challenging setting of cutaneous and mucosal SCC could benefit from a tailor-made approach, with EGFR and αvβ6 as targets.
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Luo L, Yan L, Amirshaghaghi A, Wei Y, You T, Singhal S, Tsourkas A, Cheng Z. Indocyanine Green-Coated Polycaprolactone Micelles for Fluorescence Imaging of Tumors. ACS Appl Bio Mater 2020; 3:2344-2349. [PMID: 32455339 DOI: 10.1021/acsabm.0c00091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Recently, near-infrared (NIR) fluorescent dyes such as indocyanine green (ICG) have received tremendous interest as contrast agents for use in fluorescence-guided, intraoperative cancer resection surgery. However, despite showing great promise, ICG has many shortcomings such as rapid clearance and poor tumor accumulation. To improve the selective accumulation of ICG within tumors, numerous groups have formulated ICG into nanoparticles, but these approaches can suffer from rapid leakage of ICG, use of materials that exhibit poor or incomplete excretion, or complex chemistries that are not easily amenable to scale up for clinical use. Here, we developed a simple one-step method to prepare ICG-based fluorescent micelles that are composed solely of unmodified ICG and polycaprolactone (PCL), two clinically used materials with well-characterized safety profiles. The ICG-PCL micelles are prepared via oil-in-water emulsions, and the resulting micelles exhibit a uniform size, good reproducibility, and high loading efficiency. In vivo fluorescence imaging demonstrated that the ICG-PCL micelles led to a significant improvement in the accumulation and retention of ICG, in four different tumor models, compared with free dye, making them an attractive option for image-guided surgery.
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Affiliation(s)
- Lijun Luo
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Lesan Yan
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Ahmad Amirshaghaghi
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Yulong Wei
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Tianyan You
- School of Agricultural Equipment Engineering, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Sunil Singhal
- Center for Precision Surgery, Perelman School of Medicine and Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Andrew Tsourkas
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Zhiliang Cheng
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
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Voskuil FJ, de Jongh SJ, Hooghiemstra WTR, Linssen MD, Steinkamp PJ, de Visscher SAHJ, Schepman KP, Elias SG, Meersma GJ, Jonker PKC, Doff JJ, Jorritsma-Smit A, Nagengast WB, van der Vegt B, Robinson DJ, van Dam GM, Witjes MJH. Fluorescence-guided imaging for resection margin evaluation in head and neck cancer patients using cetuximab-800CW: A quantitative dose-escalation study. Theranostics 2020; 10:3994-4005. [PMID: 32226534 PMCID: PMC7086353 DOI: 10.7150/thno.43227] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/05/2020] [Indexed: 12/13/2022] Open
Abstract
Tumor-positive resection margins are present in up to 23% of head and neck cancer (HNC) surgeries, as intraoperative techniques for real-time evaluation of the resection margins are lacking. In this study, we investigated the safety and potential clinical value of fluorescence-guided imaging (FGI) for resection margin evaluation in HNC patients. We determined the optimal cetuximab-800CW dose by quantification of intrinsic fluorescence values using multi-diameter single-fiber reflectance, single-fiber fluorescence (MDSFR/SFF) spectroscopy. Methods: Five cohorts of three HNC patients received cetuximab-800CW systemically: three single dose cohorts (10, 25, 50 mg) and two cohorts pre-dosed with 75 mg unlabeled cetuximab (15 or 25 mg). Fluorescence visualization and MDSFR/SFF spectroscopy quantification was performed and were correlated to histopathology. Results: There were no study-related adverse events higher than Common Terminology Criteria for Adverse Events grade-II. Quantification of intrinsic fluorescence values showed a dose-dependent increase in background fluorescence in the single dose cohorts (p<0.001, p<0.001), which remained consistently low in the pre-dosed cohorts (p=0.6808). Resection margin status was evaluated with a sensitivity of 100% (4/4 tumor-positive margins) and specificity of 91% (10/11 tumor-negative margins). Conclusion: A pre-dose of 75 mg unlabeled cetuximab followed by 15 mg cetuximab-800CW was considered the optimal dose based on safety, fluorescence visualization and quantification of intrinsic fluorescence values. We were able to use a lower dose cetuximab-800CW than previously described, while remaining a high sensitivity for tumor detection due to application of equipment optimized for IRDye800CW detection, which was validated by quantification of intrinsic fluorescence values.
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Kossatz S, Pirovano G, Demétrio De Souza França P, Strome AL, Sunny SP, Zanoni DK, Mauguen A, Carney B, Brand C, Shah V, Ramanajinappa RD, Hedne N, Birur P, Sihag S, Ghossein RA, Gönen M, Strome M, Suresh A, Molena D, Ganly I, Kuriakose MA, Patel SG, Reiner T. Validation of the use of a fluorescent PARP1 inhibitor for the detection of oral, oropharyngeal and oesophageal epithelial cancers. Nat Biomed Eng 2020; 4:272-285. [PMID: 32165735 PMCID: PMC7136849 DOI: 10.1038/s41551-020-0526-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/06/2020] [Indexed: 11/09/2022]
Abstract
For oral, oropharyngeal and oesophageal cancer, the early detection of tumours and of residual tumour after surgery are prognostic factors of recurrence rates and patient survival. Here, we report the validation, in animal models and a human, of the use of a previously described fluorescently labelled small-molecule inhibitor of the DNA repair enzyme poly(ADP-ribose) polymerase 1 (PARP1) for the detection of cancers of the oral cavity, pharynx and oesophagus. We show that the fluorescent contrast agent can be used to quantify the expression levels of PARP1 and to detect oral, oropharyngeal and oesophageal tumours in mice, pigs and fresh human biospecimens when delivered topically or intravenously. The fluorescent PARP1 inhibitor can also detect oral carcinoma in a patient when applied as a mouthwash, and discriminate between fresh biopsied samples of the oral tumour and the surgical resection margin with more than 95% sensitivity and specificity. The PARP1 inhibitor could serve as the basis of a rapid and sensitive assay for the early detection and for the surgical-margin assessment of epithelial cancers of the upper intestinal tract.
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Affiliation(s)
- Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Nuclear Medicine, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Giacomo Pirovano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Arianna L Strome
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sumsum P Sunny
- Integrated Head and Neck Oncology Research Program, Mazumdar Shaw Medical Foundation, Narayana Health, Bengaluru, India
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Narayana Health, Bengaluru, India
| | | | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon Carney
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Brand
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Summit Biomedical Imaging, New York, NY, USA
| | - Veer Shah
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravindra D Ramanajinappa
- Integrated Head and Neck Oncology Research Program, Mazumdar Shaw Medical Foundation, Narayana Health, Bengaluru, India
| | - Naveen Hedne
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Narayana Health, Bengaluru, India
| | - Praveen Birur
- Integrated Head and Neck Oncology Research Program, Mazumdar Shaw Medical Foundation, Narayana Health, Bengaluru, India
- Department of Oral Medicine and Radiology, KLES Institute of Dental Sciences, Bangalore, India
| | - Smita Sihag
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Amritha Suresh
- Integrated Head and Neck Oncology Research Program, Mazumdar Shaw Medical Foundation, Narayana Health, Bengaluru, India
| | - Daniela Molena
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Moni A Kuriakose
- Integrated Head and Neck Oncology Research Program, Mazumdar Shaw Medical Foundation, Narayana Health, Bengaluru, India
- Cochin Cancer Research Center, Kochi, India
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
- Chemical Biology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Wang W, Fang Z, Zhang X, Cai H, Zhao Y, Gu W, Yang X, Wu Y. A Self-Assembled "Albumin-Conjugate" Nanoprobe for Near Infrared Optical Imaging of Subcutaneous and Metastatic Tumors. ACS Appl Bio Mater 2020; 3:327-334. [PMID: 35019449 DOI: 10.1021/acsabm.9b00839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The need for in situ accurate identification of tumor assisted real-time image-guided surgical resection calls for new near-infrared fluorescence agents with high tumor-sensitivity and excellent biocompatibility. Here, an albumin-conjugate nanoparticle system HSA-Er-RI-Cl was designed, synthesized, and applied in cancer imaging, which simultaneously achieved the EPR effect, hypoxia-targeting, and EGFR-targeting property. Our novel nanoprobe is composed of human serum albumin (HSA) and double-targeting small molecule conjugate (Er-RI-Cl): a hypoxia-targeting heptamethine carbocyanine dye (RI-Cl) conjugated with a clinic anti-EGFR antagonist (Erlotinib) by covalent bonding. This conjugate could bind to albumin proteins, forming albumin-conjugate complexes, and those complexes self-assemble into particles with diameters of approximately 100 nm in the aqueous solution. The tumor hypoxia and EGFR targeting specificity of HSA-Er-RI-Cl was, respectively, evaluated in vitro and in vivo. Using murine xenograft subcutaneous and brain metastatic tumor models, we demonstrated that HSA-Er-RI-Cl is a highly potent tumor-targeting NIR agent for noninvasive imaging with remarkable tumor localization and excellent pharmacokinetic properties.
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Affiliation(s)
- Weiwei Wang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital/Faculty of Basic Medicine, Chemical Biology Division of Shanghai Universities E-Institutes, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhixiao Fang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital/Faculty of Basic Medicine, Chemical Biology Division of Shanghai Universities E-Institutes, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xingming Zhang
- Department of Clinical Laboratory, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Haiyan Cai
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital/Faculty of Basic Medicine, Chemical Biology Division of Shanghai Universities E-Institutes, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yucheng Zhao
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital/Faculty of Basic Medicine, Chemical Biology Division of Shanghai Universities E-Institutes, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wenli Gu
- Department of Clinical Laboratory, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xi Yang
- Department of Oral & Maxillofaciale-Head and Neck Oncology, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yingli Wu
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital/Faculty of Basic Medicine, Chemical Biology Division of Shanghai Universities E-Institutes, Key Laboratory of Cell Differentiation and Apoptosis of the Chinese Ministry of Education, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Fakurnejad S, Krishnan G, van Keulen S, Nishio N, Birkeland AC, Baik FM, Kaplan MJ, Colevas AD, van den Berg NS, Rosenthal EL, Martin BA. Intraoperative Molecular Imaging for ex vivo Assessment of Peripheral Margins in Oral Squamous Cell Carcinoma. Front Oncol 2020; 9:1476. [PMID: 31998640 PMCID: PMC6965069 DOI: 10.3389/fonc.2019.01476] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: Complete surgical resection is the standard of care for treatment of oral cancer although the positive margin rate remains 15–30%. Tissue sampling from the resected specimen and from the wound bed for frozen section analysis (FSA) remains the mainstay for intraoperative margin assessment but is subject to sampling error and can require the processing of multiple samples. We sought to understand if an ex vivo imaging strategy using a tumor-targeted fluorescently labeled antibody could accurately identify the closest peripheral margin on the mucosal surface of resected tumor specimen, so that this “sentinel margin” could be used to guide pathological sampling. Materials and Methods: Twenty-nine patients with oral squamous cell carcinoma scheduled for surgical resection were consented for the study and received systemic administration of a tumor-targeted fluorescently labeled antibody (Panitumumab IRDye800CW). After surgical resection, the tumor specimen was imaged using a closed-field fluorescent imaging device. Relevant pathological data was available for five patients on retrospective review. For each of these five patients, two regions of highest fluorescence intensity at the peripheral margin and one region of lowest fluorescence intensity were identified, and results were correlated with histology to determine if the region of highest fluorescence intensity along the mucosal margin (i.e., the sentinel margin) was truly the closest margin. Results: Imaging acquisition of the mucosal surface of the specimen immediately after surgery took 30 s. In all of the specimens, the region of highest fluorescence at the specimen edge had a significantly smaller margin distance than other sampled regions. The average margin distance at the closest, “sentinel,” margin was 3.2 mm compared to a margin distance of 8.0 mm at other regions (p < 0.0001). Conclusions: This proof-of-concept study suggests that, when combined with routine FSA, ex vivo fluorescent specimen imaging can be used to identify the closest surgical margin on the specimen. This approach may reduce sampling error of intraoperative evaluation, which should ultimately improve the ability of the surgeon to identify the sentinel margin. This rapid sentinel margin identification improves the surgeon's orientation to areas most likely to be positive in the surgical wound bed and may expedite pathology workflow.
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Affiliation(s)
- Shayan Fakurnejad
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Giri Krishnan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.,The Department of Otorhinolaryngology, Head and Neck Surgery, The University of Adelaide, Woodville South, SA, Australia
| | - Stan van Keulen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Naoki Nishio
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Fred M Baik
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael J Kaplan
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - A Dimitrios Colevas
- Division of Medical Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Nynke S van den Berg
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Eben L Rosenthal
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
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Nishio N, van Keulen S, van den Berg NS, Lu G, LaRochelle EP, Davis SC, Martin BA, Fakurnejad S, Zhou Q, Birkeland AC, Kaplan MJ, Divi V, Colevas AD, Pogue BW, Rosenthal EL. Probe-based fluorescence dosimetry of an antibody-dye conjugate to identify head and neck cancer as a first step to fluorescence-guided tissue preselection for pathological assessment. Head Neck 2020; 42:59-66. [PMID: 31571335 DOI: 10.1002/hed.25964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/24/2019] [Accepted: 09/06/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Despite the rapid growth of fluorescence imaging, accurate sampling of tissue sections remains challenging. Development of novel technologies to improve intraoperative assessment of tissue is needed. METHODS A novel contact probe-based fluorescence dosimeter device, optimized for IRDye800CW quantification, was developed. After evaluation of the device in a phantom setup, its clinical value was defined ex vivo in patients with head and neck squamous cell carcinoma who received panitumumab-IRDye800CW. RESULTS Ten patients were enrolled with a total of 216 data points obtained. Final histopathology showed tumor in 119 spots and normal tissue in 97 spots. Fluorescence-to-excitation ratios in tumor tissue were more than three times higher than those in normal tissue. The area under the curve was 0.86 (95% CI: 0.81-0.91) for tumor detection. CONCLUSIONS Fluorescence-guided tissue preselection using a fluorescence dosimeter could have substantial impact on tissue sampling for frozen section analysis and potentially reduce sampling errors.
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Affiliation(s)
- Naoki Nishio
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Stan van Keulen
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Nynke S van den Berg
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Guolan Lu
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | | | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Brock A Martin
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Shayan Fakurnejad
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Quan Zhou
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrew C Birkeland
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael J Kaplan
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vasu Divi
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - A Dimitrios Colevas
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, California
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Eben L Rosenthal
- Department of Otolaryngology - Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Thiem DGE, Scharr K, Pabst AM, Saka B, Kämmerer PW. Facial cutaneous squamous cell carcinoma - microscopic safety margins and their impact on developing local recurrences. J Craniomaxillofac Surg 2019; 48:49-55. [PMID: 31810842 DOI: 10.1016/j.jcms.2019.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Surgical excision remains the treatment of choice for facial cutaneous squamous cell carcinoma (cSCC) despite there being no generally accepted diameter of clear margins. Therefore, the aim of this study was to evaluate the impact of microscopic clear margins diameter (mCMD) with respect to the development of local recurrences (LR). MATERIALS AND METHODS The medical records of 99 patients with a total of 142 cases of facial cSCC, who underwent surgical treatment between January 2010 and December 2015, were reviewed for demographic data and clinicopathological features. RESULTS 100 cases were diagnosed as primary cSCC and 42 cases as secondary cSCC. Of these, nine (6.3%) developed LR. Mean time to LR was 20 months, with the cheek as the predominant site 55.5% (n = 5). Wound closure was either primary (56%) or secondary (44%), depending on the site. Although no significant correlation between mCMD and LR was found (rPearson = 0.029; rPearson = 0.015), >4.1 mm was shown to be a negative cut-off-value (horizontally and vertically) without LR (100% vs 0%). CONCLUSIONS Based on these results, however descriptive they are, the authors consider histological confirmation of clear margins to be necessary for reducing the formation of LR. Thus, consistent testing and histopathological reporting, in a multicentered effort, are needed to further clarify the role of mCMD in the development of cSCC-LR.
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Affiliation(s)
- D G E Thiem
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany.
| | - K Scharr
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - A M Pabst
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072 Koblenz, Germany
| | - B Saka
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - P W Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany
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Vartholomatos G, Basiari L, Exarchakos G, Kastanioudakis I, Komnos I, Michali M, Markopoulos GS, Batistatou A, Papoudou-bai A, Alexiou GA. Intraoperative flow cytometry for head and neck lesions. Assessment of malignancy and tumour-free resection margins. Oral Oncol 2019; 99:104344. [DOI: 10.1016/j.oraloncology.2019.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 12/27/2022]
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van Keulen S, Nishio N, Fakurnejad S, van den Berg NS, Lu G, Birkeland A, Martin BA, Forouzanfar T, Colevas AD, Rosenthal EL. Intraoperative Tumor Assessment Using Real-Time Molecular Imaging in Head and Neck Cancer Patients. J Am Coll Surg 2019; 229:560-567.e1. [PMID: 31568855 DOI: 10.1016/j.jamcollsurg.2019.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/14/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In head and neck cancer, surgical resection using primarily visual and tactile feedback is considered the gold standard for solid tumors. Due to high numbers of tumor-involved surgical margins, which are directly correlated to poor clinical outcomes, intraoperative optical imaging trials have rapidly proliferated over the past 5 years. However, few studies report on intraoperative in situ imaging data that could support surgical resection. To demonstrate the clinical application of in situ surgical imaging, we report on the imaging data that are directly (ie in real-time) available to the surgeon. STUDY DESIGN Fluorescence intensities and tumor-to-background ratios (TBRs) were determined from the intraoperative imaging data-the view as seen by the surgeon during tumor resection-of 20 patients, and correlated to patient and tumor characteristics including age, sex, tumor site, tumor size, histologic differentiation, and epidermal growth factor receptor (EGFR) expression. Furthermore, different lighting conditions in regard to surgical workflow were evaluated. RESULTS Under these circumstances, intraoperative TBRs of the primary tumors averaged 2.2 ± 0.4 (range 1.5 to 2.9). Age, sex, tumor site, and tumor size did not have a significant effect on open-field intraoperative molecular imaging of the primary tumors (p > 0.05). In addition, variation in EGFR expression levels or the presence of ambient light did not seem to alter TBRs. CONCLUSIONS We present the results of successful in situ intraoperative imaging of primary tumors alongside the optimal conditions with respect to both molecular image acquisition and surgical workflow. This study illuminates the potentials of open-field molecular imaging to assist the surgeon in achieving successful cancer removal.
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Affiliation(s)
- Stan van Keulen
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA; Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Naoki Nishio
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Shayan Fakurnejad
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Nynke S van den Berg
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Guolan Lu
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Andrew Birkeland
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Brock A Martin
- Department of Clinical Pathology, Stanford University School of Medicine, Stanford, CA
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - A Dimitrios Colevas
- Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA
| | - Eben L Rosenthal
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
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Patel S, Singh I, Gulati A, Khurana N. A Study on Neck Nodes in Oral Cancers, with Special Reference to Skip Metastasis. Indian J Otolaryngol Head Neck Surg 2019; 71:474-81. [PMID: 31742006 DOI: 10.1007/s12070-018-1360-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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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50
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Meccariello G, Montevecchi F, D'Agostino G, Iannella G, Calpona S, Parisi E, Costantini M, Cammaroto G, Gobbi R, Firinu E, Sgarzani R, Nestola D, Bellini C, De Vito A, Amadori E, Vicini C. Trans-oral robotic surgery for the management of oropharyngeal carcinomas: a 9-year institutional experience. ACTA ACUST UNITED AC 2019; 39:75-83. [PMID: 31097824 PMCID: PMC6522856 DOI: 10.14639/0392-100x-2199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022]
Abstract
Trans-oral robotic surgery (TORS) has changed surgical management
of patients with oropharyngeal squamous cell carcinomas (OPSCC). In
this study we present surgical and oncologic outcomes of patients with
oropharyngeal squamous cell carcinomas, treated using TORS, with and
without an adjuvant therapy. Sixty patients with oropharyngeal
squamous cell carcinomas treated with TORS between January 2008 and
December 2017 have been retrospectively evaluated considering
clinicopathologic features, disease characteristics, adjuvant
treatments and oncological outcomes. TORS was performed for OPSCC to
the base of tongue in 41.7%, tonsils in 46.7%, soft palate and
posterior pharyngeal wall in 3.3% and 5%, respectively. Neck
dissection was performed in 43.3% of patients. Management strategies
included surgery alone in 30%, TORS and adjuvant radiotherapy in
33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year
overall survival of the total group was 77.6%, the 5-year disease-free
survival rate was 85.2%, and the 5-year local recurrence-free survival
rate was 90.6%. Finally, in selected patients TORS appears to yield
similar oncologic outcomes and functional outcomes to traditional
techniques and non-operative treatment with a possible benefit on
long-term quality of life. The future offers exciting opportunities to
combine TORS and radiotherapy in unique ways. However, further
research is urgently needed to clarify the indications for adjuvant
therapy following TORS resections.
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Affiliation(s)
- G Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - F Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Iannella
- Department of Organs of Sense, Ear, Nose, and Throat Section, University of Rome "La Sapienza," Italy
| | - S Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - E Parisi
- Radiotherapy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - M Costantini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - G Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.,Department of Otolaryngology, University of Messina, Italy
| | - R Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - R Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL della Romagna, Cesena, Italy
| | - D Nestola
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - C Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - A De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - E Amadori
- Radiology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola (FC), Italy
| | - C Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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