Molecular identification, expression and prognostic role of estrogen- and progesterone receptors in head and neck cancer

The aims of this study were to assess the sex hormone receptor status of head and neck (HNC) cancers. Frozen surgical samples (n = 67) of HNC patients were analyzed. Protein expression of estrogen receptor (ER)alpha, ERbeta and progesterone receptor (PgR) of tumor cells was determined by immunocytochemistry. Data were confirmed at mRNA level by nested-PCR and sequencing. ER and PgR expressions confirmed by PCR analysis were frequent in HNC: 50.7 and 49.3% respectively. Concerning the ER isoforms, ERalpha expression was predominant over ERbeta in both of oral cavity- as well as laryngeal/hypopharyngeal (LH) cancers. The delta3 splice variant of ERalpha was detected at low frequency, while the delta5 splice variant of ERbeta was frequent in HNC. The incidence of functional receptor expression (coexpression of ER and PgR) was relatively frequent also in HNC (27/67, 40.3%) which was independent of the anatomical location of the tumor. Sex hormone receptor expressions did not affect survival of HNC patients, however, in the LH cancer subgroup ER expression was associated with a trend of shortened survival (p = 0.0636, Mantel-Cox generalized savage). ERalpha,beta and PgR expressions are frequent in HNC and may affect the prognosis of the disease, at least in case of LH cancers.

The effect of leukocyte interleukin injection (Multikine) treatment on the peritumoral and intratumoral subpopulation of mononuclear cells and on tumor epithelia: a possible new approach to augmenting sensitivity to radiation therapy and chemotherapy in oral cancer--a multicenter phase I/II clinical Trial

OBJECTIVES/HYPOTHESIS

The main objective of this study was to investigate the effect of the administration of a novel immunoadjuvant, leukocyte interleukin injection, as part of an immuno-augmenting treatment regimen on the peritumoral and intratumoral subpopulations of the tumor infiltrating mononuclear cells and on the epithelial and stromal components, when administered to patients with advanced primary oral squamous cell carcinoma classified as T2-3N0-2M0, as compared with disease-matched control patients (not treated with leukocyte interleukin injection).

STUDY DESIGN

Multicenter Phase I/II clinical trial. Fifty-four patients from four clinical centers were included in the dose-escalating study (27 in each group [leukocyte interleukin injection-treated and control groups]). Cumulative leukocyte inter-leukin injection doses were 2400, 4800, and 8000 IU (as interleukin-2 equivalent).

METHODS

Paraffin-embedded tumor samples obtained at surgical resection of the residual tumor (between days 21 and 28 after treatment initiation) were used. Histological analysis, necrosis evaluation, and American Joint Committee on Cancer grading were performed from H&E-stained sections. Immunohistochemical analysis was performed on three different tumor regions (surface, zone 1; center, zone 2; and tumor-stroma interface, zone 3). Trichrome staining was used to evaluate connective tissue, and morphometric measurements were made using ImagePro analysis software. Cell cycling was determined by the use of Ki-67 marker.

RESULTS

Leukocyte interleukin injection treatment induced a shift from stromal infiltrating T cells toward intraepithelial T cells and posted a significant (P <.05) increase in intraepithelial CD3-positive T cells independent of the leukocyte interleukin injection dose, whereas the increase in CD25 (interleukin-2 receptor alpha [IL-2Ralpha])-positive lymphoid cells was significant only at the lowest leukocyte interleukin injection dose (P <.05). Furthermore, both low- and medium-dose leukocyte interleukin injection treatment induced a significant (P <.05) increase in the number of cycling tumor cells, as compared with control values.

CONCLUSION

The results could be highly beneficial for patients with oral squamous cell carcinoma. First, leukocyte interleukin injection treatment induces T-cell migration into cancer nests and, second, noncycling cancer cells may enter cell cycling on administration of leukocyte interleukin injection. This latter effect may modulate the susceptibility of cancer cells to radiation therapy and chemotherapy. The findings may indicate a need to re-evaluate the way in which follow-up treatment (with radiation therapy and chemotherapy) of patients with head and neck cancer is currently approached.

[Validity of chromosome analysis and bleomycin sensitivity assay in the prevention of head and neck cancer in Hungary]

Because of unfavourable cancer mortality statistics of Hungary, the search of different biomarkers is one of the most important demands of the national primary cancer prevention programme. The aim of this study was to clarify the usefulness of bleomycin sensitivity assay elaborated in the USA, and to find whether it serves under our environmental conditions as a biomarker of individual sensitivity and risk for head and neck cancer, beside chromosomal aberration analysis. The test reflecting mutagen sensitivity is based on the mean values of chromatid breaks induced by bleomycin in vitro in a single lymphocyte (break/cell = b/c). Since cancer formation is influenced by environmental mutagens, in contrast to others, their 111 head and neck cancer patients were matched not only with 230 healthy controls (106 nonsmokers and 124 smokers), but also with 44 strong alcoholic and smoking patients with liver diseases whose lifestyle did not differ from that of the cancer patients. According to the results of conventional chromosome analysis, the aberrant cell frequency was the highest in the cancer patients (3.34%), while in the alcoholics (2.73%) and healthy smokers (2.88%) the values were similar. Thus, the genetic instability occurring in the form of elevated rate of spontaneous chromosomal aberrations was mostly expressed in head and neck cancer patients. Mutagen sensitivity measured by the b/c values of bleomycin assay was significantly higher in both the cancer (1.16 b/c) and the alcoholic patients (1.34 b/c) compared with the controls (1.0 b/c). The bleomycin sensitivity assay, therefore, seems to be the biomarker not only of cancer, but also the disease of the same etiology such as alcohol-related liver disease. However the method is not suitable for the assessment of individual cancer risk because of the high variability of b/c values in each group, and their considerable overlapping with the controls. It can also be supported with extremely high mutagen sensitivity of Hungarian controls (63 and 67%), which is three-fold of US values (23%). The bleomycin sensitivity assay is not a selective biomarker if comparing to the controls, probably due to the action of more complex exposures under Hungarian environmental conditions. When estimating cancer risk, the results of conventional chromosome analysis offer more information than bleomycin sensitivity assay.

[Combined modality treatment of locally advanced oral and oropharyngeal cancer following primary radiotherapy with and without taxol radiosenzitization]

AIM: To determine the effect of radiosensitization with Taxol and multimodality treatments on the survival of advanced oral and oropharyngeal cancer. Patients, methods: 56 patients with St. III-IV oral or oropharyngeal cancer were treated with external beam radiotherapy; 26 of them were sensitized by low-dose paxlitaxel and 30 were irradiated traditionally. The median follow up was 23 months (17-36). Endpoints of the study were: response to radiotherapy, progression-free and overall survival and the results of surgery and chemotherapy following radiation. RESULTS: 73.3% (41/56) of treatments resulted in CR or PR with median 10 months (0-33) progression-free and 14 months (4-33) overall survival. There was no significant difference between the radiosensitized and traditional radiotherapy group (p=0.6). The survival was significantly influenced by the stage of tumor and the response to primary radiotherapy. Seven (38.9%) of 16 patients treated also by either surgery or chemotherapy for recurrent or residual disease are free of cancer, 6 (35%) alive with tumor and 5 (26.1%) died with median survivals of 21, 20.5 and 18 months, respectively. Those treated only with radiotherapy with or without sensitization are free of cancer in 31.6%, alive with cancer 5.3%, died 63.2%. CONCLUSION: There were significant correlation between tumor stage, response to radiotherapy and combined modality treatment, and surival. The radiosensitizing effect of Taxol was not obvious so far, it may be apparent in the future by analyzing the long term survival data.

[Low-dose Taxol radiosensitization in locally advanced head and neck cancers]

INTRODUCTION: Combined modality treatment with chemotherapy and radiotherapy in locally advanced head and neck cancers is an effective and often the only treatment with a chance of cure. An alternative is to use chemotherapeutic agents at low doses as radiosensitizers. In this study we examined the radiosensitizing effect of low dose Taxol in locally advanced head and neck cancer. Patients and methods: 26 patients with locally advanced squamous cell carcinoma of the oral cavity and the oropharynx were treated with external beam radiotherapy up to doses of 66-70 Gy and received concomitantly 2 mg/m(2) Taxol intravenously three times a week. Response rates according to WHO criteria, side effects according to the National Cancer Institute Common Toxicity Criteria, overall and progression-free survival were evaluated. RESULTS: All patients completed the therapy. Median radiation dose was 66 Gy, Taxol dose 40 mg/m(2) and treatment duration 54 days. 8 weeks after completion of therapy complete response was 30.8%, partial response 34.6%, stable disease 11.5% and progressive disease 23.1%. The median follow-up time was 25 months (9-36). At the cloes- out date 12 (46,1%) of the patients were alive, 9 without evidence of disease. The estimated median overall survival was 22 months (CI 14.2-34.6), the median progression-free survival 12 months (CI 5.2-18.8). We observed four grade 4, fourteen grade 3 and numerous grade 1-2 side effects. There was no treatment related death. DISCUSSION: Our regimen resulted in a worse response rate than the aggressive chemoradiation protocols treating the same disease. However, the two-year survival was comparable with the results of other studies. The advantages of our schedule are that it is well tolerated, easy to perform on an outpatient basis, resource effective and does not deteriorate the general condition of the patients, therefore successive therapy can be carried out immediately if necessary. We intend to evaluate the effectivity of this treatment in a study comparing radiotherapy with Taxol sensitization versus radiotherapy alone.

[Neoadjuvant chemotherapy in head and neck cancer]

BACKGROUND: Neoadjuvant chemotherapy has an increasing role in multimodality treatment of advanced head and neck cancer. In this paper we summarize our first results with this treatment. METHOD: Thirty-five, previously untreated, mostly inoperable head and neck cancer patients were given two cycles of Cisplatin and 5FU chemotherapy. We continued the therapy only in case of regression until four cycles, then the patients received surgical and/or radiotherapy according to their status. After the treatment patients' status was regularly evaluated. RESULTS: We detected 4 complete and 20 partial responses after the chemotherapy. Three patients became eligible for a radical operation. At this moment 10 patients are free of tumor, 8 patients died in consequence of the tumor, we have no data in 3 cases, 3 patients are given palliative therapy because of progression, 4 patients are receiving radiotherapy and 7 patients with partial response are candidates for further active oncotherapy. CONCLUSIONS: Although the number of the patients we treated is too small for a statistical analysis, our results are similar to the conclusion of the large randomized studies: after neoadjuvant chemotherapy of advanced head and neck cancer partial response can improve the result of surgical or radiological treatment. Neoadjuvant chemotherapy does not improve survival in advanced head and neck cancer, but it is of great importance because of better quality of life of patients, especially those who had organ preserving therapy.

[Exposure or cancer predisposition? Cytogenetic examination of head and neck squamous cancer patients]

Search of different biomarkers is one of the most important demands of the national cancer prevention programme. We examined the usefulness of bleomycin sensitivity assay, whether it serves as a biomarker of individual sensitivity and risk for head and neck cancer under our environmental conditions. The test is based on the measurement of the means of chromatid breaks induced by bleomycin in vitro in a single lymphocyte (break/cell=b/c). 156 head and neck cancer patients were matched not only with 295 healthy controls (146 non-smokers and 149 smokers), but also with 51 strong alcoholic and smoking patients with liver disease whose lifestyle did not differ from that of the cancer patients. The aberrant cell frequency of cancer patients (2.85%), alcoholics (2.82%) and healthy smokers (2.81%) was similar and higher (p<0.03) than the values of non-smoker controls (2.25%). Thus, the results of conventional chromosome analysis indicate the effect of exposure to mutagens, derived mainly from smoking. Mutagen sensitivity measured by the bleomycin assay was significantly higher in both the cancer- (1.13 b/c) and the alcoholic patients (1.29 b/c) compared with smoker (1.04 b/c) and non-smoker controls (0.98 b/c). The bleomycin sensitivity assay, therefore, seems to be the biomarker not only for the cancer, but also for a disease of the same aetiology such as alcohol-related liver disease. However, the method is not suitable for the assessment of individual cancer risk due to overlapping of b/c values with those of controls. The proportion of mutagen sensitive persons in the group of Hungarian controls is 42-49%, which is two-fold of those in the US and Western Europe. When we estimate the cancer risk, the results of bleomycin sensitivity assay are equivocal under our experimental conditions, and they must be applied cautiously even in combination with the results of chromosome analysis.

[Genetic marker analysis in head and neck cancer]

Prognostication of head and neck cancer (HNCC) involves molecular identification of residual tumor cells, prediction of recurrence, distant metastases or secondary tumors and prediction of the sensitvity to therapy. Biomarkers of HNCC are mutations of p53, p16 and amplification of Cyclin D and E2F4. One hundred and fifty-two HNCC cases have been evaluated for p53, hMLH1, Cyclin D and p16 gene alterations using PCR-SSCP and Western blot analysis. P53 mutations of HNCC have been found in 37.5% of cases. However, 11% of the cases showed p53 mutations in the normal peritumoral mucosa suggesting "field cancerization" process. Mismatch-repair gene mutations (MMR: hMHL1 and hMSH2) occurred with 17 and 8.6% frequency, respectively, while E2F4 mutations were even more frequent (21.4%) in HNCC. Our data suggest that E2F4 overexpression can be caused by the inactivation of the p16 gene in HNCC, while its mutations are most probably associated to the mutations of the MMR genes. These molecular informations can help to predict the biological potential of HNCC as well as the probability of the development of secondary HNCCs.

[Radial forearm and fibula free flap reconstruction after radical resection of head and neck malignancies]

The incidence of head and neck cancer has been rapidly increasing in Hungary during the last decade. Most of these tumors are discovered in advanced stage, consequently, surgical removal of the tumor results in large complex defects in the soft tisses and bone elements of the face and neck. For optimal anatomical and functional reconstruction we perform free flap transfer in increasing number of cases. Between December 1993 and March 2001 in the Head and Neck Surgery Department of the National Institute of Oncology the defects after resection of head and neck tumors were reconstructed with free flaps in 85 cases. Radial forearm flap in 64 cases, fibula osteoseptocutaneous flap in 14 cases were used. In 87% of the patients the postoperative period was uneventful, the surgical complications were not more numerous than following traditional reconstructions. The average duration of operations became shorter by 2.5 hours during the last two years than before. In most of the cases we achieved good functional and esthetic results. The quality of life of the patients was excellent in 14%, almost normal in 73% and bad with serious problems of social life in 13%. It is surprising that there was no significant difference between the survival of neck node positive and negative patients. In our practice the replacement of large defects in the head and neck region with free flaps is a reliable and useful method for reconstruction.

[Juvenile aneuploid papillary cancer of the thyroid with pulmonary metastasis]

The long-term cause-specific survival results of papillary thyroid cancer patients in Hungary are (78%) worse than the best international data (90%). The authors have recited its causes through the case of a young papillary thyroid cancer patient during the diagnostics (aspiration cytology, diagnostic imaging technics, DNA-analysis) the treatment (surgery-external radiotherapy-radioiodine treatment) and the follow-up (HTG, diagnostic imaging).

[Steroid hormone receptors in squamous cell carcinoma of the head and neck]

In this study we have tried to find new prognostic markers to extend the therapeutical modalities for patients with head and neck squamous cell carcinoma. During evolution the development of the pharyngolaryngeal region differs in males and females, therefore this region can be considered as one of the target organs for sex steroids. Some of the tumours, originating from this area, contain hormone receptors that theoretically makes them susceptible for hormone therapy. Therefore the real concentration of steroid receptors is of great clinical importance. We determined the estradiol, progesterone and testosterone receptor content using biochemical method in tumour tissue of 33 male patients with head and neck squamous cell carcinoma. The receptors in the macroscopically intact mucosa in 15 of all tumour cases were also measured. The patients were followed for 18-24 month after operation and postoperative irradiation performed according to the protocol of the Head and Neck Surgery department. There were 26/33 (79%) estradiol receptor positive, 14/33 (42%) progesterone receptor positive and 18/30 (60%) testosterone receptor positive cases among the tumour samples. The healthy mucosa samples were positive in 6/15 (40%), 2/15 (13%) and 3/15 (20%) of cases, respectively. The differences in proportion of positive status between tumour and healthy mucosa was statistically significant. We established that during the control period the highest rate of the tumour-free survival was in the estradiol receptor positive, progesterone receptor negative group. Consequently the steroid receptor status of head and neck squamous cell carcinomas might help in assessing the prognosis of survival, and in possible choice for endocrine treatment, in order to complete the complex tumour therapy.

[Treatment of keloids (review of the literature, therapeutic suggestions)]

The authors treated 25 patients with 31 keloids. They used cryotherapy after intralesional steroid infiltration. One area was treated 3-4 times. All patients showed more or less improvement. 18 keloids were completely cured, 9 improved, 2 showed only minimum change, the treatment had to be given up in two patients. The method has been found effective but is recommended primarily in case of small and not too old lesions.

[Use of a stoma-pouch after temporary pharyngostoma and neck fistula following surgery in the head and neck region]

The authors report on a new way of stoma care that to their best knowledge has not been used yet in head and neck surgery patients. Their cases demonstrate the usefulness of this method for the rehabilitation of patients with pharyngeal stoma of any origin.

[Combined effect of CO2 and Nd:YAG laser on the rat tongue]

Authors fixed the handpieces of a CO2 and Nd:YAG lasers together so, that the two laser beams had a common focus. It is histologically proved in this paper, that the combined effect fulfills all the known advantages of either of the two lasers, while disadvantages are largely eliminated. Based on these results the device is planned to be introduced in oral surgery.

The morphological basis for development of Reinke's oedema

Normal human vocal cords and surgically removed Reinke's oedema were studied by light and electron microscopy. The Reinke's space between the lamina propria and vocal ligament was filled with loose connective tissue sheets, which seemed to be an organic part of the vocal ligament. The structure suggested the possibility of the lamellae moving on each other. This could be important for the vibratory function of vocal cords. Inside the lamellae, masses of inmature young elastic fibres were found. Reinke's oedema develops in the superficial elastic sheets. Therefore in the case of surgical intervention the specially structured rubbery elastic vocal cord mucosa must be removed, which is essential to perfect vibratory function.

Ultrastructure of the hepatic perisinusoidal cells in man and other mammalian species

Perisinusoidal (P.S.) cells occurring in the spaces of Disse in the livers of normal cats, dogs, miniature pigs, albino rats, human adults and children were examined by electron microscopy. The ultrastructural details of the P.S. cells and their topographic relationships with hepatocytes, sinusoidal lining cells and reticulum fibers are described. Species differences between P.S. cells were primarily a dissimilarity in lipid content: the main ultrastructural features were the same in all species studied. The P.S. cells of the rat liver displayed only low endocytotic activity, and no phagosome formation following intravenous administration of horseradish peroxidase. The close topographic relationship of the P.S. cells with the intralobular reticulum fibers was reminiscent of the intimate connection between fibroblasts and collagen fibers, or, in cat liver, of the reticulum cell--reticulum fiber association seen in lymphoid organs. Fibroblasts were not found inside the hepatic lobules. These findings support the conclusion that the reticulum fibers of hepatic lobules are produced by perisinusoidal cells which, however, display also other functions.

Demonstration of hepatitis B surface antigen by orcein staining in paraffin sections of cirrhotic liver

Blood and liver from 44 and 30 patients, died in cirrhosis and other diseases, respectively were tested for the presence of HBSAg. Blood samples obtained at autopsy and in seven cirrhosis cases also before death were tested for HBSAg by counter-electrophoresis. Detection of HBSAg in hepatocytes was carried out in paraffin sections by the modified orcein staining technique of Shikata et al. Ten of 14 HBSAg seropositive and 2 of 30 HBSAg seronegative cirrhotic patients had orcein positive hepatocytes, which were not found in any liver specimen from the 30 non-cirrhotic seronegative patients. The orcein positive substance localized in the cytoplasm of hepatocytes, less often it was also seen in a few Kupffer cells. The hepatocellular carcinoma cells present in part of the livers studied did not contain any orcein positive substance. Histological changes in the cirrhotic livers showed morphological indication of the presence of HBSAg, except on staining with orcein. The modified orcein staining technique is a simple, handy procedure for use in any routine pathological laboratory and has the additional advantage of detecting HBSAg also in stored paraffin blocks.