High incidence of occult familial SDHD cases amongst Czech patients with head and neck paragangliomas

Introduction

Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors, which are mostly benign in nature. Amongst all genes, Succinate Dehydrogenase Subunit D (SDHD) is the most commonly mutated in familial HNPGLs. In about 30% of HNPGLs, germline mutations in SDHD can also occur in the absence of positive family history, thus giving rise to "occult familial" cases. Our aim was to evaluate the pattern of SDHD germline mutations in Czech patients with HNPGLs.

Materials and methods

We analyzed a total of 105 patients with HNPGLs from the Otorhinolaryngology departments of 2 tertiary centers between 2006 - 2021. All underwent complex diagnostic work-up and were also consented for genetic analysis.

Results

Eighty patients aged 13-76 years were included; around 60% with multiple PGLs were males. Carotid body tumor was the most frequently diagnosed tumor. Germline SDHD mutation was found in only 12% of the Czech patients; approximately 78% of those harboring the mutation had negative family history. The mutation traits had higher affiliation for multiple tumors with nearly 70% patients of ≤ 40 years of age.

Conclusion

An SDHD mutation variant was shared amongst unrelated patients but no founder-effect was established. Our findings confirmed that the pattern of SDHD mutation distribution amongst HNPGLs in Czech Republic differs from most studies worldwide.

The FSHR Expression in Head and Neck Squamous Cell Cancer. A Pilot Immunohistochemical Study

BACKGROUND/AIM

Follicle-stimulating hormone receptor (FSHr), expressed on endothelial cells of vessels in different malignant tumors, has been recently investigated as a potential pan-receptor of cancer treatment. However, the expression of this receptor has also been confirmed in other tissues under pathological conditions including cancer. The aim of the presented pilot study was to evaluate the expression of FSHr in head and neck squamous cancer (HNSCC).

PATIENTS AND METHODS

A total of 28 HNSCC patient samples were immunohistochemically analyzed for the presence of FSHr using a commercially available primary antibody.

RESULTS

FSHr was detected not only in the tumor tissue, but also in the basal layer or dysplastic parts of squamous mucosa and also in fibroblasts surrounding the tumor tissue.

CONCLUSION

FSHr is present on different benign or malignant mesenchymal and epithelial structures in HNSCC. A brief literature review revealed a wider role of FSHr in the development of neoplasia.

Abstract 1002: Dysfunction of HPV16-specific CD8+ T cells derived from oropharyngeal tumors is related to the expression of Tim-3 but not PD-1

Human papillomavirus (HPV) type 16 infection is one of the most important etiological agents of oropharyngeal squamous cell carcinoma. Patients with HPV-positive squamous cell carcinomas of the head and neck were reported to have a better clinical outcome than patients with HPV-negative tumors. Because HPV16 E6 and E7 oncoproteins are highly immunogenic and constitutively expressed within the tumor cells, HPV-specific T cell immunity may contribute to the better prognosis of HPV-positive tumors. We analyzed the frequency, phenotype and function of HPV16 E6/E7-specific tumor-infiltrating T cells (TILs) in oropharyngeal tumors and tested the effect of anti-PD1 mAb (nivolumab), soluble Tim-3 (sTim-3) and homeostatic in vitro expansion on these characteristics. We show that 73.1% of HPV-associated oropharyngeal tumors are positive for HPV16-specific T cells capable of producing IFNγ upon stimulation with E6/E7 peptide pools. These IFNγ-producing HPV-specific TILs were mainly PD-1+Tim-3-CD8+ T cells, identifying Tim-3 rather than PD-1 as a marker of T cell dysfunction. Consequently, specific IFNγ production was further enhanced by combined nivolumab plus sTim-3 treatment, but not with nivolumab alone. Our data provide the rationale for exploring additional setups of anti-PD-1 mAb treatment, including combinations with other check-point blockers, such as Tim-3 and/or with HPV16-directed therapeutic vaccines.

Citation Format: Simona Partlova, Kamila Hladikova, Vladimir Koucky, Anna Fialova, Radek Spisek, Jan Boucek, Michal Zabrodsky, Michael Halaska, Ruth Tachezy, Marek Grega, Jean-François Fonteneau. Dysfunction of HPV16-specific CD8+ T cells derived from oropharyngeal tumors is related to the expression of Tim-3 but not PD-1 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1002.

Early experience on a modern, thin cochlear implant family. A retrospective, international multicenter study

RATIONALE

Cochlear implantation is the most effective method of rehabilitation for patients with severe to profound sensorineural hearing loss. Binaural hearing forms the basis of the development of hearing-associated cortical networks in infants and toddlers, but simultaneous bilateral implantation is often postponed due to the demands of classical surgical methods, which are associated with large incisions and a deep bony well.

OBJECTIVE

The authors report on the use of a modern, thin implant type and the possibilities it provided to simplify the surgical technique.

METHODS AND RESULTS

Recent models of the Cochlear™ Nucleus® implant family were studied in an international retrospective multi-center study: 6 otolaryngologists in 5 centers shared their experiences on 73 consecutively implanted, thin implants. The surgical incision could be made shorter than before and only shallow bony wells or none at all were created in 4 out of 5 centers. No complications occurred.

DISCUSSION

This study underlines that implants with thin electronics capsules enable a simplified, fast and safe implantation procedure that allows simultaneous bilateral cochlear implantation.

Maternal and obstetrical outcome in 35 cases of well-differentiated thyroid carcinoma during pregnancy

OBJECTIVES/HYPOTHESIS

Thyroid cancer, with 6% to 10% of cancer diagnoses, is one of the most common malignancies during pregnancy. Its treatment poses a risk for the pregnancy, as the thyroid gland plays a crucial role in the evolution of pregnancy. The aim of this study is to evaluate treatment of primary well-differentiated thyroid carcinoma during pregnancy and fetal and maternal outcomes.

STUDY DESIGN

This is an international cohort study.

METHODS

Primary thyroid cancer patients were identified from the database of the International Network on Cancer, Infertility, and Pregnancy registration study. Data on histopathological characteristics, diagnostic and therapeutic interventions, outcome (obstetrical, neonatal, and maternal) and maternal follow-up were analyzed.

RESULTS

Thirty-five patients with well-differentiated thyroid carcinoma were eligible. All 35 patients underwent surgery, 29 (83%) of which during pregnancy. Procedures during pregnancy were mainly total thyroidectomies (n = 24). The median number of days between diagnosis and surgical treatment was different between the groups with surgery during and after pregnancy (27 vs. 139 days, P < .001). Both maternal and neonatal outcomes were uncomplicated, regardless of gestational age during surgery.

CONCLUSIONS

Well-differentiated thyroid carcinoma diagnosed during pregnancy has a favorable outcome for both mother and child. Surgical management during pregnancy has no negative impact on the pregnancy regardless of the trimester at the time of surgery. However, the potential negative effects of thyroid surgery early in pregnancy demand management of these patients in an experienced multidisciplinary team to provide the best possible care for these patients and their unborn babies.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:1493-1500, 2018.

Imaging of Early Response to Predict Prognosis in the First-Line Management of Follicular Non-Hodgkin Lymphoma with Iodine-131-Rituximab Radioimmunotherapy

The purpose of this study was to evaluate prediction of prognosis after first-line radioimmunotherapy (RIT) of advanced follicular non-Hodgkin lymphoma (FL), by imaging with fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography (¹⁸F-FDG-PET/CT) three months after induction treatment by Iodine-131-rituximab (¹³¹I-rituximab). Objective response was determined using the Deauville 5-point scale in 68 prospective clinical trial patients. Baseline ¹⁸F-FDG-PET/CT studies were used to calculate total-metabolic-tumor-volume (TMTV). Non-imaging studies included the Follicular lymphoma international prognostic index (FLIPI) and absolute baseline monocyte and lymphocyte counts. Patients were monitored for over ten years (median follow-up 59 months), and no patient was lost to follow-up. Complete response (CR) of 88% predicted excellent prognosis with median time-to-next-treatment (TTNT) not yet reached. Those patients (12%) who failed to achieve CR (Deauville ≤ 3) on ¹⁸F-FDG-PET/CT at three months had significantly poorer outcomes (p < 0.0001) with a median TTNT of 41 months. Requirement for re-treatment was predicted by FLIPI and absolute baseline monocyte count but not lymphocyte count. The TTNT was accurately predicted by ¹⁸F-FDG-PET/CT Deauville response at three months following first-line therapy of FL with RIT. Early response demonstrated by imaging does, therefore, foretell prognosis in the individual FL patients.

Baha implant as a hearing solution for single-sided deafness after retrosigmoid approach for the vestibular schwannoma: surgical results

Skull base tumors and, in particular, vestibular schwannoma (VS) are among the etiological reasons for single-sided deafness (SSD). Patients with SSD have problems in understanding speech in a noisy environment and cannot localize the direction of sounds. Baha is one of the most frequently used systems for SSD compensation. Out of 38 patients with SSD after retrosigmoid removal of VS who underwent testing with Baha softband, 16 were satisfied and were indicated for Baha implantation. Two surgical approaches have been used-the Nijmegen linear incision technique with subdermal thinning (Group I, implant BI300) and fast surgery technique without subdermal thinning (Group II, implant BIA400). The duration of the surgery, the implant stability measured by Ostell, and skin or soft tissue reactions in long range follow-up were evaluated and compared between Group I and II. There was a difference in duration of surgery, in Group II procedures averaged significantly faster (p > 0.001). In both groups, there was a similar trend of the gradual increase of implant stability. In the Group I and II, there was comparable rate of the skin or soft tissue reactions grade 0, I, II, or III. We have proved Baha to be a suitable possibility for SSD patients after the removal of VS, regardless of the approach. After the retrosigmoid approach to the VS, the key step of Baha implantation must be to reach intact healthy bone to avoid implantation into scar tissue.

Abstract A120: The infiltration of Th17 cells in tumor microenvironment negatively correlate with the prognosis of the patients with head and neck squamous cell carcinoma

Introduction: Head and Neck squamous cell carcinoma (HNSCC) remains to the malignancies with the unsure prognosis. Regarding the etiology, we are facing different clinical manifestation, behavior and overall survival. This fact can be explained by the differences in the immune response of the patients. Understanding of the basic principles of the immune system of HNSCC patients would help us to better combine the therapeutical strategies with the respect to the immune cell subpopulations and their regulation. One of the most important cells are Th17 lymphocytes, which are increased in the peripheral blood and the microenvironment of many types of cancers.

Methods: 178 patients with primary HNSCC were included to the study. Samples of the peripheral blood and from the primary tumors, metastatic lymph nodes and non-affected lymph nodes were collected at the moment of surgical therapy and measured by flow cytometry. The data were analyzed by the Cox regression and compared with the group of healthy blood donors. Sixty six tumors out of 178 primary tumors were localized in the tonsillar region, 50 in the root of the tongue, 33 in the larynx and 8 in hypopharynx. The average follow-up was 40 months.

Results: For the prognosis of the patients the most important oncological parameters were T and N stadium of the disease (p = 0.02, resp. p = 0.03), radicality of the surgery (p = 0.006), presence of the adverse prognostic risk factors (p = 0.01). From the analyzed parameters of the immune system we found negative prognostic correlation of the level of B lymphocytes (CD19+; p = 0.03) and the positive prognostic correlation of the level of naïve CD4+ T cells (CD4+CD45RA+, p = 0.02) in the peripheral blood of the patients. We found strong negative prognostic correlation of the Th17 cells (CD4+CD161+) in the peripheral blood (p = 0.04) and also in the tumor microenvironment (p = 0.005).

Conclusion: We can conclude that the examination of parameters of immune system could be helpful for better understanding of biological behavior and interaction of the HNSCC. The level of Th17 cells in both periphery and in the tumor microenvironment correlate with the worst survival of the patients with the HNSCC. The analyses of the Th17 level in the peripheral blood before the therapy could help us with the prediction of the cause of the disease. The future studies should be focused on the changes in immune cells infiltration in response to the different therapeutical strategies in HNSCC oncology. Acknowledgments: The research was supported by AZV MZ CR (grant No. NV16-28594A and NV16-28600A).

Note: This abstract was not presented at the conference.

Citation Format: Jan Boucek, Michal Zabrodsky. The infiltration of Th17 cells in tumor microenvironment negatively correlate with the prognosis of the patients with head and neck squamous cell carcinoma [abstract]. In: Proceedings of the Second CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; 2016 Sept 25-28; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(11 Suppl):Abstract nr A120.

Revision operations after previous stapes surgery for persisting hearing loss

OBJECTIVES

The aim of the study was to find out the reasons of the recurrent or persisting hearing loss after previous stapes surgery indicated for otosclerosis.

BACKGROUND

Revision stapes surgery is a relatively safe surgical method. Recurrent or persisting conductive hearing loss is commonly caused by prosthesis dislocation and adhesions in the oval window. Hearing loss is directly proportional to the number of previous operations.

METHOD

Retrospective analysis of 48 patients after revision stapes surgery was done over a period of 4 years (2005-2008). Improvement of the hearing and the reasons of a previous surgery failure were studied.

RESULTS

RESULTS were compared to the other studies. The main reason of the failed surgery was adhesions and dislocation of the prosthesis. The mean postoperative air-bone gap was 12.0 dB. A mean postoperative air-bone gap closure within 10 dB occurred in 24 cases (55.8 %), between 11-20 dB occurred in 11 cases (25.6 %) and above 20 dB in 8 cases (18.6 %). The original prosthesis was replaced with a new one in 41 (95.3 %) cases. In 2 cases (4.7 %), previous prostheses were left in place and fixed by a ionomer glass cement to the long process of incus.

CONCLUSION

Revision stapes surgery is a relatively safe surgical procedure allowing to improve hearing. The number of previous stapes surgery deteriorates hearing (p < 0.05) (Tab. 4, Ref. 20).

Kinematic and dynamic biomechanical values in relation to muscle activity during contact head impact

OBJECTIVE

For the evaluation of neck injury the relative distance was observed between a marker placed on the forehead and a marker placed on the shoulder and also by change of the angle. To compare the severity of head injury a value of maximum head acceleration was used, HIC and a 3 ms criterion. All criteria were related to the activity of musculus sternocleidomastoideus and musculus trapezius in a situation of expected or unexpected contact impact.

MATERIALS AND METHODS

The situation was recorded using a Qualisys system, head acceleration of probands in three axes was recorded using the accelerometer, activity of neck muscles was monitored by a mobile EMG.

RESULTS

Maximum head acceleration was 5.61 g for non-visual and 5.03 g for visual. HIC36 was 6.65 non visual and 5.97 for visual. 3-ms criterion was 5.37 g for non-visual and 4.89 g for visual and max. force was 291 N for non-visual and 314 N for visual. The average time of muscle activation of the observed group without visual perception is 0.355 s after hitting an obstacle, with visual perception 0.085 s before the crash.

CONCLUSIONS

Kinematic values indicate more favourable parameters for neck injuries for visual. Head injury criteria show an average decrease of about 10% for visual. We can conclude that the visual perception means a significant increase in pre-activation of the observed muscle group of almost 745% and lower activation in following phase of approximately 90%.

Radiotherapy of abdomen with precise renal assessment with SPECT/CT imaging (RAPRASI): design and methodology of a prospective trial to improve the understanding of kidney radiation dose response

Background

The kidneys are a principal dose-limiting organ in radiotherapy for upper abdominal cancers. The current understanding of kidney radiation dose response is rudimentary. More precise dose-volume response models that allow direct correlation of delivered radiation dose with spatio-temporal changes in kidney function may improve radiotherapy treatment planning for upper-abdominal tumours.

Our current understanding of kidney dose response and tolerance is limited and this is hindering efforts to introduce advanced radiotherapy techniques for upper-abdominal cancers, such as intensity-modulated radiotherapy (IMRT). The aim of this study is to utilise radiotherapy and combined anatomical/functional imaging data to allow direct correlation of radiation dose with spatio-temporal changes in kidney function. The data can then be used to develop a more precise dose-volume response model which has the potential to optimise and individualise upper abdominal radiotherapy plans.

Methods/design

The Radiotherapy of Abdomen with Precise Renal Assessment with SPECT/CT Imaging (RAPRASI) is an observational clinical research study with participating sites at Sir Charles Gairdner Hospital (SCGH) in Perth, Australia and the Peter MacCallum Cancer Centre (PMCC) in Melbourne, Australia. Eligible patients are those with upper gastrointestinal cancer, without metastatic disease, undergoing conformal radiotherapy that will involve incidental radiation to one or both kidneys. For each patient, total kidney function is being assessed before commencement of radiotherapy treatment and then at 4, 12, 26, 52 and 78 weeks after the first radiotherapy fraction, using two procedures: a Glomerular Filtration Rate (GFR) measurement using the ⁵¹Cr-ethylenediamine tetra-acetic acid (EDTA) clearance; and a regional kidney perfusion measurement assessing renal uptake of ^99mTc-dimercaptosuccinic acid (DMSA), imaged with a Single Photon Emission Computed Tomography / Computed Tomography (SPECT/CT) system. The CT component of the SPECT/CT provides the anatomical reference of the kidney’s position. The data is intended to reveal changes in regional kidney function over the study period after the radiotherapy. These SPECT/CT scans, co-registered with the radiotherapy treatment plan, will provide spatial correlation between the radiation dose and regional renal function as assessed by SPECT/CT. From this correlation, renal response patterns will likely be identified with the purpose of developing a predictive model.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12609000322235

Abstract B94: The role of Th17 cells in the head and neck squamous cell carcinoma evolution

Head and neck squamous cell carcinoma (HNSCC) is the most frequent histotype of the mucosal malignant tumor in this region. Many new diagnostic and therapeutic modalities have been implemented in the diagnostic and treatment protocols however all of them failed to prove a significantly improved overall survival of patient. Surgery combined with radiotherapy and chemotherapy remains a mainstay of the current treatment approaches. A better understanding of the tumor behavior and its immunological profile and microenvironment (e.g. HPV, Treg) allowed us to modify the treatment strategy.

Regulatory T cells (Treg, CD4+CD25+Foxp3+) were described as one of the critical factors for regulation or inhibition of effective anti-cancer immune response. Increased Treg frequency in the peripheral circulation was proven to correlate with the progression HNSCC. In many cancers a synergy of Treg and Th17 (CD4+161+) has been shown. So far, little is known about the importance of Tc17 (CD8+161+) in HNSCC. Particularly, the relationship between Tc17 and tonsillar cancers could be very interesting, because the CCL20 receptor (ligand for CCR6 overexpressed on Tc17) was also frequently found in tonsillar epithelia.

There were 119 patients with HNSCC included in the study from September 2010. Out of 119 primary tumors 50 were localized in the tonsillar region, 42 in the root of the tongue, 20 in the larynx and 7 in hypopharynx. All patients underwent primary surgical therapy, in dependence on the final pathological staging 15 underwent adjuvant chemo-radiation, 73 adjuvant radiation and 31 had no adjuvant therapy.

We examined periphery blood from all patients with the focus on lymphocyte subpopulation (CD3+, CD4+CD25+, CD4+/CD8+, CD19+, CD4+CD45RA+, CD8+CD28-, CD3-CD16+CD56+, CD4+CD25+Foxp3+, CD4+161+, CD8+161+) before the start of anti-tumor therapy. The infiltration of immunocompetent cells in the tumor microenvironment of specimens from primary tumors, from metastases to the neck lymph nodes and from control lymph nodes was measured in a subgroup of patients (68), where samples were taken during the surgery. The correlation of Treg and Th17 resp. Tc17, was analyzed with a special interest.

The percentage of Th17 cells (CD4+CD161+) in peripheral blood does not differ in patients with HNSCC (5.8%, SD 2.5) and in healthy controls (5.6%, SD 3.5, p = 0.46) and also the presence of Tc17 (CD8+CD161+) in peripheral blood shows the same pattern in both groups (7.0%, SD 5.5 vs. 8.0%, SD 4.3, p = 0.31).

The percentage of Th17 cells detected in primary tumors was significantly much higher than in metastatic neck lymph nodes or in neck lymph nodes without metastatic extension (7.1%, SD 7.2 vs. 4.2%, SD 3.0 vs. 4.8%, SD 2.0, p=0.01 resp. p=0.03). There was no difference in the infiltration of Tc17 cells, nor was also observed increased infiltration by Tc17 tonsillar carcinomas compared with other localizations of HNSCC. Very interesting and highly significant was the correlation of Treg infiltration with percentage of Th17 (Treg high vs. Treg low group, CD4+161+: 5.14%, SD 4.63 vs. 8.99%, SD 8.6, p= 0.03) in the samples of primary tumors.

Our results show that Th17 are increasingly detected in the primary HNSCC. Their importance for the prognosis of patients could be analyzed over a longer period of time.

Acknowledgments: The research was supported by IGA MZ CR (Grant No. 11544 and 11542).

Citation Format: Michal Zabrodsky, Jan Betka, Tomas Eckschlager, Blanka Rihova, Jan Boucek. The role of Th17 cells in the head and neck squamous cell carcinoma evolution. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr B94.

Pre-activation and muscle activity during frontal impact in relation to whiplash associated disorders

OBJECTIVE

For the evaluation of neck injury the relative distance was observed between a marker placed on the forehead and a marker placed on the shoulder and also by change of the angle. To compare the severity of head injury a value of maximum head acceleration was used, HIC and a 3 ms criterion. All criteria were related to the activity of musculus sternocleidomastoideus and musculus trapezius in a situation of expected or unexpected impact.

MATERIALS AND METHODS

The situation was recorded using a Qualisys system, head acceleration of probands in three axes was recorded using the accelerometer, activity of neck muscles was monitored by a mobile EMG.

RESULTS

Maximum head acceleration was 12.1 g for non-visual and 8.2 g for visual. HIC36 was 5.7 non visual and 4.0 for visual. 3-ms criterion was 11.5 g for non-visual and 7.8 g for visual. The average time of muscle activation of the observed group without visual perception is 0.027 s after hitting an obstacle, with visual perception 0.127 s before the crash.

CONCLUSIONS

Kinematic values indicate more favourable parameters for neck injuries for visual. Head injury criteria show an average decrease of about 30% for visual. We can conclude that the visual perception means a significant increase in pre-activation of the observed muscle group of almost 400% and lower activation in both following phases of approximately 40%.

Impact of Regulatory T Cells in Oropharyngeal Cancer

Objective: Oropharyngeal cancer is the most frequent type of malignancy in the head and neck area. Regulatory T cells (Treg, CD4+CD25+Foxp3+) and Th17 cells were described as critical factors for regulation or inhibition of effective anti-cancer immune response and, consequently, prognosis and survival.

Method: We examined Treg and Th17 from periphery blood and tumor samples of patients with oropharyngeal cancer before the start of anti-tumor therapy. We particularly focused on lymphocytes subpopulations (CD3+, CD3-CD16+CD56+, CD4+, CD8+, CD19+, CD4+CD45RA+, CD3+CD4+CD25+, CD161+CD4+ a CD161+CD8+) and tumor markers (SCC, CEA, AAT, Cyfra 21-1).

Results: In comparison with control group (nononcologic surgery), the Treg population in the peripheral blood of the patients with oropharyngeal cancer was 1.6-fold higher. Infiltration of Treg in specimens from primary tumors and metastatic neck lymph nodes was higher (8.7% and 9.6%) in comparison with oropharyngeal tissue and neck lymph nodes without tumor or metastatic extension (3.12% and 3.3%, both p+CD161+cells and 12.8% CD8+CD161+ cells, and in tumor tissue, 1.66% CD4+CD161+ cells and 3.9% CD8+CD161+ cells. Level of tumor marker CEA correlated with higher T stadium (T3+4, t-test, P < .005).

Conclusion: We can conclude that regulatory T cells and Th17 generally represent a highly important factor in the progression of many types of malignancies and our data indicated their particular importance for oropharyngeal cancer.

A novel prognostic model for malignant mesothelioma incorporating quantitative FDG-PET imaging with clinical parameters

PURPOSE

Existing prognostic systems for malignant pleural mesothelioma do not incorporate imaging information. We aimed to identify the contribution of quantitative fluorodeoxyglucose positron emission tomography (FDG-PET) analysis to other prognostic variables in this disease.

EXPERIMENTAL DESIGN

Patients with malignant pleural mesothelioma underwent helical thoracoabdominal computed tomography and FDG-PET scans at baseline. Patients were treated as clinically indicated and followed for survival. FDG-PET variables derived included total glycolytic volume, a composite of tumor volume and glycolytic activity.

RESULTS

Ninety-three patients were accrued from 2003 to 2006. Of 89 eligible assessable patients, 28 had undergone pleurodesis before enrolment. Seventeen patients remained alive at analysis; median survival is 15.4 months. On univariate analysis, significant prognostic factors were: total glycolytic volume on FDG-PET (P = 0.003), sarcomatoid histology (P < 0.0005), weight loss (P = 0.031), computed tomography stage (P = 0.015), and European Organization for Research and Treatment of Cancer good prognostic score (P = 0.049). In patients with epithelioid or biphasic histology, baseline total glycolytic volume remained predictive of survival in patients with (P = 0.01) or without (P = 0.018) previous pleurodesis. In multivariate analysis, no variable other than histology contributed to the model in patients with sarcomatoid histology; total glycolytic volume and weight loss contributed to the models in patients with nonsarcomatoid histology. computed tomography-assessed tumor-node-metastasis stage did not contribute to the model. A nomogram, which incorporates quantitative PET parameters and pleurodesis into prognostic information, is presented.

CONCLUSIONS

Sarcomatoid histology remains the strongest prognostic factor. In patients with non sarcomatoid disease, volumetric FDG-PET parameters are more predictive of survival than tumor-node-metastasis staging, suggesting that tumor volume and glycolytic activity may be more important determinants of prognosis in malignant pleural mesothelioma than anatomic extent of disease.

Occult thyroid carcinoma

Some medical definitions remain the same for many years, others change due to the progress in the diagnostic tools, which are able to distinguish markers and symptoms until then undetectable. Occult thyroid carcinoma is a general term indicating clinically different situations, whereas the incidentally detected papillary thyroid microcarcinoma is the most important from the clinical point of view. It is fundamental, for therapeutic management, to determine biological parameters which would define a small group of papillary thyroid microcarcinomas with aggressive biological behaviour. The most promising genetic and molecular markers for papillary thyroid carcinoma risk stratification are discussed in this review. Preoperative evaluation of these markers, obtained through analysis of ultrasonography-guided fine needle biopsy specimens of papillary thyroid microcarcinoma, could be very valuable in guiding treatment of this type of cancer.

Regulatory T cells and their prognostic value for patients with squamous cell carcinoma of the head and neck

Regulatory T cells (Treg) are important regulators of anti-cancer immune responses, and an increase in Treg frequency was observed in the blood of cancer patients. Blood samples from 112 patients with head and neck squamous cell carcinoma antigen (HNSCC) were obtained at the time of tumour diagnosis, and lymphocyte subpopulations (CD3⁺; CD3⁻CD16⁺CD56⁺; CD4⁺; CD8⁺; CD19⁺; CD4⁺CD45RA⁺) with emphasis on Treg counts (CD3⁺CD4⁺CD25⁺), complete blood count and tumour markers (squamous cell carcinoma [SCC]; CEA; α-1-antitrypsin [AAT]; Cyfra 21–1; C-reactive protein [CRP]) were analysed. The data were grouped according to TNM classification, and their significance for the course of the disease at an interval of 1 year after the end of the therapy was determined. The percentage of CD8⁺ cells increased and the CD/D8 ratio decreased with tumour grade. The ratio of B lymphocytes decreased in patients with locoregional metastases (11.25%versus 9.22%). Treg (15.2%) and CD4⁺ cells (45.3%) increased, while NK cells (11.8%) decreased in HNSCC patients compared to controls (9.0%, 38.1% and 15.8%, respectively). The data obtained at time of diagnosis were used to assess the significance of tumour markers (SCC, Cyfra 21–1 and AAT) for evaluation of prognosis. The erythrocyte counts (4.64 × 10¹²/l versus 4.45 × 10¹²/l) and haemoglobin levels (14.58 g/dl versus 14.05 g/dl) decreased, while Treg counts (8.91%versus 15.70%) increased in patients with early recurrence. Our results show that examination of these parameters could be helpful for prognostication in HNSCC patients and aid improvement of treatment strategy.

Marker profiling of normal keratinocytes identifies the stroma from squamous cell carcinoma of the oral cavity as a modulatory microenvironment in co-culture

PURPOSE

The microenvironment established by stromal cells may or may not influence phenotypic aspects of epithelial cells and may be relevant for tumor and stem cell biology. We address this issue for keratinocytes using tumor-derived stromal cells in a co-culture system.

MATERIALS AND METHODS

We isolated stromal cells from human squamous cell carcinoma tissue and studied their effect on phenotypic characteristics of normal human interfollicular keratinocytes in vitro.

RESULTS

Stromal fibroblasts significantly influence immuno- and lectin cytochemical properties of co-cultured normal keratinocytes. Expression of keratins 8 and 19, the nucleolar protein nucleostemin, parameters related to adhesion/growth-regulatory galectins and the epithelial-mesenchymal transition were altered. This biological activity of tumor-derived stromal cells, which did not require cell contact, appeared to be stable, because it was maintained during passaging of keratinocytes in the absence of cancer cells.

CONCLUSIONS

Tumor-derived stromal fibroblasts acquire distinct properties to shape a microenvironment conducive to altering the phenotypic characteristics of normal epithelial cells in vitro.

Nucleostemin expression in squamous cell carcinoma of the head and neck

BACKGROUND

This study presents initial data on presence of nucleostemin--a nucleolar protein typical of stem cells in the normal squamous epithelium of the oropharynx and larynx - in squamous cell carcinoma originating from these epithelia.

MATERIALS AND METHODS

Differentiation and proliferation markers such as keratins, beta-catenin, galectin-1, and Ki-67 were studied in parallel with nucleostemin for defining cell characteristics.

RESULTS

Nucleostemin was detected in nucleoli of both proliferating basal cells and terminally differentiated suprabasal cells of normal epithelium and in tumor cells. Importantly, malignant transformation was connected with a significant enlargement of nucleostemin-positive nucleoli in these cell types.

CONCLUSION

Detection of nucleostemin in head and neck cancer cells, together with the size of nucleoli, may be important in the evaluation of tumor differentiation and biology.

Nuclear presence of adhesion-/growth-regulatory galectins in normal/malignant cells of squamous epithelial origin

Cellular activities in the regulation of growth or adhesion/migration involve protein (lectin)-carbohydrate recognition at the cell surface. Members of the galectin family of endogenous lectins additionally bind distinct intracellular ligands. These interactions with protein targets explain the relevance of their nuclear and cytoplasmic presence. Expression profiling for galectins and accessible binding sites is a histochemical approach to link localization with cellular growth properties. Non-cross-reactive antibodies for the homodimeric (proto-type) galectins-1, -2 and -7 and the chimera-type galectin-3 (Gal-3) as well as the biotinylated lectins were tested. This analysis was performed with the FaDu squamous carcinoma cell line and long-term cultured human and porcine epidermal cells as models for malignant and normal cells of squamous cell epithelial origin. A set of antibodies was added for phenotypic cell characterization. Strong nuclear and cytoplasmic signals of galectins and the differential reactivity of labeled galectins support the notion of their individual properties. The length of the period of culture was effective in modulating marker expression. Cytochemical expression profiling is a prerequisite for the selection of distinct proteins for targeted modulation of gene expression as a step toward functional analysis.

131I-Anti CD20 Radioimmunotherapy of Relapsed or Refractory Non-Hodgkins Lymphoma: A Phase II Clinical Trial of a Nonmyeloablative Dose Regimen of Chimeric Rituximab Radiolabeled in a Hospital

In order to increase the availability and affordability of radioimmunotherapy of refractory or relapsed non-Hodgkins lymphoma, we developed and evaluated radioiodinated rituximab in an ongoing physician-sponsored Phase II Clinical Trial. The chimeric 1gG(1) anti CD 20 monoclonal antibody rituximab was radiolabeled with iodine-131 using a modified Chloramine T method with high radiochemical purity (98% +/- 0.82) and preservation of immunoreactivity. All patients received therapeutic loading doses of unlabeled rituximab (375 mg/m(2)) immediately prior to administration of tracer (200 MBq (131)I) or therapy (1.7-4.3 GBq (131)I) activities of (131)I-rituximab to provide additive immunotherapy and enhance tumor uptake of the radiolabeled antibody. Objective response rate (ORR) was 71% in 35 patients with a median follow-up of 14 months (range 4-28 months). Complete remission (CR) was achieved in 54% of patients, with median duration 20 months. Toxicity evaluation included an additional 7 patients followed for at least 3 months. Tracer dosimetry studies were performed in each patient and the whole body radiation absorbed dose was limited to a mean prescribed dose (MPD) of 0.75 Gy. Myelosuppression was reversible and in only 2 of 42 patients was grade IV hematological toxicity observed. No hemopoietic support was required in any patient. There was no instance of hemorrhage or infection in this group of patients in each of whom individual prospective dosimetry was performed prior to (131)I rituximab radioimmunotherapy for relapsed or refractory non-Hodgkins lymphoma.

Baia Mare accident--brief ecotoxicological report of Czech experts

On 30 January 2000, following the breach in the tailing dam of the Aurul SA Baia Mare Co., a major spill of about 100,000 m(3) of cyanide and metal-rich liquid waste was released into the river system near Baia Mare in northwest Romania. The pollutants flowed via different tributaries into the Tizsa (Tisa) river and finally through the Danube river into the Black Sea. Along the way pollutants (especially cyanides) caused rapid death of aquatic organisms and animals living close to the poisoned rivers. Following request from the governments of Romania, Hungary, and the Federal Republic of Yugoslavia, United Nations sent international mission experts to the area of accident. The Czech team of four experts took very active part in this mission. Samples of surface water collected by this team 3 weeks after the accident showed high toxicity in the rivers on the Romanian territory. Due to this impact, water from the Szamos river and a large area of the Tisza river in Hungarian territory was still medially toxic. Improvement of this situation was detected only in downstream areas of the Tisza/Tisa river. The high toxicity of surface water from the locality of the Lapos river upstream of the accident indicated the possibility of toxic pollution from other sources in the area. Aquatic sediments were highly toxic only in the Aurul reservoir and its surrounding area. Rapid decline of their toxicity indicated more limited adverse impact of the "Aurul pollution" in comparison with surface water. From ecotoxicological results it is evident that there is an urgent need to start abatement activities in the Baia Mare area because the possibility of future accidents still exists (this hypothesis was proved by further accidents on 10.3.2000 and the beginning of May 2000).

[Solving crisis situations in psychiatry]

Provision within the area of medical care has been made for psychological and social intervention in some crisis situations. A Help line telephone service called "Linka nadĕje" was established in 1965 and a crisis intervention centre in 1989. Client characteristics, and an analysis of telephone calls made during the course of three ten year periods (N = 27,268 total phone calls) are compared with 10,021 contacts and 1,781 first admissions during a five year period at the crisis centre. Data showed that both institutions help meet current crisis and in the long term they should both reduce the risk of psychological crisis, reduce the incidence of suicide, they should also help prevent both primary and secondary illness and supply sufficient information on the surrounding area.

[The profile of the physician-specialist in the field of social medicine and health care administration]

The contributions to the discussion on the profile of medical specialists in social medicine and the organization of the health services were discussed by the Advisory Board of the main specialist of the Ministry of Health and Social Affairs CSR for the discipline of social medicine and organization of the health services on April 17, 1989. They are also in the already published first version published n Ceskoslovenské zdravotnctví 37, 1989, No. 4, p. 145-150.

[Continuing education of administrators in Czechoslovak health care]

In their contribution to training and postgraduate training the authors pay in the first part of their paper attention to postgraduate training of directors of district and factory institutes of national health which is implemented in the form of periodic innovation courses. They use as a basis a survey made in 63 respondents who took part in the above courses. In the questionnaires the set-up and contents of training were evaluated, the view of directors as regards the concept and character of these courses. In the second part the authors submitted information of the contents of further periodic innovation courses for directors--public health medical officers.

[Equipment for lyoluminescent dosimetry]

The paper deals with experience gained during construction of photometry set suitable for application in lyoluminiscent dosimetry. Results of stability measurement are presented and possibilities of constructing these apparatuses using Czechoslovak parts are discussed.