Evaluation of patients with oral squamous cell carcinoma treated by radical irradiation with mold radiotherapy using a customized device: a retrospective clinical study

Background

It is very important to determine the indication of mold radiotherapy for the radical treatment of oral cancer. We investigated eight patients with oral squamous cell carcinoma who were treated by radical irradiation with mold radiotherapy using a customized device.

Methods

The subject is a case of curable superficial oral cancer of a few millimeters, or cancer of a size that can be cured by the placement of the radiation source. Of the eight patients, six were male and two were female, aged 64–93 years (mean, 78.9 years; median, 73.5 years). The primary sites were the buccal mucosa in three cases, gingiva in two cases, and floor of the mouth, soft palate, and lower lip in one case each. Five cases were in the T1 stage, and the remaining three cases were in T2. With respect to thickness, seven cases were of the superficial type and could not be detected by magnetic resonance imaging or computed tomography, and the remaining case showed a tumor thickness of 7.5 mm. All cases were diagnosed as squamous cell carcinoma by biopsy. Radical irradiation using mold radiotherapy was planned for all eight patients. Irradiation was delivered in 9–10 sessions, with a total dose of 45–50 Gy.

Results

Complete response was attained in six of the eight patients and partial response was observed in two patients, requiring additional treatment.

Conclusion

Since all patients with complete response had superficial cancers, we hypothesized that superficial cancers of the oral cavity with thicknesses of few millimeters could be indicated for mold irradiation. This method can be applied in complicated cases and older patients in whom surgery or chemotherapy may not be feasible. We believe that the results of our clinical studies will be of great help in choosing this method.

A modified preauricular and transmandibular approach for surgical management of osteosarcoma of the mandibular condyle within the masticator space and infratemporal fossa: a case report

Background

Osteosarcomas of the head and neck region are rare entities that comprise < 10% of all osteosarcomas. Multimodality treatment of patients with osteosarcoma is well-established for osteosarcoma in long bones, and the benefits of chemotherapy in long bones are clearly known. However, there is no consensus regarding the effects of chemotherapy in cases of head and neck osteosarcoma. The prognostic factor for head and neck osteosarcoma is complete tumor resection with negative margin, which is a radical surgery. However, a clear margin may be difficult to achieve in the head and neck region.

Case presentation

We present a case of a 69-year-old Japanese woman who developed osteosarcoma of the condyle within the masticator space and infratemporal fossa, which was treated with radical surgery using a modified preauricular and transmandibular approach. Although we recommended adjuvant treatment after surgery, the patient refused this treatment. There was no evidence of local recurrence or distant metastasis through 30 months of follow-up.

Conclusions

Our modified preauricular and transmandibular approach allowed access to the masticator space and infratemporal fossa, thereby increasing complete resection of the tumor and resulting in minimal functional and cosmetic deficits.

Chewing suppresses the stress-induced increase in the number of pERK-immunoreactive cells in the periaqueductal grey

We investigated the effects of chewing under immobilization stress on the periaqueductal gray (PAG) matter using phosphorylated extracellular signal-regulated kinase (pERK) as a marker of responding cells. Immobilization stress increased pERK-immunoreactive cells in the PAG. Among four subdivisions of the PAG, the increase of immunoreactive cells was remarkable in the dorsolateral and ventrolateral subdivisions. However, increase of pERK-immunoreactive cells by the immobilization stress was not so evident in the dorsomedial and lateral subdivisions. The chewing under immobilization stress prevented the stress-induced increase of pERK-immunoreactive cells in the dorsolateral and ventrolateral subdivisions with statistical significances (p<0.05). Again, chewing effects on pERK-immunoreactive cells were not visible in the dorsomedial and lateral subdivisions. These results suggest that the chewing alleviates the PAG (dorsolateral and ventrolateral subdivisions) responses to stress.

Combination of chewing and stress up-regulates hippocampal glucocorticoid receptor in contrast to the increase of mineralocorticoid receptor under stress only

In general, acute immobilization stress increases plasma corticosterone levels that signal the hypothalamic-pituitary-adrenal axis. Mineralocorticoid receptors and glucocorticoid receptors in the hippocampus perform crucial roles in this feedback mechanism. In the present study, we investigated the effects of chewing under stress on the rat hippocampal mineralocorticoid and glucocorticoid receptors by immunohistochemistry. We separated rats into a control group, a 2-h immobilization stress group (stress only group), and a 2-h immobilization stress group that was allowed to chew on a wooden stick for the latter 1h (stress with chewing group). Mineralocorticoid receptor immunoreactive cells with nucleus staining in the hippocampal CA1 area were scattered in the pyramidal cell layer. The stress only group showed the densest distribution of immunoreactive cells; however, the density of the immunoreactive cells in the stress with chewing group was similar to that of the control group. Changes in immunoreactive cell density were not visible in other areas of the hippocampus, namely, the CA3 area and dentate gyrus. Image analysis indicated that the increase in the mineralocorticoid receptor immunoreactive area within a fixed area in the stress only group was statistically significant compared with those in the control group and the stress with chewing group. On the other hand, glucocorticoid receptor immunoreactive cells in the CA1 area seemed to be increased in the stress with chewing group, but not in the stress only group. Image analysis indicated that this increase was statistically significant. These results suggest that immobilization and immobilization with chewing differentially affect these two types of glucocorticoid receptors in the rat hippocampus. Considering that chewing has alleviative effects against stress, glucocorticoid receptor elevation in the hippocampal CA1 area is one of the neuronal mechanisms of coping with stress.