The DAHANCA 32 study: Electrochemotherapy for recurrent mucosal head and neck cancer

Abstract

Background

Electrochemotherapy is an established treatment for cutaneous tumors. This study aimed at determining efficacy of electrochemotherapy in recurrent head and neck cancer.

Methods

Phase II clinical trial in patients with recurrent head and neck carcinomas with no curative treatment options. Electrochemotherapy was performed under general anesthesia. Primary endpoint was tumor response (CT scanning) evaluated at week 8. Secondary endpoints included biopsy results, MRI and fluorodeoxyglucose‐positron emission tomography scanning, safety, toxicity, pain score, and quality‐of‐life questionnaires.

Results

Of 26 patients treated, 5 (19%) achieved complete response, 10 (39%) partial response, resulting in an objective response of 58%. Two responders remain without recurrence. No serious adverse events occurred during treatment. Four events occurred posttreatment: one bleeding episode, two episodes with mucosal swelling, and one patient died due to disease progression.

Conclusion

Electrochemotherapy is efficient against local recurrence of head and neck cancer with an overall response rate of 58%.

https://ift.tt/2S3Jz5I

Radiographic nodal prognostic factors in stage I HPV‐related oropharyngeal squamous cell carcinoma

Abstract

Background

The updated AJCC Cancer Staging Manual groups all p16‐positive oropharyngeal squamous cell carcinoma (OPSCC) with unilateral nodal involvement within 6 cm into the new clinical N1 classification, consolidating a heterogeneous group of disease with varying radiographic findings.

Methods

A central radiological review was conducted identifying 233 patients with stage I node‐positive (cT1‐2N1) disease who underwent definitive concurrent chemoradiation. Factors evaluated included lymph node size, low‐neck lymphadenopathy, retropharyngeal lymphadenopathy, overt radiographic extracapsular extension, and matted lymphadenopathy.

Results

On multivariate analysis adjusted for age, smoking history, and chemotherapy regimen, low‐neck lymphadenopathy (hazard ratio (HR) = 6.55; P < .001) and retropharyngeal lymphadenopathy (HR = 3.36; P = .009) predicted for inferior progression‐free survival (PFS). low‐neck lymphadenopathy (HR = 6.38; P = .001) and retropharyngeal lymphadenopathy (HR = 3.32; P = .02) also predicted for inferior overall survival (OS). All other radiographic characteristics showed no prognostic impact for PFS or OS.

Conclusions

This analysis suggests that caution should be advised against de‐intensification efforts among patients with stage I node‐positive p16‐positive OPSCC with low‐neck lymphadenopathy or retropharyngeal lymphadenopathy.

https://ift.tt/2zUrPmf

Prospective instrumental evaluation of swallowing, tongue function, and QOL measures following transoral robotic surgery alone without adjuvant therapy

Abstract

Background

Transoral robotic surgery (TORS) has been utilized to deintensify treatment. No studies have measured swallow safety and efficiency, nor assessed the functional impact of TORS alone.

Methods

This prospective cohort underwent baseline and 1‐month postsurgery assessments including modified barium swallow evaluation, using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) rating system, tongue range of motion assessment, the Performance Status Scale (PSS), and quality of life with the MD Anderson Dysphagia Inventory (MDADI).

Results

All DIGEST safety scores were 0 (normal) at both time points. DIGEST efficiency scores were mildly impaired in 2 of 10 patients postsurgery. PSS scores revealed all patients were on regular diets, were 100% understandable, and were eating in public at both time points. Tongue Range of Motion scores were 100 of 100 at both time points. MDADI scores were not significantly different across time points.

Conclusions

Careful identification of patients can result in excellent outcomes following TORS. Future studies will examine longer follow‐up of speech, swallowing, and tongue function in patients undergoing TORS surgery.

https://ift.tt/2S5oQOH

Influence of comorbidity on therapeutic decision making and impact on outcomes in patients with head and neck squamous cell cancers: Results from a prospective cohort study

Abstract

Background

High prevalence of comorbidity in head and neck squamous cell carcinoma (HNSCC) often lead to suboptimal treatment. The presence study aims to evaluate the presence of comorbidity, its impact on therapeutic decision making, treatment compliance, and overall survival in HNSCC.

Methods

Five hundred eighteen patients with nonmetastatic HNSCC, elder than 18 years of age, without any prior history of cancer or anticancer treatment in the last 5 years were evaluated using Adult Comorbidity Evaluation 27 (ACE 27) index.

Results

Two hundred ninety three (56.6%) patients had comorbidity, and 20.6% had deviation from the ideal treatment plan. Higher grade of comorbidity led to less likely completion of guideline‐concordant therapy (moderate ACE 27 vs none: odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26‐0.82, P < .01*; severe ACE 27 vs none: OR 0.23, 95% CI 0.08‐0.57, P < .01*). Patients who completed guideline‐concordant treatment had the best outcomes as compared to those who could not (median survival: not reached vs 9.56 months, hazard ratio 3.66, 95% CI: 2.8‐4.79; P < .01*).

Conclusion

Presence of increasing severity of comorbidity in HNSCC influences therapeutic decision making. Survival outcomes are poorer in patients receiving guideline‐discordant treatment.

https://ift.tt/2S5oHuD

Reply to Letter to the Editor regarding “Carbon Dioxide Embolism during Transoral Robotic Thyroidectomy: A Case Report”

https://ift.tt/2S1K2Fl

Salivary gland tumors: Molecular characterization and therapeutic advances for metastatic disease

Abstract

Salivary gland cancers represent a rare group of tumors composed by over 20 histological subtypes. Initially treated as one single disease, its diagnosis, prognosis, and treatment are currently being stratified based on morphology. More recently, insight has been provided on the molecular characterization of each subtype, further improving diagnostic accuracy and paving the way for personalized therapy. In this article, we provide a comprehensive review of recent breakthroughs, preliminary results of novel therapy, and future directions on the treatment of these complex malignancies.

https://ift.tt/2S1K7J9

Expression of CD44, EGFR, p16, and their mutual combinations in patients with head and neck cancer: Impact on outcomes of intensity‐modulated radiation therapy

Abstract

Background

Progress in radiation treatment of head and neck squamous cell carcinoma (HNSCC) deserves the studies focused on molecular predictors that would help to enhance individually tailored treatment.

Methods

p16/epidermal growth factor receptor (EGFR)/cluster of differentiation‐44 (CD44) was immunohistochemically analyzed in 165 HNSCC patients.

Results

In the entire group and the p16 negative cohort, better 3‐year overall survival and locoregional control correlated with p16 positivity, CD44, and EGFR negativity were observed. Combined analysis revealed the worst results in the CD44+/p16−, EGFR+/p16−, and EGFR+/CD44+ groups and in the EGFR+/CD44+ within p16 negative cohort. Multivariate analysis found tumor stage, Karnofsky index, p16, and CD44 as prognostic factors of overall survival and clinical stage, and p16 as a prognostic factor for locoregional control. Clinical stage and Karnofsky index affected overall survival and tumor stage. EGFR affected locoregional control in the p16 negative subgroup.

Conclusion

Our study confirmed the negative effect of CD44 and EGFR and the positive effect of p16 on radiotherapy results.

https://ift.tt/2A29bJ2

Effect of radiotherapy on the chemical composition of root dentin

Abstract

Background

The radiotherapy can directly affect the bond strength of the adhesive materials, interfering in the prognosis of restorative treatments, which may be caused by chemical changes in dentin structure.

Methods

Twenty inferior homologues premolars were distributed in 2 groups (in vitro study) (n = 10): nonirradiated and irradiated. The specimens were submitted to the analysis of phosphate (ν₁PO₄³⁻;ν₂PO₄³⁻;ν₄PO₄³⁻), carbonate (ν₃CO₃²⁻), amide I, CH₂, amide III, and amide I/III ratio by confocal Raman spectroscopy. Data were submitted to statistical analysis (T test, P < .05).

Results

In intracanal dentin, the irradiated group had lower ν₄PO₄³⁻ values (1.23 ± 0.06) compared to nonirradiated group (1.40 ± 0.18) (P < .05), with no difference for ν₁PO₄³⁻ and ν₂PO₄³ peaks (P > .05). The irradiated (1.56 ± 0.06) had lower carbonate, amide III (1.05 ± 0.19), and amide I/III ratio values (0.19 ± 0.06) compared to nonirradiated group (1.42 ± 0.10, 1.28 ± 0.24, and 0.31 ± 0.10, respectively) (P < .05). For medium dentin irradiated group (1.30 ± 0.12) had lower phosphate values compared to nonirradiated group (1.48 ± 0.22) (P < .05). In cementum, there was no statistical difference between the groups.

Conclusion

The radiotherapy was able to cause changes in ν₄PO₄³⁻, carbonate, and amide III peaks of root dentin.

https://ift.tt/2zZElky

Prognostic value of C‐reactive protein/albumin ratio for patients with hypopharyngeal and laryngeal cancer undergoing invasive surgery involving laryngectomy

Abstract

Background

The C‐reactive protein/albumin (CRP/Alb) ratio has been recently established as a prognostic indicator in various cancer types. However, few reports regarding the prognostic value of the CRP/Alb ratio in head and neck cancer exist. This study aimed to investigate the significance of the CRP/Alb ratio in clinical outcomes after invasive surgery involving laryngectomy for hypopharyngeal and laryngeal cancer.

Methods

We evaluated 56 patients who underwent total laryngectomy or total pharyngolaryngectomy between 2003 and 2012. Univariate and multivariate analyses were retrospectively performed to examine the prognostic value of the CRP/Alb ratio in these patients.

Results

The optimal cutoff value of the CRP/Alb ratio was 0.32. Multivariate analysis showed that the CRP/Alb ratio was a significant and independent predictor of poor overall and disease‐free survival.

Conclusion

The CRP/Alb ratio may be a novel and useful indicator for predicting postoperative outcomes in patients with hypopharyngeal and laryngeal cancer.

https://ift.tt/2zZEmVE

Smoking and papillomavirus DNA in patients with p16‐positive N3 oropharyngeal squamous cell carcinoma

Abstract

Background

We investigated the survival of patients with a p16‐positive N3 oropharyngeal squamous cell carcinoma (OPSCC) and the prognostic significance of patient, tumor, and treatment characteristics.

Methods

We retrospectively reviewed the data of patients treated at our Cancer Center for a p16‐positive N3 OPSCC between 2003 and 2016. End points were overall survival (OS) and progression‐free survival (PFS).

Results

A total of 29 patients were included. The 5‐year OS and PFS were 67.5% and 59.1%, respectively. Smoking history above 10 pack‐years and the absence of human papillomavirus DNA were associated with worse OS (P = .02 and P = .03, respectively) and PFS (P = .02 and P = .02, respectively). Induction chemotherapy or radical neck dissection were not associated with different treatment outcomes.

Conclusion

Patients with an N3 p16‐positive oropharyngeal cancer in our series had a 5‐year OS rate of 67.5%. Smoking history and viral DNA were prognostic factors associated with survival.

https://ift.tt/2S5oMOX

Receptor tyrosine kinase MET as potential target of multi‐kinase inhibitor and radiosensitizer sorafenib in HNSCC

Abstract

Background

The multi‐kinase inhibitor sorafenib displays antitumoral effects in head and neck squamous cell carcinoma (HNSCC); however, the targeted kinases are unknown. Here we aimed to identify those kinases to determine the mechanism of sorafenib‐mediated effects and establish candidate biomarkers for patient stratification.

Methods

The effects of sorafenib and MET inhibitors crizotinib and SU11274 were analyzed using a slide‐based antibody array, Western blotting, proliferation, and survival assays. X‐rays were used for irradiations.

Results

Sorafenib inhibited auto‐phosphorylation of epidermal growth factor receptor and MET, which has not been described previously. MET expression in HNSCC cells was not always associated with activity/phosphorylation. Furthermore, sorafenib‐dependent cell kill and radiosensitization was not associated with MET level. Although MET inhibitors blocked proliferation, they caused only mild cytotoxicity and no radiosensitization.

Conclusion

We identified MET as a new potential target of sorafenib. However, MET inhibition is not the cause for sorafenib‐mediated cytotoxicity or radiosensitization.

https://ift.tt/2A1MlBs

Regression of human immunodeficiency virus‐associated oral Kaposi sarcoma with combined antiretroviral therapy: A case report and literature review

Abstract

Background

Kaposi's sarcoma (KS) is the most prevalent malignant neoplasia in human immunodeficiency virus positive (HIV+) patients for which the primary mode of management was chemotherapy.

Methods

We have presented the case of a newly diagnosed HIV+ male patient who was diagnosed with a pedunculated nodule in the anterior region of the hard palate, measuring 3.5 cm in diameter and with 2 months of evolution.

Results

Histopathological examination confirmed the clinical hypothesis of KS. Soon after the diagnosis, the patient started using combined antiretroviral therapy (Biovir and Kaletra), presenting a significant reduction of the lesion after 4 weeks. With 1.5 cm in diameter, the lesion was surgically removed. The patient was followed‐up for 10 years without any recurrence.

Conclusion

In antiretroviral‐naive patients with a well‐preserved immune system, the use of cART may be efficient in reducing the progression of the KS lesions, thus avoiding the use of chemotherapeutic agents.

https://ift.tt/2zYgzFy

Masticatory function and related factors after oral oncological treatment: a 5‐year prospective study

Abstract

Background

Chewing ability is often compromised in patients with oral cancer. The aim of this study was to identify which factors affect masticatory performance in these patients.

Methods

Patients with primary oral cancer were assessed for up to 5 years after primary treatment. Healthy controls were assessed once. A mixed‐model analysis was performed, with masticatory performance as outcome measure.

Results

A total of 123 patients were included in the study. Factors positively associated with masticatory performance were number of occlusal units (OU), having functional dentures, and maximum mouth opening (MMO). The impact of tumor location and maximum bite force (MBF) differed per assessment moment. Masticatory performance declined for up to 1 year but recovered at 5 years after treatment.

Conclusion

Masticatory performance in patients treated for oral cancer is affected by MBF, MMO, number of OU, and dental status. These should be the focus of posttreatment therapy.

https://ift.tt/2zZ5V14

Tobacco smoking, alcohol drinking, betel quid chewing, and the risk of head and neck cancer in an East Asian population

Abstract

Background

The smoking prevalence among men in China is high, but the head and neck cancer incidence rates are low. This study's purpose was to investigate the impact of tobacco, betel quid, and alcohol on head and neck cancer risk in East Asia.

Methods

A multicenter case‐control study (921 patients with head and neck cancer and 806 controls) in East Asia was conducted. The odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression.

Results

Head and neck cancer risks were elevated for tobacco (OR = 1.58), betel quid (OR = 8.23), and alcohol (OR = 2.29). The total attributable risk of tobacco and/or alcohol was 47.2%. Tobacco/alcohol appeared to account for a small proportion of head and neck cancer among women (attributable risk of 2.2%). Betel quid chewing alone accounted for 28.7% of head and neck cancer.

Conclusions

Betel quid chewing is the strongest risk factor for oral cavity cancer in this Chinese population. Alcohol may play a larger role for head and neck cancer in this population than in European or U.S. populations.

https://ift.tt/2S96bSt

Three prognostic indexes as predictors of response to adjuvant chemoradiotherapy in patients with oral squamous cell carcinoma after radical surgery: A large‐scale prospective study

Abstract

Background

To develop and validate practical prognostic indexes (PIs) for predicting the prognosis and response to postoperative adjuvant therapy in patients with oral squamous cell carcinoma (OSCC).

Methods

A large cohort of 1071 OSCC patients were randomized to either training set (N = 708) or validation set (N = 363). Three types of PIs were developed according to the nomogram scores, β coefficients and excess hazard ratios, respectively. Restricted cubic spline was used to demonstrate the relationship between PIs and the risks of death.

Results

First, a nomogram was developed incorporating age at diagnosis, smoking status, clinical stage, tumor differentiation, lymph node status, comorbidity, and neutrophil to lymphocyte ratio levels. Then, three PIs were established with high survival predictive ability, and were superior to AJCC staging system (all P < .05). The risks of death were escalated continuously with the increasing number of PIs. Interestingly, adjuvant chemoradiotherapy was positively associated with poor overall survival in patients with low PIs, but exerted a beneficial effect on patients with high PIs.

Conclusion

Combined nomogram with further established PIs not only predicts the survival probability of OSCC patients, but also continuously quantifies the risk of death. High PIs could predict a beneficial response to adjuvant chemoradiotherapy, whereas low PIs indicate an unfavorable response.

https://ift.tt/2S4HBlw

Efficacy of allergen-blocker mechanical barrier gel on symptoms and quality of life in patients with allergic rhinitis

Abstract

Propose

Allergic rhinitis (AR) is a very common, chronic and global health problem. In the last two decades, the efficiency of barrier-enforcing measures in AR has been investigated. In this study, we aimed to evaluate the effect of allergen-blocker mechanical barrier gel (MBG) (AlerjiSTOP^®) treatment on symptoms and quality of life score (QoLS) in patients with seasonal and perennial allergic rhinitis.

Methods

A single-center, prospective study was conducted between January 2017 and May 2018. Patients diagnosed with allergic rhinitis with a visual analogue scale (VAS) of 5 or higher (moderate/severe) were enrolled in the study. Patients were evaluated in terms of VAS, nasal symptom score (NSS), ocular symptom score (OSS), total symptom score (TSS) and QoLS at baseline, 1 week and 1 month of MBG treatment.

Results

A total of 83 patients with AR were enrolled in the study. Clinical and laboratory examinations showed that 50 (60.2%) patients were mono-sensitized. Allergen-blocker mechanical barrier gel treatment was performed as monotherapy in 22 (26.5%) patients. Median VAS, NSS, OSS and TSS decreased from 7 to 4, 8 to 3, 4 to 0 and 12 to 4, respectively (p < 0.0001). Correlation analysis revealed positive correlations between lower pediatric rhinoconjunctivitis quality of life questionnaire scores for patients under 12 years of age and decrease in VAS, NSS and TSS (r = 0.380, p = 0.008; r = 0.544, p < 0.0001; r = 0.543, p < 0.0001). Positive correlations were detected between lower rhinoconjunctivitis quality of life questionnaire (self-administered) scores for patients ≥ 12 years of age and decrease in VAS, NSS, OSS and TSS (r = 0.703, p < 0.0001; r = 0.465, p = 0.005; r = 0.526, p = 0.001; r = 0.624, p < 0.0001).

Conclusion

In conclusion, we found significant decrease in all symptom scores and improvement in QoLS of patients treated with MBG as monotherapy and combination therapy.

https://ift.tt/2PHi1AW

Influence of patient-specific anatomy on medical computed tomography and risk evaluation of minimally invasive surgery at the otobasis

Abstract

Purpose

With the increasing use of new minimally invasive approaches in temporal bone surgery, the need arises for evaluation of the risk of injury to sensitive anatomical structures. The factors that influence the measurement uncertainty (variation in representation of position and shape of anatomical structures) of imaging are of relevance. We investigate the effect of patients' anatomy on the measurement uncertainty of medical CT.

Methods

Six formalin-fixed temporal bones were used, fiducial markers were bone-implanted, and 20 CT scans of each temporal bone were generated. Surgically threatened anatomical structures of importance were defined. Manual segmentation was performed to create 3D surface models, and different Gaussian filters were applied. Analysis points were established along the border of the superior semicircular canal to determine the deviation between the 3D images of the labyrinth. The standard uncertainty was calculated, and one-way analysis of variance was performed (significance level = 5%) to evaluate the effect of certain factors (patient, side, Gaussian filter) on the measurement uncertainty.

Results

The influence of patient-specific anatomy on the measurement uncertainty of medical CT (p = 0.049) was demonstrated for the first time. The applied Gaussian filter (p = 0.622) and the patient's side (p = 0.341) showed no significant effect.

Conclusion

The applied method and the results of the statistical analysis suggest that the patient's individual anatomical conditions affect the measurement uncertainty of medical CT. Thus, the patient's anatomy must be considered as an important influencing factor during risk evaluation concerning minimally invasive and image-guided surgery.

https://ift.tt/2zWgcLu

An internal carotid artery pseudoaneurysm with neck hematoma: A rare cause of a life-threatening neck mass mimicking an abscess

Publication date: Available online 14 December 2018

Source: Auris Nasus Larynx

Author(s): Ana Penezić, Luka Ljubešić, Tomislav Gregurić, Krešo Zurak, Davor Vagić, Dijana Zadravec

Abstract

A neck mass has a broad and complex differential diagnosis, generally divided into neoplastic, congenital and inflammatory categories. An internal carotid artery hemorrhage with pseudoaneurysm formation is a very rare entity that may resemble other common conditions in the differential diagnosis. Large, expanding or symptomatic pseudoaneurysm is critical to efficiently diagnose and manage, due to risk of life-threatening hemorrhage. We present a case of an adult male patient with clinical and laboratory signs of severe neck cellulitis and a large gradually increasing neck mass, primarily suggestive of an abscess. Neck CT and MRI imaging revealed the presence of a disruption of the internal carotid artery resulting in a large hematoma and formation of pseudoaneurysm. A multidisciplinary team of interventional radiologists and ENT surgeons successfully treated the patient by endovascular placement of stents and subsequent surgical drainage. Awareness of such a rare, life-threatening condition and efficient multidisciplinary teamwork are essential for patient management.

https://ift.tt/2SNmBzF

Polymorphisms associated with oral clefts as potential susceptibility markers for oral and breast cancer

Publication date: Available online 14 December 2018

Source: Archives of Oral Biology

Author(s): Edimilson Martins de Freitas, Renato Assis Machado, Edilmar de Moura Santos, Felipe Rodrigues de Matos, Hébel Cavalcanti Galvão, Priscila Bernardina Miranda Soares, Roseana de Almeida Freitas, Hercílio Martelli

ABSTRACT

Objective

To evaluate the association of single nucleotide polymorphisms (SNPs) in genes/loci consistently altered in nonsyndromic oral clefts in patients with oral and breast cancer in a Brazilian population.

Design

This case-control study evaluated the association of SNPs in IRF6 (rs642961), WNT3A (rs708111), GSK3β (rs9879992), 8q24 (rs987525) and WNT11 (rs1533767), representing regions consistently identified as of susceptibility for oral clefts, with oral cancer (oral squamous cell carcinoma) and breast cancer. Logistic regression analyses were used for confounding adjustments, and p values ≤0.01 were considered statistically significant (Bonferroni correction = 0.05 / 5 polymorphic markers).

Results

The minor G allele of rs9879992 in GSK3β was associated with oral cancer risk (p = 0.02), whereas rs1533767 in WNT11 showed a protective effect against it (p = 0.04). Several SNP-SNP interactions containing GSK3β rs9879992 were significantly associated with oral cancer after 1,000 permutation test. To breast cancer, the A allele of rs987525 was associated with increase risk in early stage (p = 0.02) and SNP-SNP interactions involving the 5 SNPs were significantly observed, with the most significant interaction among rs708111, rs1533767, rs9879992 and rs642961 (p_{1000permutation}<0.001).

Conclusion

Our results reveal associations of SNPs consistently altered in oral cleft with oral and breast cancer risk, raising interesting possibilities to identify risk markers for those tumors.

https://ift.tt/2rF9cOo

Home Environment and Diseases in Early Life are Associated with Allergic Rhinitis

Publication date: Available online 14 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Xue Kang, Hailuo Tu, Tengfei Tian, Zhiqun Huang, Liping Luo, Li Shen, Jing Ye

Abstract

Objective

Risk factors in relation to allergic rhinitis (AR) remain unclear despite considerable interest. This study aimed to analysis the relationship between home environment and diseases in early life and AR.

Methods

In a case-control survey, 242 AR patients and 258 healthy persons responded to questionnaires designed to capture pre-pregnancy/pregnancy diseases, maternal medication usage, diseases in early life of participants, family allergic history and home environmental factors. Forty risk factors potentially connected with AR were investigated and analyzed with chi-square test and logistic regression.

Results

There was no correlation between mother's disorders such as periodontitis, chronic rhinitis, diabetes etc. and AR (p>0.05). A logistic regression analysis showed that neonatal jaundice (p<0.001), respiratory system infection (p<0.001), diarrhea (p<0.01), eczema (p<0.01) in the early life and home environmental factors such as house decoration (p<0.01), mold environment (p<0.001), keeping flowers and plants (p<0.001), passive smoking (p<0.01) were associated with AR.

Conclusion;Diseases in early life and home environment are closely associated with AR.

https://ift.tt/2rBuJYr