Showing papers in "European Journal of Cancer. Part B: Oral Oncology in 1994"
TL;DR: It is concluded that the superiority of intensive oral hygiene care is not clinically impressive and the percentage of documented septicaemia was not higher in patients who underwent intensive oral care.
Abstract: Between February 1986 and November 1989, 166 patients who were candidates for a bone marrow transplantation entered a randomised controlled clinical trial to compare limited oral hygiene care (LIM) and intensive oral hygiene care (INT) in the prevention of mucositis. Randomisation was stratified on the initial oral status (good vs. bad IOS). Intensive oral hygiene care included an initial treatment of dental lesions and tooth and gum brushing during aplasia. Limited oral hygiene care excluded preventive dental treatment and gingival and tooth brushing. Mucositis was classified as absent, mild, moderate or severe, according to the clinical aspects of the different sites in the mouth and to two scales of pain evaluation. Of the 150 evaluable patients (75 in each group), 134 developed moderate/severe mucositis (64 in the INT group and 70 in the LIM group) (log-rank test P < 0.02). The superiority of intensive oral care was observed both in patients with and without total body irradiation (TBI) and in patients with a good or bad IOS; the observed risk of mucositis was reduced by 70% in each of these four subgroups. Duration of moderate/severe mucositis was, although not significantly, lower in the INT group (17 days, S.D. = 12) than in the LIM group (19 days, S.D. = 13). The median time of mucositis occurrence was 11 days in the INT group and 9 days in the LIM group. Contrary to a widespread belief, the percentage of documented septicaemia was not higher in patients who underwent intensive oral care. We conclude that, although statistically significant, the superiority of intensive oral hygiene care is not clinically impressive.(ABSTRACT TRUNCATED AT 250 WORDS)
175 citations
TL;DR: The risk of presenting with advanced stage vs. early stage disease was evaluated in a prospective study of 336 consecutive patients with oral and oropharyngeal carcinomas referred to three head and neck surgery services during the period from February 1986 to December 1988.
Abstract: The risk of presenting with advanced stage vs. early stage disease was evaluated in a prospective study of 336 consecutive patients with oral and oropharyngeal carcinomas referred to three head and neck surgery services in Sao Paulo, Curitiba and Goiania during the period from February 1986 to December 1988. Income and educational levels were not associated with stage distribution. The risk of having advanced disease was dependent upon male gender. Another important determinant of advanced stage was tumour location on the less visible surfaces of the oral cavity and oropharynx. Although there was a clear increase in delay of referral among cases who were seen by more than one health professional, duration of symptoms and patient and professional delays were not associated with the risk of advanced disease in unifactorial analysis. The following factors were independently associated with the risk of advanced disease for lip carcinoma: a painful ulcer, alcoholism and delay caused by a non-specialist medical doctor. The risk factors associated to advanced oral carcinoma were: type of lesion, odynophagia/dysphagia, delay caused by a dentist and delay caused by a non-specialist medical doctor. Two of the most important immediate consequences of advanced stage were a conspicuous increase in treatment costs and a longer hospital stay.
158 citations
TL;DR: It is confirmed that cryotherapy can decrease 5FU-induced stomatitis and should be recommended for patients receiving bolus 5FU -containing regimens.
Abstract: Recently, a randomised study demonstrated the utility of oral cooling (cryotherapy) in the prevention of 5-fluorouracil (5FU)-induced stomatitis. In order to verify these results a confirmatory study, using identical treatment regimen, was initiated. 84 patients treated with a 5-FU-containing regimen were randomised to a control arm or to receive oral cryotherapy. End point evaluation was obtained by a global assessment of the physician's judgement and patients' description of mucositis severity graded 0-4. Mucositis was significantly reduced by cryotherapy considering both the first cycle of therapy (the mean toxicity score for cryotherapy was 0.59 and it was 1.1 for the control group, P < or = 0.05) and all the chemotherapeutic courses (the mean toxicity score for cryotherapy was 0.36 when it was 0.69 for the control group, P < or = 0.05). In conclusion, the present study confirms that cryotherapy can decrease 5FU-induced stomatitis and should be recommended for patients receiving bolus 5FU-containing regimens.
115 citations
TL;DR: The state of p53 tumour suppressor and the frequency of high-risk human papillomavirus (HPV) infections were studied in nine human oral cancer cell lines.
Abstract: The state of p53 tumour suppressor and the frequency of high-risk human papillomavirus (HPV) infections were studied in nine human oral cancer cell lines. Three cancer cell lines (SCC-4, Tu-177 and FaDu) had similar amounts of p53 transcripts to normal cells, but contained significantly higher levels of p53 protein than the normal control cells. Sequencing highly conserved open reading frames of the p53 gene of these cancer cells showed point mutations in the SCC-4 and Tu-177 cell lines, a base transition from CCC to TCC occurred at codon 151; and in the line FaDu, a mutation of CGG to CTG occurred at codon 248. The HEp-2 and 1483 cancer lines contained significantly lower levels of p53 protein compared to the normal counterpart. Sequencing of p53 cDNA for HEp-2 and 1483 lines showed no mutations, but northern analysis revealed that these cell lines expressed HPV-18 E6/E7 messages. Four cell lines (SCC-9, SCC-15, SCC-25, and Tu-139) expressed negligible amounts of p53 transcripts compared to the normal counterpart and undetectable levels of p53 protein. These cell lines contained mutations in the highly conserved open reading frames of the p53 gene as follows: the SCC-9 had a deletion of 32 base pairs between codons 274 and 285; the line SCC-15 had an insertion of five base pairs between codons 224 and 225; the line SCC-25 had a deletion of two base pairs in codon 209; and the Tu-139 line had a deletion of 46 base pairs between codons 171 and 186.(ABSTRACT TRUNCATED AT 250 WORDS)
99 citations
90 citations
TL;DR: The data indicate that there is at most a weak familial aggregation of oral/pharynx cancers, and it seems likely that environmental factors contribute to the familial tendency observed in this study.
Abstract: We examined the relationship between a family history of cancer and risk of oral and pharyngeal cancer using epidemiological data from a large case-control investigation of these tumours. 487 (45.7%) of the cases and 485 (41.0%) of the controls reported cancer in a parent or a sibling. After controlling for age, race, sex, study location, respondent status and smoking and alcohol use, the OR associated with any cancer in the family was 1.1 [95% confidence interval (CI) 0.9-1.3]. Risks were non-significantly elevated among those with a history of cancers arising from the oral cavity/pharynx (OR = 1.2, 95% CI 0.7-2.3), oesophagus/larynx (OR = 1.6, 95% CI 0.7-3.8) and lung (OR = 1.2, 95% CI 0.8-1.8), with the excess risk primarily among those for whom a male relative, particularly a brother, was affected with these smoking-related cancers. In addition, an elevated risk of oral/pharynx cancer was found among those whose sisters developed other cancers (OR = 1.6, 95% CI 1.1-2.2). Subsite analyses revealed stronger elevated risks of smoking-related cancers in relatives of pharyngeal cancer cases (OR = 1.7, 95% CI 1.1-2.8) than of oral cancer patients. The data indicate that there is at most a weak familial aggregation of oral/pharynx cancers. Furthermore, since the excess familial risk of oral/pharynx cancer was associated with smoking-related cancers among male but not female relatives, it seems likely that environmental factors (notably smoking and drinking) contribute to the familial tendency observed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
85 citations
TL;DR: It is shown that amplification of 11q13 DNA markers is a prominent event occurring in head and neck SCC and may contribute to the pathogenesis and evolution of a subset of patients bearing this type of cancer.
Abstract: Amplification of 11q13 DNA markers, particularly hst-1 FGF4 oncogene and the bcl-1 locus, was evaluated in 178 head and neck squamous cell carcinomas (SCCs) by Southern blot and slot blot hybridisation. Coamplification of hst-1 FGF4 and bcl-1 genes was found in 57% of primary tumours and in 60% of the 89 metastatic lymph nodes tested. The pattern of amplification was significantly similar in matched sets of primary SCCs and metastatic lymph nodes. Levels of amplification, quantified by densitometric analysis of slot blots, ranged from 2 to 18-fold normal gene dosage. Also, c-myc oncogene (8q24) was found amplified less frequently, since 7% of 169 SCCs tested contained amplification of this gene, the level of which ranged from 2 to 8-fold. Hst-1 bcl-1 gene amplification was observed more frequently in the tumours arising from the hypopharynx. Coamplification of hst-1 and bcl-1 genes was significantly positively associated with tumours with nodal involvement (P = 0.001). Incidence of hst-1 bcl-1 gene amplification is higher in the tumours with a clinical stage III or IV. Hst-1 bcl-1 gene amplification was not related to tumour differentiation or local invasiveness. This prospective study shows that amplification of 11q13 DNA markers is a prominent event occurring in head and neck SCC and may contribute to the pathogenesis and evolution of a subset of patients bearing this type of cancer.
81 citations
TL;DR: 524 patients with histologically proven squamous cell carcinoma of the oral cavity who were previously untreated are studied for prognostic factors; only two factors, T stage and N stage, were highly significant predictors of survival; survival falling with increasing stage.
Abstract: 524 patients with histologically proven squamous cell carcinoma of the oral cavity who were previously untreated are studied for prognostic factors. There were various associations between T stage and site; T2 being more common in buccal cancer, T1 in tongue cancer, T4 in floor of mouth tumours and T2 in the roof of the mouth. Floor of mouth cancer tended to be more frequently associated with positive cervical lymph nodes than were other sites (45%). Well-differentiated tumours tended not to be associated with nodal disease (66%). Small tumours tended not to be associated with nodal metastases whereas large ones were. Univariate analysis of observed survival showed that well differentiated tumours had a slightly better survival than poorly-differentiated tumours (a difference of 8%). Survival fell with increasing T stage and with increasing pT stage. Positive resection margins and advanced pT stage in particular had a dismal prognosis. Survival also fell with increasing N stage and with increasing pathological N stage and extranodal rupture adversely affected prognosis. When the data were analysed by Cox's multivariate regression only two factors were found to be significant. These were T stage and N stage. Both were highly significant predictors of survival; survival falling with increasing stage.
81 citations
TL;DR: Immunohistochemical studies supported a diagnosis of leiomyoma in all 6 cases but PTAH was positive in only 3 of them and the other 3 were identified as granular cell tumour, myofibroma and neurofibroma, respectively.
Abstract: Leiomyoma is the most common benign neoplasm in the uterus and stomach but is rare in the oral cavity. There were only 5 oral cases in a series of 7748 leiomyomas of all sites. Benign smooth muscle neoplasms are classified into leiomyoma (solid leiomyoma), angiomyoma (vascular leiomyoma) and epithelioid leiomyoma (leiomyoblastoma). 6 cases diagnosed as leiomyoma were retrieved from the files of two oral biopsy services over the past 25 years. A light microscopic study including trichrome and phosphotungstic acid haematoxylin (PTAH) stains, and an immunohistochemical study with the following markers: desmin, muscle specific actin, myoglobin, vimentin, S-100 protein, neuron-specific enolase, factor VIII and Ulex europeus were done with suitable controls. The haematoxylin and eosin and Masson's trichrome stains supported a diagnosis of leiomyoma in all 6 cases but PTAH was positive in only 3 of them. The immunohistochemical study confirmed the diagnosis of leiomyoma in 3 cases. The other 3 were identified as granular cell tumour, myofibroma and neurofibroma, respectively. The review of the literature contributed the following data: mean age was 41 and median age 39 in 134/142 patients. A male sex prevalence 72/137 patients (54.0%) was noted. The lips were the most common site with 39 cases (27.46%) followed by the tongue 26 (18.30%), cheeks and palate 22 (15.49%), gingiva 12 (8.45%), and mandible 8 (5.63%). Prognosis of oral leiomyomas is excellent. Immunohistochemistry is a precise and reliable method for definitive diagnosis of oral leiomyoma.
78 citations
TL;DR: Patients with squamous cell carcinoma of the lip and oral cavity followed for the occurrence of second primary tumours (SPTs) in the respiratory and upper digestive tract seem to be more at risk for SPTs than patients with an index tumour in the other (sub)sites of the mouth.
Abstract: 727 patients with squamous cell carcinoma (SCC) of the lip and oral cavity have been followed for the occurrence of second primary tumours (SPTs) in the respiratory and upper digestive tract (RUDT). 74 patients (10%) developed at least one SPT in the RUDT. The incidence of SPTs was expressed per 1000 person-years of follow-up. In our study about 28 SPTs per 1000 person-years of follow-up were seen in the RUDT. Patients were at risk for a second primary tumour, at a steady rate of approximately 2.8% per year during at least 10 years. Furthermore, patients with an index tumour in the lower part of the mouth (floor of mouth, retromolar area and lower alveolar process), which is more related to tobacco and/or alcohol, seem to be more at risk for SPTs than patients with an index tumour in the other (sub)sites of the mouth.
78 citations
TL;DR: The increased expression of EGFR and Ki67 in NPC at late tumour stage indicates their possible use in malignancy grading of NPC.
Abstract: The expression of Ki67 antigen, epidermal growth factor receptor (EGFR) and the Epstein-Barr virus (EBV)-encoded latent membrane protein (LMP1) in nasopharyngeal carcinoma (NPC) was immunohistochemically determined. In cases with sufficient material western blot analysis was applied to analyse the LMP1 expression. Biopsies from 20 Chinese and 3 Swedish patients with NPC were included in the study. Our results demonstrated a nuclear Ki67 staining, a membrane EGFR staining, and a dot-like cytoplasmic and/or membrane LMP1 staining pattern in tumour cells of NPC. The proportion of Ki67-positive cells correlated with tumour stage. A strong expression of EGFR was frequently seen in patients with tumour stages III and IV and was paralleled by a higher proportion of Ki67-positive cells. The majority of the LMP1-positive cases strongly expressed EGFR and had a higher proportion of Ki67-positive cells, indicating a possible effect of EBV LMP1 on the proliferation of tumour cells in NPC. The increased expression of EGFR and Ki67 in NPC at late tumour stage indicates their possible use in malignancy grading of NPC.
TL;DR: 34 patients with primary extranodal non-Hodgkin lymphoma of the oral cavity have been studied with reference to age, sex, clinical symptoms, location of primary tumour, histological subtype, grade of malignancy according to the Working Formulation.
Abstract: 34 patients with primary extranodal non-Hodgkin lymphoma (PE-NHL) of the oral cavity have been studied with reference to age, sex, clinical symptoms, location of primary tumour, histological subtype, grade of malignancy according to the Working Formulation, stage of disease, treatment and follow-up. The clinicopathological features of these oral PE-NHL correspond with those of PE-NHL in general. Survival was influenced by stage of disease and grade of malignancy.
TL;DR: Analysis of the potential prognostic value of tobacco and alcohol consumption in 161 consecutive patients with intra-oral squamous cell carcinoma showed that clinical stage, tumour size, tobacco consumption and tobacco consumption, but not alcohol consumption, had significant influences on prognosis.
Abstract: The aim of this study was to assess the potential prognostic value of tobacco and alcohol consumption in 161 consecutive patients with intra-oral squamous cell carcinoma. The patients were included in a prospective clinico-experimental and epidemiological study to secure valid data on tobacco and alcohol consumption. Univariate analysis showed that patients with an alcohol consumption above the median had a significantly ( P =0.03) poorer prognosis than other patients, with 5-year cause-specific survivals of 54 ± 6 and 33 ± 6%, respectively. Similarly, patients with a tobacco consumption above the median had a worse prognosis than other patients, with 5-year cause-specific survivals of 55 ± 6 and 39 ± 6%, respectively. This difference was on the borderline of significance, P =0.056. Tobacco and alcohol consumption were correlated and each of them correlated with sex, males having a higher consumption than females. T-stage, N-stage, clinical stage, tumour size and sex all had a significant prognostic impact. To elucidate whether tobacco and alcohol consumption had an independent prognostic value, a multivariate analysis by means of the Cox proportional hazards regression analysis was performed. This analysis showed that clinical stage ( P =2 × 10 −5 ), tumour size ( P =0.007) and tobacco consumption ( P =0.046), but not alcohol consumption, had significant influences on prognosis. Thus, smoking cessation programmes seem warranted both from a prophylactic and a therapeutic point of view.
TL;DR: It is concluded that the appearance of p53 protein occurs early in carcinogenesis but that cells also may show increased proliferation without involving immunohistochemically detectable alterations in the p53 gene.
Abstract: Paraffin embedded material from 15 patients suffering from head and neck squamous cell carcinoma (NNSCC) bordered by dysplastic mucosal areas was immunohistochemically investigated for the presence of p53 protein and Ki-67 proliferation marker. p53 protein was present in 9 cases (60%), invariably in invasive cancer areas as well as in adjacent non-invasive dysplastic mucosa. Only cells exhibiting atypia contained p53 protein. Ki-67 proliferation marker was present in the basal cells of the normal epithelium and more extensive in dysplasias and HNSCC. The presence of Ki-67 closely coincided with p53 protein in the 9 cases exhibiting this. No differences in Ki-67 expression were found between p53 positive and negative cases. It is concluded that the appearance of p53 protein occurs early in carcinogenesis but that cells also may show increased proliferation without involving immunohistochemically detectable alterations in the p53 gene.
TL;DR: The majority of glands irradiated with 40-52 Gy recovered not only in secretion rates but also with respect to the components studied in this investigation.
Abstract: Parotid saliva composition was studied before, during and up to 18 months after the irradiation period in 16 cancer patients treated for malignancies in the head and neck region. Stimulated parotid saliva was collected prior to radiotherapy and, when possible, weekly during treatment. New samples were taken 2, 4, 6, 12 and 18 months after the end of radiotherapy. Nine of the 16 patients were treated with bilateral irradiation fields and 7 patients with unilateral irradiation fields, with a total dose not exceeding 52 Gy. During the entire irradiation period the fraction of glands producing measurable volumes of saliva decreased to 40%. In the postirradiation period the number of active glands gradually increased and saliva secretion rate returned to an average of 72% of the initial value 18 months after the end of irradiation. The concentrations of the measured variables increased already during the first week of radiotherapy and at the end of the treatment period the concentrations for total protein, salivary peroxidase, hexosamine and salivary IgA were significantly increased. The concentrations for total protein, salivary peroxidase and salivary IgA were still increased 6 months after the end of irradiation. At the 18-months observation all concentrations had returned to normal, as evaluated in a paired t-test. The majority of glands irradiated with 40–52 Gy recovered not only in secretion rates but also with respect to the components studied in this investigation.
TL;DR: There was no difference between the proliferating activities of the different histological types of solid ameloblastomas and its correlation to the biological behaviour according to each histological type, and it is believed that PCNA would be useful in showing the differentiation between benign and malignant amelOBlastomas.
Abstract: The aim of this study is to evaluate the proliferating activity of ameloblastomas and its correlation to the biological behaviour according to each histological type. 38 cases of solid and unicystic ameloblastomas were reviewed including 1 case of ameloblastic carcinoma and 1 recurrent case. An anti-PCNA antibody, PC10(Dako), was applied for the detection of proliferating cell nuclear antigen (PCNA) in paraffin embedded tissue sections. Also 20 cases of dentigerous cysts were reviewed. In conclusion, we observed that there was no difference between the proliferating activities of the different histological types of solid ameloblastomas. Because 1 case of ameloblastic carcinoma and one recurrent case revealed remarkably high PCNA reactivity, we believe that PCNA would be useful in showing the differentiation between benign and malignant ameloblastomas. In unicystic ameloblastomas, plexiform intraluminal growth was considered to be an important feature in tumorous transformation of cystic epithelium.
TL;DR: This review compares the keratins in normal oral epithelia, which show a mainly site-dependent expression, with those in squamous cell carcinoma, and recommends that the anti-keratin antibodies must be fully characterised and their interaction with the relevant tissue, both frozen and conventionally processed, should be evaluated.
Abstract: The major value of intermediate filaments (IFs) in biological and applied research lies in their high order of cell and tissue specificity. This is particularly well illustrated in keratin (K) expression in various oral epithelia. Although the original class of IF is usually conserved in tissues after neoplastic transformation, epithelia show a tendency to shift their pattern of keratin expression in a manner which, while not predictable with precision, may sometimes be of diagnostic or prognostic significance. This review compares the keratins in normal oral epithelia, which show a mainly site-dependent expression, with those in squamous cell carcinoma. Key changes in the latter are the presence of simple epithelial keratins, K8 and K18 (occasional K7), reduced expression of differentiation-linked keratins (K1, K10, K4 and K13) and a tendency for down-regulation of primary keratins, K5 and K14. Moderate and severe dysplasias also tend to exhibit K8 and K18 with concomitant disordered expression of differentiation-linked keratins. There are reports of similar changes after neoplastic transformation in other mucosal sites and skin. Before this information can be applied diagnostically in immunocytochemical studies, the anti-keratin antibodies must be fully characterised and their interaction with the relevant tissue, both frozen and conventionally processed, should be evaluated.
TL;DR: A retrospective investigation of the incidence of side-effects affecting eating and their effect upon quality of life more than 1 year after treatment, was undertaken to evaluate long-term patient rehabilitation of oropharyngeal carcinoma patients.
Abstract: The ability to eat determines not only a patient's nutritional status, but also influences quality of life. A retrospective investigation of the incidence of side-effects affecting eating and their effect upon quality of life more than 1 year after treatment, was undertaken to evaluate long-term patient rehabilitation. 25 patients with oropharyngeal carcinoma were interviewed. Nutritional intake and effect on diet were assessed by analysis of patient diet diaries. Nutritional status was measured from weights recorded at time of treatment and anthropometric measurements at time of study. All patients completed a quality-of-life questionnaire and the importance of side-effects was measured by a ranking exercise. Seventy-two per cent of patients required modifications of dietary consistency. Energy and protein intakes decreased with increasing degrees of dietary modification. Side-effects affecting eating persisted in 23 out of 25 patients, with 80% still having a dry mouth at a mean of 3.5 years post-treatment. Forty per cent had not regained weight lost during treatment. The top ranked side-effects perceived to be of greatest importance to quality of life all related to the ability to eat. A return to “normal eating” is not possible in all patients.
TL;DR: Findings confirm the exceptionally high rate of second cancers (especially of the aerodigestive tract) following oral cancer, describe the clinical and pathological features of patients with multiple cancers and indicate the importance of preventive measures.
Abstract: A survey was made of second primary cancers among patients who were enrolled in a large case-control investigation of oral and pharyngeal cancer, hereafter called oral cancer, during 1984-1985 in four areas of the United States. Among the original 1090 patients with oral cancer (nearly all squamous cell carcinomas), 107 developed a second cancer (one-half of them squamous cell) by the end of follow-up in June 1989 (average follow-up 2.6 years), with 69% occurring in the oral cavity, pharynx, oesophagus, larynx or lung. Rates of second tumours varied by age and socioeconomic status, but not sex or race, and were higher among those whose initial cancer was localised, even after adjusting for their longer survival. Long-term survival was lower among those with second cancers. Conditional on surviving for 2 years, the survival at 5 years was under 50% and nearly 70%, respectively, for those with versus those without a second cancer in the first 2 years. These findings confirm the exceptionally high rate of second cancers (especially of the aerodigestive tract) following oral cancer, describe the clinical and pathological features of patients with multiple cancers and indicate the importance of preventive measures.
TL;DR: Social status and occupation-specific risks of cancers of the lip, tongue, mouth and pharynx were studied in a nationwide series of 2369 men and 809 women diagnosed in Finland in 1971-1985 and recorded in the files of the Finnish Cancer Registry.
Abstract: Social status and occupation-specific risks of cancers of the lip, tongue, mouth and pharynx were studied in a nationwide series of 2369 men and 809 women diagnosed in Finland in 1971-1985 and recorded in the files of the Finnish Cancer Registry. Codes for social status (four classes) and occupation (336 categories) were drawn from the files of the 1970 Population Census. The standardised incidence rates (SIR) were defined as the ratios of observed and expected numbers of cases, the expected ones being based on the sex, age, site and calendar period-specific incidence rates in the Finnish population. The SIR of lip cancer in the lowest social class was five times that of the highest one, thus indicating the effects of social class differences in smoking habits. The effect of outdoor work on the development of lip cancer was also strongly supported by this study. The social class-adjusted SIR for fisherman was 2.7 (95% C.I. 1.3-5.0), for forestry managers 2.2 (1.2-3.6), for timber workers 1.9 (1.2-2.9) and for farmers 1.8 (1.2-2.6). For cancers of the oral cavity and pharynx there was no clear correlation with social class. However, the SIR for these cancers among farmers was significantly reduced. The occupation-specific SIRs pointed more to alcohol than smoking aetiology. In the case of cancer of the tongue, no aetiological clues whatsoever could be found. The role of direct occupational factors in the aetiology of any of these cancers seemed to be minimal.
TL;DR: The patient died 5 years after the initial diagnosis with lymph node and diffuse pulmonary metastases, which can support the view that this tumour can behave in an aggressive way and has true metastatic potential, despite the absence of malignant cellular features.
Abstract: The authors present a case of a rare type of odontogenic tumour, recently described as “clear cell odontogenic tumour”. The patient died 5 years after the initial diagnosis with lymph node and diffuse pulmonary metastases. This fact can support the view that this tumour, histologically characterised by the presence of cells with a clear cytoplasm, can behave in an aggressive way and has true metastatic potential, despite the absence of malignant cellular features.
TL;DR: Clinical approaches to advanced squamous cell carcinoma of the head and neck are changing dramatically as physicians become increasingly familiar with multidisciplinary treatments.
Abstract: Chemotherapy has been used for many years as a palliative approach to advanced squamous cell carcinoma of the head and neck. Regimens employed have slowly evolved during this time, and the combination of cisplatin and 5-fluorouracil is still standard chemotherapy for such a tumour. However, clinical approaches to advanced squamous cell carcinoma of the head and neck are changing dramatically as physicians become increasingly familiar with multidisciplinary treatments. Integrating chemotherapy and radiotherapy, neo-adjuvant or adjuvant treatments and organ preservation are stimulating fields of investigation involving chemotherapy which definitely warrant further investigation.
TL;DR: The increase in the number of p53-positive biopsies was correlated with the dysplasia and loss of differentiation in the premalignant and malignant lesions, and the proliferation status of the lesions determined by PCNA expression.
Abstract: Hyperplastic lesions of the oral mucosa such as leukoplakia and oral lichen planus can eventually develop into squamous cell carcinomas (SCC) and provide an excellent model for multistage carcinogenesis. The development of carcinomas is assumed to be the result of interaction of genetic factors, locally applied carcinogens and immunological unresponsiveness. The purpose of this study was, therefore, to determine the role of alterations of the tumour suppressor gene p53, and the proliferation status of the lesions determined by PCNA expression. We investigated p53 and PCNA expression in 265 tissue sections of normal mucosa, premalignant, malignant and metastatic lesions of the oral mucosa by immunohistology. Quantitative analysis showed a gradual increase in PCNA expression from normal mucosa to moderately differentiated SCC. p53 expression was detectable in benign premalignant lesions. The increase in the number of p53-positive biopsies was correlated with the dysplasia and loss of differentiation in the premalignant and malignant lesions.
TL;DR: This retrospective study failed to find a significant difference in the incidence of death due to an uncontrolled neck evolution whatever the neck management in patients presenting with early oral cancer.
Abstract: From 1974 to 1983, 579 patients presenting with early oral cancer (excluding lip tumours) were treated at Centre Oscar Lambret. Of these, 429 were treated locally by brachytherapy with local control achieved in 82% of the cases (90% after salvage surgery). Treatment-related complications occurred in 19% of the cases, requiring surgical management in 13 patients. In contrast, only 51% of the 35 patients treated by external radiotherapy and brachytherapy were controlled, resulting in a poor 5-year survival (14%). Results for the 24 patients treated surgically were similar to those of brachytherapy alone. Finally, for T1 T2 N0 patients, the advantages of an elective neck dissection are not clear and could be clarified by a randomised trial. Indeed, this retrospective study failed to find a significant difference in the incidence of death due to an uncontrolled neck evolution whatever the neck management.
TL;DR: It is concluded that radical surgery in young patients with a craniofacial osteosarcoma gives long-term disease-free survival.
Abstract: 14 patients with an osteosarcoma of the craniofacial bones were evaluated retrospectively. 10 patients were males and 4 were females, ages varied from 10 to 74 years with a mean of 37 years. Ten tumours were located in the maxilla and four in the mandible. All patients underwent surgical resection of the tumour. One patient was irradiated postoperatively with 67.5 Gy and another patient received adjuvant chemotherapy with melphelan. Follow-up ranged from 6 months to 10 years with a mean of 4 years 2 months. Of 14 patients, 5 have died of local disease of whom 1 also had distant metastasis. Disease-free survival was 82.5% after 2 years and 68.8% after 5 years. Overall survival was 79.1% after 5 years. Univariate statistical analysis was carried out, revealing age < 35 years (P = 0.033) and radical surgery (P = 0.007) as statistically significant factors in disease-free survival. It is concluded that radical surgery in young patients with a craniofacial osteosarcoma gives long-term disease-free survival.
TL;DR: Loss of heterozygosity (LOH) was not confined to patients exposed to recognised risk factors such as heavy smoking or alcohol consumption and was present at an early stage in the disease suggesting that this genetic alteration may be a fundamental event for oral cancer.
Abstract: Evidence suggests that the accumulation of genetic lesions in dominant oncogenes and tumour suppressor genes is involved in the development of human cancers. We have used restriction fragment length polymorphism analysis to identify chromosomal deletions which may indicate the location of potential tumour suppressor genes. Deletion of chromosome 3p was found in 17 21 (81%) of informative primary oral squamous cell carcinoma (SCC) using a polymorphic probe recognising the D3F15S2 locus (3p21). Loss of heterozygosity (LOH) was not confined to patients exposed to recognised risk factors such as heavy smoking or alcohol consumption and was present at an early stage in the disease suggesting that this genetic alteration may be a fundamental event for oral cancer.
TL;DR: The combination of simple keratin expression and DNA content improved the cancer detection rate beyond that obtainable with DNA range profile alone.
Abstract: Refinements in oral exfoliative cytology may make it a suitable screening technique for the early diagnosis of oral cancer. In this study DNA range profiles were combined with keratin expression in an attempt to improve the diagnostic accuracy of oral exfoliative cytology. Smears were taken from 33 biopsy-proven oral cancers and the contralateral normal site. For DNA range profiles the smears underwent Feulgen hydrolysis, with DNA distribution being assessed using the Vickers M85 microdensitometer. For keratin expression a panel of antikeratin antibodies were applied. The smears for keratin expression were then graded on a three-point scale. Abnormal DNA range profiles were observed in 23 of 33 smears taken from oral cancers and in two smears from normal oral mucosa (sensitivity 70%, specificity 90%, positive predictive value 90%). The simple epithelial keratins 8 and 19 were identified in the majority of oral cancer smears. The sensitivity of keratin 19 was greater (90%). However, keratin 8 was the most useful keratin marker associated with malignancy (sensitivity 62%, specificity 100%, positive predictive value 100%). The combination of simple keratin expression and DNA content improved the cancer detection rate beyond that obtainable with DNA range profile alone.
TL;DR: Mucoepidermoid carcinomas of the major salivary glands from 48 patients who received their treatment at a single institution were studied for prognostic indicators and multivariate analysis indicated that histological grade, proliferative activity, symptoms at diagnosis, clinical stage of disease and type of surgery were significant prognostic/ survival factors in the biological assessment of this neoplasm.
Abstract: Mucoepidermoid carcinomas (MEC) of the major salivary glands from 48 patients who received their treatment at a single institution were studied for prognostic indicators. Uni- and multivariate statistical analyses were performed on several clinicopathologic factors and also on flow cytometric (FCM) DNA content data of the carcinomas. Clinical prognostic factors associated with decreased survival included age > 60 years (P = 0.01), male gender (P = 0.002), symptoms at diagnosis (P = 0.03), stage of disease (P 3.0 cm (P = 0.02), lymph node involvement (P = 0.0004) and positive surgical margins (P = 0.007). DNA FCM factors associated with decreased survival included aneuploid tumours (P = 0.08) and proliferative activity (S+G2M > 5%, P = 0.07). Multivariate analysis indicated that histological grade, proliferative activity, symptoms at diagnosis, clinical stage of disease and type of surgery were significant (P < or = 0.05) prognostic/survival factors in the biological assessment of this neoplasm.
TL;DR: This review highlights the literature to date in the realm of circulating markers for head and neck carcinoma and suggests combinations of markers may improve the utility for some aspects of patient management.
Abstract: Biological markers of disease enhance the ability to diagnose, treat and evaluate results of therapy and are especially intriguing for their potential use in the management of malignant tumours. The serum levels of various biochemical substances have been shown to be abnormal for many cancers and are utilised in the management of affected patients. Several markers have been thoroughly investigated for potential clinical utility in head and neck carcinoma. Although no single marker has been found to be adequately sensitive and specific, combinations of markers may improve the utility for some aspects of patient management. This review highlights the literature to date in the realm of circulating markers for head and neck carcinoma. A discussion of the potential usefulness and limitations of such markers follows.