Oral Oncology 2020-11-29

The impact of early oral feeding following head and neck free flap reconstruction on complications and length of stay

Cyrus J. Kerawala, Francesco Riva, Vinidh Paleri

Publicatie 27-11-2020


Although the concept of maintaining a period of 'nil by mouth' following head and neck reconstruction is commonly held ideas on delaying function have changed dramatically since the introduction of peri-operative care recovery programmes. This study sought to evaluate the outcomes of early feeding on patients undergoing free flap reconstruction of oral defects with particular emphasis on post-operative complications and length of stay. Data was gathered prospectively on two cohorts of patients treated in a tertiary referral centre comparing those undergoing a five-day post-operative period of 'nil by mouth' with a second group in which the aim was to start fluids and soft diet on the day following surgery. Complications and length of stay were evaluated. Both early and late feeding groups comprised of 200 patients. No significant differences were observed in terms of age, gender, smoking and alcohol use or tumour T and N stages between the two groups. 8% of patients had complications at the recipient site but no difference was observed in the rates of flap dehiscence or fistula formation between the two groups. Early feeding was associated with a statistically reduced length of hospital stay (mean 11.6 days vs 20.6 days, p < 0.01). Early oral feeding following head and neck free flap reconstruction is not associated with an increase incidence of peri-operative complications but reduces hospital stay. The latter may have far-reaching implications for patients' physical and psychological well-being in addition to health care resources.

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Human papillomavirus genotype distribution in head and neck cancer: Informing developing strategies for cancer prevention, diagnosis, treatment and surveillance

S.S. Mashiana, P. Navale, B. Khandakar, S. Sobotka, M.R. Posner, B.A. Miles, W. Zhang, M. Gitman, R.L. Bakst, E.M. Genden, W.H. Westra

Publicatie 25-11-2020


Current clinical practice algorithms for HPV testing make no effort to discern the impact of genotypes for patients with head and neck squamous cell carcinoma (HNSC). Data was collected for all patients with HNSCs that had undergone HPV testing at an academic hospital as part of clinical care (2012-2019). Screening was performed using real-time PCR targeting L1 of low and high-risk HPV types, followed by genotyping of positive cases. Genotype status was correlated with age, site and histologic parameters. Of the 964 patients tested, 68% had HPV-positive cancers. Most arose from the oropharynx (OP) (89%) and sinonasal tract (5%). The most frequent genotype was 16 (84.4%) followed by 35 (5.6%), 33 (4.1%), 18 (2.7%), 45 (1.1%), 69 (0.8%) and others (1.3%). There was an association between genotype (16 vs non-16) and tumor origin (OP vs non-OP) (p < 0.0001). HPV18 was associated with transformation to an aggressive small cell phenotype, but HPV16 was not (22% vs 0%, p < 0.0001). Patients with HPV-non-16 OP carcinomas were older than patients with HPV16 OP carcinomas, but the difference was not significant. HPV genotypes are variable and unevenly distributed across anatomic sites of the head and neck. The association of HPV18 with small cell transformation suggests that variants can track with certain phenotypes in ways that may account for differences in clinical behavior. This study challenges the prevailing assumption of HPV equivalency across all high-risk genotypes in ways that may inform preventive, diagnostic, therapeutic and surveillance strategies.

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Synchronous primary neoplasia in patients with oropharyngeal cancer: Impact of tumor HPV status. A GETTEC multicentric study

Florent Milliet, Alexandre Bozec, Renaud Schiappa, Julien Viotti, Anouchka Modesto, Olivier Dassonville, Gilles Poissonnet, Bruno Guelfucci, Alain Bizeau, Sebastien Vergez, Agnes Dupret-Bories, Renaud Garrel, Nicolas Fakhry, Laure Santini, Benjamin Lallemant, Guillaume Chambon, Anne Sudaka, Frederic Peyrade, Esma Saada-Bouzid, Karen Benezery

Publicatie 01-11-2020


Patients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk of synchronous primary neoplasia (SPN) which could impact their management. The aims of this study were to evaluate the risk and distribution of SPN in OPSCC patients according to their HPV (p16) status, the predictive factors of SPN and the impact of SPN on therapeutic strategy and oncologic outcomes. All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. Univariate analyses were conducted using Chi-2 and Fisher exact tests. For multivariate analyses, all variables associated with a p ≤ 0.10 in univariate analysis were included in logistic regression models. Among the 1291 patients included in this study, 75 (5.8%) displayed a SPN which was preferentially located in the upper aerodigestive tract, lung and esophagus. Comorbidity level (p = 0.03), alcohol (p = 0.005) and tobacco (p = 0.01) consumptions, and p16 tumor status (p < 0.0001) were significant predictors of SPN. In multivariate analysis, p16+ status was significantly associated with a lower risk of SPN (OR = 0.251, IC95% [0.133;0.474]). Patients with a SPN were more frequently referred for non-curative treatment (p = 0.02). In patients treated with curative intent, there was no impact of SPN on the therapeutic strategy (surgical vs. non-surgical treatment). We observed no overall survival differences between patients with or without SPN. P16 tumor status is the main predictive factor of SPN in OPSCC patients. This study provides crucial results which should help adapt the initial work-up and the global management of OPSCC patients.

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Gender and race interact to influence survival disparities in head and neck cancer

Angela L. Mazul, Akash N. Naik, Kevin Y. Zhan, Katelyn O. Stepan, Matthew O. Old, Stephen Y. Kang, Erik R. Nakken, Sidharth V. Puram

Publicatie 25-11-2020


Gender and race disparities in head and neck squamous cell carcinoma (HSNCC) survival are independently well documented, but no prior studies have examined the joint effect of these factors on HSNCC outcomes. We aim to comprehensively estimate the effect of gender and race on overall survival in HNSCC. We constructed a retrospective cohort from the National Cancer Database for primary HNSCC of the larynx, hypopharynx, oral cavity, and oropharynx from 2010 to 2015. We used Kaplan-Meier curves and Cox proportional hazards regressions to calculate hazard ratios adjusting for treatment type, age, insurance, staging classifications, and comorbidities. Oral cavity cancer was significantly more common among Hispanic and White females compared to other sites. Female non-oropharyngeal HNSCC cases had better five-year overall survival than males (56.3% versus 54.4%, respectively), though Black females (52.8%) had poorer survival than both White (56.2%) and Hispanic (57.9%) males. There were significant differences in oropharyngeal cancer by HPV status. Notably, Black females with HPV-positive oropharyngeal OPSCC had far worse survival than any other race and gender group. These results persisted even when adjusting for potential mediating factors. Clearly gender is a significant prognosticator for HNSCC and has meaningful interactions with race. The distinct site distributions across gender and race reveal important insights into HNSCC among females. Taking into account these gender disparities while considering race is essential to providing appropriate care to head and neck patients and accurately counselling these individuals on prognosis and outcomes.

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Development of a novel 7 immune-related genes prognostic model for oral cancer: A study based on TCGA database

Xiao-Tong Zhao, Yan Zhu, Jie-Fu Zhou, Yu-Jing Gao, Fang-Zhou Liu

Publicatie 22-11-2020


Oral squamous cell carcinoma (OSCC) is an aggressive tumor whose prognosis has little improvement in the last three decades. Various immune-related genes have been suggested as significant roles in the development and progression of malignant cancers. In this study, we acquired and integrated differentially expressed genes of OSCC patients, including immune-related genes and transcription factors (TFs), from The Cancer Genome Atlas (TCGA) database. TF-mediated network was established to exploring the regulatory mechanisms of prognostic immune-related genes. A 7 immune-related genes prognostic model for OSCC was obtained, including CGB8, CTLA4, TNFRSF19, CCL26, NRG1, TPM2 and PLAU, which was further proved to be an independent prognostic indicator after adjusting for other clinical factors. The immune-related genes prognostic index was significantly negatively correlated to the infiltration abundances of B cells (P < 0.05) and CD8+ T cells (P < 0.05). The novel proposed immune-based prognostic model not only provided a promising biomarker and a way to monitor the long-term treatment of OSCC, but also gave a new insight into a potential immunotherapy strategy.

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Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19

Glenn J. Hanna, Eleni M. Rettig, Jong C. Park, Mark A. Varvares, Jochen H. Lorch, Danielle N. Margalit, Jonathan D. Schoenfeld, Roy B. Tishler, Laura A. Goguen, Donald J. Annino, Robert I. Haddad, Ravindra Uppaluri

Publicatie 16-11-2020


The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38-91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4-33.6) among all patients, and 71.5% (95%CI: 38.2-92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.

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Clinical features of head and neck cancer patients with brain metastases: A retrospective study of 88 cases

Alvin K. Liu, Jonn Wu, Eric Berthelet, Nafisha Lalani, Nicole Chau, Eric Tran, Sarah Nicole Hamilton

Publicatie 14-11-2020


Brain metastases (BM) arising from head and neck cancer (HNC) are rare and not well characterized. This study aims to describe the clinicopathological features, treatments, prognostic factors, and survival in HNC patients with BM. Non-thyroid HNC patients referred to BC Cancer from 1998 to 2016 were retrospectively reviewed for BM. The Kaplan-Meier method, log-rank test, and Cox regression analysis were used to assess post-BM survival and prognostic factors. Out of 9432 HNC patients, 88 patients developed BM (0.9%, median follow-up 3.4 years). On average, the BM were diagnosed 18.5 months after the primary diagnosis and tended to arise after distant metastases to extracranial sites (85%) such as the lungs (78%). At BM presentation, 84% were symptomatic and two thirds had a poor performance status (ECOG ≥ 2, 68%). The median post-BM survival was 2.5 months (95% CI 2.1-3.3 months). On multivariable analysis, management of BM with radiotherapy (RT) alone (3.3 months, 95% CI 2.3-4.6, p = 0.005) and RT with surgery (4.4 months, 95% CI 2.8-6.9, p < 0.001) was associated with longer survival compared to best supportive care alone (1.4 months, 95% CI 1.0-2.0 months). Age, sex, performance status, sub-localization of the primary HNC, presence of extracranial metastases, and number of intracranial metastases were not associated with post-BM survival (all p ≥ 0.05). This is the largest study to date in BM from HNC. BM occur late in the course of HNC and carry a poor prognosis. Treatment with intracranial radiotherapy both with and without surgery was associated with improved survival.

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External validation of nodal failure prediction models including radiomics in head and neck cancer

Tian-Tian Zhai, Frederik Wesseling, Johannes A. Langendijk, Zhenwei Shi, Petros Kalendralis, Lisanne V. van Dijk, Frank Hoebers, Roel J.H.M. Steenbakkers, Andre Dekker, Leonard Wee, Nanna M. Sijtsema

Publicatie 15-11-2020


To externally validate the previously published pre-treatment prediction models for lymph nodes failure after definitive radiotherapy in head and neck squamous cell carcinoma (HNSCC) patients. This external validation cohort consisted of 143 node positive HNSCC patients treated between July 2007 and June 2016 by curative radiotherapy with or without either cisplatin or cetuximab. Imaging and pathology reports during follow-up were analyzed to indicate persisting or recurring nodes. The previously established clinical, radiomic and combined models were validated on this cohort by assessing the concordance index (c-index) and model calibration. Overall 113 patients with 374 pLNs were suitable for final analysis. There were 20 (5.3%) nodal failures from 15 patients after a median follow-up of 36.1 months. Baseline characteristics and radiomic features were comparable to the training cohort. Both the radiomic model (Least-axis-length of lymph node (LALLN) and correlation of gray level co-occurrence matrix (Corre-GLCM)) and the combined model (T stage, gender, WHO performance score, LALLN and Corre-GLCM) showed good agreement between predicted and observed nodal control probabilities. The radiomic (c-index: 0.71; 95% confidence interval (CI): 0.59-0.84) and combined (c-index: 0.71; 95% CI: 0.59-0.82) models performed better than the clinical model (c-index: 0.57; 95% CI: 0.47-0.68) on this cohort, with a significant difference between the combined and clinical models (z-score test: p = 0.005). The combined model including clinical and radiomic features was externally validated and proved useful to predict nodal failures and could be helpful to guide treatment choices before and after curative radiation treatment for node positive HNSCC patients.

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Prognostic impact of regulatory T cell in head and neck squamous cell carcinoma: A systematic review and meta-analysis

Jae Hoon Cho, Young Chang Lim

Publicatie 13-11-2020


The impact of regulatory T (Treg) cells as a prognostic factor of survival in head and neck squamous cell carcinoma (HNSCC) remains controversial. We aimed to evaluate the prognostic value of Treg cells in patients with HNSCC through a meta-analysis. Through a literature search in PubMed, Embase, and Cochrane, we included 11 articles in this meta-analysis and investigated the effect of Treg cell level on the survival of patients with HNSCC. Also, we performed a subgroup analysis according to the study sample (blood vs. tumor tissue), primary tumor site, HPV infectivity, or Treg cell marker. High levels of circulating Treg cells in the peripheral blood of patients with HNSCC can significantly increase the disease specific survival rate of patients. Moreover, subgroup analysis showed that high levels of Treg in peripheral blood were significantly associated with better disease specific survival in patients with oral cancer, a subsite of HNSCC, but not in those with other head and neck subsite. Positivity of HPV infection did not influence the prognosis of patients with HNSCC. Increase in the levels of circulating Treg cells in peripheral blood can be a prognostic factor of survival in patients with oral cancer.

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Obesity and the prevention of thyroid cancer: Impact of body mass index and weight change on developing thyroid cancer – Pooled results of 24 million cohorts

Mohanad R. Youssef, Adin S.C. Reisner, Abdallah S. Attia, Mohamed Hosny Hussein, Mahmoud Omar, Anna LaRussa, Carlos A. Galvani, Mohamed Aboueisha, Mohamed Abdelgawad, Eman Ali Toraih, Gregory W. Randolph, Emad Kandil

Publicatie 11-11-2020


Body weight may be a modifiable risk factor predisposing to different cancers. To establish a potential impact of weight change on thyroid cancer risk, we conducted a meta-analysis to evaluate the effect of body mass index (BMI) and weight change over time as a risk of developing thyroid cancer (TC). A systematic search was performed up to February 25, 2020. Pooled relative risk (RR) were estimated using fixed and random models. Heterogeneity between articles was examined using Q-test and I A total of 31 studies including 24,489,477 cohorts were eligible. Pooled analysis revealed that normal and underweight cohorts were associated with a decreased risk of TC (RR = 0.68, 95%CI = 0.65-0.71, p < 0.001) and (RR = 0.92, 95%CI = 0.91-0.93, p < 0.001), respectively. In contrast, overweight and obese cohorts were more likely to develop TC (RR = 1.26, 95%CI = 1.24-1.28, p < 0.001 and RR = 1.50, 95%CI = 1.45-1.55, p < 0.001, respectively). Obesity was associated with higher risk of developing TC among women (RR = 1.29, 95%CI = 1.14-1.46, p < 0.001), but not men (RR = 1.25, 95%CI = 0.97-1.62, p = 0.08). Furthermore, weight gain increased the risk of developing TC (RR = 1.18, 95%CI = 1.14-1.22, p < 0.001), while weight loss decreased the risk (RR = 0.89, 95%CI = 0.85-0.93, p < 0.001). Results showed similar trends of weight change effect in both males and females. Obesity is associated with higher risk of developing TC in women. However, maintaining a healthy weight is associated with reduced risk of TC in both women and men. Shifting our practice to include weight control strategies will help lead to cancer prevention.

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Safety of boneless reconstruction of the mandible with a CAD/CAM designed titanium device: The replica cohort study

Alberto Bedogni, Giordana Bettini, Giorgio Bedogni, Giorgia Menapace, Andrea Sandi, Fabio Michelon, Roberto Di Carlo, Piero Franco, Giorgia Saia

Publicatie 08-11-2020


We evaluated the safety of REPLICA, a CAD/CAM-designed patient-specific titanium mandible, in patients with mandibular defects not suitable for reconstruction with traditional techniques. We performed a cohort study with a composite primary outcome assigned at the end of a 1-year follow-up. The outcome was assigned in the presence of all the following: 1) absence of intraoral or skin extrusion of REPLICA; 2) decrease or cessation of oral pain; 3) stability or increase in mouth opening; 4) resumption of oral feeding without the need of nasogastric tube; 5) absence of fracture at multidetector computer tomography (MDCT); 6) absence of displacement (MDCT); 7) absence of screw loosening (MDCT). The secondary outcome was the patient-reported QOL at 6 months of follow-up as detected by the EORTC QLQ-C30 and QLQ-H&N35 questionnaires. Between March 2012 and June 2017, 18 consecutive patients, with a median (IQR) age of 67 (65;74) underwent reconstruction of mandibular defects with REPLICA at our Unit. The primary outcome was reached by 14 of the 18 patients. QOL data were available for 15 patients at the 6-month follow-up, showing a good profile of general and disease-specific QOL. REPLICA offered a safe solution at 1-year for the treatment of mandibular defects not suitable for reconstruction with traditional techniques, and was associated with subjective well-being and satisfaction. Further studies are needed to assess the full range of indications of REPLICA.

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Combinatorial approaches targeting the EGFR family and c-Met in SCCHN

Dongsheng Wang, Yue Lu, Sreenivas Nannapaneni, Christopher C. Griffith, Conor Steuer, Guoqing Qian, Xu Wang, Zhengjia Chen, Mihir Patel, Mark El-Deiry, Dong M. Shin, Xia He, Zhuo G. Chen, Nabil F. Saba

Publicatie 04-11-2020


We aimed to develop novel combinations of inhibitors targeting EGFR family members and c-Met for the treatment of recurrent SCCHN. Three different c-Met inhibitors in combination with a pan-HER inhibitor (crizotinib/afatinib, tivantinib/afatinib and cabozantinib/afatinib) were investigated for their anti-tumor effects on SCCHN cell lines in vitro. In vivo activity of the combinations was tested in SCCHN cell line xenografts and patient-derived xenograft (PDX) animal models generated from patients with recurrent SCCHN. Western blot assay indicated that activation of EGFR, HER2, HER3, and c-Met was blocked by all three combinations and the downstream PI3K/AKT and ERK signaling pathways were inhibited. Sulforhodamine B colorimetric assay revealed SCCHN cell growth was more effectively inhibited by the combinations than by single agents, particularly in cell lines with high c-Met expression. Furthermore, the combinations were more potent in inducing apoptosis than each of the single agents. In the PDX models, the combination treatments exhibited significantly better efficacy in tumor growth inhibition compared to the respective single agents. In conclusion, we demonstrated that the simultaneous targeting of EGFR, HER2, and c-Met is more effective than the individual inhibition of these targets in vitro and in SCCHN cell line xenograft and PDX models. Our findings pave the way for further clinical investigation of such combinations in SCCHN.

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UK consensus recommendations on the management of oral epithelial dysplasia during COVID-19 pandemic outbreaks

Caroline Elizabeth McCarthy, Stefano Fedele, Michael Ho, Richard Shaw

Publicatie 25-11-2020


Oral Epithelial Dysplasia (OED) is associated with an increased risk of oral cancer development. The SARS-CoV-2 pandemic is necessitating the suspension or dramatic reduction of face-to-face non-urgent elective services, including OED clinics. Little is known regarding the potential impact of elective services suspension upon the risk of OED progression, and whether alternative strategies (e.g. remote consultations) may be introduced to ensure OED surveillance. The aim of this paper is to provide expert-opinion consensus recommendations for the management of OED during the current and future pandemic outbreaks. A working group of nine UK-based senior clinicians and academics in Oral and Maxillofacial Surgery and Oral Medicine was created and twelve consensus statements were developed using a modified-Delphi process. Greater than 80% agreement was considered a consensus. Consensus was achieved for all twelve statements (89-100% agreement). The group agreed that, during the temporary suspension of elective services associated with COVID-19 pandemic outbreaks, patients with OED can be risk stratified to determine the length of accepted delay in face-to-face consultation. Remote consultations with patient-provided clinical photographs may be a useful way of maintaining a level of surveillance in this group of patients. Using an expert working group methodology, we have developed consensus recommendations for the monitoring of individuals with OED during pandemic outbreaks associated with temporary suspension of elective services. This has identified areas of future research and highlighted the need for a stronger evidence base to inform the set-up and delivery of surveillance regimens for patients with OED.

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Survivin expression and impact on head and neck cancer outcomes

Saad A. Khan, Michael Burke, Fang Zhu, Dong-Hua Yang, Cara Dubyk, Ranee Mehra, Miriam J. Lango, John A. Ridge, David J. Sher, Barbara Burtness

Publicatie 23-11-2020


Survivin is an inhibitor of apoptosis that is proposed as a target for anti-cancer therapy because of its high expression in cancer cells. It has potential as a prognostic and predictive biomarker of response to radiation and systemic therapies. We report its expression in head and neck squamous cell carcinoma (HNSCC) and its correlation with treatment response and survival. We measured survivin protein expression in tumor specimens from 96 patients with HNSCC treated at Fox Chase Cancer Center, of whom 21 were p16+. Quantitative automated immunofluorescence was employed to score nuclear and cytoplasmic survivin in 5 tissue microarrays (TMAs) consisting of 316 H&N tumor cores and 107 control tissue cores. Survivin levels were then correlated to therapy response and survival outcomes. Using the median score as the cutoff, overall survival (OS) was significantly shorter for the group expressing higher survivin in nuclear (p = 0.013), cytoplasmic (p = 0.018) and total compartments (p = 0.006). No correlation was seen between survivin expression and patient sex or grade of tumor, T or N stage, or p16 status. Survivin expression in metastases did not significantly differ from that in primary tumors. Levels of p53 expression showed a significant positive correlation with higher survivin expression in the cytoplasm (p = 0.0264) and total compartments (p = 0.0264), but not in the nucleus (p = 0.0729). Survivin expression above the median is associated with shorter overall survival in HNSCC, including for patients treated with chemotherapy or radiation. p16 expression did not correlate with survivin levels.

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The impact of nodal status in major salivary gland carcinoma: A multicenter experience and proposal of a novel N-classification

Davide Lombardi, Michele Tomasoni, Alberto Paderno, Davide Mattavelli, Marco Ferrari, Simonetta Battocchio, Francesco Missale, Francesco Mazzola, Giorgio Peretti, Davide Mocellin, Daniele Borsetto, Jonathan M. Fussey, Paul Nankivell, Nikoleta Skalidi, Mario Bussi, Leone Giordano, Andrea Galli, Gianluigi Arrigoni, Elena Raffetti, Paul Pracy

Publicatie 03-11-2020


Despite differences in oncological behavior, the 8th edition of AJCC TNM staging currently proposes the same N-classification for major salivary glands (MSG) carcinoma and squamous cell carcinoma of the upper aerodigestive tract. The present study aims to investigate a more reliable definition of N-categories for MSG carcinoma. A retrospective multicenter study was performed, including 307 patients treated for primary MSG carcinoma from 1995 to 2019. Outcome measures included overall survival (OS), disease specific survival, and local, regional, and distant recurrence. Survival analysis was performed using log-rank test and Cox proportional-hazards model. Overall number (ON) and largest diameter (LD) of nodal metastases, including intra-parotid metastases, were considered to develop three novel proposals of N-classification; their performance were compared with the current TNM staging using Akaike information criterion (AIC), Bayesian information criterion (BIC), and Nagelkerke pseudo-R Intra-parotid nodes, ON and LD of nodal metastases emerged as major prognosticators for OS, while extra-nodal extension did not impact on any survival. The current N-classification did not show a satisfactory OS stratification. Three novel N-classifications were developed according to number of metastatic nodes (0 vs 1-3 vs ≥ 4) and/or their maximum diameter (<20 mm vs ≥ 20 mm). They all showed better accuracy in OS stratification, and achieved better AIC, BIC and Nagelkerke pseudo-R All the proposed N-classifications improved OS stratification and could help in defining a specific N-classification for MSG carcinoma. Their validation and assessment in an external cohort is needed.

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Tumor microenvironment and Oral Squamous Cell Carcinoma: A crosstalk between the inflammatory state and tumor cell migration

Alessandro Alves, Leonardo Diel, Grasieli Ramos, Antônio Pinto, Lisiane Bernardi, John Yates, Marcelo Lamers

Publicatie 01-11-2020


To analyze the inflammatory millieu in oral squamous cell carcinoma (OSCC) tumors and the influence of macrophages related-cytokines on the tumor cell migration. Inflammatory protein profile and macrophage population (M2/M1 ratio) of human OSCC fragments were analyzed by proteomic analysis and flow cytometry assay respectively. To evaluate the effects of inflammation on OSCC behavior, we analyzed the role of polarized macrophages and cytokines (IL-6, IL-1β and TNF-α) on OSCC cell lines (SCC25 and Cal27) responsiveness by western blotting (cell signaling) and time-lapse (cell migration). Also, it was addressed the crosstalk of IL-6-STAT3 axis with cell migration signaling using a STAT3 inhibitor (Stattic®) and a pull down assay for the RhoGTPase Rac1 activity. It was observed a ~2 fold predominance of M2 over M1 macrophages and a pro-inflammatory state in OSCC fragments. The M2 conditioned media increased migration speed and directionality of highly invasive OSCC cells (SCC25). OSCC cell lines were responsive to cytokine stimuli (IL6, IL-1β and TNF-α), but only IL-6 increased migration properties of OSCC cells. This effect was dependent on STAT3-phosphorylation levels, which interfered with Rac1 activation levels. Our results suggest that the inflammatory milieu might favor invasion and metastasis of OSCC by the direct effect of macrophage-related cytokines on tumor migration.

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Treatment decision-making among patients with oropharyngeal squamous cell cancer: A qualitative study

Melina J. Windon, Daisy Le, Gypsyamber DSouza, Elaine Bigelow, Karen Pitman, Emily Boss, David W. Eisele, Carole Fakhry

Publicatie 02-11-2020


Oropharyngeal squamous cell cancer (OPSCC) is now the most common site of head and neck squamous cell cancer. Despite the focus on treatment deintensification in clinical trials, little is known about the preferences, experiences and needs of patients with OPSCC when deciding between surgery and radiation therapy as primary treatment with curative intent. In this qualitative study, pre-treatment and post-treatment oropharyngeal cancer patients were recruited to take part in one-on-one interviews (n = 11 pre-treatment) and focus group discussions (n = 15 post-treatment) about treatment decision-making. Recordings were transcribed and assessed for emergent themes using framework analysis. From the one-on-one interviews and focus group discussions with OPSCC patients, fourteen themes were identified. Participants expressed alarm at diagnosis, decisional conflict, and a variety of roles in decision-making (physician-controlled, shared, and autonomous). Decisions were driven by the perceived recommendation of the treatment team, a desire for physical (surgical) tumor removal, fear of adverse effects of treatment, and patient-specific values. Although participants felt well-informed by their treating physicians, they identified a need for additional patient-centered information. Participants were critical of the poor quality of information available on the internet, and acknowledged the advantage of hearing the experiences of post-treatment patients. The experiences identified herein may be used to guide patient-centered communication during patient counseling and to inform interventions designed to support patients' needs at diagnosis, ultimately helping to implement high-quality, patient-centered care.

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Identifying an oligometastatic phenotype in HPV-associated oropharyngeal squamous cell cancer: Implications for clinical trial design

Christopher W. Fleming, Matthew C. Ward, Neil M. Woody, Nikhil P. Joshi, John F. Greskovich, Lisa Rybicki, David Xiong, Kevin Contrera, Deborah J. Chute, Zvonimir L. Milas, Catherine H. Frenkel, Daniel S. Brickman, Daniel R. Carrizosa, Jamie Ku, Brandon Prendes, Eric Lamarre, Robert R. Lorenz, Joseph Scharpf, Brian B. Burkey, Larisa Schwartzman

Publicatie 01-11-2020


Patients with human papillomavirus (HPV) associated squamous cell carcinoma of the oropharynx (SCC-OP) have improved overall survival (OS) after distant metastasis (DM) compared to HPV negative patients. These patients may be appropriate candidates for enrollment on clinical trials evaluating the efficacy of metastasis-directed therapy (MDT). This study seeks to identify prognostic factors associated with OS after DM, which could serve as enrollment criteria for such trials. From an IRB approved multi-institutional database, we retrospectively identified patients with HPV/p16 positive SCC-OP diagnosed between 2001 and 2018. Patterns of distant failure were assessed, including number of lesions at diagnosis and sites of involvement. The primary outcome was OS after DM. Prognostic factors for OS after DM were identified with Cox proportional hazards. Stepwise approach was used for multivariable analysis. We identified 621 patients with HPV-associated SCC-OP, of whom 82 (13.2%) were diagnosed with DM. Median OS after DM was 14.6 months. On multivariable analysis, smoking history and number of lesions were significantly associated with prolonged OS. Median OS after DM by smoking (never vs ever) was 37.6 vs 11.2 months (p = 0.006), and by lesion number (1 vs 2-4 vs 5 or more) was 41.2 vs 17.2 vs 10.8 months (p = 0.007). Among patients with newly diagnosed metastatic HPV-associated SCC-OP, lesion number and smoking status were associated with significantly prolonged overall survival. These factors should be incorporated into the design of clinical trials investigating the utility of MDT, with or without systemic therapy, in this population.

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Countermeasure and opportunistic screening systems for oral cancer

Takamichi Morikawa, Takahiko Shibahara, Masayuki Takano, Masashi Iwamoto, Takashi Takaki, Kiyohiro Kasahara, Takeshi Nomura, Nobuo Takano, Akira Katakura

Publicatie 01-11-2020


Tokyo Dental College started oral cancer screening in cooperation with a local dental association in 1992. Reveal the usefulness of Countermeasure and Opportunistic Screening Systems for Oral Cancer. The actual results of countermeasure and opportunistic oral cancer screening systems are reported. Countermeasure screening for the public was performed in each region, and opportunistic screening was performed in a general dental clinic of a cooperating physician. In countermeasure screening, 19,721 persons were checked from 1992 to 2018; the gender ratio was 1:3. The close examination rate was 4.45%. The detection rates of oral cancer and oral potentially malignant disorders were 0.13% and 1.85%, respectively. In opportunistic screening, 29,912 persons were checked from 2006 to 2018; the gender ratio was 2:3. The close examination rate was 2.33%. The detection rates of oral cancer and oral potentially malignant disorders were 0.08% and 2.15%, respectively. The close examination rate was significantly lower in opportunistic screening than in countermeasure screening. The oral cancer detection rates and the positive predictive value for cancer were equivalent. In addition, the detection rate of oral potentially malignant disorders was significantly higher in opportunistic screening than in countermeasure screening. Oral cancer detection rates were equivalent between countermeasure and opportunistic screenings, and opportunistic screening were more effective on number of participants and the close examination rate, and the detection rate of oral potentially malignant disorders.

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The head and neck cancer genome in the era of immunotherapy

N. Ari Wijetunga, Yao Yu, Luc G. Morris, Nancy Lee, Nadeem Riaz

Publicatie 17-11-2020


The recent success of immunotherapy in head and neck squamous cell carcinoma (HNSCC) has necessitated a new perspective on the cancer genome. Here we review recent advances in the carcinogenesis and molecular genetics of HNSCC with an eye on their implications for cancer immunity. Newer sequencing technologies have recently facilitated dissection of the complex interaction between the HPV virus, tumor, host factors, and the tumor microenvironment (TME) that help shed light on how the immune system interacts with head and neck malignancies.

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COVID-19 screening protocols for preoperative assessment of head and neck cancer patients candidate for elective surgery in the midst of the pandemic: A narrative review with comparison between two Italian institutions

Marco Ferrari, Alberto Paderno, Lorenzo Giannini, Diego Cazzador, Cristina Ciardiello, Giovanni Carretta, Cesare Piazza, Piero Nicolai

Publicatie 01-11-2020


Preoperative screening had a key role in planning elective surgical activity for head and neck cancer (HNC) during the COVID-19 pandemic. All patients undergoing surgery for HNC at two Italian referral hospitals (University of Padua and National Cancer Institute [NCI]) during the peak of the COVID-19 epidemic in Italy were included. Accuracy of screening protocols was assessed. In the Padua protocol, 41 patients were screened by pharyngeal swab. The entire sample (100%) was admitted to surgery, diagnostic accuracy was 100%. In the NCI protocol, 23 patients underwent a telephone interview, blood test, and chest CT. Twenty patients (87%) were negative and were directly admitted to surgery. In the remaining 3 (13%), pharyngeal swab was performed. The screening was repeated until a negative chest CT was found. Diagnostic accuracy was 85%. Dedicated screening protocols for COVID-19 allow to safely perform elective HNC surgery.

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14 “S” in head and neck cancers

Pirabu Sakthivel, Kingston Samy, Smriti Panda, Chirom Amit Singh

Publicatie 06-11-2020


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Comparative cost analysis between definitive radiotherapy and transoral surgery for oropharyngeal squamous cell carcinoma: A SEER-Medicare analysis

David J. Sher, Jingsheng Yan, Andrew T. Day, Saad Khan, Hong Zhu

Publicatie 04-11-2020


Primary radiotherapy (RT) and transoral surgery (TOS) are effective local therapy treatments for oropharyngeal squamous cell carcinoma (OPSCC), but their cost profiles differ. We compared the one-year costs of these competing treatments using a large claims-based database. Eligible individuals were patients in the SEER-Medicare registry diagnosed with OPSCC between 2000 and 2011. Patients were categorized as receiving either primary RT +/- chemotherapy, or TOS +/- adjuvant RT or chemoradiotherapy (CRT), and all treatment costs from 1 month prior to diagnosis to 1 year after diagnosis were calculated. Univariable and multivariable linear regression models were used to determine predictors of payer expenditure. Patient-borne pharmacy costs were also analyzed. The cohort included 3497 patients (73% RT, 27% TOS), of whom 73% were locally advanced. The mean total 13 month costs for RT alone, CRT, TOS alone, TOS + RT and TOS + CRT were $39,083, $63,537, $25,468, $36,592, and $99,919, respectively, for early-stage patients. For locally advanced individuals, the mean costs were $45,049, $68,099, $40,626, $53,729, and $71,397, respectively. On multivariable analysis, the adjusted increase in total costs versus RT alone were $21,844, -$5431, $7984, and $28,581 for CRT, TOS alone, TOS + RT, and TOS + CRT, respectively. The difference between CRT and TOS + RT became non-significant for TOS patients undergoing transoral surgery plus neck dissection. Cisplatin was associated with significant less cost than cetuximab and taxane-based chemotherapy. In this population of elderly patients, transoral surgery was generally associated with less expensive treatment, with the addition of chemotherapy serving as the main driver of increased cost.

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Medicinal treatment of oral submucous fibrosis: Why is research not still translated into actual practice?

Gargi S. Sarode, Sachin C. Sarode, Shankargouda Patil

Publicatie 29-11-2020


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Treating sinonasal crusting and infection after palatal and sinonasal cancer resection with topical antibiotic irrigations

Madeline Goosmann, Steven Chang, John Craig

Publicatie 28-11-2020


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Two distinct TP53 mutations in HNSCC primary tumor: Only one circulates in the blood

Federica Ganci, Matteo Allegretti, Valentina Manciocco, Francesco Fiorentino, Giuseppe Sanguineti, Patrizio Giacomini, Raul Pellini, Francesca Spinella, Giovanni Blandino

Publicatie 26-11-2020


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Tracheostomy stomal seeding following oral cavity resection

J.M. Hintze, C. Fitzgerald, B. Lang, J. OShea, C. Barry, S. Brennan, P. Lennon

Publicatie 25-11-2020


Tracheal stoma recurrence following oral cavity surgery is exceedingly rare. Although several different mechanisms for this have been described, the pathogenesis still remains uncertain. We present the case of a gentleman who presented 6-months following oral cavity SCC resection with a large fungating mass at his previous tracheostomy site, and also review the reported literature on this rare phenomenon. Four weeks after diagnosis of his recurrence he underwent a total laryngectomy, wide-local skin excision and reconstruction with a pectoralis major pedicled flap. He recovered well initially following his operation, however unfortunately contracted nosocomial SARS-Cov2 and succumbed from respiratory complications during his post-operative recovery. Stomal recurrence after temporary tracheostomy for oral cavity malignancies are very rare. Previously reported management of these can vary from surgical to palliative treatment. Methods to prevent these include delaying tracheostomy until after surgical resection, packing the pharynx during resection and adjuvant radiotherapy.

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Maxillary bone metastasis, as an early sign of breast cancer; an unusual & rare site of metastasis from the common cancer

Irappa Madabhavi, Malay Sarkar, Chidanand Chavan, Mansi Trivedi

Publicatie 25-11-2020


Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Due to their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. In this article we present a rare, unusual & exceptional case of left maxillary mass which on further evaluation leading to diagnosis of left breast carcinoma with metastasis to isolated left maxillary bone. Sixty five year old postmenopausal woman of low socioeconomic status with good performance status presented with a 3 months history of progressive pain and swelling in the left maxillary region. Fine Needle Aspiration Cytology (FNAC) from the maxillary mass shows invasive ductal carcinoma. On further clinical, radiographic, and histopathological examination findings from the breast lesion confirmed the diagnosis of hormone receptor positive metastatic breast carcinoma. In view of painful metastatic maxillary lesion with breast disease she was managed with a palliative radiotherapy to the maxillary lesion and palliative chemotherapy with Doxorubicin-Cyclophosphamide and bhisphosphonate-Zolendronic acid. Patient responded very well to palliative radiotherapy and chemotherapy, in view of hormone receptor positive breast cancer, now she is on Tab. Anastrazole 1 mg once a day along with monthly Zolendronic acid injection since last 13 months without any symptoms of disease evolution. A high index of clinical thought of metastatic cancer to maxilla is necessary when evaluating patients who complain of maxillary pain and swelling without a history of pain or swelling in the head and neck & non-head and neck region. To the best of our knowledge, this is the first reported case of a metastatic isolated solitary maxillary bone metastasis presenting as an early sign of breast cancer.

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Role of Onco rehabilitation in head and neck cancer

Dibyendu Roy, Ankita Patel, Gaurav Goswami, Soumyashree Samantaray, Neha Gupta, Santosh Kumar Singh

Publicatie 24-11-2020


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Optimising elective neck dissection for early oral cancers

Deep Chakrabarti, Naseem Akhtar, Sumaira Qayoom, Shiv Rajan, Vijay Kumar, Rajeev Gupta, Arun Chaturvedi

Publicatie 18-11-2020


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Mammary analog secretory carcinoma of the thyroid gland: A rare cancer harboring TRK fusion

Nai-si Huang, Yi-ming Cao, Zhong-wu Lu, Qing Guan, Jia-ying Chen, Ben Ma, Tong-zhen Chen, Qian-ming Bai, Yu-long Wang, Qing-hai Ji

Publicatie 16-11-2020


Mammary analog secretory carcinoma (MASC), or secretory carcinoma of the thyroid is an extremely rare disease harboring ETV6-NTRK3 gene fusion with TRK activation. Here we report the twelfth case of MASC of the thyroid worldwide. A 36-year-old female was diagnosed with poor-differentiated thyroid carcinoma (PDTC). Pathology consultant and immunochemical workups showed the tumor cells were negative for TTF1, TG, PAX8, positive for S100, Vimentin, GATA-3, and focally positive for mammaglobin. Fluorescence in situ hybridization (FISH) assay using a dual-color break-apart probe showed ETV6 translocation t(12p13) (ETV6) was present and established the diagnosis of MASC. Next-generation sequencing (NGS) of a 47-gene panel identified exon 1-5 of ETV6 gene were fused with exons 15-19 of NTRK3 gene. The patient experienced three loco-regional recurrences within 12 months and eventually developed inoperable local disease as well as bilateral lung metastasis. She is currently receiving anti-TRK treatment with a follow-up time of 33 months. A literature review of MASC in the thyroid was also conducted.

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BRAFV600E mutation in oral melanocytic nevus and oral mucosal melanoma

Taynara Asevedo Campos de Resende, Bruno Augusto Benevenuto de Andrade, Vanessa Fátima Bernardes, Bruna Pizziolo Coura, Wilson Delgado-Azãnero, Adalberto Mosqueda-Taylor, Oslei Paes de Almeida, Carolina Cavaliéri Gomes, Ricardo Santiago Gomez

Publicatie 16-11-2020


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TERT promoter mutation in patients with second primary of tongue squamous cell carcinoma

Evren Erkul, Ismail Yilmaz

Publicatie 16-11-2020


It is well known that head and neck squamous cell carcinomas are characterized by genetic alterations, genomic instability and different immune defects and Telomerase reverse transcriptase promoter mutations have been found with high rates in patients with tongue squamous cell carcinomas. We presented a non-smoker, no alcohol consuming woman who had a second primary tongue SCC after four and a half years later of her first tongue SCC with TERT promoter mutation. The primary tumor and its recurrences in woman with tongue SCC who have never smoked and had no alcohol consumption may need to be differing from other tongue carcinomas. TERT promoter mutations may have a relation in etiopathogenesis of tumor and mutations need to be on mind in future studies.

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Amelanotic melanoma presenting as a tongue tumor

Ana Kober Leite, Marco Aurélio V. Kulcsar, Danielli Matsuura, Leandro Luongo Matos, Luiz Paulo Kowalski

Publicatie 15-11-2020


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Abducens palsy as first manifestation of a nasopharyngeal carcinoma

Daniela Rego-Lorca, Bárbara Burgos-Blasco, Elena Hernández-García, Blanca Domingo-Gordo

Publicatie 15-11-2020


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Oral acute graft versus host disease after donor lymphocyte infusions: Clinicopathological characterization in a monocenter cohort

Nuno Gomes, Anne Huynh, Cécile Borel, Sarah Guenounou, Christian Recher, Beatrice Barres, Emmanuelle Vigarios, Vincent Sibaud

Publicatie 15-11-2020


Donor lymphocyte infusions (DLI) are used after hematopoietic stem cell transplant (HSCT) in order to boost the graft-versus-tumor effect. The most significant toxicity is acute or chronic graft-versus-host disease (GVHD), whose clinical symptoms mirror those occurring after HSCT. By contrast, oral acute GVHD lesions have been exceptionally described post-DLI. We report on a monocenter cohort of 12 adult patients that developed oral acute GVHD after DLI. The majority was treated for acute myeloid leukemia. A total of 29 DLI treatments were applied and the median time between the last DLI and the oral mucosal lesions was 42 days. Most patients presented these oral lesions concomitant with skin lesions and none of them had exclusive oral involvement. Oral lichenoid changes were observed in 11 patients, including plaque-like lesions and/or reticulated white streaks consistent with Wickham's striae, affecting mainly the buccal mucosa and dorsal or lateral aspects of the tongue. Mucosal histopathological findings showed a patchy-to-florid lichenoid interface dermatitis for 3 biopsied patients. Eight patients also experienced salivary gland changes. The treatment of oral lesions included high- to very high-potency topical corticosteroids in the majority of patients. Oral GVHD lesions have seldom been described after DLI, and only exceptionally in an acute setting. Our results are not consistent with those reported in the literature evaluating GVHD after DLI. In fact, oral acute GVHD lesions post-DLI appeared very common and similar to the oral lichenoid reactions of chronic GVHD following HSCT. The main limitations of this work are its retrospective design and the relatively small sample size.

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Modalities to restrain the progression of oral potentially malignant diseases and oral squamous cell carcinoma in COVID-19 pandemic

Alka Hande, Archana Sonone, Amol Gadbail, Madhuri Gawande, Swati Patil, Preethi Sharma

Publicatie 15-11-2020


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Comment on “Malignant transformation evidences of Oral Lichen Planus: When the time is of the essence” by Zotti F et al (May 2020)

Rajiv S. Desai, Pankaj M. Shirsat, Shivani Bansal, Pooja Prasad, Abinashi Jena

Publicatie 14-11-2020


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Optimum surgical margins in squamous cell carcinoma of the oral tongue: Does shrinkage matters?

Namrata Sengupta, Gargi S. Sarode, Sachin C. Sarode, Amol R. Gadbail, Shailesh Gondivkar, Shankargouda Patil

Publicatie 14-11-2020


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Impact of pre-operative serum C-reactive protein and cell-free chromatin levels on tumor aggressiveness and survival outcome in oral cavity squamous cell carcinoma

Hitesh R. Singhavi, Naveen Khare, Arjun Singh, Aakanksha Khandelwal, Sadhana Kannan, Akshay Patil, Indraneel Mittra, Pankaj Chaturvedi

Publicatie 14-11-2020


We recruited 69 consecutive patients with oral cavity squamous cell carcinoma (OSCC) between January 2017 and January 2019 for this study. All patients underwent up-front surgery followed by adjuvant radio- and/or chemotherapy as indicated. Pre-operative serum levels of C-reactive protein (CRP) and cell-free chromatin (cfCh) were estimated by ELISA and post-operative histopathological features were recorded. CRP levels were significantly associated with poor histopathological features, advanced stage, bone erosion, extracapsular spread and pathological nodal status. CRP levels were not associated with survival. CfCh levels were significantly associated with bone erosion and neck nodes and patients with higher cfCh levels had significantly poor overall survival.

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Reconstruction of buccal mucosa: A minimalist symbiotic approach with local flaps

Vasantha Dhara, Adarsh Kudva, A. Chithra, Jyotsna Rajan, Anupam Singh

Publicatie 10-11-2020


Buccal mucosa defects following resection of premalignant or malignant lesions require adequate reconstruction. Both locoregional and microvascular flaps have been extensively used based on operator and patient factors. This paper focuses on the outcomes of a simplified approach for reconstruction of large buccal mucosa defects with posterior extent using a combination of two loco regional flaps. A combination of buccal fat pad graft and nasolabial flap was used to reconstruct large defects spanning the buccal mucosa extending to the soft palate or retromolar trigone areas. Post operative outcomes were noted in patients who underwent reconstruction using this combination technique. This paper highlights the favourable results and ease of technique with this combination of flaps, i.e complete coverage of large buccal mucosa defects extending to critical areas such as soft palate, retromolar trigone or tonsillar pillars; avoiding sophisticated free flaps. Satisfactory healing with adequate functional and esthetic outcomes were seen. Defects post ablation of buccal mucosa lesions, larger than 5 cm × 5 cm, can be reconstructed using double local flaps. Buccal fat pad and nasolabial flaps heal excellently with nil morbidities and their combination provides a simple and an economical alternative option for reconstructive surgeons.

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Recurrent head and neck cancers in the skull base, stereotactic radiosurgery palliation, and risk prognosticators

Federico Ampil, Hugo Cuellar, Cherie-Ann Nathan, Donald Smith, Anthony Sin

Publicatie 08-11-2020


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POEMS syndrome in the maxillofacial region

Vaibhav Sahni

Publicatie 05-11-2020


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Long-term survival in patients with intermediate-risk head and neck cancer treated with adjuvant radiotherapy

Federico L. Ampil, Cherie-Ann Nathan, Ameya Asarkar

Publicatie 04-11-2020


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Airway obstruction from tracheostomy balloon cuff herniation during oral cancer removal. Emergency successfully managed and lessons learnt from device malfunction

Manlio Pandolfini, Arianna Di Stadio, Michael J. Brenner, Barbara Pichi, Raul Pellini, Brendan McGrath, Luca DAscanio

Publicatie 03-11-2020


Tracheostomy tube cuff balloon herniation is a rare event and can determine airway obstruction. Sometimes the obstruction is not very evident but, if it is not correctly solved, can determine a severe hypoxia with patient's death. We present a 49-year-old male patient, with cT4aN0M0 squamous cell carcinoma of the oral cavity, who was admitted to the hospital for definitive surgical resection. Due to mass an endo-oral intubation was not possible, so a surgical tracheotomy was performed. General anaesthesia was induced with Propofol (2 mg/kg) and Fentanil (1 mcg/kg) without gas. Surgery commenced via a trans-oral and trans-cervical approach, but it was halted after approximately 2 min as oximetry demonstrated a progressive fall from 98% to 78%. After confirmation of correct function of anaesthetic devices, the endotracheal cannula was tested; although surgeon deflated the tube cuff, repositioned the tube, and re-inflated the cuff, oxygen saturation did not change. So, the cannula was changed and patient's saturation increased up to normal value. The balloon cuff of the cannula showed a herniation, responsible of insufficient ventilation. Cuff herniation should be considered in case of unexpected airway obstruction, and a systematic, rapid approach to investigation and management should ensure timely identification and correction.

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The coagulome of Head and Neck Squamous Cell Carcinoma

Zuzana Saidak, Antoine Galmiche, Marine Lottin, Lydia Montes, Simon Soudet, Marie-Antoinette Sevestre, Florian Clatot, Haitham Mirghani

Publicatie 02-11-2020


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T4a in 8th AJCC tongue cancers – A non-existent entity in surgical practice!

Pirabu Sakthivel, Smriti Panda, Chirom Amit Singh, Madhu Rajeshwari

Publicatie 02-11-2020


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Cemento-ossifying fibroma and juvenile ossifying fibroma: Clarity in terminology

Rajiv S. Desai, Shivani Bansal, Pankaj M. Shirsat, Pooja Prasad, Shumail Sattar

Publicatie 02-11-2020


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Metronomic therapy using Methotrexate and Celecoxib: A Boon for Oral Cancer patients during COVID-19 Pandemic

Mohammed Imaduddin, Mahesh Sultania, B. Vigneshwaran, Dillip Kumar Muduly, Madhabananda Kar

Publicatie 05-11-2020


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Functional outcomes and tracheostomy dependence following salvage oropharyngeal surgery

Molly E. Heft Neal, Rebecca W. Gao, Julia R. Brennan, Catherine T. Haring, Steven B. Chinn, Andrew G. Shuman, Keith A. Casper, Kelly M. Malloy, Chaz L. Stucken, Scott A. Mclean, J. Chad Brenner, Teresa Lyden, Anna Blakely, Michelle L. Mierzwa, Jennifer Shah, Caitlin Schonewolf, Paul L. Swiecicki, Frank P. Worden, Gregory T. Wolf, Carol R. Bradford

Publicatie 13-10-2020


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Using 3D-printed nose models in nasopharyngeal swab training

Jeremy Chee, Xinyi Lin, Wei Sian Lim, Woei Shyang Loh, Mark Thong, Lishia Ng

Publicatie 13-10-2020


The COVID-19 pandemic has swept across the globe with massive effects on health care systems as well as global economies. Enhanced testing has been put forward as a means to reduce transmission while awaiting the development of targeted therapy or effective vaccination. However, achieving accurate testing necessitates proper nasopharyngeal swab techniques. We aimed to design and investigate the utility of an anatomically accurate three-dimensional (3D) printed model of the nose in the training for nasopharyngeal swabs. These models were implemented during training sessions for healthcare workers. All participants surveyed felt that the 3D printed models were useful and beneficial in the training of nasopharyngeal swab techniques. 3D printed nose models are a useful tool in nasopharyngeal swab training. Their usage may help to facilitate the training of potential swabbing manpower in the upscaling of testing capabilities and volumes in this COVID-19 era.

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"Clinical interpretation of findings from a systematic review and a comprehensive meta-analysis on clinicopathological and prognostic characteristics of oral squamous cell carcinomas (OSCC) arising in patients with oral lichen planus (OLP): Authors reply"

Miguel Ángel González-Moles, Saman Warnakulasuriya, Isabel González-Ruiz, Lucía González-Ruiz, Ángela Ayén, Daniel Lenouvel, Isabel Ruiz-Ávila, Pablo Ramos-García

Publicatie 13-10-2020


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