Oral Oncology

Factors associated with the quality of life for hospitalized patients with HPV-associated oropharyngeal squamous cell carcinoma

13-02-2020 – Xiaoyan Yin, Chunguang Shan, Jingmiao Wang, Haizhong Zhang

Journal Article

Purpose

Oropharynx squamous cell cancer (OPSCC) is a type of head and neck squamous cell carcinoma. The raising OPSCC incidence is mainly attributed to human papillomavirus (HPV). HPV-related OPSCC has a relatively good prognosis, the concerns are focused on the improvement of quality-of-life (QOL). We aimed to figure out the factors which may affect the QOL of HPV-related OPSCC patients after treatment.

Methods

This study included patients with HPV-related OPSCC. The QOL of the patients were analyzed through the administration of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30)-Chinese version, the European Organization for Research and Treatment of Cancer Head and Neck Cancer Module-35 (EORTC QLQ-H&N-35)-Chinese version, and Eating Assessment Tool-10 (EAT-10). Multivariable regression analysis was employed to detect the influence of predictor variables on the QOL of patients.

Results

A total of 294 HPV-related OPSCC patients were involved in this research. The results of EORTC QLQ-C30, EORTC QLQ-H&N-35, and EAT-10 demonstrated that the treatment decreased the QOL of HPV-related OPSCC patients. Several different factors including marital status, consumption of tobacco and alcohol, tumor sites, clinical stages, therapeutic strategies, and neck dissection were proved to have influence on QOL of HPV-related OPSCC after treatment.

Conclusion

Based on the analyzation of the QOL at baseline and after treatment, we demonstrated several factors which influenced the QOL of HPV-associated OPSCC patients after treatment. These results can make a great contribution to the improvement of the QOL after treatment.

Regular aspirin intake and prognosis of TxN2-3M0 nasopharyngeal carcinoma: A cohort study based on propensity score matching

15-02-2020 – Hui Chang, Ya-lan Tao, Wei-jun Ye, Wei-wei Xiao, Yun-fei Xia, Yuan-hong Gao

Journal Article

Objectives

Distant metastasis is the leading cause of death in patients with N2-3 nasopharyngeal carcinoma (NPC). And aspirin is found to reduce metastasis and improve prognosis in some other malignancies, such as colorectal cancer. This study aimed to evaluate the clinical value of regular aspirin intake (RAI) in N2-3 NPC treated with standard chemoradiotherapy.

Materials and Methods

Totally 2064 patients diagnosed with Tx
N2-3M0 NPC from Jan. 2008 to Dec. 2015 and treated with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy were involved. According to RAI, these patients were divided into 2 groups between which a propensity score matching was made, with a ratio of 1:3 and a series of clinical characteristics (age, gender, T stage, N stage and EBV DNA) as covariates. Then survivals and acute toxicities were compared in the 464 matched patients.

Results

RAI appeared to bring better overall (87.7% vs. 79.6%, P = 0.031), metastasis-free (87.8% vs. 76.5%, P = 0.017) and disease-free (85.9% vs. 75.5%, P = 0.033) survivals. It simultaneously increased total incidences of myelosuppression (55.2% vs. 32.2%, P < 0.001), oral mucositis (60.3% vs. 38.2%, P < 0.001), cervical dermatitis (60.3% vs. 38.5%, P < 0.001) and xerostomia (49.1% vs. 33.3%, P = 0.002). But RAI failed to affect incidence of any grade 3/4 toxicity.

Conclusions

Post-diagnosis RAI might be a tolerable approach to control distant metastasis and provide survival benefit for N2-3 NPC in combination with standard chemoradiotherapy.

Association between dietary inflammatory index and upper aerodigestive tract cancer risk: A systematic review and dose-response meta-analysis

13-02-2020 – Jiahao Zhu, Yuxiao Ling, Shuai Mi, Hanzhu Chen, Jiayao Fan, Shaofang Cai, Chunhong Fan, Qing Shen, Yingjun Li

Journal Article

Objectives

The relationship between dietary inflammatory index (DII) and upper aerodigestive tract (UADT) cancer risk have been investigated in a growing number of epidemiological studies. However, their findings were inconsistent, and no systematic review or meta-analysis has been conducted up to now. This meta-analysis was carried out to examine potential dose-response relationship between DII score and UADT cancer risk.

Material and methods

A systematic search was conducted for relevant studies in PubMed and Web of Science up to March 28, 2019. Categorical meta-analysis as well as linear and non-linear dose-response meta-analysis were performed to evaluate association between DII and UADT cancer risk.

Results

Nine case-control studies with a total of 4138 cases and 15,326 healthy controls were eligible in the present meta-analysis. The pooled odds ratios (ORs) of UADT cancer risk were 2.07 95% confidence interval (CI): 1.82, 2.35 for the highest DII score compared with the lowest and 1.53 (95% CI: 1.39, 1.69) for higher DII score compared with lower score, respectively. Furthermore, a one-unit increment in DII score was associated with an increased risk of 18% for UADT cancers (OR: 1.18; 95% CI: 1.15, 1.21). An upward trend towards a positive association between elevated DII score and UADT cancer risk was also observed in non-linear dose-response meta-analysis.

Conclusions

The present meta-analysis provides evidence of highly pro-inflammatory diets that might increase risk of UADT cancers. Therefore, reducing pro-inflammatory components in diets should be considered to prevent and control UADT cancers.

Effectiveness of a guided self-help exercise program tailored to patients treated with total laryngectomy: Results of a multi-center randomized controlled trial

12-02-2020 – Femke Jansen, Simone E.J. Eerenstein, Ingrid C. Cnossen, Birgit I. Lissenberg-Witte, Remco de Bree, Patricia Doornaert, György B. Halmos, José A.U. Hardillo, Gerben van Hinte, Jimmie Honings, Cornelia F. van Uden-Kraan, C. René Leemans, Irma M. Verdonck-de Leeuw

Journal Article

Objective

To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL).

Materials and methods

This randomized controlled trial included patients treated with TL in the last 5 years. Patients were randomized into the intervention group (self-help exercise program with flexibility, range-of-motion and lymphedema exercises and self-care education program) or control group (self-care education program). Both groups completed measurements before and 3 and 6-months after randomization. The primary outcome was swallowing problems (SWAL-QOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), self-management (patient activation: PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate-high in case a patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention and to investigate whether neck dissection, treatment indication (primary/salvage TL), time since treatment, severity of problems, and preferred format (online/booklet) moderated the effectiveness.

Results

Moderate-high adherence to the exercise program was 59%. The intervention group (n = 46) reported less swallowing and communication problems over time compared to the control group (n = 46) (p-value = 0.013 and 0.004). No difference was found on speech, shoulder problems, patient activation and HRQOL. Time since treatment moderated the effectiveness on speech problems (p-value = 0.025): patients within 6 months after surgery benefitted most from the intervention. Being treated with a neck dissection, treatment indication, severity of problems and format did not moderate the effectiveness.

Conclusion

The guided self-help exercise program improves swallowing and communication.

Trial registration. NTR5255.

Impact of routine surveillance imaging on detecting recurrence in human papillomavirus associated oropharyngeal cancer

12-02-2020 – Joycelin F. Canavan, Bridgett A. Harr, Joanna W. Bodmann, Chandana A. Reddy, Jodi R. Ferrini, Denise I. Ives, Deborah J Chute, Christopher W. Fleming, Neil M. Woody, Jessica L. Geiger, Nikhil P. Joshi, Shlomo A. Koyfman, David J. Adelstein

Journal Article

Objectives

This study examines the utility of surveillance imaging in detecting locoregional failures (LRF), distant failures (DF) and second primary tumors (SPT) in patients with human papillomavirus (HPV) associated oropharyngeal cancer (OPC) after definitive chemoradiotherapy (CRT).

Methods and materials

An institutional database identified 225 patients with biopsy proven, non- metastatic HPV+ OPC treated with definitive CRT between 2004 and 2015, whose initial post-treatment imaging was negative for disease recurrence (DR). Two groups were defined: patients with <2 scans/year Group 1 and patients with ≥2 scans/year Group 2. The Mann-Whitney test or Chi-square was used to determine differences in baseline characteristics between groups. Fine & Gray regression was used to detect an association between imaging frequency, DR and diagnosis of SPT.

Results

Median follow up was 40.8 months. 30% of patients had ≥T3 disease and 90% had ≥ N2 disease (AJCC 7th edition). Twenty one failures (9.3%) were observed, 7 LRF and 15 DF. Six LRF occurred within 24 months and 14 DF occurred within 36 months of treatment completion. Regression analysis showed Group 2 had increased risk of DR compared to Group1 (HR 10.3; p = 0.002) albeit with more advanced disease at baseline. Five SPT were found (2 lung, 2 esophagus, and 1 oropharynx) between 4.5 and 159 months post-CRT.

Conclusion

Surveillance imaging seems most useful in the first 2-3 years post treatment, and is particularly important in detecting DF. Surveillance scans for SPT has a low yield, but should be considered for those meeting lung cancer screening guidelines.

Cutaneous squamous cell carcinoma in the organ transplant recipient

18-02-2020 – Kristin Bibee, Andrew Swartz, Shaum Sridharan, Cornelius H.L. Kurten, Charles B. Wessel, Heath Skinner, Dan P. Zandberg

Journal Article, Review

One in twenty solid organ transplant recipients (SOTRs) will develop a highly morbid or fatal cutaneous carcinoma after transplantation. The majority of these cases develop on the head and neck and may require intervention on the part of dermatology, dermatologic surgery, otolaryngology, transplant medicine, radiation oncology, and medical oncology. In this review, we discuss the problem of cutaneous squamous cell carcinoma (c
SCC) in SOTRs as well as the prognostic factors and management strategies to care for this population.

The p38/MKP-1 signaling axis in oral cancer: Impact of tumor-associated macrophages

15-02-2020 – Zhenning Li, Fa-yu Liu, Keith L. Kirkwood

Journal Article, Review

Oral squamous cell carcinomas (OSCC) constitute over 95% of all head and neck malignancies. As a key component of the tumor microenvironment (TME), chronic inflammation contributes towards the development, progression, and regional metastasis of OSCC. Tumor associated macrophages (TAMs) associated with OSSC promote tumorigenesis through the production of cytokines and pro-inflammatory factors that are critical role in the various steps of malignant transformation, including tumor growth, survival, invasion, angiogenesis, and metastasis. The mitogen-activated protein kinases (MAPKs) can regulate inflammation along with a wide range of cellular processes including cell metabolism, proliferation, motility, apoptosis, survival, differentiation and play a crucial role in cell growth and survival in physiological and pathological processes including innate and adaptive immune responses. Dual specificity MAPK phosphatases (MKPs) deactivates MAPKs. MKPs are considered as an important feedback control mechanism that limits MAPK signaling and subsequent target gene expression. This review outlines the role of MKP-1, the founding member of the MKP family, in OSCC and the TME. Herein, we summarize recent progress in understanding the regulation of p38 MAPK/MKP-1 signaling pathways via TAM-related immune responses in OSCC development, progression and treatment outcomes.

Trans-oral robotic surgery in the management of parapharyngeal space tumors: A systematic review

15-02-2020 – Armando De Virgilio, Andrea Costantino, Giuseppe Mercante, Pasquale Di Maio, Oreste Iocca, Giuseppe Spriano

Journal Article, Review

Purpose

To perform a systematic review of studies evaluating Trans-oral Robotic Surgery (TORS) in the treatment of parapharyngeal space (PPS) tumors.

Methods

A comprehensive electronic search was performed in PubMed/MEDLINE, Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted on November 9, 2019.

Results

Twenty-two studies were included for the systematic review which analyzed a total of 113 patients (median age 53.5, IQR 41.5–58.1). The most common PPS tumor treated with TORS was the pleomorphic adenoma (n = 66; 58.4%). All tumors were successfully resected. The median tumor size was 4.8 cm (n = 73; IQR 3.8–5.4). Combined transcervical (TORS-TC) and transparotid (TORS-TP) approaches were used in 13 (11.5%) and 5 (4.4%) patients, respectively. Capsule disruption was noted in 11 cases (14.5%), while tumor fragmentation was observed in 7 patients (10.3%). The median time of hospitalization was 3 days (n = 79; IQR 2–4.1). Oral diet was possible from the day after surgery in the majority of patients (n = 34, 68%). The most common complication was dysphagia (n = 5, 4.5%).

Conclusions

This systematic review confirms the safety and feasibility of TORS in the treatment of PPS lesions. Given the low quality of included studies, further evidence is needed in order to establish clinical guidelines.

Cost-effectiveness analysis of gemcitabine plus cisplatin versus docetaxel, cisplatin and fluorouracil for induction chemotherapy of locoregionally advanced nasopharyngeal carcinoma

20-02-2020 – Qiuji Wu, Weiting Liao, Jiaxing Huang, Pengfei Zhang, Nan Zhang, Qiu Li

Journal Article

Background

Recently, patients who received induction chemotherapy plus concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma were found to have survival advantages compared with those receiving concurrent chemoradiotherapy alone in two large randomized trials. Based on these two trials, we present a cost-effectiveness analysis to compare gemcitabine and cisplatin (GP) versus cisplatin, fluorouracil, and docetaxel (TPF) for induction chemotherapy to treat locoregionally advanced nasopharyngeal carcinoma.

Methods

We constructed a Markov model to compare the cost and effectiveness of GP versus TPF. Clinical data including the frequency of adverse events, recurrence and death obtained from two randomized phase III trials were used to calculate transition probabilities and costs. Health utilities were estimated from the literature. Incremental cost-effectiveness ratios, expressed as dollars per quality-adjusted life-year (QALY), were calculated, and incremental cost-effectiveness ratios less than $27,534.25/QALY (3 × the per capita GDP of China, 2018) were considered cost-effective. One-way sensitivity and probabilistic sensitivity analyses explored the robustness of the model.

Results

Our base case model found that the total cost was $53,082.68 in the GP group and $45,482.66 in the TPF group. The QALYs were 6.82 and 4.11, respectively. The incremental cost-effectiveness ratio favoured the GP regimen, at an incremental cost of $2,804.44 per QALY. The probabilistic sensitivity analysis found that treatment with the GP regimen was cost-effective 100% of the time at a willingness-to-pay threshold of $27,534.25‬/QALY.

Conclusion

In this model, GP was estimated to be cost-effective compared with cisplatin, fluorouracil, and docetaxel for patients with locoregionally advanced nasopharyngeal carcinoma from the payer’s perspectives in the China.

Chemotherapy in the definitive management of oral cancers: Where do we stand today?

08-02-2020 – Jessica L. Geiger, David J. Adelstein

Journal Article

The treatment of locally advanced oral cavity cancer is often multimodal, involving surgical resection, radiotherapy (RT), and chemotherapy. Systemic therapy is the mainstay of treatment for recurrent/metastatic disease. While the concurrent use of cisplatin with post-operative RT is well established in patients with high risk features of extranodal extension and/or positive surgical margins following resection, the role of chemotherapy in other curative settings is not clear. Studies reporting success of induction chemotherapy or definitive chemoradiotherapy in absence of primary resection include all anatomic sites of head and neck cancer, and oral cavity cancer subset is rarely reported as a separate analysis, thus limiting the interpretation of results. This article will focus on the use of systemic therapy for locoregionally advanced oral cavity cancer.

Global patterns and trends in cancers of the lip, tongue and mouth

28-01-2020 – Adalberto Miranda-Filho, Freddie Bray

Journal Article

Objectives

Global descriptions of international patterns and trends in oral cancer are informative in providing insight into the shifting epidemiologic patterns and the potential prevention of these tumours. We present global statistics on these cancers using the comprehensive set of national estimates and recorded data collated at the International Agency for Research on Cancer (IARC).

Methods

The estimated number of lip and oral cavity cases and deaths in the 185 countries for the year 2018 was extracted from IARC’s GLOBOCAN database of national estimates. To examine trends, recorded data series on lip and oral cavity cancers, as well as corresponding population-at-risk data were extracted from successive volumes of Cancer Incidence in Five Continents.

Results

Globally, the highest incidence was found in South-Central Asia and parts of Oceania, with the highest estimated incidence rates in Papua New Guinea, Pakistan and India. The highest observed rates of lip cancer were in Australia, while India had the highest incidence rates of mouth and oral tongue cancer. Trends are diverse, with lip cancer incidence rates continuing to decrease for both sexes; the incidence rates of mouth cancer are also in decline in males, although increasing rates among females were observed in some populations.

Conclusion

There are some grounds for optimism given the prospects for control of these cancers. Primary prevention should however focus on the reduction of the main causes, namely, tobacco and alcohol consumption.

Oral potentially malignant disorders: A comprehensive review on clinical aspects and management

26-01-2020 – Saman Warnakulasuriya

Journal Article

Oral potentially malignant disorders (OPMDs) include a group of conditions that affect the oral mucosa with an increased risk of malignancy. During their evolution visible changes may be found in the colour or in the thickness of the oral mucosa and these changes can be detected during an oral examination. Their clinical presentations are diverse and their natural history is not well described. Oral leukoplakia is the most commonly encountered OPMD in clinical practice. Use of optical fluorescence imaging or staining with toluidine blue may increase the number of lesions detected compared to oral visual examination alone and may increase border distinction at a subjective level. When stratifying their risk consideration is given to the presence of red areas, size exceeding 200 mm2, presence of lichenoid features and a higher grade of dysplasia in the pathology report. Up to a third of OPMDs may transform to squamous cell carcinomas.

Molecular biology of oral cavity squamous cell carcinoma

10-01-2020 – Phillip J. Hsu, Kenneth Yan, Hailing Shi, Evgeny Izumchenko, Nishant Agrawal

Journal Article

Oral cavity squamous cell carcinoma (OCSCC) is a heterogeneous and complex disease that arises due to dysfunction of multiple molecular signaling pathways. Recent advances in high-throughput genetic sequencing technologies coupled with innovative analytical techniques have begun to characterize the molecular determinants driving OCSCC. An understanding of the key molecular signaling networks underlying the initiation and progression of is essential for informing treatment of the disease. In this chapter, we discuss recent findings of key genes altered in OCSCC and potential treatments targeting these genes.

The role of adjuvant (chemo-)radiotherapy in oral cancers in the contemporary era

10-01-2020 – Shao Hui Huang, Ezra Hahn, Simion I. Chiosea, Zhi-Yuan Xu, Ji-Shi Li, Lin Shen, Brian OSullivan

Journal Article

Squamous cell carcinoma of oral cavity (OSCC) is predominantly managed with surgery. Post-operative radiotherapy (PORT) and chemoradiotherapy (POCRT) enhance disease control in OSCC patients with adverse anatomic and pathologic primary and nodal features. Knowledge about disease behavior, surgery and radiotherapy advances, and the emergence of new systemic agents prompt refinement of PORT volumes and POCRT regimens. Traditional and emerging prognostic models that include adverse histopathological features underpin such approaches. This review summarizes research over recent decades with emphasis on the 2015 to Feb 2019 period describing: (1) Indications for PORT and/or POCRT, addressing surgical “margin status” including the definition of a “clear” margin to permit withholding PORT/POCRT; these concepts include characterizing the specimen yielding these measurements, the optimal time point to assess these findings, and the putative value of a “revised margin” performed during the same operative procedure, (2) Emerging prognostic factors including nodal burden (total number of involved lymph nodes) and perineural invasion, (3) PORT volume design, dose/fractionation and optimal surgery-to-PORT interval, (4) Chemotherapy dose, schedule, and agents, and (5) On-going clinical trials involving systemic agents and combinations of chemotherapy with immunotherapy.

The course of symptoms of anxiety and depression from time of diagnosis up to 2xa0years follow-up in head and neck cancer patients treated with primary (chemo)radiation

07-02-2020 – F.E. van Beek, F. Jansen, L. Mak, B.I. Lissenberg-Witte, J. Buter, M.R. Vergeer, J. Voortman, P. Cuijpers, C.R. Leemans, I.M. Verdonck-de Leeuw

Journal Article

Objectives

To identify sociodemographic and clinical factors, health-related quality of life (HRQOL) and head and neck cancer (HNC) symptoms associated with the course of symptoms of anxiety and depression from pretreatment to 24-month follow-up among HNC patients after (chemo)radiation.

Materials and methods

Patients (n = 345) completed questionnaires on anxiety and depression (HADS), HRQOL and symptoms (EORTC QLQ-C30/QLQ-H&N35) before treatment, and 6-weeks,3-,6-12-,18-, and 24-months after treatment. Mixed model analyses were used to investigate the course of anxiety and depression from pretreatment to 24-months in relation to factors assessed at baseline, and the course of anxiety and depression from 6- to 24-months, in relation to factors assessed at 6-months.

Results

Increased risk for anxiety (HADS-anxiety > 7) was 28.7% among patients before treatment, which declined to 10.0% at 24-months. Increased risk for depression (HADS-depression > 7) was 15.1% before treatment, 18.2% at 3-months, 7.2% at 12-months and 16.0% at 24-months. Factors assessed at baseline which were significantly associated with the course of anxiety were age, pain, problems with social contact, and feeling ill, whereas chemotherapy, worse emotional functioning, speech problems and weight loss were significantly associated with the course of depression. Regarding factors assessed at 6-months, chemotherapy, worse cognitive and social functioning, insomnia, swallowing problems and trouble with social eating were associated with the course of anxiety. Nausea/vomiting, dyspnea, coughing, and feeling ill were associated with the course of depression (p-values < 0.05).

Discussion

Factors associated with a worse course of anxiety and depression are younger age, treatment with chemotherapy, worse HRQOL and higher symptom burden.

Defining secure surgical bone margins in head and neck squamous cell carcinomas: The diagnostic impact of intraoperative cytological assessment of bone resection margins compared with preoperative imaging

18-02-2020 – Markus Nieberler, Herbert Stimmer, Daniela Rasthofer, Katharina Nentwig, Gregor Weirich, Klaus-Dietrich Wolff

Journal Article

Background

Imaging provides crucial staging information for treatment planning of head and neck squamous cell carcinomas (HNSCCs). Despite technical progress in imaging techniques, defining the extent of bone involvement preoperatively remains challenging and requires intraoperative information to control for adequate resection. The intraoperative cytological assessment of the bone resection margins (ICAB) provides information whether bone is infiltrated by carcinoma. The aim of this study was to assess the diagnostic value of preoperative imaging compared with ICAB in order to achieve carcinoma-free bone margins.

Materials and Methods

108 HNSCC patients underwent preoperative computed tomography (CT), magnetic resonance imaging (MRI) and orthopantomogram (OPG) for staging and surgical planning. Curative resection was planned based on imaging. Intraoperatively, the resection margins were controlled by ICAB. The diagnostic value of preoperative imaging and ICAB was assessed with reference to the histological findings.

Results

CT showed a sensitivity of 89.7%, specificity of 63.0%, positive predictive value (PPV) of 85.9%, and negative predictive value (NPV) of 70.8%. MRI revealed a sensitivity of 45.5%, specificity of 66.7%, PPV of 71.4% and NPV of 40.0%. OPG-imaging had a sensitivity of 64.7%, specificity of 76.2%, PPV of 81.5%, NPV 57.1%. In comparison, ICAB provided a sensitivity of 78.6%, specificity of 95.7%, PPV 73.3%, and NPV 96.7%. The accuracy was 82.1%, 52.9%, 69.0%, and 93.5% for CT, MRI, OPG, and ICAB, respectively.

Conclusion

Preoperative imaging lacks accuracy in defining adequate bone resection margins, compared with ICAB. ICAB supports preoperative imaging and intraoperative frozen sections to improve bone margin control.

Molecular profiling of circulating tumor cells predicts clinical outcome in head and neck squamous cell carcinoma

12-02-2020 – Hiroe Tada, Hideyuki Takahashi, Yuki Kuwabara-Yokobori, Masato Shino, Kazuaki Chikamatsu

Journal Article

Objectives

The relationship between the molecular profiling of circulating tumor cells (CTCs) and clinical factors is a challenge. In this study, we performed molecular detection and characterization of CTCs in patients with head and neck squamous cell carcinoma (HNSCC).

Materials and methods

CTCs captured by microfilter were analyzed for the expression of multiple epithelial markers (EPCAM, MET, KRT19, and EGFR) by RT-q
PCR. The CTCs-positive samples were further analyzed for the expression of 10 genes (PIK3CA, CCND1, SNAI1, VIM, CD44, NANOG, ALDH1A1, CD47, CD274, and PDCD1LG2). Finally, we analyzed whether the molecular profiling of CTCs was associated with clinical factors.

Results

Twenty-eight (63.6%) of the 44 HNSCC patients were positive for at least one epithelial-related gene. CTC-positivity was significantly correlated with treatment resistance (p = 0.0363), locoregional recurrence (p = 0.0151), and a shorter progression-free survival (PFS) (p = 0.0107). Moreover, the expression of MET in CTCs was associated with a shorter PFS (p = 0.0426). Notably, patients with CD274-positive CTC showed prolonged PFS (p = 0.0346) and overall survival (p = 0.0378) compared to those with CD274-negative CTC. Conclusion: Our results suggest that molecular profiling characterized by the gene expression of CTCs influences clinical factors in patients with HNSCC.

Evaluating for disparities in place of death for head and neck cancer patients in the United States utilizing the CDC WONDER database

02-02-2020 – Sarah J. Stephens, Fumiko Chino, Hannah Williamson, Donna Niedzwiecki, Junzo Chino, Yvonne M. Mowery

Journal Article

Objective

Evaluate trends in place of death for patients with head and neck cancers (HNC) in the U.
S. from 1999 to 2017 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database.

Materials/methods

Using patient-level data from 2015 and aggregate data from 1999 to 2017, multivariable logistic regression analyses (MLR) were performed to evaluate for disparities in place of death.

Results

We obtained aggregate data for 101,963 people who died of HNC between 1999 and 2017 (25.9% oral cavity, 24.6% oropharynx/pharynx, 0.4% nasopharynx, and 49.1% larynx/hypopharynx). Most were Caucasian (92.7%) and male (87.0%). Deaths at home or hospice increased over the study period (R2 = 0.96, p < 0.05) from 29.2% in 1999 to 61.2% in 2017. On MLR of patient-level data from 2015, those who were single (ref), ages 85+ (OR 0.78; 95% CI: 0.68, 0.90), African American (OR 0.73; 95% CI: 0.65, 0.82), or Asian/Pacific Islanders (OR 0.66; 95% CI: 0.54, 0.81) were less likely to die at home or hospice. On MLR of the aggregate data (1999–2017), those who were female (OR 0.87; 95% CI: 0.83, 0.91) or ages 75–84 (OR 0.79; 95% CI: 0.76, 0.82) were also less likely to die at home or hospice. In both analyses, those who died from larynx/hypopharynx cancers were less likely to die at home or hospice.

Conclusions

HNC-related deaths at home or hospice increased between 1999 and 2017. Those who were single, female, African American, Asian/Pacific Islander, older (ages 75+), or those with larynx/hypopharynx cancers were less likely to die at home or hospice.

One-step nucleic acid amplification for detecting lymph node metastasis of head and neck squamous cell carcinoma

01-02-2020 – Lucie Peigné, Florence Godey, Mathieu Le Gallo, François Le Gall, Alain Fautrel, Jeff Morcet, Franck Jégoux

Journal Article

Background

In head and neck squamous cell carcinoma (HNSCC) 30% of c
N0 patients have occult metastasis. LN invasion is a major prognostic factor. Sentinel lymph node (SLN) is an option for c
N0 neck management. One-step nucleic acid amplification (OSNA) used to analyze SLN in breast cancer is also a candidate to get more reliable intraoperative HNSCC lymph node (LN) staging.

Objective

To compare OSNA analysis to pathological analysis in c
N0 HNSCC.

Materials and methods

157 LN from 26 c
N0 HNSCC patients were prospectively analyzed (6.3LN/patient). Exclusion criteria were previous surgery or radiotherapy. Each node was cut into 4 equal pieces alternatively sent to pathological analysis and OSNA technique. IHC CK19 was performed on the primary tumor biopsy and RT-q
PCR of CK19, PVA and EPCAM on the LN lysate of discordant cases.

Results

OSNA was able to provide intraoperative result in all patients. OSNA detected 21 metastases. There were 139 concordant LN (88.5%). There were 18 initial discordant LN (11.5%), 13 (8.3%) were OSNA positive/pathological analysis negative, 5 (3.2%) were OSNA negative/pathological analysis positive. After elimination of allocation bias, false negative rate was 1.3%, sensitivity and specificity were 90% and 95.6%, PPV and NPV were 75% and 98.5%.

Conclusion

Our results suggest that OSNA should be considered to improve SNB analysis both for increasing micro metastasis diagnosis and offer extemporaneous results.

Study registered under clinicaltrials.gov database number NCT02852343.

Prospective feasibility analysis of salvage surgery in recurrent oral cancer in terms of quality of life

29-01-2020 – Dominik Horn, Sven Zittel, Julius Moratin, Karl Metzger, Oliver Ristow, Johannes Krisam, Jens Bodem, Michael Engel, Christian Freudlsperger, Jürgen Hoffmann, Kolja Freier

Journal Article

Objectives

The goals of the present study were to prospectively analyze salvage surgery with microvascular reconstruction in recurrent squamous cell carcinoma of the oral cavity (OSCC) in terms of oncological outcome and quality of life.

Patients and methods

From 2012 to 2015, 28 patients underwent salvage surgery due to recurrent OSCC or second primary OSCC without the option of curative re-irradiation.

Endpoints were disease-specific survival and progression-free survival after 12 months. The survival was estimated by using the Kaplan-Meier blotting. Quality of life data (European Organization for Research and Treatment of Cancer – EORTC: QLQ-C30 and QLQ-H&N35) was assessed at baseline and subsequently every 3 months up to one year.

Results

Estimated 1-year-survival was 68.4% and progression-free survival was 38.5%. Overall quality of life was significantly reduced three months after salvage surgery baseline (mean 64.15) versus time 1 (mean 53.04); p = 0.002. However, the patients experienced a recovery within the first year baseline (mean 64.15) versus time 4 (mean 70.33); p = 0.176. Furthermore, the sensation of pain is significantly reduced after salvage surgery baseline (mean 47.53) versus time 2 (mean 31.25); p = 0.036. Microvascular reconstruction success rate was 93.1%.

Conclusion

Salvage surgery is a curative treatment option in recurrent and intensively pretreated OSCC. Microvascular reconstruction is feasible with acceptable morbidity and high success rates. Quality of life can be preserved. Further studies combining checkpoint inhibition with salvage surgery are justified.

Selective neck dissection in the treatment of head and neck squamous cell carcinoma patients with a clinically positive neck

17-01-2020 – Fernando López, Laura Fernández-Vañes, Patricia García-Cabo, Gianluigi Grilli, César Álvarez-Marcos, José Luis Llorente, Juan Pablo Rodrigo

Journal Article

Objective

To determine the effectiveness and outcomes of SND in the treatment of patients with squamous cell carcinoma of the head and neck (SCCHN) with clinically positive neck (c
N+) at diagnosis.

Material and Methods

We retrospectively reviewed 159 patients with SCCHN with c
N+ at diagnosis, who underwent a SND with curative intent at a tertiary care academic teaching hospital in Spain. We registered patient and tumor characteristics, date and site of recurrences, together with the outcomes. Survival rates were calculated by the Kaplan-Meier method. The minimum follow-up was 18 months or till death.

Results

A total of 28 neck recurrences were found in the whole series but only 10 neck recurrences occurred in absence of local recurrence. The regional control in the neck in absence of local recurrence was observed in 94% of patients. The neck recurrence rates did not correlated with the p
N classification (P = 0.49), the administration of postoperative radiotherapy (P = 0.49) or extranodal extension (P = 0.43). The 5-year regional recurrence-free survival rate was 80% and 92% if only isolated neck recurrences are considered.

Conclusions

SND offers an effective and oncologically safe surgical procedure in selected patients with clinically positive metastatic nodes in the neck. Our findings suggest that in c
N1 and c
N2 tumors, SND could replace the modified radical neck dissection without compromising oncologic efficacy.

Global treatment patterns and outcomes among patients with recurrent and/or metastatic head and neck squamous cell carcinoma: Results of the GLANCE H&N study

25-01-2020 – Viktor Grünwald, Diana Chirovsky, Winson Y. Cheung, Federica Bertolini, Myung-Ju Ahn, Muh-Hwa Yang, Gilberto Castro, Alfonso Berrocal, Katrin Sjoquist, Hélène Kuyas, Valérie Auclair, Xavier Guillaume, Seongjung Joo, Roshani Shah, Kevin Harrington, on behalf of the GLANCE H&N STUDY Investigators

Journal Article

Objectives

Given a lack of universally-accepted standard-of-care treatment for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC), study objectives were to assess treatment utilization and survival outcomes for R/M HNSCC in the real-world setting.

Materials and methods

A multi-site retrospective chart review was conducted in Europe (Germany, United Kingdom, Italy, Spain), Asia Pacific (Australia, South Korea, Taiwan), and Latin/North America (Brazil and Canada) to identify patients who initiated first-line systemic therapy for R/M HNSCC between January 2011 and December 2013. Patients were followed through December 2015 to collect clinical characteristics, treatment and survival data.

Results

Among 733 R/M HNSCC patients across 71 sites, median age was 60 years (inter-quartile range 54–67), 84% male, and 70% Eastern Cooperative Oncology Group performance status 0–1; 32% had oral cavity and 30% oropharyngeal cancers. The most common first-line regimen across all countries consisted of platinum-based combinations (73%), including platinum + 5-fluorouracil (5-FU) (26%), cetuximab + platinum ± 5-FU (22%), or taxane + platinum ± 5-FU (16%). However, use of different platinum-based combinations varied substantially; administration of cetuximab + platinum ± 5-FU was frequent in Italy (81%), Germany (46%) and Spain (38%), whereas use in other countries was limited. Median follow-up was 22.6 months (95% confidence interval CI: 21.5–24.6 months). Median real-world overall survival was only 8.0 months (95% CI: 7.0–8.0), with one-year survival reaching only 30.9% (95% CI: 27.5–34.3).

Conclusion

Systemic therapies used in clinical practice for patients with R/M HNSCC vary substantially across countries. Prognosis remains poor in this patient population, highlighting the need for newer, more efficacious treatments.

Comorbidity in head and neck cancer: Is it associated with therapeutic delay, post-treatment mortality and survival in a population-based study?

10-01-2020 – Sabine Stordeur, Viki Schillemans, Isabelle Savoye, Katrijn Vanschoenbeek, Roos Leroy, Gilles Macq, Leen Verleye, Cindy De Gendt, Sandra Nuyts, Jan Vermorken, Claire Beguin, Vincent Grégoire, Liesbet Van Eycken

Journal Article

Objectives

This study aims to investigate the relationship between comorbidities and therapeutic delay, post-treatment mortality, overall and relative survival in patients diagnosed with squamous cell carcinoma of the head and neck (HNSCC).

Patients and Methods

9245 patients with a single HNSCC diagnosed between 2009 and 2014 were identified in the Belgian Cancer Registry. The Charlson Comorbidity Index (CCI) was calculated for 8812 patients (95.3%), distinguishing patients having none (0), mild (1–2), moderate (3–4) or severe comorbidity (>4). The relationship between CCI and therapeutic delay was evaluated using the Spearman correlation. Post-treatment mortality was modelled with logistic regression, using death within 30 days as the event. The association between comorbidity and survival was assessed using Cox proportional hazard models.

Results

Among 8812 patients with a known CCI, 39.2% had at least one comorbidity. Therapeutic delay increased from 31 to 36 days when the CCI worsened from 0 to 4 (rho = 0.087). After case-mix adjustment, higher baseline comorbidity was associated with increased post-surgery mortality (mild, OR 3.52 95% CI 1.91–6.49; severe, OR 18.71 95% CI 6.85–51.12) and post-radiotherapy mortality (mild, OR 2.23 95% CI 1.56–3.19; severe, OR 9.33 95% CI 4.83–18.01) and with reduced overall survival (mild, HR 1.39, 95% CI 1.31–1.48; severe, HR 2.41 95% CI 2.00–2.90). That was also the case for relative survival in unadjusted analyses (mild, EHR 1.77 95% CI 1.64–1.92; severe, EHR = 4.15 95% CI 3.43–5.02).

Conclusion

Comorbidity is significantly related to therapeutic delay, post-treatment mortality, 5-year overall and relative survival in HNSCC patients. Therapeutic decision support tools should optimally integrate comorbidity.

Prognostic and clinicopathological significance of PD-L1 and tumor infiltrating lymphocytes in hypopharyngeal squamous cell carcinoma

11-01-2020 – Chunyan Hu, Shu Tian, Lan Lin, Jiahao Zhang, Hao Ding

Journal Article

Objectives

Limited information is available regarding programmed death-ligand 1 (PD-L1) and tumor-infiltrating lymphocytes (TILs) in hypopharyngeal squamous cell carcinoma (HPSCC). Therefore, we investigated the expression of PD-L1 and the volume of TILs in HPSCC to determine whether these biomarkers were associated with patient clinicopathologic characteristics and prognosis. Furthermore, we explored p16 status and analyzed its possible correlations with clinical outcomes.

Methods

Tissues of 111 HPSCC patients were immunohistochemically analyzed for PD-L1, CD8, CD4, and Foxp3 expression to assess the microenvironment. We also assessed the p16 status. The expression of PD-L1 and TILs were analyzed with respect to patient clinicopathologic variables and prognosis.

Results

Twenty-four (21.6%) patients had PD-L1 expression in ≥1% of tumor cells. PD-L1 expression was significantly correlated with a high level of TILs (P < 0.05). Kaplan–Meier analysis showed that higher CD8+ and Fox
P3+ TIL infiltration was strongly associated with superior overall survival (OS, P = 0.005 and P = 0.008) and disease-free survival (DFS, P = 0.015 and P = 0.048). Univariate and multivariate analyses confirmed that CD8+ TIL exhibited strong prognostic significance. The combination of PD-L1+ with CD8high expression was a prognostic factor and was associated with better OS (P = 0.025). Moreover, p16 positivity was detected in five patients (4.5%) and was only occasionally involved in HPSCC.

Conclusion

Our findings indicate that high CD8 and Fox
P3 expression in HPSCC contributes to longer patient survival. Although PD-L1 expression was not associated with outcome, PD-L1 positivity in combination with CD8high expression may have greater predictive potential.

MRI evaluation of involvement of parotid and submandibular glands by tongue squamous cell carcinoma

07-01-2020 – Aarati Panchbhai, Rahul Bhowate

Journal Article

Objectives

The majority of cases of salivary gland involvement are diagnosed in its late stages as may be missed in the evaluation, the low detection rate of involvement of salivary gland by OSCC may have significant impact on spread and recurrence of the OSCC.

The study aimed to evaluate involvement of parotid and submandibular salivary glands by tongue oral squamous cell carcinoma.

Material and method

The 144 histo-pathologically proven cases of tongue squamous cell carcinoma were evaluated for clinical staging, margins and extent of tumor and involvement of salivary gland on T1T2 Weighted, STIR, diffusion-weighted and contrast-enhanced MRI sequences and data was subjected to analysis.

Results

In tongue OSCC, total 9 (6.25%) patients showed salivary gland involvement, 2 of them involved parotid glands and 7 of them involved submandibular gland. The OSCC involving the salivary glands were in Stage 4 except for 2 cases with predilection for antero-lateral border and tendency towards midline crossing. Out of 9 cases that showed salivary gland involvement, the 5 cases showed direct involvement from the spreading lesion, the 3 cases showed the infiltration from adjacent lymph nodes and 2 cases showed infiltration from sublingual gland and medial pterygoid muscle.

Conclusion

The present study revealed the greater percentage of OSCC with salivary gland involvement as compared to previous studies; in contradiction present study demonstrated higher involvement of submandibular gland compared to parotid gland with additional imaging features in salivary glands (15.97%) suggesting the likely possibility of their involvement by OSCC in near future.

Oncological safety of submental island flap for reconstruction of pathologically node-negative and node-positive T1–2 oral squamous cell carcinoma-related defects: A retrospective study and comparison of outcomes

04-01-2020 – Jinbing Wang, Yiran Tan, Yi Shen, Mingming Lv, Jun Li, Jian Sun

Journal Article

Objectives

To evaluate the oncological safety and reliability of the submental island flap (SIF) technique in patients with pathologically node-negative (p
N0) and node-positive (p
N+) T1–2 oral squamous cell carcinoma (OSCC) undergoing surgical tumor resection and concurrent SIF reconstruction.

Patients and methods

Retrospectively, we reviewed patients with p
N0 and p
N+ T1–2 OSCC who underwent tumor resection and defect reconstruction with SIF from April 2008 to September 2016, focusing on flap viability, patterns and predictors of locoregional failure, salvage treatments, and oncologic prognosis.

Results

Of 160 patients with primary T1–2 OSCC, 33 were p
N+ and 127 were p
N0. All SIFs beside two were successful (98.75%). During follow-up, 18 patients experienced locoregional tumor relapse, of which 14 were p
N0 and four were p
N+. The 5-year recurrence-free survival was 88.73% vs. 86.93% for the p
N0 and p
N+ groups, respectively (p = .847). The p
N + patients had poorer prognosis than p
N0 patients (5-year overall survival, 66.35% vs. 91.10% respectively p = .005; disease-specific survival, 74.87% vs. 91.88% respectively p = .016). Multivariate analyses indicated there was no independent predictor for locoregional recurrence, but p
N+ was predictive for poor prognosis (p = .03).

Conclusion

SIF is a reliable flap for the reconstruction of OSCC-related small- and medium-sized soft tissue defect. With careful neck dissection and appropriate postoperative adjuvant treatment, the application of SIF did not increase the risk of locoregional tumor recurrence in patients with p
N+ T1–2 OSCC compared with those with p
N0 T1–2 OSCC.

Effectiveness of low-level laser therapy for oral mucositis prevention in patients undergoing chemoradiotherapy for the treatment of head and neck cancer: A systematic review and meta-analysis

18-02-2020 – Vinícius Hallan Souza de Lima, Olavo Barbosa de Oliveira-Neto, Pedro Henrique da Hora Sales, Thiago da Silva Torres, Fernando José Camello de Lima

Journal Article, Review

Oral Mucositis is a frequent and debilitating inflammatory complication in patients with head and neck malignancies and may lead to unplanned treatment interruptions due to intense pain and dysphagia. This systematic review with meta-analysis was performed to determine the effectiveness of low-level laser therapy in preventing oral mucositis in this context. The following databases were searched through September 2018, with last search performed on May 2019, for clinical trials: MEDLINE via PubMed, Cochrane Central, Scopus, Lilacs, ISI Web of Science and SIGLE via Open Grey. From 14,525 records, 4 studies were included in the review and 3 studies were included in meta-analysis. Data from 500 patients (mean age of 53.595 and 54.14 for intervention and control groups, respectively) were analysed. Meta-analysis showed that laser therapy prevents oral mucositis incidence in 28% and 23% of cases during the third and fourth follow-up week, respectively, in comparison to a placebo-treated control group. There was no statistically significant difference the prevention of pain; dysphagia and quality of life were not analysed due to missing. Laser therapy was effective in preventing oral mucositis from the 15th to the 45th days of chemoradiotherapy. However, new primary studies with low risk of bias are needed so a higher scientific evidence can be obtained.

The effectiveness of probiotics in prevention and treatment of cancer therapy-induced oral mucositis: A systematic review and meta-analysis

11-01-2020 – Zekai Shu, Peijing Li, Bingqi Yu, Shuang Huang, Yuanyuan Chen

Journal Article, Review

Oral mucositis (OM) is a common and troublesome adverse side effect of many cancer therapy modalities (chemotherapy, radiotherapy, and chemo-radiotherapy), which can cause pain, ulceration, dysphagia, malnutrition, even treatment interruption. Probiotics may be effective in preventing and treating of cancer therapy-induced OM. We performed a systematic review and meta-analysis of the effectiveness of probiotics in prevention and treatment of cancer therapy-induced OM. Four databases and one trial registry were searched as of the 12th of May 2019 to identify all eligible randomized controlled trials (RCT). Five studies involving 435 patients were included in this study. Methodological quality and outcomes were evaluated in every study included. Pooled results showed a moderate heterogeneity (P = 0.15, I2 = 44%). The pooled RRs indicated that the use of probiotics decreased the risk of OM for grade ≥3 (RR = 0.66, 95%CI = 0.54–0.81, P < 0.0001) as well as all grades (RR = 0.83, 95% CI = 0.72–0.97, P = 0.02). There was no significant difference between probiotics and placebo for cancer therapy completion rate (RR = 1.14, 95%CI = 0.65–2.00, P = 0.64). The subgroup analysis indicated that the use of probiotics was not statistically significant for patients receiving chemo-radiotherapy (RR = 0.52, 95% CI = 0.26–1.04, P = 0.07). In conclusion, probiotics may reduce the incidence and mitigate the severity of cancer therapy-induced OM. Further trials with a randomized, double-blind and multicentric study design are needed to confirm this effect. The PROSPERO registration number of this systematic review and meta-analysis is CRD42019130414.

Malignant transformation evidences of Oral Lichen Planus: When the time is of the essence

19-02-2020 – Francesca Zotti, Riccardo Nocini, Giorgia Capocasale, Andrea Fior, Martina Peretti, Massimo Albanese

Letter

Oral Lichen Planus (OLP) is an inflammatory chronic disease, its potential of malignant transformation is widely known, especially for lesions affecting mucosa.

This letter aims to highlight, thanks to results obtained from a long-term observation of one hundred patient suffering from OLP, the importance to set proper and sufficiently long follow-ups. An important evidence observed is the malignant developing after 4 years of observation in 4 cases of 8. This leads to conclude that follow-up for OLP lesions is required to be as long as possible in order to timeously intercept malignant transformations of these lesions and to perform a realistic early diagnosis. Final suggestion is to design more prospective studies based of long observation period.

Paraneoplastic manifestations of salivary gland tumours: A case report and review

18-02-2020 – Abdullah Nasser, Bibianna Purgina, Scott Laurie

Letter

Salivary gland cancers are an uncommon and heterogenous group of malignancies, accounting for approximately 3% of head and neck tumors. We describe a case of a patient who presented with paraneoplastic Cushing’s syndrome secondary to metastatic salivary ductal carcinoma (SDC). Paraneoplastic ACTH secretion initially responded to chemotherapy with complete resolution of clinical symptoms. To our knowledge, this is the first described case of an ACTH-secreting SDC. We also review other paraneoplastic syndromes (PNS) that have been reported in association with salivary gland cancers.

Mantle cell lymphoma of the oral cavity: An uncommon site for an uncommon lesion, two new cases and literature review

06-02-2020 – Ludmila Lukach, Hadas Lehman, Alejandro Livoff, Oded Nahlieli, Eli Michaeli, Irit Allon

Letter

Use of a submandibular gland flap for closure of oral cutaneous fistula

06-02-2020 – Liudi Yang, Juan Wei, Weiming Wang, Mi He, Long Huang, Tong Su

Letter

We reported a rare case of submandibular oral cutaneous fistula (OCF) in a 27-year-old female. A submandibular gland flap (SMGF) was prepared after fistula resection to fill the dead space under the mouth floor. Based on this case report and a literature review, we discussed the pathogenesis and treatment of OCF, and compared the differences between the SMGF and other types of flaps.

Prioritisation of research topics for head and neck cancer in Africa – Report of the International Collaboration On Improving Cancer outcomes in low and middle income countries – ICOnIC Africa

26-01-2020 – Neil Sharma, Johannes Fagan, Melissa Wallace, Elize Joubert, Linda Greef, Anna Konney, Hannah Simonds, Verna Vanderpuye, Vikash Sewram, Taryn Young, Hisham Mehanna, Daniel Adekunle, Ayman Amin, Joyce Aswani, Kenneth Baidoo, Aneel Bhangu, Melesse Biadgelign, Deborah Constant, Justine Davies, Camilla Dawson

Journal Article

Reply to “Is no biopsy appropriate for oral potentially malignant lesion(s) without loss of autofluorescence using VELscope?”

26-01-2020 – Linjun Shi, Chenxi Li, Wei Liu

Letter

Oral Kaposi’s sarcoma in a HIV-negative young patient

22-01-2020 – Niccolò Lombardi, Elena Varoni, Andrea Sardella, Giovanni Lodi

Letter

Oral MALT Lymphoma: Something to remember

22-01-2020 – Francesca Zotti, Andrea Fior, Fabio Lonardi, Massimo Albanese, Riccardo Nocini, Giorgia Capocasale

Letter

Oral MALT Lymphoma is rare condition and its pathogenesis are related to persistent immune stimulation caused by chronic infection or inflammation. We report a case of MALT lymphoma of the palatal minor salivary glands in a 73-year-old white woman with clinical history of osteoporosis and systemic lupus erythematosus associated with Sjögren’s syndrome.

This letter aims to call the attention on large number of factors to take into account in evaluating patients with an history of auto-immune diseases.

This idea results from our difficulty in identifying this pathology in first diagnosis, due to rarity of this condition and severe comorbidity associated.

Treatment of end-stage pharyngeal strictures after laryngectomy with fasciocutaneous microvascular reconstruction

12-01-2020 – Janice L. Farlow, Andrew J. Rosko, Matthew E. Spector

Letter

Pharyngeal strictures can develop after laryngectomy for larynx cancer, particularly in combination with radiation. Some patients develop intractable strictures where conservative swallowing therapy and pharyngeal dilations fail. Secondary reconstruction of these patients has not been described in the literature. We report our experience with completion pharyngectomy and fasciocutaneous free tissue reconstruction for this patient population. Five subjects who had undergone laryngectomy and radiation were successfully reconstructed with fasciocutaneous free tissue transfer using the radial forearm or anterolateral thigh with minimal post-operative complications. Following surgery, enteral tube feeding requirements were eliminated, and all diets were advanced. A few patients still required a modified diet or continued dilations. We thus demonstrate that pharyngectomy with secondary reconstruction is an effective option for end-stage pharyngeal strictures, though this should only be undertaken with careful patient selection.

HPV testing: A quality metric

04-01-2020 – Antoine Eskander, Zain A. Husain

Editorial

Increased clinical and plasma EBV DNA responses to platinum-gemcitabine after nivolumab in patients with heavily platinum-pretreated nasopharyngeal cancer

24-12-2019 – S. Cabezas-Camarero, R. Pérez-Alfayate, F. Puebla, M.N. Cabrera-Martín, P. Pérez-Segura

Letter

Financial burden of oral squamous cell carcinoma in India

24-12-2019 – Rahul Anand, Deepak Pandiar, Mala Kamboj

Letter

Metachronous mediastinal and lung metastases from head and neck cancer: A case series, literature review and considerations for treatment

22-12-2019 – Federico Ampil, Carlos Previgliano, Carrie Porter, Troy Richards, Amol Takalkar

Letter

Metachronous mediastinal and lung metastases (MMLM), important sources of morbidity and mortality, in people with head and neck cancer (HNC) have received little attention. Between 1980 and 2004, 37 patients with treated HNC and MMLM diagnosed on follow-up imaging (with histological confirmation in 14 cases) were identified. The median interval from diagnosis of HNC to the appearance of MMLM was 14.5 months. The overall median survival was 4 months, and the 1-year crude survival rate (CSR) was 16%. A meaningful difference in the 1-year CSRs between the palliative radiation treated and untreated subjects (39% and 4%, respectively, p < 0.01) was observed. Because associated costs of health care utilization are considerable, and yet survival is limited, optimum management of MMLM-HNC with improvement of prognosis remains a challenge.

Intolerance to pungent spices among patients receiving radiation and chemotherapy for head and neck cancers

21-12-2019 – Akanksha Aanya, Prasanna Suresh Hegde, Christine Alexis Fernando, Shalini Thakur, Vishal Rao

Letter

Corrigendum to “Cutaneous keratinocyte cancers of the head and neck: Epidemiology, risk factors and clinical, dermoscopic and reflectance confocal microscopic features” Oral Oncol. 98 (2019) 109–117

16-12-2019 – Katie J. Lee, Mitchell Robinson, H. Peter Soyer

Published Erratum

Follicular dendritic cell sarcoma of the parotid gland: A case report

17-12-2019 – Pugen An, Yizhou Li, Jizhi Zhao

Letter

Follicular dendritic cell sarcoma (FDCS) is an exceedingly rare malignant neoplasm. The management of this tumor is fully challenging due to its rarity and lack of documentations. We share a case with primary parotid FDCS. This case report depicts the clinicopathological features of FDCS, which intends to serve as a reference to clinicians in its correct identification.

Chemotherapy after progression on nivolumab is essential for responders with genetic alterations of driver gene: Review of two recurrent/metastatic oral squamous cell carcinoma patients

17-12-2019 – Kazuhiro Ogi, Junichi Kobayashi, Takafumi Nakagaki, Junya Okamoto, Kazushige Koike, Naoki Hirokawa, Masanori Someya, Hiroki Sakamoto, Kohichi Takada, Takashi Tokino, Yasushi Sasaki, Hiroyoshi Hiratsuka, Akihiro Miyazaki

Letter

Radiation induced hypothyroidism – Why is early intervention necessary?

05-12-2019 – Kshitij Aggarwal, Shalini Thakur, Vishal Rao, Sameep S. Shetty

Letter

Is no biopsy appropriate for oral potentially malignant lesion(s) without loss of autofluorescence using VELscope®? A large prospective diagnostic study

01-12-2019 – James Sciubba, Joel Epstein

Editorial

Radiation induced hypothyroidism – Why is early intervention necessary?

12-11-2019 – Kshitij Aggarwal, Shalini Thakur, Sameep S. Shetty, Vishal Rao

Letter

Response to R. Jayaraj

07-11-2019 – Etienne Dauzier, Benjamin Lacas, Pierre Blanchard, Anne Aupérin, Jean-Pierre Pignon

Letter

Innovations in risk-stratification and treatment of Veterans with oropharynx cancer; roadmap of the 2019 Field Based Meeting

28-10-2019 – V.C. Sandulache, Y.L. Lei, L.E. Heasley, M. Chang, C.I. Amos, E.M. Sturgis, E. Graboyes, E.Y. Chiao, N. Rogus-Pulia, J. Lewis, A. Madabhushi, M.J. Frederick, A. Sabichi, M. Ittmann, W.G. Yarbrough, C.H. Chung, R. Ferrarotto, Weiyuan Mai, H.D. Skinner, U. Duvvuri

Editorial