Description

Oral Oncology is an international interdisciplinary journal which draws together for the first time issues relating to the aetiopathogenesis, epidemiology, prevention and management of oral and perioral tumours and of oral disease in patients with malignancies. Papers are invited on the following aspects of cancers arising in the lip, tongue, mouth, salivary glands, pharynx, and the related bones, soft tissues, and lymph glands. (1) Natural history of oral cancer and pre cancer, basic pathology, mestastatic mechanisms. (2) Cellular and molecular markers for diagnosis and prognosis, oncogenes, viruses, growth factors, and adhesion molecules. (3) Epidemiology, risk factors, prevention, screening, and intervention. (4) Advances in imaging and other functional diagnostic modalities. (5) Surgical advances, lasers, photo dynamic therapy, cyro surgery, micro vascular surgery. (6) Multimodality treatment, radiotherapy, chemotherapy, immunotherapy, gene therapy. (7) Advances in reconstruction and rehabilitation, grafts, alloplasty, bone and connective tissue biology, osteoradionecrosis. (8) Teamwork in cancer care, quality of life, nursing, speech and swallowing therapy, nutrition, counselling, pain control, terminal care. (9) Oral effects of tumours at both local and distant sites and their treatment. Research data may be submitted as a paper, short communication or letter. The journal will consider negative results from well designed studies, which may be published as short communications or letters. Letters may be published as short communications. Letters that comment on an article previously published in the same journal or that express a viewpoint about oncology are also invited. All published papers and short communications, and selected letters containing research data are peer reviewed.

Publisher details

Elsevier

Publications in this journal

• Therapy options and long-term results of sinonasal malignancies.

  Authors: Andreas Arnold, Panagiotis Ziglinas, Katharina Ochs, Nadine Alter, Andreas Geretschläger, Kurt Lädrach, Peter Zbären, Marco Caversaccio

  Oral oncology.

  OBJECTIVES: Nasal and paranasal sinus malignancies are rare. The most common lesions are located in the nasal cavity and the maxillary sinus, although they also occur in the ethmoid, sphenoid andOBJECTIVES: Nasal and paranasal sinus malignancies are rare. The most common lesions are located in the nasal cavity and the maxillary sinus, although they also occur in the ethmoid, sphenoid and frontal sinuses. Treatment often combines surgery, radiotherapy and chemotherapy. Endoscopic surgical approaches are increasingly used in order to reduce the morbidity associated with standard open resection. The aim of our study was to analyse the long-term treatment results of sinonasal malignancies (SNM), with a special focus on surgical approaches. MATERIALS AND METHODS: A retrospective review of 123 patients treated in a tertiary referral centre from 1992 to 2008 was conducted, which included information on tumour stage, histology, treatment and follow-up. RESULTS: A variety of histological types were found with squamous cell carcinoma being the most frequent (n=38), followed by melanoma (n=24) and adenocarcinoma (n=21). Open surgery was performed in 55 patients, and endoscopic resection was performed in 28 patients. Nineteen patients were treated with primary radiation therapy (RTX), four underwent primary chemotherapy (CTX), and 15 had primary chemoradiation (RCTX). Two patients died prior to therapy onset. A comparison of survival rates did not show a significant difference between the treatment groups. Patients that underwent endoscopic resection had significantly fewer postoperative complications. CONCLUSION: In carefully selected patients, endoscopic surgery of SNM showed a similar outcome as open surgery, but with a significantly lower complication rate.

• New rehabilitation protocol for oral sinus communications in BRONJ patients.

  Authors: F C S Almeida, M S Moreira, M Marcucci, M M Marques, M E Araujo, D P da Silva

  Oral oncology.

• A randomized trial of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy for locoregionally advanced nasopharyngeal carcinoma.

  Authors: Pei-Yu Huang, Ka-Jia Cao, Xiang Guo, Hao-Yuan Mo, Ling Guo, Yan-Qun Xiang, Man-Quan Deng, Fang Qiu, Su-Mei Cao, Ying Guo, Li Zhang, Ning-Wei Li, Rui Sun, Qiu-Yan Chen, Dong-Hua Luo, Yi-Jun Hua, Hai-Qiang Mai, Ming-Huang Hong

  Oral oncology.

  The aim of this randomized study was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) versus induction chemotherapy plus radiotherapy (IC+RT) for patientsThe aim of this randomized study was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) versus induction chemotherapy plus radiotherapy (IC+RT) for patients with locoregionally advanced nasopharyngeal carcinoma. From August 2002 to April 2005, 408 patients were randomly divided into two groups: an IC+CCRT group and an IC+RT group. Patients in both groups received the same induction chemotherapy: two cycles of floxuridine (FuDR)+carboplatin (FuDR, 750mg/m(2), d1-5; carboplatin, area under the curve [AUC]=6). The patients received radiotherapy 1week after they finished the induction chemotherapy. The patients in the IC+CCRT group also received carboplatin (AUC=6) on days 7, 28, and 49 of radiotherapy. Eight patients did not meet the inclusion criteria, and the remaining 400 cases were analyzed. Grade III or IV toxicity was found in 28.4% of the patients in the IC+CCRT group and 13.1% of those in the IC+RT group (P<.001). Five-year overall survival rates were 70.3% and 71.7% (P=0.734) in the IC+CCRT and IC+RT groups, respectively. No significant differences in failure-free survival, locoregional control, and distant control were found between the two groups. Compared with the IC+RT program, the IC+CCRT program used in the present study did not improve the overall survival and failure-free survival in patients with locoregionally advanced nasopharyngeal carcinoma. Using carboplatin in the concurrent chemoradiotherapy was not suitable for nasopharyngeal carcinoma.

• Highly-conformal intensity-modulated radiotherapy reduced toxicity without jeopardizing outcome in patients with paranasal sinus cancer treated by surgery and radiotherapy or (chemo)radiation.

  Authors: Abrahim Al-Mamgani, Dominiek Monserez, Peter van Rooij, Gerda M Verduijn, Jose A U Hardillo, Peter C Levendag

  Oral oncology.

  OBJECTIVES: To report oncologic outcomes of patients with paranasal sinus cancer (PNSC) treated by surgery and radiotherapy or (chemo)radiation and to investigate the impact of improving theOBJECTIVES: To report oncologic outcomes of patients with paranasal sinus cancer (PNSC) treated by surgery and radiotherapy or (chemo)radiation and to investigate the impact of improving the radiation technique on outcomes and toxicity. MATERIALS AND METHODS: Between 1999 and 2010, 82 consecutive patients with PNSC were treated by surgery and radiotherapy or by definitive (chemo)radiation. Three-dimensional conformal (3DCRT) or highly-conformal intensity-modulated RT (IMRT) was used. Endpoints were local control (LC), regional control (RC), disease-free (DFS), cause-specific (CSS), and overall survival (OS), late toxicity, and quality-of-life (QoL). RESULTS: After median follow-up of 51months, the 5-year actuarial rates of LC, RC, DFS, CSS, and OS were 74%, 94%, 56%, 64%, and 54%, respectively. Grade ⩾2 late toxicity at 5-years was 28%. High T-stage and perineural invasion were significantly associated with poor LC and RT-technique with late toxicity. Late toxicity was significantly lowered using IMRT, compared to 3DCRT (17% vs. 52%, p<0.0001). Visual preservation were significantly improved using IMRT (88% and 65%, respectively, p=0.01). LC-rate was also improved by IMRT (80% vs. 64%, respectively, p=0.2). QoL-scores deteriorated during and shortly after treatment but returned in almost all scales to baseline levels within 3-12months. CONCLUSIONS: Surgery and radiotherapy or definitive (chemo)radiation resulted in good LC rates but with high rate of late side-effects. However, late toxicity and permanent visual impairment were significantly decreased by using highly-conformal IMRT without jeopardizing outcome. The improvements in the therapeutic ratio achieved by using IMRT would allow dose escalation of RT to further improve outcomes.

• The clinical determinants of malignant transformation in oral epithelial dysplasia.

  Authors: M W Ho, J M Risk, J A Woolgar, E A Field, J K Field, J Steele, B P Rajalwat, A Triantafyllou, S N Rogers, D Lowe, R J Shaw

  Oral oncology.

  BACKGROUND: While the size and clinical appearance are known risk factors for malignant transformation of potentially malignant oral the importance of site, grade of dysplasia and exposure toBACKGROUND: While the size and clinical appearance are known risk factors for malignant transformation of potentially malignant oral the importance of site, grade of dysplasia and exposure to environmental carcinogens remains controversial. We aim to report the clinical determinants of malignant progression in a series of patients with histopathologically graded oral epithelial dysplasia (OED). METHODS: We recruited patients with a histopathological diagnosis of OED to a longitudinal observational study in a tertiary oral dysplasia clinic. Clinical, histopathological and risk factor data were recorded at baseline. One of three clinical endpoints were determined: malignant transformation, progression of dysplasia grade, remission/stable dysplasia grade. RESULTS: Ninety-one patients meeting the criteria gave consent for inclusion to the cohort, with outcomes reported after a median follow up of 48months. An estimated 22% (SE 6%) of patients underwent malignant transformation within 5years, with significant predictors being: non-smoking status (χ(2)=15.1, p=0.001), site (χ(2)=15.3, p=0.002), non-homogeneous appearance (χ(2)=8.2, p=0.004), size of lesion >200mm(2) (χ(2)=4.7, p=0.03) and, of borderline significance, high grade (χ(2)=5.8, p=0.06). Gender, age, number of lesions and alcohol history did not predict for malignant transformation. CONCLUSIONS: Although a number of these clinical determinants have previously been associated with higher malignant transformation in OED, the high-risk nature of lesions in non-smokers is of particular note and requires a greater emphasis and recognition amongst clinicians dealing with OED. It suggests that those non-smokers with OED, have an inherited or acquired predisposition and should be treated more aggressively; these should form the focus for further investigation.

• Expression of ERCC1 predicts clinical outcome in locoregionally advanced nasopharyngeal carcinoma treated with cisplatin-based induction chemotherapy.

  Authors: Pei-Yu Huang, Yan Li, Hai-Qiang Mai, Rong-Zhen Luo, Yu-Chen Cai, Li Zhang

  Oral oncology.

  The aim of the present study was to evaluate the correlation between excision repair cross-complementation group 1 (ERCC1) protein with the clinical outcome of nasopharyngeal carcinoma (NPC) patientsThe aim of the present study was to evaluate the correlation between excision repair cross-complementation group 1 (ERCC1) protein with the clinical outcome of nasopharyngeal carcinoma (NPC) patients treated with cisplatin-based induction chemotherapy. One hundred one Stage III-IVB nonkeratinizing NPC patients who were treated with cisplatin (DDP)+fluorouracil (5-Fu) induction chemotherapy were recruited. Pre-treatment tumor biopsy specimens were analyzed for ERCC1 by immunohistochemistry. The relationship of ERCC1 expression and chemotherapy response and survival of these NPC patients was analyzed. The objective response to induction chemotherapy of NPC patients with low ERCC1 expression compared with high ERCC1 expression was 88.2% vs. 72% (P=0.041). The 5-year distant failure-free survival (D-FFS) of NPC patients with low ERCC1 expression compared with high ERCC1 expression was 73.5% vs. 51.3% (P=0.037). ERCC1 expression was a significant prognostic factor for overall survival and D-FFS using Cox regression analysis. High tumor ERCC1 expression predicts low chemotherapy response and poor survival mainly caused by more metastasis in locoregionally advanced NPC treated with cisplatin-based induction chemotherapy.

• Preoperative vs. postoperative radiochemotherapy in patients with N2 squamous cell carcinoma of the oral cavity.

  Authors: Matthias Kreppel, Hans-Theodor Eich, Christian Brüggenolte, Timo Dreiseidler, Daniel Rothamel, Uta Drebber, Alexander Kübler, Joachim E Zöller, Martin Scheer

  Oral oncology.

  BACKGROUND: The aim of our study was to evaluate retrospectively whether neoadjuvant or adjuvant radiochemotherapy yields better survival for patients with N2-oral squamous cell carcinoma and toBACKGROUND: The aim of our study was to evaluate retrospectively whether neoadjuvant or adjuvant radiochemotherapy yields better survival for patients with N2-oral squamous cell carcinoma and to identify subgroups, which may benefit from one of the therapeutic settings. No studies have been carried out to investigate whether radiochemotherapy should be applied before or after surgery. METHODS: In total, 151 patients with oral squamous cell carcinoma with N2-nodal-status were reviewed. Eighty five patients received neoadjuvant radiochemotherapy, 66 patients were treated with surgery and adjuvant radiochemotherapy. Overall survival was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. RESULTS: Patients treated with neoadjuvant radiochemotherapy had a significantly improved 5-year survival in comparison to patients, who received adjuvant radiochemotherapy (46.3% vs. 27.4%, p=0.035). A subgroup analysis by T-stage revealed that neoadjuvant and adjuvant radiochemotherapy yielded similar 5-year survival rates for patients with T2N2-tumors (42.3% vs. 41.2%, p=0.871), whereas patients with T4bN2-tumors significantly benefitted from neoadjuvant treatment (37.3% vs. 9.7%, p=0.019). CONCLUSIONS: Neoadjuvant radiochemotherapy is an effective treatment for patients with nodal status N2-oral squamous cell carcinoma, however prospective randomized trials are needed to confirm, which patients should be treated with neoadjuvant or adjuvant radiochemotherapy.

• Dermatitis associated with cetuximab and radiotherapy: The potential benefit with recombinant human epidermal growth factor and a concern regarding the use of steroids.

  Authors: Swaroop Revannasiddaiah, Priyanka Thakur, Manish Gupta

  Oral oncology.

• Effects of multidisciplinary care on the survival of patients with oral cavity cancer in Taiwan.

  Authors: Yueh-Hsin Wang, Pei-Tseng Kung, Wen-Chen Tsai, Chih-Jaan Tai, Shih-An Liu, Ming-Hsui Tsai

  Oral oncology.

  OBJECTIVES: The incidence of oral cavity cancer is high in Taiwan. To improve patient survival, multidisciplinary team (MDT) care was implemented. This research compared the survival of MDT careOBJECTIVES: The incidence of oral cavity cancer is high in Taiwan. To improve patient survival, multidisciplinary team (MDT) care was implemented. This research compared the survival of MDT care participants/non-participants and examined the effect of MDT care on patient characteristics. MATERIALS AND METHODS: In this study, 19,513 patients with newly diagnosed oral cavity cancer were recruited from 2004 to 2007 in Taiwan. Matching based on the propensity of receiving MDT care was used. In total, 9297 patients were observed until 2008. A Cox proportional hazards model was applied to elucidate the relative risks of death. RESULTS: The relative risk of death was lower for patients with MDT care than for those without such care (HR=0.84; 95% CI=0.78-0.90). Males had a higher risk of death than females (HR=1.20; 95%CI=1.04-1.38). Older age, lower income, and more severe comorbidity were associated with a higher risk of death. The effect of MDT care was stronger for older patients than for younger patients. Patients treated in public hospitals had a 1.24-fold (95%CI=1.13-1.36) higher risk of death than patients treated in private hospitals. Patients treated in hospitals or by attending physicians with higher service volumes had a lower relative risk of death (HR=0.89 and 0.78, respectively). The effect of MDT care was strong among patients with less severe comorbidities and patients without catastrophic illnesses. CONCLUSION: The relative risk of death was lower for MDT care participants. The effect of MDT care was stronger among older patients and patients with fewer comorbidities.

• A systematic review of head and neck cancer quality of life assessment instruments.

  Authors: Bukola Ojo, Eric M Genden, Marita S Teng, Kathrin Milbury, Krzysztof J Misiukiewicz, Hoda Badr

  Oral oncology.

  Although quality of life (QOL) is an important treatment outcome in head and neck cancer (HNC), cross-study comparisons have been hampered by the heterogeneity of measures used and the fact thatAlthough quality of life (QOL) is an important treatment outcome in head and neck cancer (HNC), cross-study comparisons have been hampered by the heterogeneity of measures used and the fact that reviews of HNC QOL instruments have not been comprehensive to date. We performed a systematic review of the published literature on HNC QOL instruments from 1990 to 2010, categorized, and reviewed the properties of the instruments using international guidelines as reference. Of the 2766 articles retrieved, 710 met the inclusion criteria and used 57 different head and neck-specific instruments to assess QOL. A review of the properties of these utilized measures and identification of areas in need of further research is presented. Given the volume and heterogeneity of QOL measures, there is no gold standard questionnaire. Therefore, when selecting instruments, researchers should consider not only psychometric properties but also research objectives, study design, and the pitfalls and benefits of combining different measures. Although great strides have been made in the assessment of QOL in HNC and researchers now have a plethora of quality instruments to choose from, more work is needed to improve the clinical utility of these measures in order to link QOL research to clinical practice. This review provides a platform for head and neck-specific instrument comparisons, with suggestions of important factors to consider in the systematic selection of QOL instruments, and is a first step towards translation of QOL assessment into the clinical scene.

• Bisphosphonate-related osteonecrosis of the jaws - A review.

  Authors: Sebastian Kühl, Christian Walter, Stephan Acham, Roland Pfeffer, J Thomas Lambrecht

  Oral oncology.

  The aim was to evaluate the knowledge about bisphosphonate-related osteonecrosis of the jaws (BRONJ). A bibliographic search in Medline, PubMed and the Cochrane Register of controlled clinical trialsThe aim was to evaluate the knowledge about bisphosphonate-related osteonecrosis of the jaws (BRONJ). A bibliographic search in Medline, PubMed and the Cochrane Register of controlled clinical trials was performed between 2003 and 2010 by using the terms bisphosphonate and osteonecrosis of the jaw. The amount of publications per year, the type of journal for publication, and the evidence level of the trial were evaluated. Next to this the incidences and the success of treatment strategies for BRONJ were identified. A total of 671 publications were reviewed. Since 2006 more than 100 publications on BRONJ per year (with an upward trend) have been published, mostly in dental journals. The evidence level could be determined for 176 publications and only one grade Ia study was found. The studies showed a wide variety in design, most of them being retrospective. The incidence of BRONJ is strongly dependent on oral or intravenous application and varies between 0.0% and 27.5%. There is no scientific data to sufficiently support any specific treatment protocol for the management of BRONJ. Further clinical studies are needed to evaluate the incidence and treatment strategies at a higher level of evidence. Therefore uniform study protocols would be favourable.

• Expression of podoplanin and ABCG2 in oral erythroplakia correlate with oral cancer development.

  Authors: Jin-Qiu Feng, Jun-Guo Mi, Lan Wu, Li-Wei Ma, Lin-Jun Shi, Xi Yang, Wei Liu, Chen-Ping Zhang, Zeng-Tong Zhou

  Oral oncology.

  Oral erythroplakia (OE) is a notoriously aggressive oral premalignant lesion with a high tendency to oral cancer development, but it's biological behavior is largely unknown. The objective of theOral erythroplakia (OE) is a notoriously aggressive oral premalignant lesion with a high tendency to oral cancer development, but it's biological behavior is largely unknown. The objective of the current study was to determine podoplanin and ABCG2 immunoexpression in OE and both correlation to malignant transformation of OE. In a retrospective follow-up study, the expression patterns of podoplanin and ABCG2 were determined using immunohistochemistry in samples from 34 patients with OE, including patients with untransformed lesions (n=17) and patients with malignant transformed lesions (n=17). Podoplanin and ABCG2 expression was observed in 15 (44.1%) and 21 (61.8%) of 34 patients, respectively. Multivariate analysis revealed that podoplanin and ABCG2 expression was associated with 6.31-fold (95% confidence interval [CI], 1.02-38.92; P=0.047) and 14.39-fold (95% CI, 2.02-102.29; P=0.008) increased the risk of transformation, respectively. Point prevalence analysis revealed that 90.9% (95% CI, 70.7-100) of the patient with both podoplanin and ABCG2 positivity developed oral cancer. Collectively, our data indicated that the expression patterns of podoplanin and ABCG2 in OE were associated with oral cancer development, suggesting that podoplanin and ABCG2 may be valuable predictors for evaluating oral cancer risk.

• Development of oral cancer screening test by detection of squamous cell carcinoma among exfoliated oral mucosal cells.

  Authors: Takuma Kugimoto, Kei-Ichi Morita, Ken Omura

  Oral oncology.

  OBJECTIVES: The early detection of oral cancer improves patient outcomes. However, despite our growing knowledge of oral cancers, patients often present with advanced disease. The development ofOBJECTIVES: The early detection of oral cancer improves patient outcomes. However, despite our growing knowledge of oral cancers, patients often present with advanced disease. The development of simple screening methods is desirable to provide an alternative to screening examinations by specialists. Thus, we developed a method of oral cancer detection among exfoliated oral mucosal cells, and we evaluated the feasibility of implementing an oral cancer screening test that is examiner independent. MATERIAL AND METHODS: The study population consisted of 185 subjects: 89 with oral cancer, 18 with oral leukoplakia, and 78 controls. We used real-time polymerase chain reaction (PCR) to detect the biomarkers serpin peptidase inhibitor B3 (SCCA1), interleukin 15 (IL-15), and thrombomodulin (THBD). RESULTS: The sensitivities for the detection of oral cancer and oral leukoplakia were 72.0% (77/107) with SCCA1, 75.7% (81/107) with IL-15, and 56.1% (60/107) with THBD, and the specificities were 73.1% (57/78) with SCCA1, 64.1% (50/78) with IL-15, and 78.2% (61/78) with THBD. Analysis of the sensitivity according to tumor size revealed that sensitivity was lower for large tumors. When analyzing the sensitivity according to the clinical growth pattern, the sensitivity was observed to be low for endophytic tumors. CONCLUSION: We developed an oral cancer screening test based on real-time PCR analysis of SCCA1 that is examiner independent, and the sensitivity and specificity were approximately 70%; therefore, we concluded that the performance of this method using a single biomarker was suboptimal.

• The strength/weakness of the AJCC/UICC staging system (7th edition) for nasopharyngeal cancer and suggestions for future improvement.

  Authors: Anne W M Lee, W T Ng, L K Chan, Oscar S H Chan, W M Hung, C C Chan, Peter T C Cheng, Henry Sze, T S Lam, T K Yau

  Oral oncology.

  BACKGROUND AND PURPOSE: To evaluate the current AJCC/UICC staging system (7th edition) for nasopharyngeal carcinoma and to explore for future improvement. MATERIALS AND METHODS: A total of 985BACKGROUND AND PURPOSE: To evaluate the current AJCC/UICC staging system (7th edition) for nasopharyngeal carcinoma and to explore for future improvement. MATERIALS AND METHODS: A total of 985 patients, initially staged with preceding 5-6th edition, were retrospectively re-staged with the 7th edition. All were assessed by magnetic resonance imaging, and all 945 non-disseminated patients were irradiated with conformal/intensity-modulated technique. RESULTS: Staging factors by both the 5-6th edition and the 7th edition were strongly significance for important endpoints (p<0.001). Down-staging of the previous T2a to T1 and, stages IIA to I in the 7th edition was appropriate. However, the impacts on overall stage distribution and prognostication were minimal. Further down-staging of the current T2 to T1, N2 to N1, stages II to I, and merging of N3a and N3b, stages IVA and IVB were suggested. With the 7th edition, the 5-year disease-specific survival (DSS) was 100% for stage I, 95% for II, 90% for III, 67% for IVA, 68% for IVB and 18% for IVC. The corresponding DSS for the proposed stages I, II, III and IV were 95%, 86%, 67% and 18%, respectively. CONCLUSIONS: The changes introduced in the 7th edition were appropriate, but the magnitude of improvement was minimal. With improving results by modern management, further simplification of the staging system is suggested. The proposed system could lead to more accurate prognostication, further validation is warranted.

• Oral cavity, pharyngeal and salivary gland cancer: Disparities in ethnicity-specific incidence among the London population.

  Authors: Chris D Donaldson, Ruth H Jack, Henrik Møller, Margreet Lüchtenborg

  Oral oncology.

  OBJECTIVES: We examined the association between ethnicity and the incidence of oral and pharyngeal cancers in the London population. METHODS: Data on London residents diagnosed with oral andOBJECTIVES: We examined the association between ethnicity and the incidence of oral and pharyngeal cancers in the London population. METHODS: Data on London residents diagnosed with oral and pharyngeal cancer (ICD-10 codes C00-C14) between 1998 and 2007 were retrieved from the Thames Cancer Registry. Age-standardised incidence rate ratios (IRR) for cancers of the nasopharynx (C11), oropharynx (C09-C10), hypopharynx (C12-C13), oral cavity (C00.3-C06), salivary glands (C07-C08) and Waldeyer's ring (C02.4, C09, C11.1, C14.2) were calculated for different ethnic groups using White males and females as the baseline groups. RESULTS: Records on 5833 individuals were examined, and ethnicity information was available for 4679 (80%) of these patients. The incidence rate of oral and pharyngeal cancer combined was 9.0 and 3.9 per 100,000 for males and females, respectively. Compared with their White counterparts, the highest incidence rate ratios of nasopharyngeal cancer were seen in Chinese males (IRR: 23, 95% confidence interval (CI): 7-73) and females (IRR: 16, 95% CI: 2-107). Waldeyer's ring cancers were most common in Bangladeshi and White groups. Analysis of the oropharynx and oral cavity cancers gave rise to variable but less obvious patterns among the different ethnic groups, whereas less variation was observed between ethnic groups for cancers of the hypopharynx and salivary glands. CONCLUSION: The incidence rates of individual oral and pharyngeal cancer types are low, but seem to vary by ethnic group. The variation in incidence appears to be unique to the different cancer subtypes and may therefore reflect specific ethnicity-related risk factors.

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

  Authors: Hiroyuki Goda, Koh-Ichi Nakashiro, Ryota Oka, Hiroshi Tanaka, Hiroyuki Wakisaka, Naohito Hato, Masamitsu Hyodo, Hiroyuki Hamakawa

  Oral oncology.

  OBJECTIVES: Lymph node stage is an important prognostic factor in head and neck squamous cell carcinoma (HNSCC). We previously reported the clinical usefulness of sentinel lymph node biopsy diagnosedOBJECTIVES: Lymph node stage is an important prognostic factor in head and neck squamous cell carcinoma (HNSCC). We previously reported the clinical usefulness of sentinel lymph node biopsy diagnosed by genetic analysis using quantitative RT-PCR. However, this method takes about 3h. In this study, we attempted to develop a more efficient method for the intraoperative genetic detection of lymph node metastasis in HNSCC. MATERIALS AND METHODS: A total of 312 lymph nodes (65 patients) were diagnosed by the one-step nucleic acid amplification (OSNA) method using GD-100. OSNA consists of a short homogenization step followed by amplification of cytokeratin 19 (CK19) mRNA directly from the lysate. Each lymph node was divided into two to diagnose metastasis. One half was used for the OSNA assay, and the other was subjected to semi-serial sectioning, sliced at 200-μm intervals and examined by H&E and cytokeratin AE1/AE3 immunohistochemical staining. The accuracy of OSNA assay was evaluated based on histopathological diagnosis. RESULTS: Sixty-one of 312 lymph nodes were pathologically metastasis-positive. The overall concordance rate between the OSNA assay using breast cancer criteria and histopathology was 94.2%. The optimal cut-off for the copy number of CK19 mRNA in assessing lymph node metastasis of HNSCC was 300copies/μl, which had the highest diagnostic accuracy (95.2%). The OSNA assay can be completed within 30min. CONCLUSION: The OSNA assay, which shows high sensitivity and specificity, suggests the possibility to be used as a novel tool for the genetic detection of lymph node metastasis in HNSCC patients.

• Primary chemoradiotherapy for oral cavity squamous cell carcinoma.

  Authors: Anthony K Crombie, Camile Farah, Lee Tripcony, Graeme Dickie, Martin D Batstone

  Oral oncology.

  OBJECTIVES: To evaluate the survival of patients with oral cavity squamous cell carcinoma (SCC) treated with chemoradiotherapy (CRT) or radiotherapy (RT). To record the rate of osteoradionecrosisOBJECTIVES: To evaluate the survival of patients with oral cavity squamous cell carcinoma (SCC) treated with chemoradiotherapy (CRT) or radiotherapy (RT). To record the rate of osteoradionecrosis (ORN) and need for alternative feeding of patients with oral cavity cancer treated with CRT or RT. MATERIALS AND METHODS: All patients with first presentation of oral cavity SCC treated with CRT or RT only at the Royal Brisbane & Women's Hospital (RBWH) between 2000 and 2007 were included. Patient Demographics (age, sex), ACE-27 Co-morbidity index, Staging (TNM staging system), Type of Chemotherapy and Dose of RT, Overall Survival (OS) and Disease-Specific Survival (DSS), Attempt at Salvage, development of distant metastases, development of ORN and success of treatment for ORN and requirement for alternative feeding (PEG/NGT) were recorded. RESULTS: Fifty-four patients met the inclusion criteria. One patient died due to toxicity of treatment. The 5-year OS was 29%. The 5-year DSS was 30%. The rate of ORN amongst survivors was 36%. CONCLUSIONS: CRT is successful in a small number of patients with oral cavity SCC. When compared to the published literature, surgery with or without post-operative RT has better survival rates. Salvage surgery does not appear to be a viable option for management of recurrence post CRT. The consequences of treatment, namely ORN and need for alternative feeding, are high.

• Distant metastases from head and neck squamous cell carcinoma. Part I. Basic aspects.

  Authors: Robert P Takes, Alessandra Rinaldo, Carl E Silver, Missak Haigentz, Julia A Woolgar, Asterios Triantafyllou, Vanni Mondin, Daniela Paccagnella, Remco de Bree, Ashok R Shaha, Dana M Hartl, Alfio Ferlito

  Oral oncology.

  The incidence of distant metastasis in head and neck squamous cell carcinoma (HNSCC) is relatively low but remains a major determinant of prognosis and therefore an important factor in clinicalThe incidence of distant metastasis in head and neck squamous cell carcinoma (HNSCC) is relatively low but remains a major determinant of prognosis and therefore an important factor in clinical decision making. The most frequently involved sites for distant metastasis are the lung (approximately 70% of cases), followed by bone and liver. There are often conflicting reports on which parameters are risk factors for distant metastasis, but the most important predictive factors appear to be the site of the primary tumor (hypopharynx in particular), advanced T- and N-classification, histological grade and the ability to achieve locoregional disease control. Metastasis results from a selection of tumor cells that have acquired the properties to withstand multiple and often unfavorable circumstances and settle in distant organs. Most of these processes involve interaction between tumor cells, their microenvironment and host factors. Increasing knowledge of the biology of distant metastasis may result in the development of diagnostic and therapeutic strategies targeted to this usually terminal stage for patients with HNSCC.

• Distant metastases from head and neck squamous cell carcinoma. Part II. Diagnosis.

  Authors: Remco de Bree, Missak Haigentz, Carl E Silver, Daniela Paccagnella, Marc Hamoir, Dana M Hartl, Jean-Pascal Machiels, Vinidh Paleri, Alessandra Rinaldo, Ashok R Shaha, Robert P Takes, C René Leemans, Alfio Ferlito

  Oral oncology.

  The detection of distant metastases is critical for prognostication and for the choice of treatment in patients with head and neck squamous cell carcinoma (HNSCC). Pretreatment screening for distantThe detection of distant metastases is critical for prognostication and for the choice of treatment in patients with head and neck squamous cell carcinoma (HNSCC). Pretreatment screening for distant metastases should be conducted particularly for patients with high risk factors, prior to locoregional treatment decisions. Different diagnostic techniques are discussed. Unfortunately, most studies lack sufficient follow-up to reliably assess false-negative results. Moreover, the designs of most studies vary substantially with regard to homogeneity of groups (tumor types and stages), timing (pretreatment, follow-up) and definition of risk factors (patient selection). Therefore, only a few studies are comparable. The combination of F-18 fluoro-d-glucose-positron emission tomography (FDG-PET) and a dedicated CT (at least of the chest) is the most important imaging protocol at the present time. Eventually, whole-body-MRI (WB-MRI) may possibly replace PET-CT for screening patients for distant metastases.

• Distant metastases from head and neck squamous cell carcinoma. Part III. Treatment.

  Authors: Missak Haigentz, Dana M Hartl, Carl E Silver, Johannes A Langendijk, Primož Strojan, Vinidh Paleri, Remco de Bree, Jean-Pascal Machiels, Marc Hamoir, Alessandra Rinaldo, Daniela Paccagnella, Ashok R Shaha, Robert P Takes, Alfio Ferlito

  Oral oncology.

  Distant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial presentation, remain an important manifestation of cancer recurrence and mortality. Although generallyDistant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial presentation, remain an important manifestation of cancer recurrence and mortality. Although generally considered incurable with a dismal prognosis despite palliative therapy, highly selected patients with distant metastases may have a long term survival benefit from aggressive surgery or radiotherapy. Advances in systemic treatments also may improve patient survival. This article reviews the current state of management of HNSCC patients with distant metastases.

• Oral dysplasia and squamous cell carcinoma: Correlation between increased expression of CD21, Epstein-Barr virus and CK19.

  Authors: Ru Jiang, Xin Gu, Tara N Moore-Medlin, Cherie-Ann Nathan, Lindsey M Hutt-Fletcher

  Oral oncology.

  OBJECTIVES: Epstein-Barr virus is an orally transmitted human gammaherpesvirus that infects B lymphocytes and epithelial cells. Although most primary infections are asymptomatic, long term carriageOBJECTIVES: Epstein-Barr virus is an orally transmitted human gammaherpesvirus that infects B lymphocytes and epithelial cells. Although most primary infections are asymptomatic, long term carriage of the virus can be associated with either lymphoid or epithelial malignancies. The association of EBV with oral squamous cell carcinomas is sporadic and it is uncertain if the virus is involved in initiation of the tumor or, possibly, in its progression. Complement receptor type 2, CR2 or CD21, is a receptor for the major attachment protein of EBV, which significantly enhances epithelial cell infection, but its expression on normal tissues is restricted to tonsil and adenoid epithelium. As cells become dysplastic they are reported to express higher levels of CK19. We sought to evaluate whether CD21 and CK19 expression change as oral epithelial cells outside Waldeyer's ring become dysplastic. MATERIALS AND METHODS: Epithelial cells were isolated by laser capture microdissection and levels of CD21, CK19 and EBV RNA were measured by quantitative reverse transcriptase PCR. RESULTS: We report that expression of CD21 increases in frequency and intensity as oral epithelial cells become more dysplastic and that expression correlates with an increase in infection by EBV. Tumors or dysplastic lesions that carry EBV also generally express higher levels of CK19 than those that do not. CONCLUSION: The findings suggest that dysplasia may make cells more susceptible to infection by EBV and that infection by the virus may alter the phenotype of the infected cell in a manner which could affect prognosis.

• Oral microbial carriage in oral squamous cell carcinoma patients at the time of diagnosis and during radiotherapy - A comparative study.

  Authors: Wanjari G Sonalika, S Amsavardani Tayaar, Kishore G Bhat, B R Patil, M V Muddapur

  Oral oncology.

  OBJECTIVES: Tobacco chewing habit, presence of squamous cell carcinoma in oral cavity and radiotherapy causes alterations in healthy oral microflora. Abnormal flora developed due to radiotherapy inOBJECTIVES: Tobacco chewing habit, presence of squamous cell carcinoma in oral cavity and radiotherapy causes alterations in healthy oral microflora. Abnormal flora developed due to radiotherapy in oral squamous cell carcinoma (OSCC) patients can exacerbate mucositis and can cause systemic infections. The role of oral microorganisms in carcinogenesis is gaining interest recently. Abnormal flora in development of second tumor in the field of first tumor is to be established. The study fundamentally tries to evaluate the shift that occurs during the radiotherapy in OSCC patients. METHODS: Microbial analysis of saliva samples from OSCC patients undergoing radiotherapy, tobacco chewers and controls was undertaken. The microorganisms were grouped into categories as total aerobes, total anaerobes, candida, coliforms and gram negative anaerobic bacteria. RESULTS: The frequency of isolation of total aerobes, total anaerobes, coliforms and gram negative anaerobic bacteria was significantly high in OSCC patients compared to healthy controls whereas candida was isolated most frequently during radiation period. The tobacco chewers showed significant increase in colony forming units of total aerobes and coliforms. All the microbial groups were high in OSCC and radiotherapy patients. While OSCC patients showed significant increase in total anaerobes and gram negative anaerobes, candida was increased in radiotherapy patients only. CONCLUSION: Habits promote coliforms. Tumor supports efficiently anaerobes and candida. The latter is supported more by radiation. The study stresses the importance on administration of appropriate antimicrobial therapy right at the time of diagnosis of the lesion.

• Phase II study of gefitinib adaptive dose escalation to skin toxicity in recurrent or metastatic squamous cell carcinoma of the head and neck.

  Authors: Cesar A Perez, Hunho Song, Luis E Raez, Mark Agulnik, Tatyana A Grushko, Allison Dekker, Kerstin Stenson, Elizabeth A Blair, Olufunmilayo I Olopade, Tanguy Y Seiwert, Everett E Vokes, Ezra E W Cohen

  Oral oncology.

  BACKGROUND: Gefitinib has activity in patients with advanced squamous cell carcinoma of the head and neck (SCCHN) and skin toxicity has been postulated to be a predictor of response and improvedBACKGROUND: Gefitinib has activity in patients with advanced squamous cell carcinoma of the head and neck (SCCHN) and skin toxicity has been postulated to be a predictor of response and improved outcome. METHODS: This open-label, multi-institution, phase II study evaluated the activity of gefitinib at individually escalated doses up to 750mg to achieve the skin toxicity grade ⩾2. RESULTS: Forty four patients were enrolled. Only twenty-three (52%) experienced skin rash grade ⩾2. Of 44 patients, partial responses were noted in 3 (7%), stable disease in 8 (18%) and progressive disease in 33patients. Median progression-free survival was 1.9months (95% CI 1.6-2.2) and median overall survival was 5.1months (95% CI 2.4-7.8). Grade of skin rash was not associated with response rate (p=0.169) nor tumor control rate (p=0.284); however, higher gefitinib trough levels were associated with disease control. Of the 11 tissue samples analyzed for EGFR gene copy by FISH, 7 were EGFR FISH positive, but this was not associated with improved tumor control or survival. CONCLUSIONS: Gefitinib has clinical activity as monotherapy in SCCHN. Dose escalation of gefitinib is feasible and may increase skin toxicity, but our data do not support increased activity.

• Genome-wide disease association study in chewing tobacco associated oral cancers.

  Authors: Renu Bhatnagar, Jyoti Dabholkar, Dhananjaya Saranath

  Oral oncology.

  With a view to identify genomic risk variants in chewing-tobacco associated oral cancer patients, a genome-wide association study was conducted in patients of Indian ethnicity with long term tobaccoWith a view to identify genomic risk variants in chewing-tobacco associated oral cancer patients, a genome-wide association study was conducted in patients of Indian ethnicity with long term tobacco chewing habit. We analyzed 55 oral cancer patients and 92 healthy controls for single nucleotide polymorphisms, using high throughput microarray Illumina Infinium II Assay platform and Human CNV370k-bead chip containing 370,000 single nucleotide polymorphisms. The PLINK software platform defined 298 SNPs with minor allele frequency of several genes significantly increased in oral cancer patients as compared to the controls (p<0.001). Illumina Genome Viewer Software Version 3.2.9, further delineated 93 SNPs with p-values ranging from 9.3×10(-4) to 1.38×10(-5) and Odd's ratio of 2.18-8.48, associated with 70 genes. Analysis using Kyoto Encyclopedia of Genes and Genome Pathway database, indicated SNP association with several genes including GRIK2, RASGRP3, CAMK4, SYK, RAPTOR, FHIT, DCC, active in signal transduction; MMP2, CNTNAP2, PTPRJ associated with tumor cell migration; and apoptotic gene IRAK3. The data indicates an inherent role for the genetic constitution of individuals in oral carcinogenesis, with the genomic variants contributing to increased risk or susceptibility to oral cancer.

• The value of tumor diameter in predicting prognosis of oropharynx cancer treated with chemoradiation.

  Authors: Matthew C Ward, Ling Lan, Amy Y Chen, Jonathan J Beitler

  Oral oncology.

  OBJECTIVES: The tumor node metastasis (TNM) system is the most widely used staging system for cancers of the oropharynx, yet is known to omit key prognostic indicators. Tumor volume has been shown inOBJECTIVES: The tumor node metastasis (TNM) system is the most widely used staging system for cancers of the oropharynx, yet is known to omit key prognostic indicators. Tumor volume has been shown in other head and neck sites to add predictive power but is not as useful in the oropharynx. This study investigates the value of other methods in quantifying tumor burden. METHODS: Treatment plans of oropharyngeal cancer patients treated non-operatively were retrospectively reviewed. Potential prognostic factors including TNM, demographics, smoking history, and various tumor dimensions were analyzed. RESULTS: Records identified 93 patients treated with definitive concurrent chemoradiation who had at least one year of follow-up and a clear GTV contour on the original treatment plan. On univariate analysis, tumor diameter and tumor volume showed a significant relationship to overall and disease-free survival. Tumor stage, age and smoking history showed significance in regard to overall survival. On multivariate analysis tumor diameter showed independent significance but not TNM or tumor volume. CONCLUSION: Our method of measuring tumor diameter has independent prognostic significance in the oropharynx where GTV has shown questionable value.

Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.