Report of head and neck cancer registry of Japan, Clinical statistics of registered patients, 2002. Oral cavity. Jpn J Head and Neck Cancer 32: 15-34, 2006.
日本口腔腫瘍学会学術委員会編：舌癌取扱い指針 ワーキング・グループ案（第1版）. 口腔腫瘍2005;17:13-85.
日本頭頸部腫瘍学会編：頭頸部癌取扱い規約 第5版．金原出版, 2012．.
Hae-young Kim, John R Elter, Thomas G Francis, Lauren L Patton
Prevention and early detection of oral and pharyngeal cancer in veterans.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Nov;102(5):625-31. doi: 10.1016/j.tripleo.2005.10.036. Epub 2006 Apr 24.
Abstract/Text
OBJECTIVES: To assess knowledge of oral and pharyngeal cancer (OPC) clinical signs and risk factors, the association between the risk factors and OPC, and the experience with OPC screening between newly diagnosed OPC patients and controls among a population of veterans in North Carolina.
STUDY DESIGN: A case-control study with 31 OPC cases and 30 frequency-matched controls recruited from 2003 to 2004. Bivariate analysis using chi-square statistics and multivariate logistic regression was implemented to estimate the association with OPC.
RESULTS: Only 34% of respondents knew 1 clinical sign and 4 or 5 risk factors for OPC. The lifetime accumulation of tobacco had a significant relationship with OPC (>20 pack-years; OR, 3.2; 95% CI, 1.01-10.3). Many respondents had not had an oral cancer examination within 3 years, mostly through ignorance. Most VA OPC patients were diagnosed by physicians, rather than by dentists.
CONCLUSIONS: A considerable knowledge deficit on OPC was found among North Carolina veterans. Use of tobacco was a risk factor for OPC in this population.
Sangeeta Gajendra, Gustavo D Cruz, Jayanth V Kumar
Oral cancer prevention and early detection: knowledge, practices, and opinions of oral health care providers in New York State.
J Cancer Educ. 2006 Fall;21(3):157-62. doi: 10.1207/s15430154jce2103_14.
Abstract/Text
BACKGROUND: The purpose of this study was to assess the knowledge, practices, and opinions of dentists and dental hygienists in New York State regarding oral cancer prevention and early detection.
METHOD: We sent questionnaires to a stratified random sample of dentists and dental hygienists selected from a list of licensed oral health care providers in New York State. We analyzed responses to the questionnaires, and we derived descriptive statistics.
RESULTS: The effective response rate was 55% and 65% among dentists and dental hygienists, respectively. About 85% of dentists and 78% of dental hygienists reported providing annual oral cancer examination to their patients aged 40 and above. Although a majority assessed tobacco use, fewer practitioners assessed alcohol use. Both dentists and dental hygienists lacked knowledge in some aspects of risk factors, signs, and symptoms of oral cancer. However, dentists had significantly higher knowledge scores than dental hygienists.
CONCLUSION: Dentists and dental hygienists in New York State are knowledgeable about oral cancer, but there are gaps in the knowledge of certain risk factors and in the oral cancer examination technique.
N Homann, H Jousimies-Somer, K Jokelainen, R Heine, M Salaspuro
High acetaldehyde levels in saliva after ethanol consumption: methodological aspects and pathogenetic implications.
Carcinogenesis. 1997 Sep;18(9):1739-43.
Abstract/Text
Chronic ethanol ingestion leads to an enhanced risk of upper gastrointestinal tract cancer. Although many hypotheses for the tumor promoting effect of alcohol exist, the pathogenetic mechanisms remain unclear since alcohol in itself is not carcinogenic. Acetaldehyde, the first metabolite of ethanol, has been shown to have multiple mutagenic effects and to be carcinogenic to animals. Previous research has revealed that acetaldehyde can be formed from ethanol via microbial alcohol dehydrogenase. Thus, at least part of the proposed tumorigenic effect of ethanol may be linked to local production of acetaldehyde from ethanol by oral microflora. In this study we demonstrate the production of marked amounts of acetaldehyde in saliva after ingestion of moderate amounts of ethanol. Considerable inter individual variation in acetaldehyde production capacity is also shown. In vivo acetaldehyde production is significantly reduced after a 3-day use of an antiseptic mouthwash (chlorhexidine). In vitro acetaldehyde production was shown to be linear in time, inhibited by 4-methylpyrazole and it could not be saturated under ethanol conditions that are relevant in vivo. There was a significant positive correlation between salivary acetaldehyde production in vitro and in vivo. We conclude, that the microbial formation of acetaldehyde in saliva could be one explanation for the tumor promoting effect of ethanol on the upper gastrointestinal tract. Moreover, this may support the epidemiological finding, that poor oral hygiene is an independent risk factor for oral cavity cancer.
Bengt Göran Hansson, Kerstin Rosenquist, Annika Antonsson, Johan Wennerberg, Elsy-Britt Schildt, Anna Bladström, Gunilla Andersson
Strong association between infection with human papillomavirus and oral and oropharyngeal squamous cell carcinoma: a population-based case-control study in southern Sweden.
Acta Otolaryngol. 2005 Dec;125(12):1337-44. doi: 10.1080/00016480510043945.
Abstract/Text
CONCLUSIONS: The results of this study demonstrate a strong association between infection with high-risk types of human papillomavirus (HPV) and oral and oropharyngeal squamous cell carcinoma (OOSCC), suggesting that high-risk HPV types play a key role in carcinogenesis. The estimated proportion of OOSCC cases attributable to HPV infection was 35%.
OBJECTIVE: HPV appears to have an aetiological role in OOSCC, despite the fact that the reported prevalences of HPV in both OOSCC patients and healthy individuals have varied widely. We aimed to investigate the presence and spectrum of both high- and low-risk HPVs in all consecutive cases of OOSCC in a Swedish healthcare region over a 3-year period and in population-based, matched healthy controls.
MATERIAL AND METHODS: A total of 131 patients with OOSCC were studied. Samples taken from the surface of the tumour and from the tonsillar fossa using cotton-tipped swabs were investigated, together with exfoliated cells collected using a mouthwash. Tonsillar fossa and mouthwash specimens were collected in the same way from 320 matched controls. All samples were tested for HPV DNA by nested polymerase chain reaction using the primer pairs MY09/MY11 and GP5 + /GP6+, and in positive cases the HPV type was determined by DNA sequencing.
RESULTS: Infection with high-risk HPV was shown to be a strong risk factor for OOSCC (OR = 63; 95% CI 14-480). Forty-seven (36%) of the cancer patients had > or =1 specimen that was positive for a high-risk HPV type (81% of which were HPV 16), while only 3 (0.94%) of the controls were positive for a high-risk HPV type. Seven (5.3%) of the cancer patients and 13 (4.1%) of the controls were positive for any of the mucosal, mucocutaneous or cutaneous low-risk HPV types.
S Silverman, K Bhargava, L W Smith, A M Malaowalla
Malignant transformation and natural history of oral leukoplakia in 57,518 industrial workers of Gujarat, India.
Cancer. 1976 Oct;38(4):1790-5.
Abstract/Text
In Gujarat, India, 6718 industrial workers, over 35 years of age, with oral leukoplakia (confirmed clinically and microscopically), were studied. After 2 years, 4762 (71%) of the individuals were re-examined. The buccal mucosa was the most common site of occurrence; 98.3% of these individuals had oral habits, with smoking alone or smoking in combination with "pan" or "supari" chewing accounting for 74.9% of the habit forms. Six individuals (0.13%) with oral leukoplakia developed oral carcinomas within 2 years. This incidence of malignant transformation was equivalent to 63/100,000 per year, which far exceeds that of new oral cancers expected even in high-risk populations. While 57.3% the leukoplakic lesions remained unchanged during a 2-year interval, 31.6% disappeared and 11% had an altered appearance. This study confirmed the precancerous nature of oral leukoplakia.
S Silverman, M Gorsky, F Lozada
Oral leukoplakia and malignant transformation. A follow-up study of 257 patients.
Cancer. 1984 Feb 1;53(3):563-8.
Abstract/Text
Two hundred fifty-seven patients with oral leukoplakia were studied and followed for an average period of 7.2 years. All lesions were more than one cm in size and had been present and observed for a minimum of 6 months. Of the initial biopsies, 235 revealed a benign hyperkeratosis and 22 others contained some degree of epithelial dysplasia. Seventy-three percent of the patients used tobacco, with cigarette usage being the predominant form. Forty-five patients (17.5%) subsequently developed squamous carcinomas in the hyperkeratotic epithelial site in an average time of 8.1 years. Eight of these malignant transformations came from patients who originally had epithelial dysplasia. High risks for malignant transformation also included non-smoking patients, the clinical presence of erythroplasia (erythroleukoplakia), and a clinical verrucous-papillary hyperkeratotic pattern. Duration of the leukoplakia progressively increased the total number of malignant transformations, with the largest rate occurring in the second year. This study confirms that oral leukoplakia is a precancerous lesion and that certain characteristics indicate greater risks and warrant consideration of more aggressive management.
宮原 裕：頭頸部腫瘍学入門．東京医学社，2004; p61-68.
日本口腔腫瘍学会・日本口腔外科学会編, 口腔癌診療ガイドライン2019年版 , 金原出版, 2019.
K Maeda, T Suzuki, Y Ooyama, K Nakakuki, M Yamashiro, N Okada, T Amagasa
Colorimetric analysis of unstained lesions surrounding oral squamous cell carcinomas and oral potentially malignant disorders using iodine.
Int J Oral Maxillofac Surg. 2010 May;39(5):486-92. doi: 10.1016/j.ijom.2009.11.001. Epub 2009 Dec 5.
Abstract/Text
To determine whether the measurement of staining with 3% Lugol's solution provided efficient criteria for determining the area of resection for oral carcinomas and oral potentially malignant disorders, the authors analyzed the color of unstained lesions (USLs) in relation to histopathological findings. After vital iodine staining, USLs were seen in 48 of 54 patients (88.9%). A significant difference was seen in the value of lightness between stained lesions (SLs) and USLs for patients with moderate and severe epithelial dysplasia (P<0.001). The deviation between the macroscopically observable and the histopathological boundaries was -0.65+/-1.26 mm (range: -4.36 to 1.52). Color charts prepared on the basis of values for lightness and hue reproduced the macroscopic color differences in USLs, suggesting that it may become possible to diagnose USLs histologically on the basis of the measured color values and use of color charts to help determine the resection area in surgery.
Copyright 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
UICC: TNM cassificationof malignant tumours, Edited by L.H.Sobin and Ch.Wittekind. 6 th ed. Wiley-Liss. Ney York, 2002, P22-26.
M Umeda, H Komatsubara, Y Ojima, T Minamikawa, Y Shibuya, S Yokoo, J Ishii, T Komori
A comparison of brachytherapy and surgery for the treatment of stage I-II squamous cell carcinoma of the tongue.
Int J Oral Maxillofac Surg. 2005 Oct;34(7):739-44. doi: 10.1016/j.ijom.2005.02.015.
Abstract/Text
The treatment method for early stage tongue cancer is still controversial in Japan. The aim of this study is to compare the prognosis for patients with early tongue cancer treated with brachytherapy and surgery. A retrospective study was conducted to compare the efficacy of low-dose-rate brachytherapy (LDR), high-dose-rate brachytherapy (HDR), and surgery for early tongue cancer. A total of 180 patients with stage I-II tongue cancer were divided into three treatment groups: LDR (78), HDR (26), and surgery (71). Local recurrence was seen in thirteen patients (17%) of the LDR, nine (35%) of the HDR, and four (6%) of the surgery group. After salvage therapy, final local cure was obtained for 71 patients (91%) of the LDR, 22 (85%) of the HDR, and 71 (100%) of the surgery group. Neck failure was recorded for eight patients in the LDR, six in the HDR, and three in the surgery group. The respective 5-year overall survival rates for the LDR, HDR and surgery groups were 84.0%, 72.9%, 95.4% for stage I, and 72.2%, 51.5%, 93.8% for stage II. These findings show that surgery is the optimal treatment method for patients with stage I-II tongue cancer.
National Comprehensive Cancer Network : NCCN Clinical practice guidelines in oncology. Head and neck cancers Version 1, 2006.
Jacques Bernier, Christian Domenge, Mahmut Ozsahin, Katarzyna Matuszewska, Jean-Louis Lefèbvre, Richard H Greiner, Jordi Giralt, Philippe Maingon, Frédéric Rolland, Michel Bolla, Francesco Cognetti, Jean Bourhis, Anne Kirkpatrick, Martine van Glabbeke, European Organization for Research and Treatment of Cancer Trial 22931
Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer.
N Engl J Med. 2004 May 6;350(19):1945-52. doi: 10.1056/NEJMoa032641.
Abstract/Text
BACKGROUND: We compared concomitant cisplatin and irradiation with radiotherapy alone as adjuvant treatment for stage III or IV head and neck cancer.
METHODS: After undergoing surgery with curative intent, 167 patients were randomly assigned to receive radiotherapy alone (66 Gy over a period of 6 1/2 weeks) and 167 to receive the same radiotherapy regimen combined with 100 mg of cisplatin per square meter of body-surface area on days 1, 22, and 43 of the radiotherapy regimen.
RESULTS: After a median follow-up of 60 months, the rate of progression-free survival was significantly higher in the combined-therapy group than in the group given radiotherapy alone (P=0.04 by the log-rank test; hazard ratio for disease progression, 0.75; 95 percent confidence interval, 0.56 to 0.99), with 5-year Kaplan-Meier estimates of progression-free survival of 47 percent and 36 percent, respectively. The overall survival rate was also significantly higher in the combined-therapy group than in the radiotherapy group (P=0.02 by the log-rank test; hazard ratio for death, 0.70; 95 percent confidence interval, 0.52 to 0.95), with five-year Kaplan-Meier estimates of overall survival of 53 percent and 40 percent, respectively. The cumulative incidence of local or regional relapses was significantly lower in the combined-therapy group (P=0.007). The estimated five-year cumulative incidence of local or regional relapses (considering death from other causes as a competing risk) was 31 percent after radiotherapy and 18 percent after combined therapy. Severe (grade 3 or higher) adverse effects were more frequent after combined therapy (41 percent) than after radiotherapy (21 percent, P=0.001); the types of severe mucosal adverse effects were similar in the two groups, as was the incidence of late adverse effects.
CONCLUSIONS: Postoperative concurrent administration of high-dose cisplatin with radiotherapy is more efficacious than radiotherapy alone in patients with locally advanced head and neck cancer and does not cause an undue number of late complications.
Copyright 2004 Massachusetts Medical Society
Jay S Cooper, Thomas F Pajak, Arlene A Forastiere, John Jacobs, Bruce H Campbell, Scott B Saxman, Julie A Kish, Harold E Kim, Anthony J Cmelak, Marvin Rotman, Mitchell Machtay, John F Ensley, K S Clifford Chao, Christopher J Schultz, Nancy Lee, Karen K Fu, Radiation Therapy Oncology Group 9501/Intergroup
Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck.
N Engl J Med. 2004 May 6;350(19):1937-44. doi: 10.1056/NEJMoa032646.
Abstract/Text
BACKGROUND: Despite the use of resection and postoperative radiotherapy, high-risk squamous-cell carcinoma of the head and neck frequently recurs in the original tumor bed. We tested the hypothesis that concurrent postoperative administration of cisplatin and radiotherapy would improve the rate of local and regional control.
METHODS: Between September 9, 1995, and April 28, 2000, 459 patients were enrolled. After undergoing total resection of all visible and palpable disease, 231 patients were randomly assigned to receive radiotherapy alone (60 to 66 Gy in 30 to 33 fractions over a period of 6 to 6.6 weeks) and 228 patients to receive the identical treatment plus concurrent cisplatin (100 mg per square meter of body-surface area intravenously on days 1, 22, and 43).
RESULTS: After a median follow-up of 45.9 months, the rate of local and regional control was significantly higher in the combined-therapy group than in the group given radiotherapy alone (hazard ratio for local or regional recurrence, 0.61; 95 percent confidence interval, 0.41 to 0.91; P=0.01). The estimated two-year rate of local and regional control was 82 percent in the combined-therapy group, as compared with 72 percent in the radiotherapy group. Disease-free survival was significantly longer in the combined-therapy group than in the radiotherapy group (hazard ratio for disease or death, 0.78; 95 percent confidence interval, 0.61 to 0.99; P=0.04), but overall survival was not (hazard ratio for death, 0.84; 95 percent confidence interval, 0.65 to 1.09; P=0.19). The incidence of acute adverse effects of grade 3 or greater was 34 percent in the radiotherapy group and 77 percent in the combined-therapy group (P<0.001). Four patients who received combined therapy died as a direct result of the treatment.
CONCLUSIONS: Among high-risk patients with resected head and neck cancer, concurrent postoperative chemotherapy and radiotherapy significantly improve the rates of local and regional control and disease-free survival. However, the combined treatment is associated with a substantial increase in adverse effects.
Copyright 2004 Massachusetts Medical Society
Jacques Bernier, Jay S Cooper, T F Pajak, M van Glabbeke, J Bourhis, Arlene Forastiere, Esat Mahmut Ozsahin, John R Jacobs, J Jassem, Kie-Kian Ang, J L Lefèbvre
Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501).
Head Neck. 2005 Oct;27(10):843-50. doi: 10.1002/hed.20279.
Abstract/Text
BACKGROUND: In 2004, level I evidence was established for the postoperative adjuvant treatment of patients with selected high-risk locally advanced head and neck cancers, with the publication of the results of two trials conducted in Europe (European Organization Research and Treatment of Cancer; EORTC) and the United States (Radiation Therapy Oncology Group; RTOG). Adjuvant chemotherapy-enhanced radiation therapy (CERT) was shown to be more efficacious than postoperative radiotherapy for these tumors in terms of locoregional control and disease-free survival. However, additional studies were needed to identify precisely which patients were most suitable for such intense treatment.
METHODS: Both studies compared the addition of concomitant relatively high doses of cisplatin (on days 1, 22, and 43) to radiotherapy vs radiotherapy alone given after surgery in patients with high-risk cancers of the oral cavity, oropharynx, larynx, or hypopharynx. A comparative analysis of the selection criteria, clinical and pathologic risk factors, and treatment outcomes was carried out using data pooled from these two trials.
RESULTS: Extracapsular extension (ECE) and/or microscopically involved surgical margins were the only risk factors for which the impact of CERT was significant in both trials. There was also a trend in favor of CERT in the group of patients who had stage III-IV disease, perineural infiltration, vascular embolisms, and/or clinically enlarged level IV-V lymph nodes secondary to tumors arising in the oral cavity or oropharynx. Patients who had two or more histopathologically involved lymph nodes without ECE as their only risk factor did not seem to benefit from the addition of chemotherapy in this analysis.
CONCLUSIONS: Subject to the usual caveats of retrospective subgroup analysis, our data suggest that in locally advanced head and neck cancer, microscopically involved resection margins and extracapsular spread of tumor from neck nodes are the most significant prognostic factors for poor outcome. The addition of concomitant cisplatin to postoperative radiotherapy improves outcome in patients with one or both of these risk factors who are medically fit to receive chemotherapy.
(c) 2005 Wiley Periodicals, Inc.
Jacques Bernier, Jay S Cooper
Chemoradiation after surgery for high-risk head and neck cancer patients: how strong is the evidence?
Oncologist. 2005 Mar;10(3):215-24. doi: 10.1634/theoncologist.10-3-215.
Abstract/Text
Patients with locally advanced, operable head and neck squamous cell carcinoma (HNSCC) are known to be at high risk of treatment failure, ranging from local regrowth to lymphatic spread to systemic dissemination. Attacking specifically each of these patterns of failure implies the use of a multimodal approach. Throughout the past two decades the management of stages III/IV HNSCC remained a matter of debate, especially with regards to treatment intensity and sequencing. Surgery and/or radiotherapy were the mainstay of local-regional treatment in patients with locally advanced disease, but treatment outcome often remained disappointing. In the hope of improving the prognosis after radical surgery, cisplatin-based combinations have been administered before surgery, in the interval between surgery and radiotherapy, or after radiotherapy. Until very recently these combinations, at best, decreased systemic failures without having a real impact on local outcome or survival. Indeed, until the mid-1990s, most trials that had tested postoperative combinations of chemotherapy and radiotherapy did not show any significant benefit. In 2004 level I evidence was established with the publication of the results of two large-scale, independent but similar trials conducted in Europe and the U.S. Both studies demonstrated that, compared with postoperative irradiation alone, adjuvant concurrent chemoradiation was more efficacious in terms of local-regional control and disease-free survival. With the publication of these two trials the evidence demonstrating the potential value of concurrent postoperative chemoradiotherapy in high-risk operable head and neck cancer is strong; however, additional studies and comparative analysis of the selection criteria and treatment outcomes across these two trials will be needed to gain a more accurate assessment of benefit and risk levels in specific patients with operable, locally advanced disease.
R C Paniello, K S Virgo, M H Johnson, M F Clemente, F E Johnson
Practice patterns and clinical guidelines for posttreatment follow-up of head and neck cancers: a comparison of 2 professional societies.
Arch Otolaryngol Head Neck Surg. 1999 Mar;125(3):309-13.
Abstract/Text
OBJECTIVES: To determine and compare the current follow-up practice patterns of members of 2 professional societies of head and neck surgeons, and to compare these with the societies' published clinical practice guidelines.
DESIGN: A survey was mailed to the 640 members of the American Society for Head and Neck Surgery (ASHNS); results were compared with those of a similar survey of the 824 members of the Society of Head and Neck Surgery (SHNS) and with the clinical practice guidelines of the consensus committee of both societies.
MAIN OUTCOME MEASURES: Data were collected regarding the frequency of follow-up visits after potentially curative resection of head and neck epidermoid carcinoma and the types of diagnostic studies performed at each visit.
RESULTS: A total of 318 ASHNS members responded to 1 of the mailings (49.7%), of which 280 responses (43.8%) were evaluable. Most surgeons relied on directed history, physical examination, and routine chest radiograph at varying intervals for detection of recurrences and second primary tumors. Other tests were used sporadically. For frequency of follow-up testing, the percentage of surgeons who followed the published guidelines varied from 97% in postoperative year 1 to 62% in postoperative year 5. A mean of 24% of surgeons varied from the guidelines in their use of chest radiographs, and 45% varied in their use of liver function tests. The ASHNS members used significantly more office visits than the SHNS members during the first 2 postoperative years.
CONCLUSIONS: The strategies used by members of the ASHNS and the SHNS for posttreatment surveillance after potentially curative resection of malignant neoplasms of the head and neck were generally similar but showed some important differences. Most surgeons used directed history and physical examination at regular intervals, and annual chest radiographs. The follow-up practices of most members of these societies, which have recently merged, fall within the recommendations of the Clinical Guidelines Task Force.
Mallika Tewari, Pramod Rai, Gautam Bir Singh, Mohan Kumar, Hari S Shukla
Long-term follow-up results of Nd: YAG laser treatment of premalignant and malignant (Stage I) squamous cell carcinoma of the oral cavity.
J Surg Oncol. 2007 Mar 15;95(4):281-5. doi: 10.1002/jso.20677.
Abstract/Text
BACKGROUND AND OBJECTIVES: Only few studies (none from India) have reported the role of Neodymium Yttrium-Aluminum-Garnet (Nd: YAG) laser for treatment of premalignant and stage I (T1N0M0) oral cancer. This study aimed to assess the outcome of Nd: YAG laser in the said lesions after a follow-up of 5 years.
DESIGN: Prospective study;
SETTING: a tertiary care hospital, North India.
PATIENTS AND METHODS: Fifty biopsy proven patients of premalignant/malignant (Stage I) lesions oral cavity underwent Nd: YAG laser treatment after prior informed consent from January, 1997 to January, 2000. Patients were followed-up for 5 years. In addition to local recurrence, patient's mucosal response to laser in terms of pain, mastication, salivation, paraesthesias, facial expressions, and speech was also recorded.
RESULTS: Twenty-seven patients had leukoplakia, 3 erythroplakia, 6 carcinoma in situ (CIS), and 14 stage I squamous cell carcinoma (SCC) of oral cavity. Four patients required repeat laserization for residual/ recurrent lesion and 15 patients were lost to follow-up. Recurrence free survival (RFS) at 5-years in premalignant and stage I SCC patients was 97.2 and 78.6%, respectively. A minimal persistent edema was observed in 6 (12%) patients at the end of 7th day, rest all tolerated the procedure well.
CONCLUSIONS: The present study indicates that Nd: YAG laser is an effective and safe surgical option management of premalignant and malignant lesions of oral cavity.
(c) 2007 Wiley-Liss, Inc.
Takafumi Hayashi, Jusuke Ito, Shuhzou Taira, Kouji Katsura, Susumi Shingaki, Hideyuki Hoshina
The clinical significance of follow-up sonography in the detection of cervical lymph node metastases in patients with stage I or II squamous cell carcinoma of the tongue.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Jul;96(1):112-7. doi: 10.1067/moe.2003.S1079210403002592.
Abstract/Text
OBJECTIVE: We sought to assess the reliability of repeated sonography in the detection of cervical lymph node metastases at the earliest stage during a follow-up period in patients with stage I or stage II carcinoma of the tongue.
STUDY DESIGN: Eighteen consecutive patients with stage I or II squamous cell carcinoma of the tongue were included. When possible, every patient was examined with sonography approximately every 2 weeks during the follow-up period.
RESULTS: With repeated sonography on 18 patients, 7 metastatic nodes of 7 patients (39%) meeting our criteria were found. With the use of computed tomography, we diagnosed 10 nodes (including the 7 nodes observed with sonography) in these 7 patients as metastatic. A histopathologic examination revealed that 12 nodes in the same 7 patients had metastatic foci. For sonography, the sensitivity per node was 58%, whereas that of computed tomography was 83%.
CONCLUSIONS: Follow-up sonography enabled the detection of all patients who had subsequent subclinical lymph node metastases. However, the sensitivity of sonography in the detection of smaller metastatic nodes was lower than that of computed tomography.
T K Ong, C J Kerawala, I C Martin, F W Stafford
The role of thorax imaging in staging head and neck squamous cell carcinoma.
J Craniomaxillofac Surg. 1999 Dec;27(6):339-44. doi: 10.1054/jcms.2000.0094.
Abstract/Text
The overall survival rate for patients with head neck squamous cell carcinoma remains disappointingly static despite improved locoregional control. This has been attributed to the development of distant metastases and second primary malignancies in these patients, a large proportion of which occur in the thorax. We retrospectively analysed the incidence of thoracic malignancies in 138 patients presenting with newly diagnosed (n = 107) or recurrent (n = 31) cancer of the head and neck over a 4-year period. All 138 patients had undergone both computerised tomography of the thorax (CT) and conventional chest radiography within one month of presenting with biopsy proven squamous cell carcinoma. Seventeen percent of these were found to have simultaneous thoracic malignancies. CT thorax was more sensitive in detecting simultaneous thoracic malignancies compared with standard chest X-ray (24/138 versus 9/138, odds ratio of 3:1 in favour of CT). All thoracic malignancies detected by chest X-ray were also detected by CT thorax. Patients presenting with recurrent tumors were significantly more likely to have simultaneous thoracic malignancies than those with newly diagnosed cancer (11/31 versus 13/107, chi2 test with Yates correction, chi2 = 4.66, p = 0.03). The primary site (laryngeal, oral or pharyngeal) or presence of nodal disease did not have an effect on the incidence of simultaneous thoracic malignancies. The presence of distant metastases and second primary malignancies has major implications in the management and prognosis of patients presenting with head and neck squamous cell carcinoma, with a large proportion of such patients succumbing to their disease within one year of diagnosis. As CT scanning of the thorax was a more effective screening investigation than standard chest X-ray in the detection of simultaneous thoracic malignancy, we recommend it for use in the staging of patients presenting with cancer of the head and neck.
Kwok Seng Loh, Dale H Brown, James T Baker, Ralph W Gilbert, Patrick J Gullane, Jonathan C Irish
A rational approach to pulmonary screening in newly diagnosed head and neck cancer.
Head Neck. 2005 Nov;27(11):990-4. doi: 10.1002/hed.20261.
Abstract/Text
BACKGROUND: The purpose of this study was to determine the detection rate of lung metastasis or a synchronous lung primary tumor in patients with newly diagnosed head and neck mucosal squamous cell carcinoma (SCC) and to determine factors that are associated with positive findings.
METHODS: This was a prospective cohort study of 102 patients with head and neck mucosal SCC diagnosed in a tertiary cancer center. Chest x-rays and a CT scan of the thorax were performed. An indeterminate nodule on CT scan was followed with either a repeat scan to assess progression or a CT-guided needle biopsy. Metastasis or synchronous lung primary tumor were determined by CT scan. The findings were correlated with age, sex, duration of symptoms, site of primary tumor, grade of tumor, T classification, and N classification.
RESULTS: A CT scan of the thorax showed abnormalities or suspicious nodules in 20 patients (19.6%). With either follow-up scans or CT-guided biopsy, 10 patients were eventually proven to have pulmonary metastasis and one a synchronous lung primary tumor. Of those eleven patients (10.8%), seven had normal chest x-ray. Eight (72.7%) of 11 patients with a positive CT scan had N2 or N3 disease in contrast to 32 (35.2%) of 91 patients with a normal CT scan (p = .02). Seven patients (63.6%) with a positive CT scan had T4 disease, whereas 34 (37.4%) with a normal CT scan had T4 disease (p = .08). Primary tumors arising in the oropharynx, hypopharynx, and supraglottis had a greater risk of a positive CT scan than tumors arising in the oral cavity, glottis, or unknown sites (OR = 5.4; 95% CI, 1.3-21.9). Age, sex, duration of symptoms, and grade of disease did not predict a positive CT scan.
CONCLUSIONS: The detection rate of lung metastasis or a synchronous lung primary tumor by CT scan is 10.8%. We recommend the use of CT scans of the thorax in screening the lungs of newly diagnosed patients with T4 and/or N2 or N3 oropharyngeal, hypopharyngeal, and supraglottic SCC.
(c) 2005 Wiley Periodicals, Inc.
T Petit, C Georges, G M Jung, C Borel, G Bronner, H Flesch, G Massard, M Velten, P Haegele, S Schraub
Systematic esophageal endoscopy screening in patients previously treated for head and neck squamous-cell carcinoma.
Ann Oncol. 2001 May;12(5):643-6.
Abstract/Text
BACKGROUND: An attempt was made to improve metachronous oesophageal cancer prognosis through bi-annual systematic esophageal endoscopy screening in patients treated for head and neck cancer.
PATIENTS AND METHODS: Bi-annual esophageal endoscopy, without a staining procedure, was performed in 1560 patients from 1987 to 1997. The distribution of previous head and neck cancer was oral cavity (20%), oropharynx (30%), hypopharynx (34%), and larynx (16%). All patients had initial panendoscopic inspection before HNSCC treatment. Esophageal tumors were considered to be second synchronous primaries when discovered within the first six months of initial tumor diagnosis.
RESULTS: Fifty metachronous esophageal asymptomatic cancers (42 T1 and 7 in situ carcinomas) were diagnosed by endoscopy. The median time between the HNC and the esophageal carcinoma was 43 months (7-137 months). Metachronous esophageal carcinoma was discovered in 2.6% of patients with oral cavity tumor, 5.7% of patients with oropharynx tumor, 2.3% of patients with hypopharynx tumor, and 1.7% of patients with larynx tumor. Causes of death were: 41.1% related to esophageal tumor with tumor progression, metastatic evolution, or treatment toxicity; 28.9% related to non malignant causes; 26.6% related to a cancer that was not of esophageal origin.
CONCLUSIONS: Over a 10-year period, systematic bi-annual esophageal endoscopy uncovered metachronous esophageal tumors in 3.2% of 1560 patients originally treated for head and neck carcinoma, developing in a median time of 47 months. Patients with initial oropharyngeal tumors had a significantly higher risk of metachronous esophageal SCC, compared to the other tumor sites (P < 0.02 with Fisher exact test). Given the elevated death rate not related to the esophageal cancer and the median survival of 16 months, any potential benefit from this time-consuming procedure is debatable.
Martin Kunkel, Gregor J Förster, Torsten E Reichert, Jong-Hyeon Jeong, Peter Benz, Peter Bartenstein, Wilfried Wagner, Theresa L Whiteside
Detection of recurrent oral squamous cell carcinoma by [18F]-2-fluorodeoxyglucose-positron emission tomography: implications for prognosis and patient management.
Cancer. 2003 Nov 15;98(10):2257-65. doi: 10.1002/cncr.11763.
Abstract/Text
BACKGROUND: Patients with recurrent oral squamous cell carcinoma (OSCC) have a dismal prognosis and represent a therapeutic challenge. A positron emission tomography (PET) scan with [(18)F]-2-fluorodeoxyglucose ([(18)F]FDG) can improve early cancer detection. The current study evaluates the prognostic value of [(18)F]FDG-PET scan in patients with recurrent OSCC.
METHODS: The authors studied 97 patients with previously resected OSCC who were restaged by PET scanning. Of the 97 patients, 64 had no evidence of clinical disease and 33 were suspected of having disease by imaging, clinical findings, or pathologic evaluation. The median follow-up period was 35.4 months after a PET scan. The end points included disease recurrence, a disease recurrence-free period 6 months after a PET scan, or death.
RESULTS: The overall sensitivity of a PET scan did not exceed 90% and its specificity varied from 67% for local disease recurrence/second primaries to 99% for lymph node metastasis. Increased [(18)F]FDG uptake predicted increased hazard of death (hazard ratio: 6.83; P = 0.00034) and proved to be a highly predictive marker of disease status. A significant association was established for incremental standardized uptake values and 3-year patient survival (P=0.0089), indicating that intense glucose metabolism in the tumor is a negative marker of survival in recurrent OSCC. Overall, survival was longer in patients with a negative rather than a positive PET scan (P < 0.00001).
CONCLUSIONS: PET scanning was found to be highly valuable for diagnosing OSCC recurrence in a postoperative setting. It provided prognostic information and played an important role in patient counseling and management.
Copyright 2003 American Cancer Society.
W Fischbach, T Meyer, K Barthel
Squamous cell carcinoma antigen in the diagnosis and treatment follow-up of oral and facial squamous cell carcinoma.
Cancer. 1990 Mar 15;65(6):1321-4.
Abstract/Text
The squamous cell carcinoma (SCC) antigen was determined by radioimmunoassay in the serum of 40 untreated patients with SCC of the oromaxillofacial region. The mean (+/- SEM) serum concentration for these patients (3.8 +/- 0.8 ng/ml) was significantly higher than that of 52 disease-free patients coming to routine postoperative care (1.2 +/- 0.1 ng/ml) and of 74 healthy controls (1.1 +/- 0.07 ng/ml). Using a arbitrary limit of 2.2 ng/ml, pathologic serum levels of SCC were observed in 15 (38%) of 40 untreated patients, whereas only four (7.7%) of 52 tumor-free patients revealed an elevated serum SCC. Serial measurements of SCC were pretherapeutically available in 28 patients as well as during individual therapy and further follow-up. All but one of these patients had a normal serum SCC postoperatively. The authors' results demonstrate that the clinical value of SCC lies mainly in monitoring the course of the disease. Careful follow-up studies should be undertaken to determine whether serial determination of SCC is promising in early prediction of tumor reoccurrence.
吉田英彦，甲原玄秋，他：口腔癌診断に対する血清 SCC抗原測定の臨床的意義．癌と化学療法 1989;16: 3595-3601.
I Haas, U Hauser, U Ganzer
The dilemma of follow-up in head and neck cancer patients.
Eur Arch Otorhinolaryngol. 2001 May;258(4):177-83.
Abstract/Text
The aims of tumor follow-up in head and neck cancer patients are (1) evaluation of therapeutic efficacy, (2) management of impairments, (3) detection of new tumor manifestations, and (4) psychosocial care. In general standardized 5-year-protocols are used for all such patients. However, it is questionable whether a rigid follow-up schedule is optimal for a very heterogeneous tumor population. Therefore 603 patients with sqamous cell carcinoma of the oral cavity, pharynx or larynx, or with cervical metastasis from an unknown primary site (CUP syndrome), who had been diagnosed and treated curatively by an operation with or without radiotherapy (n = 523) or just by radio(chemo)therapy (n = 80) between 1985 and 1994, and who had been followed-up regularly according to a standardized plan, were worked-up retrospectively. Data were evaluated for the manifestation and prognosis of curable new tumor manifestations as well as for tumor-specific factors likely to select groups which should be followed more or less intensively. Within a 5-year follow-up period new tumor growth was detected in 152/603 (25%) patients: 79 local and 31 regional recurrences, 18 systemic metastases and 24 second primary cancers. Where follow-up was extended beyond the 5th year, 168/603 (28%) patients presented a new tumor manifestation. One hundred and sixteen of the 152 (28%) patients had another operation with or without radiotherapy or had radio(chemo)therapy alone. So far 18/116 (14%) patients have survived their new tumor manifestation for more than 5 years and 30/116 for more than 2 years. Tumor-specific data on the initial tumors (T stage, N stage, site) did not indicate the risk of a new tumor manifestation, but 87% of patients who survived their new tumor manifestation for more than 2 years initially had T1 or T2 tumors and only 30% initially had N+ necks. Occurrence of distant metastasis or a second primary outside the head and neck region limited survival to < or = 2 years after detection. In terms of survival, follow-up efforts should therefore concentrate on detection of locoregional recurrence, particularly if an option for further curative local therapy exists. The limited success of detection of new tumor manifestations in terms of survival does not justify a reduction in tumor-follow-up examinations, since the benefit of the other efforts cannot be determined from survival figures.
G W Hanks, F Conno, N Cherny, M Hanna, E Kalso, H J McQuay, S Mercadante, J Meynadier, P Poulain, C Ripamonti, L Radbruch, J R Casas, J Sawe, R G Twycross, V Ventafridda, Expert Working Group of the Research Network of the European Association for Palliative Care
Morphine and alternative opioids in cancer pain: the EAPC recommendations.
Br J Cancer. 2001 Mar 2;84(5):587-93. doi: 10.1054/bjoc.2001.1680.
Abstract/Text
An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.
Copyright 2001 Cancer Research Campaign.
O M Salazar, T Sandhu, N W da Motta, M A Escutia, E Lanzós-Gonzales, A Mouelle-Sone, A Moscol, M Zaharia, S Zaman
Fractionated half-body irradiation (HBI) for the rapid palliation of widespread, symptomatic, metastatic bone disease: a randomized Phase III trial of the International Atomic Energy Agency (IAEA).
Int J Radiat Oncol Biol Phys. 2001 Jul 1;50(3):765-75.
Abstract/Text
PURPOSE: To find the fastest and most effective/efficient method to economically deliver fractionated half-body irradiation (HBI) for widespread (WS), symptomatic, metastatic bone cancer.
METHODS AND MATERIALS: A Phase III trial with 3 HBI arms: (Arm A) Control (15 Gy/5 fractions/5 days); (Arm B) Hyperfractionation (HF) (8 Gy/2 fractions/1 day); (Arm C) Accelerated HF (12 Gy/4 fractions/2 days). Six countries randomized 156 patients (all with WS bone metastases): 51, 56, and 49 patients to Arms A, B, and C, respectively. There were 72 (46%) breast, 50 (32%) prostate, 9 (6%) lung, and 25 (16%) miscellaneous primary tumors. Initial performance status (PS) was 1-2 in 101 (65%) and PS 3-4 in 55 (35%). The lower, upper, and middle halves of the body were treated 79, 68, and 9 times.
RESULTS: Pain relief was seen in 91% of patients (45% complete [CR] and 46% partial [PR]) within 3-8 days. Overall (OS), median (MST), and pain-free (PFS) survival was 174, 150, and 122 days. Breast tumors had a higher OS (279 days) than that of other primary tumors, but when analyzed by treatment, was not significantly different than prostate tumors in Arm A. No survival differences were found in patients with PS 1-2 vs. 3-4, CR vs. PR, bone with/without visceral metastases, or by the number of metastases (< or > 15 bone lesions). Quality of life (QOL) assessed by the percent of the remaining life free of pain was 71%; furthermore significant improvements in PS, pain, and narcotic scores were seen after HBI. Toxicity was very acceptable (41% none, 50% mild/moderate, 12% severe but transitory); more was seen with upper HBI.
CONCLUSION: In terms of response, time to response, OS, MST, PFS, QOL, and toxicity, schedules for Arms A and C were similar for all but prostate primaries. Schedule for Arm B, which delivered the lowest biologic dose in the shortest time, had significantly worse results in pain relief, OS, MST, PFS, and QOL. Results indicate that, for most primary tumor types (except prostate), delivering two HBI daily doses of 3 Gy in 2 consecutive days is as effective as delivering a daily dose of 3 Gy for 5 consecutive days. Thus, this is a faster and much more convenient HBI schedule for the palliation of pain in widespread cancer.
D Tong, L Gillick, F R Hendrickson
The palliation of symptomatic osseous metastases: final results of the Study by the Radiation Therapy Oncology Group.
Cancer. 1982 Sep 1;50(5):893-9.
Abstract/Text
Different dose fractionation irradiation schedules have been evaluated in a randomized Radiation Therapy Oncology Group (RTOG) study to determine their palliative effectiveness in patients with osseous metastases. The frequency, promptness and duration of pain relief were utilized as measures of response. Ninety percent of patients experienced some relief of pain and 54% achieved eventual complete pain relief. Important prognosticators included the initial pain score and the site of the primary lesions. Administration of steroid or chemotherapy during the one-month on-study period did not influence the frequency of pain relief. The low-dose, short-course schedules were as effective as the high-dose protracted programs.
Bipin T Varghese, Rachel Cherian Koshy, Paul Sebastian, Elsamma Joseph
Combined sphenopalatine ganglion and mandibular nerve, neurolytic block for pain due to advanced head and neck cancer.
Palliat Med. 2002 Sep;16(5):447-8.
Abstract/Text
吉濱泰斗, 西山明慶, 他：出血制御のために動脈塞栓術を施行した末期口腔癌の3例. 口腔腫瘍2003;15:13-19.
Jean K Brown, Tim Byers, Colleen Doyle, Kerry S Coumeya, Wendy Demark-Wahnefried, Lawrence H Kushi, Anne McTieman, Cheryl L Rock, Noreen Aziz, Abby S Bloch, Barbara Eldridge, Kathryn Hamilton, Carolyn Katzin, Amy Koonce, Julie Main, Connie Mobley, Marion E Morra, Margaret S Pierce, Kimberly Andrews Sawyer, American Cancer Society
Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices.
CA Cancer J Clin. 2003 Sep-Oct;53(5):268-91.
Abstract/Text
Cancer survivors are often highly motivated to seek information about food choices, physical activity, dietary supplement use, and complementary nutritional therapies to improve their treatment outcomes, quality of life, and survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information on which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity issues during the phases of cancer treatment and recovery, living after recovery from treatment, and living with advanced cancer; selected nutritional and physical activity issues such as body weight, food choices, and complementary and alternative nutritional options; and selected issues related to breast, colorectal, lung, prostate, head and neck, and upper gastrointestinal cancers. In addition, handouts containing commonly asked questions and answers and a resource list are provided for survivors and families. Tables that grade the scientific evidence for benefit versus harm related to nutrition and physical activity for breast, colorectal, lung, and prostate cancers are also included for this growing body of knowledge to provide guidance for informed decision making and to identify areas for future research.
八木原一博, 岡部貞夫, 他：経皮経食道胃管挿入術（PTEG）による口腔癌経口摂取不良患者に対する長期栄養管理. 口腔腫瘍 2004;16:27-33.
M Iwase, T Takemi, M Manabe, M Nagumo
Hypercalcemic complication in patients with oral squamous cell carcinoma.
Int J Oral Maxillofac Surg. 2003 Apr;32(2):174-80. doi: 10.1054/ijom.2002.0261.
Abstract/Text
Hypercalcemia is one of the metabolic complications associated with cancer. To assess the frequency of hypercalcemia in patients with squamous cell carcinoma (SCC), 242 patients who were evaluated as having SCC in the oral cavity between July 1995 and June 2001 were investigated. All patients were periodically monitored for their serum level of calcium (Ca). Hypercalcemia was defined as a serum Ca concentration higher than 11 mg/dl. By this definition, hypercalcemia was detected in 12 of the 242 patients (5.0%). All 12 patients were at an advanced stage of oral SCC. In these 12 patients, the serum level of parathyroid hormone-related protein (PTH-rP) was also significantly elevated. Therefore, we diagnosed these diseases as humoral hypercalcemia of malignancy (HHM). Moreover, we studied the efficacy of anti-hypercalcemic therapy on the quality of life (QOL). The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 was used for estimation of QOL. The patients with HHM who were administrated drugs such as bisphosphonate and calcitonin showed a reduction in their Ca and PTH-rP levels, and the six of ten EORTC QLQ-C30 subscales (emotional functioning, cognitive functioning, fatigue, dyspnoea, nausea/vomiting and appetite loss) were also improved after the anti-hypercalcemic therapy. However, these suppressive effects were temporary. The median survival time after the diagnosis of HHM was only 54.9+/-18.3 days (range 27-86 days). Therefore, HHM in SCC appears to be an ominous prognostic sign. Although anti-hypercalcemic therapy has a palliative role, the patients may be in less discomfort during the terminal stage of their illness.
