Predictivity of human papillomavirus positivity in advanced oral cancer.

BACKGROUND AND OBJECTIVE: Human papillomavirus (HPV) is a known prognostic factor world over in patients of carcinoma oropharynx. The role of HPV in oral cancers has not been investigated adequately. We tried to identify standard clinicopathological features in oral cancer, which would predict HPV‑positivity. METHODS: This was a retrospective analysis of 124 cases of T4 oral cancer patients at our center. HPV‑positive was defined in accordance with positive p16 immunohistochemistry done on pretreatment local tumor site biopsy. Age, sex, habits (smoking history and oral tobacco), Eastern Cooperative Oncology Group performance status (ECOG PS), T stage, N stage, grade, and site were selected, for testing of prediction for HPV‑positivity. The analysis was performed by R studio version 3.1.1. Two‑sample test for equality of proportions with continuity correction was used to identify factors predicting for HPV‑positivity. P = 0.05 was considered as significant. RESULTS: Of 124 patients, 16 patients (12.9%) were HPV‑positive. The median age of the whole cohort was 43 years (interquartile range 37–52 years) with 15 females (12.1%). All had squamous cell carcinoma (100%). The grade of the tumor was well differentiated in 9 patients (7.2%), moderately differentiated in 98 patients (79.1%), and poorly differentiated in 17 patients (13.7%). The ECOG PS 0 in 19 patients (15.3%), 1 in 104 patients (83.9%), and 2 in 1 patient (0.8%). The subsite of the tumor was buccal mucosa in 74 patients (59.7%), anterior two‑third of tongue in 33 patients (26.6%), and others in 17 patients (13.7%). None of the tested factors except the use of oral tobacco were statistically significantly associated with HPV‑positivity. History of tobacco usage had a statistical trend toward ability to predict HPV‑positivity. The proportion of patients with HPV‑positive oral cancer in patients without history usage of oral tobacco was 31.3% while it was 10.2% in patients with previous history of tobacco use (P = 0.03). CONCLUSION: Standard clinicopathological variables could not predict for HPV‑positivity. Negative history of tobacco (smokeless) usage showed statistical trends toward ability to predict HPV‑positivity in oral cancer patients.

Is taxane/platinum/5 fluorouracil superior to taxane/platinum alone and does docetaxel trump paclitaxel in induction therapy for locally advanced oral cavity cancers.

BACKGROUND: Cisplatin and 5 fluorouracil drug combination is inferior to the combination of taxane with these 2 drugs. However, often in clinical practice at our center giving TPF (docetaxel, cisplatin, 5 fluorouracil) is difficult in view of logistics and tolerance issues. In such a scenario, we prefer to use the 2 drugs combination of platinum and taxane. However, no study has addressed whether a 2 drugs combination, which includes taxane is inferior to the 3 drugs combination and which the taxane of choice is in the 2 drugs combination of taxane and platinum. METHODS: This is a retrospective analysis of prospectively collected data of patients undergoing induction chemotherapy (IC) in oral cavity cancers from 2010 to 2012. We chose for analysis those patients who had a baseline scan done within 4 weeks of starting therapy and a follow‑up scan done within 2 weeks of completion of the second cycle of IC. Response was scored in accordance with RECIST version 1.1. Chi‑square analysis was done to compare response rates (RRs) between regimens. RESULTS: Two hundred and forty‑five patients were identified. The median age was 45 years (24–70 years), 208 (84.9%) were male patients, and 154 patients (62.9%) had primary in the Buccal mucosa. The regimens received were TPF 22 (9%), docetaxel + cisplatin 97 (39.6%), paclitaxel + cisplatin 89 (36.3%), docetaxel + carboplatin 16 (6.5%) and paclitaxel + carboplatin 21 (8.6%). The overall RRs were complete response, partial response, stable disease and progressive disease in 4 (1.6%), 56 (22.9%), 145 (59.2%) and 40 (16.3%). The 3 drugs regimen (TPF) had 50% RR as compared to 22% RR with 2 drugs regimen (P = 0.004). Docetaxel containing regimens had 30.3% RR as compared to 17.2% RR with paclitaxel containing regimens (P = 0.094). CONCLUSIONS: TPF has better RR than a 2 drugs taxane‑containing regimen and docetaxel leads to a better RR than paclitaxel for IC in locally advanced oral cavity cancers.

Referral pattern for neoadjuvant chemotherapy in the head and neck cancers in a tertiary care center.

BACKGROUND: Use of any treatment modality in cancer depends not only on the effectiveness of the modality, but also on other factors such as local expertise, tolerance of the modality, cost and prevalence of the disease. Oropharyngeal and laryngeal cancer are the major subsites in which majority of neoadjuvant chemotherapy (NACT) literature in the head and neck cancers is available. However, oral cancers form a major subsite in India. MATERIALS AND METHODS: This is an analysis of a prospectively maintained data on NACT in the head and neck cancers from 2008 to 2012. All these patients were referred for NACT for various indications from a multidisciplinary clinic. Descriptive analysis of indications for NACT in this data base is presented. RESULTS: A total of 862 patients received NACT within the stipulated time period. The sites where oral cavity 721 patients (83.6%), maxilla 41 patients (4.8%), larynx 33 patients (3.8%), laryngopharynx 8 patients (0.9%) and hypopharynx 59 patients (8.2%). Out of oral cancers, the major indication for NACT was to make the cancer resectable in all (100%) patients. The indication in carcinoma of maxilla was to make the disease resectable in 29 patients (70.7% of maxillary cancers) and in 12 patients (29.3% of maxillary cancers) it was given as an attempt to preserve the eyeball. The indication for NACT in laryngeal cancers was organ preservation in 14 patients (42.4% of larnyngeal cancer) and to achieve resectability in 19 patients (57.6% of larnyngeal cancer). The group with laryngopharynx is a cohort of eight patients in whom NACT was given to prevent tracheostomy, these patients had presented with early stridor (common terminology criteria for adverse events Version 4.02). The reason for NACT in hypopharyngeal cancers was for organ preservation in 24 patients (40.7% of hypopharyngeal cancer) and for achievement of resectability in 35 patients (59.3% of hypopharyngeal cancer). CONCLUSION: The major indication for NACT is to make disease resectable at our center while cases for organ preservation are few.

Oral metronomic scheduling of anticancer therapy-based treatment compared to existing standard of care in locally advanced oral squamous cell cancers: A matched-pair analysis.

CONTEXT: Head and neck cancers in developing countries present with advanced disease, compounded by poor access to tertiary care centers. AIM: We evaluated oral metronomic scheduling of anticancer therapy (MSAT) in advanced operable oral cancers, in conjunction with standard therapy. SETTINGS AND DESIGN: This was a retrospective matched‑pair analysis carried out in a tertiary referral cancer center. MATERIALS AND METHODS: Advanced operable oral cancer patients having a waiting period for surgery > 3 weeks were administered MSAT. Patients then underwent standard therapy (surgery +/‑ adjuvant radiation/chemoradiation) as warranted by the disease, followed by MSAT maintenance therapy. Outcomes of the MSAT group were compared with stage‑matched controls with similar waiting periods. STATISTICAL ANALYSIS: Survivals were found using the Kaplan‑Meier method and compared between groups using the log rank test. RESULTS: Response was seen in 75% of 32 patients. Two‑year disease‑free survivals (DFS) in MSAT and control groups were 86.5 and 71.6%, respectively. Two‑year DFS in MSAT group who received at least three months of MSAT was 94.6% (P = 0.03). CONCLUSIONS: Oral MSAT is an economical, effective, and safe adjuvant therapy for oral cancers. It has the potential for preventing progression of the disease and improving DFS.

Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: Does it make a difference.

Impact Factor for 2013 is 1.131 Click here to download free Android Application for this and other journals Click here to view optimized website for mobile devices Journal is indexed with MEDLINE/Index Medicus and Science Citation Index ExpandedShare on facebookShare on twitterShare on citeulikeShare on connoteaShare on googleShare on linkedinMore Sharing Services MINI SYMPOSIUM: HEAD NECK CANCER Year : 2013 | Volume : 50 | Issue : 1 | Page : 1-8 Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: Does it make a difference? VM Patil1, V Noronha1, VK Muddu1, S Gulia1, B Bhosale1, S Arya2, S Juvekar2, P Chatturvedi3, DA Chaukar3, P Pai3, A D'cruz3, K Prabhash1 1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India 2 Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India 3 Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India Date of Web Publication 20-May-2013 Correspondence Address: K Prabhash Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra India DOI: 10.4103/0019-509X.112263 PMID: 23713035 » Abstract Background: Locally advanced and unresectable oral cavity cancers have a poor prognosis. Induction might be beneficial in this setting by reducing tumor bulk and allowing definitive surgery. Aim: To analyze the impact of induction chemotherapy on locally advanced, technically unresectable oral cavity cancers. Materials and Methods: Retrospective analysis of patients with locally advanced oral cavity cancers, who were treated with neoadjuvant chemotherapy (NACT) during the period between June 2009 and December 2010. Data from a prospectively filled database were analyzed for information on patient characteristics, chemotherapy received, toxicity, response rates, local treatment offered, patterns of failure, and overall survival. The statistical analysis was performed with SPSS version 16. Results: 123 patients, with a median age of 42 years were analyzed. Buccal mucosa was the most common subsite (68.30%). Three drug regimen was utilized in 26 patients (21.10%) and the rest received two drug regimen. Resectability was achieved in 17 patients treated with 3 drug regimen (68.00%) and 36 patients receiving 2 drug regimen. Febrile neutropenia was seen in 3 patients (3.09%) receiving 2 drug regimen and in 9 patients (34.62%) receiving 3 drug regimen. The estimated median OS was not reached in patients who had clinical response and underwent surgery as opposed to 8 months in patients treated with non-surgical modality post NACT (P = 0.0001). Conclusion: Induction chemotherapy was effective in converting technically unresectable oral cavity cancers to operable disease in approximately 40% of patients and was associated with significantly improved overall survival in comparison to nonsurgical treatment.

Induction of Non-Steroidal Anti-Inflammatory Drug-Activated Gene(NAG-1) in Human Oral Cavity Cancer Cells and its Effect on Apoptosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drug (NSAID)-activated gene (NAG-1), which is induced by NSAIDs, has proapoptotic and antitumorigenic effects in colorectal cancer cells. However, NAG-1 induction and its effect on the apoptosis in human oral cavity cancer cells (SCC 1483) have not been determined. MATERIALS AND METHOD: NAG-1 expression by various NSAIDs in SCC 1483 cells was investigated by Western blot analysis. The induction of apoptosis by NSAID and the relationship between NAG-1 expression and apoptosis were determined by Western blot assay and flow cytometry. Drosophila cells stably expressing NAG-1 were constructed and NAG-1 conditioned medium (NCM) were made. Apoptosis was examined with flow cytometry on SCC 1483 cells treated with NCM. RESULTS: Diclofenac was the most potent inducer of NAG-1. Diclofenac inhibited the proliferation of SCC 1483 cells and this inhibition was proved as apoptosis. Diclofenac induced the expression of NAG-1 and also induced apoptosis in time and dose dependent manner. In the concentrated NCM, the expression of NAG-1 was intense and apoptosis was induced by addition of 5 mu of NCM. CONCLUSION: Based on these data, we could assure that NSAIDs induced NAG-1 in oral cavity cancer cells and NAG-1 induced apoptosis. Therefore, we suggest that it is possible to use NSAIDs as a chemopreventive agent in oral cavity cancer. Further studies on the mechanism of NAG-1 and clinical use will be needed.

Neo-adjuvant chemotherapy by using methotrexate prior to radiation therapy in the treatment of advanced oral cancers.

One hundred and forty-one advanced squamous sell carcinomas of the oral cavity (T3,4; NO-3;MO) were treated with neoadjuvant chemotherapy by using methotrexate 50 mg. administered intravenously, once weekly for 3-5 injections and then followed by radiation therapy 6000 – 6500 cGy in 6-6.5 weeks. Seventy patients with the same tumour extent, receiving radiation therapy alone were randomized numerically for the control group. The result of combined treatment showed 86 percent effective on the basis of objective primary tumour response with MTX alone, and 46 percent showed CR. For the nodal status, only 53 percent showed effective and only 10 percent was CR. After radiation therapy, the response of both primary and lymph node in the study group showed definitely more effective than the control group. Seventy-two percent of patient in the study group showed CR, while only 20 percent of the radiation alone group showed CR. The patients in the study group also showed better survival rate with 14 percent of 5-year survival rate, while none of the control group survived more than 5 years after treatment. All the patients tolerated methotrexate and radiation treatment very well. Only grad 1 and 2 toxicities were found.