Incidence of human papillomavirus infection in oral leukoplakia. Indications for a viral aetiology.

Epidemiological and experimental studies have indicated a possible role of human papillomavirus (HPV) in the etiopathogenesis of oral premalignant lesions and tumors. The aim of this study was to establish the incidence of HPV infection and the typing of genotypes in some patients with nonmalignant oral cavity pathology and healthy subjects. We selected 80 subjects affected by the following pathologies: oral leukoplakia (20), squamous cell papilloma (6), various forms of stomatitis (30), lichen planus (15), burning mouth syndrome (BMS, 9). Ten healthy subjects were used as control. The patients underwent a brushing directly on the lesion or on the lower gums and on the dorsal surface of the tongue and a new, sensitive method of in situ hybridization (ISH) with colorimetric signal amplification was used for HPV detecting. The samples were tested with a Mix probe, which identifies most of the HPV genotypes and, in positive cases, the specific probe for the 6-11, 31-33-51 and 16-18 genotypes, was used. Leukoplakia and papilloma were , therefore, associated with the HPV infection, differently from the other pathologies and healthy oral mucosa (chi-squared < 0.005). In conclusion, according to our findings, HPV is a specific risk factor for the development of oral premalignant lesions.

Anti-p53 and anti-heat shock proteins antibodies in patients with malignant or pre-malignant lesions of the oral cavity.

BACKGROUND: Evaluation of circulating anti-p53 antibodies is an easy-to-perform, widely employed, procedure to assess the p53 status in cancer patients. MATERIALS AND METHODS: Levels of circulating anti-p53 antibodies in patients affected either by oral SCC or by pre- malignant oral lesions were assayed using a commercial ELISA kit. Autoantibody titers to Hsp60 and Hsp72 were determined by conventional ELISA. RESULTS: Anti-p53 antibodies were detected in 3 out of 16 SCC-bearing patients (18.7%) and in 9 out of 13 patients suffering from pre-malignant oral lesions (69.2%). High titers of anti-Hsp60 autoantibodies were detected in 3 out of 29 patients (10.3%), while in all patients anti-Hsp72 titers were in the normal range. CONCLUSION: The presence of anti-p53 antibodies in both SCC-bearing patients and in patients with pre-malignant lesions support the notion that p53 gene mutation is an early event in oral tumorigenesis and suggest that this assay could be useful for diagnostic screening of pre-neoplastic lesions at high risk of recurrence and/or transition towards overt malignancy.

Multiple primary tumours in patients with oral squamous cell carcinoma.

A series of patients with oral squamous cell carcinoma (SCC) observed at the "Regina Elena" Cancer Institute was retrospectively reviewed in order to analyse the risk factors for multiple and second primary tumours (SPTs), their impact on survival and effective measures to control this phenomenon. In a survey of 200 individuals with a median follow-up of 3.2 years (25th percentile: 1.2, 75th percentile: 5.5), the incidence rate of SPTs was 14%: 39% arose in the oral cavity, 18% in the oropharynx, 10% in the lung and 7% both in the lip and larynx. There were no cases of secondary oesophageal tumours. Ninety-six per cent of the diagnosed histological types of SPTs were SCCs. Forty per cent of the new cancers were synchronous and 60% were metachronous, developing at a steady rate of 1.5% per year with no evidence of plateau. The overall incidence, adjusted by the length of follow-up, was 40 SPTs per 1000 person-years of follow-up. Although all the patients were at a greater risk for SPTs, the rates widely varied, according to specific factors: heavy tobacco consumption accounted for a statistically significant risk excess which was particularly high among younger smokers with an index tumour of the lower oral cavity. No difference was noticed in relation to the index neoplasm stage. In patients both with localised and advanced index tumours, 5-year survival rates were lower in those with SPTs and the difference was statistically significant for the 2-year survivors who were most likely to overcome the first disease. The present study confirms, the exceptionally high incidence of multifocal SCC in oral cancer patients and emphasizes the importance of preventive measures, since careful screening procedures, carried out to detect multifocal tumours at an early stage, should improve survival in these patients.

[Correlation between dietary vitamin A consumption and onset of precancerous lesions in the oral cavity]. / Correlazione tra consumo di vitamina A nella dieta e insorgenza di lesioni precancerose della cavità orale.

The efficacy of vitamin A in the prevention of oral cavity cancer has been studied during the last years due to the interest for a possible application of new drugs in the treatment of second primary tumours and multiple neoplasms. Fifty patients with oral precancerous lesions treated at the "Centre for prevention of oral cavity cancer" of the "Regina Elena" Institute in Rome, have been subjected to a rigorous questionnaire about their use of vitamin A in the diet. Moreover a standard sample of fifty healthy people without oral cavity lesions.

Retinol dietary intake and oral leukoplakia development.

To investigate the clinical outcome of unbalanced diet in patients with oral precancerosis and to assess a possible relationship between dietary factors and the development of oral leukoplakia, a case-control study was carried out within a cohort of 53 subjects treated at our Centre in October-November 1997. Enrolled subjects and suitable controls underwent a careful interview on their own alimentary habits with a particular interest in retinol and carotenoids major sources. An individual qualitative and quantitative assessment of retinol-equivalents dietary intake, yielding average values for each group, allowed to compare the cohorts and to relate data also to tobacco use and to the severity of histopathological findings. Case levels were always significantly lower than controls (P<0.001), disregarding smoking, whilst no difference resulted between smokers and non smokers within the same groups. No statistical influence seemed to link alimentary vitamin A to the development of oral dysplasia but this work strengthen the epidemiological opinion that specific dietary factors are of great importance in oral oncology.

[A system for the clinico-functional staging of the quality of life of patients with malignant neoplasms of the oro-facial area]. / Sistema di stadiazione clinico-funzionale della qualità di vita dei pazienti affetti da neoplasie maligne del distretto oro-facciale.

The anatomical region identified with the "head and neck region" has got the highest functional concentration of the human body and the highest incidence of malignant tumours per unit of surface. A pathology, that forced to serious and destroying surgical interventions in this area, will carry necessarily out a series of mutilations and functional restrictions on the whole organism. Leawing out the central nervous system, the head is site of important functions like breathing and feeding, in addition to essential functions for the relationship life like vocal expression and sight. For a correct interpretation of the quality of life in patients with neoplastic lesions in this anatomical area, it is very important to assess what kind of function has been more or less compromised and therefore what kind of limitation interfere between patient and the surrounding environment and between patient and himself. In order to provide a useful instrument for the measurement of the therapeutical acts consequences and in order to quantify the qualitative aspects of oncological patient's residual life, has been elaborated a test of "functional evaluation of the oro-facial district". This system, according to the modern oncology requests that value the dificoltous but important concept of "life quality", allows the interpretation of elements otherwise dispersive because of the various and different physiological functions localized in the considered anatomical district. The examined physiological functions have been subdivided in vital, primary or secondary, and through the use of an objective evaluation score card, they have allowed to classify the patients with orofacial oncological pathology in definite and listed functional stages.

[The CO2 laser treatment of melanotic lesions of the oral mucosa. A clinical case report]. / Trattamento con laser a CO2 delle lesioni melaniche delle mucose del cavo orale. Presentazione di un caso clinico.

The authors, in a careful review of the literature, talk about the melanotic lesions of the mucous membranes of the oral cavity, explaining the etiopathogenesis, the various classifications, the diagnosis and the therapy. They also expound the features of laser and its application in management of a clinical case of melanotic lesion of the oral cavity.

[The chemoprevention of oral carcinoma with vitamin A and/or N-acetylcysteine]. / Chemioprevenzione del carcinoma orale con vitamina A e/o N-acetilcisteina.

EUROSCAN (EUROpean Study on Chemoprevention with vitamin A and N-acetylcysteine) is a study which has the aim to demonstrate the efficacy of vitamin A and N-acetylcysteine in the prevention of second primary tumours in patients treated for lung, larynx and oral cancer. In this study are involved more than 50 medical centres in all Europe, co-ordinated by European Organization for research and Treatment of Cancer (EORTC). In December 1993 almost 2300 patients have been randomized; at the present day, in our department, we follow 29 patients curatively treated for oral cancer (pTNM: pT1N0M0, pT2N0M0, pT2N1M0) and, for this reason, at high risk to develop local recurrences or second primary tumours. These patients are allocated to four different arms according to the drugs they take: vitamin A as retinol palmitate (300,000 UI a day for the first year and 150,000 UI for the second year), N-acetylcysteine (600 mg a day for two years), both these drugs, no drugs (control group). During follow-up all the patients have clinical examinations and blood tests (in patients taking vitamin A) every 3-6 months. The randomization is expected to stop around September 1994, when, probably, the number of 2600 patients will be reached. The first analysis allowing a conclusion on chemopreventive efficacy of retinol and N-acetylcysteine will be performed not before September 1996 with a median follow-up time of more than 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)

[The epidemiological features in carcinoma of the oral cavity]. / Rilievi epidemiologici sul carcinoma della cavità orale.

In the present paper, the authors, after a review of some classifications of oral cavity carcinoma (TNM) staging, histological grading and clinical stadiation, deal with some epidemiological remarks according to Italian Tumours Registers from 1983 up to 1987. Incidence, mortality, distribution by age and anatomic site are shown with reference to standard and cut rates. At last, they underline the importance of an early diagnosis in order to give these patients, after therapy a better quality of life.

[Prosthetic rehabilitation in patients with malignant tumors of the soft palate. A clinical case report]. / Riabilitazione protesica nei pazienti con tumori maligni del palato molle. Presentazione di un caso clinico.

Soft palate neoplasms are relatively rare and their care requires not only an adequate surgical removal but also a post-treatment rehabilitation. In this article the authors after having considered the importance of the soft palate function on the individual's ability to shallow and speak, describe one case of squamous cell carcinoma of the soft palate and treated with surgery followed by prosthetic rehabilitation. Especially it is pointed out the utility of a palatal obturator in the care of deleterious esthetic and psychological aspect of the residual anatomical defect, considering the possibility of the re-establishment the integrity of the tissues and structures in the oral cavity by hand-made prosthesis more and more exact and functional.

[Diagnostic delay in neoplasms of the oral cavity]. / Il ritardo diagnostico nelle neoplasie della cavità orale.

The authors present the results of a study of delayed diagnosis in oral cancer. They report 93 cases of malignant oral tumors collected since 1987 at "Regina Elena" Cancer Institute Rome. The study revealed a very high incidence of advanced stage patients, in spite of the easy clinical examination of these malignancies, because there is a very high delay between subjective symptoms and appropriate therapy. Stress is laid on the importance of diagnostic delay on the prognosis and quality of residual life after therapy, early diagnosis being the best strategy against cancer.

[Experience in staging malignant tumors of the orofacial area]. / Esperienze di stadiazione dei tumori maligni del distretto oro-facciale.

The paper reports the authors experience at the Regina Elena Institute for the Study and Treatment of Tumours in Rome during the period 1987-1989 concerning the setting up of a register for primary malignant tumours of the head and neck. This experience has allowed various parameters to be assessed from the initial diagnosis through the subsequent diagnostic and therapeutic procedures [correction of iter]. The stage of disease was assessed in 134 patients using a TNM system proposed by UICC for tumours located in the oral cavity, oro- and hypo-pharynx and maxillary sinuses. At the end of the period a complete definition was made of some typical aspects of the disease in question: firstly, the high incidence of patients with advanced stages of disease found at the first diagnosis, and secondly, the significant delay in confirming the diagnosis of the tumour in spite of the ease with which the area may be explored. In conclusion, the authors comment on current systems of TNM classification, underlining the need for a more correct interpretation and assessment of findings related to neoplastic orofacial pathologies.

[Malignant tumors of the palate. Histology, diagnosis and therapy]. / I Tumori maligni del palato. Istologia, diagnosi e terapia.

The Authors describe the most important malignant tumors of the palate, considering the histological, clinical and Rx aspects. The exact and early evaluation of these tumors allows a right therapeutic procedure with the possibility of avoiding surgical complete demolition of the upper jaw. On this purpose the Authors underline the importance of the early diagnosis. A follow-up study of forty-five cases is described. All the patients had a resection of the upper jaw. In this study it's evident that a diagnostic inadmissible delay is the cause of a high number of cases at an advanced stage, all that to the prejudice of the quality and prospect of life.

[The prognostic correlation between a delay in the diagnosis and the survival of patients with malignant tumors of the oral cavity]. / Correlazione prognostica fra ritardo nella diagnosi e sopravvivenze nei pazienti affetti da tumori maligni della cavità orale.

The results obtained in the analysis of a series of patients suffering from malignant tumours of the oral cavity, all of whom died as a result of the primary pathology, are reported. The initial diagnostic delay is particularly examined, correlating this with survival times so as to monitor in statistically correct fashion and evaluate the influence of diagnosis-therapy latency on prognosis.

[Anesthesia problems of patients with malignant oral neoplasms undergoing inductive chemotherapy protocol and surgery]. / Problemi anestesiologici nei pazineti affetti da neoplasie maligne del cavo orale sottoposti a protocollo di chemioterapia induttiva e chirurgia.

The Authors expand the results about thirty-nine Patients with advanced malignant tumours of the oral cavity treated with inductive chemotherapy and radical surgery. They considered the choice of a correct scheme of anaesthesia in the surgical treatment for Patients with particular health conditions and previously subjected to inductive chemotherapy. The necessity to practice a pre- and post-operative therapy for subduing the very frequent and serious concomitant diseases is underlined.

Mucocele of neurosurgical interest: clinical considerations on five cases.

The authors present five patients with mucocele, submitted to neurosurgery. Two had mucoceles spreading from the frontal and/or the anterior ethmoidal sinuses and had only compressive mass symptoms, either on the ocular globe or on the frontal lobe or on both. Three patients had mucoceles growing from the sphenoid and/or posterior ethmoidal sinuses. In these latter, the mass symptoms were less evident. All the patients suffered excruciating retro-ocular pain and two presented cranial nerve damage. The correct diagnosis in these cases is crucial to avoid a too aggressive treatment since these patients are generally sent to a neurosurgeon for a suspected cranial base malignancy or an invasive pituitary adenoma. The principles of a correct differential diagnosis and of operative treatment are outlined based on an analysis of the literature and the authors experience.

[Results of a questionnaire on malignant tumors of the oral cavity]. / Risultati di un questionario sulle neoplasie maligne della cavità orale.

A set of 23 questions on malignant neoplasms of oral cavity has been submitted to a group of 38 graduate in dentistry and dental prosthesis, at the time of their qualifying examination. The answers reveal a sufficient degree of knowledge of the problem but also indicate that some specific aspects of this important question should be probed.

[Reflections on the treatment of advanced stage malignant orofacial tumors]. / Alcune riflessioni sulla terapia dei tumori maligni oro-facciali in stadio avanzato.

The presence in all series of numerous patients with advanced (stage III and IV) tumours of the oral cavity has led many researchers to propose different, often highly aggressive treatments to improve the poor prognosis in these cases. The various therapeutic combinations do not show satisfactory results in terms of cost-benefit and quality of life of the patients. In addition, the series is not sufficiently homogeneous to permit an objective judgment on the effectiveness of the different treatments. A broader effort is therefore suggested for the early diagnosis of these cancers and for greater statistical discipline in assessing results.

[Cognitive investigation on the quality of life of patients with oro-facial neoplasms in advanced stage]. / Indagine conoscitiva sulla qualità di vita dei pazienti con neoplasie oro-facciali in stadio avanzato.

As part of a Ministry of health founded research project into the quality of life among advanced cancer patients and in collaboration with the National Tumour Institutes of Milan, Naples and Genoa, an investigation was conducted on a national and international scale into the quality of the assistance given to cancer patients. Specific subjects of investigation included: the existence of pain treatment centres, home help and the type of psychological support offered such patients. In addition a questionnaire was presented to Italian oncologists, hospital staff and general practitioners covering areas like deontological problems of information, emotional, responses and quality of treatment. The answers revealed differences in the profiles of these three categories that make a significant contribution to the current discussion of the problem of the quality experienced by advanced cancer patients.