Evaluating synchronous esophageal cancer in head and neck cancer patients using Lugol dye chromoendoscopy.

OBJECTIVE: Routine screening for esophageal cancer in head and neck cancer patients in Thailand is controversial, because of concerns regarding the screening methods and cost effectiveness. Since Lugol dye chromoendoscopy is an effective technique for early detection of squamous cell carcinoma of the esophagus, the objectives of the present study are to evaluate the synchronous esophageal cancer in head and neck cancer patients and the effectiveness of Lugol dye chromoendoscopy for routine screening. MATERIAL AND METHOD: All diagnosed patients with head and neck cancer between September 1, 2009 and June 30, 2011 were enrolled into the study. Both conventional esophagoscopy and Lugol dye chromoendoscopy were done. The incidence of esophageal cancer was calculated. A diagnostic statistical analysis was done to compare the diagnostic properties between conventional esophagoscopy and Lugol dye chromoendoscopy. Univariate and multivariate logistic regression analyses were used to find significant factors associated with esophageal cancer in this study. RESULTS: Eighty-nine head and neck cancer patients were enrolled in this study. The incidence of esophageal cancer in head and neck cancer patients was 12.4% (11/89). Conventional esophagoscopy found a highly suspicious malignant lesion in only six patients, while the Lugol dye chromoendoscopy detected all 11 esophageal cancers. The sensitivity and specificity for conventional esophagoscopy were 54.5% and 100%, respectively, andfor Lugol dye chromoendoscopy were 100% and 70.5%, respectively. The three significant factors that increased the likelihood of synchronous esophageal cancer from univariate analysis were age less than 50 years, presence of dysphagia, and an unstained Lugol dye area ≥10 mm. Howeve, these factors were not statistically significant by multivariate analysis. CONCLUSION: Lugol dye chromoendoscopy is a promising tool to enhance the diagnosis of esophageal cancer among head and neck cancer patients.

Comparative proteomic analysis of oral squamous cell carcinoma and adjacent non-tumour tissue from Thailand.

OBJECTIVE: The study was aimed at analysing and identifying the proteins that are differentially expressed in oral squamous cell carcinoma (OSCC) compared to adjacent non-tumour tissue. MATERIALS AND METHODS: Two-dimensional (2D) sodium dodecyl sulphate-polyacrylamide gel electrophoresis accompanied by mass spectrometry (matrix-assisted laser desorption/ionisation-time-of-flight mass spectrometry and liquid chromatography-tandem mass spectrometry) was used to analyse and identify the differentially expressed proteins in 10 pairs of tumours and adjacent non-tumour tissues from five cases of early-stage and five cases of late-stage OSCC. The statistical differences of the protein spots were analysed by the Wilcoxon signed-rank test. A validation study using immunohistochemistry and quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) was performed. RESULTS: A total of 68 proteins (63 up-regulated, five down-regulated) were differentially expressed in early-stage disease, and 39 proteins (37 up-regulated, two down-regulated) were significantly altered in late-stage disease. Among these, 14 proteins were altered in both groups. A total of 44 proteins were identified, including heat shock proteins (HSPs: Hsp90, HSPA5 and HSPA8), keratins (K1, K6A and K17), tubulin, cofilin 1, 14-3-3σ and metabolic enzymes. These proteins are involved in various cellular processes essential for cell growth, survival and cell migration. The validation study on α-tubulin and 14-3-3σ using immunohistochemistry and KIAA1199 expression using real-time RT-PCR confirmed the results in proteomics analysis. CONCLUSIONS: The study identified many proteins, both known and unknown, for cancer cell processes. At least two proteins, KIAA1199 and Horf6, are novel for oral cancer.

The prognostic value of p53, Bcl-2 and Bax expression in laryngeal cancer.

OBJECTIVE: Determine the prognostic value of p53, Bcl-2 and Bax expression in cancer of the larynx. MATERIAL AND METHOD: Ninety-four patients diagnosed with laryngeal squamous cell carcinoma were analyzed for 5-year overall survival in relation to immunohistochemical expression of p53, Bcl-2, and Bax proteins. RESULTS: The present study included 86 males and eight females with a mean age of 65.1 years. Half of the patients (51%) were in stages III and IV. Radiation (44.7%) and radiation plus surgery (40.4%) were the main treatments. The frequency of p53, Bcl-2, and Bax expression was 58.1%, 18.5%, and 87.2%, respectively. The 5-year overall survival rate was 49.7%. Univariate analysis revealed that T-stage, N-stage and treatment were significantly associated with 5-year overall survival. In the multivariate Cox regression, T-stage, treatment, and Bcl-2 expression were significantly associated with survival. Positive Bcl-2 expression was associated with better survival (Hazard ratio 0.23, 95% CI 0.06-0.81). CONCLUSION: The positive Bcl-2 expression is an independent prognostic marker in laryngeal squamous cell carcinoma.

Survival and prognostic factors of different sites of head and neck cancer: an analysis from Thailand.

BACKGROUND: Head and neck cancers are prevalent in Thailand, in particular in the southern region of the country. However, survival with a large data set has not been reported. The purpose of the present study was to evaluate the survival figures and the prognostic factors in a cohort of patients treated in a university hospital located in the south of Thailand. PATIENTS AND METHODS: Consecutive new cases of primary carcinoma of the oral cavity, oropharyx, hypopharynx and larynx, treated at Songklanagarind Hospital during 2002 to 2004, were analyzed. The 5-year overall survival rates were obtained by the Kaplan-Meier method. Prognostic factors were identified through multivariate Cox regression analysis. RESULTS: A total 1,186 cases were analyzed. Two-thirds (66.6%) of the cases were at advanced stage (stage III and IV) at presentation. The five-year overall survivals for the whole cohort, oral cavity, oropharynx, hypopharynx and larynx were 24.1%, 25.91%, 19.2%, 13.4%, 38.0% respectively. Stage and treatment type were strong prognostic factors for all sites. An age ≥80 years was associated with poor survival in oral cavity and larynx cancer. CONCLUSIONS: The results revealed remarkably poor outcomes of the patients in the series, indicating a strong need to increase the proportion of early stage presentations and maximize the treatment efficacy to improving outcomes. Very old patients are of particular concern for treatment care of oral cavity and larynx cancer.

Concurrent chemoradiotherapy with carboplatin followed by carboplatin and 5-fluorouracil in locally advanced nasopharyngeal carcinoma.

BACKGROUND: This study aimed to evaluate acute major toxicities, the response rate, 3-year overall survival and progression-free survival rate of locally advanced nasopharyngeal carcinoma patients on concurrent carboplatin chemoradiotherapy followed by carboplatin and 5-fluorouracil. METHODS: A prospective study of fifty patients diagnosed with locally advanced nasopharyngeal carcinoma received conventional radiation therapy with a total dose of 6600-7000 cGy in 6-7 weeks and concurrent chemotherapy of three cycles of carboplatin during radiotherapy, followed by adjuvant chemotherapy using carboplatin plus 5-fluorouracil for two cycles. RESULTS: Weight loss and mucositis were the two most common acute major grades 3-4 toxicities (42%). Myelosuppression occurred subsequently, including leukopenia (30%), neutropenia (20%), anemia (12%), and thrombocytopenia (6%). Only 8% of patients developed grades 3-4 nausea and vomiting. No patients had renal and electrolyte abnormalities. Regarding the response evaluation, 100% of patients achieved an objective response rate of the primary tumor (92% complete response, and 8% partial response). Similarly, all patients also achieved an objective response rate of the neck node (64% complete response and 36% partial response). The 3-year overall survival rate and progression-free survival rate were 89.7% and 72.7%, respectively. CONCLUSIONS: Concurrent chemoradiotherapy with carboplatin followed by carboplatin and 5- fluorouracil could be considered as an alternative regimen for locally advanced nasopharyngeal carcinoma patients pertaining to a good overall response rate, 3-year overall survival and progression-free survival rate with good tolerability.

A randomized controlled trial for perioperative morbidity in microdebrider versus cold instrument dissection tonsillectomy.

BACKGROUND: Tonsillectomy is a common procedure in children. It could produce moderate to severe post operative pain and morbidity. Preserving tonsillar capsule attached to pharyngeal constrictor muscle by microdebrider technique may reduce pain when compared to conventional cold dissection technique. OBJECTIVE: To compare the postoperative pain, perioperative, and postoperative morbidity between the microdebrider-assisted intracapsular tonsillectomy (MT) and cold instrument dissection tonsillectomy (CT). MATERIAL AND METHOD: Forty children with ages between 3-14 years old in Songklanagarind Hospital with tonsillar hypertrophy were randomly assigned to have MT and CT in each group. Data of perioperative morbidity, time to start taking food, LOS, treatment satisfaction, post operative pain, and amount of analgesia were recorded for 7 days. Post operative complication was also followed-up. RESULTS: There were no statistical significantly differences between groups in operation time, time to start taking food, LOS, and amount of postoperative analgesia and treatment satisfaction score. The MT had significantly more blood loss during operation (54.3 +/- 35.45 mL) than the CT (14.78 +/- 18.71 mL) (p < 0.001). The MT had significantly less post operative pain score on postoperative day 2 (2.50 +/- 1.15 and 1.05 +/- 0.83) and 3 (1.70 +/- 0.80 and 1.05 +/- 0.76) (p < 0.05) but no difference on day 0, 1, 4, 5, 6. Pain score after analgesia was significantly better in the MT on day 0 (2.45 +/- 0.94 and 3.40 +/- 1.47) (p = 0.024) but no difference on day 1-6. There were no significant differences in fentanyl use for break through pain, immediate and delayed complications between the groups. CONCLUSION: MT is an effective alternative procedure for children with tonsillar hypertrophy and results in improved postoperative pain but have more intraoperative blood loss.