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      Concomitant-chemoradiotherapy-associated oral lesions in patients with oral squamous-cell carcinoma

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          Abstract

          Objective

          : Oral squamous-cell carcinoma (OSCC) accounts for >90% of oral cancers affecting adults mostly between the fourth to seventh decades of life. The most common OSCC treatment is concomitant chemoradiotherapy (CCRT) having both loco-regional and distant control, but CCRT has acute and chronic toxic effects on adjacent normal tissue. This study aimed to determine the side effects of CCRT on the oral mucosa and to characterize the clinicopathology of oral lesions in patients with OSCC.

          Methods:

          This descriptive, cross-sectional study was certified by the Ethical Review Committee (UHS/Education/126-12/2728) of the University of Health Sciences, Lahore, Pakistan. OSSC patients ( n=81) with various histological subtypes, grades, and stages were recruited, and findings on their oral examination were recorded. These patients received 70, 90, and 119 Gy of radiotherapy dosages in combination with the chemotherapy drugs cisplatin and 5-fluorouracil. Data were analyzed using SPSS 20.0.

          Results

          : The most common presentation of OSCC was a nonhealing ulcer (63%) involving tongue (55.6%). Clinical findings included mucositis (92.6%) and xerostomia of mild, moderate, and severe degrees in 11.1%, 46.9%, and 35.8% cases, respectively. Ulcers (87.7%), palpable lymph nodes (64.2%), limited mouth opening (64.2%) and fistula (40.7%) were also observed. In females, the association of radiotherapy dosage with limited mouth opening, xerostomia, and histological grading was statistically significant ( P<0.05). The association of chemotherapy drugs with xerostomia ( P=0.003) was also statistically significant.

          Conclusions

          : CCRT induced mucositis, xerostomia, and trismus in patients with OSCC.

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          Increasing incidence of oral tongue squamous cell carcinoma in young white women, age 18 to 44 years.

          Mark Weissler, Steven Couch, Marshall Carpenter … (2011)
          To evaluate the incidence of oral cavity squamous cell carcinoma (OCSCC) and oral tongue squamous cell carcinoma (OTSCC) in young white women, age 18 to 44 years. We analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and OTSCC. Three cohorts were examined: all ages, age 18 to 44 years (ie, "young"), and age > 44 years. Individuals were stratified by sex and/or race. Percentage change (PC) and annual percentage change (APC) were calculated. Joinpoint regression analyses were performed to examine trend differences. Overall, incidence of OCSCC was decreasing for all ages. However, incidence was increasing for young white women (PC, 34.8; APC, 2.2; P < .05). Incidence of OTSCC was decreasing for all ages except in the age 18 to 44 years group (PC, 28.8; APC, 1.8; P < .05). Young white individuals had increasing incidence trends of OTSCC (white women: PC, 111.3; APC, 4; P < .05; young white men: PC, 43.7; APC, 1.6; P < .05). The APC of OTSCC was significantly greater in young white women compared with that in young white men (P = .007). Furthermore, incidence of SCC in all other subsites of the oral cavity was decreasing. Nonwhites had a decreasing incidence of OCSCC and OTSCC. Cause-specific survival was similar among whites age 18 to 44 and individuals older than age 44 years. OTSCC is increasing among young white individuals age 18 to 44 years, particularly among white women. Young white women may be a new, emerging head and neck cancer patient population.
          Article 0 comments Cited 115 times – based on 0 reviews     Review now
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            Dose, volume, and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer.

            H. Kim, Thomas L. Marsh, J Ship … (1999)
            To determine the relationships between the three-dimensional dose distributions in parotid glands and their saliva production, and to find the doses and irradiated volumes that permit preservation of the salivary flow following irradiation (RT). Eighty-eight patients with head and neck cancer irradiated with parotid-sparing conformal and multisegmental intensity modulation techniques between March 1994 and August 1997 participated in the study. The mean dose and the partial volumes receiving specified doses were determined for each gland from dose-volume histograms (DVHs). Nonstimulated and stimulated saliva flow rates were selectively measured from each parotid gland before RT and at 1, 3, 6, and 12 months after the completion of RT. The data were fit using a generalized linear model and the normal tissue complication probability (NTCP) model of Lyman-Kutcher. In the latter model, a "severe complication" was defined as salivary flow rate reduced to < or =25% pre-RT flow at 12 months. Saliva flow rates data were available for 152 parotid glands. Glands receiving a mean dose below or equal to a threshold (24 Gy for the unstimulated and 26 Gy for the stimulated saliva) showed substantial preservation of the flow rates following RT and continued to improve over time (to median 76% and 114% of pre-RT for the unstimulated and stimulated flow rates, respectively, at 12 months). In contrast, most glands receiving a mean dose higher than the threshold produced little saliva with no recovery over time. The output was not found to decrease as mean dose increased, as long as the threshold dose was not reached. Similarly, partial volume thresholds were found: 67%, 45%, and 24% gland volumes receiving more than 15 Gy, 30 Gy, and 45 Gy, respectively. The partial volume thresholds correlated highly with the mean dose and did not add significantly to a model predicting the saliva flow rate from the mean dose and the time since RT. The NTCP model parameters were found to be TD50 (the tolerance dose for 50% complications rate for whole organ irradiated uniformly) = 28.4 Gy, n (volume dependence parameter) = 1, and m (the slope of the dose/response relationship) = 0.18. Clinical factors including age, gender, pre-RT surgery, chemotherapy, and certain medical conditions were not found to be significantly associated with the salivary flow rates. Medications (diuretics, antidepressants, and narcotics) were found to adversely affect the unstimulated but not the stimulated flow rates. Dose/volume/function relationships in the parotid glands are characterized by dose and volume thresholds, steep dose/response relationships when the thresholds are reached, and a maximal volume dependence parameter in the NTCP model. A parotid gland mean dose of < or =26 Gy should be a planning goal if substantial sparing of the gland function is desired.
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              The chemoradiation paradigm in head and neck cancer.

              Tanguy Seiwert, Joseph K Salama, Everett E. Vokes (2007)
              In this article, we use the example of head and neck cancer to show how concurrent chemoradiotherapy is used to treat a cancer where locoregional control is central for treatment success. The advent of concurrent chemoradiation has significantly contributed to the curability of head and neck cancer, including locoregionally advanced disease. Preserving organ function and reducing toxic effects are increasingly the focus of clinical trials. We review the available chemoradiotherapy platforms used for head and neck cancer, with initial discussions focused on single-agent cytotoxic-based regimens. We then assess the literature on multiagent-based regimens and include a discussion of the integration of novel agents, such as EGFR inhibitors, and antiangiogenic drugs into treatment platforms. Although single-agent cisplatin-based chemoradiotherapy is still widely used as a standard therapy, we propose that evidence increasingly shows that multiagent-based chemoradiotherapy, and EGFR-inhibitor-based treatments, offer distinct advantages. We provide guidance for clinicians based on current clinical trial evidence on how to choose appropriate treatment platforms for their patients.
              Article 0 comments Cited 55 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Muhammad Kashif
                Journal
                Journal ID (nlm-ta): Cancer Biol Med
                Journal ID (iso-abbrev): Cancer Biol Med
                Journal ID (publisher-id): CBM
                Title: Cancer Biology & Medicine
                Publisher: Chinese Anti-Cancer Association (Tianjing China )
                ISSN (Print): 2095-3941
                Publication date (Print): May 2017
                Volume: 14
                Issue: 2
                Pages: 176-182
                Affiliations
                [1 ]Oral Pathology Department, Akhtar Saeed Medical and Dental College, Lahore 54000, Pakistan
                [2 ]Immunology Department, University of Health Sciences, Punjab 54600, Pakistan
                [3 ]Dentistry Department, Fauji Foundation Hospital, Lahore 54000, Pakistan
                [4 ]Morbid Anatomy and Histopathology Department, University of Health Sciences, Punjab 54600, Pakistan
                Author notes
                Article
                Publisher ID: CBM-2016-0096-R2
                DOI: 10.20892/j.issn.2095-3941.2016.0096
                PMC ID: 5444929
                PubMed ID: 28607808
                SO-VID: 4e66aca7-7371-4bbf-9e0c-a4d4724bc5b1
                Copyright © Copyright 2017 Cancer Biology & Medicine
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

                History
                Date received : 28 November 2016
                Date accepted : 23 December 2016
                Categories
                Subject: Original Article

                Keywords: oscc,ccrt,oral lesions,xerostomia,trismus
                Data availability:
                Keywords: oscc, ccrt, oral lesions, xerostomia, trismus

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