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Background: The immune peptidome of OPSCC has not previously been studied. Cancer-antigen specific vaccination may improve clinical outcome and efficacy of immune checkpoint inhibitors such as PD1/PD-L1 antibodies., Methods: Mapping of the OPSCC HLA ligandome was performed by mass spectrometry (MS) based analysis of naturally presented HLA ligands isolated from tumour tissue samples (n = 40) using immunoaffinity purification. The cohort included 22 HPV-positive (primarily HPV-16) and 18 HPV-negative samples. A benign reference dataset comprised of the HLA ligandomes of benign haematological and tissue datasets was used to identify tumour-associated antigens., Results: MS analysis led to the identification of naturally HLA-presented peptides in OPSCC tumour tissue. In total, 22,769 peptides from 9485 source proteins were detected on HLA class I. For HLA class II, 15,203 peptides from 4634 source proteins were discovered. By comparative profiling against the benign HLA ligandomic datasets, 29 OPSCC-associated HLA class I ligands covering 11 different HLA allotypes and nine HLA class II ligands were selected to create a peptide warehouse., Conclusion: Tumour-associated peptides are HLA-presented on the cell surfaces of OPSCCs. The established warehouse of OPSCC-associated peptides can be used for downstream immunogenicity testing and peptide-based immunotherapy in (semi)personalised strategies., (© 2023. The Author(s).)

Background: For head and neck squamous cell cancer (HNSCC), standard therapy consists of surgery, radiation, and/or chemotherapy. Antineoplastic immunotherapy could be an option in an adjuvant setting and is already in palliation. A functional immune system is a prerequisite for successful immunotherapy. However, effects of the standard-of-care therapy on the patients' immune system are not fully understood., Methods: Peripheral blood mononuclear cells (PBMC) were collected from patients with HNSCC (n = 37) and healthy controls (n = 10). PBMC were stimulated with staphylococcal enterotoxin B (SEB). Simultaneous expression of various cytokines was measured in CD4 + and CD8 + T cells by multicolor flow cytometry, and polyfunctional cytokine expression profiles were determined on a single-cell basis., Results: Expression levels of all measured cytokines in CD4 + T cells were higher in patients after chemoradiotherapy (CRT) as compared to untreated HNSCC patients or normal controls. After CRT, the frequency of polyfunctional CD4 + T cells, which simultaneously expressed multiple cytokines, was significantly increased as compared to untreated patients (p < 0.01)., Conclusion: CRT increases polyfunctionality of CD4 + T cells in HNSCC patients, suggesting that standard-of-care therapy can promote immune activity in immune cells. These polyfunctional CD4 + T cells in the blood of treated HNSCC patients are expected to be responsive to subsequent immunotherapeutic approaches.

Immunotherapy against head and neck cancer stem cells Immunologic therapies like antibodies in solid tumors like squamous cell cancer of the head and neck are administered either alone or in combination with radiation and chemotherapy. Despite some respectable successes, the effect of this therapy reaches its limits due the ability of the tumor to escape the immune system. Cancer stem cells seem to play an important role in this process due to their intrinsic resistance to conventional therapy and the ability to regenerate tumor heterogeneity. This way they substantially contribute to the formation of recurrences and metastases. Therefore, future immunotherapies should target specifically this subpopulation, possibly in combination with other therapeutic modalities. In this review the immunologic features of cancer stem cells and their potential as target for immunotherapies is summarized., (© Georg Thieme Verlag KG Stuttgart · New York.)

Immunoglobulin G4 (IgG4)-related disease (also known as hyper-IgG4 disease) is a recently defined emerging condition with highly heterogeneous clinicopathological features and variable disease manifestations. This disorder is characterized by unifocal or multifocal (multiorgan) involvement by tumefactive plasma cell-rich inflammatory infiltrates associated with prominent fibrosclerosis. This not uncommonly interferes with organ function resulting in diverse clinical symptoms. The autoimmune pancreatitis represents the prototype of this disease; however, to date almost all organs have been reported to be involved in this disorder. In the head and neck area several presentations of this disease may be encountered in salivary glands, lacrimal glands, thyroid gland, lymph nodes, soft tissue of the neck, ear and sinonasal tract. However, IgG4 positive plasma cells are occasionally prominent in non-specific chronic inflammatory conditions of the head and neck and the oral cavity unrelated to autoimmune diseases or systemic disorders, thus representing diagnostic pitfalls. The diagnosis of IgG4-related disease should be based on a combination of typical histological, clinical and serological findings.

Macrophage migration inhibitory factor is a critical proinflammatory cytokine produced by cells of innate and adaptive immune system. MIF plays a key role in cell cycle regulation and in the pathogenesis of many cancers. Recently, MIF has been studied in the upper aerodigestive tract cancer for its involvement in tumor progression, invasion, proliferation and cell motility. In addition, MIF appears to be a mediator in angiogenesis and in the development of metastasis and locoregional lymph node, which are often associated with a poor prognosis. The mechanisms of action responsible for MIF involvement in tumor progression are not completely elucidated. However, the main effects of MIF are mediated by the CD74 receptor. MIF binding to its receptor is responsible for the activation of several signaling pathways (ERK1/2 - MAPK, JAB1 - CSN5, PI3K - Akt), the inhibition of p53 and the stimulation of angiogenic factors including VEGF and IL-8. The overexpression of MIF also causes a reduction of the anti-tumor activity of the immune system. Finally, MIF could be an interesting biomarker in the diagnosis and monitoring of upper aerodigestive tract cancers. In this paper, we assess the state of knowledge of MIF involvement in upper aero-digestive tract cancers and we analyze the therapeutic perspectives.

Infection with human papilloma virus (HPV) has been identified as the cause of recurrent papillomatosis and of a subgroup of squamous cell carcinomas of the head and neck. A change in prevalence of these lesions, especially for oropharyngeal carcinoma, can be expected as a consequence of the introduction of prophylactic HPV vaccines for young women, targeting the most frequent high- and low-risk HPV subtypes. Vaccination for the major low-risk HPV types has proven to be highly effective against genital warts and activity against papillomatosis can be expected. The possibilities of prophylactic HPV vaccination as well as new developments and the rationale for therapeutic vaccines are discussed on the basis of the current literature.

The head and neck squamous cell carcinoma microenvironments contain many immune cells and their secretory products. Many of these cells belong to the mononuclear phagocyte system. The aim of this review is to study the interactions between mononuclear phagocytes and head and neck squamous cell carcinoma tissue. The role of inflammation in tumours and the cytokine interleukin-6 will be highlighted. Future therapy strategies in the treatment of head and neck cancer might be directed towards mononuclear phagocytes and their cytokine production.

Perioperative immunonutrition is aiming at modulating altered immunological and metabolic functions in the context of major surgery. It is defined as the supplementation of constitutionally essential substrates such as glutamine, arginine, omega-3-fatty acids or nucleotides. The application of such formula is recommended for patients undergoing major abdominal-surgical procedures and tumour surgery in the head neck area. The substitution should be given 5-7 days before and after the intervention.

Background: The trifunctional bi-specific antibody Removab bridges and activates CD3 positive T cells to EpCAM on carcinoma cells and simultaneously binds to an accessory immune cell, thus inducing tumor cell lysis. Following intravenous application, Removab may induce cytokine-related side effects resulting in a sepsis like syndrom. It was questioned, if peripheral mononuclear blood cells (PBMN) already opsonized with Removab could retain antitumor activity and induce less cytokine release than the mere antibody., Methods: PBMN of patients with head and neck cancer were incubated with Removab and the released cytokines were washed out. Then the Removab-opsonized PBMN were coincubated with genuine tumor cells of the same patient on a chorioallantois membrane for 24 h (T 24) and 48 h (T 48). Tumor cells coincubated with Cisplatin or solely cell culture medium served as control., Results: Coincubation of tumor cells with opsonized PBMN resulted in a 32 % decrease of viable cells at T 24 and a 37 % decrease at T 48, whereas viable cells increased by 10 % at T 24 or 3 % at T 48 when incubated with medium alone (p < 0.05). This tumor cytotoxicity was similar to that of Cisplatin (35 % at T 24/37 % at T 48)., Conclusion: In an autologous human ex vivo tumor system, Removab-opsonized PBMN induce tumor cell lysis with significantly reduced cytokine release after i. v. application.

Background and Aim: The aim of this investigation was the quantification of leukocyte/lymphocyte populations in the peripheral blood of ENT-carcinoma patients before and long after therapy. PROBANDS AND METHOD: PBL T-lymphocytes and NK-cells were examined in 346 patients and 31 controls using flow cytometry. In 248 participants additional populations of leukocytes, monocytes, granulocytes, lymphocytes in toto, CD4+- and CD8+-lymphocytes, CD4+8+-lymphocytes, B-lymphocytes, activated T-lymphocytes, NK-cells and CD3+56+-T-lymphocytes were studied., Results: We demonstrated a long-term reduction in T-lymphocytes (CD4+-lymphocytes) in patients more than 10 years after receiving therapy, caused mainly, but not solely, by radio/chemotherapy. We also showed a long-term, significant increase in NK-cells after more than 10 years in patients following therapy without renewed carcinoma in comparison to controls, patients prior to therapy or patients with a recurrence of carcinoma., Conclusions: Due to long-term deficits in CD4+-lymphocytes, and considering the possible protective effect of NK-cells in treated patients, an immune-supportive therapy is recommended.

Introduction: The zeta-chain as an important component of the T cell receptor (TCR) is involved in the transduction of intracellular signals and is therefore critical for T cell activation and subsequent induction of an anti-tumor response. In patients with squamous cell carcinoma of the head and neck (SCCHN) several mechanisms of immune suppression have been described. The expression of the TCR zeta-chain of both peripheral blood lymphocytes (PBLs) and tumor infiltrating lymphocytes (TILs) has been analysed in patients with SCCHN and correlated to clinical data., Methods: TIL and PBL from 47 patients with SCCHN were obtained. To determine expression of the zeta-chain in both PBLs and TILs, double immunostaining with mAbs and flow cytometric analysis was performed. The technique combined an intracellular staining with a surface staining., Results: As compared to healthy controls (n = 23), zeta-chain expression was significantly reduced (p < 0.002) in patients with SCCHN (n = 23) with lowest expression in those with UICC VI disease. Our results show a tight correlation between the loss of zeta-chain expression and the clinical aggressiveness of the tumor. Higher tumor stages frequently show a higher loss of the zeta-chain. In 11 patients zeta-chain expression of the PBL could be compared with TIL. Independent of the tumor stage the loss of the zeta-chain expression is much higher in TIL than in PBL. The loss of the zeta-chain expression also correlates with the progression of the disease. Patients with a high loss of the zeta-chain expression develop a recurrence more frequently., Conclusion: The loss of the zeta-chain documents a systemic immune defect, which even occurs in early tumor stages. Additionally to locoregional approaches future therapeutic strategies should also focus on systemic immunomodulation.

Suppressed cellular immunity is common in patients with squamous cell carcinoma of the head and neck (HNSCC). It was demonstrated in previous studies that administration of interleukin 2 (IL-2) results in enhanced antitumoral immunity in vitro as well as in vivo. Since the serum half-life of IL-2 is relatively short, repeated applications are necessary to achieve therapeutically effective serum concentrations, but this strategy might cause severe side effects. Therefore, methods that provide high local cytokine levels over a prolonged period of time without the need for repeated injections are desirable. Gene therapy as an innovative treatment approach using tumor cells stably transduced to produce IL-2 might meet these criteria. In vitro manipulated tumor cells, if readministered in the vicinity of non-manipulated tumor cells, may enhance a specific anti-tumor response in vivo without systemic side effects. The present manuscript reviews the current literature dealing with IL-2-protein and -gene therapy with special emphasis on head and neck cancer. Our own in vitro results with IL-2 gene therapy in conjunction with published data from other authors argue in favour of an in vivo approach for this therapeutic strategy that is currently in progress in our department.

Objective: IL-2 is the primary interleukin responsible for activation of the cell-mediated (Th1) arm of the immune response. Our objective was to determine whether a correlation existed between circulating levels of interleukin-2 as well as its soluble receptor (sIL-2R) and the clinical course of recurrent respiratory papillomatosis., Methods and Materials: Fifteen children with a histological diagnosis of RRP were recruited. Age at the time of study, time since first diagnosis, and number of surgical interventions were recorded. The number of surgically treated recurrences per year was then calculated. We obtained serum samples from each of these 15 children and from 10 normal control subjects. We then performed in vitro determination of serum IL-2 and soluble IL-2 receptor levels using enzyme-linked immunosorbent assay (ELISA) techniques., Results: IL-2 was significantly lower (136.6 vs. 199.9 pg/mL, P =.035) in papilloma patients than in control subjects. IL-2R was also lower in papilloma patients (531.7 vs. 785.8 U/mL, P =.025). There was no statistical age difference between the papilloma and control groups. Among patients with papillomatosis, IL-2 and sIL-2R levels were significantly higher in those with aggressive disease (>4 surgically treated recurrences per year) versus non-aggressive disease (179.2 vs. 99.2 pg/mL, P =.024; and 697 vs. 387 U/mL, P =.022). Age was also significantly lower in the aggressive papilloma group (P =.002)., Conclusions: Levels of interleukin-2 and IL-2 receptor were significantly lower in patients with recurrent respiratory papillomatosis compared with normal children. These data support the presence of an aberrant cell-mediated immune response in children with recurrent respiratory papillomatosis.

Purpose: It is well known that chemotherapy and radiotherapy in other tumor sites than head and neck cause immunomodulating effects. The purpose of this trial was to assess the influence of radiochemotherapy in head and neck on cellular and subcellular immunity., Patients and Methods: In a phase II/III-trial fifty patients with advanced squamous cell carcinoma of the head and neck were treated by simultaneously accelerated radiochemotherapy with Carboplatin (70 mg/sqm). Total radiation dose was 66 Gy/35 days. The following immunological parameters were investigated at several time points during therapy: total lymphocytes, total T-lymphocytes, CD4+ lymphocytes, CD8+ lymphocytes, monocytes, natural killer cells, interleukin-2-receptor-positive T-cells, MHC class II-positive B-cells, monocytes and T-cells, CD4/CD8-ratio; Cytokines: II-1, soluble II-1-receptor antagonist, II-2, soluble II-2-receptor, II-3, II-4, II-6, soluble II-6-receptor, II-8, interferon-alpha, granulocytes-macrophages-colony-stimulating-factor, tumor necrosis factor-alpha, soluble intercellular adhesion molecule-1. In addition, responses to the in vitro stimulation of lymphocytes by mitogens was tested., Results: During therapy lymphocyte subpopulation counts decreased significantly but reversibly. Simultaneously, the function of lymphocytes was significantly but reversibly reduced. Also, II-8-concentration decreased significantly whereas concentrations of II-6 and soluble II-1-receptor antagonist significantly increased., Conclusions: The accelerated radiochemotherapy with Carboplatin induces a severe impairment of cellular immunity, followed by compensatory cytokine reaction.

The immunomodulating effect of primary surgical intervention was investigated in 33 patients with squamous cell carcinomas of the oral cavity, pharynx and larynx. An operation time longer than 7 h was significantly associated with a decrease in lymphocytes, CD4(+) T-lymphocytes and CD8(+) T-lymphocytes. The CD4/CD8-ratio as a marker for the down-regulation of the cellular immune response was slightly decreased but was still in the normal range. CD4-lymphocyte counts increased 7 days after operation while CD8 lymphocytes were found elevated 4 weeks after surgery. The in vitro stimulation of the lymphocytes was impaired for 1 to 4 weeks. Interleukins, interferon-gamma and tumor necrosis factor did not show any changes after surgery. Decreases of lymphocytes, especially CD4(+) and CD8(+) lymphocytes, were significantly associated with the time of operation and the volume of blood loss. Extensive trauma, age, different kinds of anesthesia and intensive care interventions were not associated with specific immunomodulating effects, although these factors might be responsible for suppressing cytokine responses.

The aim of the study was the induction of an antitumor immune response by genetic modification of tumor cells. This was done by transfecting the costimulatory molecule B7.1 into a murine tumor cell line SCCVII/SF in order to increase T cell recognition and to install an immunologic memory. One cohort of immunocompetent mice C3 H/HeN were injected with B7.1 expressing tumor cells, while the control group received parental B7.1 negative tumor cells. In a second step those immunized mice were rechallenged by parental tumor cells and tumor growth was compared to a new control group. Transfection with B7.1 prohibits outgrowth of the SCCVII cell line. Animals that have been vaccinated in this way are partially immune towards a secondary exposition to B7.1 negative tumor cells. Outgrowth of this recurrent tumor is slowed down. Such an immunization builds up an immunologic memory. Vaccination with B7.1 expressing tumor cells lead to a partial protective tumor immunity in the SCCVII-C3 H/HeN mouse model.

Background: The rationale for the study was based on the hypothesis that decreased or absent expression on tumor cells of adhesion molecules, the class I or class II major histocompatibility complex (MHC) molecules, or costimulatory molecules might be responsible, in part, for the poor ability of squamous cell carcinoma of the head and neck (SCCHN) to induce generation of antitumor effector cells in vitro and in vivo., Objective: To investigate expression of intercellular adhesion molecule-1 (ICAM-1) and lymphocyte function associated antigen-3 (LFA-3) and distribution of the costimulatory molecules, B7.1, B7.2, and CD40, and of class I and class II MHC molecules on SCCHN cells in situ and on SCCHN cell lines., Setting: University medical centers., Design: Expression of ICAM-1, LFA-3, MHC molecules, B7.1, B7.2, and CD40 was evaluated in human SCCHN biopsy specimens by immunohistochemistry and on SCCHN cell lines by flow cytometry. To confirm our hypothesis that impaired T-cell activation observed in patients with SCCHN is caused by the absence of costimulatory B7 molecules, a B7-negative SCCHN cell line was transduced with the B7.1 gene, using a retroviral vector, and tested in mixed lymphocyte tumor cocultures., Results: In contrast to abundant expression of ICAM-1, LFA-3, class I MHC molecules, and CD40, the absence of B7.1, B7.2, and class II MHC molecules on tumor cells was observed in situ and in vitro. Lymphocytes and antigen-presenting cells in inflammatory infiltrates surrounding tumor cell clusters expressed both costimulatory and adhesion molecules. The SCCHN lines negative for B7.1 and class II MHC antigens failed to induce proliferation of T cells in mixed lymphocyte tumor cocultures. However, when these cell lines were transduced with the B7.1 gene, their ability to induce T-cell proliferation in mixed lymphocyte tumor cocultures was restored., Conclusions: The absence of B7 protein or class II MHC antigen expression on human SCCHN cells is responsible for the failure of these tumors to induce proliferation of T cells in vitro. Transduction of the B7.1 gene into SCCHN restores the ability of the tumor to induce T-cell proliferation in vitro.

Aim: Until now no serological markers were available towards the diagnosis of squamous-cell carcinomas of the head and neck (HNSCC) particularly in the detection of posttherapeutic recurrent diseases and metastases. Previous reports described patients with malignant diseases of various tissues exhibiting a characteristic and highly significant alteration in the subclass composition of serum IgG, consisting of a reduction in %IgG1 and an increase of %IgG2. In this study we present for the first time results of this IgG-shift in patients suffering from HNSCC., Patients and Methods: A total of 111 patients was investigated at our clinic, all suffering from primary, histopathologically verified squamous cell carcinomas of the head and neck. These patients were investigated as to %Ig G1/IgG2 prior to any treatment. A second group consisted of 35 patients with local recurrences, 15 patients with distant metastases and 27 patients without tumour at the time of investigation, who were in observation for 1 to 5 years after primary treatment (T0). Thirdly, a total of 33 patients was included who were afflicted with a variety of benign diseases of the head and neck, such as chronic rhinosinusitis, chronic tonsillitis and also lateral or median cysts of the neck. Data of the three groups were compared with those of 174 healthy volunteer controls. 5 ml blood were taken from a forearm vein and the quantitation of subclasses IgG1, IgG2 and total IgG was performed by affinity chromatography. The single values obtained with all experimental groups and healthy controls showed normal distribution for primary cancer patients versus healthy control. Accordingly, significant differences between mean values were calculated with the two-sided Students t-test, and cut-off values were calculated as the arithmetic means of mean values obtained from the groups to be compared. Diagnostic sensitivities and specificities were defined as percentages of patients with %IgG1 smaller, and of healthy controls with %IgG1 greater than the cut-off value., Results: We found a highly significant alteration in the subclass composition of serum IgG, consisting of a reduction in %IgG1 and an increase in %IgG2 in our HNSCC groups. The present data suggest the changes in %IgG1 and %IgG2 as a useful serological tumour marker to detect primary or recurrent and/or metastatic squamous-cell carcinomas of the head and neck., Conclusion: The shift in %IgG1/%IgG2 exhibited diagnostic sensitivities and specificities comparable to, or--particularly at early tumour stages--by far higher than conventional serological tumour markers. Whereas conventional serological markers directly correspond to tumourogenically derived products, the shift in %IgG1/IgG2 represents an indirect marker, consisting of a change of the host's immune system due to the presence of malignant tumours.

Background: Squamous cell carcinoma is the most common cancer of the head and neck. The application of monoclonal hybridoma technology to the identification and characterization of molecules preferentially expressed in carcinoma cells may provide potentially important diagnostic and therapeutic tools., Methods: After immunization of mice with viable squamous cell carcinoma cells derived from human tumors of the upper aerodigestive tract hybridomas were selectively grown for production of monoclonal antibodies. Monoclonal antibodies produced by 690 hybridoma clones were tested on immunoreactions with frozen sections of human squamous cell carcinoma and reactive tonsils., Results: Immunohistochemical trials showed that monoclonal antibodies produced by hybridoma clone K-640 are strongly accumulated at the plasma membrane whereas no immunoreaction in squamous epithelium of the tonsil could be detected. By means of ELISA it could be shown that these antibodies belong to the class of IgM. Immunoblotting revealed that the antibodies recognize antigenes with approximate molecular weights of 52 and 54 kD., Conclusions: The experiments suggest that the hybridoma clone K-640 produces antibodies which bind to the plasmamembrane of the tumor cells. Further recloning steps of this hybridoma clone could possibly enhance the specificity of these antibodies for squamous cell carcinoma.

Objective: Mutations of the p53 gene are the most prevalent genomic changes in human malignancies. The detection of these mutations is usually carried out by gene sequencing or with immunohistochemical methods. A new approach is to search for p53 antibodies in serum of cancer patients. The cause for the production of antibodies against p53 is unclear. The aim of this study was to show the correlation between p53 pointmutations and p53 antibodies in patients with squamous cell carcinoma of the head and neck (SCCHN)., Methods: A semiquantitative ELISA was employed to screen the serum of 117 patients with SCCHN for p53 antibodies. Sixty-one tumor samples were evaluated with SSCP-analysis for point mutations in exons 4 to 9., Results: Twenty-three (19.7%) of the cancer patients had antibodies to p53. There was no significant difference in the frequency of p53 point mutations in exon 4 to 9 between the whole cancer patient group and the p53 antibody positive group., Conclusions: The accumulation of p53 in the tumor cell is one hypothesis as to how p53 becomes immunogenic. This leads to a decrease in tolerance after a certain amount of time. In contrast to this it is assumed that after a p53 point mutation, important protein determinants are changed and p53 becomes antigenic. The results of this study indicate that p53 point mutations in SCCHN seem to have no influence on the development of p53 antibodies. Therefore this study supports the theory that the loss of tolerance and subsequently the antibody production is induced by an accumulation of p53. The type of p53 point mutations on exon 4-9 seems to have no influence that p53 gains immunogenic potential in SCCHN:

Background: The mutated form of the nuclear tumor suppressor protein p53 plays an important role as oncogene in the malignant transformation of cells. A new serologic parameter are antibodies against the p53 protein, that are found in many carcinoma entities and localizations and may have a prognostic relevance. Antibodies against p53 in the serum of patients with squamous cell carcinoma of the head and neck (SCCHN) have not yet been described., Methods: A set of 117 sera from patients with SCCHN were screened for serum antibodies against p53 with ELISA (Dianova, Hamburg). The serum of 41 healthy blood donors served as controls. Tumor tissue of 45 patients was examined with ELISA for p53 protein accumulation., Results: In 23 patients (19.7%) with SCCHN p53 antibodies were demonstrated. The control sera were all negative for p53 antibodies. No correlation was found between the presence of p53 antibodies and tumorstage, tumor grading, age or sex of the patient or tumorlocalization. Thirteen of the 15 tumor samples from p53 antibody positive patients showed detectable levels of p53 protein., Conclusions: The frequency of p53 antibodies in patients with SCCHN is comparable with the occurrence of these antibodies in other malignancies. An accumulation of p53 in the tumor tissue seems to be necessary to initiate the antibody production. p53 antibodies seem to be an indicator for malignancy in SCCHN and may be of potential diagnostic and prognostic value.

The search for methods providing selective action on some subpopulations of immune system cells is an important task of oncologic immunology. Adaptive immunotherapy [AI] may create new options in this field. AI was used as adjuvant in combined therapy of 180 patients with ENT cancer. The response was confirmed by correction of some immunological, cytological, biochemical, immunochemical, radioimmunological, biophysical and rheological parameters. Practical guides are presented on AI use at different stages of combined treatment.

Background: Several investigations showed increased levels of the soluble interleukin-2 receptor (sIL-2 R) in chronic and malignant diseases. A correlation between elevated sIL-2 R levels and disease activity or tumor size was observed in some patients. At present, there are no studies of sIL-2 R serum levels in patients with squamous cell carcinomas of the upper aerodigestive tract., Methods: SIL-2 R levels were measured in sera of 86 patients with squamous cell carcinoma of the head and neck and of 25 healthy controls with a sandwich ELISA., Results: Significantly elevated serum levels of sIL-2 R were detected in 49 out of 86 patients (56.9%) with squamous cell carcinoma of the head and neck. The mean serum level in the healthy controls was 437 U/ml compared to 895 U/ml in carcinoma patients. A correlation was found between tumor size, number of metastases and the sIL-2 R level. There was no correlation with histological type or tumor localization., Discussion: The physiological role of sIL-2 R is still unknown. Elevated levels of sIL-2 could be a sign of activation of the immune system. But they also might be involved in causing the disease. The sIL-2 R serum levels in patients with squamous cell carcinoma of the head and neck may serve as an unspecific indicator for tumor size and dissemination., Conclusion: Posttherapeutic titer controls could be of prognostic value. Additionally, sIL-2 R may help to select appropriate patients for an immunotherapy with recombinant IL-2.

The effect of locoregional postoperative radiation therapy on cellular immunity was investigated in 11 patients with head and neck cancer. During the course of the radiation therapy, total lymphocyte counts, CD8+ lymphocyte counts and especially CD4+ lymphocyte counts decreased significantly. The mean CD4+ lymphocyte counts dropped from 739/microliters to 183/microliters (p < 0.001) and the average CD4+/CD8+ ratio also decreased significantly. In addition all patients showed impaired in vitro lymphocyte stimulation responses to several mitogens, with reductions found to be 10% to 50% of normal responses. Within 3-4 weeks after radiation therapy there was a slight increase of CD4+ lymphocyte counts and the in vitro lymphocyte stimulation responses showed a tendency to normalization. These results indicate that locoregional postoperative radiation therapy in patients with head and neck cancer can induce a severe impairment of cellular immunity.

Both nasopharyngeal and tumors and epithelial cancer of topographically different sites of the mouth, laryngopharynx are shown to be associated in many cases with high immunity to virus Epstein-Barr (VEB) antigens. VEB-associated antibody quantitation in patients with laryngeal, laryngopharyngeal, oral and lingual cancer revealed that the malignant process dissemination and the tumor differentiation are related to immune response to VEB antigens: the more advanced is cancer and the poorer is its differentiation, the more pronounced is the immune response.

The incidence and titer of ANCA were examined with 871 sera from patients with otorhinolaryngological diseases at our hospital. The cytoplasmic pattern of ANCA (c-ANCA) whose titer was more than 16 was detected only in the sera of patients with Wegener's granulomatosis (WG). The incidence of c-ANCA in active WG was more than 90%. The perinuclear staining pattern of ANCA (p-ANCA) was detected in almost 40% of patients with Sjögren's syndrome, 2.0% of inflammatory diseases and 1.0% of tumorous diseases. A high diagnostic value of c-ANCA in WG was found in patients with otorhinolaryngological diseases.

Monoclonal antibodies were used to examine the presence and nature of tumor associated macrophages and T-lymphocytes in 26 cases of squamous cell carcinoma of head and neck. The content of macrophages varied according to the differentiation of the carcinoma: high differentiation was evidenced by a labelling index by an index between 13.5% and 23.7%, poor differentiation from 27.4% to 35.8%. T-lymphocytes were found where tumors were inflamed, but there was no significant correlation between tumor differentiation and infiltrating T-lymphocytes. The present results that prognosis decreases with the increasing number of tumor associated macrophages in squamous cell carcinoma.

Specific circulating serum proteins may reflect unique properties governing the growth and progression of head and neck cancers. One hundred three previously untreated patients with squamous cell carcinoma of the head and neck were prospectively evaluated for serum IgA, IgG, and IgM and C1q-binding macromolecules. Immunoglobulins were assessed by the immunoturbidimetric technique. C1q-binding macromolecules (C1qBM) were measured utilizing the iodine-125 assay of Zubler et al (J Immunol 1976; 116: 232-5). Neither the level of serum immunoglobulins nor C1qBM values were correlated with the primary site, AJC (American Joint Committee on Cancer) stage of disease, or size of primary lesion. Likewise, comparison of serum IgA with C1qBM values demonstrated that these laboratory parameters were independent variables (r = 0.15 by Pearson linear regression). Univariate statistical analysis, utilizing the Cox proportional hazard model, showed serum IgA and C1qBM values to each contribute significantly to the ability to predict survival in patients with advanced squamous cell carcinoma of the head and neck (p = 0.01 and 0.003, respectively). Furthermore, multivariate analysis reveals that both C1qBM and serum IgA levels contribute significantly to the hazards model beyond staging in predicting survival (p less than 0.001). Predictive results were most apparent in patients with stage IV disease and related to the probability of both regional and distant metastatic recurrences. Conversely, serologic analysis provided no information in patients who were staged early. These results support pretreatment multiparametric serologic analysis of patients with squamous cell carcinoma of the head and neck.

Present-day developments in oncological applications of laser therapy are adaptive laser immunotherapy (ALIT) and photodynamic therapy (PDT). ALIT (helium-neon laser) was used in 35 ENT-cancer patients to irradiate immunocompetent leukocytes isolated from blood in an Amino cell separator. The use of ALIT in the combined treatment of our patients improved their health condition. Cytological, immunochemical and immunological examinations of blood revealed an increased count of activated lymphocytes, normalization of acute-phase proteins, stimulation of cell-mediated immunity and nonspecific resistance. The pharmacokinetics and photodynamic activity of porphyrin compounds in mice with inoculated tumors were investigated. Experimental observations demonstrated that the application of photodynamic therapy of hematoporphyrins in ENT-oncology seems very promising.

Correction of the immune status is one of the burning problems of current otorhinolaryngology. Recent developments in immunology allow interference at the cellular level. However, otorhinolaryngological practice is still based on oral, parenteral or local use of ineffective drugs. This paper presents early results of the application of extracorporeal cytapheresis combined with the modulator treatment of lymphocytes for the surgical therapy of 25 patient with ENT malignant neoformations of different stage and localization. Leukocytapheresis, i. e. separation of leukocytes, was performed by means of an Aminco (USA) or FK-3,5 (USSR) cell separator and the separated cells were treated with diuciphone. This method yielded good results as suggested by immunological, immunochemical, biophysical, and cytological measurements of blood. The method seems promising for ENT-cancer therapy.

A multicenter and retrospective study of the diagnosis value of SCC-TA4 in squamous cell carcinomas of 4 localisations was made with the 2 thresholds of 2 and 2.5 ng/ml. However, 3.1% of controls have a SCC value above 2.5 ng/ml. Sixteen benign gynecologic pathologies had no positive level. The benign digestive (N = 73), bronchial (N = 345) pathologies and no squamous cell carcinomas (N = 93, N = 220 respectively), had SCC-TA4 mean levels significantly lower than corresponding squamous cell carcinomas (N = 153, N = 128 respectively). Sensitivity of the test varied from 40% in the squamous cell carcinomas of the lung, to 72% in the squamous cell carcinomas of the uterine cervix. Specificity was always very high and varied from 91% in the SCC of lung, to 100% in the SCC of uterine cervix. For the SCC of uterine cervix, oesophagus and head and neck, the mean values and incidence of positive levels increased significantly with increasing tumor size and advancing disease stage. For the SCC of uterine cervix, mean SCC-TA4 levels and percentages of positive levels above 2 ng/ml were significantly higher for the patients with recurrence (22.5 +/- 4.6 ng/ml; 76%) or with metastasis appearance (23.6 +/- 5.4 ng/ml; 77%) than for the patients in remission (less than 1.5 ng/ml; 0%). In the SCC of oesophagus, we report levels before treatment that are significantly higher for the patients with metastasis at the first attempt (4.2 +/- 5.1 ng/ml; 59%), and an elevated SCC level at the diagnosis evoked a SCC of lung already disseminated (8.8 +/- 12.1 ng/ml; 50%) that will fail to respond to treatment (4.0 +/- 4.2 ng/ml; 48%).

Results from pre-treatment SCC antigen assay were assessed in 106 patients with epidermoid carcinoma of the upper aerodigestive ways. The control population consisted of healthy blood donors (N = 61). Blood antigen levels ranged 1.6 ng/ml to 21.5 ng/ml in the patient population. 35 patients in 106 (i.e., 33% of cases) had levels considered pathological (greater than 2.00 ng/ml). Antigen levels were higher with increasing tumor size and when adenopathy was more marked (N+, N+R+). However, no correlation could be found with the T (stage)--N (histological) classification of tumors or with the site of lesion. Tumor immunologic response was obviously not uniform. Although the SCC antigen presents no diagnostic value, it appears to bear some prognostic significance, regardless of the tumoral stage. Antigen levels below 2.00 ng/ml correlate with (p less than 0.001) good immediate therapeutical results. On the other hand, serum levels greater than 2.00 ng/ml correlate either with non-sterilization, or with locoregional recurrence and/or rapid development of metastases. Other studies are required to confirm these data, and to demonstrate the value of long-term SCC antigen monitoring in these patients.

E, E-active and autologous-rosette-forming-lymphocytes (E, Eact-, auto-RFC) were studied in 66 patients with lung cancer (2 stage I, 17 stage II, 20 stage III, 27 stage IV), 42 patients with head and neck cancer (14 stage III, 28 stage IV) and 22 patients with esophagus cancer (11 stage II, 6 stage III, 5 stage IV). Compared to controls, E-RFC were found to be depressed in each of the three different localizations (p less than 0.001), Eact-RFC were found to be depressed in head and neck as well as esophagus cancer (p less than 0,05 and p less than 0,01 respectively) and auto-RFC were found to be depressed in lung and esophagus cancer (p less than 0,01). Mean survival times of patients with RFC over and under 1 SD below the average value were compared. Significant differences were demonstrated in E-RFC and auto-RFC for head and neck cancer and in Eact-RFC for lung cancer.