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Background: It is a truth universally acknowledged that the diagnosis of cancer is a huge stress for both individuals and families. While many psychosocial variables have been shown to influence the mental well-being, these factors are so complicated and interlinked with each other, that their integrated effect on oral cancer patients, who constitute a large morbid group of patients, is yet to be recognized. Aims and Objectives: The present research work aims to find more about the prevalence of stress, anxiety, and depression among patients with cancers of the oral cavity and work out on some key potentially predictive factors associated with anxiety and depressive symptoms. Materials and Methods: A cross-sectional observational study was carried out for patients of oral cancer, attending the radiation oncology out-patient department (OPD) at Medical college, Kolkata, between April 2022 and March 2023, a 1-year period. A total of 89 patients with oral cancer were interviewed with questionnaires on demographic variables, depression anxiety stress scale 21, and National Comprehensive Cancer Network Distress Thermometer. Chi-square tests and Spearman Correlation tests were conducted where appropriate to explore relationships between different variables. Results: The prevalence of stress symptoms, anxiety symptoms, and depressive symptoms was 44% (39/89), 60% (53/89), and 84% (75/89), respectively, among the patients interviewed. Addiction history of the patients was an important association found in this study. Conclusion: The prevalence of stress and depressive symptoms was high among the oral cancer patients attending the Radiation Oncology OPD at our institution as well as levels of anxiety. Certain social variables such as relationship with spouse, children, and other family members had a profound effect on the mental well-being of the patients. Furthermore, certain factors such as addiction to tobacco and its different forms reduced the coping up capability of the patients.

Background: It is a truth universally acknowledged that the diagnosis of cancer is a huge stress for both individuals and families. While many psychosocial variables have been shown to influence the mental well-being, these factors are so complicated and interlinked with each other, that their integrated effect on oral cancer patients, who constitute a large morbid group of patients, is yet to be recognized. Aims and Objectives: The present research work aims to find more about the prevalence of stress, anxiety, and depression among patients with cancers of the oral cavity and work out on some key potentially predictive factors associated with anxiety and depressive symptoms. Materials and Methods: A cross-sectional observational study was carried out for patients of oral cancer, attending the radiation oncology out-patient department (OPD) at Medical college, Kolkata, between April 2022 and March 2023, a 1-year period. A total of 89 patients with oral cancer were interviewed with questionnaires on demographic variables, depression anxiety stress scale 21, and National Comprehensive Cancer Network Distress Thermometer. Chi-square tests and Spearman Correlation tests were conducted where appropriate to explore relationships between different variables. Results: The prevalence of stress symptoms, anxiety symptoms, and depressive symptoms was 44% (39/89), 60% (53/89), and 84% (75/89), respectively, among the patients interviewed. Addiction history of the patients was an important association found in this study. Conclusion: The prevalence of stress and depressive symptoms was high among the oral cancer patients attending the Radiation Oncology OPD at our institution as well as levels of anxiety. Certain social variables such as relationship with spouse, children, and other family members had a profound effect on the mental well-being of the patients. Furthermore, certain factors such as addiction to tobacco and its different forms reduced the coping up capability of the patients. [ABSTRACT FROM AUTHOR]

Objectives: The pathogenesis of oral cavity cancers is complex. We tested the hypothesis that oral microbiota dysbiosis is associated with oral cavity cancer. Materials and methods: Patients with primary oral cavity cancer who met the inclusion and exclusion criteria were included in the study. Matching healthy individuals were recruited as controls. Data on socio-demographic and behavioral factors, self-reported periodontal measures and habits, and current dental status were collected using a structured questionnaire and periodontal chartings. In addition to self-reported oral health measures, each participant received a standard and detailed clinical examination. DNA was extracted from saliva samples from patients and healthy controls. Next-generation sequencing was performed by targeting V3-V4 gene regions of the 16 S rRNA with subsequent bioinformatic analyses. Results: Patients with oral cavity cancers had a lower quality of oral health than healthy controls. Proteobacteria, Aggregatibacter, Haemophilus, and Neisseria decreased, while Firmicutes, Bacteroidetes, Actinobacteria, Lactobacillus, Gemella, and Fusobacteria increased in oral cancer patients. At the species level, C. durum, L. umeaens, N. subflava, A. massiliensis, and V. dispar were significantly lower, while G. haemolysans was significantly increased (p < 0.05). Major periodontopathogens associated with periodontal disease (P. gingivalis and F.nucleatum) increased 6.5- and 2.8-fold, respectively. Conclusion: These data suggested that patients with oral cancer had worse oral health conditions and a distinct oral microbiome composition that is affected by personal daily habits and may be associated with the pathogenicity of the disease and interspecies interactions. Clinical relevance: This paper demonstrates the link between oral bacteria and oral cancers, identifying mechanistic interactions between species of oral microbiome. [ABSTRACT FROM AUTHOR]

Introduction: Pectoralis major myo-cutaneous (PMMC) flap continues to be a widely used tool to reconstruct oral cavity defects. But an unreliable and unstable vascular supply can lead to complications like flap loss, Oro-cutaneous fistula and wound dehiscence. Preservation of the lateral thoracic artery (LTA) has been suggested to improve the vascularity of the skin paddle. The present study aspires to compare the complications and flap related outcomes after preserving or sacrificing the LTA while reconstructing oral cavity defects with bi-folded PMMC flap. Materials and Methods: Retrospective analysis of the data of 61 male patients who were reconstructed with bi-folded PMMC flaps between January 2022 and September 2022 was done. 36 patients were reconstructed using a PMMC flap where the LTA was sacrificed, whereas in 25 patients the LTA was preserved. Data was analyzed in terms of patient factors and flap related complications. Results: The overall complication rate including major/minor complications was 44.26% with flap detachment at 22.95% being the commonest complication observed. 13.11% patients developed an Oro-cutaneous fistula and partial and complete flap loss were seen in 9.83% and 4.91% respectively. LTA preservation was significantly associated with only decreased flap detachment rates (p value < 0.05). No significant association was noticed between other flap related complications and LTA preservation. Conclusion: Reconstructing larger defects with a PMMC flap where the LTA is preserved can help improve the vascularity of the flap and decrease various major/minor flap related complications. [ABSTRACT FROM AUTHOR]

Background: We prospectively assessed acute and late toxicity in post‐operative oral cavity squamous cell carcinoma (PO‐OCSCC) treated with adjuvant dysphagia optimized intensity‐modulated radiotherapy (Do‐IMRT) versus standard IMRT (S‐IMRT). Material and methods: Fifty‐six patients of PO‐SCC without indications of concurrent chemotherapy were alternatively allocated to adjuvant Do‐IMRT (n = 28) versus S‐IMRT (n = 28) arms. High‐ and low‐risk planning target volume received 60 and 54 Gy, respectively, in 30 fractions over 6 weeks. Dysphagia aspiration‐related structures (DARS) were contoured in both arms. While dosimetric constraints were given in Do‐IMRT arm, doses to DARS were only observed without dose constraints in S‐IMRT arm. Acute and late toxicity were assessed by common terminology criteria for adverse events (CTCAE) v5.0 and RTOG criteria, respectively. Results: The primary site of disease was buccal mucosa (64% vs. 53%) and oral tongue (21% vs. 32%), in Do‐IMRT and S‐IMRT, respectively. The mean doses to DARS was significantly less with Do‐IMRT (all p < 0.001) as compared to S‐IMRT. Median follow‐up was 24.2 months. Grade ≥2 oral pain was less in the Do‐IMRT arm (50% vs. 78.6%, p = 0.05). Grade ≥2 late dysphagia at 2 years were significantly less in Do‐IMRT arm (0% vs. 17.9%, p = 0.016). Two‐year locoregional control was 89.2% in Do‐IMRT and 78.5% in S‐IMRT (p = 0.261). Conclusion: DARS can be spared in PO‐OCSCC patients treated with Do‐IMRT without compromising coverage of the target volumes. Limiting doses to DARS leads to lesser acute and late toxicity without compromising locoregional control. [ABSTRACT FROM AUTHOR]

Background and aims: Free flaps are the standard method of reconstruction in advanced oral SCC. But the high incidence of oral SCC in India and the limited availability of plastic surgery pushes for alternate modes of reconstruction. Pectoralis major myocutaneous flap reconstruction has been widely practised in our country. Aims: To assess the reliability of bipaddle pectoralis major myocutaneous flap for the reconstruction of complex defects following resection of locally advanced oral SCC. Methods: This study is retrospective in design. A total of 72 patients with advanced oral SCC requiring bipaddle reconstruction operated in the period of September 2019 to August 2022 were included in the analysis. All relevant clinical, intraoperative and histopathological data along with swallowing and speech function assessment at 3 and 6 months were collected and analysed. Results: 87.5% (n=63) of the patients received surgery as the primary modality of treatment in this study. The various grades of flap necrosis were seen in 16.7% (n=12) patients whereas the rates of major flap necrosis were seen in 5.6% (n=3) of the study patients. All major complications were seen in female patients. A delay in radiotherapy was seen in 12.7% (n =7 of 55) patients with the presence of major complications being significantly associated with delay in radiotherapy. A mean FIGS swallowing and speech function of 3 for both functions were noted in this study at 6 months after surgery. Conclusion: A PMMC flap reconstruction continues to be a reasonable and reliable alternative form of reconstruction for oral SCCC patients with acceptable early and late outcomes. [ABSTRACT FROM AUTHOR]

Aims: The present study examines the role of demographic and pathological features of primary tumours in predicting neck metastasis in early oral cavity cancers, which has been a matter of debate. Methods: A single-centre, retrospective, institution review was conducted of all the patients presented to our centre from January 2014 to December 2021. Patient characteristics were compared between the two lymph node groups (lymph node positive and lymph node negative) and significant prognostic factors were determined. Results: A total of 462 oral squamous cell carcinoma (OSCC) patients were included, 407 male and 55 female. Tobacco chewing (59.2%) was a major habit with buccal mucosa (49.5%) and tongue (44.8%) as primary sites. The majority of the patient's histology was of SCC (96.8%) with grade II (moderately differentiated, 74.5%). Univariate logistic regression analysis to predict lymph node metastasis showed pT size (< 0.001), LVI (< 0.001), and PNI (< 0.001) as significant tumor characteristics. On multivariate, pT size (OR-1.58, P – 0.0001) and LVI (OR-19.70, P – 0.0001) were reported to be statistically significant to predict lymph node metastasis. Conclusion: Reporting and studying the clinico-pathological features of primary tumors can give vital information in predicting the neck node metastasis in OSCC patients. [ABSTRACT FROM AUTHOR]

Follow-up of patients treated for head and neck cancer is an important part of the overall treatment. Oral cancers are one of the leading causes of dysphagia. Swallowing dysfunction occurs owing to the disease itself, its predisposing factors, and the treatment. This study aims to evaluate swallowing dysfunction in patients with oral cavity cancers. This prospective study was carried out in a tertiary care hospital institution. Thirty patients with T3, T4 oral cancers were evaluated using institutional dysphagia score and fiber optic endoscopic evaluation of swallowing (FEES) (Penetration-Aspiration Scale, Yale Pharyngeal Residue Scale) before treatment, after surgery, and after adjuvant therapy. Advanced-stage tumor, larger resections, and adjuvant therapy are risk factors for dysphagia postoperatively. Although the dysphagia score is our institutional score, the results are promising, that is, 10 % of patients having symptoms at baseline evaluation, which increased to 60% and 70% after surgery and adjuvant radiotherapy respectively. Our study findings of the Penetration Aspiration Scale are 13% aspiration rate at the baseline evaluation, which increased to 57% and 73% after surgery and after adjuvant radiotherapy, respectively, and these results are consistent with those of other report studies. The Vallecular Residual Scale showed that there was a significant association between three different timelines and demonstrated dysphagia among study subjects. Subjective and objective assessment of swallowing dysfunction before and after the treatment of head and neck cancers is underreported and underrecognized. Most of the patients in our study had significant swallowing impairment after treatment. FEES is a very effective procedure to diagnose dysphagia and will help in incorporating better preventative and rehabilitative measures. [ABSTRACT FROM AUTHOR]

Objective: The space comprised between tumor and neck lymph nodes (T‐N tract) is one of the main routes of tumor spread in oral cavity tumors. Aim of the study was to investigate the impact of T‐N tract involvement on the postoperative radiotherapy (PORT) outcomes. Materials and Methods: Patients (pts) treated between 2000 and 2016 with indication to PORT were retrospectively retrieved. Inclusion criteria were: (a) locally advanced tumors of the oral cavity, (b) who received with indication to PORT (c) with a minimum follow‐up of six months. Results: One hundred and fifty‐seven pts met the inclusion criteria (136 pts treated with PORT and 21 pts not treated with PORT). In the PORT cohort, the T‐N tract involvement had no impact on both OS (p =.09) and LRFS (p =.2). Among the non‐PORT cohort, both OS (p =.007) and LRFS (p =.017) were worse for pts with positive T‐N tract compared to those with negative T‐N tract. PORT improved both OS (p =.008) and LRFS (p =.003) in pts with positive T‐N tract but not in those with negative T‐N tract (p =.36 and p =.37, respectively). Conclusions: Our results suggest that involvement of T‐N tract should be considered as prognostic factors informing the indication to PORT. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cavity carcinoma (OCC) is the 11th most frequently diagnosed cancer; despite a multimodal treatment, locally advanced OCC, managed by surgery and adjuvant therapies, remains at high risk of recurrence, with a 5-year overall survival (OS) of 51%. The efficacy of postoperative chemotherapy in addition to radiotherapy (POCRT) in low–intermediate risk OCC is a controversial matter in the absence of high-risk features (ENE, R1). To establish the role of POCRT in a population with solely minor risk factors (perineural invasion or lymph vascular invasion; pN1 single; DOI ≥ 5 mm; close margin; node-positive level IV or V; pT3 or pT4; multiple lymph nodes without ENE), we performed a systematic review and meta-analyses focused on OS, disease-free survival (DFS), and local-recurrence-free survival (LRFS). Thirteen studies met the inclusion criteria and were included in the quantitative meta-analyses. Our preliminary results are in favor of POCRT in terms of OS but not conclusive for DFS and LRFS. Further analyses are suggested. When presenting with major pathological risk factors, adjuvant radio-chemotherapy for oral cavity cancers (OCC) is recommended, but the addition of chemotherapy to radiotherapy (POCRT) when only minor pathological risk factors are present is controversial. A systematic review following the PICO-PRISMA methodology (PROSPERO registration ID: CRD42021267498) was conducted using the PubMed, Embase, and Cochrane libraries. Studies assessing outcomes of POCRT in patients with solely minor risk factors (perineural invasion or lymph vascular invasion; pN1 single; DOI ≥ 5 mm; close margin < 2–5 mm; node-positive level IV or V; pT3 or pT4; multiple lymph nodes without ENE) were evaluated. A meta-analysis technique with a single-arm study was performed. Radiotherapy was combined with chemotherapy in all studies. One study only included patients treated with POCRT. In the other 12 studies, patients were treated with only PORT (12,883 patients) and with POCRT (10,663 patients). Among the patients treated with POCRT, the pooled 3 year OS rate was 72.9% (95%CI: 65.5–79.2%); the pooled 3 year DFS was 70.9% (95%CI: 48.8–86.2%); and the pooled LRFS was 69.8% (95%CI: 46.1–86.1%). Results are in favor of POCRT in terms of OS but not significant for DFS and LRFS, probably due to the heterogeneity of the included studies and a combination of different prognostic factors. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate the predictive ability of the American Joint Committee Cancer (AJCC) eighth edition (AJCC8) staging system for oral cavity cancers and validate these changes rendering the hypothesis of improving prognostication. We conducted a retrospective study including all oral cavity squamous cell carcinoma patients visiting our tertiary center from 2012 to 2015, staged as per the AJCC seventh edition (AJCC7) and AJCC8 systems. Stage‐specific disease‐free survival (DFS) and overall survival (OS) were calculated using the Kaplan‐Meier method. Concordance index (CI) and Akaike information criterion (AIC) were used to calculate the predictive accuracy of the both systems. The study sample consisted of 863 subjects followed up for a median of 24 months. Buccal mucosa complex (BMC) was the most common site (n = 496). We observed a 25.8% (n = 222) overall upstaging in the eighth edition, significantly seen in early tongue cancers (TCs) (Stage I) and advanced BMC cancers (Stage III). An increase in CI and reduction in AIC scores were indicative of a superior predictive accuracy for the eighth edition in assessing DFS (confidence interval [CI*] = 0.650–0.654; AIC = 3,022–3,014) and OS (CI* = 0.643–0.648; AIC = 2089–2086) across all stages. The accuracy was higher for TCs as compared to BMC. Although not statistically significant, we observed an increase in soft risk factors at higher stages in the eighth edition as compared to its predecessor. We concluded that the AJCC8 has a higher predictive accuracy than the AJCC7 edition, making it a reliable prognosticative tool. What's new? The American Joint Committee Cancer (AJCC) 8th edition staging system recently incorporated tumor depth of invasion and extranodal extension as two major prognostic factors. The true global impact of these changes on stage distribution and prognosis remains unknown, however, particularly in oral cancer. This retrospective study conducted in India included 863 patients staged as per the 7th and 8th edition systems with a median 24 month‐follow‐up. Overall, 25.8% patients underwent upstaging as per the new classification system. Patients with upstaged disease had poorer survival outcomes. The 8th edition staging system had higher accuracy in predicting outcomes among oral cancer patients. [ABSTRACT FROM AUTHOR]

To determine effects of reconstruction in advanced oral cavity cancers in achieving a quality of life (QOL), which can help patients to cope with their routine day to day activity. A Cross sectional analysis involving 32 patients of stage III and IV oral cavity cancers already operated in the department of otolaryngology and head and neck surgery was carried out. All these patients had resection of their tumors along with reconstruction. Patients who consented for QOL assessment and follow up through personal visit and telephonic interviews were included in the study. Voice related quality of life; Swallowing related QOL; overall Quality of life (WHO QOL BREF II) and disability assessment scale (WHO DAS II) were used for assessing the various QOL parameters during post-operative period. Patients with stage T3 tumors had better QOL compared to patients with T4 stage tumors. Patients who had reconstruction with free flaps had better QOL compared to those with Pectoralis Major myocutaneous (PMMC) flaps or those reconstructed with combinations of flaps involving delto-pectoral flaps or local flaps along with a free flap or PMMC. Patients with lower stage tumors have better QOL even after reconstruction. If available, free flaps should be preferred over local flaps. Delto-pectoral flaps should be a less preferred option in terms of QOL. Every patient should be counseled accordingly while any reconstruction plan is included in the management of cancers of oral cavity. [ABSTRACT FROM AUTHOR]

Nodal metastases is the most important prognostic marker for oral cavity cancers. Nodal dissection at level IIb risks damage to the spinal accessory nerve. We aim to study positivity of level IIb lymph nodes in oral cancers. In this non-randomized prospective observational study, 65 patients of oral cavity cancers were evaluated. Appropriate surgery for primary tumour and neck dissection were undertaken. All patients underwent level II b dissection. Out of 67 neck dissections (27 elective and 40 therapeutic), 7 patients had level IIb positive for metastases (10.44 %) with no isolated or contralateral metastases at level IIb and direct correlation with level IIa nodes. There was no statistical association of level IIb positivity with stage or site of primary. Level IIb dissection can be avoided in N0 necks. For therapeutic neck dissections, Level IIb should be cleared if there are positive nodes at level IIa. [ABSTRACT FROM AUTHOR]

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Aim of the Study: Aim was to assess the clinical significance of the rate of tumor regression in carcinoma buccal mucosa undergoing radical radiotherapy. Materials and Methods: Sixty six patients were enrolled in the study with proven buccal cancers requiring radical radiotherapy, from 1990 to 1996. Radiotherapy was delivered using a combination of external beam and brachytherapy with preloaded cesium 137 needles. The response to the radiation was assessed at the completion of external beam radiation and 6 weeks after brachytherapy. An analysis correlating various parameters influencing the long term disease free survival and overall survival was done. Results: Response assessed at the end of external beam radiation correlated strongly with the overall survival and the disease free interval (P=0.000). No other factor influenced the survival. Conclusion: The rate of the tumor regression can predict the overall outcome in patients with buccal cancers treated with radiation. Completion of the planned course of radiation in patients who do not show a substantial reduction in size by 4.5 weeks of conventional radiation does not improve the results. [ABSTRACT FROM AUTHOR]

Context: Mitochondrial DNA (mtDNA) copy number correlates with tumor pathology in some cancers. Objective: To investigate mtDNA copy number in head and neck cancer (HNC). Materials and methods: mtDNA copy number was determined and compared between HNC patients and malignancy-free controls. Results: The mtDNA copy number was significantly higher in HNC patients, increased with cancer progression and correlated negatively with patient survival. Discussion: mtDNA copy number appears to be associated with HNC stage and survival, but confirmation requires similar studies in larger cohorts. Conclusion: Studies to establish the nature of the relationship between mtDNA copy number and HNC are warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of the following study is to investigate the efficacy and impact of induction chemotherapy in T4b oral cavity cancers. MATERIALS AND METHODS: It's a retrospective analysis of prospectively collected data of T4b oral cavity cancer patients who were offered induction chemotherapy and then assessed for resectability at the end of 2 cycles of chemotherapy. Post-induction these patients either underwent surgical or non-surgical local intervention depending upon their response. These patients were then followed-up until either recurrence progression or death whichever was later. Statistical analysis was performed by SPSS version 16. Descriptive analysis was performed. Factors affecting achievement of resectability were sought by univariate and multivariate analysis. The impact of surgery on overall survival (OS) was studied using Kaplan Meier survival analysis with the use of log rank test. RESULTS: A total of 110 patients received chemotherapy. Median age been 41.5 years (range 25-66 years). 21 (20%) of our patient received 3 drug regimen while the rest of our patients received 2 drug regimen. Partial response was achieved in 28 patients, stable disease in 49 patients and progression was noted in 23 patients. Resectability was achieved in 34 (30.9%) of 110 patients. The estimated median OS in patients who underwent surgery was 18.0 months (95% confidence interval [CI]: 13.6-22.46 months) and for those treated with non-surgical treatment was 6.5 months (95% CI: 5.6-7.4 months) (P = 0.0001). CONCLUSION: Use of induction chemotherapy is safe and can achieve resectability in 30.9% of our T4b patients. In those patients undergoing resection have much better OS then those who underwent non-surgical local treatment. [ABSTRACT FROM AUTHOR]

Oral cancers constitute a major burden of cancer in northeastern part of India. This can be attributed to the increased consumption of tobacco in various forms such as chewing, snuffing, powder or paste and smoking along with betel nut and areca nut. The majority of patients with oral cavity cancer present in an advanced stage which carries a poor prognosis. We present here a case of locally advanced (T4b) oral cavity cancer where 5-fluorouracil (5FU) and methotrexate (MTX) were used as neoadjuvant chemotherapy to attain a surgically resectable stage. The objective of this case report is to show the efficacy and impact of 5FU and MTX as induction chemotherapy in advanced oral cancers. [ABSTRACT FROM AUTHOR]

Persistent human papillomavirus (HPV) infection is an important risk factor for a subset of head and neck cancers (HNCs). However, estimates of the HPV-attributable fraction of oropharyngeal cancers vary greatly, and the proportion is increasing. Growing evidence indicates smaller proportions of oral cavity and laryngeal cancers are also HPV-attributable, but this requires further investigation. The primary objective of the BROADEN study is to estimate the fraction of HNCs attributable to HPV in selected European and Asian countries by anatomic site. Secondary objectives are to determine HPV genotypes involved and to describe primary tumor and patient characteristics by HPV status. BROADEN is a non-interventional, cross-sectional study of patients with HNC in China, France, Germany, Italy, Japan, Portugal, and Spain. The HPV-attributable HNC fraction will be determined within pre-defined time-periods (2008–2009, 2013–2014 [China only], 2018–2019). Approximately 9000 patients from an estimated 90 hospitals with reference HNC diagnostic units and local reference pathology laboratories will participate. Sample size estimates were generated by grouped anatomic site (oropharynx, oral cavity, nasopharynx, hypopharynx, and larynx) and country. HPV testing (HPV-DNA and p16 immunohistochemistry [IHC]) will be performed at a central laboratory on formalin-fixed paraffin-embedded tissue samples. All HPV-DNA-positive samples and HPV-DNA-negative/p16 IHC-positive samples, plus 10% of remaining HPV DNA-negative (control) samples will be tested for HPV mRNA. BROADEN is a large global epidemiologic study to estimate current and recent past HPV burden in oropharyngeal and non-oropharyngeal HNCs. BROADEN is expected to provide robust estimates of HPV attributability by anatomic site in participating countries. [ABSTRACT FROM AUTHOR]

Our aim was first to evaluate the association between blood vessel density (BVD) and free platinum concentration in experimentally induced tumours in rabbits. We also investigated the association between tumour BVD and the clinical response of patients who had undergone targeted carboplatin intra-arterial (i.a.) chemoradiotherapy. VX2 carcinoma cells were transplanted into 46 inbred female Japanese white rabbits. In the i.a. group, carboplatin was infused into the lingual artery, and in the intravenous (i.v.) group, carboplatin was infused through the auricular vein. In the clinical study, we evaluated 19 patients with squamous cell carcinomas of the oral cavity and oropharynx, who had undergone targeted carboplatin i.a. chemoradiotherapy and had been administered i.a. tegafur/uracil chemotherapy before surgery. We quantified angiogenesis in both studies. Increased BVD was associated with a higher free platinum concentration in the tumour region in the i.a. group of rabbits. In the clinical study, using multivariate logistic regression analysis, only the BVD was related independently to the treatment effect. Therefore, BVD is a valid predictor of the effects of i.a. targeted carboplatin chemotherapy and concurrent radiotherapy for treating human oral and oropharyngeal squamous cell carcinomas. [ABSTRACT FROM AUTHOR]

[Display omitted] • Ayurvedic gargle therapy (Gandush) is recommended for several oral diseases. • Decoction of poly-herbal formulation (Gandush Churna) has antimicrobial activity. • Significantly decrease oral bacterial and fungal load in oral cancer patients. • Reduce radiation side-effects like stomatitis, pain, etc. in oral cancer patients. • Herbal gargle is a simple, palatable, safe and effective complementary therapy. Exploring the antioxidant and antimicrobial potential of a standardized proprietary poly-herbal powder and evaluating its clinical efficacy as an Ayurvedic gargle (Gandush) for reducing oral microbial load and side effects of radiotherapy in oral cavity cancer patients was the aim of this pilot study. Formulation (Gandush Churna) comprising Terminalia chebula Retz., Terminalia bellirica (Gaertn.) Roxb. , Phyllanthus emblica L. and Curcuma longa L. and its decoction (Gandush Kwath) were standardized. In-vitro antioxidant potential and antimicrobial activity against selective bacterial and fungal strains were studied. Oral cavity cancer patients who had undergone radiotherapy were enrolled. The decoction was prepared by soaking Gandush Churna in water, boiling and reducing by 50 %; and was used for gargling, twice a day, for 7 days. Total microbial count and identification of microbiota in the oral cavity as well as symptoms graded as per Common Terminology Criteria for Adverse Events, were noted before and after the treatment. Change in microbial load and shift in symptom gradations were analyzed. A monograph with physicochemical, chromatography, safety and stability parameters was developed. The decoction possessed good in - vitro antioxidant and antimicrobial activities. Gargling therapy significantly reduced bacterial load while mildly controlled the fungal infection in oral cavity cancer patients. It significantly reduced the severity of symptoms viz. stomatitis and local pain, with considerably decreased xerostomia and dysphagia. Intervention of gargle therapy using poly-herbal formulation may serve as an effective complementary treatment to improve oral hygiene and reduce side effects of radiotherapy in oral cancer patients. [ABSTRACT FROM AUTHOR]

Abstract Background Oral cavity cancers (ORC) are the most common cancers, and standard treatment is radical surgery with postoperative radiotherapy. However, locoregional failure remains a major problem, indicating radioresistance an important issue. Our previous work has shown that GP96 contributed to radioresistance in nasopharyngeal and oral cancer cell lines. In this study, we determined clinical significance of GP96 in ORC by evaluation of GP96 expression and its association with disease prognosis in patients receiving radiotherapy Methods Total of 79 ORC patients (77 males, median age: 48 years old) receiving radical surgery and postoperative radiotherapy between Oct 1999 and Dec 2004 were enrolled. Patients in pathological stages II, III and IV were 16.5%, 16.5% and 67%, respectively. For each patient, a pair of carcinoma tissue and grossly adjacent normal mucosa was obtained. GP96-expression was examined by western blot analysis, and the association with clinicopathological status was determined. Results Three-year locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS) and overall survival (OS) rates were 69%, 79%, 63% and 57%, respectively. We found that 55 patients (70%) displayed GP96-overexpression in the tumor tissue, which correlated with a higher pN stage (p = 0.020) and tumor depth (> 10 mm) (p = 0.045). Nodal extracapsular spreading (ECS) and GP96-overexpression predicted adverse LRC (p = 0.049 and p = 0.008). When stratified by nodal ECS, the adverse impact of GP96 remained significant in three-year LRC (p = 0.004). In multivariate analysis, GP96-overexpression was also an independent predictor of LRC, DSS and OS (p = 0.018, p = 0.011 and p = 0.012). Conclusion GP96 may play roles in radioresistance which attributes to tumor invasiveness in oral cancer patients receiving radiotherapy. GP96 may serve as a novel prognostic marker of radiotherapy. However, further independent studies are required to validate our findings in a larger series.

Aim: Our objective was to evaluate the diagnostic role of dual-phase fluor-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography-computed tomography (PET-CT) and planar lymphoscintigraphy in patients with oral cavity cancer (OCC). We also investigated the combined impact of F-18 FDG PET-CT and sentinel lymph node biopsy (SLNB) in decision making for patients with OCC., Methods: Sixteen patients (4 female, 12 male; age range, 29-81 years) were included in this prospective study. F-18 FDG PET-CT [1 (early) and 2 h (delayed) after injection] and planar lymphoscintigraphy (2h before the surgery) were performed for all the patients before surgery. The sensitivity, specificity, and negative and positive predictive values in F-18 FDG PET-CT for the early and the delayed scans and tumor/liver uptake (T/L) in the lymph nodes were calculated. Receiver operating characteristic curves were obtained for standardized uptake value (SUV)max and T/L., Results: Histopathological evaluations revealed that 5 patients had metastatic lymph nodes (pN+) whereas 11 patients had benign lymph nodes (pN-). Out of 43 lymph nodes visualized as cN(+) in F-18 FDG PET-CT, 14 were pathologically positive for malignancy, whereas 29 were pathologically benign. There was no statistical difference between the N(+) and N(-) patients in terms of age, depth of primary tumor, and the number of mitoses. However, there was a significant difference between the N(+) and N(-) patients (P=.011) in terms of early and delayed F-18 FDG uptake of primary tumors. There was a statistically significant difference in the value of SUVmax between the early and the delayed scans for the malignant lymph nodes (P=.00)., Conclusion: This study indicates that F-18 FDG PET-CT is a reliable method for the correct evaluation of primary tumor and N staging in OCCs. Delayed phase of F-18 FDG imaging may increase primary lesion detectability due to higher FDG uptake in primary tumors compared to the early phase of imaging. F-18 FDG PET-CT might demonstrate skip metastasis in lymph nodes which can be missed with SLNB. Although SUV values increased in the delayed phase of F-18 PET-CT imaging in detecting lymph node metastases, the specificity and positive predictive value did not increase., (Copyright © 2015 Elsevier Inc. All rights reserved.)