• Title, Summary, Keyword: head and neck cancers

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Role of Concomitant Chemoradiation in Locally Advanced Head and Neck Cancers

  • Lasrado, Savita;Moras, Kuldeep;Pinto, George Jawahar Oliver;Bhat, Mahesh;Hegde, Sanath;Sathian, Brijesh;Luis, Neil Aaron
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.10
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    • pp.4147-4152
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    • 2014
  • Standard therapy for advanced head and neck cancer consists of a combination of surgery and radiation. However, survival of this patient population has not improved during the past 20 years. Many different multimodality treatment schedules have been proposed, and chemotherapy is often used with the intent of organ preservation. The present study was intended to establish the efficacy of concomitant chemoradiation with a single agent carboplatin in advanced head and neck cancers.The objectives were to investigate the feasibility of concomitant administration of carboplatin, monitor acute toxicity during radiotherapy, and determine subacute side effects, such as wound healing following surgery after chemoradiotherapy. A prospective study was conducted wherein a total of 40 patients with stage III and IV squamous cell carcinomas of oral cavity, oropharynx, hypopharynx and larynx were enrolled. All patients were treated with external beam radiotherapy and weekly carboplatin area under curve (AUC of 5). Radiotherapy was given in single daily fractions of 1.8-2 grays (Gy) to a total dose of 66-72 Gy. Salvage surgery was performed for any residual or recurrent locoregional disease. Neck dissection was recommended for all patients with neck disease showing less than a complete response after chemoradiation. A total of 40 patients were enrolled of whom 32 were males and 8 were females. Highest incidence of cancer was seen in the 5th-6th decades of life with a median age of 47.7 years. Oropharyngeal tumours constituted a maximum of 21 patients followed by hypopharynx in 10, larynx in 7 and oral cavity in 2. 80% of the patients had a neck node on presentation of which 40% had N2-N3 nodal status. TNM staging revealed that 58% of patients were in stage III and 43% in stage IV. Evaluation of acute toxicity revealed that 50% had grade II mucositis, 25% grade III mucositis, 2.5% grade IV mucositis. 50% of patients had grade I skin reactions, 65% of patients had grade I thrombocytopenia, and 24% of patients had grade I anaemia. After completion of treatment 65% of patients had complete response at the primary and regional sites, and 35% of patients had a partial response of whom 23% underwent neck dissection and 5% of them underwent salvage surgery at the primary site. At the end of one year there were six deaths and four recurrences and 70% were free of disease. Concurrent chemoradiation with carboplatin provided good locoregional control for locally advanced head and neck cancers. This regimen, although toxic, is tolerable with appropriate supportive intervention. Primary site conservation is possible in many patients. Chemoradiotherapy appears to have an emerging role in the primary management of head and neck cancers.

A Clinical Study of the Elective Neck Dissection (예방적 경부청소술의 임상적 의의에 관한 연구)

  • Kim Myun-Joo;Lee Kwang-Sun;Choi Jong-Ouck
    • Korean Journal of Head & Neck Oncology
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    • v.7 no.1
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    • pp.10-16
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    • 1991
  • Elective neck dissection (END), provide proper information on nodal status and stage which are significant prognosticator in head and neck cancers with clinically $N_{(0)}$ neck. But there are many controversies for the extents, methods of surgery, moreover, whether normal lymph nodes, local defencer, have to be removed or not. The authors performed 47 END in 39 patients of head and neck squamous cell carcinoma from 1984 to 1989 and a retrospective study of the cases was conducted. Eighteen percent of nodal metastasis and five percent of extracapsular spread were found in END specimens. We concluded that END provide significant information for the management and evaluation of prognosis in head and neck cancer.

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GENETIC SUSCEPTIBILITIES OF CYTOCHROME P450 1A1, 2E1, AND N-ACETYLTRANSFERASE 2 TO THE RISKS FOR KOREAN HEAD AND NECK CANCER PATIENTS (한국인 두경부암종 환자에서 Cytochrome P450 1A1, 2E1 및 N-acetyltransferase 2 효소의 다형성 분석에 따른 유전적 감수성에 대한 연구)

  • Lee, Young-Soo;Kim, Te-Gyun;Woo, Soon-Seop;Shim, Kwang-Sub;Kong, Gu
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.22 no.4
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    • pp.373-382
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    • 2000
  • Individual genetic susceptibilities to cancers may result from several factors including differences in xenobiotics metabolism to chemical carcinogens, DNA repair, altered oncogenes and suppressor genes, and environmental carcinogen exposures. Among them, genetic polymorphisms of metabolizing enzymes to chemical carcinogens have been recognized as a major important host factors in human cancers. They have two main types of enzymes: the phase I cytochrome P-450 mediating enzymes (CYPs) and phase II conjugating enzymes. The purpose of this study is to determine the frequencies of genotypes of phase I (CYP1A1 and CYP2E1) and phase II (NAT2) metabolizing enzymes in healthy control and head and neck cancer patients of Korean and to identify the relative high risk genotypes of these metabolizing enzymes to head and neck cancer in Korean. The author has analyzed 132 head and neck cancer patients and 113 healthy controls using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results were as following; 1. The frequencies of genotypes of CYP1A1, CYP2E1 and NAT2 in healthy control were as following; CYP1A1 exon 7 polymorphism; Ile/Ile: Ile/Val: Val/Val = 59.3%: 36.3%: 4.4% CYP2E1 Pst I polymorphism, C1/C1: C1/C2: C2/C2 = 61.1%: 32.1%: 6.2% NAT2 polymorphism; F/F: F/S: S/S = 43.4%: 48.7%: 8.0% 2. In analysis of phase I enzyme, Val/Val genotype in CYP1A1 exon 7 polymorphism and C2/C2 genotype in CYP2E1 Pst I polymorphism were associated with relative high risks to head and neck cancers (Odds' ratio: 2.09 and 1.37, respectively). 3. Among the genotypes of NAT2 enzyme polymorphism, S/S genotype of NAT2 enzyme had 1.03 times of relative risk to head and neck cancers. 4. In combined genotyping of CYP1A1, CYP2E1, and NAT2 enzymes polymorphisms, the patients with Val/Val and C1/C1, C2/C2 and fast acetylator, and Val/Val and fast acetylator had higher relative risks than the patients with each baseline of combined genotypes (Odds' ratio: 2.82, 1.98 and 2.1, respectively). These results suggest the combined genotypes of Val/Val and C1/C1, C2/C2 and fast acetylator, and Val/Val and fast acetylator were more susceptible to head and neck cancers in Korean. And genotyping of metabolizing enzymes could be useful for predicting individual susceptibility to head and neck cancer.

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Genetic Deletions of GSTM1 and GSTT1 in Head and Neck Cancer: Review of the Literature from 2000 to 2012

  • Masood, Nosheen;Yasmin, Azra;Kayani, Mahmood A.
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.6
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    • pp.3535-3539
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    • 2013
  • Head and neck cancer is one of the leading causes of deaths worldwide. Two genes GSTM1 and GSTT1 involved in phase II of carcinogen detoxification have been frequently studied in the literature. Their null genotypes are thought to be associated with increased head and neck cancer risk. However, the published reviews are not up to date and many important papers have been skipped. The current literature review was restricted to the null genotypes of the GSTM1 and GSTT1 genes with special emphasis on the genotypic status. We found that the size of study sample varied greatly and the oral cavity cancer was more influenced by GSTM1 and GSTT1 gene deletions. With respect to ethnicity Asians are more prone to head and neck cancers with these null genotypes as compared to Europeans and Americans. The current review showed significant associations (OR=9.0, 95%CI; 1.4-9.5; OR=3.7, 95%CI; 1.4-9.5) of GSTM1 and GSTT1 null genotypes with head and neck cancers. Review confirms the data of previous reviews that GSTM1 and GSTT1 gene polymorphisms may be risk factors for cancer initiation.

Concurrent Cisplatin and Radiotherapy in Refractory Patients to Induction Chemotherapy and Recurrent Head and Neck Cancer (유도항암요법에 반응치 않는 환자와 재발한 두경부암환자에서 Cisplatin과 방사선 동시치료)

  • Kim Hoon-Kyo;Kang Jin-Hyoung;Lee Kyung-Sik;Kim Dong-Jip;Chang Hong-Suk;Yoon Sei-Chul;Cho Seung-Ho;Sub Byung-Do
    • Korean Journal of Head & Neck Oncology
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    • v.8 no.1
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    • pp.21-24
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    • 1992
  • In patients with locally advanced head and neck cancers who do not respond to induction chemotherapy and who have locoregional recurrence after local treatment subsequent radiotherapy alone does not have any additative effect. The theoretical rationale and promising clinical response of concurrent chemoradiotherapy in patients with the head and neck cancers have been recently conducted Ten patients(9 stage IV, q stage III) were treated with concurrent chemoradiotherapy(radiotherapy start from day 1 of chemotherapy; cisplatin $100mg/m^2$ intravenously every 3 weeks for $3{\sim}4$ cycles on day 1.22 and 43..). Four patients achieved complete response(CR) and overall response rate was 80% (8/10). The major toxicities we re leukopenia (90%), nausea/vomiting(80%), stomatitis(80%) and peripheral neuropathy(30%). Most of these side effects were mild to moderate and reversible.

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Incidence and Mortality from Mucosal Head and Neck Cancers amongst Australian States and Territories: What It Means for the Northern Territory

  • Singh, Jagtar;Jayaraj, Rama;Baxi, Siddhartha;Ramamoorthi, Ramya;Thomas, Mahiban
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.10
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    • pp.5621-5624
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    • 2013
  • Mucosal head and neck cancers are squamous cell carcinomas that develop in the upper-aero digestive epithelium. Together they constitute the sixth most common cancer with an estimated 900,000 new cases and 350,000 deaths each year reported worldwide. The risk factors are tobacco, alcohol and human papillomavirus (HPV). Our research team initially reported a high incidence rate of HNC in the indigenous population of the Northern Territory. Mortality rates also vary in the Australian States and Territories, with particularly high mortality observed in the Northern Territory. There is a paucity of incidence studies of HNC for the Australian States and Territories. Therefore this review primarily focuses on variation in incidence and mortality iacross the country and highlights specifically the high incidence and mortality in the Northern Territory. Attention is also given to sex-specific incidence and mortality rates.

Impact of positive/close margins in oropharyngeal cancer according to the HPV status (HPV 관련성에 따른 구인두암에서의 positive/close 절제연의 의미)

  • Jung, Yuh-Seog
    • Korean Journal of Head & Neck Oncology
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    • v.34 no.2
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    • pp.1-9
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    • 2018
  • With the emerging knowledge about tumor biology specific for human papillomavirus (HPV)-related head and neck cancers, the classical understanding about the curative surgery in head and neck cancers are starting to progress, customized for their HPV-associations and ultimately specific for tumor biologic characteristics. The common rule for surgery should reflect the biologic characteristics of target tumors, but still, multi-institutional large-scale data could be scarce, due to the subjective feature of surgical treatment itself. However, the impact of HPV for margin determination is now being questioned by multiple groups, and typical example is European Cooperative Oncology Group (ECOG)-3311 study. Here, we review the impact of viral association for surgical decision and its biological background and implications.

Survival in Head and Neck Cancers - Results of A Multi-Institution Study

  • Nandakumar, Ambakumar
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.1745-1754
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    • 2016
  • Background: The prime output of Hospital Based Cancer Registries is stage and treatment based survival to evaluate patient care, but because of challenges of obtaining follow-up details a separate study on Patterns of Care and Survival for selected sites was initiated under the National Cancer Registry Programme of India. The results of stage and treatment based survival for head and neck cancers by individual organ sites are presented. Materials and Methods: A standardized Patient Information Form recorded the details and entered on-line at www.hbccrindia.org to a central repository - National Centre for Disease Informatics and Research. Cases from 12 institutions diagnosed between 1 January 2006 and 31 December 2008 comprised the study subjects. The patterns of treatment were examined for 14053 and survival for 4773 patients from five institutions who reported at least 70% follow-up as of 31 December 2012. Results: Surgical treatment with radiation for cancer tongue and mouth showed five year cumulative survival (FCS) of 67.5% and 60.4% respectively for locally advanced stage. Chemo-radiation compared to radiation alone showed better survival benefit of around 15% in both oro and hypo-pharyngeal cancers and their FCS was 40.0%; Hazard Ratio (HR):1.5;CI=1.2-1.9) and 38.7%; (HR):1.7; CI=1.3-2.2). Conclusions: The awareness about the requirement of concurrent chemo-radiation in specifically cancers of the oro and hypopharynx has to be promoted in developing countries. The annual (2014) estimate number of new Head and Neck cancers with locally advanced disease in India is around 140,000 and 91,000 (65%) patients do not receive the benefit of optimal treatment with ensuing poorer survival.

Educational Levels and Delays in Start of Treatment for Head and Neck Cancers in North-East India

  • Krishnatreya, Manigreeva;Kataki, Amal Chandra;Sharma, Jagannath Dev;Nandy, Pintu;Rahman, Tashnin;Kumar, Mahesh;Gogoi, Gayatri;Hoque, Nazmul
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10867-10869
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    • 2015
  • Background: There are various patient and professional factors responsible for the delay in start of treatment (SOT) for head and neck cancers (HNC). Materials and Methods: This retrospective study was conducted on data for HNC patients registered at the hospital cancer registry in North-East India. All cases diagnosed during the period of January 2010 to December 2012 were considered for the present analysis. Educational levels of all patients were clustered into 3 groups; illiterates (unable to read or write), qualified (school or high school level education), and highly qualified (college and above). Results: In the present analysis 1066 (34.6%) patients were illiterates, 1,869 (60.6%) patients were literates and 145 (4.7%) of all patients with HNC were highly qualified. The stage at diagnosis were stage I, seen in 62 (34.6%), stage II in 393 (12.8%), stage III in 1,371 (44.5%) and stage IV in 1,254 (40.7%). The median time (MT) to the SOT from date of attending cancer hospital (DOACH) was, in illiterate group MT was 18 days, whereas in the qualified group of patients it was 15 days and in the highly qualified group was 10 days. Analysis of variance showed there was a significant difference on the mean time for the delay in SOT from DOACH for different educational levels (F=9.923, p=0.000). Conclusions: Educational level is a patient related factor in the delays for the SOT in HNCs in our population.

Characteristics of Oral Tongue and Base of the Tongue Cancer: A Hospital Cancer Registry Based Analysis

  • Krishnatreya, Manigreeva;Nandy, Pintu;Rahman, Tashnin;Sharma, Jagannath Dev;Das, Anupam;Kataki, Amal Chandra;Das, Ashok Kumar;Das, Rajjjyoti
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.4
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    • pp.1371-1374
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    • 2015
  • Background: Tongue cancer is one of the leading sites of cancer in our population. Aim: To evaluate the socio-demographic profiles and stages at diagnosis of oral tongue (OT) and base of tongue (BT) cancers, and identify any possible variations in characteristics. Materials and Methods: A retrospective analysis was conducted on tongue cancer cases, divided into OT and BT, registered at the hospital cancer registry of North-East India during January 2010 to May 2013. Cases were analyzed for age, gender, residential status and different levels of education for patients, the stage at diagnosis and presence of distant metastasis. Results: A total of 1,113 cases of tongue cancers were registered, 846(76.1%) of BT and 267(23.9%) of OT. While 33.9% of BT cancer patients were above 65 years of age, the figure for OT cancers was 18.4%, stages III and IV accounting for 90.8% and 77%, respectively. The relative risk for distant metastasis in OT cancers was 3.3 (95% CI 1.08-10.1, p=0.03). Conclusions: In the subsites of tongue cancers in our population, the majority arose from the base of tongue, these tending to occur in older individuals and presenting at late stage.