• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.7031-7038
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• 2015

Background: Arginine may play important roles in tumor progression by providing ornithine for polyamine biosynthesis, required for cell growth. The aim of this work was to determine the expression of arginine metabolic pathway enzymes in head and neck squamous cell carcinoma (HNSCC) in northeast India. Materials and Methods: The expressions of arginase isoforms (ARG1 and ARG2), ornithine aminotransferase (OAT) and ornithine decarboxylase (ODC) were examined in fifty paired HNSCC and adjacent non-tumor tissues by immunohistochemistry. Immunocytochemistry, semiquantitative reverse transcription sq-PCR and quantitative real-time qPCR were used to assess protein and mRNA expressions in peripheral blood of fifty HNSCC patients and hundred controls. Results: ARG1 and ODC protein and mRNA were strongly expressed in peripheral blood from HNSCC patients. No ARG2 expression was observed. In vivo, expression of ARG1, ARG2 and ODC was significantly higher in tumor than in non-tumor tissues. Most tumors expressed low levels of OAT, with no difference in tissues or blood, compared to controls. The absolute extent of maximal ARG1 upregulation with qPCR showed 6.23 fold increase in HNSCC. Conclusions: These findings strongly suggest that in HNSCCs, the ARG1 pathway is stimulated leading to the formation of polyamines as indicated by higher ODC expression, which promote tumor growth.

• Korean Journal of Head & Neck Oncology
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• v.26 no.1
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• pp.14-18
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• 2010

Objectives : We evaluated the use of FDG PET/CT for the identification of cervical nodal metastases of SCC of the oral cavity and oropharynx with histological correlation. Material and Methods : We reviewed 46 medical records, from January 2004 to July 2007, of patients who underwent FDG PET/CT and CT/MRI for SCC of the oral cavity and oropharynx before surgery. We recorded the lymph node metastases according to the neck level affected and the system used for the imaging-based nodal classification. Results : The FDG PET/CT had a sensitivity of 75.6% and a specificity of 96.7% ; it had a higher sensitivity than the CT/MRI for identification of cervical metastases on the side of the neck(26/28 vs. 20/28, p=0.031) and at each of the cervical levels(34/45 vs. 26/45, p=0.008). There was a significant difference in the $SUV_{max}$ between the benign and malignant cervical lymph nodes($3.31{\pm}3.23$ vs. $4.22{\pm}2.57$, p=0.028). The receiver-operating-characteristic (ROC) curve analysis for differentiating the benign from the malignant cervical lymph nodes, showed that the area under the curve(AUC) of the FDG PET/CT was 0.775. The cut-off value for the $SUV_{max}$ was 2.23 based on the ROC curve. There was a significant correlation between the $SUV_{max}$ and the size of the cervical lymph nodes(Spearman r=0.353, p=0.048). Conclusion : FDG PET/CT images were more accurate than the CT/MRI images. In addition, the $SUV_{max}$ cut-off values were important for evaluating cervical the cervical nodes in the patients with SCC of the oral cavity and oropharynx.

• Korean Journal of Head & Neck Oncology
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• v.32 no.2
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• pp.69-72
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• 2016

Lung cancer is one of high mortality malignancy. It is known that skin metastasis from lung cancer is uncommon. We report a very rare case of finger tip metastasis from double primary cancer of the lung and lower lip. A 79 year-old man diagnosed with non small cell lung cancer presented with protruding solid mass in his lower lip. It showed central necrosis with purulent discharge. It had appeared rapidly growing features. Simultaneously, another solid mass accompanying painful swelling without skin lesion was found in his left middle finger tip. Both two solid masses were moderately differentiated squamous cell carcinomas. Lower lip mass was a primary cancer, while middle finger tip mass was diagnosed with clinically metastatic cancer from lung or lower lip, which means that it had double primary cancer origin.

• 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.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6419-6425
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• 2013

Background: Neoadjuvant chemotherapy (NACT) is a treatment modality whereby chemotherapy is used as the initial treatment of HNSCC in patients presenting with advanced cancer that cannot be treated by other means. It leads to shrinkage of tumours to an operable size without significant compromise to essential oro-facial organs of the patients. The molecular mechanisms behind shrinkage due to NACT is not well elucidated. Materials and Methods: Eleven pairs of primary HNSCCs and adjacent normal epithelium, before and after chemotherapy were screened for cell proliferation and apoptosis. This was followed by immunohistochemical analysis of some cell cycle (LIMD1, RBSP3, CDC25A, CCND1, cMYC, RB, pRB), DNA repair (MLH1, p53) and apoptosis (BAX, BCL2) associated proteins in the same set of samples. Results: Significant decrease in proliferation index and increase in apoptotic index was observed in post-therapy tumors compared to pre-therapy. Increase in the RB/pRB ratio, along with higher expression of RBSP3 and LIMD1 and lower expression of cMYC were observed in post-therapy tumours, while CCND1 and CDC25A remained unchanged. While MLH1 remained unchanged, p53 showed higher expression in post-therapy tumors, indicating inhibition of cell proliferation and induction of apoptosis. Increase in the BAX/BCL2 ratio was observed in post-therapy tumours, indicating up-regulation of apoptosis in response to therapy. Conclusions: Thus, modulation of the G1/S cell cycle regulatory proteins and apoptosis associated proteins might play an important role in tumour shrinkage due to NACT.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8549-8556
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• 2014

Head and neck squamous cell carcinoma (HNSCC) is one of the world top ten most common cancers with its highest occurrence in the Indian subcontinent and different aggressive and etiological behavioural patterns. The scenario is only getting worst with the 5 year survival rates dropping to 50%, persistent treatment failures and frequent cases of relapse/recurrence. One of the major reasons for these failures is the presence of cancer stem cells (CSCs), a small population of cancer cells that are highly tumourigenic, capable of self-renewal and have the ability to differentiate into cells that constitute the bulk of tumours. Notably, recent evidence suggests that cancer stem cells are especially resistant to conventional therapy and are the "drivers" of local recurrence and metastatic spread. Specific markers for this population have been investigated in HNSCC in the hope of developing a deeper understanding of their role in oral cancer pathogenesis, elucidating novel biomarkers for early diagnosis and newer therapeutic strategies. This review covers the fundamental relevance of almost all the CSC biomarkers established to date with a special emphasis on their impact in the process of oral tumourigenesis and their potential role in improving the diagnosis, prognosis and treatment of OSCC patients.

• Archives of Plastic Surgery
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• v.47 no.1
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• pp.88-91
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• 2020

Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignancy. This report describes the case of an unusual extensive SCC involving the whole hemiface, which required reconstruction with a combination of a dual vascular free transverse rectus abdominis muscle (TRAM) flap and a skin graft. A 79-year-old woman visited our hospital with multiple large ulcerated erythematous patches on her right hemiface, including the parieto-temporal scalp, bulbar and palpebral conjunctiva, cheek, and lip. A preliminary multifocal biopsy was performed in order to determine the resection margin, and the lesion was resected en bloc. Orbital exenteration was also performed. A free TRAM flap was harvested with preserved bilateral pedicles and was anastomosed with a single superior thyroidal vessel. The entire TRAM flap survived. The final pathological examination of the resected specimen confirmed that there was no regional nodal metastasis, perineural invasion, or lymphovascular involvement. The patient was observed for 6 months, and there was no evidence of local recurrence. Usage of a TRAM flap is appropriate for hemifacial reconstruction because the skin of the abdomen matches the color and pliability of the face. Furthermore, we found that the independent attachment of two extra-flap anastomoses to a single recipient vessel can safely result in survival of the flap.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.15-20
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• 2007

Background and Objectives：Supraglottic partial laryngectomy is oncologically sound surgical procedure for selected cases of laryngeal cancer which maintains physiologic speech and swallowing without permanent tracheostoma. The purpose of this study is to evaluate the oncologic and functional results of supraglottic partial laryngectomy and neck dissection for supraglottic cancer. Materials and Methods：Between 1991-2005, Twenty-three supraglottic cancer patients, underwent supraglottic partial laryngectomy, were studied retrospectively. There were 5 patients with cT1, 14 with cT2, 4 with cT3 and 11 patients with cN0, 1 with cN1, 10 with cN2, 1 with cN3. All patients underwent neck dissection and postoperative radiotherapy was added to twenty patients. They were reviewed with respect to primary subsites, extended subsites, treatment result, survival rate, factors affecting the prognosis, postoperative complication, time of decannulation and oral diet, and postoperative voice. Results：Among eleven patients with clinically negative node, six patients had pathologically positive nodes. So occult metastasis was 54.5%. Two patients recurred at cervical lymph node and one had distant metastasis to lung. Local and regional control were 100% and 91.3%. The overall 3-year and 5-year survival rate were 84%, 78%, respectively. Nineteen cases were squamous cell carcinomas and four were basaloid squamous cell carcinomas. Basaloid subtype was significantly affected to survival. Decannulation and oral feeding were possible in 100%. Conclusions：Supraglottic partial laryngectomy is oncologically safe and functionally good procedure in supraglottic cancers. Elective neck dissection is beneficial in management of occult cervical metastasis.

• Korean Journal of Radiology
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• v.20 no.8
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• pp.1266-1274
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• 2019

Objective: To determine whether radiologic extranodal extension (ENE) appearing on pretreatment CT and MRI could predict the prognosis in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Materials and Methods: The study population was obtained from a historical cohort diagnosed with HPV-related OPSCC. A total of 134 OPSCC patients who had a metastatic lymph node on pretreatment CT or MRI were included, and radiologic ENE was evaluated by two experienced head and neck radiologists. Kaplan-Meier and multivariate Cox regression analyses were performed to evaluate the impact of radiologic ENE on progression-free survival (PFS). The diagnostic performance of CT and MRI for the diagnosis of ENE was also evaluated in patients who underwent neck dissection. Results: Seventy patients (52.2%) showed radiologic ENE-positive findings. Although patients showing radiologic ENE had a worse 3-year PFS (83.7% vs. 95.3%, p = 0.023), the association between radiologic ENE and PFS was not statistically significant on multivariate analysis (p = 0.141; hazard ratio, 2.68; 95% confidence interval, 0.72-9.97). CT or MRI had a sensitivity of 62%, specificity of 77.8%, and accuracy of 71.9% for predicting pathologic ENE. Conclusion: Radiologic ENE on CT or MRI did not predict poor PFS in patients with HPV-related OPSCC, although there was a trend towards worse PFS. Further studies are warranted to determine whether radiologic ENE is a useful imaging biomarker to risk-stratify patients with HPV-related OPSCC.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.126-131
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• 2005

Objectives: To evaluate the efficacy and safety of induction chemotherapy with docetaxel and cisplatin in locally advanced head and neck cancer. Materials and Methods: Between June 1998 and December 2004, 30 patients were enrolled and among them, 20 patients were evaluable. Patients were treated with docetaxel $75mg/m^2$ and cisplatin $60mg/m^2$ on day 1 every 21 days. Results: The median age was 71(range 54-80) years old. All 20 patients were male. Nineteen patients had pathologically squamous cell carcinoma and 1 had undifferentiated carcinoma. Fourteen of 20 patients(70%) demonstrated an objective response with two(10%) achieving a complete clinical response and eleven(60%) a partial response. The median response duration was 5.3(1.6-32.1) months and the median time to progression was 5.6(1.4-33.8) months. The median overall survival of all patients was 14(range 2.2-34) months. The median overall survival of responders was 17.5(range 5-34) months and that of non-responders was 3.2(range 2.2-23) months, but it was not statistically significant(p=0.106). During a total of 92 cycles, granulocytopenia worse than CTC(Common toxicity criteria) grade 2 occurred in 6%, thrombocytopenia in 2%, and anemia in 3%, respectively. Non-hematologic toxicities were minor and easily controlled. Conclusion: The induction chemotherapy of docetaxel and cisplatin has moderate efficacy with acceptable toxicities in patients with locally advanced head and neck cancer.