Long-term disease-free survival in surgically-resected oral tongue cancer: a 10-year retrospective study

Sopravvivenza libera da malattia a lungo termine nel tumore della lingua mobile operato: studio retrospettivo a 10 anni.PLAIN-LANGUAGE-SUMMARY: Early and loco-regionally advanced oral tongue squamous cell carcinoma (OTSCC) can be treated by surgery alone or followed by adjuvant radiotherapy or chemoradiotherapy. Nevertheless, up to 40% of patients develop tumour relapse. The aim of our study is to investigate the clinical and pathological features associated with reduced disease-free survival (DFS) in a cohort of surgically-resected OTSCC patients. One hundred and six patients surgically resected for OTSCC were retrospectively identified from clinical records. DFS was calculated according to the Kaplan\u2013Meier method and differences between variables were assessed with Log-Rank test. A multivariable Cox regression model was used to analyse the impact of different prognostic factors on DFS. After a median of follow-up of 8.9 years, 22 events, including 11 deaths, were observed. Overall, the 5-year DFS-rate was 87.4%. The presence of extra-nodal extension (p = 0.023) and perineural invasion (p = 0.003) were significantly correlated with shorter DFS (in univariate analysis). In multivariable analysis, extra-nodal extension and perineural invasion confirmed their role as independent prognostic factors associated with an increased risk of disease recurrence [hazard ratio (HR) 2.87, 95% CI 1.11-7.42, p = 0.03; HR 3.85, 95% CI 1.49-9.96, p = 0.006, respectively]. p16 and p53 expressions in tumour cells were detected in 12% (n = 9) and 46% (n = 40) of cases, respectively. No differences in DFS were observed between p16+ and p16- (p = 0.125) and between p53+ and p53- tumours (p = 0.213). In conclusion, radical surgery, eventually followed by adjuvant radiotherapy or chemo-radiotherapy, can achieve high cure rates in OTSCC. After long-term follow-up, perineural invasion and extra-nodal extension confirmed their role as prognostic factors associated with reduced DFS in OTSCC patients

A review on the treatment of relapsed/metastatic head and neck cancer

The efficacy of traditional chemotherapy in inducing objective responses and prolonging survival in recurrent or metastatic head and neck cancer has been disappointing. More recent drugs have not proven superior to the classic regimen of cisplatin and 5-fluorouracil. Anti-EGFR monoclonal antibodies, either as single agents or associated to chemotherapy, have been shown to be active and little toxic. Among them, cetuximab has proven to be the most promising. Indeed the Extreme study, which compared the classic couple cisplatin (CDDP) 5-fluorouracil with the same regimen plus cetuximab, has constituted a remarkable innovation. The results of that trial seem to indicate a third agent added to CDDP and 5-fluorouracil improved both progression-free survival and overall survival in the recurrent or metastatic setting. Unfortunately, the results obtained with the tyrosine kinase inhibitors are less impressive, and additional studies are needed to explore the potentiality of this class of drug. As far as antiangiogenetics are concerned, the research is insufficient for any conclusion to be drawn in terms of efficacy. It is hoped that, in the near future, the most active combination between biological agents and traditional chemotherapy will be found, so that the path successfully taken in other neoplastic diseases may be retraced

Clinical analysis of multiple primary malignancies in the elderly

Cancer incidence raises progressively during life span; it is estimated that by the year 2030 almost 70% of all neoplasms will occur in people over 65 years old. As carcinogenesis is a multistep, time-requiring process, it is expected that as people live longer they are more likely to develop cancer, and therefore, the prevalence of multiple primary malignancies (MPM) is destined to increase with age. PATIENTS AND METHODS: Records of all consecutive cancer patients referred to our center from January 2004 to January 2007 were reviewed. We chose the definition of MPM proposed by Warren and Gates. Multiple malignancies were assessed for elderly (>or=70 years old) and younger patients. t-Test and Mc Nemar test were used; subgroup analysis was also performed according to age stratification. RESULTS: A total of 1,503 consecutive patients were considered; 566 were 70 years old or more (mean age 76.5 years, range 70-96 years) and 878 were younger (mean age 57 years, range 18-69 years). The prevalence of multiple malignancies in the elderly people versus younger ones was 15% and 6%, respectively (P = 0.001). As far as the elderly population is concerned, 21% (56/271) of males compared with 14% (42/295) of females had developed MPM; no significant difference was found between the subgroups with MPM or not as far as age (P = 0.16), comorbidities (P = 0.79), medications (P = 0.76), CIRS-G score and index (P = 0.47, P = 0.54), and PS (P = 0.93) are concerned. Most frequent associations among cancer types were prostate with lung (10/87, 11%), prostate with colorectal cancer (10/87, 11%), and smoking-related cancer, namely lung and head and neck cancer (X/Y, 6%). CONCLUSIONS: Elderly patients are more likely to develop MPM compared to younger ones. Significant cancer association according to field cancerogenesis concept was the one of smoking-related cancer; other MPM patterns were apparently a random phenomeno

Changes in intracortical circuits of the human motor cortex following theta burst stimulation of the lateral cerebellum.

none11Objective: The cerebellum takes part in several motor functions through its influence on the motor cortex (M1). Here we applied the theta burst stimulation (TBS) protocol, a novel form of repetitive Transcranial Magnetic Stimulation (rTMS) over the lateral cerebellum. The aim of the present study was to test whether TBS of the lateral cerebellum could be able to modulate the excitability of the contralateral M1 in healthy subjects. Methods: Motor evoked potentials (MEPs) amplitude, short intracortical inhibition (SICI), long intracortical inhibition (LICI) and short intracortical facilitation (SICF) were tested in the M1 before and after cerebellar continuous TBS (cTBS) or intermittent TBS (iTBS). Results: We found that cTBS induced a reduction of SICI and an increase of LICI. On the other hand, cerebellar iTBS reduced LICI. MEPs amplitude also differently vary following cerebellar stimulation with cTBS or iTBS, resulting decreased by the former and increased by the latter. Conclusions: Although the interpretation of these data remains highly speculative, these findings reveal that the cerebellar cortex undergoes to bidirectional plastic changes that modulate different intracortical circuits within the contralateral primary motor cortex. Significance: Long lasting modifications of these pathways could be useful to treat various pathological conditions characterized by altered cortical excitabilitynoneKoch G; Mori F; Marconi B; Codecà C; Pecchioli C; Salerno S; Torriero S; Lo Gerfo E; Mir P; Oliveri M; Caltagirone CKoch, G; Mori, F; Marconi, B; Codecà, C; Pecchioli, C; Salerno, S; Torriero, S; Lo Gerfo, E; Mir, P; Oliveri, M; Caltagirone,

Complete pathological response of hepatocellular carcinoma with systemic combination chemotherapy

Prognosis of advanced hepatocellular carcinoma is dismal when locoregional treatments have failed. Systemic chemotherapy is seldom effective in inducing objective response and prolonging survival. We report a case of complete pathological remission of hepatocellular carcinoma after three cycles of systemic chemotherapy. A 64-year-old woman presented with histologically documented hepatocellular carcinoma without associated liver disease, relapsed after earlier locoregional therapy. Surgery was not performed as thoracic computerized tomography (CT) demonstrated pulmonary bilateral nodules. The patient was treated with chemotherapy consisting of three cycles of epirubicin, cisplatin, and infusional 5-fluorouracil (ECF regimen); stable lung disease and a good partial response in the liver were obtained as documented by CT scan. Hepatic segmentectomy was therefore performed and the histologic examination revealed necrosis without evidence of residual disease. Two more cycles of adjuvant chemotherapy were infused after surgery. At 1-year follow-up the patient is alive and free of disease according to a positron emission tomography/CT scan. It is suggested that an aggressive regimen like ECF should be considered in fit patients who are not affected by concomitant liver diseas

COMBINED SURGERY AND POST-OPERATIVE RADIOTHERAPY OR CHEMORADIOTHERAPY FOR LOCALLY ADVANCED TONGUE CANCER

Background: Treatment options for locally advanced tongue squamocellular carcinoma (SCC) include surgery alone, radiotherapy alone, or multimodality treatment. These highly aggressive tumors are best treated by partial glossectomy in order to save organ function and postoperative radiotherapy (RT). When positive margins and/or extracapsular nodal extension are found, postoperative hemoradiotherapy (CRT) is warranted. We report on our experience with this approach. Methods: A total of 20 patients (pts) with primary tongue SCC were treated with surgery and postoperative RT. All pts underwent partial, hemi-, or subtotal glossectomy; 16 pts (80%) underwent ipsilateral radical or modified radical neck dissection. Ten pts received postoperative RT alone (median dose 6000 cGy) while 10 pts received postoperative CRT consisting of RT and Cisplatin 100 mg/m2 days 1-22- 43. Stage distribution was as follows: stage III, 5; stage IV, 15. Median follow-up is 23 months. Results: For the entire group of pts, the actuarial 2-year locoregional control rate was 80%; the same rate was recorded for both stage III and IV disease. The actuarial 2-year overall survival rate was 70%. There was one local failure among 10 pts with negative margins (local control 95%) and 3 among pts with positive margins (local control 85%). Four pts developed distant metastases, 2 with negative and 2 with positive margins. Postoperative treatment was well tolerated. Three pts treated by RT and 4 pts treated by CRT experienced grade 3 oral mucositis. Late major complications of RT and CRT included 3/20 pts requiring permanent G-tubes and/or tracheostomy to prevent aspiration. Conclusions: Surgery plus postoperative RT is an intensive treatment for SCC of the tongue which offers high locoregional control rate in patients with negative margins. Postoperative CRT can be safely administered to pts with positive margins and/or extracapsular nodal extension achieving satisfactory results in terms of both locoregional control and distant failure