Intra-operative point-of-procedure delineation of oral cancer margins using optical coherence tomography.

ObjectivesSurgical margin status is a significant determinant of treatment outcome in oral cancer. Negative surgical margins can decrease the loco-regional recurrence by five-fold. The current standard of care of intraoperative clinical examination supplemented by histological frozen section, can result in a risk of positive margins from 5 to 17 percent. In this study, we attempted to assess the utility of intraoperative optical coherence tomography (OCT) imaging with automated diagnostic algorithm to improve on the current method of clinical evaluation of surgical margin in oral cancer.Materials and methodsWe have used a modified handheld OCT device with automated algorithm based diagnostic platform for imaging. Intraoperatively, images of 125 sites were captured from multiple zones around the tumor of oral cancer patients (n = 14) and compared with the clinical and pathologic diagnosis.ResultsOCT showed sensitivity and specificity of 100%, equivalent to histological diagnosis (kappa, ĸ = 0.922), in detection of malignancy within tumor and tumor margin areas. In comparison, for dysplastic lesions, OCT-based detection showed a sensitivity of 92.5% and specificity of 68.8% and a moderate concordance with histopathology diagnosis (ĸ = 0.59). Additionally, the OCT scores could significantly differentiate squamous cell carcinoma (SCC) from dysplastic lesions (mild/moderate/severe; p ≤ 0.005) as well as the latter from the non-dysplastic lesions (p ≤ 0.05).ConclusionThe current challenges associated with clinical examination-based margin assessment could be improved with intra-operative OCT imaging. OCT is capable of identifying microscopic tumor at the surgical margins and demonstrated the feasibility of mapping of field cancerization around the tumor

Resistance/response molecular signature for oral tongue squamous cell carcinoma

Worldwide, the incidence of oral tongue cancer is on the rise, adding to the existing burden due to prevailing low survival and high recurrence rates. This study uses high-throughput expression profiling to identify candidate markers of resistance/response in patients with oral tongue cancer. Analysis of primary and post-treatment samples (12 tumor and 8 normal) by the Affymetrix platform (HG U133 plus 2) identified 119 genes as differentially regulated in recurrent tumors. The study groups had distinct profiles, with induction of immune response and apoptotic pathways in the non-recurrent and metastatic/invasiveness pathways in the recurrent group. Validation was carried out in tissues by Quantitative Real-Time PCR (QPCR) (n = 30) and Immunohistochemistry (IHC) (n = 35) and in saliva by QPCR (n = 37). The markers, COL5A1, HBB, IGLA and CTSC individually and COL5A1 and HBB in combination had the best predictive power for treatment response in the patients. A subset of markers identified (COL5A1, ABCG1, MMP1, IL8, FN1) could be detected in the saliva of patients with oral cancers with their combined sensitivity and specificity being 0.65 and 0.87 respectively. The study thus emphasizes the extreme prognostic value of exploring markers of treatment resistance that are expressed in both tissue and saliva

A minimal set of internal control genes for gene expression studies in head and neck squamous cell carcinoma

Selection of the right reference gene(s) is crucial in the analysis and interpretation of gene expression data. The aim of the present study was to discover and validate a minimal set of internal control genes in head and neck tumor studies. We analyzed data from multiple sources (in house whole-genome gene expression microarrays, previously published quantitative real-time PCR (qPCR) data and RNA-seq data from TCGA) to come up with a list of 18 genes (discovery set) that had the lowest variance, a high level of expression across tumors, and their matched normal samples. The genes in the discovery set were ranked using four different algorithms (BestKeeper, geNorm, NormFinder, and comparative delta Ct) and a web-based comparative tool, RefFinder, for their stability and variance in expression across tissues. Finally, we validated their expression using qPCR in an additional set of tumor:matched normal samples that resulted in five genes (RPL30, RPL27, PSMC5, MTCH1, and OAZ1), out of which RPL30 and RPL27 were most stable and were abundantly expressed across the tissues. Our data suggest that RPL30 or RPL27 in combination with either PSMC5 or MTCH1 or OAZ1 can be used as a minimal set of control genes in head and neck tumor gene expression studies

A distributed cancer care model with a technology-driven hub-and-spoke and further spoke hierarchy : findings from a pilot implementation programme in Kerala, India

Background: The technology enabled distributed model in Kerala is based on an innovative partnership model between Karkinos Healthcare and private health centers. The model is designed to address the barriers to cancer screening by generating demand and by bringing together the private health centers and service providers at various levels to create a network for continued care. This paper describes the implementation process and presents some preliminary findings. Methods: The model follows the hub-and-spoke and further spoke framework. In the pilot phases, from July 2021 to December 2021, five private health centers (partners) collaborated with Karkinos Healthcare across two districts in Kerala. Screening camps were organized across the districts at the community level where the target groups were administered a risk assessment questionnaire followed by screening tests at the spoke hospitals based on a defined clinical protocol. The screened positive patients were examined further for confirmatory diagnosis at the spoke centers. Patients requiring chemotherapy or minor surgeries were treated at the spokes. For radiation therapy and complex surgeries the patients were referred to the hubs. Results: A total of 2,459 individuals were screened for cancer at the spokes and 299 were screened positive. Capacity was built at the spokes for cancer surgery and chemotherapy. A total of 189 chemotherapy sessions and 17 surgeries were performed at the spokes for cancer patients. 70 patients were referred to the hub. Conclusion: Initial results demonstrate the ability of the technology Distributed Cancer Care Network (DCCN) system to successfully screen and detect cancer and to converge the actions of various private health facilities towards providing a continuum of cancer care. The lessons learnt from this study will be useful for replicating the process in other States

Recent advances and controversies in head and neck reconstructive surgery

Advances in head and neck reconstruction has made significant improvement in the quality of life and resectability of head and neck cancer. Refinements in microsurgical free tissue transfer leave made restoration of form and complex functions of head and region a reality. Standardized reconstructive algorithms for common head and neck defects have been developed with predictable results. Some of the major advances in the field include- sensate free tissue transfer, osseo integrated implant and dental rehabilitation, motorized tissue transfer and vascularized growth center transfer for pediatric mandible reconstruction. However there exist several controversies in head and neck reconstructive surgery. Some are old; resolved partially in the light of recent clinical evidences and others are new, developed as a result of newly introduced reconstructive techniques. These include, primary versus secondary reconstruction, pedicled versus free flaps, primary closure versus free tissue transfer for partial glossectomy defects, reconstruction of posterior mandible and reconstruction of orbital exenteration defects. Rapid advances in the field of tissue engineering and stem cell research is expected to make radical change in the field of reconstructive surgery. This manuscript review progress in head and neck reconstructive surgery during the last decade, current controversies and outline a road map for the future

Reconstruction in skull base surgery: Review of current concepts

Surgical resection plays a main role in the management of complex tumors involving the skull base. Advances in reconstructive surgery has made these resections to be carried out with less morbidity and better outcome in terms of disease control and functional rehabilitation. The reconstruction methods range from utilizing local galeal tissue to distant tissues transferred as free flaps. The reconstructive methods can be grouped according to the area of the skull base reconstructed, namely, the anterior, middle or posterior skull base. The article reviews the anatomical tissue requirement at each of these subsites and the suitable method available. At the end of the article, the readers should be able to understand the anatomical and functional requirements after skull base resection and should be able to plan the reconstruction using an algorithmic approach

Reconstruction of the laryngopharynx

Defects in the laryngopharynx following surgical excision of the tumors can be involving either part or full of the circumference of the lumen. The methods of reconstruction use skin or mucosal lined surface, which have their own merits and demerits. Advent of free flaps have given the surgeon choice of multiple flaps which could take their place instead of a gastric pull up which entails mediastinal dissection. The article reviews the methods available and discusses the relative merits and indications of these, in partial and full lumen reconstruction of the laryngopharynx. Loss of the capacity to speak is a grave morbidity associated with these procedures and there have been significant advances in the rehabilitation of speech after laryngectomy. The current status of the methods of speech rehabilitation is discussed in detail. The reader will at the end, be presented with an algorithmic approach to choose the method of reconstruction depending on the size and site of the defect, as practiced the authors′ service

Reconstruction of the laryngopharynx

Defects in the laryngopharynx following surgical excision of the tumors can be involving either part or full of the circumference of the lumen. The methods of reconstruction use skin or mucosal lined surface, which have their own merits and demerits. Advent of free flaps have given the surgeon choice of multiple flaps which could take their place instead of a gastric pull up which entails mediastinal dissection. The article reviews the methods available and discusses the relative merits and indications of these, in partial and full lumen reconstruction of the laryngopharynx. Loss of the capacity to speak is a grave morbidity associated with these procedures and there have been significant advances in the rehabilitation of speech after laryngectomy. The current status of the methods of speech rehabilitation is discussed in detail. The reader will at the end, be presented with an algorithmic approach to choose the method of reconstruction depending on the size and site of the defect, as practiced the authors′ service