Oral cancer in the young with no tobacco exposure: A distinct epidemiological subset?

Objectives: To describe oral squamous cell carcinoma (OSCC) in the young (<45 years) with no tobacco exposure and identify the determinants of locoregional control and survival. Materials and Methods: This is a retrospective analysis of 82 young patients of OSCC with no tobacco exposure treated with surgery and adjuvant therapy. Survival analysis was performed, and determinants of control and survival were identified by Cox proportional hazards regression model. Results: Overall 67% were male, and the median age was 40 years. Survival was excellent: for Stages I, II, III, and IV, 5-year overall survival was 97%, 95%, 75%, and 64% and disease-free survival (DFS) was 84%, 79%, 57%, and 59%, respectively. On multivariable analysis, perineural invasion (PNI) predicted DFS and local and distant control. Conclusion: This cohort had excellent survival when treated appropriately with adjuvant therapy. PNI may represent the need for treatment escalation. Further study is required to identify if this is a biologically distinct cohort

Outcomes following pharyngeal reconstruction in total laryngectomy – Institutional experience and review of literature

Background: Pharyngeal reconstruction is a challenging aspect of reconstruction after resections for head-and-neck cancer. The goals of reconstruction are to restore the continuity of the pharyngeal passage to enable oral alimentation and rehabilitation of speech wherever possible. This study was performed to determine the outcomes following pharyngeal reconstruction in total laryngectomy (TL) using different reconstructive options and to determine the predictors of pharyngocutaneous fistula (PCF) and swallowing dysfunction. Materials and Methods: Retrospective analysis of patient data between 2003 and 2010 of patients undergoing TL with partial or total pharyngectomy. Demographic and treatment details were collected and analysed. Univariate analysis was performed to determine predictors of PCF and swallowing dysfunction. Results: Fifty-seven patients underwent pharyngeal reconstruction following TL, 31 of whom had received prior treatment. Following tumour resection, 31 patients had circumferential defects and 26 patients had partial pharyngeal defects. The flaps used include pectoralis major myocutaneous flap (n = 29), anterolateral thigh flap (n = 8), gastric pull-up (n = 13) and free jejunal flap (n = 7). PCF was seen in 20 patients, of which 15 (75%) were managed conservatively and 5 required another surgery. At last follow-up, 99 patients (68%) were on full oral alimentation. Tracheo-oesophageal puncture and prosthesis insertion was done in 20 patients, of whom 17 (85%) developed satisfactory speech. Partial pharyngeal defects were associated with a higher risk of PCF on univariate analysis (P = 0.006) but were not significant on multivariate analysis. Post-operative swallowing dysfunction was significantly higher with hypopharyngeal involvement by tumour (P = 0.003). Conclusion: Pharyngeal reconstruction in TL is feasible with good results. Majority of the patients swallow and regain acceptable swallowing function within 3 months

Imaging advances in oral cavity cancer and perspectives from a population in need: Consensus from the UK-India oral cancer imaging group

Oral squamous cell carcinoma (OSCC) accounts for a third of the cancer burden in India, with a correspondingly high cancer-specific mortality. Although treatment of OSCC in India mirrors that of high-income nations, extreme burden of disease, late presentation, and the associated advanced stage of disease pose unique challenges in a resource-constrained environment. Despite a multimodal treatment paradigm, survival rates are low. Often the cause for late presentation is the delayed diagnosis, inappropriate investigation and referral, and compromised or incorrect treatment, leading to poor patient outcomes and costs to the health-care provider. To address these issues, the first UK-India Symposium on Advances in Oral Cancer Imaging Symposium was organized in Bangalore, India, in April 2019; participants included radiologists, imaging scientists, clinicians, and data scientists from the United Kingdom, India, Singapore, and the United States. Following the discussions held during this meeting, in this manuscript, we present evidence-based guidance for the role of imaging in OSCC, recommendations for service development, and details of future potential for evolution in head and neck imaging