Complete response of recurrent oral squamous cell carcinoma treated with cetuximab in combination with radiotherapy: A case series

Salvage surgery for recurrent oral squamous cell carcinoma (OSCC) often leads to a poor quality of life (QOL). The present study described three cases that resulted in favorable locoregional control with cetuximab in combination with radiotherapy (Cmab + RT). Case 1 had regional recurrence of OSCC at the lower right mastoid area 4 months after primary surgery. Case 2 had regional recurrence of OSCC at the parotid area 7 months after primary surgery. Case 3 had local recurrence of OSCC at the masticatory muscle and Rouviere\u27s lymph nodes 1 year and 3 months after primary surgery. In all cases, Cmab + RT was performed, and disease‑free survival was confirmed 4 months, 2 years and 6 months, and 10 months after Cmab + RT, respectively. Immunohistochemically, all resected tumors had no expression of 110‑kDa catalytic subunit of class IA phosphatidylinositol 3‑kinase (PI3Kp110α). In conclusion, if salvage surgery for recurrent OSCC results in a significantly low QOL, then shifting to chemoradiotherapy may be appropriate as a treatment strategy. In addition, strong evidence indicated that PI3Kp110α expression is associated with Cmab therapy efficacy

A case of sagittal splitting ramus osteotomy and genioplasty in a patient with congenital factor VII deficiency

Blood coagulation factor VII is involved in the extrinsic clotting system, and congenital defects or deficiencies affecting blood coagulation factor VII are rare. We report the case of a patient who was diagnosed with factor VII deficiency based on a preoperative examination and then underwent factor VII replacement therapy and orthognathic surgery, together with a brief discussion of the literature.The patient was a 25-year-old woman. She presented to our hospital after being diagnosed with jaw deformity and underwent sagittal splitting ramus osteotomy and genioplasty under general anesthesia. Preoperative tests revealed an abnormally short prothrombin time. Blood tests detected very low coagulation factor VII activity (33%), and so the patient was diagnosed with factor VII deficiency.We conducted preoperative factor VII replacement therapy to inhibit bleeding, and then the abovementioned surgical procedure was performed safely. The operative time was 1 hour 30 minutes, and little intraoperative blood loss occurred. The patient\u27s postoperative course was good, e.g., no abnormal bleeding occurred, and she was discharged on postoperative day 7

A New Strategy for Surgical Intervention of Bisphosphonate-Related Osteonecrosis of the Jaw : A retrospective study.

Bisphosphonates (BPs) are now widely used to treat various skeletal complications. Although the number of reported cases ofbisphosphonate-related osteonecrosis of the jaw (BRONJ) is rapidly increasing worldwide, therapeutic strategies remain controversial.Conservative treatments including antibacterial mouth rinses, the systemic administration of antibiotics, and superficial debridement in stage II BRONJ have been recommended by the American Association of Oral and Maxillofacial Surgeons position paper. However, these treatments are only partially successful. We performed a surgical intervention that consisted of osteotomy and primary wound closure in patients with stages II and III BRONJ. Forty-three out of 44 cases were treated effectively by this strategy, leading to improvements in quality of life. All BRONJ patients treated with oral BPs were treated successfully by the surgical intervention. We also proposed a surgical intervention for patients with stage II BRONJ

A clinicopathological study of perineural invasion and vascular invasion in oral tongue squamous cell carcinoma

The risk factors for recurrence of head and neck cancer are classified as being of high or intermediate risk. Those of intermediate risk include multiple positive nodes without extracapsular nodal spread, perineural/vascular invasion, pT3/T4 primary tumours, and positive level IV/V nodes. However, little evidence is available to validate these intermediate risk factors. We analyzed perineural/vascular invasion in 89 patients who underwent radical surgery for oral tongue squamous cell carcinoma, whose records were reviewed retrospectively. Perineural invasion was found in 27.0% of cases and vascular invasion in 23.6%; both had a strong relationship with histopathological nodal status (P = 0.005). The 5-year disease-specific survival (DSS) and overall survival rates of patients with perineural invasion were significantly lower than those of patients without perineural invasion (P < 0.001 and P = 0.002, respectively). The 5-year DSS of UICC stage I and II cases with perineural/vascular invasion was significantly lower than those without (P < 0.001 and P = 0.008, respectively). Perineural invasion and vascular invasion are risk factors for regional metastasis and a poor prognosis. We recommend elective neck dissection when perineural/vascular invasion is found in clinical stage I and II cases. The accumulation of further evidence to consider intermediate risks is required

Immunohistochemical study of vascular endothelial growth factor‑C/vascular endothelial growth factor receptor‑3 expression in oral tongue squamous cell carcinoma: Correlation with the induction of lymphangiogenesis

The aim of the present study was to elucidate the associations between the expression of the vascular endothelial growth factor-C (VEGF-C)/VEGF receptor-3 (VEGFR-3) axis and lymphangiogenesis, regional lymph node metastasis and clinicopathological factors in oral tongue squamous cell carcinoma (OTSCC) using immunohistochemistry. The expression of VEGF-C, VEGFR-3 and podoplanin was immunohistochemically evaluated in specimens obtained from 65 patients with OTSCC (T1-2, N0) who had undergone radical surgery alone. The associations between the expression of VEGF-C, VEGFR-3 and podoplanin, and lymphangiogenesis, regional lymph node metastasis and clinocopathological factors were determined by immunohistochemical analysis. VEGF-C, VEGFR-3 and combined VEGF-C/VEGFR-3 expression was significantly higher in cases with regional recurrence compared with those without lymph node involvement (P<0.001). As regards lymphangiogenesis, a significant correlation was observed between podoplanin expression and VEGF-C, VEGFR-3 and combined VEGF-C/VEGFR-3 expression (P<0.001). Therefore, lymphangiogenesis in the peritumoral stroma was associated with lymph node metastasis. However, podoplanin expression did not exhibit a significant correlation with the progression of lymph node metastasis. The results of the present study suggest that the VEGF-C/VEGFR-3 axis may be associated with lymph node metastasis through lymphangiogenesis. Determining the VEGF-C/VEGFR-3 expression status may help predict which patients will develop regional recurrence and provide novel targets for therapies to suppress lymph node metastasis in the treatment of OTSCC

Isolation and characterization of cancer stem-like side population cells in human oral cancer cells.

Recent studies suggest that cancer stem cells may be responsible for tumorigenesis and contribute to some individuals\u27 resistance to cancer therapy. Some studies demonstrate that side population (SP) cells isolated from diverse cancer cell lines harbor stem cell-like properties; however, there are few reports examining the role of SP cells in human oral cancer. To determine whether human oral cancer cell lines contain a SP cell fraction, we first isolated SP cells by fluorescence activated cell sorting, followed by culturing in serum-free medium (SFM) using the SCC25 tongue cancer cell line, so that SP cells were able to be propagated to maintain the CSC property. Differential expression profile of stem cell markers (ABCG2, Oct-4 and EpCAM) was examined by RT-PCR in either SP cells or non-SP cells. Growth inhibition by 5-FU was determined by the MTT assay. Clonogenic ability was evaluated by colony formation assay. SCC25 cells contained 0.23% SP cells. The fraction of SP cells was available to grow in SFM cultures. SP cells showed higher mRNA expression of stem cell markers (ABCG2, Oct-4 and EpCAM) as compared with non-SP cells. Moreover, SP cells demonstrated more drug resistance to 5-FU, as compared with non-SP cells. The clone formation efficiency of SP cells was significantly higher than non-SP cells at an equal cell number (P<0.01). We isolated cancer stem-like SP cells from an oral cancer cell line. SP cells possessed the characteristics of cancer stem cells, chemoresistance, and high proliferation ability. Further characterization of cancer stem-like SP cells may provide new insights for novel therapeutic targets

Oral surgery in patients with antiphospholipid syndrome

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by recurrent thrombosis, other associated autoimmune disease, and/or obstetrical morbidity along with persistent production of antiphospholipid antibodies. Because of the nature of this systemic disease, most patients are medicated with antithrombotic agents and abundant glucocorticoids. This study reports a cohort of 16 patients with APS, who underwent oral surgery between 2010 and 2017 at the Nagasaki University Hospital. Because oral antithrombotic therapy was continued in the perioperative period, all wounds were strictly closed by suturing to prevent postoperative bleeding. Perioperative laboratory dates and medications were assessed. All patients achieved local postoperative hemostasis and did not exhibit systemic complications. Moreover, there were no postoperative systemic and/or local infections. Oral surgeons should suture oral wounds and ensure local hemostasis to prevent postoperative bleeding. Because patients with APS are likely to develop thrombosis despite continued administration of antithrombotic medications, strict perioperative examination of blood coagulation is needed. Furthermore, it is important to consider the damage and stress caused due to oral surgery. Moreover, when necessary, glucocorticoid therapy should be carefully administered, in accordance with the degree of invasion and judgment of the attending physician

Tooth extraction in a patient after autologous skeletal myoblast sheet transplantation for severe dilated cardiomyopathy

The authors describe the first case of tooth extraction in a patient treated with autologous skeletal myocardial sheet transplantation for severe dilated cardiomyopathy. This condition is associated with significant morbidity and mortality that may have identifiable causes or may be idiopathic or inherited. In addition to local disinfection, antimicrobial prophylaxis and continuous anticoagulant therapy during the perioperative period of tooth extraction were needed to prevent infective endocarditis and ensure the success of regenerative therapy of the heart

Lower gingival squamous cell carcinoma with brain metastasis during long-term cetuximab treatment: A case report

Long-term cetuximab treatment can lead to acquired resistance, and tumor progression and/or new lesions often occur. The present report describes a case of lower gingival squamous cell carcinoma with brain metastasis during long-term cetuximab treatment in a 60-year-old man, including findings of an immunohistochemical study. The resected primary tumors, biopsy of the lung metastasis before administration of cetuximab, and brain metastasis specimens mediated by cetuximab were immunohistochemically examined. Histologically, the metastatic brain lesion showed hyperkeratinizing tumor cells with deeply stained irregular nuclei with necrotizing tumor cells, and a decrease in cell density was exhibited in part of the tumor nest. Moreover, the brain lesion was less malignant compared with the primary tumor and metastatic lung lesions. Immunohistochemically, the metastatic brain lesions showed low expression of epidermal growth factor receptor (EGFR) and high expression of N-cadherin compared with the primary tumor and metastatic lung lesions. These results suggest that acquired resistance to cetuximab may be associated with low EGFR expression and increased epithelial-to-mesenchymal transition potential