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

1472pimmunotherapy in elderly patients 75 yrs with advanced non small cell lung cancer nsclc a multicenter italian experience

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Surgical and non surgical treatment

OBJECTIVES This contribution aims to update the dentist on some important knowledge about cancer of the mouth, particularly on the surgical, medical and radiotherapy treatment in a multidisciplinary approach. MATERIALS AND METHODS The material reported here represents the most up-to-date data on the subject, in a sort of a summary of the indications found in the medical literature and the experience of operators engaged on a daily basis in the treatment of head and neck cancer patients. RESULTS As already reported in the previous Modules of this ECM Course, the neoplasms of the head and neck area, and of the oral cavity in particular, represent aggressive diseases, burdened by 50% of loco- regional recurrences or distant metastases. For this reason, their treatment requires an initial collaboration between surgeon, oncologist and radiotherapist. Moreover, there are many other figures who play a crucial role in the overall management of these patients. The choice of the optimal treatment option, in the single patient, has recently become more difficult in consideration of the different possibilities that derive from the advances in surgery, radiotherapy and medical treatment: only a multidisciplinary approach is able to offer the right treatment in the right patient. It is now widely known that carcinoma of the posterior third of the tongue that is HPV-positive (Human Papilloma Virus, HPV) has a better response to treatment if radiotherapy is provided, and better overall survival when compared with HPV-negatives case. Radiotherapy (RT) has become an integral part of the multidisciplinary approach and frequently accompanies the fundamental therapeutic strategy still represented by surgery. The adoption of Intensity Modulated Radiation Therapy (IMRT) has reformed the approach to oral cancer. IMRT has been shown to improve accuracy towards tumor tissue, reducing the involvement of surrounding healthy tissues, leading to lower general toxicities. Surgical intervention in the most advanced cases always requires large excisions followed by reconstructions with loco-regional flaps or free microvascular flaps. It is always necessary, when anatomicalpossibilit\ue0 ly possible, to provide a margin of at least 1 cm of clinically healthy tissue and, in any case, intraoperative sections of frozen tissue allow to obtain confirmation of free margins. The optimal reconstructive option is represented by free microvascular flaps, which offer the best results obtainable in relation to speech and swallowing functions. With regard to medical therapy, cetuximab is one of the few drugs authorized for use in head-neck neoplasms. It is a monoclonal antibody, targeting Epidermal Growth Factor Receptor (EGFR), whose efficacy when used alone is rather modest. Other agents, such as cisplatin or 5-fluorouracil, which interfere with cell division, often used in combination with cetuximab increase responses. CONCLUSIONS The function of the multidisciplinary team in head-neck tumours is to bring together different healthcare professionals whose goal is to improve the prognosis and quality of life of patients. There are numerous clinical researches that testify to the advantages of this approach. Surgeons, radiotherapists and oncologists must be involved but also other figures (speech therapists, dieticians, psychologists, dentists\u2026 whose role will be described in the next Module). CLINICAL SIGNIFICANCE Only a multidisciplinary approach, with a careful initial assessment of the stage of the disease and of the psycho-physical conditions of the patient, is able to obtain the best possible results in the case of malignant neoplasms of the oral cavity and of the head-neck district

Multimodality treatment of osteosarcoma of the jaw : a single institution experience

Osteosarcomas of the jaws are rare mesenchymal tumors frequently diagnosed in the fourth decade of life which account for 6\ua0% of all osteosarcomas. This study evaluated the efficacy on the patients outcome of multimodality treatment consisting of surgery, chemotherapy and radiotherapy. The records of 22 patients affected by jaw osteosarcoma treated with a combination of surgery, poly-chemotherapy and adjuvant radiotherapy in selected cases were reviewed. Response rate, progression-free survival and overall survival were evaluated. Neoadjuvant chemotherapy resulted in an overall response rate of 83.3\ua0%, necrosis of grade I or II was obtained, respectively, in 44.4 and 55.6\ua0% of the patients, and surgery was radical in all patients. At a median follow-up of 60\ua0months, the 5-year progression-free survival and overall survival were 73.5 and 77.4\ua0%, respectively. These outcome parameters significantly correlated with age at diagnosis and grade of chemotherapy-induced necrosis. A complex multimodality approach including chemotherapy and radiotherapy, along with radical surgery, can maximize the outcome of patients affected by osteosarcoma of the jaws

Anti-epidermal growth factor receptor skin toxicity : a matter of topical hydration

Skin toxicity is a frequent complication of anti-epidermal growth factor receptor therapy, which can be an obstacle in maintaining the dose intensity and may negatively impact on the clinical outcome of cancer patients. Skin lesions depend on the disruption of the keratinocyte development pathways and no treatment is clearly effective in resolving the cutaneous alterations frequently found during antiepidermal growth factor receptor therapy. Among systemic treatments, oral tetracycline proved to be useful in preventing skin manifestations. We describe the case of a patient affected by metastatic colorectal cancer, for whom a combination of chemotherapy and cetuximab was used as second-line treatment. The patient developed a symptomatic papulopustular skin rash that disappeared completely after a twice-daily application of a hydrating and moisturizing cream, mainly consisting of a mixture of paraffin, silicone compounds, and macrogol. The marked cutaneous amelioration allowed the patient to continue cetuximab without any further symptoms and was associated with a partial radiological response