32 Early Primary Tumor with Advanced Neck Disease

2019 ◽  
2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5536-5536
Author(s):  
Rusana Simonoska

5536 Background: In Sweden, approximately 500-600 cases of oral cancer are diagnosed every year. These include cancer of the gingiva, retromolar trigonum, bucca, hard palate, tongue and floor of the mouth. Each year, around 15 cases of gingival cancer (GC) are diagnosed in the Stockholm region. The goal of this study was to study the onset of symptoms, treatment, prognosis, and sequelae of GC in order to optimize the treatment. Methods: The study consists of a retrospective review of medical records of all diagnosed cases of GC in Stockholm region between 2000-2010, identified through the ENT-clinic Karolinska Hospital patient database. Results: Our retrospective study comprised 156 patients diagnosed with GC. The average age was 72 years sharing equally between the sexes, 50% were smokers. 98% had a squamous cell carcinoma (scc). Presenting symptoms were often lump or ulceration in the gums, pain, bleeding or discomfort/misfit of dentures. Around 30% had premalignant lessons in the oral cavity before diagnosis. 3/4-th of all GC was localized in the lower jaw. 66% of the GC-patients presented as aT4 cancer. At presentation, 26% had a regional metastasis and of those 90% had their primary tumor in the lower jaw. Six cases had bilateral neck disease. 81% of the patients with regional metastasis had low to medium grade of scc differentiation of the primary tumor. 84% of all patients with regional metastasis had a T4 primary tumor. Neck dissection was performed in 38% (n=59). Of these 35 cases where staging neck, i.e. N0 at presentation and in 7 cases (20%) a positive neck disease was found. The risk for second primary was 15%. The overall 5-year survival was 24%. Conclusions: Advanced age and high number of T4 cancer at diagnosis partly explains the poor survival statistics. Almost 30% of the patients in our material have had premalignant lessons in the oral cavity before the cancer diagnosis and are at high risk for new tumors (second primary); therefore patients with GC should be followed up for at least 5 years, possibly longer in the presence of premalignant lessons. GC of the lower jaw is more likely to metastasize than GC of the upper jaw. Due to 20% occult metastasis occurrence in the staging neck cases, we recommend staging neck dissection for patients with GC.


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1137-1137
Author(s):  
Yujia Shen ◽  
Salomon Manier ◽  
Jihye Park ◽  
Yuji Mishima ◽  
Marzia Capelletti ◽  
...  

Abstract Introduction: Recent data show that Multiple Myeloma (MM) always progresses from a precursor state (monoclonal gammopathy of undetermined significance [MGUS]/smoldering multiple myeloma [SMM]) to overt MM indicating that there is continuous dissemination/clonal evolution of tumor cells from the original stages of tumor development to the time of clinical presentation. A major challenge in understanding the progression and metastasis of MM is to distinguish alterations driving the tumor growth and evolution from passenger mutations. Genetic screens are powerful tools for assaying phenotypes and identifying causal genes in various hallmarks of cancer progression. The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) system has emerged as a powerful technology to efficiently and simultaneously perform genome editing of multiple genes. Here we report a genome-wide CRISPR/Cas9-mediated loss of function screen in a xenograft mouse model to investigate the essential drivers of tumor growth and metastasis in MM. Methods: Lentiviral particles from 2 subpools of a human sgRNA library (Avana), each containing 1 sgRNA per gene were introduced into MM1.S (Cas9+/GFP+/Luc+) cell line with the pre-determined amount of virus to achieve 30-50% infection efficiency, corresponding to a multiplicity of infection (MOI) of ~0.5-1. Cells were selected with puromycin for 5-7 days following infection to remove uninfected cells. Selected cells were injected subcutaneously into SCID-Beige mice on both flanks. Genomic DNA from pre-transplantation cells, early primary tumors (~3 weeks post tumor cell injection), late stage primary tumors and metastatic bone marrow samples were extracted. gDNA was amplified following adaptor ligation and barcoding of the samples and PCR products were subsequently sequenced on a HiSeq2000 (Illumina). Results: To investigate the sgRNA library dynamics in different sample types (pre-transplantation cells, early primary tumor, late primary tumor, and bone marrow metastasis), we compared the overall distributions of sgRNAs from all sequenced samples. The early tumor sample replicates of both subpools on average retained 77.3% and 94.7% of the sgRNAs found in the pre-transplanted cell populations, while the late primary tumors retained 59.4% and 65.6% of the sgRNAs respectively, compared to early tumors. Interestingly, only a small fraction of sgRNAs (1.1% and 3.4% of sgRNAs in the pre-transplantation cells, 10.7% and 7.2% of sgRNAs in the late primary tumors for the 2 subpools respectively) were detected in the metastatic bone marrow samples. Using gene set enrichment analysis (GSEA), we found that the gene targets of the most enriched sgRNAs in the bone marrow samples were preferentially involved in important cellular processes, such as cell cycle regulation, protein translation, and several signaling pathways. Additionally we compared sgRNAs present in early primary tumor versus pre-transplantation cells and late primary tumor and found that many sgRNAs were depleted during tumor progression, indicating that their target genes were important for progression. These depleted sgRNAs in both stages mainly targeted genes involved in mTORC1 and DNA repair pathways, many of which are regulated by MYC and cell cycle related targets of E2F transcription factors. Conclusion: We established a platform for future in vivo Cas9 screens using the genome-wide CRISPR screening libraries to explore potential new targets in regulating tumor dissemination, colonization and metastasis in MM. In addition, this in vivo screening could potentially be used to investigate essential genes of response to targeted therapies or/and immunotherapies. Thus, CRISPR/Cas9-based in vivo screening is a powerful tool for functional genomics discoveries. Disclosures Roccaro: Takeda Pharmaceutical Company Limited: Honoraria. Ghobrial:BMS: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria; Takeda: Honoraria; Noxxon: Honoraria; Amgen: Honoraria.


2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 329-329
Author(s):  
E. Abel ◽  
S. H. Culp ◽  
N. M. Tannir ◽  
S. F. Matin ◽  
P. Tamboli ◽  
...  

329 Background: In metastatic renal cell carcinoma (mRCC) patients treated with sunitinib and the primary tumor in situ, there is minimal predictive data available to help guide clinicians during treatment with targeted therapy. In prior studies, early primary tumor response (PTR) was associated with improved overall PTR, but the effect on overall survival (OS) is unknown. The purpose of our study was to evaluate whether early PTR was associated with improved OS in mRCC patients undergoing treatment with sunitinib. Methods: We reviewed our institutional database to identify patients with mRCC treated with sunitinib with primary tumor in situ. Clinical and pathological data were collected for each patient. Sequential abdominal CT or MRI scans were reviewed to evaluate PTR. Early PTR was defined as ≥ 10% decrease in tumor diameter within the first 90 days of treatment. Univariable and multivariable stepwise Cox proportional hazards regression analysis were performed to identify predictors of OS in these patients. Results: 75 consecutive patients were identified between 2005 and 2009 with a median follow-up of 15 months. 24 patients exhibited an early PTR; median maximum response 23.1% (range: −53.4, −10.2) and decrease in primary tumor diameter at a median of 90.5 days. Early PTR was associated with a decreased risk of death on multivariate analysis (HR: 0.18; 95% CI 0.05, 0.62, p<0.01). In addition, median OS was improved in patients with an early PTR (30.2 vs. 12.7 months). Independent predictors of decreased survival on multivariate analysis included local symptoms, multiple bone metastases, clinical evidence of venous thrombus, LDH > upper limit of normal, and >2 visceral metastatic sites. Conclusions: Early PTR ≥ 10% is associated with improved survival, better response in metastatic sites, and better overall PTR in patients with mRCC. Future studies should consider this variable when evaluating sunitinib in mRCC treatment. [Table: see text]


1992 ◽  
Vol 101 (3) ◽  
pp. 222-228 ◽  
Author(s):  
W. Frederick McGuirt ◽  
Robert S. Feehs ◽  
Harriet L. Strickland ◽  
Gene Bond ◽  
William M. McKinney

Early primary head and neck cancers (stages I and II) and occult metastatic neck disease have caused debate regarding the choice between surgery and irradiation. The arguments for each are reviewed with a new consideration: the acceleration and/or induction of carotid atherosclerosis in irradiated patients. We present clinical case reports (n = 9), a retrospective clinical evaluation for the occurrence of carotid atherosclerosis in irradiated head and neck cancer patients (n = 57), and a comparison study of the extent and distribution of atherosclerosis in irradiated (n = 29) and nonirradiated head and neck cancer patients controlled for age, blood pressure, and tobacco use. The results show that carotid atherosclerosis is found in a wider anatomic distribution and to a greater extent in irradiated than in nonirradiated patients. We conclude that carotid atherosclerosis is induced and/or accelerated by neck irradiation. The implications as they relate to choice of treatment, to pretreatment evaluations, and to long-term follow-up are discussed.


2013 ◽  
Vol 19 (1) ◽  
pp. 5-10
Author(s):  
Md Mosleh Uddin ◽  
Belayat Hossain Siddiquee ◽  
Syed Farhan Ali Rajib ◽  
Kazi Shameemus Salam

Due to close relationship of vital structures in the neck, certain complications are inherent to neck dissection (ND) for the treatment of patients with metastatic neck disease of squamous cell carcinoma. Aim: To compare the incidence of complications of Comprehensive ND done in primary neck and in irradiated neck. Methods: A cross sectional study of 267 patients with metastatic squamous cell carcinoma in the neck, with or without primary tumor, under gone ND with a curative intension, was made from January 2007 to December 2011 (five years). It was done to identify perioperative complications and to compare them in NDs done in primary neck and in irradiated neck. Result: Total 267 patients with unilateral Comprehensive ND, with or without en-block of the primary tumor, were studied. There was no death. The most frequent complication was marginal mandibular nerve injury (4.05% in primary neck and 8.51% in irradiated neck) followed by intra operative hemorrhage (1.16% in primary neck and 3.19% in irradiated neck). Conclusion: There were no perioperative death in either category; nerves were the most commonly injured structures. Complications were higher in neck dissection in irradiated neck than in primary neck dissection.DOI: http://dx.doi.org/10.3329/bjo.v19i1.14857 Bangladesh J Otorhinolaryngol 2013; 19(1): 5-10


2009 ◽  
Vol 8 (8) ◽  
pp. 2412-2423 ◽  
Author(s):  
Aaron P. Petty ◽  
Stephen E. Wright ◽  
Kathleen A. Rewers-Felkins ◽  
Michelle A. Yenderrozos ◽  
Beth A. Vorderstrasse ◽  
...  

2011 ◽  
Vol 185 (4S) ◽  
Author(s):  
E. Jason Abel ◽  
Stephen H. Culp ◽  
Nizar M. Tannir ◽  
Surena F. Matin ◽  
Pheroze Tamboli ◽  
...  

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