18F-FDG PET-CT in the Management of Patients Receiving Definitive Radiotherapy for Malignancies of the Head and Neck

The study investigated the utility and timing of 18F-FDG PET-CT to evaluate for residual/recurrent or metastatic HNC in patients treated with definitive intensity modulated radiation therapy (IMRT) with or without chemotherapy, planned with 18F-FDG PET-CT. The incidence and timing of locoregional recurrence, distant metastatic disease, new primary malignancies, and death were evaluated in 261 patients retrospectively. Findings were classified based on pathology or clinical follow-up and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG PET-CT were determined overall as well as at the time of each 18F-FDG PET-CT. The overall accuracy for 18F-FDG PET in the detection of residual/recurrent malignancy or metastatic disease was 96.4%. Of those in whom cancer recurred locally, 57% were identified based on physical examination and other imaging findings and 43% were identified initially on 18F-FDG PET-CT surveillance imaging when no disease was evident clinically. 18F-FDG PET-CT has a high diagnostic capability of detecting residual/recurrent malignancy or malignant metastatic disease in patients with HNC following IMRT ± concurrent chemotherapy, supporting 18F- FDG PET-CT’s use to evaluate patients for recurrent malignancy in the post-IMRT period, even without clinical evidence of disease.

A Cytogenetic Study on the Efficacy of Chyawanprash Awaleha as an Antioxidant in Oral Premalignant Cancer

Background. Chyawanprash awaleha (Cp) is an Ayurvedic rasayana formulation and is used as a genoprotective agent. Objective. The present cytogenetic study has been done to investigate the efficacy of Cp against betel quid chewers suffering from oral precancerous lesions through satellite association (SA) assay. Materials and Methods. The frequency of SA was analyzed in 21 betel quid chewing oral precancerous lesions patients and then they were divided into 2 groups. Group 1 consisted of 15 patients, advised to quit betel quid chewing and fed with 20 gms of Cp, twice a day for three months. Group 2 consisted of 6 patients, who refused Cp feed but accepted to quit betel quid chewing. At the end of three months, both groups were assessed cytogenetically. Results. The frequency of SA was statistically significant in both groups, but an elevated mean difference was observed more in Group 1 than in Group 2. Conclusion. The study indicates that betel quid cessation reduces the effect of DNA damage in oral precancerous lesions. But the increased mean difference in SA in Group 1 compared to Group 2 clearly indicates that Cp can further minimize the genotoxic effect caused by mutagenic agents present in betel quid.

Establishment of a Tongue Squamous Cell Carcinoma Cell Line from Indian Gutka Chewer

CD cell line has been established from a poorly differentiated squamous cell carcinoma of tongue. This is a first ever cell line established from an Indian gutka chewer. Cell line was characterized for morphology, ultrastructure, doubling time, expression of epithelial markers, DNA content, karyotyping, STR markers, p53 mutations, HPV status, and tumorigenicity in SCID mice with all-trans-retinoic acid and cisplatin. The epithelial phenotype of the cell line was confirmed with surface markers and ultrastructure. The cell line is hyperploid with chromosomal alterations like gain of chromosomes 8q and 11q. CD cell line shows a unique pattern on STR genotyping and carries a missense mutation R273C in TP53. It does not show genomic integration of HPV. The cells are nontumorigenic to SCID mice and show growth inhibition upon treatment with cisplatin, and all-trans-retinoic acid. This cell line may be useful as an in vitro tool to understand the molecular changes associated with oral cancers.

Comparative Study of Superselective Intra-Arterial Chemoradiotherapy versus Radical Surgery on Distant Metastasis for Advanced Oral Cancer

Background. Distant metastasis is considerably more frequent in superselective intra-arterial chemoradiotherapy than other radical treatments for advanced oral cancers. However, there is no evidence supporting such claim. The purpose of this study was to report our experience in superselective intra-arterial chemoradiotherapy and conventional surgical management with particular focus on distant metastasis. Methods. One hundred seventy-two patients with oral squamous cell carcinoma in stages III and IV were included in this study. Retrospective analysis for DM rates and background between surgical management and superselective intra-arterial chemoradiotherapy was performed. Results. Distant metastasis developed clinically was detected in 24 out of 141 patients (17.0%) treated surgically and in 6 out of 31 patients (19.4%) treated with superselective intra-arterial chemoradiotherapy. There was no significant difference in the rate of distant metastasis between the 2 groups. Comparison of patients in both groups with and without distant metastasis revealed no differences in age, T classification, N classification, and treatment effect. Neck recurrence was the only significant risk factor for distant metastasis. Conclusion. No significant difference was found in the rate of distant metastasis between patients treated with surgical treatment and superselective intra-arterial chemoradiotherapy, and additional effort is needed to reduce the risk of distant metastasis.

Head and Neck Solitary Extramedullary Plasmacytoma

Introduction. This study aimed to report the characteristics and treatment outcome of 13 patients with solitary extramedullary plasmacytomas of the head and neck and analytical literature review. Materials and Methods. Nine patients (69%) were treated with gross surgical resection followed by radiotherapy, three (23%) were primarily treated with radiotherapy alone, and one (8%) was treated with surgery alone. Results. There were 3 women and 10 men with the median age of 52 years. Nasal cavity (46%) and paranasal sinuses (23%) were the most common primary sites. After a median follow-up of 28 months, 10 patients are alive and free of disease, one is alive with multiple myeloma, and two died of multiple myeloma. In the literature review the median age was 58 years and male/female ratio was 2.7. Sinonasal tract was the most common primary site. Ten-year local control and progression to multiple myeloma rates were 88% and 23%, respectively. The 5- and the 10-year overall survival rates were 71 and 69%, respectively. Conclusion. Radiation therapy with or without surgery is an effective treatment for patients with head and neck extramedullary plasmacytoma. However, long-term follow-up for detection of local recurrence and progression to multiple myeloma is essential.

Awareness of Oral Cancer in a Northwestern Nigerian State: Assessing the Knowledge, Opinion, and Practice of Traditional Healers and Herbalists

Background: Traditional healers/herbalists remain one of the most accessible and popular options of care to people suffering from cancers particularly at the community level in Nigeria. The majority of patients with oral cancer present at the terminal stage after exploring unorthodox care. This study assesses the awareness of oral cancer among traditional caregivers in Kano State, Northwestern (NW) Nigeria. Methods: Self-administered, structured questionnaires were administered to a cross section of 21 traditional caregivers. Results: Of the 21 traditional caregivers studied, the majority (66.7%) had never heard of oral cancer and only 7 (33.3%) were aware. The level of knowledge on oral cancer was assessed using a scoring system classifying respondents as having adequate (>50%) or inadequate (<50%) knowledge. There was a significant educational status gap as respondents with informal education had lesser knowledge than that of their counterparts who had formal education (61.9% versus 19.0%) (P = 0.012). Conclusions: It is important to have allied healthcare providers informed about oral cancer, as their knowledge and awareness of oral cancer and its risk factors, which were low in our study, are vital in prevention and early detection. Impact: This study provides an insight into oral cancer prevention using traditional herbalists who are popular caregivers for those seeking health-related solutions.

The Outline of Prognosis and New Advances in Diagnosis of Oral Squamous Cell Carcinoma (OSCC): Review of the Literature

Objective. Oral squamous cell carcinoma (OSCC) has a remarkable incidence over the world and a fairly strenuous prognosis, encouraging further research on the prognostic factors and new techniques for diagnosis that might modify disease outcome. Data Sources. A web-based search for all types of articles published was initiated using Medline/Pub Med, with the key words such as oral cancer, prognostic factors of oral cancer, diagnostic method of oral cancer, and imaging techniques for diagnosis of oral cancer. The search was restricted to articles published in English, with no publication date restriction (last update April, 2013). Review Methods. In this paper, I approach the factors of prognosis of OSCC and the new advances in diagnostic technologies as well. I also reviewed available studies of the tissue fluorescence spectroscopy and other noninvasive diagnostic aids for OSCC. Results. The outcome is greatly influenced by the stage of the disease (especially TNM). Prognosis also depends or varies with tumour primary site, nodal involvement, tumour thickness, and the status of the surgical margins. Conclusion. Tumour diameter is not the most accurate when compared to tumour thickness or depth of invasion, which can be related directly to prognosis. There is a wide agreement on using ultrasound guided fine needle aspiration biopsies in the evaluation of lymph node metastasis.

Assessment of Quality of Life and Speech after Implant-Retained Oral Rehabilitation in Head and Neck Cancer Patients

Aim. To assess quality of life and speech after rehabilitation with implant-retained dental prosthesis in head and neck cancer patients. Material and Methods. Twenty-six patients who were diagnosed with tumour of the maxilla and mandible were selected for rehabilitation with implant-retained dental prosthesis following resection and reconstructive surgery. They were evaluated for quality of life (EORTC QLQ-C30 and H-N35 questionnaires, version 3), speech, and swallowing (questionnaire and Dr. Speech software, version 4) before implant treatment and at six-, twelve-, and eighteen-month followup. Statistical analysis of quality of life, speech, and swallowing for different duration of their preoperative status was done. Quality of life, speech, and swallowing in grafted and native groups and radiated and nonradiated groups were also compared. Results. Quality of life was statistically significant in scale of pain, speech, and trouble with social eating, pain killers, and weight loss. It was insignificant when radiated and nonradiated or grafted and native jaw groups were compared. Improvement in movement of the tongue, swallowing ability, salivation taste, and intelligibility of speech was also observed. Conclusion. The surgical treatment of head and neck cancers with microvascular surgery and dental rehabilitation with implants restores function, esthetics, and patient’s well-being.