Advanced Stage Oropharyngeal Carcinoma Research Articles

Dysphagia, trismus and speech impairment following radiation-based treatment for advanced stage oropharyngeal carcinoma: a one-year prospective evaluation.

The objective was to assess swallowing, mouth opening and speech function during the first year after radiation-based treatment (RT(+)) after introduction of a dedicated preventive rehabilitation program for stage III-IV oropharyngeal carcinoma (OPC). Swallowing, mouth opening and speech function were collected before and at six- and twelve-month follow-up after RT(+) for OPC as part of ongoing prospective assessments by speech-language pathologists . Objective and patient-perceived function deteriorated until 6months and improved until 12months after treatment, but did not return to baseline levels with 25%, 20% and 58% of the patients with objective dysphagia, trismus and speech problems, respectively. Feeding tube dependency and pneumonia prevalence was low. Despite successful implementation, a substantial proportion of patients still experience functional limitations after RT(+) for OPC, suggesting room for improvement of the current rehabilitation program. Pretreatment sarcopenia seems associated with worse functional outcomes and might be a relevant new target for rehabilitation strategies.

The First Report of Basilar Invagination and Brainstem Compression as a Complication of Head and Neck Radiation: Options for Treatment and Techniques for Endonasal Clivectomy and Odontectomy

• Advanced stage oropharyngeal carcinoma is commonly treated with multimodality therapy. Organs at risk in the head and neck region include the spinal cord, brainstem, salivary glands, swallowing structures, and mandible • Late complications occur months to years after treatment and include xerostomia, small vessel damage and osteoradionecrosis, soft tissue fibrosis, trismus, articulatory sequelae, xerostomia, and dysphagia. • It is estimated that between 5 and 15% of head and neck radiotherapy patients will have late tissue complications from radiotherapy. • In 236 patients with oropharyngeal carcinoma treated with combined chemoradiation therapy, osteomyelitis occurred in 9%. • We report the first case of cervical instability and basilar invagination as a rare complication of primary radiation therapy for head and neck cancer.

8546 The prognostic value of p16 status in advanced stage oropharyngeal carcinoma according to treatment regimen

8546 The prognostic value of p16 status in advanced stage oropharyngeal carcinoma according to treatment regimen

Oropharyngeal carcinoma and its treatment in Finland between 1995–1999: a nationwide study

The survival figures for advanced stage oropharyngeal carcinoma (OPC) have remained moderate in spite of radical combined modality treatments. The purpose of this study was to investigate the used treatment approach and the outcome of OPC in a nationwide study. Retrospective clinicopathological data of all patients diagnosed with OPC between 1995 and 1999 at the five university hospitals in Finland were reviewed. All patients had a minimum 4-year follow-up. A total of 168 patients (145 men and 23 women, mean age 59 years; range 28 - 89 years) were included. The T categories were as follows: T1, n =34; T2, n =55; T3, n =40; T4, n =39. One hundred and seventeen (69.6%) patients presented with neck node metastases and three (1.8%) patients with distant metastases. In the majority (61.3%) of the patients the tumor was located in the lateral wall of the oropharynx. In 144 (85.7%) patients the treatment was performed with curative intent. Of these, surgery of the primary tumor was performed in 123 (85.4%) patients, and the defect was reconstructed with a pedicled flap or free tissue transfer in 66 (53.7%) of these patients. A neck dissection (ND) was performed in 86 (69.9%) out of these 123 cases. Surgery was the only treatment modality in 10 (6.9%) patients. Radiation therapy (RT) only (with or without chemotherapy) was given to 21 (14.6%), combined treatment with surgery + radiation therapy (S + RT) to 110 (76.4%) and surgery + chemoradiotherapy (S + CRT) to 3 (2.1%) patients. Overall (OS) 3- and 5-year survival rates were 58 and 45%, respectively. Disease-specific (DSS) 5-year survival rates by T-class for the patients treated with curative intent were as follows: T1, 77%; T2, 70%; T3, 66%; T4, 53%. The variable treatment approach, the frequent locoregional recurrences and the moderate survival point out the need to consider new strategies in the management of OPC.

MCM2: Test of utility as a molecular marker in advanced-stage oropharyngeal carcinoma

5590 Background: MCM2 is a member of the family of minichromosome maintenance (MCM) proteins that play an important role in the regulation of DNA replication. MCM2 has been shown to be a proliferation marker in several types of tissue. In this study we examined the utility of the proliferation marker MCM2 as a molecular prognostic marker in 30 oropharyngeal squamous cell carcinomas. Methods: Parallel sections of 30 oropharyngeal tumors were stained with antibodies against MCM2. The tumor sub-sites were: base of tongue in 11 patients, tonsillar fossa in 13 patients, pharyngeal wall in 5 patients, and faucial arch in 1 patient. The percentage of positively stained nuclei was scored for each antibody. Clinicopathologic patient data were retrospectively collected from medical charts. Results: The average age at presentation was 52 years and 2 months (range 43 - 80 years) in the overall patient population. Twenty-four patients were men and six patients were women. Twenty-eight patients (93%) presented with advanced stage (Stage III and IV) disease. There was no significant difference in the proportion of cells stained by anti-MCM2 between patients who died of the disease and those who remained alive (67.6% versus 62.9%, respectively, p=.74). Similarly, employing a multivariate Cox regression analysis, risk of death was not found to be associated with elevated MCM2 expression. These findings did not vary by disease subsite. Conclusions: Our data suggest that the cellular proliferation marker MCM2 is of limited clinical utility as a disease prognosticator in individuals diagnosed with advanced stage oropharyngeal carcinoma. The role of MCM2 as a molecular prognosticator in patients with early stage disease requires further investigation. No significant financial relationships to disclose.

MCM2: Test of utility as a molecular marker in advanced-stage oropharyngeal carcinoma

5590 Background: MCM2 is a member of the family of minichromosome maintenance (MCM) proteins that play an important role in the regulation of DNA replication. MCM2 has been shown to be a proliferation marker in several types of tissue. In this study we examined the utility of the proliferation marker MCM2 as a molecular prognostic marker in 30 oropharyngeal squamous cell carcinomas. Methods: Parallel sections of 30 oropharyngeal tumors were stained with antibodies against MCM2. The tumor sub-sites were: base of tongue in 11 patients, tonsillar fossa in 13 patients, pharyngeal wall in 5 patients, and faucial arch in 1 patient. The percentage of positively stained nuclei was scored for each antibody. Clinicopathologic patient data were retrospectively collected from medical charts. Results: The average age at presentation was 52 years and 2 months (range 43 - 80 years) in the overall patient population. Twenty-four patients were men and six patients were women. Twenty-eight patients (93%) presented with adv...

Long-term treatment results of postoperative radiation therapy for advanced stage oropharyngeal carcinoma : Michael J. Zelefsky, Louis B. Harrison, John G. Armstrong. Cancer 70(10):2388–2395, 1992

Long-term treatment results of postoperative radiation therapy for advanced stage oropharyngeal carcinoma : Michael J. Zelefsky, Louis B. Harrison, John G. Armstrong. Cancer 70(10):2388–2395, 1992

Long-term treatment results of postoperative radiation therapy for advanced stage oropharyngeal carcinoma.

The authors report the long-term treatment results for advanced stage base of tongue (BOT) and tonsillar fossa (TF) carcinomas treated with surgery and postoperative radiation therapy (RT) at Memorial Sloan-Kettering Cancer Center. Between 1973 and 1986, 51 patients with squamous cell carcinoma of the BOT (n = 31 patients) and TF (n = 20 patients) were treated with surgery plus RT. Indication(s) for RT included: advanced disease (Stage T3/T4, 34 patients [66%]); close or positive margins (33 patients, 64%) and multiple positive neck nodes (43 patients, 84%). The 7-year actuarial local control rates for BOT and TF lesions were 81% and 83%, respectively. Local control was achieved in 17 of 18 (94%) patients with T3 lesions, and 12 of 16 (75%) patients with T4 lesions. Among patients with positive or close margins who received postoperative doses of 60 Gy or more, the long-term control rate was 93%. The presence of a treatment interruption had a negative effect on the local control rates. The actuarial control among patients who required a treatment break was 64%; for those not requiring interruption of their treatment, the actuarial control was 93% (P = 0.05). At 7 years, the overall survival for all patients was 52%, and the disease-free survival was 64%. The actuarial incidence of neck failure was 21% and 18% for BOT and TF, respectively. The likelihood of having distant metastasis at 7 years for all patients was 30%. The actuarial incidence of having a second malignancy was 35% for patients with BOT disease. Second malignancy was not observed among patients with TF lesions. The authors conclude that surgery and postoperative RT can provide excellent long-term, disease-control rates for patients with advanced BOT and TF tumors. However, current strategies for BOT lesions have been directed at tongue preservation without surgery.