Carcinomas Of Upper Aerodigestive Tract Research Articles

To study HPV and EBV in squamous cell carcinoma of upper aerodigestive tract by immunohistochemistry markers

Squamous cell carcinoma (SCC) in upper aerodigestive tract (UADT) is one of the predominant causes of mortality and morbidity in a developing nation like India. The major risk factors being tobacco usage and alcohol. Besides these there are certain viruses like high-risk Human Papilloma Virus (HPV) and Epstein Bar Virus (EBV). Which have a potential role in the etiology of SCC. More over these HPV positive tumors have better prognosis compared to HPV negative ones due their radiosensitivity. There are several methods employed in identification of these viruses of which IHC is cost effective, reliable with high sensitivity and specificity.In the present study, we identified 30 cases of SCC in UADT sent to Pathology department. Expression of p16 for HPV and LMP1 for EBV was performed on the tissue blocks manually.p16 was positive in around 17% (5/30 cases) whereas LMP1 showed 0% (0/30 cases) positivity. Majority of patients with p16 positivity in SCC of UADT are in the older age (above 50 years), showed moderately differentiated (Grade II) SCC, had nodal metastasis at the time of presentation. Some studies showed the association of HPV of SCC in UADT in younger population have better prognosis compared to HPV negative ones. In the current study HPV was identified (17%) in older population (above 55 years) and none of the cases showed positivity for LMP1(EBV).

Association of human papillomavirus and Epstein-Barr virus with squamous cell carcinoma of upper aerodigestive tract.

Cancers of the upper aero-digestive tract (UADT) are fifth most common cancer in the world with around 10,55,000 new cases and 7,25,000 deaths worldwide. Tobacco and alcohol act synergistically and are the two most important etiological factors responsible for about 75% of SCC. Studies have reported changing trends in the incidence of SCC showing an increasing shift in epidemiology attributed to the infection by viruses. The most commonly implicated viruses are the Human Papillomavirus (HPV) and Epstein-Barr virus (EBV). To study association of Human Papilloma virus (HPV) and Epstein Barr virus (EBV) with 100 newly diagnosed cases of squamous cell carcinoma (SCC) of upper aerodigestive tract (UADT) and correlate its association with clinical parameters, histomorphological grade and staging using immunohistochemical markers p16, LMP1, p53, p63. The study was conducted in the department of Pathology, Maulana Azad medical college and associated hospitals, New Delhi from September 2018-April 2019. Specimens was routinely processed. Immunohistochemistry (IHC) was done using p16, LMP1, p53, p63 monoclonal antibodies. SPSS 20 software. The quantitative analysis was done using Pearson chi-square test. Probability values < 0.05 was be considered statistically significant. HPV was present in 29% cases while EBV in 38% cases. Oral cavity was the most common site involved by both HPV and EBV. Co-infectivity was found in 4% cases. There was significant male predominance in both. HPV was more prevalent in age >45 years while EBV was equally distributed in <45 years and >45 years. Moderately differentiated squamous cell carcinoma was the commonest grade involved by both the viruses. A significant correlation was found between EBV and alcohol. p53 positivity had an inverse relationship with HPV positivity. P63 expression was higher in HPV and EBV positive cases. In resource constraint settings, p16 and Latent membrane protein 1 can be used as surrogacy markers for Human Papilloma virus and Epstein Barr virus along with p53 and p63 for its association with histomorphological grade and stage.

Demography and Pattern of Tobacco Usage in Carcinoma of Upper Aerodigestive Tract.

Upper aerodigestive tract (UADT) malignancies account for significant proportion of all malignancies. The aim of the study is to know the demography and patterns of tobacco consumption and the proportion of non-tobacco consumers in patients with UADT carcinoma. Patient diagnosed with primary UADT carcinoma visiting outpatient department in a tertiary centre from February 2009 to May 2011 were included in the study. 150 patients were documented with UADT carcinoma and analysed. Among these 133 were males and 17 were female. 40% of them had smoking, 25% had smokeless tobacco, 13% had both smoking and smokeless tobacco and 22% hadn't had any form of tobacco. Carcinoma larynx is the most common site and glottis is the commonest subsite. Most individuals who developed UADT carcinoma have used tobacco in some form. The high proportion of UADT carcinoma in non-tobacco consumer is alarming.

331P - The role of ultrasound and ultrasound guided fine needle aspiration cytology in detection and management of neck node metastases in clinically N0 patients with carcinoma of upper aero-digestive tract in remote part of underdeveloped country

331P - The role of ultrasound and ultrasound guided fine needle aspiration cytology in detection and management of neck node metastases in clinically N0 patients with carcinoma of upper aero-digestive tract in remote part of underdeveloped country

348P - Ultrasound, ultrasound guided FNAC and CT for the detection of neck node metastases in clinically N0 patients with carcinoma of upper aero-digestive tract

Poster: 2015 ASM / R-0063 / Ultrasound, ultrasound guided FNAC and CT for the detection of neck node metastases in clinically N0 patients with carcinoma of upper aero-digestive tract by: A. M. Bajracharya 1, S. Thulkar2, A. Seith Bhalla2, A. Thakkar2; 1Tansen/NP, 2New Delhi/IN

Tumour Associated Tissue Eosinophilia as a Prognostic Indicator in Squamous Cell Carcinoma of Upper Aerodigestive Tract

Immune response is known to develop against malignant tumours. Malignant tumours express newer antigen on their cell surface membrane which elicit immunological reaction in and around tumoural tissue. In early part of immune reaction neutrophil, eosinophil migrates followed by monocyte-macrophage cell. Tumor associated tissue eosinophilia (TATE) is believed to play a significant role in the biological behavior of the carcinoma. Eosinophil infiltrate in association with the head and neck squamous cell carcinoma (SCC) have been reviewed from time-to-time. The significance of such an association has been variably thought to be either a potential diagnostic tool for stromal invasion or as a prognostic indicator. The aim of this study was to investigate and evaluate the possible role of the tumour associated tissue eosinophilia (TATE) as a predictive indicator for the grading and establishing prognosis of the upper aerodigestive tract squamous cell carcinoma (SCC).

Second primary tumor in patients with upper aerodigestive tract cancer

SummaryIn the first three years after treatment of patients with squamous cell carcinoma of upper aerodigestive tract (UADT), there is a high incidence of recurrences. After the third year, the occurrence of second primary tumor (SPT) is an important cause of morbimortality.AimTo evaluate the incidence and the characteristics of the SPT in patients with squamous cell carcinoma of UADT, treated with curative intention.MethodsRetrospective study where the incidence, localization and treatment of SPT had been analyzed and survival rates were calculated.ResultsOf the 624 analyzed cases, 59 (9.4%) had SPT during follow-up (4 synchronous and 55 metachronous). The SPT free survival rate ranged from 2 to 191.3 months (median of 42.5 months). In 20 cases (33.9%) the SPT was diagnosed after the fifth year of follow-up. The most frequent site of STP was the UADT mucosa (49.1%), followed by the lungs (22.0%) and the esophagus (11.9%). The best survival after-SPT occurred in cases of UADT STP (32.2% in 5 years, median 16.2 months).ConclusionThe STP incidence was 9.4%. In 33.9% of the cases, the SPT was diagnosed after the fifth year of follow-up. The most frequent localization of STP was the UADT mucosa.

Epigenetic pathogenesis of human papillomavirus in upper aerodigestive tract cancers.

Human papillomavirus (HPV) has been recently associated with squamous cell carcinoma of upper aerodigestive tract (SCC of UADT), but its possible role in promoting aberrant methylation in these tumors has largely remained unexplored. Herein, we investigated the association of HPV with aberrant methylation in tumor-related genes/loci consisting of the classical CpG Island Methylator Phenotype (CIMP) panel markers (p16, MLH1, MINT1, MINT2, and MINT31) and other frequently methylated cancer-related genes (DAPK1, GSTP1, BRCA1, ECAD, and RASSF1) and survival of UDAT cancers. The study includes 219 SCC of UADT patients from different hospitals of Northeast India. Detection of HPV and aberrant promoter methylation was performed by PCR and Methylation Specific PCR respectively. Association study was conducted by Logistic regression analysis and overall survival analysis was done by Kaplan-Meier plot. HPV was detected in 37% of cases, with HPV-18 as the major high-risk sub-type. Although HPV presence did not seem to affect survival in overall UADT cancers, but was associated with a favourable prognosis in head and neck squamous cell carcinoma. Hierarchical clustering revealed three distinct clusters with different methylation profile and HPV presence. Among these, the CIMP-high subgroup exhibited the highest HPV positive cases (66%). Furthermore, multivariate analysis revealed a strong synergistic association of HPV and tobacco towards modulating promoter hypermethylation in UADT cancer (OR = 27.50 [95% CI = 11.51-88.03] for CIMP-high vs. CIMP-low). The present study proposes a potential role of HPV in impelling aberrant methylation in specific tumor related loci, which might contribute in the initiation and progression of SCC of UADT.

Comparison of PET/CT with conventional imaging modalities (USG, CECT) in evaluation of N0 neck in head and neck squamous cell carcinoma

BackgroundEvaluation of a clinically N0 neck is mandatory in cases of squamous cell carcinoma of head and neck region in order to determine the need to address the neck. The study was designed to compare the accuracy of PET/CT scan with that of USG and CECT Neck in assessing clinically N0 neck in cases of squamous cell carcinoma of upper aerodigestive tract. MethodsSingle center, prospective, study over a 2 year period. All Cases of squamous cell carcinoma of upper aerodigestive tract with no palpable neck lymphadenopathy and who were scheduled for surgery were evaluated with USG, CECT and 18F-FDG PET/CT, of the neck. Post operative histopathology was correlated with pre-operative nodal status. Statistical analysis was done using the chi square test. ResultsIn the 49 patients enrolled, 51 neck sides underwent dissections. Sensitivity of USG, CECT and PET-CT was 4.76%, 23.80% and 71.43% respectively while the specificity was 93.33%, 93.33% and 96.67% respectively. The positive predictive value (PPV) calculated for USG, CECT and PET-CT was 33.33%, 71%, 93.5% respectively while the negative predictive value (NPV) 58.33%, 63.63% and 82.85% respectively. ConclusionsIn N0 neck in head and neck squamous cell carcinoma, though FDG-PET-CT is more accurate than either USG or CECT in staging of the neck, it is not accurate enough to alter the current treatment paradigm.

A French national network for rare head and neck cancers (REFCOR).

e16013 Background: Squamous cell carcinomas of upper aerodigestive tract and endemic undifferenciated nasopharyngeal carcinomas are the most frequent head and neck (H&amp;N) cancers. Apart from these two entities, malignant H&amp;N tumors are uncommon due to their location and/or their histological type. They account for 10% of H&amp;N cancers (around 2,000 new cases/year in France). The rarity of these cancers limits the progress in all aspects. Treatments are based on low level scientific proofs. In most histological types, chemotherapy is uneffective. Prognosis is usually threatening. It was necessary to federate medical centers at a national level to enhance epidemiological knowledge, quality of patient management and to promote research projects. Methods: Structuration of the network included: 2008-2009: 4 working groups to edit recommandations of good practice in diagnosis and treatment of sinus cancers, salivary glands cancers, ear cancers, upper aerodigestive tract non squamous cell carcinoma cancers; 2009: A national database including sociodemographical, clinical, epidemiological, histological and follow-up data; 2009: Organization of biorepositories; 2010: A national group of expert pathologists for diagnosis advice (telepathology); 2011: Specialized multidisciplinary clinics at regional and national levels. Results: To date, 783 patients were included in the database by 29 centers. Tumor sites were sinus/nasal fossa (53%), Salivary glands (28%), Upper aerodigestive tract (18%), ear (1%). Stage at diagnosis repartition was 15% stage I, 24% stage II, 17% stage III, 44% stage IV. Main histological types are adenocarcinoma (17%), Adenoid Cystic carcinoma (9%), mucoepidermoid carcinoma (5%), muquous melanoma (5%). 337 biospecimens are referenced. Conclusions: The majority of french centers involved in H&amp;N cancers treatment contribute to this project. This network is a unique tool for improving the knowledge of rare H&amp;N tumors. Ongoing epidemiological studies will shortly be published. Translational studies based on biospecimens will follow. Collaboration with other networks such as the Salivary Gland Tumors Biorepository could be useful in the next future. Funding source: French National Institute of Cancer (INCa).

Update of Assessment of Survival in Head and Neck Cancer after Regional Recurrence

Objective. To evaluate site of regional recurrence in patients with squamous cell carcinoma of upper aerodigestive tract after neck dissection and the results of salvage treatment. Methods. 95 patients with regional recurrence as the first manifestation of relapse were selected between 943 patients who underwent neck dissection. We evaluated level and side of recurrence, as well disease control after salvage treatment. Results. Level II was the most frequent site of recurrence. Salvage treatment was performed in 51% of ipsilateral and in 75% of contralateral (nondissected neck) recurrences. Control of the disease 12 months after salvage surgery was 25% in the ipsilateral and 37% in contralateral recurrences. Conclusions. Cervical recurrences occur predominantly in level II. Relapse in level I is frequent only in oral cavity tumors and relapse in level V is rare. The neck recurrence carries a poor prognosis even among patients who underwent retreatment with curative intent.

Revisit of Field Cancerization in Squamous Cell Carcinoma of Upper Aerodigestive Tract: Better Risk Assessment with Epigenetic Markers

We quantified field cancerization of squamous cell carcinoma in the upper aerodigestive tract with epigenetic markers and evaluated their performance for risk assessment. Methylation levels were analyzed by quantitative methylation-specific PCR of biopsied specimens from a training set of 255 patients and a validation set of 224 patients. We also measured traditional risk factors based on demographics, lifestyle, serology, genetic polymorphisms, and endoscopy. The methylation levels of four markers increased stepwise, with the lowest levels in normal esophageal mucosae from healthy subjects without carcinogen exposure, then normal mucosae from healthy subjects with carcinogen exposure, then normal mucosae from cancer patients, and the highest levels were in cancerous mucosae (P < 0.05). Cumulative exposure to alcohol increased methylation of homeobox A9 in normal mucosae (P < 0.01). Drinkers had higher methylation of ubiquitin carboxyl-terminal esterase L1 and metallothionein 1M (P < 0.05), and users of betel quid had higher methylation of homeobox A9 (P = 0.01). Smokers had increased methylation of all four markers (P < 0.05). Traditional risk factors allowed us to discriminate between patients with and without cancers with 74% sensitivity (95% CI: 67%-81%), 74% specificity (66%-82%), and 80% area under the curve (67%-91%); epigenetic markers in normal esophageal mucosa had values of 74% (69%-79%), 75% (67%-83%), and 83% (79%-87%); and both together had values of 82% (76%-88%), 81% (74%-88%), and 91% (88%-94%). Epigenetic markers done well in the validation set with 80% area under the curve (73%-85%). We concluded that epigenetics could improve the accuracies of risk assessment.

Revisit of Field Cancerization in Squamous Cell Carcinoma of Upper Aerodigestive Tract: Better Risk Prediction With Epigenetic Markers

Revisit of Field Cancerization in Squamous Cell Carcinoma of Upper Aerodigestive Tract: Better Risk Prediction With Epigenetic Markers

Cetuximab concomitant with gemcitabine and radiotherapy in advanced squamous cell carcinomas of upper aerodigestive tract: a pilot study

To explore the response and toxicity of advanced non-metastatic squamous cell carcinomas of upper aerodigestive tract (SCC-UADT) to a combination of cetuximab concomitant with gemcitabine and radiotherapy. We managed patients with concomitant treatment of cetuximab (400 mg/m(2) as uploading dose, then 250 mg/m(2), IV) concomitant with gemcitabine (50 mg/m(2)) weekly for seven courses, and radiotherapy in classical fractionation until completion of 70 Gy. Primary endpoints were complete response (CR) to treatment and toxicity. We evaluated patients for toxicity on a weekly basis; evaluation of response included physical examination, endoscopy, computed tomography (CT) scan and biopsy when indicated, and was performed 6 weeks after completion of radiotherapy. Additional evaluations were done every 3 months to document disease status. Between November 2004 and November 2005, 20 patients were included. CR was 82.4%, overall response was 100%. Neck disease reached CR in 61.5% and partial in 38.5% of patients. The main toxicities were nausea, lymphopenia, neutropenia and mucositis. Grade 3 and 4 side effects were presented in 70.6% of patients, but mucositis, and lymphopenia without clinical repercussions, occurred in 88.2% of patients. Gastrostomy was required in 11.8% of patients to maintain nutrition. Radioepithelitis developed in 76.5%, but only three of these (23.1%) were grade III. Median overall survival was 53 months (range 6-55 months) and median progression-free survival has not yet been reached at the time of evaluation. Although toxicity is important, this approach has interesting activity and deserves further investigation.

Abstract A142: Radiation-induced acute toxicity in head and neck cancers: Nutritional status as a special parameter

Abstract Introduction: Acute radiation toxicity is a limiting factor of radiotherapy for head and neck cancers. This acute toxicity depends on number of factors like dose of radiation, dose per fraction, total dose, treatment portals, machines used etc. Nutritional status (NS) of the patient is also an important factor of head and neck cancer so far, development of acute toxicity and tolerance is concerned. Keeping other variables unchanged, how NS affects radiation induced toxicity was the main object of the study. Patients and Methods: Total 280 patients of squamous cell carcinoma of upper aero-digestive tract were selected for the study. NS of all patients were calculated. The degree of acute toxicity during the course of radiation and 3 weeks after completion of external radiation were noted. The acute toxicity was recorded as per RTOG acute toxicity criteria. NS is assessed by 1. clinical examination, 2. anthropometric measurement, 3. biochemical investigations, 4. hematological examinations, 5. dietetic assessment. Anthropometric measurement done by: 1. weight (kg), 2. height (cm), 3. wrist circumference, 4. waist circumference, 5. waist: hip ratio, 6. body mass index = weight (kg) height2 (m2), 7. triceps skin fold thickness. Biochemical Estimation is done by: 1. serum albumin, 2. serum transferrin, 3. serum ceruloplasmin. Immunologicalparameters are: 1. total circulating lymphocyte count (more than 2000 cells / cu mm normal value, 1200 – 2000 cells / cu mm mild malnutrition, 800 – 1200 cells / cu mm moderate malnutrition, less than 800 cells / cu mm severe malnutrition), 2. delayed cutaneous hypersensitivity (DCH) test, 3. DNCB challenge test, 4. Mantoux test Acute radiation morbidity scoring was done as per criteria (RTOG). Result Analysis: There was significantly increased toxicity in patients who were poorly nutritious (n=135) as compared to those who were normally nourished (n=88). Those patients who were under nutritious also showed poor standard of oral hygiene. Rest 57 patients NS were undetermined and were excluded from evaluation. In under nutritious group, acute radiation toxicity grading was: Gr.1 (0%), Gr.2 (42.96%), Gr.3 (55.55%), &amp; Gr.4 (1.48%) respectively. On the contrary, the normal nutritious group acute toxicity developed Gr.1 (11.36%), Gr.2 (81.81%), Gr.3 (6.81%) &amp; Gr.4 (0%) respectively. Oral hygiene of poor standard was 12.5% in under nutritious patients and 4.5% in normal nutritious patients. Conclusion: Aim of this paper lies in its attempt to explore the acceptability of “Nutritional Status” as a variable in development of radiation induced toxicity, as far as acute morbidity is concerned. In that sense it is a successful phase I trial. One can conclude that there exists some correlation between radiation morbidity and NS of the patients. Therefore correction of NS before onset of radiation provides better tolerance to radiotherapy. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A142.

HPV Genotyping in Squamous Cell Carcinoma of Upper Aerodigestive Tract

BACKGROUNDSmoking and alcohol consumption are the main risk factors for squamous cell carcinoma of the upper aerodigestive tract (SCCUAT). However, human papillomavirus (HPV) has been etiologically linked with tonsillar squamous cell carcinoma (TSCC). Therefore, we investigated the etiologic role of HPV in the context of SCCUAT in Korea.METHODSArchival paraffin block samples from 136 cases previously diagnosed as SCCUAT were randomly selected. A commercial HPV DNA chip was used for HPV genotyping.RESULTSOne hundred and seventeen cases were available after checking beta-globin (47 cases of tonsil and 70 of non-tonsil). A HPV-positive result (HPV 16 and 18) occurred in 13 cases of SCCUAT, and 12 cases were tonsil (25.5%, 12/47). Among the 12 HPV-positive patients with TSCC, nine were non-smokers and non-drinkers. Most HPV-negative patients with TSCC had a history of alcohol drinking and smoking (32/35, 91.4%). HPV infection status was not significantly associated with histological grade, clinical stage, or survival in patients with TSCC.CONCLUSIONSHPV infection was significantly higher in patients with TSCC among those with SCCUAT. HPV may be independent risk factor in development of TSCC, such as smoking and alcohol drinking.

R407 – Prognostic Factors in Salvage Surgery

Problem The main cause of uncontrolled disease of the squamous cell carcinoma of upper aerodigestive tract is the loco-regional recurrence. Salvage surgery is a good option of treatment. The aim of this paper is to assess the prognostics factors in the patients with tumors of oral cavity and oropharynx treated with surgery and undergoing salvage surgery. Methods Retrospective study of 276 patients treated with surgery associated or no with postoperative radiation therapy. The patients were excluded when they presented distant metastasis, second primary tumors or previous oncological treatment. Statistic analysis: tests Chi-quadrado and Fisher. Results The average follow-up was 35.3 months, and 127 patients developed loco-regional recurrences being 76 patients approached with salvage surgery. In 65% of the patients, the salvage surgery was in the oral cavity due to the higher predominance of exclusive local relapse. The main indications of salvage surgery were in patients with early clinical stage (I/II) and loco-regional recurrence. The clinical factors prognostics in the univariate analysis were the sites of tumors (p=0.004), clinical stage of loco-regional recurrence (p=0.0001), initial clinical stage (p=0.01) and previous radiotherapy (p=0.04) and the independent clinical factors prognostics in the multivariate analysis were clinical stage of loco-regional recurrence (p=0.005), site of the primary tumor (p=0.003) and previous radiotherapy (p=0.01). Conclusion The tumor sites, previous radiotherapy and the clinical stage of loco-regional recurring were independent clinical factors prognostics. Significance The assessment of the clinical factors in the patients submitted salvage surgery.

Dietary risk factors for squamous cell carcinoma of the upper aerodigestive tract in central and eastern Europe

The incidence of squamous cell carcinoma of upper aerodigestive tract (UADT: oral cavity, pharynx, larynx, and esophagus) has been increasing in central and eastern European countries. We investigated the relationship between diet and UADT cancers in these high risk areas. We used data from hospital-based case-control study of 948 UADT cancer cases and 1,228 controls conducted in Romania, Hungary, Poland, Russia, Slovakia, and Czech Republic. Standardized questionnaire were used to collect information on 23 different food items, along with alcohol and tobacco consumptions. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the UADT cancers after adjusting for center, age, sex, tobacco & alcohol intake, and other food groups. Consumption of dairy product was negatively associated with selected UADT cancers: larynx (OR: 0.38, CI: 0.23-0.62) and esophagus (OR: 0.55, CI: 0.33-0.93). While consumption of yellow/orange vegetables were inversely associated with oral/pharyngeal and laryngeal cancer (OR: 0.53, CI: 0.35-0.81 and OR: 0.62, CI: 0.38-1.00, respectively), preserved vegetable was positively associated with oral/pharyngeal and laryngeal cancer risk (p (trend) < 0.01 for both). Specific dietary components may play a role in the development of UADT cancers in the high-risk region of central and eastern Europe.

Mucoepidermoid carcinoma of upper aerodigestive tract: clinicopathologic study of 78 cases with immunohistochemical analysis of dicer expression

MicroRNAs (miR) are small noncoding RNAs that are predicted to regulate up to 30% of protein-encoding genes. miR maturation requires functional microRNA machinery, including the Dicer protein. We review our experience with mucoepidermoid carcinoma (MEC) and characterize the prognostic value of Dicer expression. Expression of Dicer was assessed in 78 MEC by immunohistochemistry. Dicer expression was scored semiquantitatively and relative to the internal controls: large excretory/striated ducts or basal/parabasal layers of normal squamous epithelium (mucosa). Dicer scores were then correlated with clinical and pathologic parameters. Dicer over- and/or under-expression were more commonly seen in high-grade MEC (83%) than in low/intermediate grade MEC (35%; p=0.002) and in stage III/IV MEC (80%) than in stage I/II MEC (41%; p=0.04). Abnormal Dicer expression correlates with high-grade and advanced stage, acting as a univariate predictor of poor disease-specific survival (DSS) in MEC. Age and stage were independent predictors of poor DSS on multivariate analysis. Abnormal immunoexpression of Dicer in aggressive MEC suggests a role for miR and miR machinery in tumor progression.

Carcinomes épidermoïdes simultanés de la cavité buccale et de l'oropharynx

Squamous cell carcinoma of the oral cavity is often a single localization, but the discovery of another or several associated lesions is not exceptional. The goal of our study was a retrospective analysis of patients having 2 simultaneous squamous cell carcinomas of the upper aerodigestive tract (UADT), i.e. diagnosed during the same panendoscopy by excluding the esophagus and the lung. Between 1995 and 2001, 1,129 patients were treated for squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx in the Bordeaux Maxillo-facial Surgery Unit. 1% of these patients presented 2 simultaneous squamous cell carcinomas of UADT. Our series was divided in 9 men (75%) and 3 women (25%) with an average age of 61.3 years (48-86). At the end of the study 2 patients were lost to follow-up, 3 patients were alive without recurrence, and 1 patient was alive with recurrence. The average follow-up time was 17.6 months. A review of the literature gave an incidence of simultaneous squamous cell carcinomas of UADT varying from 1.3 to 12.8% according to authors. Thus, any patient having squamous cell carcinoma of the UADT must be considered as having an important potential risk to present another simultaneous cancer and to benefit from a systematic panendoscopy. In spite of an early diagnosis, the prognostic of these lesions remains bad.