Common Subsite Research Articles

Pediatric Head and Neck Tumors Associated with Li-Fraumeni Syndrome.

Cancer predisposition syndromes are germline pathogenic variants in genes that greatly raise the risk of developing neoplastic diseases. One of the most well-known is Li-Fraumeni syndrome (LFS), which is due to pathogenic variants in the TP53 gene. Children with LFS have higher risks for multiple malignancies before adulthood, often with rare and aggressive subtypes. To examine head and neck manifestations of LFS in children treated at a tertiary children's hospital over a 20-year period. A retrospective review of LFS children with neoplastic disease presenting in traditional Otolaryngologic head and neck subsites from 2000 to 2019, with patient charts reviewed for relevant clinical, imaging, and operative data. Of the 40 LFS patients initially identified, 27 neoplastic tumors were identified in 20 children within this cohort (20 primary, 7 second primary). Head and neck subsites aside from the brain or orbit were involved in 22% (6/27) of these tumors, representing 20% (4/20) of primary tumors and 29% (2/7) of second primary tumors. Both second primaries within the head and neck were within the radiation fields of the first primary tumor. The mean ages at primary and second primary diagnosis were 4.6 years (SD 3.5) and 12 years (SD 1.4), respectively. The male/female ratio was 1:6 among all patients with head and neck tumors. All 6 head and neck tumors were sarcomas. Rhabdomyosarcoma (N = 3, 50%) was the most common pathology, and the other 3 demonstrated rare tumor pathological subtypes (synovial cell sarcoma, pleomorphic myxoid liposarcoma, mandibular osteosarcoma). The neck was the most common subsite (75%) within this group for primary tumor presentation. This study identifies a high potential for head and neck involvement in children with LFS, which has not been previously described in the literature. Otolaryngological care should be included in a multidisciplinary care team surveilling these patients.

Clinicodemographic profile of head neck oncology patients in COVID-19 pandemic: A descriptive study in a tertiary hospital of Eastern Nepal

Background: Head neck cancer needs early diagnosis and treatment for better outcome. There is lack of oncological awareness in our scenario and which is further masked by COVID-19 pandemic. Further masked by scarce published data from eastern Nepal.
 Aims and Objective: Our study aims to fulfil the lacunae and helps in providing head neck oncological clinicodemographic profile that will be useful for oncological awareness and early detection that ultimately willlead proper management leading to good outcome.
 Materials and Methods: A descriptive cross sectional study performed during the COVID-19 pandemic between 15th March 2020 to 12th February 2021 for the biopsy or cytology proven head neck cancer patients. Demographic profile and clinical parameters were recorded. Statistical analysis was performed using SPSS-16 software. Analysis of clinical parameters with subsites was done by Pearson Chi Square test. The p value <0.05 was considered significant.
 Results: Fifty-six head neck cancer patients were enrolled as per inclusion criteria. Median age and median duration of clinical presentation were 59.5 years and 3.5 months respectively. Higher prevalence of diseasenoticed in male and higher age group (>60 years). Thyroid cancer was most common site (19.1%) followed by oral cancer (14.3%). Most common presentation was swelling (55.4%) followed by non-healing ulcer (14.3%). Male patients and having history of tobacco/alcohol use had more site specific cancer as evaluated by Pearson chi square test by SPSS-16 with p -value of 0.021 and 0.004 respectively.
 Conclusions: Most common subsite is thyroid followed by oral cavity. Swelling is most common clinical presentation. Advancing age, male sex and history of tobacco/alcohol use were risk factors.

Case control study comparing the HPV genome in patients with oral cavity squamous cell carcinoma to normal patients using metagenomic shotgun sequencing

The aim of this study was to carry out a case control study comparing the HPV genome in patients with oral cavity squamous cell carcinoma (OC-SCC) to normal patients using metagenomic shotgun sequencing. We recruited 50 OC-SCC cases which were then matched with a control patient by age, gender, race, smoking status and alcohol status. DNA was extracted from oral wash samples from all patients and whole genome shotgun sequencing performed. The raw sequence data was cleaned, reads aligned with the human genome (GRCH38), nonhuman reads identified and then HPV genotypes identified using HPViewer. In the 50 patients with OC-SCC, the most common subsite was tongue in 26 (52%). All patients were treated with primary resection and neck dissection. All but 2 tumors were negative on p16 immunohistochemistry. There were no statistically significant differences between the cases and controls in terms of gender, age, race/ethnicity, alcohol drinking, and cigarette smoking. There was no statistically significant difference between the cancer samples and control samples in the nonhuman DNA reads (medians 4,228,072 vs. 5,719,715, P value = 0.324). HPV was detected in 5 cases (10%) of OC-SCC (genotypes 10, 16, 98) but only 1 tumor sample (genotype 16) yielded a high number of reads to suggest a role in the etiology of OC-SCC. HPV was detected in 4 control patients (genotypes 16, 22, 76, 200) but all had only 1–2 HPV reads per human genome. Genotypes of HPV are rarely found in patients with oral cancer.

Comparison of concurrent chemoradiation with daily gefitinib versus daily erlotinib in locally advanced oropharyngeal cancers

Background: Concurrent chemoradiation had been the standard of care for locally advanced oropharyngeal cancers. The addition of newer targeted therapies such as cetuximab has resulted in improved locoregional control rates along with tolerable toxicities. The aim of this study was to evaluate the response with addition of newer generation of systemic targeted agents (gefitinib and erlotinib) in combination with chemoradiotherapy for locally advanced oropharyngeal cancer. Materials and Methods: A total of fifty patients of locally advanced carcinoma oropharynx were randomized by odd–even technique to two arms. Arm A (24 patients) received radiotherapy along with concurrent weekly carboplatin 150 mg and daily gefitinib 250 mg, whereas Arm B (25 patients) received erlotinib 150 mg daily along with same chemoradiation regimen as in arm A. Results: The mean age group in the gefitinib and erlotinib groups was 56.9 and 55.1 years. The most common subsite was base of tongue followed by tonsil. The complete response rate was nearly the same in both the arms at the end of treatment. At the end of 1 and 2 years, the disease-free survival (DFS) was more in the gefitinib group as compared to erlotinib group (41.6% vs. 29.1%) and (33.3% vs. 25%), respectively. Conclusion: There was no significant improvement in DFS and OS with the administration of tyrosine kinase inhibitor (TKI) along with concurrent chemoradiotherapy. This might be attributed to the fact that longer duration of TKI was not administered, variable bioavailability of TKIs, and other immune-dependent mechanism when compared to cetuximab and other monoclonal antibodies.

4NQO induced carcinogenesis: A mouse model for oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the most common subsite of head and neck cancer, with a 5-year survival rate of only 50%. There is a pressing need for animal models that recapitulate the human disease to understand the factors driving OSCC carcinogenesis. Many laboratories have used the chemical carcinogen 4-nitroquinoline-1-oxide (4NQO) to investigate OSCC formation. The importance of the 4NQO mouse model is that it mimics the stepwise progression observed in OSCC patients. The 4NQO carcinogen model has the advantage that it can be used with transgenic mice with genetic modification in specific tissue types to investigate their role in driving cancer progression. Herein, we describe the basic approach for administering 4NQO to mice to induce OSCC and methods for assessing the tissue and disease progression.

Impact of Preoperative Imaging on Identifying Rapid Recurrence in Head and Neck Cancer

Rapid recurrence, defined as detectable tumor recrudescence after an oncologically sound primary operation but prior to initiating postoperative radiation therapy (PORT), is now recognized to be an underreported poor prognostic factor in head and neck cancer (HNC), occurring at a rate of 15-30% across different series. We sought to determine and analyze the impact of preoperative imaging on detection of rapid recurrence at the time of Computer Tomography (CT) simulation. CT simulation images of HNC patients treated with primary surgery and PORT between 2009 and 2017 were retrospectively reviewed by a neuroradiologist blinded to patient outcome but provided with pre-operative imaging and the surgical pathology report. Findings in the operative bed, ipsilateral neck and/or contralateral neck considered either suspected or definite recurrence were categorized as rapid recurrence. Multivariable analysis (MVA) was conducted to ascertain risk factors for rapid recurrence. Variables included were: days between imaging and surgery, number of imaging modalities, extranodal extension (ENE), lymphovascular invasion (LVI), perineural invasion (PNI), and pathologic stage. A total of 188 HNC patients were included with oral cavity and squamous cell carcinoma being the most common subsite (58%) and histology (84%). Overall, 22% had ENE, 24% had LVI, 45% had PNI, and 77% were AJCC 7th edition pathologic stage III/IV. Thirty-eight patients (20%) were identified to have rapid recurrence, of which 21 were at the operative bed, 17 were at the ipsilateral neck and 13 were at the contralateral neck. 13 patients (34%) had rapid recurrence at multiple sites. The median time between initial imaging and day of surgery for patients with and without rapid recurrence was 24.5 and 27 days, respectively (p= 0.28). Pre-operative imaging modality included CT, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography fused to CT dataset (PET/CT). 107 patients (57%) had a single imaging modality and among them 86 had CT, 13 had MRI, and 8 had PET/CT. 81 patients (43%) had > 1 imaging modality; most frequently anatomic imaging (CT and/or MRI) and PET/CT (81%). The median time from initial imaging and day of surgery in patients with 1 and > 1 imaging modality were 24 and 31 days, respectively (p= 0.02). On MVA, patients with pre-operative PET/CT were less likely to have local or regional rapid recurrence (OR=0.30, 95% CI 0.13-0.73, p< 0.01). ENE was a predictor of rapid recurrence (OR 2.7, 95% CI 1.01-7.4, p= 0.05). There were no difference in ENE, LVI, PNI or pathologic stage in patients with and without PET/CT. The time between the initial imaging and the date of operation was not associated with rapid recurrence. Patients evaluated with functional preoperative imaging modalities were less likely to have rapid recurrence at the primary site and/or neck(s) at the time of CT simulation.

Is Perineural Invasion a Reasonable Indicator for Neck Dissection in cT1N0M0 Squamous Cell Carcinoma of the Oral Cavity?

Perineural invasion (PNI) is considered an adverse histological feature in oral squamous cell carcinoma (OSCC). Controversy exists regarding elective neck dissection (END) in cT1N0M0 OSCC with PNI as the only risk factor. The purpose of this study was to evaluate PNI as an indicator for END, as well as its utility when combined with the depth of invasion (DOI) as a second indicator. cT1N0M0 (AJCC8) OSCC patients treated from August 1998 to July 2017 in the Department of Oral and Maxillofacial Surgery, University of Michigan (MI), and Beijing Stomatological Hospital, Capital Medical University (BSH) were reviewed. Data from these sites included both prospectively captured data housed in a database and retrospective data. 283 cT1N0M0 OSCC patients were analyzed. The tongue was the most common subsite (56.2%). Ninety-nine (99) patients received END and 184 neck observation. PNI was found in only 8 patients (2.83%) all in the tongue or inferior gingiva. END was performed in 7 of the PNI patients. The mean depth of invasion for tumors with PNI was 3.97mm, compared to 2.54mm in tumors without PNI. PNI was statistically correlated with nodal disease (pN+) and extranodal extension (ENE+). After using DOI as a primary indicator for END, no additional PNI patients benefited from END. In addition, only 2 patients had PNI identified preoperatively both with 5mm DOI, and therefore, already indicated for END on the basis of DOI status. PNI status is statistically correlated with pN+ and ENE+pathology in cT1N0M0 OSCC. After using DOI as a primary indicator for END, PNI status had no added value in decision making. Even surgeons who do not use DOI will find very limited value in PNI status with less than 1% preoperative prevalence (0.71%) in this patient population.

Neoadjuvant Nivolumab or Nivolumab Plus Ipilimumab in Untreated Oral Cavity Squamous Cell Carcinoma

Novel approaches are needed to improve outcomes in patients with squamous cell carcinoma of the oral cavity. Neoadjuvant immunotherapy given prior to surgery and combining programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) immune checkpoint inhibitors are 2 strategies to enhance antitumor immune responses that could be of benefit. In this randomized phase 2 clinical trial conducted at 1 academic center, 29 patients with untreated squamous cell carcinoma of the oral cavity (≥T2, or clinically node positive) were enrolled between 2016 to 2019. Treatment was administered with nivolumab, 3 mg/kg, weeks 1 and 3, or nivolumab and ipilimumab (ipilimumab, 1 mg/kg, given week 1 only). Patients had surgery 3 to 7 days following cycle 2. Safety and volumetric response determined using bidirectional measurements. Secondary end points included pathologic and objective response, progression-free survival (PFS), and overall survival. Multiplex immunofluorescence was used to evaluate primary tumor immune markers. Fourteen patients were randomized to nivolumab (N) and 15 patients to nivolumab/ipilimumab (N+I) (mean [SD] age, 62 [12] years; 18 men [62%] and 11 women [38%]). The most common subsite was oral tongue (n = 16). Baseline clinical staging included patients with T2 (n = 20) or greater (n = 9) T stage and 17 patients (59%) with node-positive disease. Median time from cycle 1 to surgery was 19 days (range, 7-21 days); there were no surgical delays. There were toxic effects at least possibly related to study treatment in 21 patients, including grade 3 to 4 events in 2 (N), and 5 (N+I) patients. One patient died of conditions thought unrelated to study treatment (postoperative flap failure, stroke). There was evidence of response in both the N and N+I arms (volumetric response 50%, 53%; pathologic downstaging 53%, 69%; RECIST response 13%, 38%; and pathologic response 54%, 73%, respectively). Four patients had major/complete pathologic response greater than 90% (N, n = 1; N+I, n = 3). With 14.2 months median follow-up, 1-year progression-free survival was 85% and overall survival was 89%. Treatment with N and N+I was feasible prior to surgical resection. We observed promising rates of response in both arms, supporting further neoadjuvant studies with these agents. ClinicalTrials.gov Identifier: NCT02919683.

Genotypes and Prevalence of High-Risk Human Papillomavirus Among Patients Diagnosed With Head and Neck Cancer at Alexandria Cancer Centre

PURPOSE The purpose of this study was to provide original data on the prevalence of head and neck cancer (HNC) and high-risk human papillomavirus (HPV) genotypes among patients diagnosed with HNC in Kenya. Globocan 2018 findings indicate that cervical cancer is the second most frequent cancer in women in East Africa, which suggests a high prevalence of oncogenic HPV among the general population in this region. METHODS This was a retrospective study with laboratory analysis involving histologically confirmed head and neck tissue samples between January 2017 and December 2018. Stored tissues were retrieved and subjected to repeat microscopy, p16 immunohistochemistry, and HPV polymerase chain reaction at the Pathologists Lancet Group of Laboratories. Data were analyzed using descriptive statistics with Excel. RESULTS HNC accounted for 8.8% of all malignancies at Alexandria Cancer and Palliative Care Hospital. There were more males (64%) than females (36%). Mean age was 50.9 years (± 17.6 years). Most patients came from the western Kenya region. Approximately one third (35.7%) of participants were farmers and students combined. The following were most common subsites identified: nasopharynx (n = 25), larynx (n = 12), and tongue (n = 10); 93.5% were squamous cell carcinoma. Sixteen samples (55.2%) tested p16 positive, of these 2 (12.5%) tested positive with HPV polymerase chain reaction. One of these was from an 87-year-old female who was diagnosed with tongue cancer. Molecular analysis revealed the genotype to be HPV52, and the other was from a 49-year-old male with cancer of the postnasal space who had multiple coinfection with HPV35, -52, and -59 genotypes. CONCLUSION HNC represented 8.8% of the malignancies at Alexandria Cancer and Palliative Care Hospital; 55.2% tested p16 positive and the study managed to detect 3 high-risk HPV genotypes, HPV35, HPV52, and HPV59.

Abstract A42: Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience

Abstract Introduction: With the emergence of organ preservation protocol in head and neck cancer, management of hypopharyngeal carcinoma is generally by nonsurgical approach; however, a significant number of hypopharyngeal cancer patients present in advanced stage and exhibit poor prognosis. For such cases, thorough aggressive surgical excision of laryngopharyngoesophageal complex with appropriate reconstruction might be a viable option. Objective: To evaluate quality-of-life measures and survival outcomes in hypopharyngeal carcinoma cases undergoing above-mentioned procedure at a tertiary health care center. Methodology: A retrospective study on patients with hypopharyngeal carcinoma undergoing above-mentioned procedure was done in our tertiary care institute between September 2016 to October 2018. Results: A total of 12 patients were operated during the study period; however, 3 patients were excluded due to inadequate data. In our study, mean age of presentation was 51.3 years and majority were men (n=8). Most of the patients at the time of presentation were stage IVA or more. Postcricoid was most common subsite, followed by pyriform fossa. 4 out of 12 were operated after failed chemoradiation. Perioperative morbidity primarily in terms of complications and duration of hospital stay and quality-of-life measures consisting mainly of swallowing score were analyzed, which suggested that this procedure is tolerable and produces a reliable outcome. Conclusion: Total laryngopharyngoesophagectomy with gastric transposition is a feasible and efficacious treatment option with reasonable quality of life in carcinoma hypopharynx patients, especially after failed chemoradiation. Citation Format: Prerit Rao, K. Devaraja, Kailesh Pujary, Dipak Ranjan Nayak, R. Balakrishnan. Total laryngopharyngoesophagectomy with gastric transposition for hypopharyngeal cancer: A tertiary care center experience [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A42.

Abstract B23: The role of bone marrow transplantation in patients with Fanconi anemia and head and neck squamous cell carcinoma receiving radiotherapy: An examination of the International Fanconi Anemia (IFAR) Registry

Abstract Introduction: Fanconi anemia (FA) patients have a high predilection for developing aggressive head and neck squamous cell carcinoma (HNSCC) at an early age. Because of their aggressive HNSCC, these patients frequently require multiple modality treatment, including radiation therapy. However, their underlying chromosomal instability makes giving radiation to these patients difficult because of increased radiation-induced complications. In order to better understand this problem, we evaluated a large population of FA patients with HNSCC who received radiation therapy for HNSCC. Hypothesis: FA patients who have undergone prior bone marrow transplant (BMT) and present with head and neck squamous cell carcinoma (HNSCC) demonstrate decreased relative risk of radiation-induced complications compared to FA patients who have not received BMT. Study Design: Retrospective Cohort Study Methods: Demographic information, genotypic data, prognostic factors, therapeutic management, and survival outcomes for FA patients enrolled in the International Fanconi Anemia Registry (IFAR) who developed HNSCC from 1981-2017 were analyzed. Results: Data were collected from the IFAR registry for n=50 patients. The mean age at time of HNSCC diagnosis was 30.5 + 9.0 years, and 36% of total patients were male. 42% of the patients received adjuvant or neoadjuvant radiotherapy for HNSCC, with the most common subsites involving the oral tongue (n=8), followed by alveolus (n=3) and supraglottis (n=2). The average dose given was 48.8 + 16.9 Gy over a 28- to 70-day period. Among patients receiving radiotherapy, 24% had received a bone marrow transplant. No patients who had a prior BMT were noted to develop pancytopenia as a radiation-related complication, while 68% of those without prior BMT developed pancytopenia from radiation. 6/16 patients who did not undergo transplant completed the full course of radiation, while 4/5 BMT patients were able to complete treatment. Both mucositis and sepsis were secondary complications more common in the non-BMT group (56% vs. 40%, and 12% vs. 0%, respectively). The relative risk of pancytopenia among patients receiving BMT and adjuvant radiation was 0.15 (95% CI 0.01-2.2); however, this was not statistically significant given the small BMT-group sample size (p=0.17). Interestingly, 80% of patients in the BMT group exhibited genetic mutations of the Fanconi complementation group C. Among patients who received a BMT and adjuvant radiotherapy, 5 patients died of XRT-related complications, while only 1 patient died from these complications in the BMT group. Conclusion: While it is well known that FA patients have a high predilection for developing aggressive HNSCC at an early age, among the patients who received preradiation bone marrow transplant the incidence of radiation-induced pancytopenia was reduced. This reduction suggests that FA patients undergoing radiotherapy for HNSCC may exhibit less adverse side effects of radiation treatment if they received a prior BMT. Citation Format: Ade Obayemi, K.R. Patel, O. Rosti, A. Smogorzewska, D. Kutler. The role of bone marrow transplantation in patients with Fanconi anemia and head and neck squamous cell carcinoma receiving radiotherapy: An examination of the International Fanconi Anemia (IFAR) Registry [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B23.

The Face of War: Maxillofacial Patients in the Syrian Civil War.

The type of the armed conflict on the Syrian battle field acquired several types of injuries; including injuries that were caused by explosive, shrapnel and blast injuries.In the current study, the authors conducted an overview of maxillofacial patients, who mainly suffered from ballistic injuries in term of injuries, reconstruction, and management.Overall, 53 maxillofacial Syrian patients were treated. The most prominent injury was soft tissue lacerations (21/97) and in terms of hard tissue injuries, the most prominent site was the mandible (N = 19) while the ramus and the body presented the most common sub-sites of injury. Hard tissue injuries were treated either by close or open reduction to obtain primary stabilization.From the psychological aspect, most of the patients suffered from guilt for leaving the combat area, those patients were mostly males in their 20s or 30s. On the other hand, older patients suffered mainly from depression, stress, and fear of returning to their home land.To conclude, the Syrian civil war has several characteristics that defer from other combats. Thus, the management of Syrian patients has to be tailored accordingly.

Patterns of Failure in Parameningeal Alveolar Rhabdomyosarcoma

To determine patterns of failure, clinical outcomes, and prognostic factors among pediatric patients treated with radiation therapy for parameningeal alveolar rhabdomyosarcoma. We evaluated clinical and treatment planning records of patients aged ≤21 years with parameningeal alveolar rhabdomyosarcoma treated with definitive or adjuvant radiation therapy at our institution. The Kaplan-Meier product limit method assessed disease control and survival; the log-rank test was used to evaluate prognostic impact. We identified 24 patients with a median age of 3.5 years (range, 1-20) treated between 2009 and 2016. The median follow-up was 2.4 years for all (range, 0.3-5.6) and 3.2 years for living patients (range, 0.7-5.6). Most patients had group III (96%), node-negative (67%), positive FOX fusion status (63%) disease, and intracranial extension (54%). The paranasal sinus was the most common subsite (29%). All patients were treated with concurrent chemotherapy and proton radiation therapy with a median dose of 50.4 Gy relative biological effectiveness (range, 41.4-59.4) at a median 13 weeks after induction chemotherapy (range, 3-25). The 3-year local control, regional control, disease-free survival, and overall survival rates were 66%, 94%, 40%, and 58%, respectively. Median time to any failure was 0.5 years (range, 0.2-2.1). N1 disease and intracranial extension (ICE) portended inferior overall survival (P = .002 and .02, respectively). Female sex portended better local control (P= .05). All 7 patients with distant metastases as the first site of recurrence had central nervous system metastases. Age <4 years, absence of ICE, N0 disease, and primary tumor <5 cm were associated with a statistically significant improvement in freedom from distant metastases. Although regional nodal failures were rare, in-field local recurrences and leptomeiningeal progression in those with ICE suggest the need for modification of local and central nervous system therapies.

Mucosal Melanomas of the Head and Neck—a Tertiary Cancer Centre Experience

Mucosal melanoma is a relatively rare tumour of the head and neck with a very poor prognosis. Managing this disease entity becomes more difficult due to high chances of disease failure locoregionally and at distant sites. This study assessed the treatment outcomes and factors affecting prognosis of head and neck mucosal melanomas. Forty-one cases of mucosal melanomas of head and neck (MMHN) treated in our institution during 10 years were retrospectively reviewed. Data regarding the clinicopathological parameters and treatment outcomes was collected. Survival was calculated using Kaplan-Meier method. The most common subsite of MMHN was upper alveolus and hard palate (39%). Thirty-one of the 41 cases underwent surgery whereas 10 cases were treated with palliative intent. At presentation, 15 of 41 cases had lymph node involvement and majority of them had primary in the oral cavity: sinonasal region had low chances of lymph node metastasis. Seventy-four percent of cases underwent adjuvant post-operative radiotherapy. For surgically treated cases, 5-year disease-specific survival (DSS) was 35.7%. Mucosal melanomas of nose and paranasal sinuses had a better overall survival than oral cavity. Distant metastasis was the most common cause of disease failure in 12 of 24 cases and had a significant association with disease-specific survival. The stage of the disease was a significant prognostic indicator. Sinonasal cavity mucosal melanomas have a better prognosis than mucosal melanomas in other subsites. Overall survival for surgically treated cases was significantly better than cases treated non-surgically. Presence of lymph node metastasis reduced the survival by 50% in MMHN.

Socio-demographic and clinico-pathologic pattern of patients with colorectal cancers seen in Ahmadu Bello University Teaching Hospital, Zaria

Introduction: Colorectal cancer is a major cause of morbidity and mortality in the world. It accounts for 10.2% of cancer incidence globally, with a mortality of 9.2%. It ranks third in terms of incidence but second in terms of mortality. Colorectal cancer is not uniformly common throughout the world. Its incidence is increasing in developing countries, probably due to the acquisition of western lifestyle. Aim: The aim of this study was to determine the sociodemographic and clinicopathological pattern of patients with colorectal cancer seen in the Department of Surgery, Radiotherapy, and Oncology Centre, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, over a 10-year period. Materials and Methods: In this retrospective study, data were collected from the case files and treatment cards of 122 patients with colorectal cancer managed at the Surgical, Radiotherapy, and Oncology Department of ABUTH, Zaria, from January 2006 to December 2015. Data items analyzed included age, sex, residential area, occupation, duration of symptoms, presenting complaints, subsite, histological type, grade, and stage. All analyses were performed by SPSS version 20. Results: An annual incidence of 12.2 cases/annum was seen. Seventy (57.4%) were male and 52 (42.6%) were female. Male:female ratio was 1.3:1 and the age range was between 12 years and 78 years, majority were between 31 and 40 years (24.6%), with a mean age of 42.4 years and median age of 41 years. It was found to be more common among the urban dwellers, with the public/civil servants being the most affected (36.0%). The duration of presenting complain ranged from 3 weeks to 10 years, most patients presenting at 7–10 months with more than one symptom. Bleeding per rectum was the most common symptom seen in 20%. Adenocarcinoma was the predominant histology seen in 73% (n = 89) and 28.7% were well differentiated. The rectum was the most common subsite, while left-sided lesions (20%) were more common than right-sided lesions (17%). About 18% (n = 22) had distant metastasis. Conclusion: The study showed that colorectal cancer was more common among the younger age group, with a slight male preponderance. They were mostly urban dwellers and civil/public servants. The most common presenting symptom was bleeding per rectum and majority of the cases presented at an advanced stage. Early detection through public health education, screening programs, affordable and effective treatment, and follow-up will help reverse this trend. Conclusion: The study showed that colorectal cancer was more common among the younger age group, with a slight male preponderance. They were mostly urban dwellers and civil/public servants. Bleeding per rectum being the most common complaint, majority of the cases presented at an advanced stage. Early detection through public health education, screening programs, affordable and effective treatment, and follow-up will help reverse this trend.

Induction chemotherapy in locally advanced head-and-neck squamous cell carcinoma: Real-world outcome

Introduction: Patients with locally advanced head-and-neck squamous cell carcinoma (LAHNSCC) have a poor prognosis despite multimodality treatment. Aim: This study was done to assess the efficacy and toxicity of induction chemotherapy (IC) in patients with LAHNSCC. Materials and Methods: This was a retrospective study of patients with LAHNSCC who were treated with IC from May 2016 to July 2019 from a tertiary care cancer center in India. Results: A total of 26 patients were included in this analysis, with a median follow-up of 9.5 months. The majority of the patients had carcinoma of the oral cavity (96.2%, n = 25) and 1 (3.8%) had oropharyngeal cancer. The most common oral cavity subsites were buccal mucosa (65.4%) and gingivum (11.5%). Fifteen patients received a triplet regimen of IC and 11 patients received a doublet IC regimen. Among patients with an evaluable disease for response assessment (n = 21), complete response, partial response, stable disease, and progressive disease were seen in 9.5%, 66.7%, 19%, and 4.8%, respectively. Among patients with unresectable (Stage IVB) Oral squamous cell cancer (OSCCs), 40% underwent surgery. The median progression-free survival (PFS) was 8 months. Patients who underwent surgery after IC had a better PFS as compared to those who underwent nonoperative local therapy (12 months vs. 8 months). IC-induced Grade 3 or more toxicity occurred in 45% of the patients and mortality occurred in 2 patients (7.7%) due to neutropenic sepsis. Conclusion: IC is feasible in patients with inoperable LAHNSCC. Patients who underwent surgery after IC had a trend towards better PFS as compared to those who underwent nonsurgical local therapy after IC.

Head and neck squamous cell carcinoma in HIV, HBV and HCV seropositive patients - Prognosis and its predictors.

Patients receiving treatment for head-and-neck squamous cell carcinoma (HNSCC) also may have coexisting viral infections caused by HIV, HBV, and HCV (seropositive). There is scarce literature regarding the clinical presentation and treatment outcomes for these patients with coexisting viral infections (seropositive HNSCC). We conducted this study to assess the clinical presentation and treatment outcomes (overall survival [OS] and disease-specific survival [DSS]) of seropositive HNSCC patients. This was a retrospective cohort study on seropositive HNSCC patients registered at our center from 2012 to 2014. The viral infections were identified by the presence of the antibodies to these viruses in the patient's blood samples. Out of the 19,137 HNSCC patients registered, 156 patients had HBV, HCV, and/or HIV infection. Among these, HBV infection was the most common (n = 86/156, 55.1%) followed by HIV infection (n = 36/156, 23.1%) and HCV infection (n = 29/156, 18.6%). The oral cavity was the most common subsite involved. Majority of these patients presented at an advanced stage (advanced T stage - 71.8% and node positive - 62.2%). The majority of the patients received curative-intent treatment (65.4%). The OS at 3 years for these HNSCC patients with coexisting HIV, HBV, and HCV infection was 60%, 62.6%, and 57.5%, respectively, and their DSS at 3 years was 58.8%, 78.6%, and 53.8%, respectively. Seropositive patients with HNSCC often present in the advanced stage but have a good survival if treated appropriately.

Systemic Inflammatory Reaction in Patients With Head and Neck Cancer-An Explorative Study.

Aim: To assess the longitudinal pattern of pro-inflammatory cytokines and growth factors in serum up to 1 year following treatment for head and neck cancer.Materials and Methods: Patients with newly diagnosed, curable head and neck cancer were included (n = 30). The most common subsite was oropharynx (n = 13) followed by oral cavity (n = 9). Blood was drawn from all patients at regular intervals (before treatment, 7 weeks after the start of the treatment, and at 3 months and 1 year after termination of treatment) and analyzed for cytokines (Il-1β, Il-2, Il-4, Il-5, Il-6, Il-8, Il-10, GM-CSF, TNF-α, and IFN-γ) and growth factors (G-CSF, FGF-2, EGF, and VEGF).Results: The time point of the peak level of pro-inflammatory cytokines was 7 weeks after start of treatment which corresponded for the majority of patients with termination of radiotherapy or chemoradiotherapy. Patients undergoing chemoradiotherapy exhibited a significant increase of IL-1β, IL-6, and IL-10 at 7 weeks as compared to pre-treatment levels. At 1 year after termination of treatment four patients experienced recurrence of disease while 26 patients were considered disease-free. The patients with recurrence had significantly higher levels of IL-1β, IL-6, IL-8, and IL-10 at 7 weeks after the start of treatment than patients without recurrence. Correlated with T stadium patients with T3-T4 had higher levels of IL-1β and IL-8 than patients with T1-T2 7 weeks after the start of treatment.Conclusions: The observed immune response in this explorative study demonstrates that chemoradiotherapy may induce not only a local treatment effect on the immune system but also effects far outside the irradiated field. The result of the study indicates that analysis of a pro-inflammatory panel of cytokines in serum at 7 weeks after the start of treatment could be of prognostic value in patients with head and neck cancer. Further study of a larger cohort could help identify patients at larger risk for recurrent disease with measurements of pro-inflammatory cytokines under and after treatment.

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.

Rapid Recurrence in Head and Neck Cancer: an Underappreciated Problem with Poor Outcome

Rapid recurrence, defined as tumor recurrence after primary surgery and prior to initiating postoperative radiation therapy (PORT), is an underappreciated problem in head and neck cancer (HNC). The purpose of our study is to determine risk factors and treatment outcomes of rapid recurrence. CT simulation images of HNC patients treated with primary surgery and PORT between 2009 and 2017 were retrospectively reviewed by a neuroradiologist blinded to patient outcome but provided with pre-operative imaging and surgical pathology report. The primary site, ipsilateral neck, and contralateral neck at the time of simulation were separately evaluated and those images interpreted as either suspected or definite recurrence were categorized as rapid recurrence. Multivariable analysis (MVA) was conducted to identify risk factors for rapid recurrence as well as predictors of local, regional, and distant recurrence and overall survival (OS). Patients appreciated to have rapid recurrence at the time of CT simulation by the treating radiation oncologist were treated with dose escalated radiation. A total of 195 HNC patients were included; oral cavity and squamous cell carcinoma were the most common subsite (58%) and histology (85%), respectively. Patients were primarily white (87%) and male (61%), with median age of 63 (range 25-90). 62% of patients were AJCC 7th edition pathologic stage IV, 23% had extranodal extension (ENE), 24% had lymphovascular invasion, 45% had perineural invasion (PNI), and the mean pathologic tumor size was 2.8 cm. Rapid recurrence occurred in 40 patients (21%) with a median time from operation to CT simulation of 37 (range 12 – 91) days. On MVA, ENE was the only predictor of rapid recurrence (p= .02). Positive surgical margin occurred in 20 patients (10%) but was not associated with rapid recurrence (p= 1.0). On univariate analysis, rapid recurrence at either the primary site or ipsilateral neck was associated with local, regional, distant recurrence and OS while recurrence in contralateral neck was associated with regional recurrence and OS. Rapid recurrence was associated with local, regional, and distant recurrence on MVA (p < .001 for all). Local recurrence was associated with tumor size (p = .05) while regional recurrence was associated with tumor size, ENE and PNI (p <0.05 for all). 2 year OS in patients retrospectively appreciated to have rapid recurrence treated with 60 Gy (n= 23) and >60 Gy (n= 17) were 25% and 60%, respectively (p= .12). While rapid recurrence, ENE, PNI and tumor size were all associated with poor overall survival on MVA, rapid recurrence was the strongest predictor (HR 5.3, 95% CI 2.9- 9.7) followed by ENE (HR 2.6, 95% CI 1.3-5.3). Rapid recurrence at time of CT simulation occurs at an underappreciated rate and is associated with poor survival outcomes. Patients with ENE are at highest risk and may benefit from diagnostic imaging evaluations immediately prior to PORT. Dose escalated salvage therapy may be beneficial.