Gingival Carcinoma Research Articles

EP-1112: Radiation therapy with concurrent superselective intra-arterial chemotherapy for gingival carcinoma

EP-1112: Radiation therapy with concurrent superselective intra-arterial chemotherapy for gingival carcinoma

Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy for gingival carcinoma

The aim of this study was to review the efficacy and toxicity of radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy in the treatment of gingival carcinoma. In all, 34patients (21men and 13women) with squamous cell carcinoma of the gingiva underwent radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy. Treatment consisted of daily external irradiation and concurrent retrograde superselective intra-arterial infusion with cisplatin and docetaxel. A median total dose of 60Gy in 30fractions was delivered to tumors. Of the 34patients, 29 (85 %) achieved a complete response (CR) and 5had residual tumors. Of the 29patients with a CR, 2 had local recurrences and 1 had distant metastasis 1-15months after treatment. Twenty-six of the 36patients had survived at a median follow-up time of 36months (range 12-79months); 4 died of cancer and 4 died of non-cancer-related causes. At both 3 and 5years after treatment, the overall survival rates were 79 % and the cause-specific survival rates were 85 %. Osteoradionecrosis of the mandibular bone only developed in 1patient after treatment. Radiation therapy with concurrent retrograde superselective intra-arterial chemotherapy was effective and safe in the treatment of gingival carcinoma. This treatment may be a promising curative and organ-preserving treatment option for gingival carcinoma.

Detection of subsequent cervical lymph node metastasis in a patient with gingival carcinoma using computed tomography perfusion with a single-compartment kinetic model

We present a preliminary case report on the application of computed tomography perfusion (CTP) with a single-compartment kinetic model for early detection of subsequent lymph node metastasis in gingival carcinoma. A 47-year-old female patient with squamous cell carcinoma of the right lower molar gingiva (cT1N0M0) was reviewed. At 4 months after the initial treatment, a subsequent lymph node metastasis was suspected on monthly follow-up ultrasonography. She provided written informed consent prior to participating in the study, which had been approved by the institutional review board at our institution. After a standard head and neck contrast-enhanced CT examination, CTP images were acquired with a coverage of 32 mm (64 × 0.5-mm thickness) and a total acquisition time of 45 s, initiated at 5 s after intravenous infusion of 40 ml of 370 mg I/ml non-ionic iodine contrast agent at a rate of 4 ml/s. Post-processing of the CTP data was performed with dedicated software based on a single-compartment kinetic model (Ziosoft Inc., Tokyo, Japan). The SC flow parameter represented the blood flow per unit volume of tissue, in milliliters per minute per milliliter (i.e., min−1). The mean SC flow value was 1.144 min−1 in a totally replaced metastatic node and 0.985 min−1 in a partially replaced node, compared with 0.787 min−1 in the contralateral benign node. In conclusion, CTP with a single-compartment kinetic model is considered to be one of the useful methods for detection of a small non-necrotic subsequently developing metastatic cervical lymph node.

Prognosis for Gingival Carcinomas With a Delayed Diagnosis After Dental Extraction

In gingival squamous cell carcinoma (GSCC), the association between survival and previous dental extraction (DE) is controversial. The purpose of this study was to investigate the prognosis for patients in whom GSCC was detected after DE was performed. DE for GSCC tumor symptoms was performed in 19 patients before diagnosis (DE group) and not in 58 patients (non-DE group). The clinical features, characteristics, and prognosis were evaluated statistically between the 2 groups. The interval from DE to the first hospital visit was 1.1 to 97 weeks (median, 7.3 weeks). There was no significant difference in tumor status, node status, local recurrence, pathologically positive lymph nodes, or distant metastasis between the DE and non-DE groups. Bone invasion was observed radiographically in 6 patients with mandibular GSCC in the DE group (100%) and 13 in the non-DE group (68.4%). There was a significant difference in bone invasion between the DE and non-DE groups (P < .01). Segmental mandibulectomy was performed in 11 patients (84.6%) in the DE group and 21 patients (61.8%) in the non-DE group. Extent of resection tended to be larger for the DE group. The 5-year overall survival rate was 84.6% for the DE group and 65.8% for patients with mandibular GSCC in the non-DE group. For maxillary GSCC, the survival rates differed significantly between groups (33.3% in DE group and 73.7% in non-DE group). For mandibular GSCC, the resection field was appropriate for the extent of bone invasion after DE and the prognosis was similar to that in the non-DE group. For maxillary GSCC, a broad surgical field is suggested because of the potential for rapid spread in cancellous bony trabeculae.

Randomized, controlled phase II study of post-surgery radiotherapy combined with recombinant adenoviral human p53 gene therapy in treatment of oral cancer

The aim of this study is to evaluate clinical benefits of recombinant adenoviral human p53 (rAd-p53) gene therapy combined with radiotherapy in prevention of oral cancer recurrence after a radical resection. A total of 51 patients with tongue cancer (TCa) and 56 patients with gingival carcinoma (GCa) satisfying the inclusion criteria were randomly assigned to two groups: the experiment group (EG) and the control group (CG). The EG group received multipoint injections of rAd-p53 into the surgical wound surface at a dose of 1 × 10¹² viral particles after a radical resection. Patients in both EG and CG were given radiotherapy at a total dose of 60 Gy at 3 weeks after surgery. All these patients were followed up for at least 3 years. Two cases (2/27) of TCa and 2 (2/30) in GCa patients had a local recurrence in EG, but 8 (8/24) TCa and 8 (8/26) GCa patients in CG had a local recurrence. Both recurrent rates of TCa (33.3%) and GCa (30.8%) in CG are statistically significantly higher than those of TCa (7.4%) and GCa (6.7%) in EG, respectively. The overall recurrent rate in EG is 7%, which is also statistically significantly lower than that (32%) in CG. The 3-year overall survival (OS) rate and 3-year disease-free survival (DFS) rate of EG is 100% and 93%, respectively. The 3-year OS and DFS rates of CG are 94 and 68%, respectively. Mild or medium fever and flu-like symptoms were more frequently observed in EG and were considered to be associated with application of rAd-p53. Post-tumorectomy wound surface injection of rAd-p53 combining with radiotherapy is a safe and effective regimen for the patients with TGa or GCa.

Superselective intra-arterial chemotherapy for oral cancer by subcutaneous implantation of an intra-arterial catheter and an infusion reservoir: A new chemotherapy method to improve the quality of life and curative effect.

6096 Background: We have developed a superselective intra-arterial chemotherapy (iaCT) approach for oral cancer, in which intra-arterial catheter is retrogradely inserted via the superficial temporal artery (STA) and/or occipital artery (OA). This approach increases chemotherapy efficiency but remarkably decreases activities of daily living (ADL) because the catheter penetrates the skin over the approaching artery (STA/OA). Methods: This study assessed our new outpatient iaCT approach involving implantation of an intra-arterial catheter connected to a subcutaneous infusion reservoir. We included 10 patients who had oral cancer treated using outpatient iaCT: tongue carcinoma, 7; cheek mucosal carcinoma, 1; upper gingival carcinoma, 1; palatal carcinoma, 1. In this approach, the STA or OA or both were percutaneously dissected out, a catheter was inserted, and the catheter tip was superselectively placed in the tumor-feeding artery. The extra-arterial catheter portion was implanted through a subcutaneous tunnel and was connected to a subcutaneous infusion reservoir implanted around the mastoid process. The patients were discharged after catheterization, and the chemotherapeutic agent was intra-arterially administered at the Outpatient Chemotherapy Center of Rinku General Medical Center once or twice a week. Intra-arterial infusion was repeated 6 times per course. Results: The response rate was 100%, i.e., 8 cases of CR and 2 of PR; patients with PR underwent surgery.Their ADLs were scarecely disturbed exept for ambulatory visits. Conclusions: In this approach, the catheter is completely implanted subcutaneously; therefore, usual catheter-related issues (e.g., infection, catheter fall out) rarely occur. Because this leads to very good ADLs, outpatient chemotherapy can be safely performed. Consequently, the quality of life (QOL) improves and medical expenses decrease.Our new outpatient iaCT approach improves QOL of and curative effects for oral cancer patients if the ambulatory convenience and the performance status are good.

OP032: What can fibula flap do in jaw reconstruction?

Part A 3-D model simulation and reconstruction of composite total maxillectomy defects with fibula osteomyocutaneous flap flow-through from radial forearm flap 3-Dimensional model simulation technique and free fibula osteomyocutaneous flap flow-through from radial forearm flap were used to reconstruct a total maxillectomy defect for a 21-years-old female patient. Preoperatively, the 3-dimensional simulated resin models of skeleton and fibula were used to design. In surgery, a 22-cm length free fibula was divided into four segments to make skeletal framework as surgical planning with a radial forearm flap flow-through for the free fibula flap with the skin paddle to repair the palatal and nasal region. Free fibula and radial forearm flap were alive, and the patient was satisfied with the results both aesthetically and functionally due to dental rehabilitation which was carried out 6 months postoperatively. This preliminarily clinical study and case demonstrated the fibula osteomyocutaneous flap is an ideal donor site in total maxillectomy defect reconstruction; the flow-through forearm radial flap not only serves as the vascular bridge to midface reconstruction, but also provides sufficient soft tissue cover for the intra-oral defect. Part B Double barrel fibula free flap with second-staged dental implants for mandibular reconstruction. The aim of this study was to evaluate the method for segmental mandibular reconstruction using double-barrel fibular flap with second-staged dental implant-supported prosthetic rehabilitation. 5 patients (2 gingival carcinomas, 2 ameloblastomas and 1 keratocyst) had undergone segmental mandibulectomy with 6–9 cm defect length. After tumor resection, double barrel fibula osteomyocutaneous flaps were used to reconstruct the mandible. All the flaps were alive with no complications post-operatively. Follow-up at 6 months showed good osteo-integration in panoramic radiograph and esthetic facial appearance. The patients underwent second-stage implants 8 months after fibula transplantation and implant-supported prosthesis was installed 1–2 months later to complete teeth rehabilitation.

Adenoid cystic carcinoma in the maxillary gingiva: a case report and immunohistochemical study.

Gingival adenoid cystic carcinoma (ACC) is a rare malignancy. We describe the diagnosis and treatment of a 43 year-old woman who presented with a persistent oral ulcer for approximately 1 year, and subsequent pain in the left posterior maxillary region. Clinical examination revealed an ulcer in the left upper molar gingiva, with swelling in the region from the second premolar to the third molar. X-ray images demonstrated the involvement of the maxillary alveolar bone. The histopathological and immunohistochemical features were diagnostic of ACC. ACC is often presented as a gingival lesion; thus, it may easily be neglected by patients. The identification of this tumor using specific pathological analyses prevents misdiagnosis and enables clinicians to determine the appropriate treatment. In this case, no recurrence or distant metastasis was observed after 2 years of follow-up.

Marginal Mandibulectomy for Lower Gingival Carcinoma With a Cheek-Splitting Transbuccal Approach and Reconstruction by Buccal Fat Pad Flap: A Case Report

Marginal mandibulectomy is a frequent surgical pro-cedure to treat tumors arising at the mandibular gin-giva. If a tumor exists in the anterior region of themandible, an intraoral approach makes it possibleto resect the tumor adequately under direct visualguidance. On the other hand, it is difficult to resectthe tumor at the posterior of the mandibular gingivawith a sufficient safety margin via an intraoral ap-proach because of difficulties with instrumentationand an obstructed view of the surgical site. There-fore, a submandibular approach is frequently usedto treat tumors arising at the posterior site of themandible.

Unexpected Airway Obstruction Caused by Bilateral Hypoglossal Nerve Palsy Following Second Radical Neck Dissection

A 67-year-old woman underwent right radical neck dissection for cervical lymph node metastasis from maxillary gingival carcinoma. Two months later, metastasis in the left superior internal jugular lymph nodes were discovered, and left radical neck dissection was performed. Postoperatively, airway obstruction occurred despite performing extubation after confirming that the patient had fully recovered from anesthesia. Bilateral hypoglossal nerve palsy was diagnosed and the patient was reintubated. After extubation on the following day, airway obstruction was relieved, but slurred speech and impaired swallowing were persistent. In view of this, hypoglossal nerve function should be examined before the second radical neck dissection on the contralateral side.

Closure of oro-antral fistula after partial maxillectomy using laterally based tongue flap: A case report

Use of a tongue flap has been advocated for the treatment of various defects in the mouth, and application for the closure of extended oro-nasal fistulae is widespread because of its rich blood supply. We report herein closure of an oro-antral fistula after partial maxillectomy using a laterally based tongue flap.A 63-year-old man was diagnosed as upper gingival carcinoma. Partial maxillectomy was performed under general anesthesia. After the operation, maxillary defect was sealed with partial denture. About 5 years postoperatively, the patient complained of an unpleasant feeling of the partial denture. Closure operation was performed under general anesthesia. A tongue flap was raised from the dorsum of the tongue including mucosa and underlying muscle, based laterally. The tongue flap was turned upward and the tip was sutured to the lateral edge of the maxillary defect, then the base was sutured to the middle of the maxillary defect. The flap was well vascularized and necrosis of the flap did not occur. Five months postoperatively, the oro-antral fistula was kept completely closed. Therefore, closure of the oro-antral fistula using a tongue flap is useful for medium-sized maxillectomy defects.

In this issue – July 2012

In this issue – <scp>J</scp>uly 2012

Neoadjuvant chemoradiotherapy and surgery as treatment for oral maxillary squamous cell carcinoma in a dog

A gingival maxillary squamous cell carcinoma was diagnosed in a 12-year-old male Yorkshire Terrier. After a complete diagnostic work-up, including a computed tomography scan, the tumour was staged as T3bN1aM0 and considered non-resectable at presentation. The combination of neoadjuvant megavoltage radiotherapy and neoadjuvant and adjuvant chemotherapy with carboplatin and doxorubicin decreased the size of the tumour, allowing for surgery. The dog was free from local disease for 421 days after which it was euthanased at the owners' request.

Phase II Study of Post-surgery Radiotherapy Combined with Recombinant Adeno-viral Human P53 Gene Therapy in Treatment of Oral Cancer

Objective: To evaluate benefits of Recombinant Adeno-viral Human p53 (rAd-p53) gene therapy combined with radiotherapy in prevention of oral cancer recurrence after a radical resection. Methods: A total of 215 patients with resectable Tongue Cancer (TCa) and 268 patients with resectable Gingival Carcinoma (GCa) satisfying the inclusion criteria and were randomly assigned to two groups: the Experiment Group (EG) and the Control Group (CG). The EG received multi-point injections of rAd-p53 into the wound surface at a dose of 1 × 10 12 Viral Particles (VP) after a radical resection. Both EG and CG were given radiotherapy at a total dose of 60 Gy three weeks after surgery. All these patients will be followed at least for 3 years. Results: Among these 483 cases, 107 patients (57 in EG and 50 in CG) finished 3-years follow-up. Two cases (2/27) of TCa and 2 (2/30) in GCa patients had a local recurrence in EG, but 8 (8/24) TCa and 8 (8/26) GCa patients in CG had a local recurrence. Both recurrent rates of TCa (33.3%) and GCa (30.8%) in CG are statistically significantly higher than that of TCa (7.4%) and GCa (6.7%) in EG, respectively. The overall recurrent rate in EG is 7.0%, which is also statistically significantly lower than that (32%) in CG. Overall 3-years survival (OS) rate of EG is 100% and the progress free survival (PFS) rate is 93.0% and the minimum PFS time is 29 months. The 3-years OS and PFS rates of CG are 94.0% and 68.0%, respectively. Except for self-limited fever, no other adverse reaction was found to be relative to rAd-p53.

上顎歯肉癌に対し腫瘍切除を施行した遺伝性出血性毛細血管拡張症の1例

上顎歯肉癌に対し腫瘍切除を施行した遺伝性出血性毛細血管拡張症の1例

Multiple gingival metastasis of adenocarcinoma of the lung

Metastasis to the gingival soft tissues is an extremely rare phenomenon, and metastasis of multiple lesions (i.e. more than 2 lesions), is even more hard to find. In this study, we have reported a rare case of lung adenocarcinoma, which metastasized to the maxillary (2 lesions) and mandibular gingivae (1 lesion) in a 57 year old male patient. Metastasis was also seen to the vertebrae. The differential diagnosis consisted of acute myelomonocytic leukemia, chronic lymphocytic leukemia, haemangioma, pyogenic granuloma, giant cell granuloma, peripheral fibroma, primary gingival carcinoma and secondary metastasis. Contrast enhanced computed tomography of the lung showed a well-defined mass situated below the right hilum with lower lobe consolidation and pleural effusion on the right side with dorsal spinal metastasis. Excisional biopsy of the lesions was consistent with the diagnosis, and the immunohistochemical analysis was positive for cytokeratin 7, carcinoembryonic antigen (CEA), thyroid transforming factor 1 (TTF1), and negative for vimentin and cytokeratin 20 (CK20).

Presence of Porphyromonas gingivalis in gingival squamous cell carcinoma

Periodontal disease has been recently linked to a variety of systemic conditions such as diabetes, cardiovascular disease, preterm delivery, and oral cancer. The most common bacteria associated with periodontal disease, Porphyromonas gingivalis (P. gingivalis) has not yet been studied in the malignant gingival tissues. The objective of this study was to investigate the presence of P. gingivalis in specimens from squamous cell carcinoma patients. We have performed immunohistochemical staining to investigate the presence of P. gingivalis and Streptococcus gordonii (S. gordonii), a non invasive oral bacteria, in paraffin embedded samples of gingival squamous cell carcinoma (n=10) and normal gingiva (n=5). Staining for P. gingivalis revealed the presence of the bacteria in normal gingival tissues and gingival carcinoma, with higher levels (more than 33%, P<0.05) detected in the carcinoma samples. The staining intensity was also significantly enhanced in the malignant tissue by 2 folds (P<0.023) compared to specimens stained for the non-invasive S. gordonii. P. gingivalis is abundantly present in malignant oral epithelium suggesting a potential association of the bacteria with gingival squamous cell carcinoma.

A case of gingival carcinoma in the mandible with postoperative psychiatric disorder

A case of gingival carcinoma in the mandible with postoperative psychiatric disorder

Oral maxillary squamous carcinoma: An indication for neck dissection in the clinically negative neck

This multicenter study was undertaken to characterize the metastatic behavior of oral maxillary squamous carcinoma and to determine the role of selective neck dissection. A retrospective, multicenter study of patients surgically treated for oral maxillary squamous carcinoma was completed. Data collected included primary tumor location, cervical lymph node status, and neck failure rate. The study included 146 patients. The adjusted regional metastatic rate was 31.4%. Of those N0 (clinically negative) necks treated with or without neck dissection, 14.4% developed cervical metastasis. Within the cohort, 7.5% of patients died with distant disease. The regional salvage rate was 52.9%. None of the patients with locoregional failures were salvaged. Maxillary palatal, alveolar, and gingival squamous carcinomas exhibit aggressive regional metastatic behavior. Surgical salvage rates for neck failure are low; therefore, selective neck dissection (levels I-III) is recommended at the time of resection of T2, T3, and T4 maxillary squamous carcinomas.

Functional properties of synthetic N-acyl-L-homoserine lactone analogs of quorum-sensing gram-negative bacteria on the growth of human oral squamous carcinoma cells

Quorum sensing is defined as the ability of microorganisms to sense their population density via the release of signaling molecules composed of acyl-homoserine lactone (AHL), which is a type of autoinducer (AI). Previous structure-activity relationship (SAR) studies demonstrated that the 3-oxo group, homoserine lactone of L-form, and long acyl side chain have crucial roles in apoptosis induction. Various types of synthetic AI analogs of Pseudomonas aeruginosa were prepared, and SAR study was conducted to determine their effects against human oral squamous carcinoma cells derived from gingival carcinoma Ca9-22 cells and tongue cancer SAS cells. Not only the antiproliferative potential but also the radiation-sensitizing effects against these cells were examined. It was found that antiproliferative activity partly depended on HSL structure and acyl side chain length. Moreover, a few compounds, compound 5 and 87, showed antiproliferative effects against both Ca9-22 and SAS cells, and also induced radiation-sensitizing effects against Ca9-22 cells. Compound 5 alone induced apoptotic cell death accompanied by sub-G1 phase accumulation in cell cycle and caspase-3 activation, and radiation-sensitizing effects of compound 5 could be attributed to enhanced apoptosis induction. In contrast, there were no remarkable alterations in cell cycle distribution in Ca9-22 treated with compound 87 alone or in combination. However, both compounds lack 3-oxo and their acyl side chain lengths are not necessarily long. This SAR study demonstrated that HSL analogs, which lacked the recommended characteristics for apoptosis induction clearly showed antiproliferative and radiation-sensitizing activity in Ca9-22 cells.