Primary Squamous Cell Cancer Research Articles

PD-L1-Expression in in primary and recurrent vulvar squamous cell cancer.

Squamous cell vulvar carcinoma is a rare malignant disease of women. In higher tumor stages survival rates are poor. Therapy options are limited. Immunoncology plays an increasing role in the treatment of gynecology cancers. Data on the expression of PD-L1 in vulvar cancer are rare and contradictory. We sought to describe the expression of PD-L1 in VSCC in respect to the clinicopathologic characteristics of the tumor. We conducted a retrospective analysis including women with primary and recurrent vulvar cancer between 2000 and 2021. A next generation tissue micro array (ngTMA) was constructed for the analysis of PD-L1 expression. In total 238 women with primary VSCC and 66 cases of local or distant recurrent vulvar cancer were included. 80 women with primary VSCC (33.6%) had tumors with common positive score (CPS) <1 and 63 women (26.5%) had tumors with CPS 1-<10 and 95 women with CPS ≥10 (39.9%). In the PD-L1 positive group the rates of p53+, groin metastasis, lymphatic invasion and tumor infiltration lymphocytes were higher as compared to PD-L1 negative (CPS <1). There was no significant influence of CPS in overall survival in addition to other prognostic factors (P=0.13, likelihood ratio test). PD-L1 expression in primary vulvar cancer is associated with poorer prognosis. Hence, PD-L1 is a possible target for immune checkpoint inhibitors and women might benefit from special treatment options.

A Review on Heavy Metals in Ecosystems, Their Sources, Roles, and Impact on Plant Life

The presence of heavy metals (HMs) on Earth is essential to all forms of life. These metals are essential for plant and animal development but can have numerous negative effects on the living environment. In this review, we looked at where HMs come from, why they are harmful, and how they affect plants. Articles indexed in Google Scholar, PubMed, Research Gate, Science Direct, and a few books on heavy metals were consulted for this study. Heavy metals are essential for plant development and growth. According to this analysis, the hazardous effects of HMs are on the rise all throughout the globe, and this trend may be attributed mostly to human activity. Because of its impact on agricultural productivity and environmental changes, soil pollution caused by HMs is among the most crucial elements. Plants have evolved very sophisticated defense systems to deal with these environmental challenges. The threat that HM stress poses to plants has attracted a lot of attention worldwide because it could stunt agriculture’s long-term expansion. In spite of their importance for plants, this study found that HMs pose a significant threat to plant life. The novelty of this review lies in its detailed examination of both the beneficial and detrimental roles of HMs, providing a balanced perspective often overlooked in current literature. The significance of this work is underscored by its potential to inform sustainable agricultural practices and environmental management strategies, as it highlights the delicate balance required to harness the benefits of HMs while mitigating their risks. Despite their necessity for plant development, this review underscores the significant risks HMs pose to plant health and ecosystems.Less than 10 cases have been reported in the literature of the association of germline BRCA1 and Squamous cell Carcinoma – the esophagus. The article focuses on the probable pathogenesis of BRCA1 mutation with non-classic malignancies and the response of Poly adenosine diphosphate ribose polymerase inhibitors (PARP) inhibitors in such a scenario. We report an unusual manifestation of the BRCA1 gene with second primary oesophageal squamous cell cancer occurring five years later to triple-negative breast cancer.

Germline BRCA1 Mutation inSquamous Cell Carcinoma of Oesophagus: Driver versus Passenger Mutation

We report a rare case of 62-year-old South Asian women who visited the Molecular Pathology and Genomics Department for hereditary germline cancer genetic testing after being diagnosed with oesophageal cancer, reported as invasive keratinizing squamous cell carcinoma metastasized to the lymph nodes. Her personal history revealed that she was diagnosed with triple-negative breast cancer five years before oesophageal cancer. Germline cancer testing showed pathogenic variants in BRCA1 gene c.68_69delAG, which proved it a hereditary breast and ovarian cancer syndrome. She was started on PARP inhibitors but developed some secondary respiratory failure and succumbed to death. Less than 10 cases have been reported in the literature of the association of germline BRCA1 and Squamous cell Carcinoma – the esophagus. The article focuses on the probable pathogenesis of BRCA1 mutation with non-classic malignancies and the response of Poly adenosine diphosphate ribose polymerase inhibitors (PARP) inhibitors in such a scenario. We report an unusual manifestation of the BRCA1 gene with second primary oesophageal squamous cell cancer occurring five years later to triple-negative breast cancer.

Second primary squamous cell cancers in the HPV de-escalation Quarterback Trials.

e18049 Background: Patients with HPV oropharyngeal cancer (HPVOPC) have a cure rate approaching 90%, and will live for decades with the sequelae of therapy. Trials evaluating treatments for HPVOPC select patients by p16 status rather than using more accurate molecular testing; a fraction of these patients, approaching 5%, are HPV16 negative. Recurrent cancers are often not tested molecularly and may not be tested for p16. Applying molecular diagnostics for HPV at diagnosis and relapse can avoid significant mis-assignment, mistreatment, and inaccurate results in clinical trials. We reviewed and report results from the Quarterback Trials (QT) where molecular testing confirmed HPV status at diagnosis and recurrence. Methods: Patients entered on the QT were required to have &lt; 20 py smoking history, not be active smokers, have non-metastatic locally advanced disease, and have a molecularly confirmed HPV status, including genotype (PCR based DNA Sequencing). Subjects were treated with TPF chemotherapy for 3 cycles and patients with an adequate response were eligible for de-escalation of chemoradiotherapy (CRT) to 5600 cGy (RD). The first 20 patients were randomized to standard dose (SD) 7000 cGy (8) or RD (12). Patients who withdrew from the study or had an inadequate response to TPF, were treated with SD. Patients were monitored for recurrent disease by routine surveillance with physical examination and PET scan. Recurrences were confirmed with tissue biopsy. We performed a retrospective analysis of 2nd in-field primaries (SP) and compared them to local regional recurrences (LRF) in the entire eligible population. Results: 62 patients were consented on to the QTs. 2 patients failed screening and are not considered any further. 14 patients received 7000 cGy: 8/14 were randomized to SD, 5/14 had an inadequate response to TPF and 1/14 patient withdrew consent. One patient randomized to SD withdrew consent and stopped CRT at 5200cGy. There were 7 HPV+ LRF: (1 SD and 6 RD); and 4 molecularly documented in-field non-HPV SP squamous cell cancers: 2/14 SD (14%) and 2/46 RD (4%). 1 of 4 SP tumors was p16+; all were molecularly negative for HPV and had documented p53 mutations. Median time to LRF was 8 mo. (4-49) and 66 mo. (35-84) for SP. Median survival after LRF is 11 (4-72+) and after SP 18+ (3-36+). 4/11 (36%) of post treatment local regional squamous cancer events were not HPV related. Conclusions: Non-HPV SP SCC were not rare events in this documented HPV+, non-smoking population. SP were more common in the SD than the RD treated patients suggesting an RT dose dependency and causality, although other biologic explanations are possible. SP will increase and be a major cause of mortality in this population indicating a need for awareness during surveillance. p16 is inaccurate for determining HPV16 status at diagnosis and recurrence in HPV critical clinical trials and in-field cancer events should be molecularly assessed to determine if they are LRF or SP.

Non-HPV In-Field Second Primary Squamous Cell Cancers in the HPV De-Escalation Quarterback Trials

Non-HPV In-Field Second Primary Squamous Cell Cancers in the HPV De-Escalation Quarterback Trials

Racial disparities in outcomes of primary squamous cell cancer of the vagina: A population-based analysis of treatment and survival (1149)

Racial disparities in outcomes of primary squamous cell cancer of the vagina: A population-based analysis of treatment and survival (1149)

(388) Primary Penile Squamouse Cell Cancer Related Malignant Priapism In A Cystectomized Patient: A Case Report

Abstract Introduction Priapism is a prolonged (&amp;gt; 4 hours) and unintended erection without sexual stimulation or sexual desire. Priapism due to neoplasms is called malignant priapism, which is a rare condition that tends to occur with corporeal metastasis of other pelvic area malignancies. Priapism due to primary penile malignancies is extremely rare. Objective In this article, we present the case of a patient who underwent total penectomy and bilateral inguinal lymphadenectomy due to malignant priapism related to primary penile squamous cell cancer (SCC), and who also underwent radical cystectomy (RC) and total urethrectomy due to urothelial carcinoma 19 and 2 years prior, respectively. Methods We prepared the patient's information to present. Results An 82-year-old male patient presented to an outpatient clinic with unintended erection and penile pain of about 48 hours’ duration and was on follow-up in our clinic because of urothelial carcinoma history. The patient’s history indicated that he underwent RC and orthotopic neobladder due to muscle-invasive urothelial cancer (UC) in the bladder. No tumor was observed in the final cystectomy pathology; therefore, no adjuvant therapy was given. Seventeen years after the RC operation, he presented with hematuria and a papillary lesion detected in the mid-urethra during cystourethroscopy. Since the biopsy result from this region was compatible with high-grade UC, he underwent total urethrectomy, neobladder resection, and ileal conduit. Urethrectomy pathology results were reported as UC invading the subepithelial stroma and lymphovascular area. Adjuvant MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy was administered. On follow-up 2 years after the urethrectomy operation, he presented with prolonged priapism. On examination, a cold and erect penis with a 1 cm diameter ulcerated lesion on the glans penis were observed. Hypoxia and hypercarbia were observed on the cavernosal blood gas examination, which was compatible with ischemic priapism. The hemogram was normal. On the emergent penile duplex Doppler ultrasound showed decreased blood flow and a mass on the proximal part of the penis. Subsequently, pelvic magnetic resonance imaging was performed and a mass was observed that was fully destructive to the cavernosal bodies and had irregularly circumscribed borders (Figure 1). Afterward, the patient underwent a total penectomy and bilateral inguinal lymphadenectomy. The pathology report from the penectomy material suggested that the tumor was compatible with moderately differentiated SCC. No sign of metastasis was observed in the lymph nodes. Extensive sampling of the tumor did not reveal any UC in situ, nor SCC in situ. The penis shaft was fully infiltrated by the tumor, with SCC morphology starting from the surgical margin and damaging all the structures of the penile body (Figure 2). The patient was transferred to the oncology clinic for additional treatment planning. Conclusions Despite being the most common primary malignancy of the penis, to the best of our knowledge priapism due to primary penile SCC has been reported only once in the literature. Although metastatic disease is typically thought to be the cause, when a patient with a history of pelvic malignancy presents with malignant priapism, it should be kept in mind that primary malignancies of the penis may also cause this condition. Disclosure No

Multiple primary head and neck squamous cell cancer: Lessons learnt.

To analyze the demographic profile, treatment outcome, and factors affecting them in multiple primary head and neck squamous cell cancer (MPHNSCC) patients. Hospital case records of patients with histopathology proven MPHNSCC registered in the radiation oncology department from January 2008 to December 2020 were retrospectively studied. Modified Warren-Gates criteria were used to define MPHNSCC. Demographic and clinical details were recorded and analyzed. Twenty-seven patients had histopathology proven MPHNSCC. The median age at diagnosis of an index case was 50 years (minimum 26, maximum 70) with a male to female sex ratio of 22:5. Seventeen (62.96%) patients were tobacco users; either smoked or smokeless. The oral cavity was the commonest sub-site for both an index and second primary malignancy (22 patients; 81.48%) and the majority presented in a locally advanced stage of disease (10; 37.03% and 16; 62.95% for an index and second primary, respectively). The presentation was simultaneous, synchronous, and metachronous in 1 (3.7%), 2 (7.4%), and 24 (88.89%) patients, respectively. Two patients had three sites of MPHNSCC. The average duration of chronicity was 54.37 months (min. 8 and max. 156). MPHNSCC were ipsilateral in 10 (37.04%) patients and re-irradiation was planned for 22 (81.48%) patients with 50% treatment compliance. At the time of the last hospital visit, 18 (66.66%) patients were alive with disease, 7 (25.92%) patients were alive without disease, and 2 (7.40%) patients died of disease. A higher percentage of MPHNSCC originated from the oral cavity and the majority presented in the locally advanced stage of disease; despite the site being accessible to self-oral examination. Patient education and physician's awareness regarding the MPHNSCC are needed.

Developing and Validating Novel Nomograms for Predicting the Overall Survival and Cancer-Specific Survival of Patients With Primary Vulvar Squamous Cell Cancer.

Background: To develop and validate novel nomograms for better predicting the overall survival (OS) and cancer-specific survival (CSS) of patients with vulvar squamous cell cancer (VSCC).Methods: A retrospective analysis using a population-based database between 2004 and 2016 was carried. A 10-fold cross-validation with 200 repetitions was used to choose the best fit multivariate Cox model based on the net-benefit of decision curve analysis. Net-benefit, Harrell's C concordance statistic (C-statistic) of calibration plot, and area under the receiver operating characteristic curve (AUC) were used to evaluate the model prediction accuracy. Nomograms of the OS and CSS were generated based on the best fit model.Results: Of the 6,792 patients with VSCC, 5,094 (75%) and 1,698 (25%) were allocated to the training and validation cohort, respectively. All the variables were balanced between the training and validation cohorts. Age, insurance, tumor size, pathological grade, radiotherapy, chemotherapy, invasion depth, lymphadenectomy, sentinel lymph nodes biopsy, surgery, N stage, and M stage were in the best fit model for generating nomograms. The decision curve analysis, calibration plot, and receiver operating characteristic (ROC) curve show the better prediction performance of the model compared to previous studies. The C-statistics of our model for OS prediction are 0.80, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively, while for CSS prediction are 0.83, 0.85, and 0.84. The AUCs for 3- and 5-year OS are the same and are 0.81, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively. The AUCs for 3- and 5-year CSS are 0.78 and 0.80, 0.79 and 0.80, and 0.79 and 0.80 in those three cohorts.Conclusions: Our model shows the best prediction accuracy of the OS and CSS for patients with vulvar cancer (VC), which is of significant clinical practice value.

Stereotactic Body Radiation Therapy (SBRT) With or Without Daily Systemic Therapy for Re-Irradiation of Unresectable, Recurrent, Head and Neck Squamous Cell Carcinoma

Patients with unresectable, previously irradiated recurrent/second primary head and neck squamous cell cancers (SCC) have limited therapeutic options. Stereotactic body radiotherapy (SBRT) may overcome this inherent radioresistance, and radiosensitizing systemic therapy may further enhance RT effect. In this analysis we compared the outcomes of patients who received concurrent systemic therapy to a historical cohort to evaluate oncologic outcomes.Eligible patients had recurrent or second primary squamous cell carcinoma of the head and neck who were previously irradiated, ≥6-month interval prior to SBRT, and deemed unfit/unresectable or refused surgery. Patients were treated with SBRT to 30-40 Gy for five fractions every other day. Kaplan-Meier log-rank and Cox-proportional regression hazards analysis was performed to evaluate patient/disease factors predictive of locoregional control (LRC), and overall survival (OS), measured from the end of SBRT.A total of 63 patients met the inclusion criteria; seventeen patients enrolled on the phase 1 trial received cisplatin 15 mg/m2 prior to each fraction, and 3 patients received concurrent weekly cetuximab. The remainder of patients did not receive concurrent chemotherapy. The majority of cases were recurrences (n = 45, 71.4%). SBRT dose was 30-40 Gy (median 40 Gy). Median follow-up of the entire cohort was 6.6 months (range). One year LRC was 43.4% for patients receiving systemic therapy and 68.7% for the historical cohort (P = 0.14), and 1 year OS was 32.9% and 44.1%, respectively (P = 0.39). The addition of systemic therapy was not associated with a significant LRC or OS benefit on univariate or multivariate analysis (HR 0.80, 95% CI 0.29-2.2, P = 0.67). Gross tumor volume (GTV) ≤10 cc was significantly associated with improved LRC on univariate analysis (HR 0.31, 95% CI 0.12-0.81, P = 0.02) and trended toward significance on multivariate analysis (HR 0.3695% CI 0.13-1.02 P = 0.06). GTV≤10 cc was significantly associated with improved OS on both UVA (HR 0.27 95% CI 0.13-0.57, P < 0.01) and MVA (HR 0.20 95% CI 0.09-0.49, P < 0.01).Systemic therapy with SBRT did not appear to improve LRC or OS over SBRT alone for in the re-irradiation setting of patients with recurrent or second primary squamous cell carcinomas. We found that small tumors (GTV ≤10 cc) may be better suited for SBRT compared to larger ones (GTV > 10 cc).

Pelvic lymphadenectomy in vulvar cancer and its impact on prognosis and outcome

BackgroundThe value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general.Patients and MethodsN = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement.ResultsThe majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11–110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1–8)). These 6 patients were highly node positive with median 4.5 (2–9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months.ConclusionA relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.

Oral Cancer in the Indian Subcontinent-Survival Outcomes and Risk Factors with Primary Surgery.

To assess the oncological outcome and prognostic factors for primary Oral Squamous Cell Cancer (OSCC) staged as per AJCC 8th pTNM, and treated by the contemporary standard of primary surgery and pathology directed adjuvant radiation-chemoradiation. A single institution cohort from a tertiary care academic institution in North India. Case inclusion 2013 to 2016; n=218, median follow-up 35 months. All patients were restaged as per the AJCC 8th pTNM classification. Analysis for Overall Survival (OS), Disease-free Survival(DFS), and factors impacting outcome (Cox proportionate model Multivariate analysis). AJCC pTNM 7th to 8th edition conversion led to upstaging in 16.5%. Stage-II demonstrated greatest stage migration and apparent improvement in OS and DFS (P < .09). Discordance was noted between the presurgical (clinico-radiologic) and postsurgical (pathological) nodal status in 40.3% (88/218; 54 pathologically upstaged;34 downstaged). Pathological downstaging was particularly significant with advanced stage Gingivo-Buccal Cancers (25/73-34.7%). Stage-I-II early cancers had 3 years. OS-86.7% and DFS-78.8%; Stage-III-IV advanced cancers had 3 years. OS-56.7% and DFS-46.6%. Multivariate analysis identified poorer OS and DFS for age < 40 years (HR-1.8; 2.0), skin involvement (HR-2.1; 2.6) and pN+ status (HR-2.4; 3.5). Bone involvement did not compromise survival in this surgically treated set of patients. Age < 45 is newly identified as significantly compromising DFS and OS in Oral Cancer. Established factors of skin involvement and pN+ are confirmed as impacting DFS-OS. An apparent improvement in survival in Stage II Cancers is noted as consequent to adoption of AJCC 8th edition staging. 2 (OCEBM 2011-Inception Cohort Study for Prognosis) Laryngoscope, 131:2254-2261, 2021.

Primary squamous cell cancer of the liver- a rare complex cystic liver lesion

The journal is the official publication of the College of Surgeons of Sri Lanka. Its mission is to reach the highest standard of scientific surgical practice by dissemination of high quality scientific information and to foster and promote the growth of scientific surgery in Sri Lanka and in the region. The Sri Lanka Journal of Surgery publishes peer-reviewed leading articles, review articles, scientific articles, perspectives and case reports in the field of surgery and broadly related surgical sciences The journal adheres to the publication ethics as portrayed by the Committee on Publication Ethics (COPE) and is a member of this organisation. It is listed as an ICMJE journal which follow its recommendations (ICMJE recommendations) on Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals.

Abstract 3587: NRF2-driven KEAP1 transcription in human lung cancers

Abstract Introduction: NRF2/KEAP1 copy number variations and somatic mutations lead to NRF2 activation in a variety of human cancers. Though NRF2 plays a role in activating KEAP1 expression in turn, exact mechanisms and clinical implications remain unknown. Methods: We examined expression correlation between NRF2 and KEAP1 in RNA profiling databases (cBioportal, GEO) with focus on lung cancer. We performed qPCR and western blotting to measure KEAP1 mRNA and protein alterations during NRF2 activator or knockdown treatments. We also queried ENCODE and SRA for ChIP-seq datasets to identify NRF2 binding within KEAP1 promoters in human cells. To demonstrate the regulatory role of NRF2 binding on KEAP1 expression, we applied luciferase reporter assay and CRISPR editing to assess the ARE-related KEAP1 promoter activity and endogenous mRNA abundance change. To determine specimen-level implication of the feedback pattern, we tested gene expression ratio for predicting NRF2/KEAP1 copy number variations and somatic mutations. Results: RNA profiling datasets analysis showed that mRNA expression of KEAP1 was consistently in positive correlation with NRF2 in multiple primary squamous cell cancers, including LUSC (Pearson r=0.50, p&amp;lt;1e-15), ESCA: squamous (r=0.49, p=7.1e-7), HNSC (r=0.33, p=5e-15), and CESC: squamous (r=0.2, p=0.0014). The positive correlations were consistent across all squamous cell lung cancer datasets (Pooled r=0.5, p&amp;lt;1e-15, n=1409), but not in lung adenocarcinoma (Pooled r=0.06, p=0.11, n=2428). To determine regulatory role of NRF2 on KEAP1, we first treated multiple lung cell lines with NRF2 activator and observed significantly increased KEAP1 mRNA and protein levels. Correspondingly, we observed KEAP1 reduction in NRF2 knockdown A549 cells. ChIP-seq dataset analysis revealed highly consistent and variable NRF2 occupancy in KEAP1 promoter regions. This occupancy was drastically increased in lymphocytes and Bease2B cells after NRF2 activation. We then deleted NRF2 binding site in KEAP1 promoter and observed significant reduction of baseline and inducible luciferase activity. The ARE deletion in H292 genome reduced KEAP1 mRNA expression and increased NRF2 downstream gene expression. In one ARE homozygous deletion clone, we observed an elimination of inducible KEAP1 mRNA expression. To see if the feedback pattern can be applied to predict per-sample NRF2 signaling disruption, we calculated gene expression ratios of NRF2/KEAP1 and TXN (NRF2 target gene) /KEAP1. We found significant associations of increased TXN/KEAP1 ratio with KEAP1 deletion, and decreased NRF2/KEAP1 ratio with somatic mutation. From this result, we further developed a linear regression model that can reliably predict functional mutations in NRF2 pathway. Conclusion: NRF2-driven KEAP1 transcription suggested a calibrated NRF2 signaling transduction. Novel cancer prevention and therapy targeting NRF2 signaling will benefit from understanding this unique pattern. Citation Format: Yijun Tian, Qian Liu, Shengnan Yu, Qian Chu, Yuan Chen, Kongming Wu, Liang Wang. NRF2-driven KEAP1 transcription in human lung cancers [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3587.

Routine Use of Swallowing Outcome Measures Following Head and Neck Cancer in a Multidisciplinary Clinic Setting.

Introduction Chemoradiotherapy treatment for head and neck cancer (HNC) can have a major impact on swallowing function and health-related quality of life. The use of outcome measures in early detection of patients with swallowing problems provides the opportunity for targeting speech and language therapy (SLT) interventions to aid adaption and promote better clinical outcomes. Objective The purpose of the present study was to assess relationships between four outcomes measures over time, in a cohort of HNC patients, treated by (chemo-)radiotherapy. Methods Data were collected at 3 months and 12 months, on 49 consecutive patients with primary squamous cell cancer of the oropharynx, nasopharynx or hypopharynx stage T1–4, N0–2b, M0 disease. Results Out of 49 eligible patients, 45 completed assessment at 3 months and 20 at 12 months. The 3-month outcomes gave a strong indication of performance at 1 year. There were several strong correlations found between measures. The strongest was between the 3-month Performance Status Scale for Head and Neck Cancer (PSSHN) and the 12-month PSSHN (rs = 0.761, n = 17), the 12-month PSSHN and the 12-month Functional Oral Intake Scale (FOIS) (rs = 0.823, n = 20), and the 12-month University of Washington Head and Neck Quality of Life (UWQoL) swallow and the 12-month Water Swallow Test (WST) capacity (rs = 0.759, n = 17). Conclusion The UW-QoL swallow item and WST are easy to incorporate into routine care and should be used as part of a standard assessment of swallow outcome. These measures can serve to help screen patients for dysfunction and focus allocation of resources for those who would benefit from more comprehensive assessment and intervention by SLT.

Safety of reRT with SBRT plus concurrent and adjuvant pembrolizumab in patients with recurrent or new second primary head and neck squamous cell cancer in a previously irradiated field: RTOG 3507 Foundation (KEYSTROKE)

Safety of reRT with SBRT plus concurrent and adjuvant pembrolizumab in patients with recurrent or new second primary head and neck squamous cell cancer in a previously irradiated field: RTOG 3507 Foundation (KEYSTROKE)

Bintrafusp Alfa and Stereotactic Body Radiation Therapy for the Treatment of Recurrent or Second Primary Head and Neck Squamous Cell Cancer

Bintrafusp Alfa and Stereotactic Body Radiation Therapy for the Treatment of Recurrent or Second Primary Head and Neck Squamous Cell Cancer

Primary Squamous Cell cancer of Breast: A case report.

Primary squamous cell cancer (SqCC) of breast is a rather rare disease. These tumors are known to be quite aggressive in nature and are usually found to be treatment resistant. Currently there is no standard treatment guideline for management of primary SqCC of breast. In this case report we present a case of primary SqCC of breast in a 60-year old postmenopausal women presenting as pigmented lesion over right breast (no lump). Initial skin biopsy (core) done by dermatologist revealed squamous cell cancer in situ (Bowen’s disease); however surgical resection of the lesion and subsequent histopathological examination revealed primary SqCC (no secondary sites were found elsewhere in the body).

Accuracy of contrast-enhanced CT and predictive factors for extracapsular spread in unknown primary head and neck squamous cell cancer

To determine the accuracy of contrast-enhanced computed tomography (CECT) for nodal extracapsular spread (ECS) and identify predictive radiological signs and clinicopathological features for ECS in unknown-primary head and neck squamous cell cancer (UPHNSCC). The CECT imaging of patients who underwent primary neck dissection for UPHNSCC during 2011-2015 was analysed. The largest pathological-looking node at each radiologically involved level was evaluated in consensus by two head and neck radiologists. Parameters included longest diameter, margin sharpness, haziness in adjacent fat, necrosis, and loss of fat plane with adjacent structures. Independent assessment was also made regarding the presence/absence of ECS. Findings and clinicopathological parameters were correlated with histopathology. Thirty-one patients with 39 neck levels had metastatic nodal involvement determined on CECT. Confirmed ECS was found at 26 levels in 23 patients. Sensitivity of radiological assessment for ECS by nodal level was 81-85% (95% confidence interval [CI]=65-93%) and specificity 46-54% (95% CI=19-81%); kappa 0.87. On univariate analysis based on the largest involved node per patient, longest diameter being ≥30mm (p=0.007), haziness in adjacent fat (p=0.023), increasing age (p=0.006), and more advanced pathological nodal status (p=0.027) were statistically significantly associated with ECS. Haziness and increasing age were independent predictors on multivariate analysis (odds ratio [OR]=26.4 and 1.24). Expert assessment of ECS on CECT had good sensitivity with excellent interobserver agreement. A longest nodal diameter of ≥30mm, haziness in the surrounding fat on CECT, advanced pathological nodal status, and advancing patient age were significantly associated with ECS in UPHNSCC patients, findings not previously reported.

Primary vaginal adenocarcinoma of intestinal-type: case report of a rare gynaecological tumour.

ABSTRACTVaginal cancer is rare and accounts for only 1 to 2% of all gynaecological malignancies. They arise as primary squamous cell cancers or are the result of extension from the cervix or vulva. Primary mucinous vaginal adenocarcinoma of intestinal-type is an extremely rare malignancy of unknown histogenesis with a diagnostic dilemma for the clinician and histopathologist. We presented the case of a 40-year-old Para 0+2 woman with the complaint of a mass in the vagina and recurrent vaginal bleeding who was evaluated and worked-up for examination under anaesthesia and biopsy of the vaginal mass. The histological examination revealed the unusual intestinal-type variant of adenocarcinoma of the vagina. Recognition of this rare entity is important, particularly to avoid the pitfall of misdiagnosing metastatic disease as primary vaginal cancer.