Efficacy and Safety of Cetuximab Plus Cisplatin Alone or in Combination With Paclitaxel in Patients With Head and Neck Squamous Cell Carcinoma: A Randomized Trial.

OBJECTIVES: The aim of this study was to assess the clinical usefulness of cetuximab and cisplatin alone or in combination with paclitaxel as the first-line treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). METHODOLOGY: Three hundred patients with confirmed HNSCC from 20 different hospitals were included in this study. Patients in group I underwent a 2-hour infusion of 400 mg/m2 cetuximab (day 1), followed by a 1-hour infusion of 250 mg/m2 cetuximab weekly and 1-hour infusion of 100 mg/m2 cisplatin (days 1 and 21) per treatment cycle. Patients in group II were treated with a combination of cetuximab, cisplatin, and paclitaxel. Patients received 6 cycles of 175 mg/m2 paclitaxel given on days 1 and 21. The primary outcome of the study was progression-free survival (PFS); overall survival (OS) and objective response rate (ORR) were the secondary endpoints. RESULTS: The median PFS was 5 months and 8 months for patients in groups I and II, respectively (HR, 0.93; 95% CI, 0.85-1.78; P > 0.05). Similarly, we found no significant differences in OS between the 2 groups (median OS, 13 vs. 11 months, respectively; HR, 0.67; 95% CI, 0.42-1.43; P = 0.198). Moreover, we observed no significant difference in ORR between the 2 groups (ORR, 63.3% vs 69.9%, respectively; HR, 0.87; 95% CI, 0.36-1.67; P = 0.231). CONCLUSIONS: The combination of paclitaxel with cetuximab and cisplatin did not improve patient outcomes compared to cetuximab plus cisplatin alone. Therefore, the 2-drug regimen could be used as first-line treatment in patients with recurrent or metastatic HNSCC.

Tea intake and risk of oral, pharyngeal, and laryngeal carcinoma: a meta-analysis.

BACKGROUND: The association between tea intake and risk of oral, pharyngeal, and laryngeal carcinoma is still unclear. The aim of this meta-analysis was to quantify the effect of tea consumption on the incidence of oral, pharyngeal, and laryngeal cancer to provide a better understanding on this issue. MATERIAL/METHODS: A literature search was conducted before January 2014 in MEDLINE and EMBASE databases. The relative risk (RR) estimates that extracted or calculated from all included studies were combined together. Given the existing heterogeneity in the study design and data source, a random-effects model was obtained. RESULTS: A total of 20 articles were included in the quantitative synthesis. Fourteen RR estimates (11 from case-control studies and 3 from cohort studies) were pooled together and the result demonstrated that tea consumption reduced the incidence of oral cancer (RR=0.85; 95% CI 0.76-0.96). The summary RR of 4 observational studies (3 case-control studies and 1 cohort study) for pharyngeal cancer was 0.87 (95% CI 0.74-1.04). The association between tea consumption and oral and pharyngeal carcinoma was reported. The summary RR for laryngeal carcinoma was 1.05 (95% CI 0.70-1.57). The Begg's funnel plot and the Egger's test showed no evidence of publication bias. CONCLUSIONS: Tea consumption was associated with decreased risk of oral cancer, while no association was detected with oral/pharyngeal, pharyngeal, or laryngeal cancer.

Retrospective analysis of results of treatment for nasopharyngeal carcinoma in Macao.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a common malignancy in Southeast Asia, however, a full consensus has not yet been reached as to the value of comprehensive treatment for NPC. This study was designed to evaluate the epidemiological characteristics of NPC and their prognostic value, as well as the long-term efficacy of NPC treatment. PATIENTS AND METHODS: A total of 248 patients, with different stages of NPC, were included in this study. RESULTS: The 5-year overall survival (OS) rates for patients in stages I, II, III and IV were 90.48%, 76.71%, 76.89% and 33.87%, respectively (P=0.000), while the respective 5-year progression-free survival (PFS) rates were 85.15%, 72.36%, 63.88% and 26.26% (P=0.000). The respective 5-year OS rates, according to stage, for the group that received radiotherapy combined with chemotherapy and for the group that received radiotherapy only were as follows: stages I and II, 81.67% and 79.59% (P=0.753); stage III, 79.91% and 70.38% (P=0.143); stage IV, 35.22% and 0% (P=0.000). The respective 5-year PFS rates in these groups were as follows: stages I and II, 75.83% and 74.98% (P=0.814); stage III, 74.08% and 42.25% (P=0.027); stage IV, 27.31% and 0% (P=0.000). CONCLUSIONS: Clinical staging appears to be the most important prognostic factor for NPC. As the stage number increases, both the 5-year OS and PFS significantly decrease. Adding chemotherapy to radiotherapy was not advantageous for patients with stage I or II NPC, however the addition of chemotherapy to radiotherapy significantly improved OS and PFS in patients with stage IV NPC. The addition of chemotherapy improved PFS, but not OS in patients with stage III NPC.

Concurrent chemoradiotherapy with or without adjuvant chemotherapy in intermediate and locoregionally advanced nasopharyngeal carcinoma.

Concurrent chemoradiotherapy (CCRT) showed a significant improvement in disease control and clinical outcome in patients with intermediate and locoregionally advanced nasopharyngeal carcinoma (NPC) (stage II, III and IVA+B). However, there has been debate about the contribution and application of additional adjuvant chemotherapy (AC) to a CCRT regime. This study aims to evaluate the additional value of AC in the treatment of intermediate and locally advanced NPC with regard to toxicity and clinical outcomes. A total of 189 patients with American Joint Committee on Cancer (AJCC) stage II to stage IVB NPC were retrospectively identified. Patient characteristics, toxicity, compliance with treatment and clinical outcomes, including response to treatment, overall survival (OS), progression-free survival (PFS), relapse-free survival (RFS), freedom from local recurrence (FLR) and freedom from distant metastasis (FDM), were analyzed. The overall response rate of CCRT and CCRT/AC groups was 97.92 % and 97.83 %, respectively (P=0.643). The 5-year OS rate was 68.2 % in the CCRT group and 75.9 % in the CCRT/AC group (P=0.53). The 5-year PFS rate was 66.7 % and 71.4 % in CCRT and CCRT/AC groups, respectively (P=0.96). This study showed no evidence of an additional value of AC in CCRT treatment in disease control and clinical outcomes in patients with locally advanced NPC in endemic regions. Moreover, three additional cycles of AC after CCRT appeared to be poorly tolerated in patients. Therefore, AC should not be routinely used for treatment, although clinical trials may be justified.

Effects of Four Types of Watermelon Frost Combination Medications for the Treatment of Oral Ulcers: A Network Meta-Analysis.

Objective: The aim of this study is to identify the effectiveness of the four different watermelon frost combination medications in the treatment of oral ulcers through network meta-analysis and rank them based on their performances. Methods: Five randomized controlled studies of four distinct types of a combination medication for the treatment of oral ulcers were observed in numerous databases, and a network meta-analysis was conducted to evaluate the odds ratio (OR) and sequence of the diverse treatments using Stata software (version 13.0). The underlined studies were categorized into two groups: the control group (watermelon frost alone) and the observation group (one of four watermelon frost combinations). Results: The study comprised of 598 cases and the findings indicated that the pooled OR and 95% CI of oral ulcers that improved relative to watermelon frost alone were 3.26 (1.28 to 8.30) for watermelon frost and Kangfuxin fluid, 8.74 (2.94 to 26.02) for watermelon frost and erythromycin, 6.53 (1.81 to 23.50) for watermelon frost and metronidazole, and 2.62 (0.63 to 10.95) for watermelon frost and cydiodine buccal tablets. The study showed the significant efficacy of watermelon frost combination medications. In terms of clinical efficacy, the combination of watermelon frost and erythromycin was the most promising concomitant medication. It had an 86.3 surface under cumulative ranking (SUCRA). Conclusion: All the studied watermelon frost combinations were effective against oral ulcers validating the use of watermelon frost for oral ulcers. The combination of watermelon frost and erythromycin is the most promising candidate among the four combinations for the treatment of oral ulcers.

[Study on the effect of ultrasonic irrigation in deactivating and eliminating the endotoxin in the root canals of chronic periapical periodontitis].

OBJECTIVE: To study the effect of ultrasonic irrigation in deactivating and eliminating the endotoxin in the root canals of chronic periapical periodontitis. METHODS: 10 maxillary premolars with 2 root canals extracted because of serious chronic periapical periodontitis were opened conventionally and prepared with modified double-flared technique with apical foramen sealed. 30 microL 3% H2O2 solution was introduced into each root canal and 2 minutes ultrasonic vibration was given. Samples were taken before and after ultrasonic vibration. 10 maxillary premolars with 2 root canals of chronic periapical periodontitis of 10 patients in clinic were selected. The root canals of them were instrumented as above, followed by 2 minutes ultrasonic irrigation with asepsis distilled water. Samples were taken before, after root canal preparation and after ultrasonic irrigation. The endotoxin activity of them was tested by kinetic turbidimetric limulus test. RESULTS: The mean endotoxin activity of extracted premolars before ultrasonic vibration was 4.069 EU x mL(-1) while after ultrasonic vibration it was 16.410 EU x mL(-1). There was great statistical difference between them (P < 0.01). The endotoxin activity after ultrasonic vibration was significantly higher than that of before vibration. The clinically mean endotoxin activity before, after root canal preparation and after ultrasonic irrigation were 44.860, 4.099, and 0.116 EU mL1 respectively. There was great statistical difference between the endotoxin activity before and after root canal preparation (P < 0.01). After the preparation, the endotoxin activity droped obviously. There was great statistical difference between the endotoxin activity before and after ultrasonic irrigation (P < 0.01). After ultrasonic irrigation, the endotoxin activity droped obviously. CONCLUSION: Under the condition of simulating clinical work presence, the ultrasonic irrigation can not intensify the effect of the root canal rinse solution in deactivating the endotoxin of infected root canals, but it may intensify the effect of the root canal rinse solution in eliminating the endotoxin of infected root canals.

[Effects on Helicobacter pylori reinfection in gastric mucosa by two oral plaque control methods].

OBJECTIVE: To investigate the reinfection rate of Helicobacter pylori (H. pylori) in gastric mucosa by two measures of oral plaque control on patients, and to demonstrate the necessity and better method of plaque control on those patients. METHODS: 148 patients suffered gastritis or gastroduodenal ulcer were assigned into test group 1 (54 patients), test group 2 (55 patients) and control group (39 patients). 13C-urea breath test proved that there were no H. pylori in their gastric mucosa. Daily plaque control was used in test group 1, oral professorial interventions were added into test group 2, neither daily plaque control nor oral professorial interventions was conducted in control group. All patients were conducted 13C-urea breath test again after half a year to determine the reinfection rate of H. pylori in gastric mucosa. RESULTS: 5 patients were eliminated because of stopping mouthwash in the test group 1, 8 patients failed to control dental plaque in the test group 2. The infection rates of H. pylori in gastric mucosa of test group 1, test group 2 and control group were 67.3%, 19.1%, 82.1%, respectively. The infection rate of H. pylori of test group 2 was lower significantly than that in control group and test group 1 (chi2=33, P<0.05; chi2=31.06, P<0.05). There were no significant difference between test group 1 and control group (chi2=2.43, 0.1

[Cost effectiveness analysis of two methods of preparing molar root canals].

PURPOSE: To evaluate the short-term clinical curative effects, cost effective ratio between ProFile nickel-titanium rotary preparation technique and stainless steel hand K-files preparation technique in molar root canal therapy. METHODS: All patients were randomly divided into two groups: 49 cases were prepared with stainless steel hand K-files in routine preparation technique; 45 cases were prepared with ProFile nickel-titanium rotary instruments in step-down technique. The clinical symptoms and cost were recorded. The data was analyzed by SPSS11.5 software package. RESULTS: The satisfactory rate of clinical effect of the NRPT group was significantly higher than SSPT(P = 0.034); The mean cost of the NRPT was significantly higher than SSPT (P = 0.001), the satisfactory rate of NRPT in severe curve subgroup was significantly higher than that of SSPT (P = 0.007), however, the C/E of NRPT was 394.52 Yuan less than SSPT. The former was 192.04 Yuan more than the latter in light curve subgroup. When it was classified by periapical condition before treatment, the satisfactory rate of NRPT was significantly higher than SSPT in negative subgroup yet (P = 0.012), the C/E of the former was 32.32 Yuan more than the latter; nevertheless, the C/E of the former was 376.47 Yuan more than the latter in positive subgroup; CONCLUSIONS: It is better to prepare with ProFile nickel-titanium rotary preparation technique in severe curve subgroup, however, the light curve subgroup should be prepared with stainless steel hand K-files preparation technique. To patients with positive periodontopathy, SSPT would save the cost of treatments, nevertheless, NRPT group have a higher short-term recent effect.

[The effect of coronal preflaring on the working length measurement of root canals in molars].

PURPOSE: To study the influence of coronal preflaring of root canal on the working length measurement in molars. METHODS: 48 molars from 47 adult patients with pulpitis were divided into two groups randomly. 74 root canals of 24 molars were examined in Group 1. After preparing an access cavity, the root canal orifices were located. A 15# K-type file was inserted into root canal to detect resistance at the apical region. 75 root canals of 24 molars were examined in Group 2. Before testing the apical resistance,a size 25# and 20# ProFile.06 taper NiTi rotary instrument was used to enlarge the canal orifice and flare the coronal portion of the root canal. After placing 15# K-type files, a radiograph was taken with the bisecting-angle technique. The distance between the tip of the file and the radiographic apex was measured on the radiographs. Statistical analysis of univariate and multiple logistic regression were carried out for analysis. RESULTS: There was a significant difference between the two groups (P<0.05), there were more accurate measurements in Group 2 than in Group 1. No statistical correlation was found between X-ray measurements and age, sex and the position of molars,while there was significant correlation between maxillary molars and mandibular molars (P<0.05). CONCLUSION: Preflaring the coronal portion of the root canals could significantly increase the accurate measurements of the working length of root canals in molars.