Impact on patients with oral squamous cell carcinoma in different anatomical subsites: a single-center study in Taiwan.

The incidence of oral cavity squamous cell carcinoma (OSCC) is particularly high in South Asia. According to the National Comprehensive Cancer Network, OSCC can arise in several subsites. We investigated survival rates and the clinical and pathological characteristics of OSCC in different anatomical subsites in the Taiwanese population. We retrospectively analyzed data for 3010 patients with OSCC treated at the Changhua Christian Hospital. Subsequently, we compared clinical and pathological features of OSCC in different subsites. Pathological T4 stage OSCCs occurred in the alveolar ridge and retromolar trigone in 56.4% and 43.7% of cases, respectively. More than 25% of patients with tongue OSCC and 23.4% of those with retromolar OSCC had lymph node metastasis. The prognosis was worst for hard palate OSCC (hazard ratio 1.848; p < 0.001) and alveolar ridge OSCC (hazard ratio 1.220; p = 0.017). Retromolar OSCC recurred most often and tongue OSCC second most often. The risk for cancer-related mortality was highest for hard palate OSCC, followed by alveolar ridge and retromolar OSCC. We found distinct differences in survival among the different subsites of OSCC. Our findings may also help prompt future investigations of OSCC in different subsites in Taiwanese patients.

AHNS Series - Do you know your guidelines? Lip cancer.

BACKGROUND: Lip cancer is one of the most curable primary head and neck malignancies, as the prominent location typically lends to an early diagnosis. The incidence of lip cancer varies by sex, ethnicity, and region, but is estimated to be up to 2.5/100 000 in the United States (squamous cell carcinoma [SCC]). METHODS: This article will review the current literature and National Comprehensive Cancer Network practice guidelines in the treatment of lip cancer. RESULTS: Resection of lip cancer with negative margins remains the mainstay of therapy. Positive nodal disease should be treated with neck dissection and adjuvant radiotherapy. CONCLUSION: Lip cancer remains highly curable when diagnosed at an early stage. A multidisciplinary approach is crucial to treating patients with advanced-stage lip cancer.

Postoperative iodine-125 interstitial brachytherapy for the early stages of minor salivary gland carcinomas of the lip and buccal mucosa with positive or close margins.

BACKGROUND: The purpose of this study was to present our preliminary exploration of safety and efficacy of postoperative low-dose-rate brachytherapy for the early clinical stages of minor salivary gland carcinomas of the lip and buccal mucosa. METHODS: Twenty-seven patients with the early stages of minor salivary gland carcinomas of the lip and buccal mucosa received postoperative 125 I seed interstitial brachytherapy from March 2005 to May 2015. Actuarial likelihood estimates for local control, overall survival, and disease-free survival were calculated by Kaplan-Meier method. RESULTS: The actuarial 3-year, 5-year, and 10-year local control rates were 94.7%, 82.9%, and 82.9%, respectively. The actuarial 3-year, 5-year, and 10-year overall survival rates were 93.3%, 93.3%, and 77.8%, respectively. No patient experienced toxicity above grade 2. CONCLUSION: Postoperative 125 I seed interstitial brachytherapy is an alternative to radical surgery for early stages of minor salivary gland carcinomas of the lip and buccal mucosa, which offers satisfactory cosmetic and functional outcomes. © 2017 Wiley Periodicals, Inc. Head Neck 39: 572-577, 2017.

Experiences with functional gracilis muscle flap in lower lip reconstruction.

OBJECTIVE: Reconstruction of the lips is pivotal because the lips play an essential role in facial aesthetics and have unique functional properties. We presented our experience in reconstruction of total or subtotal lower lip defects with functional gracillis muscle flap covered split-thickness skin graft (STSG) in patients. METHODS: Between 2009 and 2011, seven patients underwent resection of lower lip squamous cell carcinoma and lip reconstruction. Gracillis muscle flap was performed for reconstruction. Recipient vessels were the facial artery and vein. Motor nerve of the gracillis muscle was coapted to the marginal branch of the facial nerve. Gracillis muscle was covered with STSG. Patients were evaluated about mouth opening, oral competence, word articulation, the color match of the graft, the contraction of the muscle by physical examination. Electromyographic studies and sensation tests were performed. RESULTS: Postoperative course was uneventful for all of the flaps. No microvascular revisions were needed. One patient was reoperated because of wound dehiscence under local anaesthesia. Mean follow up period was 15 months. After three months, movement of the reconstructed lip was observed. Color of the grafted skin was matched with the skin of the face. The patients had no problems with word articulation, oral continence, or mouth opening. The electromyographic study showed recovery of motor innervation. After 1 year, the patients demonstrated recovered sensitivity with the sensation test. CONCLUSION: Considering functional results, superior aesthetic appearance, and minimal donor-site morbidity of the functional gracillis transfer covered skin graft, we think that this method may be an alternative for reconstruction of large full-thickness defects of the lower lip. © 2015 Wiley Periodicals, Inc. Microsurgery 37:487-493, 2017.

A study of actinic cheilitis treatment by two low-morbidity CO2 laser vaporization one-pass protocols.

Therapeutic approaches to chronic actinic cheilitis focus on the removal or destruction of diseased epithelium. The CO(2) laser has become an important therapeutic alternative, achieving clinical resolution in around 90% of patients. Although many laser physical parameters have been reported, some are known for their low potential for scar induction without compromising the success of the results. The aim of this clinicohistological study was to compare the therapeutic responses to two low-morbidity protocols involving a single laser pass. A total of 40 patients with chronic multicentric and microscopically proven disease were randomly submitted to two conservative CO(2) laser protocols using a bilateral comparative model. The degree of histological atypia of the epithelium was determined in 26 patients both pre- and postoperatively for both protocols. Other histological phenomena were assessed in addition to this central analysis parameter. Clinical recurrence occurred in 12.5% of patients for each protocol, together with a significant reduction in the degree of epithelial atypia (p < 0.001), which was occasionally complete. However, no difference was found between the protocols (p > 0.05). Using these morphological parameters it was not possible to determine whether postoperative epithelial atypias in part of the sample were reactive or residual in nature. A few patients may show minor postoperative lesions. Due to their potential to achieve clinical and importantly microscopic resolution, the studied protocols may be used for mild through moderate dysplastic epithelium and clinically diffuse disease.

[Local hyperthermia by means of ballon-type electrodes in combined therapy of patients with locally spread cancer of the mouth mucosa and lower lip]. / Lokal'naia gipertermiia ballonchikovymi élektrodami v kombinirovannom lechenii mestnorasprostranennogo raka slizistoi obolochki rotovoi polosti i nizhnei guby.

Modification of the standard chemo- and radiotherapy with local hyperthermia gives evident positive results in treatment of patients with local cancer of tunica mucosa of mouth and lower lip. Since this area having uneven complex surface needs to develop radiofrequency emitting special applicators. We have used catheters with ballons filled with hypertonic solution as electrodes to adapt the mouth cavity. An electric field creating between these ballons and high surface adjustability makes this system come in useful.

Postoperative chemotherapy with cisplatin and 5-fluorouracil in cancer of the oral cavity and the oropharynx--long-term results.

Adjuvant chemotherapy has not yet been proven to have a survival benefit for patients with head and neck cancer. Studies dealing with this topic have had several faults like mingling tumor localizations and treatment modalities. To re-examine the role of postoperative chemotherapy in oral cavity cancer, a single-center study was conducted with the attempt to have higher homogeneity. 122 patients with primary squamous cell carcinoma of the lip, the oral cavity and the oropharynx have been treated with 100 mg/m2 cisplatin bolus infusion and 120-h continuous infusion of 1000 mg/m2 5-fluorouracil following radical surgery; 99 patients completed all 3 cycles. The disease-free and overall survival are reported and compared to a control group of 161 patients with cancer of the lip, the oral cavity and oropharynx treated only with surgery, and a treatment-dependent prognostic index. After a median follow-up of 79 months (range 5-18 years), the current 5-year overall survival of the chemotherapy group was 67% and the 5-year disease-free survival was 57% while the respective data for the control group are 46% and 40%. This difference is statistically significant. The comparison with the prognostic index confirmed this result. The chemotherapy group suffered from fewer local and more neck relapses and had a much longer relapse latency (29 months versus 8 months). The toxicity of the chemotherapy regimen was tolerable. In a homogeneous population with resectable oral cavity and oropharyngeal cancer, postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil resulted in a high overall survival rate which was significantly better than in a comparable population treated only with surgery and better than the survival expectation calculated with the help of a prognostic index. A prospective randomized study of postoperative chemotherapy versus control, exclusively in patients with oral cancer, is warranted.

Factors related to advanced stage oral squamous cell carcinoma in southern Thailand.

A critical factor that indicates a poor prognosis of oral squamous cell carcinoma (OSCC) is advanced stage disease. This study, therefore, aimed to identify the factors related to advanced stage (TNM staging III, IV) OSCC in Thailand. There were 161 patients with squamous cell carcinoma of the oral cavity and lip (ICD-9 140, 141, 143-5), included in the study. Sixty-two per cent of the patients presented with advanced stage disease. Information on demographic characteristics, risk habits, health-seeking behaviour prior to health care professional (HCP) consultation, tumour characteristics and patient and professional delay was obtained by questionnaire-based interview of the patients. These variables were included as initial variables in a logistic regression to calculate the odds ratio (OR) of advanced versus early stage OSCC. Having traditional herbal medication before HCP consultation significantly increased the risk of advanced stage OSCC (OR 5.77; 95% C.I. 1.25-26.62). Floor of mouth location of tumour was associated with a lower risk of advanced stage disease (OR 0.27; 95% C.I. 0.09-0.82) as was having an ulcer (OR 0.43, 95% C.I. 0.02-0.89). The findings indicate that having traditional herbal medication before HCP consultation increased the risk of advanced stage disease. The lower risk of advanced stage OSCC associated with ulcerative tumours and those on the floor of the mouth may be due to their being more readily detected by the patients.

[A new method of treating lip cancer and a device for its implementation]. / Novyi sposob lecheniia raka guby i ustroistvo dlia ego osushchestvleniia.

Immediate and late results of treatment of labial cancer in 132 patients are analyzed. The patients were exposed to radio-, thermoradio-, and thermochemoradiotherapy using a special electrode device which permits exerting a multifactorial physiopharmacological impact on the tumor. Complete resorption of the tumor occurs when total focal radiotherapeutic dose is reduced by 50%. Such a noticeable reduction of radiotherapeutic dose rules out quite a number of local and general complications.

Tratamiento de hemangiomas orales maduros (cavernosos), con el macrohisopo para criocirugía / Treatment of mature oral hemangiomas (cavernous), with the macrotip for cryosurgery

Se presentan los resultados en cinco pacientes pediátricos, del tratamiento de hemangiomas orales maduros con criocirugía, empleando el macrohisopo de algodón y gasa. Los resultados fueron excelentes en todos los casos.

Adenoid cystic carcinoma of the upper lip.

An elderly man had a large adenoid cystic carcinoma (ACC) of the upper lip. Because of the patient's desire not to have a major surgical resection, the primary modality of treatment was irradiation. A local recurrence following radiation therapy did require surgery, however without morbidity. During the postoperative course extreme physical deterioration of the patient necessitated a complete medical work-up. This revealed lung nodules, not seen previously, which were suspected of being malignant. A barium enema also revealed a sigmoid lesion suggestive of malignancy. Since none of the suspected distant sites were histologically examined, the course of the ACC is left to conjecture. Also, it is left to conjecture as to what course might have followed had the patient been treated initially with a surgical resection. The patient died 20 months after the original diagnosis of the lip tumor was made.

[Clinical picture, therapy and prognosis of orolabial cancer with special reference to regional lymphatic drainage]. / Untersuchungen zur Klinik, Therapie und Prognose orolabialer Karzinome unter besonderer Berücksichtigung des regionären Lymphabflussgebietes.

Upon classification according to the TNM system, most lip carcinomas fell into low T-categories whereas cancers of the oral cavity fell in high T-categories. The proportion of cases with palpable lymph nodes did not differ between the two sites although the extent of the palpation findings (N-category) did differ. In general differences in clinical behavior between the two locations were more apparent when a complex evaluation of all findings was undertaken. Lymph node metastases were divided into two categories whereby a more differentiated calculation of the frequency of metastasis was possible. The interpretability and accuracy of the palpation findings of regional lymph nodes corresponding to the TNM-classification is rather limited with respect to the occurrence of metastases. Patients with fixed lymph nodes or histologically confirmed or clinically certain metastases have a poor prognosis. The frequency of appearence of temporally-determined recurrences and late metastases as well as the average interval until appearence were essentially the same.