Serum anti-p53 antibodies as a diagnostic tumor marker: observations in patients with malignant and premalignant oral cavity lesions.

AIM: To determine whether serum anti-p53 antibody (p53-Abs) positivity in patients with oral carcinoma corresponds with tumor localization, histological grade, stage, and recurrence. METHODS: The study population was divided into three groups: controls; patients with a premalignant lesion; and patients with oral squamous cell carcinoma (SCC). The third group was composed of patients attending outpatient services for pathological diagnosis or for follow-up monitoring only. The cancer patients had undergone resective surgery in local anesthesia. Serum p53-Abs levels were measured using a commercial enzyme-linked immunosorbent assay (ELISA) and monitored over a 3-year follow-up period. RESULTS: Controls and patients with premalignant lesions did not test positive for p53-Abs at ELISA testing. Patients with a malignant lesion tested positive at initial diagnosis when a high histopathological grade lesion was present or localized to the posterior region of the oral cavity. Postoperative serum p53-Abs levels gradually declined until complete seronegativity. Patients with a recurrent tumor tested positive for p53-Abs. CONCLUSION: Seropositivity for p53-Abs may be associated with histopathological tumor grade, localization, and recurrence. The findings suggest that serum p53-Abs analysis is a useful diagnostic marker for oral SCC.

Combined chemotherapy, cryosurgery, and radiotherapy/surgery for oral cancer.

UNLABELLED: One hundred and twelve patients (95 males, 17 females) with untreated squamous-cell carcinoma of the oral cavity underwent a multidisciplinary treatment. FOLLOW-UP: 6-72 months (median 51 months). T1-4N0M0 lesions (tongue, 31 patients; floor, 31 patients; cheek, 17 patients; retromolar, 9 patients) were treated with cryosurgery (T1-2: 1-2 sessions, T3-4: 2-4 sessions) and contemporaneously with (cyclophosphamide, methotrexate, fluorouracil)(CMF) (T1-2:2 courses; T3-4: 3 courses). The patients, 15-20 days after the end of cryo-chemotherapy, underwent TCT (T1: 50 Gy on tumour and lymph nodes; T2-3-4: same with an extra dose of 10-15 Gy on the primary lesion). T1-4N1-3M0 patients (tongue: 8, floor: 13, cheek: 2, retromolar: 1) received the same cryotherapy and chemotherapy, followed by surgery (16 widened suprahyoid dissections, 8 conservative laterocervical dissections, 1 radical neck dissection). Overall actuarial survival at six years was 61.9%: T1-4N0M0 (88 patients) 66.6% (T1-2 76.0%; T3-4 56.9%); T1-4N1-3M0 (24 patients) 44.4% (T1-2 66.6%; T3-4 33.3%). Six-year actuarial survival by site was: tongue (39 patients) 79.2% (N0 85.9%); floor (44 patients) 55.2% (N0 57.1%); cheek (19 patients) 74.2% (N0 68.9%); retromolar (10 patients) 0% (N0 0%). Complete remission was reached four months after treatment by 97 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral and pharyngeal cancer: combined approach for multimodal therapy.

Five-year results in 60 oral and pharyngeal cancer patients treated with combined approach chemoradiotherapy (39 patients) and chemoradiotherapy plus lymph node surgery (21 patients) are reported. Complete remission (CR) was achieved in 16/39 (41%) patients treated with chemoradiotherapy alone, and in 16/21 (76%) patients who had chemoradiotherapy plus surgery. The number of CR was statistically (chi-square test) higher (p less than 0.025) in the second group. The 5-year actuarial survival was 39.7% in the group of patients treated with chemoradiotherapy plus surgery. After 5 years 53% of the patients who reached CR are living free of disease in the first group and 76% in the second group.

[Extracapsular lymph node metastasis in squamous cell carcinoma of the oral cavity after chemo-radio-surgical treatment protocol]. / Metastasi linfonodali extracapsulari nel carcinoma spinocellulare del cavo orale dopo protocollo terapeutico chemio-radio-chirurgico.

A total of 134 cases of spinocellular carcinoma of the oral cavity were treated by our division during the period March 1988-June 1992. This carcinoma histotype has a predominantly local evolution with rare long-distance hematic metastases. On the other hand, there are more frequent reports of metastases along the lymphatic route with an incidence which varies according to the site of tumour onset. Among the 134 patients treated a group of 77 were selected and admitted to a chemo-radio-surgical protocol consisting of four stages. During surgery patients in this group showed a marked reduction of both intracapsular and extracapsular lymph node involvement in almost all sites examined.

[Verrucous carcinoma of the oral cavity. Personal experience with combined chemo-surgical treatment]. / Carcinoma verrucoso del cavo orale. Esperienze personali sul trattamento chemio-chirurgico integrato.

Following an introduction regarding the anatomo-pathological and clinical aspects of verrucous carcinoma of the oral cavity, the authors review several recent reports concerning the prognosis and treatment of this tumour and its possible evolution. This is followed by a wide-ranging discussion of the differing opinions put forward by various researchers regarding the possible role of radiotherapy and in particular the high risk of triggering off latent forms and provoking the differentiated and more aggressive forms of carcinoma. The authors then illustrate their experience of integrated chemo-surgical treatment, excluding radiotherapy, administered over the past six years to patients who were brought to their attention suffering from this form of carcinoma.

[Warthin's tumor. Review of the literature and personal experience]. / Il tumore di Warthin. Revisione della letteratura ed esperienza personale.

Warthin's tumour is a much debated clinical case-characterised by the presence of epithelial proliferation and lymphoreticular stroma. Numerous controversies concern this type of tumour so much so that recently is was even denied that it can be considered a real tumour. The present paper aims to review the state of the art and report the authors' personal experience.

[Multidisciplinary treatment in advanced stages of spinocellular carcinoma of the oral cavity. Initial results]. / Trattamento multidisciplinare degli stadi avanzati di carcinoma spinocellulare del cavo orale. Primi risultati.

As in almost all forms of tumour, the best therapeutic results for those of the oral cavity is obtained following the first treatment which must be incisive and appropriate because it often represents the sole decisive possibility of recovery. In advanced forms (stages III and IV) it is best to establish a close collaboration between surgeon, cancer specialist and radiotherapist: this paper reports the authors' experience over the past 5 years with regard to advanced stages of spinocellular carcinoma of the oral cavity treated according to a chemoradiosurgical therapeutic protocol. Of the 134 cases treated by our unit, 77 were included in the protocol showing a 78% actuarial survival rate over 40 months.

[A retrospective study on the importance of preoperative control in the prognosis of spinocellular carcinoma of the oral cavity]. / Studio retrospettivo sull'importanza del controllo prechirurgico nella prognosi del carcinoma spinocellulare del cavo orale.

Surgical treatment of advanced forms of spinocellular carcinoma of the oral cavity (stages 3-4) has been integrated for a number of years with cycles of chemo- and/or radiotherapy both before and after surgery. This chemo-radio-surgical therapeutic protocol consists of four distinct stages, separated by precise treatment-free intervals, which enable the best efficacy to be achieved through synergy. A total of 60 patients were treated by our Ward using this protocol during the period March 1988-June 1992. At the time of surgery a complete negative outcome in the histological picture (pTO) was observed in 40% of cases; lesions had not regressed on only 16% of patients. A retrospective type study has been carried out using Kaplan-Meier's statistical analysis to evaluate the prognostic factors in this population: a significant correlation was found between disease-free time and survival, calculated at 40 months from the completion of the protocol, and histopathological TNM. Non correlation was found with clinical TNM: therefore, rather than the extent of the lesion at the time of diagnosis, its control during preoperative stages appears to be the major prognostic factor.

[The problem of the mandible in surgery of tonsillar tumors: proposal of a technique]. / Il problema della mandibola nella chirurgia dei tumori tonsillari: proposta di una tecnica.

The Authors report a technique of a conservative transmandibular approach for the surgical treatment of tonsillar region malignancies. The procedure is based upon the preparation of a vascular mandibular flap through two osteotomies, which are performed, the first above the mandibular foramen and the second below the mental foramen. The main advantages of present technique are: lip-chin-splitting is avoided and, due to the preservation of mandibular vascular and nervous supply, it is possible to accomplish, without risk, postoperative radiotherapy. Moreover, if dictated by oncologic reasons, this conservative procedure may easily be transformed into a radical surgery (commando or neck-jaw operation).

[Basic classification of 150 dysgnathic subjects according to Ricketts, Steiner and Cervera]. / Classificazione basale di 150 soggetti disgnatici secondo Ricketts, Steiner e Cervera.

After a short relation of the cephalometric methodology of Steiner, Ricketts and Cervera, the A. present their 150 cases in which for each single case the tracing has been achieved in a comparative method according to each of the three techniques proposed by the above mentioned authors. The analysis of the results obtained explains the differences, often important, of these results with the different methodological impostation of Steiner, Ricketts, and Cervera. It has been underlined that from a diagnostical methodology to a vigorous analysis of the neuro-splanchnocranial relationship a change of interest has been gradually achieved towards face and particularly towards the mid-third and lower face, without neglecting the anthropological concepts required in the orthognatodontical surgery.

[Verrucous carcinoma: pathologicoanatomic aspects and the clinical course and therapy]. / Il carcinoma verrucoso: aspetti anatomo-patologici e comportamento clinico e terapia.

A report of the literature concerning verrucous carcinoma is produced. Once more it is emphasized that this neoplastic disease has such peculiarities (better prognosis and different therapy) to require an immediate differential diagnosis.

[Verrucous carcinoma of the oral cavity; critical review of biopsied cases and a retrospective study of the clinical course in 14 patients]. / Il carcinoma verrucoso della cavità orale; revisione critica di una casistica bioptica e studio retrospettivo sul comportamento clinico in 14 pazienti.

With the view of studying the prognosis and therapy of "verrucous carcinoma", the authors have examined the follow-up of 14 patients, suffering from this neoplastic disease. They have pointed out a certain unhomogeneity in the results and this has most probably to be ascribed to an irrational therapeutical treatment and in particular to the possible negative influence of radiotherapy. The authors wish therefore to reaffirm the need to shortly come, also in this field to a rationalization of the therapeutic protocol.

[Odontogenic tumors. The importance of a correct histopathological diagnosis]. / Tumori odontogenetici. Importanza di una corretta diagnosi istopatologica.

The troubles in the exact diagnosis of odontogenic tumors spring from the poor knowledge of the histological type of the lesion, from mutations in the ectodermal cells of the tumors and from the uncommonness of the pathology. Wrong diagnosis in this field of stomatology often lead to unnecessary surgical resection and could be avoid with better cooperation between surgeon and pathologist.

[Carcinoma of the oral cavity: integrated treatment]. / Carcinoma del cavo orale: trattamenti integrati.

An integrated chemoradio-surgical technique for treating carcinoma of the oral cavity is described. The results obtained are particularly promising. Longer-term follow-ups are needed for final assessment.

[Intra-arterial chemotherapy. Presentation of a method to insure patency of the catheter]. / Chemioterapia endoarteriosa. Presentazione di una metodica per assicurare la pervietà del catetere.

Following some brief remarks on the main techniques of antineoplastic chemotherapy, a simple technique for guaranteeing patency of the endarterial catheter is presented. Using a special microchannel infusor, it was possible to prevent catheter obstruction in 100% of the cases treated.

[Cryotherapy, polychemotherapy and radiotherapy in the treatment of oral carcinoma. Preliminary note]. / La crio-polichemio-radioterapia nel trattamento del carcinoma del cavo orale. Nota preliminare.

Following a short introduction to outline the therapeutic approach to primary carcinoma of the oral cavity, technical modalities, and the techniques of using this new type of cryo-polychemo-radiotherapeutic association are reviewed. The extremely interesting and flattering results obtained in 30 cases of patients suffering from this form of cancer must, however, be considered fairly modest if allowance is made for the time limits (insignificant). Results will be reviewed when a longer period has gone by.

[Surgical experience of complex fractures of the middle third of the facial skeleton treated without an intermaxillary block]. / Esperienza chirurgica di fratture complesse del terzo medio dello scheletro della faccia trattate senza blocco intermascellare.

Having illustrated the functional and anatomical aspects of the upper jaw and the importance of the anterior and posterior pillars as load-bearing structures for the middle third of face, the paper reports a series of fractures of the upper jaw treated with plaque osteosynthesis without an intermaxillary block. The functional and esthetic advantages are underlined.

[Multiple lipomatosis or Launois-Bensaude disease. Technics for surgical treatment in our clinical experience]. / La lipomatosi multipla o morbo di Launois-Bensaude. Tecniche di trattamento chirurgico nella nostra esperienza clinica.

Only 200 cases of this extremely rare disease of unknown etiology have been reported in the literature. The paper examines the various surgical techniques and describes two cases operated by the authors.

[Fractures of the temporo-zygomatic arch. The clinical and therapeutic aspects]. / Fratture dell'arcata temporo-zigomatica. Considerazioni cliniche e terapeutiche.

Fractures of the orbito-maxillo-zygomatic complex are often associated with fractures of the temporo-zygomatic arcade. After a brief discussion, the authors describe a simple method to support the fractured arcade in the event of inadequate containment and/or the precarious stability of the latter.

[Our clinical experience with the cryosurgery of oral lesions of odontostomatologic interest]. / La nostra esperienza clinica con la criochirurgia delle lesioni orali di interesse odontostomatologico.

Three years' experience in the field of therapeutic cryosurgery is described. During this period, 125 patients were treated and excellent results were achieved. Carcinomas of the oral cavity, leukoplakias, and angiomas formed the bulk of the series. It is submitted that this form of management can be looked upon as the treatment of choice in these forms.