ABSTRACT
The 5-year relative survival for patients with head and neck cancer, the seventh most common form of cancer worldwide, was reported as 67% in developed countries in the second decade of the new millennium. Although surgery, radiotherapy, chemotherapy, or combined treatment often elicits an initial satisfactory response, relapses are frequently observed within two years. Current surveillance methods, including clinical exams and imaging evaluations, have not unambiguously demonstrated a survival benefit, most probably due to a lack of sensitivity in detecting very early recurrence. Recently, liquid biopsy monitoring of the molecular fingerprint of head and neck squamous cell carcinoma has been proposed and investigated as a strategy for longitudinal patient care. These innovative methods offer rapid, safe, and highly informative genetic analysis that can identify small tumors not yet visible by advanced imaging techniques, thus potentially shortening the time to treatment and improving survival outcomes. In this review, we provide insights into the available evidence that the molecular tumor fingerprint can be used in the surveillance of head and neck squamous cell carcinoma. Challenges to overcome, prior to clinical implementation, are also discussed.
Subject(s)
Biomarkers, Tumor/genetics , Head and Neck Neoplasms/diagnosis , Neoplasm Recurrence, Local/diagnosis , Squamous Cell Carcinoma of Head and Neck/diagnosis , Early Detection of Cancer , Head and Neck Neoplasms/genetics , Humans , Liquid Biopsy , Neoplasm Recurrence, Local/genetics , Sensitivity and Specificity , Squamous Cell Carcinoma of Head and Neck/genetics , Survival Analysis , Time-to-TreatmentABSTRACT
PURPOSE: To evaluate the feasibility and efficacy of a novel concept of early loaded (ie, within 2 weeks) implant-supported fixed dental prostheses (ISFDP) for patients who underwent mandibular reconstruction. MATERIALS AND METHODS: All patients requiring mandibular reconstruction between July 2013 and March 2016 at AZ Sint-Jan Brugge-Oostende AV were screened for dental rehabilitation according to the proposed concept. Of 17 patients, 10 were eligible for inclusion. Clinical and radiologic assessments of implant integration and prosthetic survival were performed at 6, 12, 24, and 36 months. Patient satisfaction was assessed prior to and after prosthetic rehabilitation using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core 30 and Head & Neck 35, as well as a visual analog scale. RESULTS: Ten patients received mandibular reconstructive surgery for an oral cavity tumor (n = 6), osteoradionecrosis (n = 3), or medication-related osteonecrosis of the jaw (n = 1). Implants were placed within an average of 6 (2 to 21) months postsurgery in a one-stage procedure. Prosthetic rehabilitation was achieved within 2 weeks in 8 of the 10 patients. Two patients received their ISFDP delayed due to postoperative complications. Implant integration and prosthetic outcome at a maximum of 36 months of follow-up were successful in 7 of the 10 patients. At that time, two patients had passed away, while one patient had the ISFPD removed because of graft necrosis after radiotherapy. Patient satisfaction was high, with significant improvement after dental rehabilitation in comparison to mandibular reconstruction alone. CONCLUSION: The present concept offers a feasible and fast prosthetic rehabilitation that improves patient quality of life.
Subject(s)
Dental Implants , Mandibular Reconstruction , Dental Implantation, Endosseous , Dental Prosthesis, Implant-Supported , Follow-Up Studies , Humans , Pilot Projects , Quality of Life , Treatment OutcomeSubject(s)
Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal, Humanized/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology , Brain Neoplasms/pathology , Glioblastoma/pathology , Periodontal Abscess/drug therapy , Surgical Wound Infection/surgery , Bevacizumab , Brain Neoplasms/surgery , Enterobacter cloacae , Enterobacteriaceae Infections/microbiology , Face/blood supply , Fatal Outcome , Glioblastoma/surgery , Humans , Male , Mandibular Nerve/pathology , Middle Aged , Necrosis/etiology , Necrosis/pathology , Recombinant Proteins , Staphylococcal Infections/microbiology , Surgical Wound Infection/microbiology , Temporal Lobe/surgeryABSTRACT
PURPOSE: The role of dental implants as part of functional and esthetic oral rehabilitation after ablative intraoral tumor surgery has been established. The purpose of this article is to highlight the phenomenon of tumor recurrence around dental implants. MATERIALS AND METHODS: Twenty-one consecutive cases of patients all treated surgically for squamous cell carcinoma of the oral mucosa between January 2003 and December 2007 were reviewed, regardless of staging. Dental rehabilitation was established by means of oral implants. Fifty-six implants were placed either during tumor ablation surgery (16 patients) of afterward (5 patients). Radiotherapy was given according to the guidelines of the NWHNT (Netherlands Working group on Head and Neck Tumors). RESULTS: In the group of simultaneous implantation, 3 patients developed local recurrence around one of the implants. No recurrence was found in the group implanted in second stage surgery. Local recurrence around a dental implant is a severe oncological setback that drew our attention. CONCLUSION: Influence on radiation fields and errors in surgical techniques are discussed, as well as the possibility of inducing changes in sensitized mucosa. Because of the small number of patients, no conclusions can be drawn. Further multicentered examinations should be performed.
