A clinicopathological study of upper aerodigestive tract cancers.

BACKGROUND: The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Cancers of the UAT constitute approximately 4% of all malignancies. In this study, the varied nature of the UAT cancers was studied to find out their incidence, etiology, and clinicopathological correlations. MATERIALS AND METHODS: This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy. RESULTS: Most patients of UAT cancers were in the age group of 40-70 years. Maximum incidence was among males (82%) compared to females (28%). The most common predisposing factor was alcohol + smoking (28%), followed by alcohol + chewing tobacco (25%). The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common. The most common site involved in UAT cancers was the oral cavity (31%), followed by oropharynx (28%), larynx (22%), hypopharynx (7%), and salivary gland (5%). The most common histopathological type was squamous cell carcinoma (SCC) (90%). Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. CONCLUSION: Studies are essential for education and awareness aimed at reducing exposure to habit-forming substances.

Coinfection with Epstein-Barr Virus (EBV), Human Papilloma Virus (HPV) and Polyoma BK Virus (BKPyV) in Laryngeal, Oropharyngeal and Oral Cavity Cancer.

Most research providing evidence for the role of oncogenic viruses in head and neck squamous cell carcinoma (SCC) development is focused on one type of virus without analyzing possible interactions between two or more types of viruses. The aim of this study was to analyse the prevalence of co-infection with human papillomavirus (HPV), Epstein-Barr virus (EBV) and polyoma BK virus (BKPyV) in oral, oropharyngeal and laryngeal squamous cell carcinomas in Polish patients. The correlations between viral infection, SCC, demographic parameters, evidence of metastases and grading were also investigated. Fresh-frozen tumour tissue samples were collected from 146 patients with laryngeal, oropharyngeal and oral cancer. After DNA extraction, the DNA of the studied viruses was detected using polymerase chain rection (PCR) assay. Males (87.7%) with a history of smoking (70.6%) and alcohol abuse (59.6%) prevailed in the studied group. Histological type G2 was recognized in 64.4% cases. The patients were most frequently diagnosed with T2 stage (36.3%) and with N1 stage (45.8%). Infection with at least two viruses was detected in 56.2% of patients. In this group, co-infection with HPV/EBV was identified in 34.1% of cases, EBV/BKV in 23.2%, HPV/BKV in 22.0%, and HPV/EBV/BKV in 20.7%. No difference of multiple infection in different locations of cancer was observed. The prevalence of poorly differentiated tumours (G3) was more frequent in co-infection with all three viruses than EBV or BKV alone. A significant correlation was observed between tumour dimensions (T) and lymph-node involvement (N) in co-infected patients compared to single infection. Further studies are necessary to clarify whether co-infection plays an important role in the initiation and/or progression of oncogenic transformation of oral, oropharyngeal and laryngeal epithelial cells.

Predictability of Recurrence using Immunohistochemistry to delineate Surgical Margins in mucosal Head and Neck Squamous Cell Carcinoma (PRISM-HNSCC): study protocol for a prospective, observational and bilateral study in Australia and India.

OBJECTIVES: Treatment failure and poor 5-year survival in mucosal head and neck squamous cell carcinoma (HNSCC) has remained unchanged for decades mainly due to advanced stage of presentation and high rates of recurrence. Incomplete surgical removal of the tumour, attributed to lack of reliable methods to delineate the surgical margins, is a major cause of disease recurrence. The predictability of recurrence using immunohistochemistry (IHC) to delineate surgical margins (PRISM) in mucosal HNSCC study aims to redefine margin status by identifying the true extent of the tumour at the molecular level by performing IHC with molecular markers, eukaryotic initiation factor, eIF4Eand tumour suppressor gene, p53, on the surgical margins and test the use of Lugol's iodine and fluorescence visualisation prior to the wide local excision. This article describes the study protocol at its pre - results stage. METHODS AND ANALYSIS: PRISM-HNSCC is a bilateral observational research being conducted in Darwin, Australia and Vellore, India. Individuals diagnosed with HNSCC will undergo the routine wide local excision of the tumour followed by histopathological assessment. Tumours with clear surgical margins that satisfy the exclusion criteria will be selected for further staining of the margins with eIF4E and p53 antibodies. Results of IHC staining will be correlated with recurrences in an attempt to predict the risk of disease recurrence. Patients in Darwin will undergo intraoperative staining of the lesion with Lugol's iodine and fluorescence visualisation to delineate the excision margins while patients in Vellore will not undertake these tests. The outcomes will be analysed. ETHICS AND DISSEMINATION: The PRISM-HNSCC study was approved by the institutional ethics committees in Darwin (Human Research Ethics Committee 13-2036) and Vellore (Institutional Review Board Min. no. 8967). Outcomes will be disseminated through publications in academic journals and presentations at educational meetings and conferences. It will be presented as dissertation at the Charles Darwin University. We will communicate the study results to both participating sites. Participating sites will communicate results with patients who have indicated an interest in knowing the results. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12616000715471).

Trends and the utilization of transoral robotic surgery with neck dissection in New York State.

OBJECTIVES: The timing of neck dissection (ND) in relation to transoral robotic surgery (TORS) is controversial. This study identifies local practice patterns and economic and social access disparities during adoption of TORS. STUDY DESIGN: We analyzed utilization patterns of TORS and ND using the New York Statewide Planning and Research Cooperative System all-payer administrative database. Statewide head and neck cancer incidence from the Centers for Disease Control and Prevention (Bethesda, MD) was used to control for overall cancer incidence. METHODS: Patient demographic, insurer, and institutional information of patients aged ≥ 18 (n = 225) years from 2008 to 2012 were evaluated. Temporal trends were analyzed with Poisson regression models for counts. RESULTS: Transoral robotic surgery was used in 386 procedures, and 58.3% involved ND (n = 225). Concurrent ND was most frequent (n = 173), followed by staged TORS then ND (n = 44) and staged ND preceding TORS (n = 8). Caucasians were more likely than Blacks/Hispanics to undergo TORS (P = 0.03). Medicare (26.2%) and Medicaid (2.7%) payers comprised a minority of patients compared to those commercially insured (70.2%). Only 20% of patients received care outside a major urban center, and these patients were more likely to undergo staged procedures, P = 0.02. Staged procedures resulted in higher mean hospital charges (P = 0.02). CONCLUSION: Concurrent TORS + ND, the most common practice in New York, is more cost-effective. Patients without commercial insurance, patients in racial minorities, or patients residing outside major urban centers may be targeted to improve care access disparities with respect to minimally invasive TORS technology. LEVEL OF EVIDENCE: 2c. Laryngoscope, 127:1571-1576, 2017.

[Primitive oto-rhino-laryngology and cervico-maxillofacial tumors: epidemiological and histological aspects]. / Cancers primitifs oto-rhino-laryngologiques et cervico-maxillo-faciaux: aspects épidémiologiques et histopathologiques.

INTRODUCTION: Establish the panorama of primitive oto-rhino-laryngology and cervico-maxillofacial tumors diagnosed at a reference center in Togo. METHODS: We conducted a retrospective, descriptive study of cancers diagnosed at the ORL and cervico-maxillofacial surgery department of the CHU Sylvanus Olympio of Lomé. It was conducted over a period of 10 years (1 January 2005 - 31 December 2014). RESULTS: ORL and cervico-maxillofacial tumors account for 0.48% of consultations and 15.3% of all ORL tumors. The average age of patients was 47 years, ranging from 3 months to 86 years. We noted a male predominance; the sex ratio was 1.45. Drinking alcohol and smoking tobacco prevailed in the cancer of the larynx. Upper aerodigestive tract (UAT) tumors accounted for 64,8%, with a prevalence of cancers of the oral cavity (36,2% of UAT), followed by cancers of the oropharynx (18,5% of UAT) and finally by cancers of the larynx (18,1% of UAT). Primary malignant cervical adenopathies accounted for 18%. The rarest lesions were cancers of the ear and of maxillomandibular bone tissue (2.24% each). Histology was dominated by squamous cell carcinoma (61.4%) followed by non-Hodgkin lymphoma (23.2%). CONCLUSION: ORL and cervico-maxillofacial tumors are frequent in Togo and can be diagnosed at any age. The predominant tumor types reported are those of the oral cavity, pharynx and primary malignant cervical adenopathies.

Prevalence and Patient-Level Risk Factors for 30-Day Readmissions Following Free Tissue Transfer for Head and Neck Cancer.

IMPORTANCE: Hospital readmissions are a marker of surgical care delivery and quality that are progressively more scrutinized. OBJECTIVE: To provide a comprehensive analysis of 30-day readmissions for patients with head and neck cancer who underwent free flap reconstruction to highlight the rate, causes, and associated patient risk factors. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study at a single tertiary care academic institution. The study consisted of 249 patients who underwent microvascular reconstruction of a presumed head and neck oncologic defect from January 1, 2000, through June 30, 2014. Follow-up continued through July 30, 2014. INTERVENTIONS: Microvascular reconstruction of an oncologic head and neck defect. MAIN OUTCOMES AND MEASURES: Incidence of 30-day all-cause readmissions, patient risk factors, and readmission indications. Regression analyses were conducted to discern patient-level risk factors related to 30-day readmissions. RESULTS: Among the 249 patients, the 30-day all-cause readmission rate was 14.5%, while the unplanned readmission rate was 11.6%. The most common reason for readmission was neck wound complications. Predictors of readmission following multivariable analysis were T4 pathologic stage (odds ratio [OR], 11.68; 95% CI, 1.37-99.81; P = .02) and having a tumor located in the oropharynx (OR, 4.64; 95% CI, 1.89-11.38; P = .001), hypopharynx (OR, 8.30; 95% CI, 1.52-45.24; P = .01), or larynx (OR, 10.97; 95% CI, 2.27-52.98; P = .003). Patients who were readmitted were more likely to experience neck wound complications (OR, 5.07; 95% CI, 1.31-19.57; P = .02) and undergo reoperation (OR, 47.20; 95% CI, 8.33-267.33; P < .001). CONCLUSIONS AND RELEVANCE: In this study, advanced pathologic tumor staging and tumor location were associated with 30-day readmissions in patients with head and neck cancer who receive free flaps. Our results provide a benchmark for risk stratification that can be used in system-based practice improvements, health care cost savings, and postoperative patient counseling.

[Changes in Incidence and Mortality Trends of Head and Neck Cancer in Rhineland-Palatinate, 2000-2009]. / Veränderung von Inzidenz und Mortalität von Kopf-Hals-Malignomen in Rheinland-Pfalz, 2000-2009.

BACKGROUND: Epidemiological data on HNC are often reported aggregated despite their anatomical and histological heterogeneity. In Germany, few studies have analyzed incidence and mortality trends separately for specific anatomic sites. Furthermore, little is known about whether the incidence of HPV-associated tumour entities of the head and neck region has increased. METHODS: Based on cancer registry data from Rhineland-Palatinate from 2000 to 2009, age-standardized incidence and mortality rates were calculated for all HNC sites and localisation groups that might be HPV-associated according to the literature. Trends were analyzed by Joinpoint regression and reported as the annual percentage change (APC). RESULTS: Throughout the study period, 8 055 incident cases and 3 177 deaths were identified. The incidence rates of overall HNC increased among women (APC:+2.2%) and declined slightly among men (- 0.9%). Significantly increasing incidence rates among women were seen for tumours of the oral cavity (+2.7%) and the oropharynx (+3.6%). Among men, a significant decrease in incidence rates for tumours of the hypopharynx (-3.4%) and the larynx (-2.7%) are noteworthy. Cancers at HPV-associated sites showed increased incidence rates in men (+3.3%) and women (+4.3%). A decrease in mortality was found for tumours of the larynx in both sexes (-5.8% men,-9.1% women). CONCLUSIONS: A detailed analysis by localisation of HNC showed significant and often opposing trends for men and women regarding incidence and mortality.

Patterns of upper aero-digestive tract cancers in Kamrup Urban District of Assam: a retrospective study.

BACKGROUND: The incidence of upper aero-digestive tract (UADT) cancers, including C00-C14, C30-C32, C15 and C16, is increasing rapidly in Kamrup Urban District (KUD) of Assam, North East (NE) India. According to the NCRP (2013) report 37.6% of all cancers in both sexes are UADT cancers in the NE region, accounting for 53.3% in males and about 27.5% in females of the total cases MATERIALS AND METHODS: A retrospective study was conducted for patient information from the period of 2008-2011. Age-standardized or age-adjusted rates (ASR or AAR) (per 100,000 person-years) were calculated using the World Standard Population as proposed by Segi and modified by Doll et al. The registry population area at risk was estimated using the 1991 and 2001 census population by sex, as well as the growth rate during that interval using the difference distribution method. RESULTS: There were 5,638 cases registered during the last four years of the study (2008-2011) accounting for 56.7% (3,198/5,638) of the total in males and 43.3% (2,440/5,638) in females. The male: female ratio was 1.31: 1.00. The overall age adjusted rates (AAR) were 179.4 and 153.8 per 100 000 males and females respectively. Cancer of the oesophagus was most common in both sexes, with most appreciable gender variation for tongue and hypopharynx, presumably reflecting differential exposure to risk factors.

Incidence and localization of abnormal mucosa findings in patients consulting ENT outpatient clinics and data analysis of a cancer registry.

For patients without symptoms and at risk, there is no established early detection program to discover carcinomas of the upper aerodigestive tract in the sense of secondary prevention. Such type of prevention seems even more desirable because the chances for a cure and the quality of life are strongly dependent on the stage of the tumor and the time of the initial diagnosis. Six hundred and eight patients without symptoms but at least one of the self-reported risk factors "smoking", "alcohol consumption" or "reflux" were examined with an endoscope or an optical microscope for pathological findings in the upper aerodigestive tract once a year. In addition, the incidence of malignancies of the upper aerodigestive tract between 2001 and 2010 was determined through the Cancer Registry of Schleswig-Holstein. Tissue samples were taken from 18 of the 608 patients. Eleven patients (1.8%) had a squamous cell carcinoma. Another patient suffered from non-Hodgkin's lymphoma and one from larynx tuberculosis. The ratio of detected malignancies in the oral cavity and the oropharynx on the one hand and the hypopharynx and larynx, which can only be examined by endoscopes, on the other hand were in our cohorts and in our survey according to the cancer registry was 5/6. The above-described methods allow examining risk patients easily and safely. According to current publications, the ratio of the found malignancies exceeds the expected ratio significantly, which presumably was caused by the examination targeting patients at risk. Due to the expanded examination area using optical instruments more than doubles the rate of discoverable malignancies compared to the limitations posed by the examination of directly visible areas of the oral cavity of the oropharynx.

Incidence trends and long-term survival analysis of sinonasal rhabdomyosarcoma.

PURPOSE: Sinonasal rhabdomyosarcoma (SNRMS) is a rare malignancy which often presents with nasal obstruction, rhinorrhea and epistaxis. It is the most common sarcoma in children. In this study, we analyze the incidence and long-term survival for SNRMS using a national population-based database. METHODS: The United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was utilized to calculate incidence and survival trends for SNRMS between 1973 and 2009. In addition, data were grouped by age, gender, race, and histopathological subtype. RESULTS: A total of 181 cases of SNRMS were analyzed for incidence trends, showing a 1.23:1 female to male ratio. While the overall incidence of SNRMS increased by 1.02% annually over the last 20years, this pattern was not equal amongst gender and racial groups. The incidence in males has increased, while in females incidence has decreased. An increase in incidence was noted in white and "others," but decreased in blacks. Using a total of 314 cases for survival analysis, we found that the rate in the white population has been consistently highest with a 5-year survival of 49.45%, 10- and 20-year survival of 48.81%. Survival rates in cases of embryonal SNRMS were also consistently higher than in cases of alveolar SNRMS. CONCLUSION: Overall incidence of SNRMS is increasing. Histologic subtype and race are important considerations in the long-term prognosis of SNRMS. Future studies will further elucidate gender and race related trends.

[Current practice of tumour endoscopy in German ENT-clinics]. / Praxis der Tumorendoskopie an deutschen HNO-Kliniken.

BACKGROUND: Second primary carcinomas (SPC) essentially influence therapy and the outcome in head and neck cancer. This study presents the current status of tumour endoscopy in German ENT-clinics. MATERIAL AND METHODS: A standardised questionnaire regarding indication, time of event, examined anatomical region and technique of tumour endoscopy was compiled, sent to all German ENT-clinics (n=159) and subsequently analysed. RESULTS: In 94-100% of the clinics, tumour endoscopy is being conducted when primary carcinoma lies within oral cavity, pharynx, larynx or is a CUP-syndrome. In 80%, 2-stage surgical procedure is preferred. Nasal cavity and tracheobronchial system (47%, 74%) are often not included in the examination. When primary cancer is seen, in 7% of the clinics a standardised biopsy of unsuspicious anatomic areas is conducted. In CUP-syndrome, unsuspicious surfaces within the pharynx do not undergo routine biopsy in 10-20% of the clinics. In tracheobronchoscopy (63.0%) and esophagoscopy (93.3%) rigid scopes are mainly used. 65% of the clinics conduct endoscopy as follow-up care. CONCLUSION: Practice of tumour endoscopy in German ENT-clinics is widespread but does not follow standardised mechanisms. Current international literature shows that there is no common consensus on value and techniques of tumour endoscopy, however, due to highly developed radiological diagnostics, risks of rigid endoscopies and unknown incidence of second primary tumours it is discussed more and more negative. To establish future guidelines, controlled studies or analysis of large populations seem to be necessary.

Incidence and mortality trends of head and neck cancer in Croatia in the period 1988-2008.

CONCLUSION: Head and neck cancer (HNC) incidence and mortality trends in men displayed a significant downward trend in Croatia during the study period. No significant changes of incidence and mortality trends were observed in women. Decreasing trends observed in men are similar to other European countries. Further decreases in HNC incidence and mortality could be achieved with more restrictive alcohol and tobacco control policies and adherence to national treatment guidelines. OBJECTIVE: To describe and interpret trends in incidence and mortality of HNC in Croatia in the period 1988-2008. METHODS: HNCs were defined as ICD-10 codes C00-C14, C32. Incidence data were obtained from the Croatian National Cancer Registry, while numbers of deaths were obtained from the WHO Mortality Databank. Joinpoint regression analysis of age-standardized rates (ASR, standard world population) and age-specific rates for 10-year age groups was used to estimate changes in trends of HNC incidence and mortality. RESULTS: HNC incidence and mortality in men declined steadily during the study period (estimated annual percent change (EAPC) of -1.5% and -1.8%, respectively). The most prominent decreases of -5.7% annually for incidence and -9.3% for mortality were observed in the youngest age group, 30-39 years. A non-significant increase in incidence (EAPC 0.9%) and decrease in mortality (EAPC -1.3%) were observed in women.

Assessment of nutritional status at the time of diagnosis in patients treated for head and neck cancer.

OBJECTIVE: To evaluate the nutritional status at the time of diagnosis of patients treated for head and neck cancer. MATERIAL AND METHODS: Single-centre prospective study. Nutritional assessment comprised: clinical interview, physical examination, and a laboratory work-up. Clinical interview assessed: reference weight, diet, calorie intake, causes of weight loss, use of dietary supplements. A subjective global assessment of nutritional status (Detsky index) was established on the basis of clinical interview. The patient's height and weight were determined and serum albumin was assayed. Weight loss, body mass index, and Buzby index were then calculated. Two groups of malnourished patients were distinguished: moderately malnourished (group 1), severely malnourished (group 2). Variables were compared between the two groups by Chi(2) test. RESULTS: One hundred and sixty-nine patients were included in the study: 145 had a history of smoking and alcohol abuse, 82 (48.5%) were malnourished and 47 of them were classified in group 1. All patients of group 1 had a normal or pureed diet. 21 (69%) patients of group 2 had a pureed or liquid diet. The mean daily calorie intake was 31kcal/kg/24h for group 1 and 20kcal/kg/24h for group 2. The main causes of weight loss were pain and dysphagia. Dietary supplements were not used by any of the patients in group 1 and by four (13%) patients in group 2. The concordance between the Detsky index and objective nutritional status was 92% for the overall population. Malnutrition was significantly more frequent among males (P=0.01), alcohol users (P=0.02), elderly subjects (P=0.01), patients with pharyngeal tumour (P=0.03), and patients with advanced tumour stage (P=0.01). CONCLUSION: The prevalence of malnutrition among patients with head and neck cancer is high. Assessment of nutritional status and appropriate management must be part of the initial work-up of these patients.

Upper aerodigestive tract cancer in patients with chronic lymphocytic leukemia: incidence, stage, and outcome.

OBJECTIVE: To compare incidence, stage, and survival of upper aerodigestive tract (UADT) cancers in patients with and without chronic lymphocytic leukemia (CLL). DESIGN: Inception cohort. SETTING: National database. PATIENTS: Individuals with CLL and UADT cancers included in the Surveillance, Epidemiology, and End Results (SEER) database. MAIN OUTCOME MEASURES: Incidence was compared by computing standardized incidence ratio (SIR), the ratio of observed UADT cancers in patients with CLL, and the number of UADT cancers expected based on the characteristics of patients with CLL and population incidence of UADT cancers. The association between CLL and UADT cancer stage was measured using odds ratio (OR) calculations. Survival of patients with UADT cancer with and without CLL was compared. RESULTS: For the SIR calculation, 36 985 patients with CLL contributed a mean 6.36 years of follow-up each, for a total of 235 314 person-years of follow-up. The SIR was 1.18 (95% CI, 0.97-1.41) for UADT cancers; 1.52 (95% CI, 1.18-1.93) for laryngeal cancer; and 1.92 (95% CI, 1.05-3.23) for cancers of the nasal cavity and paranasal sinuses. In the stage and survival analyses, 253 patients with CLL followed by a UADT cancer were compared with 133 840 patients with 1 UADT cancer only. Cancers of the UADT in patients with CLL were more likely localized (OR, 0.50; 95% CI, 0.37-0.68). Relative survival was worse in patients with CLL. In multivariate analysis, CLL was independently associated with poorer observed survival (hazard ratio, 1.45; 95% CI, 1.24-1.70). CONCLUSIONS: Larynx and nasal cavity cancers were more common in patients with CLL. Overall incidence of UADT cancers was not significantly elevated. Cancers of the UADT in patients with CLL were more likely to be localized at diagnosis than those in patients without CLL. Finally, CLL was associated with poorer survival outcomes.

Carotid stenosis after adjuvant cervical radiotherapy in patients with head and neck cancers: a prospective controlled study.

OBJECTIVES: To determine the prevalence of radiation-induced carotid stenosis, in patients who were treated for head and neck malignancies, using colour-flow duplex scanning. DESIGN: Prospective controlled study at a single medical centre. PARTICIPANTS: We enrolled two groups of patients. The first (radiotherapy group) consisted of patients who received surgical treatment and adjuvant radiotherapy of the neck. The control group consisted of patients with head and neck malignancies who received only surgical treatment. MAIN OUTCOME MEASURES: All patients were evaluated with carotid artery ecoDoppler imaging 1 week before and 36 months after the surgical procedure. Intima-media thickness was measured bilaterally at the internal carotid artery and at the bifurcation. Carotid obstruction was classified as low (0-30%), moderate (31-49%) or severe (≥50%). RESULTS: The preoperative stenosis grade did not differ between groups. In 15/25 patients (60%) in the radiotherapy group, mild stenosis evolved to moderate stenosis, while only 6/37 (16%) of the controls did (P = 0.004). Additionally, 9/39 (23%) patients in the radiotherapy group progressed to severe stenosis compared with only 3/54 (6%) controls (P = 0.029). The overall evolution showed that stenosis worsened in 24/32 (62%) patients in the radiotherapy group and 9/54 (17%) patients in the control groups (P < 0.0001). CONCLUSIONS: These results highlight the need to study the long-term incidence of cerebrovascular events in these two different populations (radiation treated and surgically treated) to identify increased cerebrovascular morbidity.

Risk of coronary artery disease is not linked to head and neck cancers: a population-based retrospective cohort study.

OBJECTIVES: To explore the possible association between the risk of coronary artery disease and head or neck cancer based on some possible shared risk factors and/or treatment-related complications. DESIGN AND SETTING: A population-based retrospective cohort study. PARTICIPANTS: All new 729 patients with head and neck cancer diagnosed between 2000 and 2003 were followed up till 2009, and the risk of subsequent coronary artery disease was calculated. For each patient, the risk was calculated in 4 age-and sex-matched population controls. Matching was not possible for factors including socio-economic group and smoking. MAIN OUTCOME MEASURES: Cox's proportional hazard regression analysis was conducted to estimate the relationship between head or neck cancer and risk of coronary artery disease. RESULTS: For patients with head or neck cancer, the overall risk for developing coronary artery disease was almost the same as that of the control group [adjusted hazard ratio (but without control for some lifestyle factors): 0.95; 95% confidence interval: 0.65-1.35]. Overall, we found no increased risk of coronary artery disease for patients with head or neck cancer when the data were categorised either by treatment methods or by cancer subsites. CONCLUSIONS: This population-based study indicated that patients with head or neck cancer were at no higher risk of developing coronary artery disease than was the general population over a 6- to 9-year period; however, we cannot exclude the risk over a longer period of time.

Squamous cell carcinomas of the head and neck in Fanconi anemia: risk, prevention, therapy, and the need for guidelines.

Fanconi anemia (FA) is a rare recessive DNA repair disorder that is clinically characterized by congenital malformations, progressive bone marrow failure, and increased incidence of malignancies, especially acute myeloid leukemia and squamous cell carcinomas of the head and neck (HNSCCs) and the anogenital regions. On a cellular level, typical features of the disorder are a high degree of genomic instability and an increased sensitivity to bi-functionally alkylating agents. So far, germ-line defects in 15 different FA genes have been identified. Some of these FA genes are also established as tumor susceptibility genes for familiar cancers.In recent years, the prevention and therapy of HNSCCs in FA patients has become more important as the percentage of patients surviving into adulthood is rising. HNSCCs appear in very young FA patients without common risk factors. Since cisplatin-based chemotherapy in combination with radiotherapy, essential parts of the standard treatment approach for sporadic HNSCCs, cannot be used in FA patients due to therapy-associated toxicities and mortalities even with reduced dosing, surgery is the most important treatment option for HNSCCs, in FA patients and requires an early and efficient detection of malignant lesions. So far, no uniform treatment protocol for the management of HNSCCs in FA patients exists. Therefore, we propose that the information on affected FA patients should be collected worldwide, practical therapeutic guidelines developed and national treatment centers established.