Prognostic importance of DNA from human papillomavirus in patients with oral squamous cell carcinoma.

BACKGROUND: Survival of patients with oral squamous cell carcinoma (OSCC) is generally low, with the likelihood of locoregional recurrence or disease progression (LR/DP). Knowledge of prognostic factors for survival is key to achieving an understanding and increased survival. The present study aimed to identify prognostic factors for patients with OSCC, especially the presence of DNA from human papillomavirus (HPV). MATERIAL AND METHODS: Retrospective cohort study including 119 patients with OSCC treated at the National Cancer Institute in Mexico City (2009-2013). Clinical information was obtained from patient records including LR/DP. Formalin-fixed, paraffin-embedded tissues were obtained and used for detecting DNA from different types of HPV. Potential prognostic factors for Overall Survival (OS) were analyzed using the Cox proportional hazards model. RESULTS: After model adjustment, factors associated with longer OS were a pre-treatment platelet count above 400,000/mm3 (HR=0.09, p=0.026) and response to primary treatment (HR=0.26, p=0.001). HPV DNA was present in 23 (19.3%) of the patients and importantly, type 16 found in 19 of them. Although survival of HPV-positive patients was longer, difference was not significant. However, among patients with LR/DP, HPV positivity was significantly associated with increased survival (HR=0.23, p=0.034). Importantly, survival was significantly different for HPV-positive patients with LR/DP > 6 months (HR=0.20, p=0.002), had higher absolute lymphocyte count at start of treatment (HR=0.50, p=0.028) or had local rescue treatment (HR=0.24, p=0.019). CONCLUSIONS: Although HPV positivity was not associated with a longer OS of OSCC patients, a better prognosis was significantly associated with HPV positivity and recurring or progressing disease, particularly with HPV type 16.

Metástasis cerebrales en pacientes con cáncer de tiroides / Brain metastases in patients with thyroid cancer

Resumen: ANTECEDENTES: el cáncer es una de las primeras causas de morbilidad y mortalidad en el mundo; la neoplasia endocrinológica más frecuente es el cáncer de tiroides. A pesar que la mayoría de los pacientes con cáncer de tiroides tienen buen pronóstico, 10 a 15% de los pacientes muestra recurrencia de la enfermedad e incluso 5% padece metástasis a distancia. Las metástasis cerebrales del cáncer de tiroides son raras y habitualmente conllevan mal pronóstico. OBJETIVO: describir las características demográficas y radiológicas, así como el pronóstico clínico de pacientes con cáncer de tiroides que requirieron consulta neurológica. MATERIAL Y MÉTODO: estudio prospectivo observacional en el que se incluyeron pacientes atendidos en un centro de referencia de tercer nivel con cáncer de tiroides que requirieron consulta neurológica entre enero de 2010 y enero de 2016. Se estudiaron las concentraciones séricas de tiroglobulina, TSH y anticuerpos anti-tiroglobulina, como se ha sugerido previamente. RESULTADOS: encontramos siete pacientes con metástasis cerebrales por cáncer de tiroides y las comparamos con registros encontrados en la bibliografía. El género masculino, la edad avanzada y las concentraciones elevadas de tiroglobulina se asociaron con mayor frecuencia de metástasis a distancia de cáncer de tiroides. CONCLUSIONES: las metástasis cerebrales de cáncer de tiroides son complicaciones poco frecuentes con pronóstico adverso. La tiroglobulina es un marcador tumoral muy útil para el seguimiento de pacientes con cáncer de tiroides ya que está elevada en pacientes con actividad sistémica y muy elevada en sujetos con metástasis cerebrales.

Abstract: BACKGROUND: Cancer is one of the first causes of both mortality and morbidity in the world. Thyroid cancer is the most common endocrine neoplasm. Although most TC patients have a good prognosis, 10 to 15% present recurrent disease and up to 5% show distant metastases. Brain metastases are unusual and are associated with a worse prognosis. OBJECTIVE: To describe the demographic and radiological characteristics, as well as clinical prognosis of patients with thyroid cancer who required neurological consultation. MATERIAL AND METHOD: A prospective observational study in which patients with thyroid cancer who required neurological consultation, attended in a tertiary referral cancer center, was done from January 2010 to January 2016. Serum levels of thyroglobulin, TSH and anti-thyroglobulin antibodies were studied, as suggested previously. RESULTS: We followed around 400 patients with TC and we found seven patients with brain metastases by thyroid cancer and compared them with records found in literature. Male gender, older age and high levels of thyroglobulin were associated with higher incidence of distant metastases of thyroid cancer. CONCLUSIONS: Brain metastases of thyroid cancer are little frequent complications with adverse prognosis. Thyroglobulin is a very useful tumoral marker for the following of patients with thyroid cancer, because it is high in patients with systemic activity and very high in patients with brain metastases.

[Neurological manifestations in patients with cancer: more than 17,000 reasons for consultation]. / Manifestaciones neurologicas en pacientes con cancer: mas de 17.000 motivos de consulta.

INTRODUCTION: Cancer is one of the leading causes of death in our population; neurologic manifestations are frequent and are associated with higher rates of morbidity and mortality. AIM: To describe the neurological manifestations in patients with cancer. PATIENTS AND METHODS: From January 2010 to December 2014 a database was created from patients with cancer, required a neuro-oncological assessment at a referral cancer center. RESULTS: 17,092 reasons for neuro-oncological consultation are described. Neoplasms most frequently associated with neurological manifestations were: breast cancer, hematologic malignancies, primary central nervous system tumors, lung cancer and gynecological malignancies. The most frequent neurological manifestations were: neuromuscular disease (including neuropathy), central nervous system metastasis, primary headaches, seizures, stroke and primary neurological tumors. CONCLUSION: It is important that neurologists, physicians and those involved in the management of patients with cancer recognize and get to know the neurological complications.

TITLE: Manifestaciones neurologicas en pacientes con cancer: mas de 17.000 motivos de consulta.Introduccion. El cancer es una de las primeras causas de muerte en nuestra poblacion. Las complicaciones neurologicas asociadas son frecuentes e incrementan significativamente la morbilidad y la mortalidad de estos pacientes. Objetivo. Describir las manifestaciones neurologicas en pacientes con cancer. Pacientes y metodos. Desde enero de 2010 hasta diciembre de 2014 se creo una base de datos de pacientes con cancer que merecian una valoracion por neurooncologia en un centro de referencia. Resultados. Se describen 17.092 motivos de consulta de neurooncologia. Las neoplasias que mas se relacionaron con manifestaciones neurologicas fueron: cancer de mama, neoplasias hematologicas, tumores primarios del sistema nervioso central, cancer de pulmon y neoplasias ginecologicas. Las manifestaciones neurologicas mas frecuentes fueron: afeccion neuromuscular, actividad tumoral en el sistema nervioso central, cefalea primaria, crisis convulsivas, enfermedad vascular cerebral y tumores neurologicos primarios. Conclusiones. Es importante que los neurologos, medicos de distintas areas de la medicina y personal paramedico, involucrados en el manejo de estos pacientes, reconozcan las complicaciones neurologicas de manera temprana.

Induction chemotherapy followed by supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) in T3NO arytenoid fixation-related glottic cancer.

Induction chemotherapy followed by supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEF) in T3NO arytenoid fixation-related glottic cancer. OBJECTIVE: Arytenoid fixation in the larynx has been considered a contraindication for performing organ preservation surgery (OPS). We present a retrospective series of cases of arytenoid fixation-related T3N0 glottic cancer treated by neoadjuvant chemotherapy followed by OPS. MATERIAL: Retrospective review of 19 patients (from 2008 to 2012) with T3NO glottic cancer who received two cycles of neoadjuvant chemotherapy with a combination of paclitaxel, cisplatin and 5-fluoruracil (PPF), with a 21-day interval between each cycle, followed by supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). RESULTS: Sixteen patients with a mean age of 56.4 years received neoadjuvant chemotherapy with a clinical response (7 partial response/9 complete response) and radiologic response by computed tomography (CT) (7 partial response/7 complete response/2 cases without CT) were treated with SCPL-CHEP and removal of the arytenoid cartilage in the tumour site (10 left/6 right), bilateral neck dissection of levels II to V and searching of the Delphian node. There was one patient who died after a recurrence in the larynx and who also had an additional concomitant second primary tumour, and a second patient with a second primary tumour in the lung, who is still alive after treatment. Disease-free survival (DFS) was 82.5% at 5 years and overall survival (OS) was 80% at 5 years. CONCLUSION: Neoadjuvant chemotherapy proved beneficial in patients waiting for surgery, helped maximize the oncologic benefit of the surgery provided (good local control using SCPL with CHEP), improved regional and distant control, minimized side effects by avoiding treatment with radiotherapy whenever possible, and proved feasible even in the presence of ipsilateral arytenoid fixation. Our results are encouraging, although a multi-centre randomized clinical trial should be performed in order to identify the true impact of this approach.

Association between age and high-risk human papilloma virus in Mexican oral cancer patients.

OBJECTIVE: Studies reporting low prevalence of HPV in OSCC with declining age at presentation are increasing. The aim of this study was to determine the prevalence of HPV in a group of OSCC cases and controls in a Mexican population. METHODS: The matched case-control study included 80 OSCC cases and 320 controls. HPV/DNA presence was evaluated through PCR amplification using three sets of consensus primers for the L1 gene. A conditional logistic regression analysis was carried out for the matched OSCC cases and controls. Interactions between risk factors and OCSS were tested in the construction process of the models. RESULTS: HPV prevalence was 5% in OSCC cases and 2.5% in controls. HPV-detected types were 16, 18 and 56. According to conditional logistics regression model, an association was detected between HR-HPV and OSCC. All HR-HPV-positive OSCC cases corresponded to young patients (<45 years), non-smokers and non-alcohol drinkers. CONCLUSIONS: The HR-HPV can be a contributing factor to oral carcinogenesis, especially in younger individuals without known risk factors such as tobacco and alcohol.

Alternating chemotherapy: gemcitabine and cisplatin with concurrent radiotherapy for treatment of advanced head and neck cancer.

BACKGROUND: Many studies have shown gemcitabine and cisplatin are radiosensitizers. Concurrent chemoradiation seems to be an efficient approach for treatment of advanced head and neck cancer (HNC), but toxicity is significant. OBJECTIVE: To evaluate safety and explore efficacy of alternating chemotherapy with gemcitabine and cisplatin concurrent with radiotherapy in patients with advanced non-metastatic HNC. PATIENTS AND METHODS: Twenty-eight patients diagnosed with advanced Squamous Cell Carcinomas of the Head and Neck (SCCHN) in stages III (28%), IVa (36%), and IVb (36%) were treated with gemcitabine: 100mg/m(2) alternating with cisplatin: 50mg/m(2) concurrent with radiotherapy at doses of 2 Gy/day until completing 70 Gy. While awaiting for concurrent treatment, eleven patients received induction chemotherapy with cisplatin: 100mg/m(2) and 5-FU: 1000 mg/m(2). Toxicity, especially in relation to mucositis, xerostomy, dysphagia, leucopenia and radiodermitis was evaluated. RESULTS: 5-year progression-free survival was 27.8 ± 17.2% (CI-95: 0-61.5) and overall survival was 55.9 ± 11% (CI: 34.4-77.5). Overall response rate was 93%; complete response was 64.3% and partial response was 28.6%. Extensive surgery for primary site was avoided in 19 patients (70.4%). Grade 3-4 adverse events were mucositis (46.4%), leucopenia (14.2%), dysphagia (25%), xerostomy (10.7%) and radiodermitis (3.6%). Response rates and toxicity were not significantly different among those patients with and without induction chemotherapy, but survival was higher in patients receiving induction. CONCLUSIONS: Gemcitabine alternating with cisplatin concurrent with radiotherapy is an active and safe treatment that deserves further study.

DNA methylation in oral squamous cell carcinoma: molecular mechanisms and clinical implications.

DNA methylation is an important regulator of gene transcription, and its role in carcinogenesis has been a topic of considerable interest in the last few years. Of the all epigenetic modifications, methylation, which represses transcription of the promoter region of tumor suppressor genes leading to gene silencing, has been most extensively studied. Oral squamous cell carcinoma (OSCC) has long been known to be the endpoint of many genetic changes, not only genomic mutations but also abnormal epigenetic modifications, as such, promoter methylation, contribute to development of this tumors. Recent studies have shown that promoter methylation of tumor suppressor genes is an important factor in carcinogenesis of OSCC. Some of the main genes that frequently showed promoter methylation in OSCC are those that participate in diverse processes such as regulation of the cell cycle, DNA repair, proliferation, and apoptosis. The aim of this review is to assess the current state of knowledge regarding promoter methylation of diverse genes in OSCC.

Cetuximab concomitant with gemcitabine and radiotherapy in advanced squamous cell carcinomas of upper aerodigestive tract: a pilot study

PURPOSE: To explore the response and toxicity of advanced non-metastatic squamous cell carcinomas of upper aerodigestive tract (SCC-UADT) to a combination of cetuximab concomitant with gemcitabine and radiotherapy. METHODS: We managed patients with concomitant treatment of cetuximab (400 mg/m(2) as uploading dose, then 250 mg/m(2), IV) concomitant with gemcitabine (50 mg/m(2)) weekly for seven courses, and radiotherapy in classical fractionation until completion of 70 Gy. Primary endpoints were complete response (CR) to treatment and toxicity. We evaluated patients for toxicity on a weekly basis; evaluation of response included physical examination, endoscopy, computed tomography (CT) scan and biopsy when indicated, and was performed 6 weeks after completion of radiotherapy. Additional evaluations were done every 3 months to document disease status. Between November 2004 and November 2005, 20 patients were included. RESULTS: CR was 82.4%, overall response was 100%. Neck disease reached CR in 61.5% and partial in 38.5% of patients. The main toxicities were nausea, lymphopenia, neutropenia and mucositis. Grade 3 and 4 side effects were presented in 70.6% of patients, but mucositis, and lymphopenia without clinical repercussions, occurred in 88.2% of patients. Gastrostomy was required in 11.8% of patients to maintain nutrition. Radioepithelitis developed in 76.5%, but only three of these (23.1%) were grade III. Median overall survival was 53 months (range 6-55 months) and median progression-free survival has not yet been reached at the time of evaluation. CONCLUSIONS: Although toxicity is important, this approach has interesting activity and deserves further investigation (AU)

hMLH1 promoter methylation is an early event in oral cancer.

Promoter methylation is believed to inactivate the expression of hMLH1. This process has been implicated in the tumorigenesis of oral squamous cell carcinoma (OSCC). Thus, the aim of this study was to determine the profile of hMLH1 methylation and protein expression in OSCC. The matched case-control study included 50 OSCC cases and 200 controls, with a median of age 64 (Q1-Q3 54-71) years. Protein expression was determined by immunohistochemical staining, and hMLH1 gene promoter methylation was analyzed by methylation-specific polymerase chain reaction (MSP). A conditional logistic regression model for risk factors was built for OSCC cases and matched controls. Promoter methylation of hMLH1 was detected in 38 (76%) OSCC cases, but in none of the control samples. Of the 38 OSCC samples with promoter methylation, 12 (32%) were negative for hMLH1 protein, and corresponded to early clinical stages (10 in stage II and 2 in stage I). All 12 unmethylated samples showed positive stain for hMLH1. Multiple logistic regression analysis showed an OR of 16.54 (IC 95%: 1.69-161.68, p=0.016) for methylation of the hMLH1 gene and early stages of OSCC, adjusting by gender and tobacco use. This study showed a high frequency of hMLH1 promoter methylation that occurred in most of the early stage cases and in about half of the late stage cases. It is proposed that hMLH1 promoter methylation is an early event that is maintained during tumor progression.

Testicular cancer in androgen insensitivity syndrome in a Mexican population

Male pseudohermaphroditism and androgen insensitivity syndrome cases have an increased risk of developing testicular cancer due to many factors such as mutations, hormonal disturbances involving gonadotropins and cryptorchidism. We describe the clinical features, diagnosis and treatment of two cases with partial androgen insensitivity syndrome and testicular cancer development, which were handled at the National Cancer Institute of Mexico (AU)

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Whole-body (18)F-FDG PET/CT in primary non-Hodgkin's lymphoma of the thyroid associated with Hashimoto's thyroiditis and bilateral kidney infiltration.

An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms.

Whole-body 18F-FDG PET/CT in primary non-Hodgkin's lymphoma of the thyroid associated with Hashimoto's thyroiditis and bilateral kidney infiltration

Paciente mujer de 82 años con hipotiroidismo y tiroiditis de Hashimoto, observó desde hace tres años la presencia de un bocio asimétrico pequeño (izquierdo > derecho). Sin embargo, un crecimiento rápido de la glándula en un periodo de 3-6 meses causó disfagia y respiración corta. La ecografía y la gammagrafía tiroidea mostraron imágenes consistentes con bocio multinodular con un nódulo hiperfuncionante en el lóbulo derecho. Por la historia previa de tiroiditis de Hashimoto y el aumento rápido en el tamaño de la glándula tiroides, se consideró un diagnóstico de linfoma tiroideo y cáncer tiroideo anaplásico. Se realizó tiroidectomía en un hospital externo para aliviar los síntomas compresivos. La aspiración con aguja fina fue insuficiente para el diagnóstico, y en la pieza de la tiroidectomía se confirmó el diagnóstico de un linfoma difuso de células grandes tipo B. En nuestro centro se realiza un rastreo con FDG-PET/CT para estadificación, mostrando metástasis intra y extraganglionares. La quimioterapia con ciclofosfamida, vincristina y dexametasona (COP modificado), produjo una respuesta dramática del tumor y una resolución completa de los síntomas compresivos

An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms

Craniofacial resection for sinunasal tumors.

INTRODUCTION: Malignant sinonasal tumors are very rare in Mexico. They ussually present as advanced disease because it is extremely difficult to make an early diagnosis; in addition, its treatment is complicated by a variety of lesions. Surgical resection remains the mainstay of treatment, but its relative therapeutic value compared with alternative treatments is controversial. OBJECTIVE: We undertook a retrospective analysis in order to evaluate results of craniofacial resections for sinonasal tumors. MATERIALS AND METHODS: A total of 20 patients, 11 men and 9 women were considered, median age was 49 years (18-74). Eleven had received previous treatment elsewhere. In 13 patients tumor was limited to maxillo-ethmoid complex, but in 6 cases tumor involved anteroinferior aspect of sphenoid sinus, in 7 extended to the orbit, in 3 to dura and two to the brain. One had cervical metastases. Median tumoral size was 5.8 cm (1-10). RESULTS: Overall complication rate was 50%. Major surgical complications occurred in 4 patients (20%): one patient developed isolated cerebrospinal fluid leakage (CEFL), 1 developed deterioration of mental status, and two developed meningitis associated with CEFL. Late complications occurred in 30% of the patients. There was not any operative death. Eleven patients received postoperative radiotherapy. Fifteen patients recurred. There were 11 local relapses, although one associated with a regional relapse, and another with regional and distant relapse. There were four isolated regional fails and six isolated distant failures. Three year overall survival was 65%, and 3-year disease free survival was 50%. Patients without previous treatment median survival was 28.3 months, meanwhile with previous treatment was 18.2 months. CONCLUSIONS: Craniofacial resection is a safe and valuable tool in the treatment of advanced sinonasal tumors involving cranial base.

Phase II trial of gemcitabine concurrent with radiation for locally advanced squamous cell carcinoma of the head and neck.

BACKGROUND: Concurrent chemoradiation is the current standard of treatment for patients with advanced unresectable head and neck squamous cell carcinoma (HNSCC). Due to the potent radiosensitizing properties of gemcitabine, we decided to assess its efficacy and toxicity with concurrent radiation in patients with advanced HNSCC. PATIENTS AND METHODS: From January 1997 to December 2001, 27 patients with locally advanced HNSCC (stage III, 37%; stage IV, 63%) were enrolled. All received a course of radiotherapy (70 Gy over 7 weeks) concurrent with weekly infusions of gemcitabine at 100 mg/m2 or 50 mg/m2. RESULTS: All patients were assessable for toxicity and 26 for response. Severe mucositis (grade 3-4) was observed in 74% of patients (grade 4, 41%). Severe hematological toxicity was uncommon. Mild and moderate xerostomy was the most common late toxicity in 23 patients (85%). The median radiation dose delivered was 70 Gy (40-80 Gy), 25 patients (93%) received > or = 80% of the intended dose. Gemcitabine dose intensity was > or = 80% in only 13 (48%) patients. The rate of complete and partial responses were 61% and 27%, respectively, for an overall response rate of 88%. At a median follow-up of 13 months (range 6-62), the actuarial 3-year progression-free survival (PFS) and overall survival (OS) were 37% and 33%, respectively. The only variable associated with prolonged survival (P = 0.0001) was the degree of response. No difference was observed in response or toxicity with either gemcitabine 50 or 100 mg/m2. CONCLUSIONS: The concurrent use of radiotherapy and gemcitabine is effective but produces manageable severe mucositis in a high percentage of patients.

Tumor angiogenesis as a prognostic factor in oral cavity carcinomas.

Currently, lymph node metastasis and thickness of the tumor are the gold standard as a predictor of survival in patients with oral cavity squamous cell carcinoma (OSCC). However, there is a significant correlation between microvessel density and the development of cervical metastases or recurrence. Previous studies have demonstrated that head and neck cancers are able to induce an angiogenic response in experimental models. This factor shows a strong correlation with regional recurrence. In this study we propose to use angiogenesis as an independent prognostic indicator of recurrence. We evaluated the expression of tumor angiogenesis in OSCC and determinated its possible usefulness as a prognostic factor. Thirty-three cases with diagnosis of OSCC were identified from January 1985 to January 1997 in the Head and Neck Department of the Instituto Nacional de Cancerología in Mexico City. These cases were analyzed retrospectively for a minimum period of six months. All of them received a conventional complete treatment to the primary tumor and lymph node metastasis. Paraffin-embedded tumor specimens were available in all patients. The tumors were scanned and the areas of highest microvessel density (MVD) were immunostained for CD-34 using QBEnd/10 antibody. Statistical analysis included descriptive statistics, Wilcoxon test curves, and Cox's proportional hazards model for multivariate analysis. We identified 33 patients with OSCC, 16 were men and 17 women. The mean age among all patients was 58.9 years old. Based on tumor size 33.3% were T1, 27.3% T2, 12.1% T3, and 27.3% T4. The median microvessel count was 32.5. The mean percentage of MVD was 37 in patients with regional recurrence and in those patients without regional metastasis was 29 (p<0.05). 57.9% of the patients who presented recurrence had vessel counts over the median (p<0.01). In fact, 6 patients (46%) who showed more than 20% of angiogenesis expression and higher MVD presented with recurrence. Only 3 patients (23%) who had less than 20% of angiogenesis expression and lower MVD developed recurrence (p<0.01). Higher MVD was seen with increasing T and N stages; however, it did not show correlation with survival. In this study, angiogenesis expression demonstrated to be an independent factor of recurrence in patients with OSCC. It is suggested that it should be used as an independent prognostic indicator. In concordance with previous reports, we observed a significant correlation between MVD determination and recurrence of the tumor, followed by lymph node metastases and tumor size.

Inmunoterapia en cáncer epidermoide de lengua recurrente, asociado a epidermólisis bulosa distrófica. Reporte de un caso / Immunotherapy for recurrent tongue epidermoid carcinoma associated to dystrophic epidermolysis bullosa. Case report

La epidermólisis bulosa distrófica (EBD) es una patología cutánea, que frecuentemente se asocia a la presencia de cánceres epidermoides cutáneos de conducta agresiva. El tratamiento quirúrgico constituye la principal modalidad de tratamiento, debido a la presencia de metástasis en forma temprana, debe consolidarse con quimioterapia o radioterapia. El uso de estas modalidades se dificulta, debido a la patología cutánea de base. Se presenta el manejo con inmunoterapia utilizando una mezcla de citocinas naturales (IRX-2), en un paciente de 27 años con cáncer epidermoide de lengua recurrente, metastásico a cuello, en quien, por sus condiciones generales, no fue posible administrar otras modalidades terapéuticas. El uso de inmunoterapia indujo una respuesta objetiva parcial y paliación sintomática sin toxicidad. El uso de este tratamiento pudiera ser considerado como manejo paliativo en pacientes con cáncer epidermoide (CE) asociado a EBD.