Dental management prior to radiation therapy in patients with head and neck cancer.

INTRODUCTION: Patients diagnosed with head and neck tumors, are treated by surgery, radiation therapy (RT), chemotherapy (CT) or a combination thereof. The goal is to describe the management protocol for patients subjected to radiation therapy (RT) and to study their long-term oral health status. MATERIALS AND METHODS: A retrospective study was performed in a sample of 50 patients. We analyzed the oral health status and all the variables included applying the adapted protocol of pre-RT. RESULTS: Prior to RT, 84% of patients required scaling and 32% conservative treatment. Around 74% of patients required at least one exodontia. The mean of exodontias for patients presenting Grade 3 of oral hygiene was 6.50 per person (p<0.0001). The pre-RT study of possible candida infection showed that 78% of patients were negative for this infection. The mean resting saliva production was 39.10 (SD: 23.30; range: 13-145), with a stimulated value of 64.78 (SD: 33.92; range: 16-200). CONCLUSIONS: All patients should be protocoled to ensure that they present optimal oral conditions prior to initiating RT treatment.

p21{Waf1/CIP1} is a poor diagnostic and prognostic marker for OSCC although its expression increases in patients with N1 regional metastasis.

OBJECTIVES: Downregulation of p21{Waf1/CIP1} (a cyclin-dependent kinase inhibitor) has been reported for mouth cancer. The goal of this article is to quantitatively report expression of p21{Waf1/CIP1} and evaluate its relationship with the clinical and prognostic factors. MATERIALS AND METHODS: this is a retrospective study of 68 patients diagnosed with OSCC. We constructed a tissue microarray to develop an immunohistochemical assessment of p21{Waf1/CIP1} expression. A multivariate analysis using a forward-selection stepwise regression model (Cox, 1972) for predicting survival was performed. RESULTS: The quantitative expression of p21{Waf1/CIP1} showed a statistically significant relationship with the risk of lymph node metastasis, showing a higher expression in patients with homolateral single nodes of less than 3 cm (N1) (X{2}=6.58; p< 0.05). We found no statistically significant relationship with any other clinical or pathological parameters. The Cox univariate regression analysis verifies that the effect of the value of p21{Waf1/CIP1} on survival was not statistically significant (p=0.6). The best predictive multivariate Cox analysis included the covariates: recurrence, p21{Waf1/CIP1}, gender, stage, and dysplasia in the adjacent margin. All these variables showed a statistically significant relationship with survival, except p21{Waf1/CIP1}. CONCLUSION: quantitative determination of p21{Waf1/CIP1} standardizes and facilitates its analysis. Although its expression increases in patients with N1 regional metastasis, the loss of p21{WAF1/CIP1} does not seem to have any relationship with the clinical and pathological variables of the tumors.