The evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumor sites with similar outcomes to those of conventional fractionated radiotherapy. The use of ...hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP).
This single-arm trial was designed to evaluate the safety and feasibility of HYP-RT with concomitant CDDP in LAHNC. Stage III and IV patients withnonmetastatic disease were enrolled. Patients were submitted to intensity modulatedradiation therapy, which comprised 55 Gy/20 fractions to the gross tumor and44-48 Gy/20 fractions to the areas of subclinical disease. Concomitant CDDPconsisted of 4 weekly cycles of 35 mg/m2. The primary endpoints were the treatment completion rate and acute toxicity.
Twenty patients were enrolled from January 2015 to September 2016, and 12 (60%) were classified as unresectable. All patients completed the total dose of radiotherapy, and 19 patients (95%) received at least 3 of 4 cycles of chemotherapy. The median overall treatment time was 29 days (27-34). Grade 4 toxicity was reported twice (1 fatigue and 1 lymphopenia). The rates of grade 3 dermatitis and mucositis were 30% and 40%, respectively, with spontaneous resolution. Nasogastric tubes were offered to 15 patients (75%) during treatment; 4 patients (20%) needed feeding tubes after 2 months, and only 1 patient needed a feeding tube after 12 months.
HYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted.
ClinicalTrials, NCT03194061 . Registered 21 Jun 2017 - Retrospectively registered.
We sought to evaluate the evolution of the nutritional status of patients with advanced cancer of the upper aerodigestive tract undergoing surgical treatment (SURG) or organ preservation protocol ...(OP). Evaluations were conducted at the beginning and end of treatment, including weight, body composition and Patient-Generated Subjective Global Assessment (PG-SGA). Each group was comprised of 29 patients. Initially, malnutrition rates were 65.5% and 51.7% in the SURG and OP groups, respectively. At the end, the values went to 55.1% in SURG and 79.3% in OP. In the OP, there was a reduction in weight (P = 0.001), fat mass (P = 0.006), fat free mass (P = 0.002), and muscle mass (P = 0.005) and an increase in scores of the PG-SGA (P = 0.008). The same was not observed in SURG, except for the weight decrease (P = 0.025). Malnutrition was prevalent in both treatment groups and patients in OP were at greater risk of nutritional decline.
Metastatic lymph node involvement influences therapy decisions and serves as a prognostic indicator in oral squamous cell carcinoma (OSCC). However, many early-stage patients with clinically negative ...lymph nodes exhibit no metastasis upon surgical staging. This study aimed to identify differentially expressed miRNAs capable of distinguishing pathologically positive (pN+) from negative (pN0) nodes in OSCC patients without clinical evidence of lymph node metastases (cN0).
Expression levels of 798 miRNAs were assessed in tumor samples from 10 pN+ and 10 pN0 patients using the Nanostring nCounter platform. Validation was performed in an independent cohort of 15 pN+ and 24 pN0 patients through RT-qPCR.
Eight miRNAs exhibited differential expression between pN0 and pN+ patients. Notably, hsa-miR-99a-5p demonstrated high sensitivity and specificity in predicting patients at higher risk of positive lymph nodes.
These findings highlight hsa-miR-99a-5p as a potential biomarker for detecting lymph node metastasis in primary OSCC tumors.
Tobacco or human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCC) represent different clinical and epidemiologic entities. This study investigated the prevalence of ...HPV-positive and HPV-negative OPSCC in a reference cancer hospital in Brazil and its association with clinical and demographic data, as well as its impact on overall survival.
HPV infection was determined by p16-IHC in pre-treatment formalin-fixed paraffin-embedded samples from all patients with OPSCC diagnosed at Barretos Cancer Hospital between 2008 and 2018. The prevalence of HPV-positive cases and its temporal trend was assessed, and the association of clinical and demographic data with HPV infection and the impact on patient overall survival was evaluated.
A total of 797 patients with OPSCC were included in the study. The prevalence of HPV-associated tumors in the period was 20.6% 95% confidence interval, 17.5-24.0 with a significant trend for increase of HPV-positive cases over the years (annual percentage change = 12.87). In a multivariate analysis, the variables gender, level of education, smoking, tumor sublocation, region of Brazil, and tumor staging had a significant impact in HPV positivity, and a greater overall survival (OS) was observed in HPV-positive patients (5-year OS: 47.9% vs. 22.0%;
= 0.0001).
This study represents the largest cohort of Brazilian patients with OPSCC characterized according to HPV status. We report significant differences in demographics and clinical presentation according to HPV status, and an increasing trend in prevalence for HPV-induced tumors.
These findings can potentially contribute to a better stratification and management of patients as well as assist in prevention strategies.
Abstract
Introduction
The prevalence of oropharyngeal squamous cell carcinoma (OSCC) related to Human Papillomavirus (HPV) is rising in the whole world.
Objective
To access the prevalence and ...temporal trend of HPV infection in oropharyngeal cancer by analyzing the expression of the p16 protein.
Methods
We conducted a transversal study in a Brazilian reference oncology center. The sample consisted of 254 patients with OSCC. The analyzed period was from 2013 to 2017. All patients underwent p16 immunohistochemistry analysis.
Results
The overall prevalence of HPV-related OSCC was of 31.9%. During the analyzed period, we observed a trend of increasing rates of OSCC that marked positive for p16 immunohistochemistry. The annual prevalence of p16-positive cases was of 20.6% in 2013, 23.9% in 2014, 33.3% in 2015, 38.3% in 2016, and 34.2% in 2017. Most of the patients were stage III and IV (84%). Female patients (odds ratio OR = 2.43; 95% confidence interval CI: 1.003–5.888;
p
= 0.049) and younger patients (OR = 2.919; 95%CI: 1.682–5.067;
p
< 0.005) were associated with a higher risk of HPV-related OSCC. Tobacco consumption had a proportional lower risk of HPV-related OSCC (OR = 0.152; 95%CI: 0063–0.366;
p
< 0.005).
Conclusion
We observed an increasing prevalence of HPV-related OSCC in a specialized cancer hospital in Brazil.
Background
This study aimed to evaluate the accuracy and oncological results of sentinel lymph node biopsy in patients with early lip and oral cavity squamous cell carcinoma (SCC) in a real‐world ...scenario.
Methods
Retrospective study including seven Brazilian centers.
Results
Four‐hundred and seven cN0 patients were accrued for 20 years. The rate of occult metastasis was 23.1% and 22 patients (5.4%) had regional failure. We found, for 5 years of follow‐up, 85.3% of regional recurrence‐free survival; 77.1% of disease‐free survival; 73.7% of overall survival; and 86.7% of disease‐specific survival. The rate of false‐negative cases was 5.4%.
Conclusion
In a real‐world scenario, sentinel lymph node biopsy for patients with SCC of the lip and oral cavity proved feasible in different settings and to be oncologically safe, with similar rates of occult lymph node metastasis and false‐negative cases, when compared to elective neck dissection, and with similar long‐term survival to that reported historically.
Fat-forming solitary fibrous tumor (SFT) is a rare variant of solitary fibrous tumor, a mesenchymal fibroblastic neoplasia with a particular branching hypervascular pattern. This tumor is usually ...classified as benign and only very few fat-forming SFTs with malignant histologic features have been reported. We report a histologically malignant fat-forming solitary fibrous tumor in a 61-year-old man, located in his neck. Ultrasonography examination was first performed showing a heterogeneous lesion, predominantly hyperechoic, with sound beam attenuation, containing two hypoechoic solid nodules. Magnetic resonance imaging and computed tomography examinations demonstrated a heterogeneous and predominantly adipose mass, containing post contrast enhancing solid nodules and thin septations. Treatment consisted of total removal of the lesion. Histologically, the tumor showed hypercellularity, numerous mitoses and cytological atypia, fulfilling the criteria for malignancy. The patient had no metastasis. This rare tumor may be confused with other fat-containing lesions on imaging examinations, mainly liposarcoma.
A 52-year-old white male patient, non-smoker and non-drinker, was diagnosed with adenoid cystic carcinoma, stage pTN0M0, treated with left subtotal maxillectomy. The treatment consisted of surgery ...applied to the maxillary bone, followed by radiotherapy, performing 30 fractions of 200cGy. The patient presented a disease recurrence in the sphenoid bone, which was treated with a new cycle of SBRT CP 4/5 × 80cGy radiotherapy. The patient was followed up by dental care during radiotherapy for preventive photobiomodulation of oral mucositis. Afterwards, oral rehabilitation was completed. Upon physical oral examination, the patient presented all teeth in the mandible and partial tooth loss in the maxilla due to the surgical approach. A 5-centimeter bone defect was observed, comprising both the soft and hard palate, and a resin prosthetic device covered the bone defect. In conclusion, our approach promoted occlusal restoration, improving both esthetics and functional speech.
Purpose
The use of tracheoesophageal prostheses has become the gold standard in vocal rehabilitation of patients undergoing total laryngectomy. However, this method also has limitations, such as the ...need for frequent replacement of prostheses due to leakage or other complications. We have designed a study to access the clinical profile of patients using tracheoesophageal prostheses as vocal rehabilitation after total laryngectomy and to determine the average rate of changes, as well as the main causes of prostheses replacement.
Methods
A retrospective cohort study was performed based on patients who underwent rehabilitation with voice prostheses after total laryngectomy between 2008 and 2017.
Results
The sample consisted of 93 patients and 432 vocal prostheses replacement events. The median change of prostheses per patient was 210.25 days, (range 57.33 to 651.50). The most frequent cause of prostheses replacement was leakage through the prostheses, 218 (50.46%). Lower level of education was associated to higher prostheses replacement rate.
Conclusion
The results of this study show that the median of prostheses durability is higher than that presented in the literature, the main cause of replacement was protheses leakage and that low educational level is associated to higher replacement rate.
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