Definitive chemoradiation for locally-advanced oral cavity cancer: A 20-year experience

Publication date: May 2018
Source:Oral Oncology, Volume 80
Author(s): Corey C. Foster, James M. Melotek, Ryan J. Brisson, Tanguy Y. Seiwert, Ezra E.W. Cohen, Kerstin M. Stenson, Elizabeth A. Blair, Louis Portugal, Zhen Gooi, Nishant Agrawal, Everett E. Vokes, Daniel J. Haraf
ObjectivesDefinitive chemoradiation (CRT) for oral cavity squamous cell carcinoma (OC-SCC) is often criticized for poor efficacy or toxicity. We describe a favorable 20-year experience of primary CRT for locally-advanced OC-SCC.Materials and MethodsPatients with locally-advanced, stage III/IV OC-SCC receiving primary concomitant CRT on protocols from 1994 to 2014 were analyzed. Chemotherapy included fluorouracil and hydroxyurea with other third agents. Radiotherapy (RT) was delivered once or twice daily to a maximum dose of 70–75 Gy. Intensity-modulated RT (IMRT) was exclusively used after 2004. Progression-free survival (PFS), overall survival (OS), locoregional control (LRC), and distant control (DC) were calculated by the Kaplan-Meier method and compared across treatment decades using the log-rank test. Rates of osteoradionecrosis (ORN) requiring surgery were compared across treatment decades using the Chi-square test.Results140 patients with locally-advanced OC-SCC were treated with definitive CRT. Of these, 75.7% had T3/T4 disease, 68.6% had ≥N2 nodal disease, and 91.4% had stage IV disease. Most common primary sites were oral tongue (47.9%) and floor of mouth (24.3%). Median follow-up was 5.7 years. Five-year OS, PFS, LRC, and DC were 63.2%, 58.7%, 78.6%, and 87.2%, respectively. Rates of ORN and long-term feeding tube dependence were 20.7% and 10.0%, respectively. Differences in LRC (P = 0.90), DC (P = 0.24), PFS (P = 0.38), OS (P = 0.10), or ORN (P = 0.38) were not significant across treatment decades.ConclusionDefinitive CRT is a viable and feasible strategy for organ preservation for patients with locally-advanced OC-SCC.



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Assessing the potential role of scaffold-mediated local chemotherapy in oral cancer

Publication date: Available online 16 March 2018
Source:Oral Oncology
Author(s): Archana A. Gupta, Nikhil Pande, Supriya Kheur, A. Thirumal Raj




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Thrombotic microangiopathy associated with Mycoplasma pneumoniae infection

Thrombotic microangiopathy (TMA) comprises a process of sequential endothelial damage, microvascular thrombosis, consumptive thrombocytopenia and microangiopathic haemolytic anaemia that can affect several organs, including the kidney. A 36-year-old woman was presented with a petechial rash 3 weeks after an upper respiratory tract infection. Laboratory results showed normocytic normochromic anaemia, thrombocytopenia and evidence of TMA with decreased haptoglobin, elevated serum lactate dehydrogenase and a peripheral blood smear with numerous schistocytes. Treatment included daily plasmapheresis and prednisolone, with favourable clinical evolution. Antibodies anti-ADAMTS13 were positive, establishing the diagnosis of acquired thrombotic thrombocytopenic purpura. There was also serological evidence of a recent infection by Mycoplasma pneumoniae, and therefore the preceding respiratory tract infection by this agent was the most likely trigger for the disease. Due to the high mortality rate and poor outcomes, the prompt diagnostic and treatment are crucial in this rare disease. The identification of triggers related to this pathology can allow new therapeutic targets or preventive strategies.

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Fixed drug eruption associated with aspirin

Description

A previously healthy 27-year-old woman presented to the outpatient urgent care clinic complaining of dark spots that appeared suddenly on both her feet and face. She had been prescribed aspirin (650 mg orally every 6 hours as needed) the day prior to presentation as therapy for migraine-type headache. She also then recalled that these spots had appeared suddenly, in exactly the same areas approximately 1 year before the current episode, also associated with ingestion of an over-the-counter medication (Alka-Seltzer; aspirin/citric acid/sodium bicarbonate). Physical examination was unremarkable with the exception of dark, erythematous, slightly oedematous round plaques asymmetrically distributed over her feet (figure 1) and left eyelid (figure 2). A complete blood count was ordered (results within normal range), and the patient was advised to substitute aspirin with ibuprofen, which controlled her headache. The skin lesions subsided and disappeared without complications within 2 weeks. 1

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Acute scrotum in setting of acute pancreatitis

Acute scrotum is a urologic emergency with many aetiologies. Acute scrotum in setting of acute pancreatitis is a rare occurrence and results from an effusion of pancreatic juices into the inguinal canal along a retroperitoneal tract. Knowledge regarding the existence of this obscure condition is essential for its diagnosis. It is thus important for medical professionals, particularly internists, surgical trainees and emergency physicians, to be aware of the condition and the options for its management.

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Case of hepatic flexure ectopic pregnancy medically managed with methotrexate

Abdominal pregnancies represent 1.4% of extrauterine pregnancies. A literature search of six cases involving bowel ectopic pregnancies provided anecdotal treatment options. This case involves a woman admitted at 6 weeks gestation with right iliac fossa and shoulder tip pain. An ultrasound scan revealed an empty uterus with free fluid in both adnexa and a 31x21 mm heterogenous mass adjacent to the right ovary. At laparoscopy, an ectopic pregnancy was identified at the hepatic flexure. The patient received two doses of methotrexate and monitored until the beta human chorionic gonadotropin reduced. The decision to manage with methotrexate was balanced against reported cases of bowel perforation and the possibility that a section of bowel may need removal if the pregnancy showed signs of invasion. Maternal mortality rate with abdominal pregnancy is 20% due to the risk of massive haemorrhage from placental separation or invasion of bowel vasculature. Medical treatment here was successful and avoided extensive surgery.

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Author Correction: Secukinumab Demonstrates Significantly Lower Immunogenicity Potential Compared to Ixekizumab

In the original publication, information regarding "ustekinumab" was incorrectly published under the Methods section. The correct information in the section "Antibodies and Control Protein" should be "(secukinumab, 150 mg/mL; ixekizumab, 90 mg/mL; adalimumab, 50 mg/mL; ustekinumab 90 mg/ml)". Infliximab, which is mentioned in that section, was not used in the study.

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