A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Masters of Medicine in the branch of Radiation Oncology Johannesburg 2015 / Radiation therapy is a highly effective method of treating oropharyngeal carcinoma, either as a single modality treatment with concurrent chemotherapy or as an adjuvant treatment after surgical resection. There exists an association with human papillomavirus (HPV) and oropharyngeal cancer, dividing oropharyngeal carcinoma into HPV positive oropharyngeal carcinoma and HPV negative oropharyngeal carcinoma. Overall survival has been analysed in these two groups and have been shown to be 80-95% for HPV positive oropharyngeal carcinomas and 57-62% in HPV negative subgroup at 3 years respectively. This retrospective review was intended to analyse patient response to treatment, overall survival, local disease free survival and the difference between HPV positive oropharyngeal carcinoma and HPV negative oropharyngeal carcinoma at Charlotte Maxeke Johannesburg Academic Hospital: Department of Radiation Oncology. Patients and methods A retrospective descriptive study was conducted on patients having received radical radiation therapy, with or without chemotherapy, from January 2009 to December 2012 with a histologically confirmed diagnosis of squamous cell carcinoma involving oropharyngeal sites only. The information obtained from records of forty-eight patients was captured on the prescribed data sheets designed for this study. Results Forty-eight eligible patients were accrued within this retrospective study. The median age of the patient group was 56 years (range 32-78) and comprised of 10 females and 38 males. The performance status was mainly Eastern Cooperative Oncology Group (ECOG) 1 (83%). The radiation therapy dose was within the range 60-70Gy, with majority patients completing 70 Gy (65%). Concurrent chemoradiation was given in 59% of patient group (28 patients). The most common site being the base of tongue (60%), followed by tonsil (36%), soft palate (2%) and posterior pharyngeal wall (2%). Eighty five percent of patients were stage IV oropharyngeal carcinoma. Only 6% of patients were tested for HPV-DNA PCR, and all were HPV positive. A total of 79% patients had a positive smoking history and 50% consumed alcohol regularly. Fifty six percent of patients tested negative for HIV, 14.6% tested positive for HIV and 29.3% had unknown HIV status. At the time of the analyses (March 2014) only 7 (15%) of patients were alive. The 2 year overall survival was 13%, the local disease free survival at 2 years was 59%. None of the prognostic factors were predictive of overall survival using univariate and multivariate analysis. Conclusion Majority of patients present in stage IV lesions with commonest sites of involvement being Base of Tongue. The local disease free survival of 2 years was 59% and the overall survival of 15%. There was no impact of prognostic factors studied on overall survival.

Submitted by INGRID DA SILVA SANTOS null (iingridsantos@hotmail.com) on 2017-06-26T03:09:39Z No. of bitstreams: 1 Dissertação de Mestrado_Repositório UNESP_INGRID DA SILVA SANTOS.pdf: 1875360 bytes, checksum: b760f2a2958eb68922d78501172c5f4e (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-06-28T16:45:33Z (GMT) No. of bitstreams: 1 santos_is_me_araca_par.pdf: 1437951 bytes, checksum: 9bb3ef4b8f15e4259996185982c7950e (MD5) / Made available in DSpace on 2017-06-28T16:45:33Z (GMT). No. of bitstreams: 1 santos_is_me_araca_par.pdf: 1437951 bytes, checksum: 9bb3ef4b8f15e4259996185982c7950e (MD5) Previous issue date: 2017-06-02 / Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM) / Evidências sugerem que o papilomavírus humano (HPV) está associado com um subgrupo de carcinomas de células escamosas da cabeça e pescoço (HNSCC). No entanto, a prevalência do HPV varia substancialmente dependendo do local anatômico e da região geográfica estudada. Aqui, nosso objetivo foi investigar a prevalência do HPV em amostras de tecido fresco de pacientes brasileiros com carcinoma de células escamosas (CEC) de boca e orofaringe combinando dois métodos confiáveis para a detecção do HPV. Foram recrutadas trinta e seis amostras de tecido fresco provenientes de CEC de boca (n= 27) e orofaringe (n= 9) para análises. As características sociodemográficas, estilo de vida e clinicopatológicas foram coletadas através dos prontuários. O DNA do HPV foi detectado por dois métodos: reação em cadeia da polimerase (PCR) em tempo real através de ensaio qualitativo de presença ou ausência do HPV-16, e testado para 37 genótipos usando Linear Array. A amplificação do gene β -globina funcionou como controle interno positivo para a análise do DNA em todas as amostras. O DNA do HPV não foi detectado em nenhum dos casos de amostras de tecido de pacientes com CEC em ambos os métodos utilizados. A ausência do HPV observada em nosso estudo pode sugerir que este não é um fator de risco prevalente nos CECs de boca e orofaringe nesta região geográfica. Os fatores de risco clássicos para o desenvolvimento desses tumores parecem ser ainda a principal causa nessa população brasileira. Investigações detalhadas do estilo de vida com maior amostragem precisam ser melhor exploradas para compreensão da baixa prevalência encontrada. / Evidence suggests that human papillomavirus (HPV) is associated with a subgroup of squamous cell carcinomas of the head and neck (HNSCC). However, the prevalence of HPV varies substantially depending on the anatomical site and geographic region studied. Here, our goal was to investigate the prevalence of HPV in fresh tissue samples from Brazilian patients with squamous cell carcinoma (SCC) of the oral cavity and oropharynx by combining two reliable methods for the detection of the HPV DNA. We recruited thirty-six fresh tissue samples from SCC of the oral cavity (n= 27) and oropharynx (n= 9) for analysis. The sociodemographic, lifestyle and clinicopathological characteristics were obtained from individual medical records. HPV DNA was detected by two methods: real-time polymerase chain reaction (PCR) through the qualitative assay of presence or absence for HPV-16, and tested for 37 genotypes by the Roche Linear Array. Amplification of the β-globin gene functioned as a positive internal control for DNA analysis in all samples. HPV DNA was detected in none of the tissue samples from patients with SCC in both methods. The absence of HPV observed in our study may suggest that this is not a prevalent risk factor in SCC of the oral cavity and oropharynx in this geographical region. The classic risk factors for the development of these tumors seem to be still the main cause in this Brazilian population. Detailed investigations of lifestyle with larger sample needs to be better explored to understand the low prevalence found. / FAPEAM: 120/2015

Purpose: This study investigates knowledge about HPV and examines if pediatric dental providers should include HPV education for guardians of patients 10-18 years. Methods: Legal guardians of 10-18 year-old patients of the Virginia Commonwealth University Pediatric Dental Clinic were enrolled in this prospective cohort study. Participants completed a baseline survey, were provided HPV education, completed an initial follow-up survey, and then completed a 6-month follow-up survey. Results: A total of 54 participants completed the baseline and initial follow-up surveys and 17 completed the 6-month follow-up survey. The average number of correct responses was 3.4 of 6 knowledge questions, which significantly improved to 5.4 at follow-up (P<.0001). The greatest increase in the percent responding correctly was regarding HPV and oropharyngeal cancer from 22% baseline to 91% at initial follow-up (P<.0001). Regarding Stage of Change, 14 (23%) of those not initially in the Action group had improved at least 1 stage. At the 6-month follow-up, 3 (43%) guardians reported completing the HPV vaccine series. Conclusions: These results demonstrate limited knowledge about HPV and highlight the pediatric dental provider’s ability to educate. Since the greatest knowledge gap pertained to HPV and oropharyngeal cancer, it is important for pediatric dental providers to increase their role in HPV education. As oral cancers are the purview of dentists, practitioners should be involved with their patients’ consideration of the HPV vaccine.

The Tumour-Node-Metastasis (TNM) classification system of tumour stage does not always reflect the actual tumour mass present at diagnosis. Recent reports propose that volumetric analysis may allow improved stratification of disease recurrence and survival in head and neck squamous cell cancer (SCC). This study aims to assess the prognostic value of tumour volume on the outcome of patients with oral cavity and oropharyngeal SCC. / A retrospective review of 73 patients was completed. Tumours were outlined semi-automatically in digitized computed tomography scans, and volumes computed based on surface triangulations of three-dimensional reconstructions with novel software developed at McGill. / Results illustrate significant interstage variability within the current TNM model. Moreover, in oral cavity and oropharyngeal SCC, tumour volume as well as T-stage are significant and independent predictors of disease free survival and overall survival.

Source: Masters Abstracts International, Volume: 45-04, page: 1935. Adviser: Erich M. Sturgis. Includes bibliographical references.

Resumo: Os resultados da presença do papilomavírus humano (HPV) em relação ao câncer das vias aerodigestivas superiores são muito controversos. Destas vias, a orofaringe tem sido a localização com maior prevalência de HPV, o que desperta grande interesse dos pesquisadores sobre a real participação do vírus na carcinogênese desta região. Este trabalho teve como objetivo verificar a prevalência de HPV em pacientes com carcinoma espinocelular de orofaringe, através da reação em cadeia polimerase (PCR) e correlacioná-la com dados demográficos, clínico-patológicos e de sobrevida. O estudo foi realizado através da análise de 27 peças oriundas de blocos de parafina obtidos de pacientes portadores de carcinoma espinocelular de orofaringe diagnosticados e tratados no Centro de Oncologia Bucal da Faculdade de Odontologia de Araçatuba - UNESP. Foram realizadas extrações do DNA com o QIAamp DNA minikit, conforme instrução do fabricante. Após confirmar a presença e integridade do DNA, foi realizada a nPCR para detecção do HPV. Dois grupos foram formados considerando-se a presença ou ausência do HPV. Foram amplificadas 26 amostras para o gene -globina sendo que o HPV foi detectado em 50% dos casos estudados. Não houve diferença estatisticamente significativa entre os grupos em relação as variáveis clínico-patológicas e a sobrevida. / Abstract: Reports on the presence of human papillomavirus (HPV) in upper aerodigestive tract are very controversial. In this tract, the oropharynx has been the site with the highest prevalence of HPV, which encourage the great interest of researchers for the real role of the virus in the carcinogenesis of this area. This study had the objective of verifying the HPV prevalence in patients with oropharyngeal squamous cell carcinoma using polymerase chain reaction (PCR) and its correlation with demographic data, clinicopathological aspects and survival. This study was accomplished by the analysis of embedded paraffin tissues of oropharyngeal squamous cell carcinoma from 27 patients diagnosed and treated in São Paulo State University, Dentistry College of Araçatuba - UNESP. DNA extraction was accomplished with QIAamp DNA minikit, according to the manufacturer's protocol. After confirming the presence and integrity of DNA, nPCR for HPV was performed. Two groups were formed, considering patients with HPV and without HPV. -globin gene was PCR amplified in 26 samples and the HPV detected in 50% of the studied cases. There was no statistically significant difference between the groups in relation of clinicopathological variables and survival. / Orientador: Glauco Issamu Miyahara / Coorientador: Eder Ricardo Biasoli / Banca: José Fernando Garcia / Banca: Elaine Maria Sgavioli Massucato / Banca: Denise Tostes Oliveira / Banca: Norberto Nobuo Sugaya / Doutor

Made available in DSpace on 2014-06-11T19:32:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-12-06Bitstream added on 2014-06-13T20:03:02Z : No. of bitstreams: 1 kawata_lt_dr_araca.pdf: 1246612 bytes, checksum: 16cc6433f58bd5e31123db2601352d36 (MD5) / Os resultados da presença do papilomavírus humano (HPV) em relação ao câncer das vias aerodigestivas superiores são muito controversos. Destas vias, a orofaringe tem sido a localização com maior prevalência de HPV, o que desperta grande interesse dos pesquisadores sobre a real participação do vírus na carcinogênese desta região. Este trabalho teve como objetivo verificar a prevalência de HPV em pacientes com carcinoma espinocelular de orofaringe, através da reação em cadeia polimerase (PCR) e correlacioná-la com dados demográficos, clínico-patológicos e de sobrevida. O estudo foi realizado através da análise de 27 peças oriundas de blocos de parafina obtidos de pacientes portadores de carcinoma espinocelular de orofaringe diagnosticados e tratados no Centro de Oncologia Bucal da Faculdade de Odontologia de Araçatuba - UNESP. Foram realizadas extrações do DNA com o QIAamp DNA minikit, conforme instrução do fabricante. Após confirmar a presença e integridade do DNA, foi realizada a nPCR para detecção do HPV. Dois grupos foram formados considerando-se a presença ou ausência do HPV. Foram amplificadas 26 amostras para o gene -globina sendo que o HPV foi detectado em 50% dos casos estudados. Não houve diferença estatisticamente significativa entre os grupos em relação as variáveis clínico-patológicas e a sobrevida. / Reports on the presence of human papillomavirus (HPV) in upper aerodigestive tract are very controversial. In this tract, the oropharynx has been the site with the highest prevalence of HPV, which encourage the great interest of researchers for the real role of the virus in the carcinogenesis of this area. This study had the objective of verifying the HPV prevalence in patients with oropharyngeal squamous cell carcinoma using polymerase chain reaction (PCR) and its correlation with demographic data, clinicopathological aspects and survival. This study was accomplished by the analysis of embedded paraffin tissues of oropharyngeal squamous cell carcinoma from 27 patients diagnosed and treated in São Paulo State University, Dentistry College of Araçatuba – UNESP. DNA extraction was accomplished with QIAamp DNA minikit, according to the manufacturer´s protocol. After confirming the presence and integrity of DNA, nPCR for HPV was performed. Two groups were formed, considering patients with HPV and without HPV. -globin gene was PCR amplified in 26 samples and the HPV detected in 50% of the studied cases. There was no statistically significant difference between the groups in relation of clinicopathological variables and survival.

No description available.

Bakgrund. Vid tumörresektion i de orofaryngeala vävnaderna, utförs mandibulotomi för att skapa åtkomst och möjliggöra kirurgiskt avlägsnande. Allvarliga komplikationer har rapporterats i litteraturen och bidragande orsaker är den kirurgiska tekniken, strålningsterapin samt en inskränkt näringstillförsel till mandibelkroppen.Syfte. Syftet med denna studie var att undersöka om bevarande av periost vid utförande av mandibulotomi, leder till färre patienter med komplikationer relaterade till mandibulotomin..Metod. Patienter som genomgick mandibulotomi mellan 2003-2012 vid Skånes Universitetssjukhus granskades retrospektivt. Trettiosex patienter inkluderades fördelade på 18 i en supraperiostal- (locking plates) och 18 i en subperiostal grupp (non-locking plates). Den kliniska uppföljningen var 12 månader och den röntgenologiska varierade mellan 10 till 17 månader efter mandibulotomin. Komplikationerna delades in i mindre allvarliga; abscess, fistel och gingival nekros samt mer allvarliga; osteoradionekros, ben- och plattblotta, non-union och mikrovaskulärlambåinfektion.Resultat. Antalet patienter med komplikationer under 12 månaders uppföljning var 14 (38,9 %). Subperiostala gruppen hade en incidens på 9 fall medan den supraperiostala hade en incidens på 5. Antalet patienter som uppvisade komplikationer vid 12 månaders uppföljning var 9 (25 %), med endast en patient representerad i den supraperiostala gruppen.Slutsats. Enligt denna retrospektiva studie har patienter, som genomgått mandibulotomi med supraperiostal placering av osteosyntesplattorna, färre persisterande komplikationer av allvarlig grad efter ett år, jämfört med en subperiostal placering. Det förefaller därför fördelaktigt att använda supraperiostal placeringsteknik, när man applicerar osteosyntesplattor efter mandibulotomi på strålade patienter. / Background. Mandibulotomy is frequently used to gain access at resection of tumours in the oropharyngeal space. Severe complications have been reported in the literature related to the surgical technique, radiation and nutritional deficiency of the mandibular body.Objective. The purpose of this study is to investigate if preserving the periosteum, while performing a mandibulotomy, leads to fewer patients with complications related to the mandibulotomy.Method. Patients undergoing mandibulotomy between 2003 and 2012 at Skåne University Hospital were reviewed retrospectively. Thirty six patients were included, 18 in the supraperiosteal group (locking plates) and 18 patients in the subperiosteal group (non-locking plates). Clinical follow up was 12 months and radiographic follow up was 10 to 17 months post-surgery. Complications were divided into minor; abscess, fistula, gingival necrosis and major; osteoradionecrosis, bone and plate exposure, non-union and micro vascular flap infection.Results. The summation of patients with complications during the 12 months follow up was 14 (38 %). The subperiosteal group was represented in 9 cases and the supraperiosteal group in 5. The total number of patients with complications persisting at 12 months after the operation were 9 (25 %), with only one patient represented in the supraperiosteal group.Conclusion. Fewer patients, undergoing mandibulotomy with the supra- compared to the subperiosteal placement of the osteosynthetic plates, showed persisting complications at one year postoperatively (p <0.05). It seems to be preferable to use a supraperiosteal fixation method when placing the osteosynthetic plates after a mandibulotomy in irradiated patients.

Introdução. Há evidências de que a desigualdade social pode influenciar o prognóstico do câncer quando foram comparadas as taxas de sobrevida segundo o status socioeconômico, entretanto isso ainda não foi estudado no Brasil. Objetivo. Analisar a desigualdade social na determinação da sobrevida específica em um, três e cinco anos, de pacientes diagnosticados com câncer de boca e orofaringe em São Paulo. Metodologia. Utilizou-se a coorte de base hospitalar do grupo de pesquisa Genoma Clínico do Câncer de Cabeça e Pescoço (GENCAPO), à qual foram aplicados novos critérios de exclusão. Assim, foram analisados dados demográficos, socioeconômicos, comportamentais, sintomas autorreferidos e de condições clínicas de 1.154 pacientes, com diagnóstico de malignidade nas regiões de boca (C00.3-C06) e orofaringe (C09-C10), arrolados de 2001 a 2009 e acompanhados por cinco anos. A desigualdade social foi aferida pela escolaridade e a ocupação. As probabilidades acumuladas de sobrevida específica em um, três e cinco anos foram calculadas pelo método de Kaplan-Meier e as diferenças entre as curvas de sobrevida, pelo teste de Log-rank. A regressão de Cox univariada e múltipla possibilitou a análise dos fatores associados à sobrevida - Hazard Ratio (HR) com IC95%. Resultados. As probabilidades acumuladas de sobrevida específica em um, três e cinco anos para câncer de boca e orofaringe, foram de 74,72%, 49,86 e 42,46%, respectivamente. Baixa escolaridade (HR=1,25; IC95%=1,03-1,51) e realização de trabalhos manuais (HR=1,37; IC95%=1,05-1,78) foram associados à menor probabilidade de sobrevivência em cinco anos na análise não ajustada. A cor da pele preta/parda, tumor de tamanho T3 ou T4 e comprometimento de linfonodos foram fatores independentemente associados à menor sobrevida específica por câncer de boca e orofaringe em um, três e cinco anos. Disfagia e dificuldade respiratória foram associados à menor sobrevida específica em um ano. Em três anos, observou-se também a otalgia e em cinco anos, a dificuldade de deglutição. Conclusões. Foi identificada associação entre a desigualdade social, menor escolaridade e trabalho manual, à menor sobrevida em 5 anos. Esses fatores, na análise ajustada pelas características demográficas, tiveram sua associação potencialmente explicada pela cor da pele preta/parda. / Introduction. There is evidence that social inequality may influence the prognosis of cancer when comparing survival rates according to socioeconomic status, but this has not been studied in Brazil. Aim. To evaluate social inequality in the determination of one, three and five years specific survival of patients diagnosed with oral and oropharyngeal cancer in São Paulo. Methodology. A hospital-based cohort of the research group \"Clinical Genome of Head and Neck Cancer\" (GENCAPO) was used, applying new exclusion criteria. Demographic, socioeconomic, behavioral, selfreported symptoms and clinical conditions characteristics of 1,154 patients, diagnosed with malignancy in the mouth (C00.3-C06) and oropharynx (C09-C10) regions, included from 2001 to 2009 and followed up for five years, were analyzed. Social inequality was measured by schooling and occupation. The cumulative probabilities of one, three, and five years specific survival were calculated by the Kaplan-Meier method and differences between the survival curves by the log-rank test. Univariate and Multiple Cox Regression allowed to analyze the factors associated with survival - Hazard Ratio (HR) with 95% CI. Results. The accumulated probabilities of one, three and five years specific survival for oral and oropharyngeal cancer were 74.72%, 49.86 and 42.46%, respectively. Low schooling (HR = 1.25, 95% CI = 1.03-1.51) and manual work (HR = 1.37, 95% CI = 1.05-1.78) were associated with a lower survival probability at five years in the unadjusted analysis. Dysphagia and breathing difficulties were associated with lower one year specific survival. At three years, it was also observed earache, and at five years, swallowing difficulty. Conclusions. An association among social inequality, lower schooling and manual labor, with the lowest survival at 5 years, was identified. These results were potentially explained by black/brown skin color in the adjusted analysis for demographic characteristics.