Carlo Giordano

Cell cycle and viral and immunologic profiles of head and neck squamous cell carcinoma as predictable variables of tumor progression

The aim of this study was to determine whether the aberrant expression of cell‐cycle or immune‐response markers together with human papillomavirus (HPV) positivity impacts patient survival in different head and neck squamous cell carcinoma (HNSCC) subsets.

Radiofrequency Inferior Turbinate Reduction Long-Term Olfactory and Functional Outcomes

Objective. The aim of this study was to assess the long-term effects of radiofrequency inferior turbinate reduction (RITR) on nasal function in patients affected by nasal obstruction secondary to turbinate hypertrophy, focusing attention on increased sense of smell and its persistence after a 2-year follow-up. Study Design. Case series with planned data collection. Setting. ENT division, university hospital. Subjects and Methods. A total of 40 consecutive patients undergoing RITR for allergic or nonallergic chronic rhinitis with inferior turbinate hypertrophy were included. We planned a series of tests, including the “Sniffin’ Sticks” test battery, anterior rhinomanometry, and the nasal Obstruction Symptom Evaluation (NOSE) scale, on the day of the procedure and at the 2-month and 2-year follow-up visits. Results. Of the 40 patients, 35 completed all the objective and subjective examinations on the day of the procedure and at the 2-month and 2-year follow-up visits. The authors found a significant decrease in nasal resistances from a mean of 1.13 Pa/cm3s−1 preoperatively to a mean of 0.29 Pa/cm3s−1 2 years postoperatively and improvement in odor threshold, discrimination, and identification scores 2 years postoperatively. The NOSE score diminished significantly 2 years after surgery from a mean of 23.14 to a mean of 4.14 (all P < .01 with the t test for repeated measures). Conclusion. This long-term evaluation showed that radiofrequency treatment for allergic or nonallergic inferior turbinate hypertrophy appeared to provide improvement in olfaction, decrease nasal resistances, and have subjective benefits, maintained 2 years after the procedure.

Clinical and Biological Prognostic Factors in 179 Cases with Sinonasal Carcinoma Treated in the Italian Piedmont Region

Objectives: In spite of aggressive surgery and high-dose radiotherapy, the long-term survival of patients with sinonasal cancer remains disappointing. In this paper, we report data from 179 consecutive cases treated in the Italian Piedmont region between 1996 and 2000 according to a fixed protocol. Methods: Clinical and pathological data and the following biological parameters were analyzed: microvessel density and growth fraction by CD31 and Ki-67 positivity, respectively, and immunohistochemical expression of vascular endothelial growth factor (VEGF). Results: The median follow-up period was 75 months (range 45–108 months). Median overall survival was 26 months; 2- and 5-year overall survival rates were 52 and 36%, respectively. Patients with T1-T2 adenocarcinoma and squamous cell cancers (SCC) had better median survival than those with other lesions (p < 0.05). Patients treated with surgery with or without radiotherapy had better survival (p < 0.01), while chemotherapy had a marginally favorable effect (p = 0.09). The type of surgery and radiotherapy dose had no impact on survival; in contrast, there was a strong association between Ki-67 expression and microvessel density and overall survival (p < 0.05 and p = 0.039, respectively), while VEGF-C was a prognostic factor in SCC patients only (p < 0.05). Conclusions: In sinonasal cancer, tumor stage and histology have a clear impact on survival; surgery with or without radiotherapy represents the main choice of treatment for such tumors. The efficacy of neoadjuvant and concomitant chemoradiotherapy needs to be further investigated. The proliferative index and angiogenesis show a major role in the natural history of this cancer.

Cisplatin, epirubicin and 5-fluorouracil combination chemotherapy for recurrent carcinoma of the salivary gland.

Nine patients (5 males, 4 females; median age, 62 years) with recurrent high-grade malignancies of major (7 cases) and minor (2 cases) salivary gland origin (4 adenoid cystic carcinomas, 2 adenocarcinomas, 2 poorly differentiated carcinomas, 1 mixed malignant tumor) were treated with cisplatin (60 mg/m2), epirubicin (50 mg/m2) and 5-fluorouracil (600 mg/m2) (CEF) by intravenous injections on the first day of a 21-day regimen. Previous therapy included surgery (1 case), radiotherapy (1 case), and surgery+radiotherapy (7 cases). There was 1, complete response (11.1%), 3 partial responses (33.3%), 2 unchanged lesions (22.2%) and 3 progressions (33.3%). Patients with local recurrence had a better response. Median remission duration was 7.5 months in CR + PR patients. Median overall survival was 8+ months; 14+ months for responders and 4 months for nonresponders. The major toxic effects were nausea/vomiting and alopecia; myelosuppression was less frequent and usually not severe.

Induction chemotherapy with cisplatin and epirubicin followed by radiotherapy and concurrent cisplatin in locally advanced nasopharyngeal carcinoma observed in a non-endemic population

BACKGROUND AND PURPOSE Chemoradiotherapy (CRT) represents the main therapy choice in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). The aim of this study was the clinical evaluation of neoadjuvant chemotherapy (NACT) followed by CRT in a non-endemic population affected by advanced NPC. MATERIALS AND METHODS Patients with locoregionally advanced NPC were treated with three cycles of induction chemotherapy (CHT) with cisplatin (100 mg/m(2)) plus epirubicin (90 mg/m(2)), followed by cisplatin (100 mg/m(2)) and concomitant radiotherapy (70 Gy). RESULTS In 40 patients treated with such protocol, after the completion of induction CHT and CRT we observed the objective response rates of 90% and 100%, respectively. Treatment tolerability and toxicity were easily controllable. With a median follow-up time of 54 months, 3- and 5-year disease-free survival was 75% and 65% and 3- and 5-year overall survival was 84% and 77%. Three- and 5-year locoregional control was 82% and 70%, and 5-year distant metastases free survival was 75%. CONCLUSIONS NACT with cisplatin and epirubicin followed by concomitant CRT represents a feasible, efficient treatment for patients with advanced NPC. This regimen ensures an excellent locoregional disease control and overall survival with a low incidence of distant metastases.

Topographic classification, clinical characteristics, and diagnostic delay of cancer of the larynx/hypopharynx in Torino, Italy.

The case series of a population‐based case‐control study of laryngeal and hypopharyngeal cancers in Torino, Italy, included 281 men with clinical and anamnestic data. Two hundred fifteen, 28, and 38 cancers originated from the endolarynx, epilarynx, and hypopharynx, respectively. Regions invaded by the tumor were divided into 26 subsites. A classification based on the number of invaded subsites was proposed, which agreed well with the T classification of the TNM system. Cancers originating from the hypopharynx invaded more subsites than cancers from the endolarynx, and among the latter, supraglottic were more invasive than glottic lesions. The number of invaded subsites was strongly associated with nodal involvement. Among symptoms at onset of disease and at diagnosis, patients with endolaryngeal lesions reported dysphonia and dyspnea more frequently, and patients with lesions from other regions had a higher prevalence of dysphagia, odynophagia, otalgia, and adenopathia. Clinical and epidemiologic results of this study suggest considering the endolarynx, epilarynx, and hypopharynx as separate anatomic entities. Diagnostic delay was not associated with tumor size and showed a negative trend with involvement of cervical lymph nodes, suggesting that stage at diagnosis is due to intrinsic differences in tumor aggressiveness.

Radiofrequency volume turbinate reduction versus partial turbinectomy: clinical and histological features.

Background Nasal obstruction is a common symptom related to turbinate hypertrophy in 20% of cases. When medical treatment failed different surgical options were available. Actually, nasal physiology impairment after surgical treatment is not fully clear. This study evaluates microscopic mucosal changes and physiological function, by means of mucociliary transport time (MCT), after radiofrequency volume turbinate reduction and partial inferior turbinectomy. Methods Forty-eight nonallergic patients were treated for chronic nasal obstruction. Twenty-six patients (group A) underwent radiofrequency turbinate reduction and 22 patients (group B) underwent partial turbinectomy associated with septoplasty. Mucosal specimen obtained before T0 and 6 months (T1) after surgery were compared by means of optical microscope and transmission electron microscope. All patients were evaluated using MCT at T0 and T1. Results Optical analysis showed circumscribed squamous metaplasia and fibrosis in specimens obtained from group A. Same changes were more evident in group B. Ultrastructural analysis evidenced loss of ciliated epithelium in group B, whereas in group A a normal number of cilia was found. In all patients at T1, MCT time was prolonged in comparison with the preoperative values. After surgery, group B showed significantly prolonged MCT in comparison with group A (p < 0.05). Conclusion In our study both surgical techniques achieved good clinical outcomes with improved nasal function, although the ciliated epithelium appeared partially impaired. These findings resulted in a prolonged MCT in all patients, especially those treated with partial turbinectomy. Compared to partial resection, intraturbinal turbinate reduction seems to be the method of choice to better preserve nasal physiology.

Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer.

Head and neck tumors and their treatments negatively affect speech, swallowing, body image, and quality of life (QOL). The purpose of this study was to allow us to evaluate the impact of flap reconstructive surgery with adjuvant radiotherapy (RT) on QOL and psychological functioning.

Docetaxel and vinorelbine: an effective regimen in recurrent squamous cell esophageal carcinoma.

Vinorelbine and docetaxel are two effective drugs in esophageal cancer; our purpose was to evaluate efficacy and toxicity of a combination of these drugs in recurrent squamous cell esophageal cancer. Twenty patients previously treated with concomitant chemoradiotherapy (n=14), surgery alone (n=2), surgery plus radiotherapy (n=2), or concomitant chemoradiotherapy + surgey (n=2) were enrolled. Thirteen patients had a local-regional recurrence, two patients had metastases, and five patients had both. The doses were 80 mg/m2 for docetaxel and 20 mg/m2 for vinorelbine on d 1 every 21 d for a maximum of six cycles. Twenty patients received a total of 106 cycles (median per patient, 5). Neutropenia was the most frequent and severe side effect (grade 4 in 80%; grade 3 in 20%).The overall response rate was 60%, which included 3 of 20 complete responses (15%) and 9 of 20 partial responses (45%). Median response duration was 7 mo (2-50+). Overall median survival was 10.5 mo (range, 2-55+).A dysphagia improvement was observed in 81% of patients. In conclusion, the data from this phase II study indicate that this combination is effective in recurrent heavily pretreated patients with a short-lasting manageable toxicity.

Chemotherapy for Recurrent Salivary Gland Malignancies: Experience of the ENT Department of Turin University

Twenty-seven patients (17 males, 10 females; median age 59 years) with recurrent high-grade malignancies of major (22 cases) and minor (5 cases) salivary gland origin (10 adenoid cystic carcinomas, 9 adenocarcinomas, 4 poorly differentiated carcinomas, 1 mixed malignant tumor, 3 mucoepidermoid carcinomas) were treated by monochemotherapy--cisplatin (CDDP) in 8 cases, or adriamycin in 5 cases--or polychemotherapy--CDDP + epirubicin + 5-fluorouracil/cyclophosphamide in 9 cases or CDDP + 5-fluorouracil in 3 cases with mucoepidermoid carcinomas. In adenocarcinoma-like tumors, patients treated by polychemotherapy showed a better response (9.1% CR, 36.3% PR) than patients treated with monochemotherapy (no CR, 23% PR). Patients with local recurrence and adenocarcinoma exhibited a better response. Median response duration: 7.5 months after poly- and 4 after monochemotherapy. Median overall survival time was 8+ months (responders: 14+) in the polychemotherapy group and 5.5 (responders: 8) in the monochemotherapy group. In the 3 cases with mucoepidermoid carcinoma 1 patient achieved a PR (33.3%) and in 2 there was no change.