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P3.91. Reassessment of risk factors for oral cancer
used to routinely screen for oral cancer even in adults because the incidence of oral cancer is rare. Hence, It would be inefficient to allocate scarce healthcare resources to the routine use of these devices for oral cancer screening. doi:10.1016/j.oos.2009.06.616
P3.91. Reassessment of risk factors for oral cancer N. Gangane *, S. Grover, A. Gupta, S. Gupta Mahatma Gandhi Institute of Medical Sciences, India A total of 140 cases of histologically confirmed oral cancer were evaluated for their demographic details, dietary habits and addiction to tobacco and alcohol using a pre-designed structured questionnaire at the Mahatma Gandhi Institute of Medical Sciences, Sevagram in Central India. These cases were matched with three sets of age and sex matched controls. Oral cancer was predominant in the age group of 50–59 years. Individuals on a non-vegetarian diet appeared to be at greater risk of developing oral cancer. Cases were habituated to consuming. hot beverages more frequently and milk less frequently than controls. Consumption of ghutka, a granular form of chewable tobacco and areca nut, was significantly associated with oral cancer cases. Cases had been using oral tobacco for longer duration than controls, and were habituated to sleeping with tobacco quid in their mouth. Most cases were also addicted to smoking tobacco and alcohol consumption. Bidi (a crude cigarette) smoking was most commonly associated with oral cancer. On stratified analysis, a combination of regular smoking and oral tobacco use, as well as a combination of regular alcohol intake and oral tobacco use were significantly associated with oral cancer cases. Synergistic effects of all three or even two of the risk factors – oral tobacco use, smoking and alcohol consumptionwas more commonly seen in cases when compared to controls. doi:10.1016/j.oos.2009.06.617
P3.92. Randomised controlled trial of Lugol’s iodine in head and neck cancer surgery (LIHNCS trial) J.A. McCaul a,b,*, D.N. Sutton a, D. Gouldesbrough a, G. Bryson a, D. McLelland a, J.D. McMahon a,c a
Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom University of Bradford, United Kingdom c Southern General Hospital, United Kingdom b
Introduction: Dysplasia at surgical margins is a predictor of local recurrence in surgical treatment of oral and oropharyngeal cancer. Normal epithelial cells store increasing glycogen from basal layer to surface. Dysplastic cells do not and this metabolic difference can be exploited to identify epithelial dysplasia by staining with Lugol’s iodine. We have previously shown that Lugol’s Iodine reduced margins positive for dysplasia, carcinoma-in-situ, and invasive carcinoma in patients undergoing primary SCCHN surgery. In our series of 50 consecutive patients margins positive for these features reduced from 32% (control) to 4% (intervention). We now report interim data from a multicentre randomised controlled trial evaluating the effectiveness of this technique. Methods: Patients undergoing surgery for oral cavity and oropharyngeal mucosal cancer are randomised to control or to Lugol’s iodine staining using a web based randomisation method stratified by centre and surgeon. Control subjects undergo removal of mucosal SCC with a macroscopic 1 cm margin and removal of adjacent mac-
231
roscopic leukoplakia. Intervention subjects have the same surgery with Lugol’s iodine used to identify dyplasia at the tumour margin and remove this where feasible. Histopathology reporting of the RCPath minimum dataset is analysed for the presence of dysplasia, Ca in situ, or invasive SCC at mucosal margins. After tumour resection and before formalin fixation specimens have carbocisteine and Lugol’s iodine applied to ensure blinding of the assessing histopathologist. Subjects are followed up to five years post treatment. Results: We will present interim data from our trial. Recruitment is on target to achieve 164 patients in multiple centres within the study period. At time of writing 24 patients have been recruited. In the control group 16.7% had margin dysplasia. Intervention group had 0% dysplasia. Discussion: Staining with Lugols iodine may be an effective method for reducing margin dysplasia at resection of SCCHN. This may reduce locoregional recurrence in SCCHN. doi:10.1016/j.oos.2009.06.618
P3.93. Prevalence of oral tongue SCC in Iran L.V. Mostaan a,*, A. Taghizadeh a, F.A. Hashemi b, B. Kaladgechi b, R. Omranipoor b, S. Babazade c a
Mashhad University of Medical Sciences, Islamic Republic of Iran Tehran University of Medical Sciences, Islamic Republic of Iran c Isfahan University of Medical Sciences, Islamic Republic of Iran b
Oral cancer is the sixth most common cancer in the world. Among oral cancers, the oral tongue is the most common subsite that is involved. It has a geographic predilection with a higher incidence reported in southeast Asia and Brazil. Higher incidence in these areas is due to the habitual usage of chewing tobacco and the betel nut. Like the other upper aero-digestive tract malignancies, alcohol and tobacco have a significant influence on this malignant degeneration. In this article, we reviewed the hospital-based epidemiologic data of patients suffering from tongue SCC from 1995 until 2005.These patients were admitted to the tertiary referral cancer center in the north, northeast and central areas of Iran. these geographic regions make up more than half of Iran’ s territory. Material and methods: From January 1995 through January 2005, 454 patients with oral tongue cancer were referred to these three cancer centers, belonging to the Tehran, Mashhad and Isfahan university of medical sciences. 213 patients (46/91%) were female and 241 (53/08%) were male. The aim of the study was to collect epidemiologic data such as age, sex, T stage and N stage. Results: The median age at the time of the patients first visit was 61/22 years (range 20–100 years. Patients (213) (46/91%) were female and 241 (53/08%) were male. According to the American Joint committee on cancer staging system, 39 patients (8/59%) were T1, 167 (36/78%) were T2, 78 (17/18%) were T3, 25 (5/5%) were T4 and 145 patients (31/9%) were Tx. 196 patients (43/17%) were N0, 44 (9/5%) were N1, 36 (7/9%) were N2, 18 (3/96%) were N3 and 160 (35/24%) patients were Nx. The disease free survival rate was also significantly longer in the combined therapy group and node negative patients than in the radiotherapy group and node positive patients respectively. Conclusion: Primary treatment was definitely surgery in 323 (71/14%) patients, RT alone in 105 (23/12%) patients and chemotherapy as a sole treatment or a part of neoadjuvant therapy in 44 patients (9/69%). Tongue cancers account for 25% of oral cavity SCC. Although surgical excision has been the main stay of treatment, combined surgery and adjuvant radiation therapy to include the primary site and the regional lymph nodes is commonly used for most advanced (stages III and IV) cancers.
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session III / Oral Oncology Supplement 3 (2009) 201–236
P3.91. Reassessment of risk factors for oral cancer N. Gangane *, S. Grover, A. Gupta, S. Gupta Mahatma Gandhi Institute of Medical Sciences, India A total of 140 cases of histologically confirmed oral cancer were evaluated for their demographic details, dietary habits and addiction to tobacco and alcohol using a pre-designed structured questionnaire at the Mahatma Gandhi Institute of Medical Sciences, Sevagram in Central India. These cases were matched with three sets of age and sex matched controls. Oral cancer was predominant in the age group of 50–59 years. Individuals on a non-vegetarian diet appeared to be at greater risk of developing oral cancer. Cases were habituated to consuming. hot beverages more frequently and milk less frequently than controls. Consumption of ghutka, a granular form of chewable tobacco and areca nut, was significantly associated with oral cancer cases. Cases had been using oral tobacco for longer duration than controls, and were habituated to sleeping with tobacco quid in their mouth. Most cases were also addicted to smoking tobacco and alcohol consumption. Bidi (a crude cigarette) smoking was most commonly associated with oral cancer. On stratified analysis, a combination of regular smoking and oral tobacco use, as well as a combination of regular alcohol intake and oral tobacco use were significantly associated with oral cancer cases. Synergistic effects of all three or even two of the risk factors – oral tobacco use, smoking and alcohol consumptionwas more commonly seen in cases when compared to controls. doi:10.1016/j.oos.2009.06.617
P3.92. Randomised controlled trial of Lugol’s iodine in head and neck cancer surgery (LIHNCS trial) J.A. McCaul a,b,*, D.N. Sutton a, D. Gouldesbrough a, G. Bryson a, D. McLelland a, J.D. McMahon a,c a
Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom University of Bradford, United Kingdom c Southern General Hospital, United Kingdom b
Introduction: Dysplasia at surgical margins is a predictor of local recurrence in surgical treatment of oral and oropharyngeal cancer. Normal epithelial cells store increasing glycogen from basal layer to surface. Dysplastic cells do not and this metabolic difference can be exploited to identify epithelial dysplasia by staining with Lugol’s iodine. We have previously shown that Lugol’s Iodine reduced margins positive for dysplasia, carcinoma-in-situ, and invasive carcinoma in patients undergoing primary SCCHN surgery. In our series of 50 consecutive patients margins positive for these features reduced from 32% (control) to 4% (intervention). We now report interim data from a multicentre randomised controlled trial evaluating the effectiveness of this technique. Methods: Patients undergoing surgery for oral cavity and oropharyngeal mucosal cancer are randomised to control or to Lugol’s iodine staining using a web based randomisation method stratified by centre and surgeon. Control subjects undergo removal of mucosal SCC with a macroscopic 1 cm margin and removal of adjacent mac-
231
roscopic leukoplakia. Intervention subjects have the same surgery with Lugol’s iodine used to identify dyplasia at the tumour margin and remove this where feasible. Histopathology reporting of the RCPath minimum dataset is analysed for the presence of dysplasia, Ca in situ, or invasive SCC at mucosal margins. After tumour resection and before formalin fixation specimens have carbocisteine and Lugol’s iodine applied to ensure blinding of the assessing histopathologist. Subjects are followed up to five years post treatment. Results: We will present interim data from our trial. Recruitment is on target to achieve 164 patients in multiple centres within the study period. At time of writing 24 patients have been recruited. In the control group 16.7% had margin dysplasia. Intervention group had 0% dysplasia. Discussion: Staining with Lugols iodine may be an effective method for reducing margin dysplasia at resection of SCCHN. This may reduce locoregional recurrence in SCCHN. doi:10.1016/j.oos.2009.06.618
P3.93. Prevalence of oral tongue SCC in Iran L.V. Mostaan a,*, A. Taghizadeh a, F.A. Hashemi b, B. Kaladgechi b, R. Omranipoor b, S. Babazade c a
Mashhad University of Medical Sciences, Islamic Republic of Iran Tehran University of Medical Sciences, Islamic Republic of Iran c Isfahan University of Medical Sciences, Islamic Republic of Iran b
Oral cancer is the sixth most common cancer in the world. Among oral cancers, the oral tongue is the most common subsite that is involved. It has a geographic predilection with a higher incidence reported in southeast Asia and Brazil. Higher incidence in these areas is due to the habitual usage of chewing tobacco and the betel nut. Like the other upper aero-digestive tract malignancies, alcohol and tobacco have a significant influence on this malignant degeneration. In this article, we reviewed the hospital-based epidemiologic data of patients suffering from tongue SCC from 1995 until 2005.These patients were admitted to the tertiary referral cancer center in the north, northeast and central areas of Iran. these geographic regions make up more than half of Iran’ s territory. Material and methods: From January 1995 through January 2005, 454 patients with oral tongue cancer were referred to these three cancer centers, belonging to the Tehran, Mashhad and Isfahan university of medical sciences. 213 patients (46/91%) were female and 241 (53/08%) were male. The aim of the study was to collect epidemiologic data such as age, sex, T stage and N stage. Results: The median age at the time of the patients first visit was 61/22 years (range 20–100 years. Patients (213) (46/91%) were female and 241 (53/08%) were male. According to the American Joint committee on cancer staging system, 39 patients (8/59%) were T1, 167 (36/78%) were T2, 78 (17/18%) were T3, 25 (5/5%) were T4 and 145 patients (31/9%) were Tx. 196 patients (43/17%) were N0, 44 (9/5%) were N1, 36 (7/9%) were N2, 18 (3/96%) were N3 and 160 (35/24%) patients were Nx. The disease free survival rate was also significantly longer in the combined therapy group and node negative patients than in the radiotherapy group and node positive patients respectively. Conclusion: Primary treatment was definitely surgery in 323 (71/14%) patients, RT alone in 105 (23/12%) patients and chemotherapy as a sole treatment or a part of neoadjuvant therapy in 44 patients (9/69%). Tongue cancers account for 25% of oral cavity SCC. Although surgical excision has been the main stay of treatment, combined surgery and adjuvant radiation therapy to include the primary site and the regional lymph nodes is commonly used for most advanced (stages III and IV) cancers.
Poster Abstracts Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Poster session III / Oral Oncology Supplement 3 (2009) 201–236