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A study of cellular immunity in head and neck cancer patients
222
P22-7 Diagnosis of neoplasm
4. Clinicopathological Study of Carcinoma that Developed from Oral Leukoplakia
Takano, M. 1, Kakizawa, T.1, Matsui, T.1, Yama, M. 1, Kohda, H. 1, Kawakami, S. 1, Noma, 1f. 2, lnoue, T.3 1Department of OMS, Suidobasi-Hospital, Tokyo Dental College, Tokyo, 21st Department of OMS, Tokyo Dental College, Chiba, 3Department of Pathology, Tokyo Dental College, Chiba, Japan This study involved nine cases of carcinoma that developed from oral leukoplakia over seven years from April, 1990. They were four males and five females, aged 55-74 years. Six patients had a previous oral cancer at another site. Carcinoma developed from leukoplakia occurred on the tongue in five cases, on the gingiva in two cases, on the palate in one case and on the buccal mucosa in one case. According to the clinical classification of the oral leukoplakia, the precancerous lesions were of the errosiva or verrucosa types. Malignant transformation occurred within eight months to ten years 9f the first diagnosis. Histopathological examinations of the tumors found them to be carcinoma in situ, squamous cell carcinoma, or verrucus carcinoma.
5. Clinical and Histopathological Observation of White Lesions of the Oral Mueosa with Special Reference to Oral Leukoplakia
Kaneko, T., Noutomi, T., Ito, M., Uchida, S., Watanabe, M., Chiba, H. Department of OMS, Tokyo Medical College, Tokyo, Japan Leukoplakia is one of the white lesions seen on the oral mucosa which occurs with relatively high frequency. Oral leukoplakia is called a precancerous lesion both because some types of oral leukoplakia may turn into a malignancy during their course and because part of the lesion may be histologically classified as dyskeratosis in some cases. Since its lesions present varied clinical pictures, oral leukoplakia often challenges differential diagnosis. Its diagnosis therefore requires histopathological assessment in addition to clinical observation. Clinical and histopathological observations were made in 40 cases selected from among the patients who presented at the outpatient clinic of our institution in the 36 months from January, 1994, to December, 1996, were diagnosed as having oral leukoplakia according to the W H O diagnostic criteria, and underwent biopsy. The present communication, is a report of our results of observation. The patients diagnosed with oral leukoplakia consisted of 23 males and 17 females with a mean age of 58 years (range 17-84). The lesions were located in the gingiva in 15 cases, the tongue in 12, the palate in 9, the buccal mucosa in two, the oral floor in one, and :the lip in one. The,clinical and histopathological findings of lesions at these sites were compared and assessed for clinicopathological features.
6. Histological and Radiological Analysis of Mandibular Invasion by Oral and Oropharyngeal Squamous Cell Carcinoma
Sato, T., Watanabe, A., Tochihara, S., Hirano, Y., Asada, K., Ishibashi, K. 2nd Department of Oral and Maxillofacial Surgery, Tsurumi Univ. School of Dental Medicine, Yokohama, Japan In order to assist the decision of whether or not mandiblesparing surgery is indicated, histopathological and radiological analysis was performed retrospectively in 53 cases of oral and oropharyngeal squamous cell carcinoma that had undergdiae composite resection of the mandible. Of the 53 cases, some mandibular bone reaction caused by tumor invasion was histologically confirmed postoperatively in 39 cases (32 mandibular gingiva, 3 oropharynx, 3 floor of the mouth, and 1 buccal mucosa in origin). Eight of these 39 cases had been irradiated prior to composite resection of the mandible. The histological pattern of bone invasion was either expansive or infiltrative. In cases in which expansive bone invasion had occurred, endosteal and/or periosteal new bone formation was fi'equently observed close to the front of the invading tumor tissue. Active infiltration along the periodontium by tumor cells in association with minimal destruction of alveolar bone was not seen in dentate areas. However, invasion through the impacted third molar was evident in a few cases. Mandibular invasion was generally pronounced and serious in patients who received imprudent tooth extraction within the tumor. Although invasion to the mandibular canal was detected in 8 cases, no cases showed distant infiltration from the main tumor along the canal. In 4 of the 8 cases that had been irradiated prior to resection of the mandible, the osteoblastic reaction was quite poor and cortical bone destruction sometimes occurred deep in the mandibular body. These findings suggest that in cases with nonirradiated mandibles that have shallow expansive tumor invasion, marginal resection without sacrificing the full thickness of the mandible is indicated.
7. A Study of Cellular Immunity in Head and Neck Cancer Patients
Tani, R., Sakamoto, A., Toratani, S., Osaki, T., Ochi, Y, Tanaka, Y, Zhang, Y, Michimukai, E., Sasahara, 1t., Okamoto, T. Department of Molecular Oral Medicine & Maxillofacial Surg. 1, Hiroshima Univ. Schl. of Dent., Hiroshima, Japan We have examined the subsets of lymphocytes, uninductive lymphokine-activated killer (LAK) activity, and inductive natural killer (NK) activity in 65 patients with squamous cell carcinoma. The correlations between cellular immunoreactivity and T N M classification, stage classification and histological differentiation were studied using the non-parametric Spearman test. Furthermore, we have studied the influence
P22-7 Diagnosis of neoplasm of chemotherapy, radiation, and operation on cellular immunity. The results of T classification and immunological parameter of single-color analysis showed that the percentage of CD3 + cells decreased significantly with upgrading of T classification. The result of T classification and immunological parameter of two-color analysis showed that the percentage of CD3+HLA-cells and that of CD57-CD16-cells decreased significantly with upgrading of the T classification. The result of N classification and immunological parameter of single-color analysis showed that N K activity increased with upgrading of the N classification. The result of stage classification and immunological parameter of single-color analysis showed that the percentage of CD3+ cells decreased with upgrading of the stage. The result of differentiation and immunological parameter of single-color analysis showed that both the percentage of CD25+ cells decreased but that of CD16+ cells increased with upgrading of the differentiation. These findings suggested that an increase of tumor dimension inhibited T-cell immunity. Furthermore, it was speculated that histological differentiation had some effect on cellular immunity.
8. Clinico-Pathologic Studies on the Significance of Systematic Treatment of Squamous Cell Carcinoma of the Oral Regions
223
9. Combination Therapy of Intra-Arterial CBDCA Infusion and Radiation as the Initial Treatment for Locally Advanced Oral Cancer
Ichihara, H., Okutomi, T., Fujitsuka, H., Wani, T., Yasuda, S., Sakai, T., Tatematsu, N.
Department of OMS, Gifu Univ. School of Medicine, Gifu, Japan Since 1993, we have treated locally invasive oral squamous cell carcinomas (8 cases in the tongue and oral floor, 2 cases in the buccal mucosa, 3 cases in the upper alveolar and gingiva, and 2 cases in the lower alveolar and gingiva) by a combination of radiotherapy and intra-arterial chemotherapy as the initial treatment. The latter was conducted by inserting a catheter from the superficial temporal artery for one-shot CBDCA administration. The dose of CBDCA was decided by the body surface area and creatinine clearance. A total dose of 30 to 50 Gy of external radiation using 60C ~ was given. About two weeks after the initial treatment, a radical surgery of the primary site was performed. A clinical CR was obtained in 1 case, a clinical PR in 12 cases, a clinical MR in 1 case and a clinical NC in 1 case. A case of clinical PR obtained a pathological CR after the radical operation. The most problematic side effects were leukopenia and thrombocytopenia, but the appearance of stomatitis was slight.
Arasaki, A., Sunakawa, 1-1., Hiratuka, H., Kishaba, M., Tsuhako, W., Miyazato, K.
Department of Oral Surgery, School of Medicine, University of the Ryukyus, Okinawa, Japan The purpose of this study was to assess the value of systematic oral cancer treatment based on clinicopathologic malignancy grade in our clinic. Two-hundred and ten patients with oral squamous cell carcinoma were surgically operated on after induction chemotherapy based on both the clinicopathologic malignancy grade and the effects of induction chemotherapy. These cases were clinicopathologically examined to determine the value of systematic oral cancer treatment in our clinic. The subjects were 210 patients that consisted of 160 males and 50 females whose average age was 60.8 years. The clinical findings were that 128 cases were TI or T2, 82 cases were T3 or T4, 97 cases were stage I or stage II, and 113 cases were stage III or stage IV. Histologically, there were 47 cases of well-differentiated type, 139 cases of moderately-differentiated type, and 24 cases of poorly-differentiated type. Regarding the mode of cancer cell invasion, there were 64 cases of type-1 or type-2, 84 cases of type-3, 44 cases of type-4C and 18 cases of type-4D. The clinical effects of induction chemotherapy were marked in 33 cases, moderate in 82 cases, and slight or ineffective in 94 cases. The histological effects of induction chemotherapy were Grade I (Shimosato's classification) in 41 cases, Grade IIA in 46 cases, Grade. IIB in 74 cases, Grade III in 18 cases, and Grade IV in 29 cases. The total five-year cumulative survival rate was 77.0%, which was favorable.
10. The Influence of Antiemetics on the Clinical Response of Neoadjuvant Chemotherapy
Komatsu, H., Shikimori, M., Koyama, T., Yamaguchi, K., Fukuda, H., Hashimoto, K. Department of Oral-and Maxillofacial Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan Introduction In our clinic, neoadjuvant chemotherapy with THP-ADM, CDDP and PEP (TPP therapy) has shown high clinical response on oral squamous cell carcinoma. The possibility that the antiemetics will influence the pharmacokinetics of chemotherapeutic drugs has been recently investigated. In this paper, the influence of antiemetics on the primary effect of TPP therapy on oral carcinoma is discussed clinically. Materials and Methods Of the 96 cases of oral squamous cell carcinoma in which TPP therapy was applied from 1990 to 1996, 84 cases were evaluated with respect to the primary effect of TPP therapy and antiemetics. The antiemetic, granisetron, was used in 58 cases (38 males, 25 females, average age of 61.0 y.o.) (group G), and 26 cases (15 males, 11 females, average age of 59.0 y.o.) (group non-G) were treated with other antiemetics. The clinical response was evaluated within standardized guidelines set by the Japanese Society for Head & Neck Cancer.
P22-7 Diagnosis of neoplasm
4. Clinicopathological Study of Carcinoma that Developed from Oral Leukoplakia
Takano, M. 1, Kakizawa, T.1, Matsui, T.1, Yama, M. 1, Kohda, H. 1, Kawakami, S. 1, Noma, 1f. 2, lnoue, T.3 1Department of OMS, Suidobasi-Hospital, Tokyo Dental College, Tokyo, 21st Department of OMS, Tokyo Dental College, Chiba, 3Department of Pathology, Tokyo Dental College, Chiba, Japan This study involved nine cases of carcinoma that developed from oral leukoplakia over seven years from April, 1990. They were four males and five females, aged 55-74 years. Six patients had a previous oral cancer at another site. Carcinoma developed from leukoplakia occurred on the tongue in five cases, on the gingiva in two cases, on the palate in one case and on the buccal mucosa in one case. According to the clinical classification of the oral leukoplakia, the precancerous lesions were of the errosiva or verrucosa types. Malignant transformation occurred within eight months to ten years 9f the first diagnosis. Histopathological examinations of the tumors found them to be carcinoma in situ, squamous cell carcinoma, or verrucus carcinoma.
5. Clinical and Histopathological Observation of White Lesions of the Oral Mueosa with Special Reference to Oral Leukoplakia
Kaneko, T., Noutomi, T., Ito, M., Uchida, S., Watanabe, M., Chiba, H. Department of OMS, Tokyo Medical College, Tokyo, Japan Leukoplakia is one of the white lesions seen on the oral mucosa which occurs with relatively high frequency. Oral leukoplakia is called a precancerous lesion both because some types of oral leukoplakia may turn into a malignancy during their course and because part of the lesion may be histologically classified as dyskeratosis in some cases. Since its lesions present varied clinical pictures, oral leukoplakia often challenges differential diagnosis. Its diagnosis therefore requires histopathological assessment in addition to clinical observation. Clinical and histopathological observations were made in 40 cases selected from among the patients who presented at the outpatient clinic of our institution in the 36 months from January, 1994, to December, 1996, were diagnosed as having oral leukoplakia according to the W H O diagnostic criteria, and underwent biopsy. The present communication, is a report of our results of observation. The patients diagnosed with oral leukoplakia consisted of 23 males and 17 females with a mean age of 58 years (range 17-84). The lesions were located in the gingiva in 15 cases, the tongue in 12, the palate in 9, the buccal mucosa in two, the oral floor in one, and :the lip in one. The,clinical and histopathological findings of lesions at these sites were compared and assessed for clinicopathological features.
6. Histological and Radiological Analysis of Mandibular Invasion by Oral and Oropharyngeal Squamous Cell Carcinoma
Sato, T., Watanabe, A., Tochihara, S., Hirano, Y., Asada, K., Ishibashi, K. 2nd Department of Oral and Maxillofacial Surgery, Tsurumi Univ. School of Dental Medicine, Yokohama, Japan In order to assist the decision of whether or not mandiblesparing surgery is indicated, histopathological and radiological analysis was performed retrospectively in 53 cases of oral and oropharyngeal squamous cell carcinoma that had undergdiae composite resection of the mandible. Of the 53 cases, some mandibular bone reaction caused by tumor invasion was histologically confirmed postoperatively in 39 cases (32 mandibular gingiva, 3 oropharynx, 3 floor of the mouth, and 1 buccal mucosa in origin). Eight of these 39 cases had been irradiated prior to composite resection of the mandible. The histological pattern of bone invasion was either expansive or infiltrative. In cases in which expansive bone invasion had occurred, endosteal and/or periosteal new bone formation was fi'equently observed close to the front of the invading tumor tissue. Active infiltration along the periodontium by tumor cells in association with minimal destruction of alveolar bone was not seen in dentate areas. However, invasion through the impacted third molar was evident in a few cases. Mandibular invasion was generally pronounced and serious in patients who received imprudent tooth extraction within the tumor. Although invasion to the mandibular canal was detected in 8 cases, no cases showed distant infiltration from the main tumor along the canal. In 4 of the 8 cases that had been irradiated prior to resection of the mandible, the osteoblastic reaction was quite poor and cortical bone destruction sometimes occurred deep in the mandibular body. These findings suggest that in cases with nonirradiated mandibles that have shallow expansive tumor invasion, marginal resection without sacrificing the full thickness of the mandible is indicated.
7. A Study of Cellular Immunity in Head and Neck Cancer Patients
Tani, R., Sakamoto, A., Toratani, S., Osaki, T., Ochi, Y, Tanaka, Y, Zhang, Y, Michimukai, E., Sasahara, 1t., Okamoto, T. Department of Molecular Oral Medicine & Maxillofacial Surg. 1, Hiroshima Univ. Schl. of Dent., Hiroshima, Japan We have examined the subsets of lymphocytes, uninductive lymphokine-activated killer (LAK) activity, and inductive natural killer (NK) activity in 65 patients with squamous cell carcinoma. The correlations between cellular immunoreactivity and T N M classification, stage classification and histological differentiation were studied using the non-parametric Spearman test. Furthermore, we have studied the influence
P22-7 Diagnosis of neoplasm of chemotherapy, radiation, and operation on cellular immunity. The results of T classification and immunological parameter of single-color analysis showed that the percentage of CD3 + cells decreased significantly with upgrading of T classification. The result of T classification and immunological parameter of two-color analysis showed that the percentage of CD3+HLA-cells and that of CD57-CD16-cells decreased significantly with upgrading of the T classification. The result of N classification and immunological parameter of single-color analysis showed that N K activity increased with upgrading of the N classification. The result of stage classification and immunological parameter of single-color analysis showed that the percentage of CD3+ cells decreased with upgrading of the stage. The result of differentiation and immunological parameter of single-color analysis showed that both the percentage of CD25+ cells decreased but that of CD16+ cells increased with upgrading of the differentiation. These findings suggested that an increase of tumor dimension inhibited T-cell immunity. Furthermore, it was speculated that histological differentiation had some effect on cellular immunity.
8. Clinico-Pathologic Studies on the Significance of Systematic Treatment of Squamous Cell Carcinoma of the Oral Regions
223
9. Combination Therapy of Intra-Arterial CBDCA Infusion and Radiation as the Initial Treatment for Locally Advanced Oral Cancer
Ichihara, H., Okutomi, T., Fujitsuka, H., Wani, T., Yasuda, S., Sakai, T., Tatematsu, N.
Department of OMS, Gifu Univ. School of Medicine, Gifu, Japan Since 1993, we have treated locally invasive oral squamous cell carcinomas (8 cases in the tongue and oral floor, 2 cases in the buccal mucosa, 3 cases in the upper alveolar and gingiva, and 2 cases in the lower alveolar and gingiva) by a combination of radiotherapy and intra-arterial chemotherapy as the initial treatment. The latter was conducted by inserting a catheter from the superficial temporal artery for one-shot CBDCA administration. The dose of CBDCA was decided by the body surface area and creatinine clearance. A total dose of 30 to 50 Gy of external radiation using 60C ~ was given. About two weeks after the initial treatment, a radical surgery of the primary site was performed. A clinical CR was obtained in 1 case, a clinical PR in 12 cases, a clinical MR in 1 case and a clinical NC in 1 case. A case of clinical PR obtained a pathological CR after the radical operation. The most problematic side effects were leukopenia and thrombocytopenia, but the appearance of stomatitis was slight.
Arasaki, A., Sunakawa, 1-1., Hiratuka, H., Kishaba, M., Tsuhako, W., Miyazato, K.
Department of Oral Surgery, School of Medicine, University of the Ryukyus, Okinawa, Japan The purpose of this study was to assess the value of systematic oral cancer treatment based on clinicopathologic malignancy grade in our clinic. Two-hundred and ten patients with oral squamous cell carcinoma were surgically operated on after induction chemotherapy based on both the clinicopathologic malignancy grade and the effects of induction chemotherapy. These cases were clinicopathologically examined to determine the value of systematic oral cancer treatment in our clinic. The subjects were 210 patients that consisted of 160 males and 50 females whose average age was 60.8 years. The clinical findings were that 128 cases were TI or T2, 82 cases were T3 or T4, 97 cases were stage I or stage II, and 113 cases were stage III or stage IV. Histologically, there were 47 cases of well-differentiated type, 139 cases of moderately-differentiated type, and 24 cases of poorly-differentiated type. Regarding the mode of cancer cell invasion, there were 64 cases of type-1 or type-2, 84 cases of type-3, 44 cases of type-4C and 18 cases of type-4D. The clinical effects of induction chemotherapy were marked in 33 cases, moderate in 82 cases, and slight or ineffective in 94 cases. The histological effects of induction chemotherapy were Grade I (Shimosato's classification) in 41 cases, Grade IIA in 46 cases, Grade. IIB in 74 cases, Grade III in 18 cases, and Grade IV in 29 cases. The total five-year cumulative survival rate was 77.0%, which was favorable.
10. The Influence of Antiemetics on the Clinical Response of Neoadjuvant Chemotherapy
Komatsu, H., Shikimori, M., Koyama, T., Yamaguchi, K., Fukuda, H., Hashimoto, K. Department of Oral-and Maxillofacial Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan Introduction In our clinic, neoadjuvant chemotherapy with THP-ADM, CDDP and PEP (TPP therapy) has shown high clinical response on oral squamous cell carcinoma. The possibility that the antiemetics will influence the pharmacokinetics of chemotherapeutic drugs has been recently investigated. In this paper, the influence of antiemetics on the primary effect of TPP therapy on oral carcinoma is discussed clinically. Materials and Methods Of the 96 cases of oral squamous cell carcinoma in which TPP therapy was applied from 1990 to 1996, 84 cases were evaluated with respect to the primary effect of TPP therapy and antiemetics. The antiemetic, granisetron, was used in 58 cases (38 males, 25 females, average age of 61.0 y.o.) (group G), and 26 cases (15 males, 11 females, average age of 59.0 y.o.) (group non-G) were treated with other antiemetics. The clinical response was evaluated within standardized guidelines set by the Japanese Society for Head & Neck Cancer.