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P49. Relationship between plasma Epstein–Barr virus DNA levels and stage of nasopharyngeal carcinoma in Singapore
S90
Abstracts / Oral Oncology 47 (2011) S74–S156
recurrence; the expression of only a subset of the tumor markers in saliva indicates that the marker database needs to be screened thoroughly to enable their application in salivary diagnostics. doi:10.1016/j.oraloncology.2011.06.291
P49. Relationship between plasma Epstein–Barr virus DNA levels and stage of nasopharyngeal carcinoma in Singapore K. Sommat National Cancer Centre, Singapore Introduction: Epstein–Barr virus is well known to be etiologically related to nasopharyngeal carcinoma. There are many studies that evaluated the role of EBV serology in the pathogenesis of NPC. These studies have also demonstrated the utility of EBV serology as a promising tumour marker in staging, prognosis and post treatment surveillance of patients with NPC. We aim to determine the relationship between plasma EBV DNA levels and the stage of NPC. Methods: We conducted a retrospective review of 161 patients with histologically confirmed NPC referred to Department of Radiation Oncology of National Cancer Centre, Singapore between January 2009 and December 2009. The patients were staged using the 6 edition AJCC system. Their plasma EBV DNA copies were determined with in-house quantitative real-time polymerase chain reaction targeted at conserved region of EBNA-1 gene of Epstein–Barr virus. Using the upper limit cut off for detectable EBV copies of 715, EBV serology values at diagnosis were reviewed and statistical analysis was done to investigate the relationship between EBV DNA values and the stage of NPC. Results: A total of 161 patients with eligible medical records were identified. (Stage: I: 7 patients, IIA: 1 patient, IIB: 25 patients, III: 61 patients, IVA: 33 patients, IVB: 29 patients, IVC: 5 patients). Discussion: Statistical Analysis in Progress, final results will be presented at the conference. doi:10.1016/j.oraloncology.2011.06.292
P50. 2-[18F]fluoro-2-deoxy-D-glucose PET can be utilized as a biological marker for predicting the hypoxic status of tongue cancer G.-C. Park *, M.-W. Han, J.-L. Roh, S.-H. Choi, S.-Y. Nam, S.-Y. Kim Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Introduction: Tumor hypoxia is associated with resistance to therapy and with poor prognosis in patients with solid tumors, including head-and-neck squamous cell carcinoma (HNSCC). Tumor hypoxia can be estimated indirectly by 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET), by measuring the extent of FDG uptake. To determine whether FDG-PET could serve as a useful technique predicting tumor hypoxia and prognosis in patients with tongue cancer, we assessed the relationship between FDG uptake and the levels of hypoxia-associated markers. Methods: We enrolled 33 patients with T2-stage tongue SCC who underwent FDG-PET imaging before treatment. Tumor uptake of FDG was assessed by measuring maximum standardized uptake values
(SUVmax). Expression of the hypoxia markers, hypoxia-inducible factor (HIF)-1, carbonic anhydrase (CA)-9, glucose transporter (GLUT)-1, and erythropoietin receptor (EPOR), was determined immunohistochemically. Pearson’s correlation coefficients were used to assess correlation between SUVmax and the expression of each hypoxic marker, and multivariate analysis was performed to determine what parameters affected clinical outcomes. Results: The median SUVmax of primary tongue masses was 5.05, and 19 patients had SUVmax > 5.05. We observed strong correlations between SUVmax and expression of HIF-1 (r = 0.403, p < 0.05), CA-9 (r = 0.563, p < 0.01), and GLUT-1 (r = 0.515, p < 0.01). Disease-free survival (DFS) differed significantly in patients with SUVmax 65.05 and >5.05 (p = 0.03). Multivariate analysis showed that SUVmax (p = 0.01), HIF-1 expression (p = 0.01), and histologic tumor grade (p = 0.04) were significant independent predictors of DFS, whereas SUVmax (p = 0.02) and histologic grade (p = 0.04) were prognostic of OS. Discussion: SUVmax as measured by FDG-PET may be a good noninvasive biomarker for prediction of hypoxic status and prognosis of tongue cancer patients.
doi:10.1016/j.oraloncology.2011.06.293
P51. Oral maxillary squamous cell carcinoma: A case series J. Ip *, S. Balasundram, W.M. Wan Mustafa Department of Oral Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia Background: Squamous cell carcinoma (SCC) of the maxillary gingiva, maxillary alveolus and hard palate is a relatively rare neoplasm. There are not many studies looking exclusively at oral maxillary SCC and its management. Objective: This clinical audit is aimed to describe the clinical characteristics, treatment modalities, local and regional recurrences and survival of patients with oral maxillary SCC. Setting: Department of Oral Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. Patients and methods: We retrospectively studied 10 patients diagnosed with maxillary SCC over an eight year duration between January 2002 and December 2009. These patients underwent ablative surgery with or without elective neck dissection, neoadjuvant or adjuvant chemo-radiotherapy. Records detailing the staging, treatment modality, presence of nodal metastasis and recurrence were assessed and information collated. Results: The 10 patients in this study were within the age range of 34–78 years (mean 57.8 years). Two patients were treated with maxillectomy only, while 7 patients had maxillectomy and adjuvant radiotherapy. One patient had concurrent chemo-radiotherapy and surgery. Four patients had clinically evident neck nodes and underwent neck dissections. Of these, 2 had histologically positive nodes. One patient had regional metastasis to the contralateral neck nodes at 17 months post-operatively and 1 patient died of the disease 6 months post-operatively. Three patients had recurrences. Two patients had recurrence in the vicinity of the primary site while 1 patient had contralateral nodal metastasis. Six out of the 10 patients were alive without disease at the end of the study period. Conclusion: In this small series of oral maxillary SCC, cervical metastasis from cancer was noted in half of the patients who underwent elective neck dissections. Elective selective neck dissection
Abstracts / Oral Oncology 47 (2011) S74–S156
recurrence; the expression of only a subset of the tumor markers in saliva indicates that the marker database needs to be screened thoroughly to enable their application in salivary diagnostics. doi:10.1016/j.oraloncology.2011.06.291
P49. Relationship between plasma Epstein–Barr virus DNA levels and stage of nasopharyngeal carcinoma in Singapore K. Sommat National Cancer Centre, Singapore Introduction: Epstein–Barr virus is well known to be etiologically related to nasopharyngeal carcinoma. There are many studies that evaluated the role of EBV serology in the pathogenesis of NPC. These studies have also demonstrated the utility of EBV serology as a promising tumour marker in staging, prognosis and post treatment surveillance of patients with NPC. We aim to determine the relationship between plasma EBV DNA levels and the stage of NPC. Methods: We conducted a retrospective review of 161 patients with histologically confirmed NPC referred to Department of Radiation Oncology of National Cancer Centre, Singapore between January 2009 and December 2009. The patients were staged using the 6 edition AJCC system. Their plasma EBV DNA copies were determined with in-house quantitative real-time polymerase chain reaction targeted at conserved region of EBNA-1 gene of Epstein–Barr virus. Using the upper limit cut off for detectable EBV copies of 715, EBV serology values at diagnosis were reviewed and statistical analysis was done to investigate the relationship between EBV DNA values and the stage of NPC. Results: A total of 161 patients with eligible medical records were identified. (Stage: I: 7 patients, IIA: 1 patient, IIB: 25 patients, III: 61 patients, IVA: 33 patients, IVB: 29 patients, IVC: 5 patients). Discussion: Statistical Analysis in Progress, final results will be presented at the conference. doi:10.1016/j.oraloncology.2011.06.292
P50. 2-[18F]fluoro-2-deoxy-D-glucose PET can be utilized as a biological marker for predicting the hypoxic status of tongue cancer G.-C. Park *, M.-W. Han, J.-L. Roh, S.-H. Choi, S.-Y. Nam, S.-Y. Kim Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea Introduction: Tumor hypoxia is associated with resistance to therapy and with poor prognosis in patients with solid tumors, including head-and-neck squamous cell carcinoma (HNSCC). Tumor hypoxia can be estimated indirectly by 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET), by measuring the extent of FDG uptake. To determine whether FDG-PET could serve as a useful technique predicting tumor hypoxia and prognosis in patients with tongue cancer, we assessed the relationship between FDG uptake and the levels of hypoxia-associated markers. Methods: We enrolled 33 patients with T2-stage tongue SCC who underwent FDG-PET imaging before treatment. Tumor uptake of FDG was assessed by measuring maximum standardized uptake values
(SUVmax). Expression of the hypoxia markers, hypoxia-inducible factor (HIF)-1, carbonic anhydrase (CA)-9, glucose transporter (GLUT)-1, and erythropoietin receptor (EPOR), was determined immunohistochemically. Pearson’s correlation coefficients were used to assess correlation between SUVmax and the expression of each hypoxic marker, and multivariate analysis was performed to determine what parameters affected clinical outcomes. Results: The median SUVmax of primary tongue masses was 5.05, and 19 patients had SUVmax > 5.05. We observed strong correlations between SUVmax and expression of HIF-1 (r = 0.403, p < 0.05), CA-9 (r = 0.563, p < 0.01), and GLUT-1 (r = 0.515, p < 0.01). Disease-free survival (DFS) differed significantly in patients with SUVmax 65.05 and >5.05 (p = 0.03). Multivariate analysis showed that SUVmax (p = 0.01), HIF-1 expression (p = 0.01), and histologic tumor grade (p = 0.04) were significant independent predictors of DFS, whereas SUVmax (p = 0.02) and histologic grade (p = 0.04) were prognostic of OS. Discussion: SUVmax as measured by FDG-PET may be a good noninvasive biomarker for prediction of hypoxic status and prognosis of tongue cancer patients.
doi:10.1016/j.oraloncology.2011.06.293
P51. Oral maxillary squamous cell carcinoma: A case series J. Ip *, S. Balasundram, W.M. Wan Mustafa Department of Oral Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia Background: Squamous cell carcinoma (SCC) of the maxillary gingiva, maxillary alveolus and hard palate is a relatively rare neoplasm. There are not many studies looking exclusively at oral maxillary SCC and its management. Objective: This clinical audit is aimed to describe the clinical characteristics, treatment modalities, local and regional recurrences and survival of patients with oral maxillary SCC. Setting: Department of Oral Surgery, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. Patients and methods: We retrospectively studied 10 patients diagnosed with maxillary SCC over an eight year duration between January 2002 and December 2009. These patients underwent ablative surgery with or without elective neck dissection, neoadjuvant or adjuvant chemo-radiotherapy. Records detailing the staging, treatment modality, presence of nodal metastasis and recurrence were assessed and information collated. Results: The 10 patients in this study were within the age range of 34–78 years (mean 57.8 years). Two patients were treated with maxillectomy only, while 7 patients had maxillectomy and adjuvant radiotherapy. One patient had concurrent chemo-radiotherapy and surgery. Four patients had clinically evident neck nodes and underwent neck dissections. Of these, 2 had histologically positive nodes. One patient had regional metastasis to the contralateral neck nodes at 17 months post-operatively and 1 patient died of the disease 6 months post-operatively. Three patients had recurrences. Two patients had recurrence in the vicinity of the primary site while 1 patient had contralateral nodal metastasis. Six out of the 10 patients were alive without disease at the end of the study period. Conclusion: In this small series of oral maxillary SCC, cervical metastasis from cancer was noted in half of the patients who underwent elective neck dissections. Elective selective neck dissection