Browsing by Subject "Head and neck cancer"

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  • Bossi, Paolo; Alfieri, Salvatore; Strojan, Primoz; Takes, Robert P.; Lopez, Fernando; Mäkitie, Antti; Saba, Nabil F.; Pablo Rodrigo, Juan; Bradford, Carol; Suarez, Carlos; Zafereo, Mark; Forastiere, Arlene A.; Vermorken, Jan B.; Quer, Miquel; Sanabria, Alvaro; Simo, Ricard; de Bree, Remco; Rinaldo, Alessandra; Ferlito, Alfio (2019)
    The pattern of clinical behaviour and response to treatment of recurrent and/or metastatic head and neck squamous cell carcinoma is heterogeneous. Treatment strategies that can be employed vary from potentially curative salvage surgery and re-irradiation to palliative systemic therapies and best supportive care. The advent of new therapeutic options, in terms of more sophisticated surgical approaches and techniques, highly conformal and precise radiation techniques and immunotherapy may offer improved control of disease and longer survival. Moreover, the epidemiological changes during the last decades, including the increase of human papilloma virus-related oropharyngeal primary tumors, are also reflected in the recurrent and metastatic setting. In this complex context the identification of predictive and prognostic factors is urgently needed to tailor treatment, to increase its efficacy, and to avoid unnecessary toxicities. A better knowledge of prognosis may also help the patients and caregivers in decision making on the optimal choice of care. The purpose of our review is to highlight the current evidence and shortcomings in this field.
  • Ruohoalho, Johanna; Aro, Katri; Makitie, Antti A.; Atula, Timo; Haapaniemi, Aaro; Keski-Santti, Harri; Kylanpaa, Leena; Takala, Annika; Back, Leif J. (2017)
    Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist-head and neck (ORL-HN) surgeons-have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology-head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P <0.005). The proportion of early PEG placements within 0-3 days increased from 3.6 to 14.6% (P <0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.
  • Asadi, Tayeba (Helsingin yliopisto, 2019)
    Pään ja kaulan levyepiteelisyöpä on kuudenneksi yleisin syöpätyyppi maailmassa. Yli 90 % pään ja kaulan syövistä on levyepiteelikarsinoomia, jotka käsittävät suuontelon, suunielun ja kurkunpään limakalvopintoja. Perinteisesti syöpäsolujen invaasiota ja syöpälääkkeiden tehoa on tutkittu kaksiulotteisissa (2D) soluviljelmissä. 2D-soluviljelmät eivät kuitenkaan pysty jäljittelemään alkuperäisten kasvainten mikroympäristöä, koska niissä solut kasvatetaan yksikerroksisena muovin päällä ilman luonnollista yhteyttä solunulkoiseen matriksiin. Onkologian alalla on kehitetty useita kolmiulotteisia (3D) malleja, kuten sferoideja, joilla voidaan tutkia syöpäsolujen migraatiota ja invaasiota. Hiiren Engelbreth–Holm–Swarmin sarkoomasta valmistettu kaupallinen tuote, Matrigeeli, on kolmiulotteisissa malleissa laajalti käytetty tyvikalvokomponentteja sisältävä matriksi. Matrigeelin ja useiden muiden kaupallisten matriksien, kuten rotan hännästä valmistetun tyypin I kollageenin, ongelmana on kuitenkin se, että ne eivät ole ihmiskasvainkudosperäisiä. Tämän vuoksi ne eivät pysty tarkasti mallintamaan ihmisen kasvaimen todellista mikroympäristöä. Ihmisen kohdunkaulan hyvänlaatuisista kasvaimista tutkimusryhmässämme valmistettu Myogeeli on tällä hetkellä ainoa ihmiskasvainperäinen matriksi, joka on osoittautunut erittäin toimivaksi ihmiskasvainperäisten syöpäsolujen invaasion tutkimuksessa. Esimerkiksi ihmisen suusyövästä eristetyt karsinoomasolulinjat invasoituvat huomattavasti tehokkaammin Myogeelissä kuin Matrigeelissä. Tutkielmani tavoitteena oli perehtyä suusyöpää ja karsinoomasolujen invaasiotutkimista käsittelevään kirjallisuuteen, seurata ja dokumentoida tohtoriopiskelija FK Katja Tuomaisen työskentelyä hänen valmistaessaan invaasiokokeita hammaslääketieteen laitoksen tutkimuslaboratoriossa. Tutkimusaineistonamme oli suusyöpäpotilaiden ien- ja kielinäytteet. Iennäytteestä onnistuimme eristämään syöpäsoluja ja kasvattamaan niitä Myogeeli-pohjaisessa sferoidimallissa. Kielinäyte oli huonompilaatuinen ja sen käsittely oli hankala. Tutkimuksessa testasimme myös syövän kemoterapiassa käytettyä epidermaaliseen kasvutekijä-reseptoriin sitoutuvaa vasta-ainetta, setuksimabia, näiden syöpäsolujen invaasiossa. Kokeissamme emme saaneet iennäytteestä kuin muutaman onnistuneen sferoidin johtuen todennäköisesti kudoksen käsittelyssä ilmenneistä ongelmista. Myöskään tutkimamme syöpälääke, setuksimabi, ei tässä kokeessa estänyt potilasnäytteestä eristettyjen syöpäsolulinjojen invaasiota. Kolmiulotteinen Myogeeli-pohjainen sferoidimallimme on myöhemmin ollut edelleen kehityksen kohteena ja siitä on vastikään julkaistu videoartikkeli.
  • Jouhi, Lauri; Mohamed, Hesham; Makitie, Antti; Remes, Satu Maria; Haglund, Caj; Atula, Timo; Hagstrom, Jaana (2017)
    A large subset of oropharyngeal squamous cell carcinomas (OPSCCs) is associated with HPV infection and has better outcome than non-viral-related tumors. Various malignancies also carry a role for TLRs, key activators of inflammation and innate immunity. We examined the expression of TLRs in OPSCC, and their association with HPV status and treatment outcome. TLR 5, 7, 9, and p16 were studied by immunohistochemistry and HPV status was detected with in situ hybridization in 202 tumors of consecutively treated OPSCC patients using tissue microarray method. The relations between TLR expression and HPV status, p16 expression, clinicopathological factors, and survival were analyzed. TLR 5, 7, and 9 expression patterns differed between HPV-positive and -negative tumors, and they were statistically significantly associated with history of smoking, heavy drinking, tumor site, grade, size (T), metastasis (N), and stage. Moreover, in HPV-positive tumors the expression of TLR 5 and 7 correlated with tumor recurrence. After adjustment, among HPV-positive OPSCC patients, high TLR 5 and low TLR 7 expression were associated with poor disease-specific survival. Our results indicate that TLR 5 and 7 may have a role in the prognostication of HPV-positive OPSCC, however, further studies are needed to clarify the comprehensive role of these TLRs in OPSCC.
  • Aro, Katri; Back, L.; Loimu, V.; Saarilahti, K.; Rogers, S.; Sintonen, H.; Roine, Risto Paavo Antero; Makitie, Antti (2016)
    Management of head and neck cancer influences both physical and mental wellbeing. Measuring the health-related quality of life (HRQoL) is important, as various treatment modalities are associated with significant morbidity and mortality. In this prospective cohort study, we tested the feasibility of the generic 15D HRQoL instrument in 214 head and neck cancer patients managed with surgery, definitive (chemo)radiotherapy, or with combined modality treatment. HRQoL was assessed at baseline and three times after treatment onset during 1 year, and compared with that of general population standardized for age and sex. At baseline, the patients' mean 15D score was significantly worse compared with general population. Overall HRQoL was at lowest at 3 months after treatment onset, it gradually improved towards 12 months but never reached baseline levels. The dimensions "vitality", "distress", "depression" and "sexual activity" showed marked deterioration at 3 months after the treatment onset, but improved gradually during 12 months. The 15D instrument seems useful for evaluation of HRQoL of head and neck cancer patients. Dimensions reflecting mental wellbeing improved gradually after 3 months, but they seldom reached baseline levels. The support for patients at the time of diagnosis, during treatment, and recovery is emphasized.