The role of molecular strategies in the evaluation of surgical margins in oropharyngeal squamous cell carcinoma
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REVIEW
The role of molecular strategies in the evaluation of surgical margins in oropharyngeal squamous cell carcinoma Anastasios N. Kanatas Æ Andrew T. Harris Æ Michael Messenger Æ David Houghton Æ Simon N. Rogers
Received: 1 June 2009 / Accepted: 12 August 2009 / Published online: 27 August 2009 Ó Springer-Verlag 2009
Abstract The recurrence of a tumour at the resection margins in head and neck squamous cell carcinoma (HNSCC) has profound implications on the morbidity and mortality of the patient. At present HNSCC does not undergo any form of molecular analysis to aid treatment strategy and prognosticate for those individuals at higher risk of recurrence. This article aims to review current research into molecular strategies for tumour evaluation, highlighting conflicting evidence and possible novel concepts for further exploration. A. N. Kanatas (&) Oral and Maxillofacial Department, Leeds Dental Institute, The Worsley Building, Clarendon Way, Leeds LS2 9LU, UK e-mail: [email protected] A. T. Harris Oral Biology, University of Leeds, Level 6 Worsley Building, Clarendon Way, Leeds LS2 9LU, UK e-mail: [email protected] M. Messenger Tissue Engineering Research, Department of Oral Biology, Leeds Dental Institute, Leeds LS2 9LU, UK e-mail: [email protected] D. Houghton Oral and Facial Specialties Department, Pinderfields General Hospital, Aberford Road, Wakefield WF1 4DG, UK e-mail: [email protected] S. N. Rogers Regional Maxillofacial Unit, Faculty of Health, Edge Hill University, University Hospital Aintree, Aintree Trust, L9 7LN Liverpool, UK e-mail: [email protected]
Keywords Head and neck cancer Epigenetics Spectroscopy Surgical margins Oral and maxillofacial cancer
Introduction Head and neck squamous cell carcinoma (HNSCC) currently undergoes histological assessment for diagnosis. This examines the morphology, degree of differentiation and number of mitoses present in the sample. Along with histology, the size of tumour, lymph node involvement, perineural invasion vascular invasion and distant metastases are taken into account in order to tailor treatment and decide on adjuvant therapy [1]. These factors are used as predictors for ‘aggressiveness’ of the tumour and likelihood of recurrence. The recurrence of a tumour at the resection margins in HNSCC has profound implications on the morbidity and mortality of the patient [1]. Previous studies have predicted that a positive surgical margin is associated with at least doubled loco-regional recurrence and 5-year survival being almost halved [2]. However; 10–30% of patients with histologically clear resection margins will suffer loco-regional recurrence [3]. The mechanism of recurrence is not fully understood but may be due to genetically altered cells with potential to initiate new invasive tumours [4–9]. The inference being, recurrence is independent of total resection of the primary tumour, or conventional histological techniques are not able to detect populations of tumourigenic cells. At present HNSCC does not
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