The clinical application of DNA content and kinetic parameters in the treatment of patients with squamous cell carcinomas of the head and neck

Abstract

Patients with squamous cell cancers of the head and neck (SCCHN) vary tremendously in their natural history and treatment outcome even amongst subgroups where the clinical and morphological parameters are similar. The ability to pretherapeutically identify individual patients and patient subgroups that differ in these regards would greatly facilitate clinical and basic science cancer research in this tumor. DNA content parameters are simple and accurate intermediate markers of a tumor's biology and reflect the fundamental process associated with the development of malignancy, chromosomal aneuploidy. In patients with SCCHN, DNA content parameters have been shown to be highly predictive of the natural history of the tumor and treatment outcome. They are also useful as intermediate markers for the study of the underlying molecular-genetic properties and processes responsible for the biological differences seen in these cancers. DNA content parameters therefore serve as fundamental 'translational' bridges in clinical and laboratory research in patients with SCCHN.

Prognostic value of clinicopathological parameters in head and neck squamous cell carcinoma: a prospective analysis

“…Both the present paper and Van Hoef et al (1993) regarding breast cancer patients have failed to confirm the clinical prognostic relevance of this new parameter. In this study, cytofluorometric analysis was performed on fresh samples, as recommended by Ensley and Maciorowski (1994) We contend that the likelihood of identifying clinically valid new prognostic factors in a non-selected population of HNSCC patients is very low. The search for new tools to aid in the therapeutic decision process is likely to be more successful in specific clinical subpopulations, i.e.…”

“…The value of ploidy as an independent prognostic parameter in heterogeneous solid tumours remains moot and controversial (Merkel and McGuire, 1990) and seems to be linked to treatment modalities (Ensley and Maciorowski, 1994). It has been reported that aneuploid tumours are more chemosensitive (Gregg, 1993) but the correlation with response to radiotherapy is not clear (Walter et al, 1991;Ensley and Maciorowski, 1994).…”

Histological Grading, Growth Fraction and DNA-Ploidy as Criteria for the Treatment of Pharyngeal and Supraglottic Squamous Cell Carcinomas: A Preliminary, Prospective Study

“…Biological parameters of tumors may help to achieve this goal. The concept of implementing these parameters in treatment policies is relatively new [8,10,23,[26][27][28][29].…”

“…Based on previous retrospective studies performed by the same and other authors in patients with squamous cell carcinomas of the upper respiratory tract [5,8,[15][16][17][21][22][23][24][25] and based on retrospective multivariate analysis of these parameters, we defined limits for tumors to be classified as low aggressive if: 2cDI was less than 3.5, 5cER less than 10%, tumor front grading less than 18, MIB1 less than 30% and PCNA less than 40%. If one of these tumor biologic criteria exceeded these limits, the tumor was classified as highly aggressive.…”

The future of radiotherapy and chemotherapy in head and neck cancer

“…Traditionally poorly differentiated tumours have had poorer prognosis with surgical management but they appear to have a signi cantly better response to chemotherapy. 7 Previously untreated patients are almost twice as likely to respond to chemotherapy as those who have undergone prior surgery or irradiation. 8,9 This is attributed to the presence of an undisturbed blood supply and better performance status and has led to the use of chemotherapy in the neoadjuvant setting in the hope of improving local control and survival.…”