RESUMEN
BACKGROUND: Late complications of novel organ preservation multimodal protocols for the treatment of locally advanced head and neck cancer may be underreported in the literature. METHODS AND RESULTS: We present the case of a 64-year-old man with T4 N0 M0 squamous cell carcinoma of the oropharynx, who enrolled on an organ-preservation protocol at our institution. He received 2 cycles of neoadjuvant chemotherapy with capecitabine, docetaxel, and carboplatin, followed by 2 more identical cycles given concurrently with radiotherapy. Nine months later, he was admitted to the hospital with Streptococcus pyogenes necrotizing fasciitis of the cervical region, leading to rapidly progressive septic shock. CONCLUSIONS: Severe infectious complications of chemoradiation for locally advanced head and neck cancer may occur months after completion of treatment. The recognition of these late side effects is crucial so as to accurately ascertain the long-term morbidity and benefits of organ-preservation protocols in this setting.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Fascitis Necrotizante/etiología , Neoplasias Orofaríngeas/terapia , Antibacterianos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/patología , Desbridamiento , Fascitis Necrotizante/terapia , Humanos , Masculino , Persona de Mediana Edad , Cuello/microbiología , Cuello/cirugía , Terapia Neoadyuvante/efectos adversos , Neoplasias Orofaríngeas/patología , Radioterapia Adyuvante/efectos adversos , Choque Séptico/microbiología , Lengua/microbiología , Lengua/cirugíaRESUMEN
BACKGROUND: The increased expression of the fibroblast growth factor receptor 4 (FGFR4) has been identified in many human cancers. Recently, a single nucleotide polymorphism changing the sense codon 388 from glycine to arginine was identified in the FGFR4 gene. The FGFR4 Arg(388) allele was found to be associated with a poor prognosis for positive node breast cancer, high-grade soft-tissue sarcoma, colon carcinoma, and head and neck squamous cell carcinoma (HNSCC). METHODS: We decided to verify the impact of the FGFR4 Arg(388) allele on survival as well as its association with histoclinical data in 75 cases of HNSCC. The FGFR4 Arg(388) allele was detected by PCR-RFLP and DNA sequencing. RESULTS: The FGFR4 Arg(388) allele was detected in 42.5% of the tumors (37% heterozygous Gly/Arg and 5.5% homozygous Arg/Arg). The presence of at least one Arg allele was significantly correlated with reduced overall survival after 24 months of follow-up. The cases involving the Arg allele presented an increased mortality risk of 2.2 if compared to the non-carrier cases. CONCLUSION: The FGFR4 Arg(388) allele is associated with a shortened survival.