PMC:3730145 / 10682-13271 JSONTXT

{"project":"2_test","denotations":[{"id":"23970998-19189340-82904813","span":{"begin":164,"end":166},"obj":"19189340"},{"id":"23970998-5078617-82904814","span":{"begin":573,"end":575},"obj":"5078617"},{"id":"23970998-6698878-82904814","span":{"begin":573,"end":575},"obj":"6698878"},{"id":"23970998-16960038-82904814","span":{"begin":573,"end":575},"obj":"16960038"},{"id":"23970998-16960038-82904815","span":{"begin":1049,"end":1051},"obj":"16960038"},{"id":"23970998-1399785-82904816","span":{"begin":1259,"end":1261},"obj":"1399785"},{"id":"23970998-23078236-82904817","span":{"begin":1524,"end":1526},"obj":"23078236"},{"id":"23970998-22182209-82904818","span":{"begin":1528,"end":1530},"obj":"22182209"},{"id":"23970998-11245242-82904819","span":{"begin":1532,"end":1534},"obj":"11245242"},{"id":"23970998-21539605-82904820","span":{"begin":1941,"end":1943},"obj":"21539605"},{"id":"23970998-6698878-82904821","span":{"begin":2421,"end":2423},"obj":"6698878"},{"id":"23970998-11245242-82904822","span":{"begin":2429,"end":2431},"obj":"11245242"},{"id":"23970998-17559521-82904823","span":{"begin":2433,"end":2435},"obj":"17559521"},{"id":"T97459","span":{"begin":164,"end":166},"obj":"19189340"},{"id":"T23037","span":{"begin":573,"end":575},"obj":"5078617"},{"id":"T39884","span":{"begin":573,"end":575},"obj":"6698878"},{"id":"T66418","span":{"begin":573,"end":575},"obj":"16960038"},{"id":"T12606","span":{"begin":1049,"end":1051},"obj":"16960038"},{"id":"T1124","span":{"begin":1259,"end":1261},"obj":"1399785"},{"id":"T45885","span":{"begin":1524,"end":1526},"obj":"23078236"},{"id":"T8589","span":{"begin":1528,"end":1530},"obj":"22182209"},{"id":"T47185","span":{"begin":1532,"end":1534},"obj":"11245242"},{"id":"T31500","span":{"begin":1941,"end":1943},"obj":"21539605"},{"id":"T62509","span":{"begin":2421,"end":2423},"obj":"6698878"},{"id":"T29979","span":{"begin":2429,"end":2431},"obj":"11245242"},{"id":"T51773","span":{"begin":2433,"end":2435},"obj":"17559521"}],"text":"2.2. Comparative Treatment Modalities: HNSCC and FOSCC\nThe most common initial management strategy for HNSCC includes surgery and/or radiation in \u003e65% of patients [20]. Similar to people, local disease control is the mainstay of therapy in cats with FOSCC. Given the advanced stage at diagnosis in most feline patients, local surgical excision is not considered a curative treatment. The mandible is considered the anatomic region most amenable to surgical resection and when deemed feasible in select cases, mandibulectomy results in median survival times of 5–12 months [26–30]. Given the importance of both functional outcome and primary tumor control, surgical decisions must account for both morbidity and the likelihood of achieving complete excision. In one study, acute and long-term postoperative morbidity were observed in 98% and 76% of the cats, respectively, with 12% of cats never regaining functional ability to eat. Despite curative-intent surgical approaches, 48% of tumor specimens had evidence of residual disease histologically [30]. In one small study, the combination of mandibulectomy and radiation therapy (RT) resulted in a median survival of 14 months, suggesting that for select cases, a better long-term prognosis may be feasible [31].\nRadiation therapy is the primary treatment modality for unresectable local disease. Radiation therapy as a single-agent therapy results in overall response rates of 54%–70%, median progression-free intervals of 1.8–3.5 m, and median survival times of 2–5.8 m [22, 32, 33]. Similar to human studies, in cats chemotherapy as a single agent for primary tumor control is considered ineffective [21]. However, adjuvant chemotherapy may have a role in both local tumor control as well as metastatic spread. Cisplatin is routinely used in HNSCC, and a similar protocol using a combination of radiation and carboplatin chemotherapy resulted in a median survival of 5.4 months in cats [34]. Given the hypoxic nature of these tumors, gemcitabine and etanidazole have been investigated in cats as hypoxia/radiosensitizers, with response rates of 75%–100% yet rapid progression with median survival times of approximately 3.7 months [35]. \nDespite therapy, most cats are euthanized due to local disease progression and the severity of subsequent clinical signs. Overall, median survival times are generally between 2 and 4 months, with a one-year survival of only 10% [27, 29, 33, 36]. While disappointing, these numbers underscore the potential to institute investigational therapies in cats with rapid timelines for study completion.\n\n"}