The prognosis of patients suffering from advanced-stage head and neck squamous cell carcinoma (HNSCC) remains poor. Medical gas plasma therapy receives growing attention as a novel anticancer modality. Our recent prospective observational study on HNSCC patients suffering from contaminated tumor ulcerations without lasting remission after first-line anticancer therapy showed remarkable efficacy of gas plasma treatment, with the ulcerated tumor surface decreasing by up to 80%. However, tumor growth relapsed, and this biphasic response may be a consequence of immunological and molecular changes in the tumor microenvironment that could be caused by (a) immunosuppression, (b) tumor cell adaption, (c) loss of microbe-induced immunostimulation, and/or (d) stromal cell adaption. These considerations may be vital for the design of clinical plasma trials in the future.
Cell-mediated immunological mechanisms are believed to be predominant in the pathogenesis of oral lichen planus (OLP;Lu et al., 2015). The current understanding suggests that OLP is a T-cellmediated autoimmune disease where CD8 + T cells trigger apoptosis of oral epithelial cells at the basal layer (Krupaa et al., 2015).Abnormal expression patterns of various inflammation-related cytokines reflect the immune dysregulation in the interactions between keratinocytes, T cells and many other cell types (Lu et al., 2015).With the development of cold physical plasma sources that are operated at body temperature, the application of this technology as a novel treatment modality for different diseases became fea-
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