Human cytomegalovirus and Epstein-Barr virus infections increase the risk of death in patients with head and neck cancers receiving radiotherapy or radiochemotherapy

Abstract

Viral infections, including cytomegalovirus (CMV) and Epstein-Barr virus (EBV), play an important role in carcinogenesis and can influence patients’ prognosis and condition during cancer treatment.The goal of this study was to investigate CMV and EBV infections in patients receiving radiotherapy or radiochemotherapy due to head and neck cancers to determine the influence of these infections on the risk of death. The observation period was 2 years.Of 41 patients enrolled, 11 received radiotherapy (simultaneous-integrated boost intensity-modulated radiation therapy [SIB-IMRT], 2.25 Gy/fraction, 30 fractions, [n = 7] or IMRT, 2 Gy per fraction, 35 fractions, [n = 4]) and 30 received radiochemotherapy (cisplatin 100 mg/m2 and SIB-IMRT [n = 13] or IMRT [n = 17]). Plasma CMV and EBV DNA levels were assessed using real-time PCR before or during treatment or 4 weeks posttreatment.The risk of death in the group positive for plasma CMV or EBV deoxyribonucleic acid (DNA) was significantly higher compared to the group without detectable plasma CMV (odd ratio [OR]: 7.5, 95% confidence interval [CI]: 1.11–50.67) or EBV DNA (OR: 10.91, 95% CI: 1.135–104.8). Results were confirmed using the Bayesian method. Plasma positivity for CMV or EBV DNA was associated with a higher risk of death (both P = .04).Viral infections negatively affect the survival of patients with head and neck cancers. Diagnosing and treating these viral infections in patients with positive results should be considered.

<p>LINC00958-MYC positive feedback loop modulates resistance of head and neck squamous cell carcinoma cells to chemo- and radiotherapy in vitro</p>

“…Head and neck squamous cell carcinoma (HNSCC) accounts for the sixth most common malignancy in the world and the third most common cancer in developing countries1 and the eighth leading cause of cancer deaths in the world 2. HNSCC risk factors include tobacco smoking, alcohol consumption, infection of Epstein-Barr virus (EBV), human papilloma virus (HPV), or consumption of salted fish and meats 3–5. These risk factors induce genetic instability6 and alter expression of different genes to activate oncogenes, but inactivate tumor suppressor genes to transform normal HN epithelium to tumor cells 7,8.…”

Herpesviruses in Head and Neck Cancers

“…An analogous study was recently performed in Sudan, and CMV was identified in almost one-third of the samples, which indicated a relatively considerable association between CMV and nasopharyngeal carcinoma [70]. In addition, some observations were made in patients with head and neck cancers who were receiving radiotherapy or radiochemotherapy to determine the impact of CMV infection on the risk of death [71]. It was concluded that the risk of death in patients who tested positive for CMV in their plasma was significantly higher than in patients with no CMV detected in their plasma, so diagnosing and treating these viral infections is crucial for better cancer treatment [71].…”

“…In addition, some observations were made in patients with head and neck cancers who were receiving radiotherapy or radiochemotherapy to determine the impact of CMV infection on the risk of death [71]. It was concluded that the risk of death in patients who tested positive for CMV in their plasma was significantly higher than in patients with no CMV detected in their plasma, so diagnosing and treating these viral infections is crucial for better cancer treatment [71]. It has been shown that CMV causes an oncogenic effect through several mechanisms, including inducing cell cycle progression, chromosomal aberrations, and VEGF expression, activating cell motility and migration, and inhibiting DNA damage repair and apoptotic pathways [72].…”

Emerging Oncogenic Viruses in Head and Neck Cancers from Romanian Patients

“…Kiprian D et al quantified the DNA/CMV in plasma of patients with HNSCC under radiotherapy and chemotherapy, and for their study patients they found that plasma positivity was associated with a higher risk of death [34]. Radunovic M et al analyzed the CMV antigen in salivary glands tumors (70.6%), and they found that CMV might play an important role in the development of these kinds of tumors [35].…”