Monthly Archives: July 2002

Radiation without chemo should remain standard for HNC

  • 7/25/2002
  • Orlando
  • Johns Hopkins Kimmel Cancer Center

Toxicities were significantly higher among patients receiving chemoradiation than for those who received radiation alone.

Adding chemotherapy to radiation for advanced head and neck cancer (HNC) treatment does not improve overall survival, according to preliminary results from a multicenter study presented at the 38th Annual Meeting of ASCO here. Although further patient follow-up is needed and additional studies are warranted, we continue to recommend that patients receive the current standard of care surgery followed by radiation alone,” said Arlene Forastiere, MD, professor of oncology and otolaryngology at the Johns Hopkins Kimmel Cancer Center in Baltimore. Early studies suggested that combining certain chemotherapy drugs and radiation may have a synergistic effect in [patients with advanced HNC],” she said. Our current study shows that adding cisplatin to standard radiation treatment does not significantly reduce recurrence.”

Forastiere and her colleagues evaluated 459 patients who had high-risk squamous cell carcinomas of the head and neck. After surgery to remove all detectable disease, all patients received 60 to 66 Gy in 30 to 33 fractions over 6.0 to 6.6 weeks. A group of 228 patients were randomly assigned to also receive 100 mg/m2 of IV cisplatin (Platinol, Bristol-Myers Squibb) on days 1, 22 and 43.

With a median follow-up of 26.6 months, there was no significant difference in local cancer recurrence between the two groups. The local-regional control rate was 73.8% for patients who received only radiation and 79.2% for those who received chemoradiation. The two-year overall survival rate was 56.6% with radiation and 62.9% with chemoradiation. The difference was not significant, Forastiere said. There was a significant difference in disease-free survival — 42.5% with radiation and 52.2% with chemoradiation — but the improvement came at the cost of significantly increased acute and total toxicity, she said.

Increased toxicity

About 58% of patients in the chemoradiation group were able to take all three doses of chemotherapy. The fact that many of these patients receiving combination therapy could not handle all of the chemotherapy suggests that we should look in another direction. Adding targeted drugs and those with fewer adverse events may be a better alternative,” Forastiere said. Grade-3 or higher toxicity occurred in 74.9% of patients in the chemoradiation arm, compared with 32.8% of those in the radiation-only arm. Most of the events related to cisplatin were from hematologic, mucous membrane or gastrointestinal toxicities. These were consistent with typical adverse events from chemotherapy, according to the study. Three patients receiving chemoradiation died during the study. There were no study deaths in the radiation-only group.

For more information:

*Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiochemotherapy in high-risk SCCA of the head and neck: initial report of RTOF 9501/Intergroup phase III trial. Abstract #903. Presented at the 38th Annual Meeting of ASCO. May 18-21, 2002. Orlando, Fla.

July, 2002|Archive|

Self-Hypnosis may cut stress, Boost Immune System

  • * 7/24/2002
  • New York
  • Rueters Health

A number of studies have suggested stress can hinder the body’s immune system defenses. Now researchers say people may be able to fight back with the stress-relieving techniques of self-hypnosis. In a study of medical students under exam-time stress, investigators found that those who received “hypnotic-relaxation training” did not show the same reduction in key immune system components that their untrained counterparts did. Janice K. Kiecolt-Glaser and colleagues at Ohio State University in Columbus reported the findings recently in the Journal of Consulting and Clinical Psychology.

The researchers looked at 33 medical and dental students during relatively low-stress periods and around the time of the first major exam of the term. Half of the students attended sessions where they learned to relax through self-hypnosis. Kiecolt-Glaser’s team took blood samples from all students at the start of the study and just before exams. They exposed the samples to foreign substances in order to observe the activity of T cells and other immune system defenses. The investigators found that during exam time, the self-hypnosis students launched stronger immune responses compared with students who did not learn the technique. And the more often students practiced the relaxation strategy, the stronger their immune response.

In previous studies, Kiecolt-Glaser and her colleagues have found that stressful times may impair the body’s wound-healing process and response to vaccination. They and other researchers have also found that relaxation techniques may combat these effects by relieving stress and boosting the immune system. “The data from this study provide encouraging evidence that interventions may reduce the immunological dysregulation associated with acute stressors,” they write.

The authors add that some of the strongest evidence for the benefits of self-hypnosis, in particular, comes from studies of surgical patients. This work has suggested the technique can reduce patients’ pain and anxiety, shorten hospital stays and speed recovery. “Given the substantial consequences of stress for wound repair,” the researchers conclude, “even small diminutions in stress or anxiety among surgery patients could have substantial clinical consequences.” SOURCE: Journal of Consulting and Clinical Psychology 2001;69.

July, 2002|Archive|

French Anti-Smoking Campaign Shocks With Images Of Dying Man

  • 7/23/2002
  • Paris, France

A new anti-smoking campaign in France hopes to shock smokers into kicking the habit – using real-life images of a man dying of lung cancer.

The health warning, which screened on television for the first time Monday, depicts an emaciated 49-year-old man sitting on his bed, five days before his death.

“This is just a smoker, who started at 14, when you think you’re immortal,” says a voice on the 27-second film. “He could never stop.” Images of the man’s life appear on his bedroom wall throughout the film, which ends with a warning: “Starting at 14 is fatal.” The man shown, Richard Gourlain, had his wife film him hoping the footage could be used to discourage others from smoking, said Gerard Dubois, president of the National Anti-Smoking Committee that produced the film. Gourlain died in 1999.

“You can say it’s sensational, it’s too tough – but we wanted to show the truth,” said Dubois. “These images correspond to reality.” The French committee decided to use shock tactics having seen the success of reality-based anti-smoking campaigns in Anglo-Saxon countries, he said. “The tobacco industry lies to promote its products – all we have to do to destroy them is tell the truth,” he said.

Another anti-smoking campaign screened on television and printed in newspapers last month alarmed many smokers. The warning said a commonly consumed product had been found to contain toxic substances. It invited people to phone a toll-free number for information. Half-a-million people called, and were told that the product was the cigarette. The National Health Institute for Prevention and Education, which dreamed up the campaign, said it was a big success.

Smokers in France bought 83 billion cigarettes last year, about 1 percent more than in 2000, according to the Center for Documentation and Information about Tobacco, an association of tobacco companies and tobacconists. Around 60,000 people die in France each year of smoking-related illnesses, according to the National Health Institute for Prevention and Education.

July, 2002|Archive|

Most Family Physicians Don’t Check For Signs Of Oral Cancer

  • 7/21/2002
  • Maryland
  • Nancy Volkers
  • InteliHealth News Service

Family physicians are aware of the risks for oral cancer, but some don’t ask their patients about risky behaviors and most don’t complete oral exams that could detect early cancer.

Researchers at the federal government’s National Institute of Dental and Craniofacial Research surveyed 240 Maryland physicians about their knowledge and practices related to oral cancer. They found that 77 percent of the physicians asked patients questions about their risk factors, but only 24 percent provided oral cancer exams to their patients aged 40 and older. (Most cases of oral cancer are found in people over 40.)

More than 60 percent of the surveyed physicians said they would be interested in a continuing education course on oral cancer. The study was published in the July issue of Oral Oncology.

Oral cancer makes up about 3 percent of all cancers diagnosed in the United States, but it is the sixth most common cancer worldwide. The two main risk factors are heavy alcohol use and use of tobacco products. More than half of oral cancers are not detected until advanced stages, when a cure is less likely.

Dentists regularly check for signs of oral cancer when they see patients, so regular visits to a dentist can help ensure that oral cancer is caught when it can be treated successfully.

OCF Note: We disagree with the last paragraph of this news article. In our own focus groups of the dental community we have found this to not be the case. OCF Founder and Executive Director Brian Hill has written an editorial appearing in a national dental trade publication this month regarding this same issue. Click here to read the editorial.

July, 2002|Archive|

Preventing Lung Cancer in Smokers

  • 7/2/2002
  • British Columbia
  • Jennifer Warner
  • WebMD Medical News

For the first time, researchers say they’ve found a drug that can actually reduce the risk of lung cancer in both former and current smokers. Stephen Lam, MD, of the British Columbia Cancer Agency, and colleagues found that a drug originally used to treat dry mouth — known as anethole dithiolethione or ADT (sold under the names Sialor or Sulfarlem) — may effectively prevent lung cancer in some people at risk.

Their study followed 101 current and former smokers who had an irregular growth in their lungs and were at high risk for developing lung cancer. After six months, those who’d taken ADT three times a day had about half the number of growths become cancerous, and developed fewer new growths, than did those who took a placebo. The findings appear in the July 3 issue of the Journal of the National Cancer Institute.

The study authors suggest that the drug works like an antioxidant — seeking out cancer-causing free radicals and destroying them.

The best way to reduce lung cancer risk is to never start smoking, or to quit if you’ve already picked up the habit. But even in those who’ve quit, the increased risk of lung cancer never completely disappears. That’s why researchers say it’s important to find some sort of drug therapy to reduce the risk of lung cancer in former smokers. “When people give up smoking late in life, the risk of lung cancer does not go away,” Lam says in a news release. In fact, 50% of lung cancer patients are former smokers. Side effects of ADT included minor stomach or intestinal problems that were easily resolved.

Lam says the next step is to determine if ADT can prevent cancer from coming back in people with head or neck cancers or those who have had surgery to remove early stage cancers in the mouth, lung, or esophagus.

July, 2002|Archive|