Yearly Archives: 2004

Coming between cowboys and chew

  • 12/30/2004
  • Ken Carlson
  • The Modesto Bee (modbee.com)

Health agency out to get Oakdale Rodeo to sever ties with maker of snuff

A campaign backed by the Stanislaus County Health Services Agency is trying to buck a tobacco company’s sponsorship of the Oakdale Rodeo.
And since the Oakdale Saddle Club, which puts on the rodeo every April, so far has refused to cut ties with the U.S. Smokeless Tobacco Co., the Health Services Agency plans another tack: a billboard due to go up next week along Highway 108 between Riverbank and Oak-dale.

The message: “Don’t let spit tobacco stain our rodeo.”

“Spit tobacco” is smokeless tobacco, such as Copenhagen and Skoal, two of U.S. Smokeless Tobacco’s products. The company is the leading producer of brand-name smokeless tobacco, also called chew and snuff.

The Buck Tobacco Sponsorship campaign is targeting rodeos in Stanislaus, Monterey, San Luis Obispo, Santa Barbara and San Diego counties. Campaign officials said rodeos are family events where cancer-causing products, such as tobacco, should not be promoted.

Michael Wagner, an Oakdale Saddle Club board member who oversees sponsorships, said he has talked with Buck Tobacco campaign officials for several months. As of now, the club has no intention of ending its relationship with U.S. Smokeless Tobacco, he said. But, he added, the club will ensure that the smokeless tobacco sampling tent at 2005’s rodeo will be nowhere near concessions that attract youngsters.

“We want to work with them, as best we can, so we can retain the benefits of the sponsorship,” Wagner said. “We are sensitive to what they are trying to do.”

At the 2004 rodeo, U.S. Smokeless Tobacco set up its sampling tent near the entrance gate and close to a concession that attracted young people, said Mark Loeser, tobacco education director for the Health Services Agency.

“If you were 18 and up, you could get free Copenhagen as you walked into the rodeo grounds,” Loeser said. “Right next to the sampling tent, they had a mechanical bull where kids pay $5 to ride a bull.”

Spectators, young and old, also saw the tobacco company’s name on a scoreboard and arena banners, he said suivant.

“What the tobacco company is trying to do is hook the next generation of users,” Loeser said.

Habitual use of smokeless tobacco puts people at higher risk of oral cancer, gum disease and heart ailments, according to health officials.

Tobacco industry money used

The nonprofit Public Health Institute is funding Buck Tobacco with tobacco company money, collected in the settlements of three lawsuits against the chewing tobacco industry. Stanislaus County got $90,000. The Health Services Agency is trying to get Oakdale community leaders, teachers and students behind the Buck Tobacco campaign.

Mike Bazinet, spokesman for Connecticut-based U.S. Smokeless Tobacco, said the company brings in a scoreboard for the Oakdale Rodeo and gives the Saddle Club a few thousand dollars in sponsorship money. In exchange, the company can display its name and give away samples at the rodeo. He said sampling tent personnel check identification to ensure that only adults are admitted. The company also is a major sponsor of the Professional Rodeo Cowboys Association, which sanctions the Oakdale event and hundreds of other rodeos.

“We feel that the sport has benefited from the association over time,” Bazinet said. “Historically, there have not been many national sponsors of the sport.”

The company provides giant traveling electronic boards that display cowboy names and scores. And, like scoreboards in football and baseball stadiums, the tobacco company boards display cheering messages, and community messages, too. Wagner said it would cost upward of $200,000 for the Saddle Club to buy a scoreboard. He said the club is open to a local sponsor providing a scoreboard, but no one has stepped forward. Mayor Pat Kuhn said the anti-tobacco campaign should focus on securing other sponsorship money for the Saddle Club.

“If they don’t want it there, they should become part of the solution,” she said. “This is a big event for our community.”

Volunteers can seek sponsors

Loeser said the grant does not authorize the county agency to solicit sponsors, but that can be done by campaign volunteers. He said he hopes to set up additional meetings with the Saddle Club in the next few months. Other sponsors of the Oakdale Rodeo include Budweiser, Coca-Cola, Fireside Dodge and Western Warehouse. Wagner said he regards U.S. Smokeless Tobacco as a responsible corporate sponsor, but said he also understands the antitobacco effort. He is co-chairman of the Stanislaus County Sheriff’s Posse Rodeo, a Turlock event that rejects tobacco company sponsorships.

“It would be nice to work out an amicable solution,” he said.

December, 2004|Archive|

COX-2 expression correlates with VEGF-C and lymph node metastases in patients with head and neck squamous cell carcinoma

  • 12/29/2004
  • Panayiotis A Kyzas1, Dimitrios Stefanou1 and Niki J Agnantis1
  • Modern Pathology (2005) 18, 153-160, advance online publication, 23 July 2004

Recent observations suggest an implication of the cyclooxygenase-2 (COX-2) in tumor lymphangiogenesis through an upregulation of vascular endothelial growth factor-C expression. It is unknown whether this mechanism also acts in squamous cell carcinoma of the head and neck region.

We performed a retrospective study of 70 patients with head and neck squamous cell carcinoma in order to investigate whether COX-2 immunohistochemical expression correlates with vascular endothelial growth factor-C expression. We also examined the association of the expression of these molecules with clinicopathologic parameters (especially lymph node status) and outcome for these patients. We performed immunostaining on formalin-fixed, paraffin-embedded tissue sections by the routine streptavidin-biotin peroxidase labeled procedure.

Increased cyclooxygenase-2 expression was observed in 30 of the 68 tumor samples (44%), while high vascular endothelial growth factor-C expression occurred in 26 of the 68 tumor samples (38%). High expression of the two proteins was correlated with the presence of lymph node metastasis at the time of diagnosis, and the observed association was even stronger when there was overexpression for both the antibodies (P<0.001). High expression of vascular endothelial growth factor-C, but not of COX-2 was correlated with increased mortality in patients with oral-larynx squamous cell carcinoma.

When multivariate Cox regression model was applied, the presence of lymph node metastasis at the time of diagnosis, combined with overexpression of both the antibodies, was the only independent prognostic factor for mortality of these patients.

Our results suggest that a lymphangiogenic pathway, in which COX-2 overexpression stimulates vascular endothelial growth factor-C upregulation, probably exists in head and neck squamous cell carcinoma. Also, the predictive ability for mortality of regional lymph node metastasis can be improved with the combined evaluation of the immunohistochemical expression of these two proteins.

Authors:
Panayiotis A Kyzas(1), Dimitrios Stefanou(1) and Niki J Agnantis(1)

Authors’ affiliation:
(1)Department of Pathology, University of Ioannina, Medical School, Ioannina, Greece

December, 2004|Archive|

Ex-smoker uses voice he has left as warning

  • 12/29/2004
  • no attribution
  • The Tennessean (Tennessean.com)

Hugh Hankins talks into a small electronic microphone held to the hole in his throat. If you’ve made a New Year’s resolution to quit smoking, you might want to listen to what he has to say about what cigarettes did for him.

”In 1978, I had 28 grand mal brain seizures,” Hankins told me, his voice sounding like those anonymous hidden sources you see on the television news. To speak, he presses the button on his microphone. His mouth moves, but the only sound that comes out is from the hole.

”I was in a coma for a week. In 1984, I developed throat cancer. I had 28 radiation treatments. Back then, they shot you in both sides of your throat — just burned you up. About six months after, they did a total laryngectomy. They cut you straight across the throat. I have no voice at all. I have no smell at all.”

Hankins’ tale is hard to listen to, both because he is difficult at times to understand and because it’s full of so many painful experiences. He has had a collapsed esophagus, a brain tumor, prostate cancer and is now on total disability. Now and then, he has to have the hole in his throat enlarged when it starts closing up.

His doctors believe the majority of his health problems were caused from his long history of smoking. Still, he said, ”I’m not complaining.” He’s happy just to be alive.

See how good cigarettes are for you?

Hankins now volunteers with the American Cancer Society, speaking to throat cancer patients and school groups to urge teens and grown-ups to quit smoking. He is president of the New Voice Club, a group of fellow laryngectomy survivors that gets together routinely.

”I’ll have to use this for the rest of my life,” he said, pointing with the microphone. ”That’s all right. There’s 127 people like me in Middle Tennessee.”

Hankins, who is 71, started smoking when he was 8.

”All the boys I grew up with smoked. I went to school with boys who were 18 years old,” he said. ”I grew up in Houston County. I couldn’t afford cigarettes, but I’d go out behind the tobacco barn, pinch some and roll my own.”

He quit in 1985, after his throat cancer was diagnosed. Even then, he didn’t want to.

”I quit in the parking lot of the hospital before I started radiation,” he said. ”I smoked that last one down to the butt.”

A traveling salesman by trade, Hankins spent years on the road smoking in airplanes (it was legal back then), in hotel rooms and in cars. When he called on department stores, they all allowed smoking in their lobbies. At his peak, he would go through three packs in a day.

”I’d just sit and smoke, sit and smoke,” he said.

Hankins’ story moved me, because I’ve been there, too. When I started at The Tennessean in 1978, I was 16 years old. Everybody smoked in the newsroom. Members of my family smoked. It was easy to join in and light up. After numerous failed tries, I finally quit smoking on Christmas Day 1990. It remains one of the hardest things I’ve ever done. Trust me, I’m not preaching. It’s hell to quit. You’ve got to want it bad. You’ve got to dig deep and find willpower beyond anything you’ve done to date. There is help.

If you need inspiration, classes or information about really quitting this time, call the American Cancer Society at 1-800-ACS-2345. Don’t wait until someone has to cut a hole in your throat.

Make 2005 the year you kicked butt.

December, 2004|Archive|

Alcohol May Fuel Cancer Tumor Growth

  • 12/27/2004
  • Kelli Miller Stacy
  • msn.health (content.health.msn.com)

Researchers say they have discovered a new clue as to how alcohol may speed up cancer progression. Since the early 1900s, alcohol consumption has been linked to cancer, particularly of the esophagus, stomach, liver, and even the breast. Doctor’s know that the more alcohol you drink, the higher your risk, but the exact role alcohol plays in cancer progression has remained a mystery.

Now scientists say they’ve unraveled the clues behind this alcohol-cancer connection. A preliminary study, published in the Jan. 15, 2005 issue of the journal CANCER, shows, for the first time, that alcohol fuels the production of a growth factor that helps create new blood vessels inside a tumor, a process called angiogenesis. Production of these new blood vessels helps feed tumor cells.

Jian-Wei Gu, MD, and colleagues from the University of Mississippi Medical Center, injected chick embryos, which contained cancer cells, with either salt water or alcohol for nine days. The alcohol content injected into the embryos was equivalent to what the researchers say is chronic alcohol administration.

Based on their previous studies they say that light to moderate amounts of alcohol can induce new blood vessel growth. Embryos exposed to the alcohol had more than eight times the amount of cancer cells in their blood vessels than the saline-exposed embryos.

The researchers also noted significant increases in tumor size and tumor blood vessel density, and higher levels of the vascular endothelial growth factor (VEGF) — a protein involved in the growth of new blood vessels in the alcohol-exposed embryos.

The findings support existing theories that alcohol accelerates the production of growth factors and new blood vessels that foster cancer growth. This “represents an important mechanism of cancer progression associated with alcoholic beverage consumption,” the authors say, in a news release.

December, 2004|Archive|

Knife boon for cancer

  • 12/24/2004
  • Calcutta, India
  • SANJAY MANDAL
  • The Telegraph

S.K. Ladla was having difficulty in swallowing and his voice had become hoarse. The doctors diagnosed the 65-year-old to be suffering from laryngo pharynx cancer — the most common variety of cancer among males in the city.

In the past, such patients had no option but to go in for radiotherapy, as surgery was not possible. But not any more. Doctors at Advanced Research and Medicare Institute removed Ladla’s larynx and pharynx, and reconstructed his foodpipe with a free flap from the forearm.

Indirect laryngoscopic examinations had earlier revealed a large growth involving the larynx, pharynx, respiratory pipe and the foodpipe. The cancer was detected after direct laryngoscopic biopsy, and a CT scan found that it was locally advanced, affecting both pipes.

“Since the cancer was locally advanced, we had to remove both the pipes. Through micro-vascular reconstruction, pharynx was repaired and the patient is doing well,” said oncologist Subhankar Deb, who along with a team of other doctors, performed the 10-hour surgery.

The carotid artery and internal jugular vein of the neck was rejoined with the vein and artery of the flap, thus maintaining nutrition and blood supply to it. “Had there not been such a reconstruction, the flap would not have survived,” Deb said. Tracheotomy was done to enable the patient to breathe.

“We had planned to reconstruct the pharynx with a flap from the intestine. Since a wall of the pharynx could be retained, the flap was taken from the forearm and the 12-cm gap was filled up by micro-vascular reconstructive surgery,” said surgeon Anupam Golash, who was part of the operating team.

“Earlier, if the larynx was affected, tracheotomy was conducted after removing the respiratory pipe. But when both the pharynx and larynx were affected, radiotherapy was the only option,” Deb said.

“This is not a common surgical method and requires good doctors and back-up infrastructure,” said oncologist Subir Ganguly, former head of the radiotherapy department of Medical College and Hospital. He was, however, of the opinion that radiotherapy and surgery are equally effective.

“One out of three male cancer patients suffer from head and neck cancer and this is mainly due to smoking,” Ganguly said.

December, 2004|Archive|

Throat cancer treatment saves voices

  • 12/24/2004
  • Ivanhoe Newswire
  • The Triangle and Fayetteville

A promising new option for people with throat cancer is combining surgery and laser treatment to save patients’ voices.

The benefactors are people like Dolly Sigel, who used to be a speech therapist. Ironically, she was recently faced with the possibility of losing her voice.

“I was devastated,” Sigel said, recalling the diagnosis of a cancerous tumor on her right vocal chord. “I couldn’t believe that this was happening to me.” One treatment option was seven weeks of radiation, but Dolly was afraid it might affect her voice. Luckily, she came across a doctor who sought a superior remedy.

“Dr. Strome was doing a new procedure that would eliminate radiation, and there was a very good chance that voice quality would be retained,” Sigel said.

In the new procedure, Otolaryngologist Marshall Strome, of the Cleveland Clinic in Ohio, uses a laser to remove the tumor and then uses cryosurgery to freeze any remaining tissue.

“What the freezing does, at least to our knowledge at this point in time, is enables that scar tissue to be less dense, more pliable and gives us a better voice quality,” he said.

Strome explained that key to removing a tumor is to leave as much normal tissue as possible. He says cryosurgery does just that.

After Sigel’s treatment, her voice returned almost immediately. “I’m very optimistic,” she said. “I just think it’s terrific. Without a doubt, with no question, this has been a blessing.” And it is a blessing she hopes will last.

Sigel said she has another message: if you smoke, quit. She did 14 years ago. The American Cancer Society says there will be about 10,000 new cases of cancer of the voice box diagnosed in the United States this year. In most cases, throat cancer is preventable. The chief risk factors are smoking and alcohol abuse.

December, 2004|Archive|

Oral Squamous Cell Carcinoma; Gene expression profile of invasive tumors characterized

  • 12/24/2004
  • staff
  • Genomics & Genetics Weekly, Dec. 17, 2004

Gene expression patterns associated with invasive oral squamous cell tumors have been identified.

“There are limited studies attempting to correlate the expression changes in oral squamous cell carcinoma with clinically relevant variables,” scientists in the United States noted.

In their study, G.A. Toruner and coauthors at the University of Medicine and Dentistry of New Jersey “determined the gene expression profile of 16 tumor and 4 normal tissues from 16 patients by means of Affymetrix Hu133A GeneChips.”

“The hybridized RNA was isolated from cells obtained with laser capture microdissection, then was amplified and labeled using T7 polymerase-based in vitro transcription,” the investigators explained. “The expression of 53 genes was found to differ significantly (33 upregulated, 20 downregulated) in normal versus tumor tissues under two independent statistical methods.”

“The expression changes in four selected genes (LGALS1, MMP1, LAGY and KRT4) were confirmed with reverse transcriptase polymerase chain reaction,” according to the report. “Two-dimensional hierarchical clustering of the 53 genes resulted in the samples clustering according to the extent of tumor infiltration: normal epithelial tissue, tumors less than or equal to4 cm in dimension, and tumors more than 4 cm in dimension (p=0.0014).”

“The same pattern of clustering was also observed for the 20 downregulated genes. We did not observe any associations with lymph node metastasis (p=0.097),” the researchers concluded.

December, 2004|Archive|

New Forays in Head and Neck Cancer Management

  • 12/24/2004
  • Avraham Eisbruch, MD
  • Medscape (medscape.com)

The superiority of radiation concurrent with chemotherapy in local/regional tumor control and disease-free survival, compared with radiation alone, has been established in several randomized studies and meta-analyses.[1] The combination of chemotherapy and radiotherapy is characterized by increased toxicity, notably acute mucositis and late dysphagia, which limit the intensity of therapy and further improvement of the therapeutic results. A new and exciting radiosensitizing strategy which has emerged in recent years for head and neck cancer is the blockage of the epidermal growth factor receptor (EGFR), which is overexpressed in the majority of head and neck carcinoma cells. Such blockage can be done by antibodies to EGFR (C225, or cetuximab), or by inhibitors of tyrosine kinase, the enzyme that is activated when EGFR is expressed. Encouraging results of phase 1/2 studies suggesting radiosensitization of head and neck cancer by cetuximab were presented several years ago.

Radiotherapy in Tandem With Cetuximab
In a special session devoted to the topic of innovations in head and neck cancer management at the 46th Annual Meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO), J.A. Bonner, MD, University of Alabama, Birmingham, and colleagues[2] presented initial results of a phase 3 study of radiotherapy with and without cetuximab for locally advanced head and neck cancer. This group of investigators randomized 424 patients with stage III or IV cancer, the majority having larynx, oropharynx, and hypopharynx cancer. The 2 treatment arms were well balanced and several radiation regimens were used, including standard or altered fractionated radiation. An early analysis of the results showed no difference in mucositis. However, there was an increased rate of fever, nausea, and grade 3 skin effects in the combined-modality arm. The most important result was an improvement of approximately 11% in the 2-year survival rate in the combined arm compared with radiation alone. These are very encouraging early results. The main weakness related to this study is the lack of concurrent chemotherapy. It is not known whether the advantage of cetuximab will hold when it is added to a combined chemoradiation regimen. Until a randomized study addressing this question is available, it is unlikely that cetuximab will be adopted in routine clinical practice.

IMRT: Defining Targets of Opportunity
The delivery of highly conformal radiotherapy (intensity-modulated radiotherapy [IMRT]) has been prevalent in recent years in head and neck cancer. IMRT is especially attractive in this tumor site due to the close proximity of the targets to many critical normal tissues. In addition, the lack of breathing-related motion in the well-immobilized head and neck reduces many of the difficulties in the delivery of highly conformal treatment. The most important clinical issue in IMRT of head and neck cancer is the adequate definition and delineation of the targets. Lacking adequate target delineation might increase the risk of marginal tumor recurrences, which would not occur had wide-field standard radiation been delivered. The lack of agreement among radiotherapists on the delineation of the targets was demonstrated by several studies presented in this session.

T.S. Hong, MD, and coworkers[3] from the University of Wisconsin, Madison, presented a survey among head and neck cancer experts who were asked to delineate targets for an identical case of tonsil cancer, stage T2N1. The tonsillar gross tumor volume, which measured 3 cm, and a single 2-cm ipsilateral level 2 node, were delineated by the study designers, in order to avoid differences in the outlining of the gross tumor volume. The participants were asked to delineate the clinical target volumes (CTVs). The study authors found remarkable heterogeneity in the delineation of the CTVs. For example, two thirds of the responders would treat the bilateral neck while one third would treat only the ipsilateral neck. A 5-fold variation in CTV volumes, as well as wide variation in the specific nodal stations, was observed and the prescribed doses varied extensively among the responders. They concluded that the variation among institutions in many aspects of target definition, delineation, and dose prescription present notable challenges for comparative analysis of the existing literature as well as for the incorporation of IMRT into multi-institutional studies.

MRI Fosters Precise Targeting
A similar study of observer variation in delineation of the primary CTV of nasopharyngeal carcinoma was presented by C. Rasch, MD, and investigators[4] from the Netherlands Cancer Institute in Amsterdam. In this study, 10 observers from 6 different institutions delineated the CTVs of 10 nasopharyngeal carcinoma patients. As expected, wide variations in target delineation were observed. However, when magnetic resonance imaging (MRI) was available to the participants, target variation was reduced significantly. This study underscores the need to use MRI for target definition in nasopharyngeal or advanced paranasal sinus cancers, in which the bones at the base of the skull obscure the details of the soft tissue on CT scans.

Another interesting study addressing clinically based principles for target delineation was presented by S. Apisarnthanarax, MD, and colleagues[5] from MD Anderson Cancer Center, Houston, Texas. This group examined the extent of extracapsular tumor extension around lymph nodes containing cancer. They concluded that a 1-cm CTV margin around the gross disease will be enough to encompass all microscopic disease extension. The limitations of this study include the relatively small volumes of the lymph nodes examined (median size of 11 mm) and the lack of consideration of the shrinkage of the pathologic specimen, compared with the dimensions expected in vivo.

Where CT Scans Fall Short
The delineation of targets for IMRT is performed routinely on CT scan datasets obtained before therapy starts. It is assumed that the anatomy on that CT represents the anatomy throughout 6-7 weeks of therapy. To test this hypothesis, E.K. Hansen, MD, and a group from the University of California, San Francisco[6] retrospectively identified 13 patients with head and neck cancer who were treated with IMRT and also underwent serial CT scans during the course of therapy. They retrospectively identified 13 patients with head and neck cancer treated with IMRT who had repeated CT imaging and replanning during the course of therapy. The investigators found no significant changes in the mean volume of the gross tumor volume between the pretherapy and during-therapy scans. In comparison, significant decrease in the mean volume of the parotid glands was observed. Because of weight loss and decreased normal tissue volume, significantly higher maximal doses to the spinal cord and brain stem were observed, compared with those planned initially. The clinical significance of these findings is not clear. It is likely that patients suffering substantial weight loss during therapy are those who demonstrate changes in the delivered doses to several organs, and may require replanning. This issue deserves prospective studies.

Reviewing Fractionation and Chemotherapy Results
The addition of concurrent chemotherapy to standard radiation has demonstrated a significant advantage in local regional tumor control and disease-free survival.[1] What is the role of combined altered fractionation and concurrent chemotherapy? A study by R. Bensadoun, MD, and colleagues[7] from a cooperative French group partially addressed this issue.

This group randomized 171 patients with unresectable oropharyngeal cancer to either:

Hyperfractionated radiotherapy: 1.2 Gy/fraction twice daily to a total of 80.4 Gy in 46 days, concurrent with chemotherapy-cisplatin 100 mg/m2, continuous-infusion 5-FU 750 mg/m2 days 1-5 in the first cycle and 430 mg/m2 in the second cycle. Cycles were delivered every 3 weeks.

The same radiotherapy without chemotherapy. The results showed that the disease-free survival was significantly better in the concurrent-therapy arm: 54% vs 37%. The median survival was 17 months in the combined-modality arm vs 10 months in the radiotherapy-alone arm. As expected, the rates of grade 3-4 acute mucositis and grade 2-3 skin reaction were higher in the combined-modality arm.

A question that still has not been answered is: Does altered fractionated radiotherapy confer any benefit when compared with a course of chemotherapy administered concurrently with standard fractionated radiotherapy? The Radiation Therapy Oncology Group is planning a randomized study in order to address this issue.

Radiotherapy Risks and Benefits
Several studies addressed various complications of radiotherapy for head and neck cancer. J.D. Martin, MD, and coworkers[8] from the British Columbia Cancer Agency presented data regarding carotid artery stenosis in 40 patients who received ipsilateral irradiation. No patient had symptoms or clinical signs of carotid artery disease. Patients underwent carotid ultrasonography and CT angiography. The investigators found 13 cases of stenosis in irradiated carotid arteries compared with 5 in nonirradiated arteries (P = .03). Significant stenosis was only found in patients receiving > 50 Gy. The only statistically significant risk factor, apart from radiation, was history of smoking. No clinical data regarding strokes were available. Although significantly elevated, this risk is still relatively small. However, the data warrant advising patients about this risk.

A.T. Monroe, MD, and investigators[9] from the University of Florida, Gainesville, presented their data highlighting the risk of radiation retinopathy following hyperfractionated irradiation. In their study, 186 patients received a significant dose to the retina as a part of curative radiotherapy for cancers of the nasopharynx, paranasal sinus, and palate. They found 31 eyes that developed radiation retinopathy, resulting in monocular blindness in 25 patients, at a median of 2.6 years since radiation. Three of 72 patients (4%) receiving a retinal dose < 50 Gy developed retinopathy, compared with 25 of 30 cases developing retinopathy after receiving > 60 Gy to the retina. It seemed that hyperfractionated radiation decreased the incidence, at the same dose, compared with standard fractionated radiation. The rate of retinopathy in this study is obviously quite high. It may be related to the lack of CT-based treatment planning in the early years of the study. In addition, there is some uncertainty regarding the doses delivered, due to the same reasons. In any case, this is an important study suggesting that the maximal dose to the retina should not approach 60 Gy.

A. Blanco, MD, and coworkers[10] from Washington University, St. Louis, Missouri, presented data that showcased the relationship of the doses to the parotid glands and salivary output and the quality of life in patients receiving IMRT for head and neck cancer. This group determined that the glands receiving a mean dose of 26 Gy were most likely to retain their salivary output, and that their output increased over time. These guidelines add to a growing body of information suggesting that a mean dose to the parotid glands of < 30 Gy is likely to preserve their function and should be recommended for the planning of IMRT in head and neck cancer.

References
Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091-2098
Bonner JA, Giralt J, Harari PM, Jones C, et al. Phase III evaluation of radiation with and without cetuximab for locoregionally advanced head and neck cancer. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 31.
Hong TS, Tome WA, Chappell RJ, Harari PM. Variation in target delineation for head and neck IMRT: An international multi-institutional study. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 47.
Steenbakkers R, Duppen J, Fitton, I, Deurloo K, et al. Observer variation in delineation of nasopharyngeal carcinoma for radiotherapy, a 3-D analysis. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 52.
Apisarnthanarax S, Elliott D, El Naggar AK, Asper JA, et al. Determining the magnitude of clinical target volumes (CTV) margins based on pathological examination of microscopic extracapsular extension of metastatic neck nodes. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 48.
Hansen EK, Xia P, Quivey J, Weinberg V, Bucci MK. The roles of repeat CT imaging and re-planning during the course of IMRT for patients with head and neck cancer. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 50.
Bensadoun R, Benezery K, Ramaioli A, Magne N, et al. Phase III multicenter randomized study of concurrent twice-a-day radiotherapy with and without cisplatin-5FU (BiRCF) in unresectable pharyngeal carcinoma. 24 months results (FNCLCC-GORTEC). Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 53.
Martin JD, Graeb D, Buckley A, Walman B, et al. Carotid artery stenosis in asymptomatic patients after ipsilateral head and neck radiotherapy. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 95.
Monroe AT, Bhandare N, Morris CG, Mendenhall WM. Preventing radiation retinopathy with hyperfractionation. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 96.
Blanco A, Deasy JO, El Naqa I, Franklin GE. Dose-volume modeling of salivary function in patients with head and neck cancer receiving radiation therapy. Program and abstracts of the American Society for Therapeutic Radiology and Oncology 46th Annual Meeting; October 3-7, 2004; Atlanta, Georgia. Abstract 98.

December, 2004|Archive|

Healthy Mouths

  • 12/22/2004
  • Jennifer Barrett Ozols
  • Newsweek Health (msnbc.com)

New screening tools could help dentists save lives through the early detection of oral cancer. Should insurance companies be paying for the tests?

A couple weeks before he was scheduled to have his teeth cleaned, Gerald Zember felt a slight pain in the back of his mouth. The retired lawyer figured he had burnt his tongue sipping hot soup or developed an ulcer from one too many spicy meals. And at first glance, Zember’s Ft. Lauderdale, Fla., dentist, William Balanoff, didn’t notice anything unusual during a routine examination—until he pulled out a new oral-cancer screening tool called ViziLite.

After Zember rinsed with a raspberry-flavored acetic solution, Balanoff inserted a ViziLite light stick into his patient’s mouth. Suddenly, a tiny white lesion became visible on the side of Zember’s tongue. “It was tiny, but I couldn’t explain it away,” says Balanoff, since Zember had no history of canker sores that could have left such a mark. Zember, 78, did have a history of smoking, though, which put him at higher risk for oral cancer. So Balanoff referred him to an oral surgeon to have the lesion checked out. A biopsy revealed the cells were cancerous. “It was so tiny, I might not have noticed it until a year or a year and a half later [once it had grown],” says Balanoff. “By then, it would have been a stage-three cancer, and his chances wouldn’t have been that good.”

About 30,000 Americans will be diagnosed with oral or pharyngeal cancer this year, and more than 8,000 people will die from it. The death rate—about 50 percent over five years—hasn’t changed much in the past few decades, in part because the cancer often isn’t detected until it’s visible to the naked eye. “Probably about two thirds of the cases at the time of diagnosis and treatment are already at an advanced stage,” says Sol Silverman, a professor of oral medicine at the University of California, San Francisco, and an oral-cancer spokesman for the American Dental Association. “So what can we do today? Early detection.”

Over the past few years, the American Dental Association has made detecting oral cancer earlier a priority, launching an awareness campaign in 1999. But it’s taken a little while for the new screening tools to catch on. ViziLite, manufactured by Phoenix-based Zila Pharmaceuticals, was approved by the Food and Drug Administration in November 2001, but not widely marketed until this year. Another device, OralCDx’s oral-brush biopsy, which uses a specialized brush to collect several test cells from the tongue’s surface, has been available since 2000. But it was only this year that Delta Dental Plan of Michigan and its affiliated plans in Ohio and Indiana became one of the nation’s first dental benefits providers to include the diagnostic tool, distributed by Sullivan-Schein Dental, as part of its standard benefits (DaimlerChrysler was the first employer group to incorporate the benefit for it’s 400,000 union workers).

Soon there may be another option, too. Zila’s OraTest, a patented five-minute mouth rinse that uses a special dye, has already been approved for use in more than a dozen other countries, but still awaits approval from the FDA—something that both Zila and the ADA’s Silverman expect to happen soon.

December, 2004|Archive|

Health-related Quality of Life Outcome for Oral Cancer Survivors after Surgery and Postoperative Radiotherapy

  • 12/21/2004
  • Fu-Min Fang et al.
  • Japanese Journal of Clinical Oncology 2004 34(11):641-646

Background:
Health-related quality of life (HRQL) data are becoming an important supplement to information pertaining to treatment outcome for cancer patients. The purpose of this study was to evaluate the HRQL outcome for oral cancer survivors after surgery plus postoperative radiotherapy (RT) and to investigate the variables associated with their HRQL.

Methods:
Sixty-six oral cancer patients with cancer-free survival after surgery plus postoperative RT of >2 years were enrolled. The Short Form-36 (SF-36) questionnaire in the Taiwan Chinese version was self-reported by all participants at the clinics. The linear regression model was used to analyze the socio-demographic and medical-related variables correlated with the physical component summary (PCS) and mental component summary (MCS) in SF-36.

Results:
The mean scores of the eight functional domains in the SF-36 were markedly lower for oral cancer survivors compared with the Taiwanese and US norms. Those with older age, lower annual family income, more advanced cancer stage and flap reconstruction had significantly worse PCS, and those with lower annual family income, unemployment and more advanced cancer stage reported significantly worse MCS. This model accounts for 63% of variance in PCS, and 51% in MCS.

Conclusions:
These results provided patient-reported evidence that oral cancer survivors lived with a worse HRQL compared with the general Taiwanese population. Socio-economic factors and cancer stage were important factors correlated with their HRQL.

Authors:
Fu-Min Fang(1), Wen-Ling Tsai(2), Chih-Yen Chien(3), Herng-Chia Chiu(4) and Chong-Jong Wang(1)

Authors’ Affiliation:
(1) Department of Radiation Oncology, (3) Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, (4) Department of Public Health, Kaohsiung Medical University, Kaohsiung and (2) Department of Cosmetic Application and Management, Yung Ta Institute of Technology and Commerce, Pintung, Taiwan

December, 2004|Archive|