Monthly Archives: January 2006

Cancer patients’ use of vitamins questioned

  • 1/31/2006
  • New York, NY
  • Tara Parker-Pope
  • DelawareOnline (www.delawareonline.com)

Many cancer patients take a range of antioxidant vitamins in hope of improving their odds, but some research suggests the supplements may be doing more harm than good.

A report published in CA, an American Cancer Society medical journal, says cancer patients shouldn’t use antioxidants during radiation or chemotherapy because the supplements may reduce the effectiveness of treatment. Worse, some research suggests that antioxidants may actually feed cancers, protecting the very cancer cells patients are trying to attack. The news further clouds the role that vitamins play in promoting good health. Earlier this year, a major study showed that certain people who regularly take vitamin E supplements had a higher risk for heart failure. The notion that antioxidants may be harmful is likely to be upsetting and confusing to the large number of cancer patients gobbling down vitamins and supplements to help fight the disease. Studies show that as many as a third to half of cancer patients are taking antioxidants, vitamins and other supplements.

Antioxidants include beta carotene, lycopene and vitamins A, B, C and E, among others. In the body, antioxidants mop up rogue molecules called free radicals, which have the potential to cause extensive cell damage and are believed to play a role in heart disease, cancer and numerous other health problems. A substance that attacks free radicals would seem to battle cancer in theory. But the results of both lab and human studies of cancer and antioxidants have been mixed. One concern is that because chemotherapy treatments sometimes act against the cancer by producing free radicals, taking antioxidants could interfere with that effect.

Some lab studies have shown that antioxidants can improve the effectiveness of cancer treatments, such as a 1997 study that showed antioxidant supplements boosted chemotherapy used for colon cancer patients. Other lab studies raise questions about their use, however. For instance, a 1995 report in the Journal of Biological Chemistry showed that cancer cells in a petri dish actually absorb more vitamin C than normal cells, suggesting that vitamin C is better at protecting tumors than healthy tissues.

Until more is known, patients undergoing treatment should avoid high-dose supplements, concludes Gabriella M. D’Andrea, breast oncologist at Memorial Sloan Kettering Cancer Center and author of the CA article. In her review of the scientific evidence on use of antioxidant supplements to prevent or treat cancer, D’Andrea found a handful of human trials that showed supplements often don’t benefit cancer patients and may be causing harm. “We would love to find a nutrient or antioxidant that could be anticancer, but I think we need to be very cautious,” D’Andrea says.

For instance, two randomized trials of patients with advanced cancer found no benefit from vitamin C supplements and suggested that survival may have been worse in the vitamin group. Two large trials of smokers and former smokers found that beta carotene supplements appeared to increase lung cancer risk. Last year, the British medical journal Lancet published a study showing that antioxidants didn’t prevent gastrointestinal cancers and may have increased mortality risk. In a 2002 study of early-stage breast cancer patients undergoing treatment, some were prescribed large doses of vitamins, minerals and antioxidants. Results weren’t conclusive but suggested survival may be worse in the antioxidant users. A major study this year of patients at risk for heart disease showed high doses of vitamin E had no impact on risk of melanoma, prostate, lung, oral, colorectal or breast cancers, but they were linked with higher risk for heart failure. A separate vitamin E study showed head-and-neck-cancer patients who took the supplement increased their risk for developing a second cancer.

D’Andrea says a large human trial is needed to show the real impact vitamins and antioxidants have on cancer patients. The problem is that such trials are expensive, and it’s notoriously difficult to study supplements because dietary patterns vary so widely and issues like fat content and fruit and vegetable consumption may alter the way one supplement acts in different people. Certainly, none of this means cancer patients should never take vitamins or other supplements. Many cancer patients suffer nutrition problems and may be advised to take vitamins. The main concern is that patients discuss diet changes with their doctor.

“A lot of people think nutrients in any dose are harmless, but that may not be the case,” says Marji McCullough, nutritional epidemiologist for the American Cancer Society. “It’s probably prudent to say people should avoid taking large doses of any single supplement unless specifically recommended to do so from their doctor.”

Patients still may be able to help themselves by adopting a lifestyle of healthful eating and exercise. In May, researchers released the results of a study of 2,400 postmenopausal women with early-stage breast cancer. The study showed that a low-fat diet can lower the chances of the cancer coming back by 24 percent.

Source:
The Wall Street Journal 1/31/2006

January, 2006|Archive|

Treatment Method Improves Survival for Advanced Laryngeal Cancer

  • 1/31/2006
  • Ann Arbor, MI
  • press release
  • Newswise (www.newswise.com)

Chemotherapy and radiation can be effective at treating cancer of the larynx, or voice box, without removing the organ that controls speech and swallowing. But it doesn’t work for everyone.

Researchers at the University of Michigan Comprehensive Cancer Center found that determining early into treatment which patients would benefit from the chemoradiation treatment and which would be better off having surgery led to better survival rates than typically expected for this type of cancer.

“Approximately 30 percent to 40 percent of patients with advanced laryngeal cancer will not be cured with chemotherapy and radiation. The survival rates for such patients have traditionally been poor. That’s why these patients should be identified as early as possible. When we did that, we found that the survival rate for these patients was markedly improved, as was the survival rate for the group of patients who were successfully treated with chemotherapy and radiation,” says study author Gregory Wolf, M.D., professor and chair of otolaryngology at the U-M Medical School.

The study appears in the Feb. 1, 2006 issue of the Journal of Clinical Oncology.

The study looked at 97 patients with advanced-stage laryngeal cancer. The larynx, or voice box, plays a role in breathing, swallowing and talking. Traditional treatment for this type of cancer has been surgery to remove the voice box or part of the voice box, leading to significant quality of life concerns.

In this study, patients began with six days of chemotherapy, after which they were examined to see whether the cancer had shrunk. Tumors shrank by more than half in three-quarters of the patients. These patients then went on to receive radiation therapy five days a week for six to seven weeks, with additional chemotherapy administered once every three weeks.

The 25 percent of patients whose cancer did not respond to the initial chemotherapy were immediately considered for surgery at that point.

Three years later, 85 percent of all the patients in the study were still alive, and 70 percent had preserved their larynx. Traditional survival rates for advanced laryngeal cancer are usually less than 60 percent. Patients in the study who had surgery early on had similar survival to the patients who had organ preservation.

“One cycle of chemotherapy can identify a group of patients whose laryngeal cancer is highly likely to be successfully treated with chemotherapy and radiation. The excellent survival rates may be a result of identifying patients earlier for surgery if they are likely to fail the chemoradiation treatment. Timely integration of surgery may be a critical component in maintaining overall survival rates that are comparable to the results of primary surgery,” says study author Susan Urba, M.D., associate professor of internal medicine at the U-M Medical School.

The researchers note that patients from this study faced half the risk of dying after three years compared to previous studies in patients with less advanced laryngeal cancer. Survival rates in this study also beat other recent studies using chemoradiation to treat this type of cancer.

“By matching the appropriate treatment to the patient based on the biology of the tumor, our study showed better cure rates,” Wolf says. “While there are significant quality of life benefits to avoiding laryngectomy, intensive combinations of chemotherapy and radiation have some severe long-term quality of life problems as well that would be good to avoid if you could identify those patients ahead of time for whom chemoradiation was not going to work.”

An estimated 9,880 people were diagnosed with laryngeal cancer in 2005, according to the American Cancer Society. For more information about laryngeal cancer, visit http://www.cancer.med.umich.edu/learn/voicebox.htm or call the U-M Cancer AnswerLine at 800-865-1125.

The researchers plan a larger, randomized multicenter trial using this approach in patients with cancers of the tongue base and tonsil.

In addition to Wolf and Urba, U-M study authors were Avraham Eisbruch, M.D., professor of radiation oncology; Francis Worden, M.D., clinical assistant professor of internal medicine; Julia Lee, research associate; Carol Bradford, M.D., professor of otolaryngology; Theodoros Teknos, M.D., associate professor of otolaryngology; Douglas Chepeha, M.D., associate professor of otolaryngology; Mark Prince, M.D., assistant professor of otolaryngology; Norman Hogikyan, M.D., associate professor of otolaryngology; and Jeremy Taylor, Ph.D., professor of biostatistics at the U-M School of Public Health and of radiation oncology at the U-M Medical School.

Funding for the study was from the U-M Specialized Program of Research Excellence (SPORE) grant, the Molecular Basis of Head and Neck Cancer Therapy and the Diane and Sinabaldo Tozzi Research Fund.

Reference:
Journal of Clinical Oncology, Vol. 24, No. 4, pp. 593-598

January, 2006|Archive|

Protein holds back growth of head and neck tumors

  • 1/31/2006
  • Pittsburgh, PA
  • press release
  • EurekAlert (www.eurekalert.ort)

A protein associated with the growth of head and neck tumors may be a tumor suppressor that could prevent the spread of cancer when it is expressed above normal levels, according to a study published in the Feb. 1 issue of the Journal of the National Cancer Institute (JNCI).
The study, led by University of Pittsburgh School of Medicine professor of otolaryngology and pharmacology, Jennifer Grandis, M.D., is the first to show that the expression of a protein called STAT1 may play a vital role in preventing head and neck tumor growth. STAT1 belongs to a family of proteins called signal transducers and activators of transcription that have been linked to tumor progression in many cancers.

“While the activation of STAT1 has been associated with increased survival in breast cancer patients, its role in head and neck cancer has not been clearly understood,” said Dr. Grandis. “Our study reveals that it is a critical survival pathway in head and neck cancer and that therapeutic strategies to restore its functioning may be of benefit to patients.”

Dr. Grandis, who also is director of the Head and Neck Cancer Program at the University of Pittsburgh Cancer Institute (UPCI), and colleagues compared the expression of STAT1 in squamous cell carcinoma of the head and neck (SCCHN) tumors to its expression in normal tissue samples. They found that STAT1 was expressed in lower levels in the tumor cells than in the normal cells. And, when they chemically altered the expression of STAT1 to increase its levels, the cancer cells diminished and died.

To alter the expression of STAT1, the researchers treated cells with an agent that removes methyl groups and modifies gene expression. Some of the SCCHN cells were then treated with chemotherapy alone and others in combination with azacytidine, an agent that reversed the process and increased STAT1 production. Those cells treated with chemotherapy and azacytidine were more responsive to the treatment and more likely to stop growing and eventually die.

“When STAT1 signaling was silenced, the tumor cells grew indicating to us that its loss promotes cancer growth,” said Dr. Grandis. “On the other hand, when the signaling was increased and combined with chemotherapy, cancer cells were more likely to die.”

More than two-thirds of head and neck cancer patients have a locally advanced stage when diagnosed. The disease has a poor five-year survival rate even after treatment. Current treatment options are limited and often cause disabling side effects.

January, 2006|Archive|

Omega-3 Fatty Acids Do Not Lower Cancer Risk

  • 1/31/2006
  • Ketchum, ID
  • staff
  • cancerconsultants.com

Researchers affiliated with the Southern California Evidence-Based Practice Center have reviewed 38 medical publications and concluded that there was no significant association between omega-3 fatty acid intake and the risk of cancer. The details of this report appeared in the January 25, 2006, edition of the Journal of the American Medical Association.

Omega-3 fatty acids have been purported to play a role in the prevention of various cancers. However, the literature is confusing with some studies showing a preventative effect, some showing an increased incidence of some cancers and most showing no effect.

The current study involved 38 articles involving 20 cohorts of patients from 7 different countries. Risks of 11 different cancers were evaluated in several different statistical methods. Of the 11 studies involving breast cancer, one showed a significant increase in risk, 3 showed a decreased risk and 7 showed no effect with increasing intake of omega-3 fatty acids. In colorectal cancer, 17 of 18 studies showed no effect of omega-3 fatty acid intake on risk. In lung cancer there were 4 studies that showed no effect, one showed an increased risk and one showed a decreased risk with high intake of omega-3 fatty acids. Similar findings were reported for prostate cancer with 15 of 16 studies showing no effect. The single study of skin cancer showed an increased incidence with increasing intake of omega-3 fatty acids. In other cancers such as head and neck, bladder, ovarian, pancreatic, stomach and lymphoma there was no effect of dietary intake of omega-3 fatty acids on risk. These authors concluded that omega-3 fatty acids did not prevent cancer and that dietary supplementation for this purpose is not effective.

Comments:
Most individuals take omega-3 fatty acids for the prevention of cardiovascular disease and not for the prevention of cancer. The only major concern about omega-3 fatty acid supplements would be evidence that omega-3 fatty acids significantly increased the risk of certain cancers canceling out other potential benefits. However, this does not appear to be the case based on this review.

Reference:
MacLean CH, Newberry SJ, Mojica WA, et al. Effects of omega-3 fatty acids on cancer risk. A systematic review. Journal of the American Medical Association . 2006;295:403-415.

January, 2006|Archive|

Swallowing After Cancer

  • 1/31/2006
  • Fresno, CA
  • staff
  • abc action news (abclocal.go.com)

Each year, there are nearly 30,000 cases of head and neck cancer. Surgery, chemotherapy and radiation all have their benefits but can leave patients with a difficult time swallowing. Now, doctors are working to improve that.

Allen Clark, M.D., is a plastic surgeon. But two years ago, he became a patient. “I actually had a lymph node come up in my neck,” he says. “Being a physician — a surgeon — knowing what that means, I was pretty sure I had cancer.”

It was throat cancer. Doctors recommended chemotherapy and radiation. But radiation caused Clark’s throat to tighten, and swallowing became excruciatingly painful.

“It’s almost like you’re drinking hot coffee that’s too hot, and you burn your throat, but you do that every day for six or seven weeks,” Bill Carroll, M.D., an otolaryngologist at University of Alabama at Birmingham, tells Ivanhoe.

Dr. Carroll and colleagues noticed patients who continued to swallow during treatment, instead of relying on a feeding tube, did better. Now, patients are taught a series of swallowing exercises they do before and during treatment.

“One of the exercises that we did was we’d hold my tongue between my teeth and swallow,” Clark says. Another is making a high-pitch “E” sound to elevate the larynx. All the exercises work to strengthen the tongue and throat muscles. Patients say the exercises are simple but can be painful.

“But most of them do try,” Dr. Carroll says. “And for the ones that are able to go ahead and do it, there seems to be a benefit.”

Clark still has some trouble with certain foods, but says the exercises have paid off.

Dr. Carroll says the goal of the exercises is to allow patients to have a more functional swallow once chemo and radiation ends. He hopes the exercises will save both time in the hospital and money spent on complications.

January, 2006|Archive|

Alcohol underestimated as cancer cause -scientists

  • 1/30/2006
  • London, England
  • Patricia Reaney
  • Reuters (www.alertnet.org)

Along with smoking and chronic infections, alcohol consumption is an important cause of several types of cancer, researchers said on Monday.

Excessive drinking raises the risk of cancer of the mouth, larynx, oesophagus, liver, colon and breast. It may also be linked with cancer of the pancreas and lung.

“Alcohol is underestimated as a cause of cancer in many parts of the world,” said Dr Paolo Boffetta of the International Agency for Research on Cancer (IARC) in Lyon, France.

“A sizeable proportion of cancer today is due to alcohol intake and this is increasing in many regions, particularly in east Asia and eastern Europe,” he added in an interview.

Boffetta and Mia Hashibe, who reviewed research into the link between alcohol and cancer, found the more alcohol consumed, the higher the risk of developing cancer.

But they advised people to drink moderately, rather than give up alcohol completely, because of its protective benefits against cardiovascular disease.

“Total avoidance of alcohol, although optimum for cancer control, cannot be recommended in terms of broad perspective of public health, in particular in countries with high incidence of cardiovascular disease,” Boffetta said in a report in The Lancet Oncology journal.

Instead, the scientists said men and women should limit how much alcohol they drink to reap the benefits but avoid the dangers.

“The most recent version of the European code against cancer recommends keeping daily consumption to two drinks for men and one for women,” Boffetta noted.

In developed countries in 2000, the World Health Organisation (WHO) estimates that alcohol caused 185,000 deaths in men and 142,000 in women, but it prevented 71,000 male deaths and 277,000 female deaths in the same year.

In developing countries, where there are fewer cases of cardiovascular disease, alcohol was linked with 1.52 million deaths in men and 301,000 in women.

The scientists found that alcohol-related diseases were a particular problem in central and Eastern Europe.

“Alcohol is probably the main factor responsible for increased risk of head and neck cancer recorded in various countries, particularly in central and east Europe,” said Boffetta.

Exactly how alcohol increases the odds of developing cancer is not clear but genetic susceptibility is an important component.

“Given the linear dose-response relation between alcohol intake and risk of cancer, control of heavy drinking remains the main target for cancer control,” Boffetta added.

January, 2006|Archive|

Can you catch cancer?

  • 1/30/2006
  • Zaire
  • Sarah Boseley
  • Mail & Guardian Online (www.mg.co.za)

Within a few years, girls will be vaccinated against cancer. Not every cancer — at least, not yet. But the cervical cancer jab is well on its way. A couple of shots in the arm, perhaps, and young women may never have to think about it again.

That is possible because cervical cancer is spread by a virus called human papilloma virus (HPV). You can catch it by sleeping with somebody who has it, so women with more sexual partners are more likely to get it.

The vaccine does not act against cancer per se, but protects against the virus that causes it. Which makes cervical cancer, effectively, an infectious disease.

Can you really catch cancer? And if cervical cancer is caused by an infection, is it remotely possible that we might also catch breast cancer, or prostate cancer, or bowel cancer? The answer is yes and no. Certainly, catching cancers is not the same as catching a cold. HPV may trigger cervical cancer, but many women infected with it will never develop the disease. There must also be other factors.

Where a virus is involved in cancer, it appears, it is one of many causes — a trigger in a chain of triggers. Along with the virus, there may have to be something in your genes that tips your chances of getting this particular cancer. Diet affects some cancers, alcohol and smoking others, and air pollution is under suspicion. But the remarkable thing about the involvement of viruses in cancer is that they are a switch that can potentially be turned off. This is not a bad news story; quite the opposite. If an infection is involved in the onset of some cancers, then there is a way to stop them developing. Potentially, we could invent a vaccine. That is exactly what has happened in cervical cancer.

We do not know to what extent viruses are implicated yet, nor in which cancers, but the estimate is that they may play a part in up to 20% of cases. The evidence is slowly accumulating. A paper recently appeared from Newcastle University that offered new evidence that minor viral infections such as colds, respiratory problems and mild flu might trigger childhood cancer.

Richard McNally, an epidemiologist, had mapped outbreaks of two cancers — forms of leukaemia and brain tumours — in children younger than 15 over a period of 45 years from a tumour database in Manchester. He discovered clusters of children who were born around the same time and in the same place — and went on to develop cancer.

Whenever clusters of childhood cancers have been spotted, parents have understandably ascribed them to the man-made environment, assuming that fallout from a power station or radiation from a phone mast must be to blame. But McNally and colleagues have identified a pattern that is exactly like is seen in infectious diseases.

“We found that place of birth was particularly significant, which suggests that an infection in the mother while she is carrying her baby, or in a child’s early years, could be a trigger factor for the cancer,” says McNally. “These could be minor common illnesses that are not even reported to the doctor, such as a cold, mild flu or a respiratory virus.” But no, he hastens to say, you cannot catch cancer. His research suggests that infection is one of the factors in its onset, but it is not the only cause.

Instead, the hypothesis his research helps to support is a double-whammy theory. Firstly, babies are born with a propensity to leukaemia. Mel Greaves, a professor at the Institute of Cancer Research in London, analysed the blood taken by midwives from the heel-pricks of newborns and found that many already have cell damage that could lead to the disease. But it is now clear that a second thing has to go wrong before a possibility becomes a likelihood. And that could be a viral infection.

This fits with the work of Leo Kinlen at Oxford University, who has been lambasted by anti-nuclear campaigners for his theory, first mooted in 1988, that childhood leukaemia is not the result of radioactive fallout and waste but caused by “population mixing”. Cancer clusters occur where whole groups from towns and cities have arrived to live and work in a remotish rural setting, he observed. The incomers bring with them new viral infections, which could spark cancers among the native local population.

In fact, infections associated with cancer have been known for some time. The neatest example of infection as a significant cause is in stomach cancer. This is not triggered by a virus, but by a bacterium called Helicobacter pylori. That discovery netted a recent Nobel prize. “Fifteen to 20 years ago,” says Heather Dickenson, principal research associate at Newcastle University’s centre for health services research, “nobody would have taken seriously the theory that stomach cancer was the result of infection.”

Helicobacter pylori is a bacterium that enters the stomach in food and drink, but does not get destroyed by the acid there. Around 30% to 40% of us are thought to be infected with it, and it can cause inflammation of the stomach lining, known as gastritis. In a small number of cases, that progresses to stomach cancer. But now we know that H. pylori is one of the guilty parties, many of these cancers (though not all) can be prevented.

Research into the links between cancer and viruses began around the start of the last century. In 1908, Wilhelm Ellermann and Oluf Bang identified a virus which they found spread leukaemia between chickens. In 1911, Peyton Rous in the United States found another chicken virus that caused sarcoma.

In that same decade, the first definitive link between infection and a human cancer was established. A British scientist called Anthony Epstein, based at the Middlesex hospital, went to listen to a British surgeon called Denis Burkitt, who had identified what is now known to be the commonest childhood cancer in Africa. This was a tumour of the jaw that became known as Burkitt’s lymphoma.

In a remarkable piece of scientific detective work, Epstein mapped the incidence of the tumour across the wet, lowland areas of Central Africa and realised he was looking at the malarial belt. He hypothesised that the cancer was caused by an infectious agent, spread by the malarial mosquito.

He and his team had no luck until one tumour biopsy arrived from Uganda in an unfit state for microscopic examination. So Epstein cultured the cells instead. To everyone’s surprise, it grew a previously unknown form of herpes virus, which became known as Epstein-Barr. Epstein-Barr was later found in almost all samples of Burkitt’s lymphoma from Africa.

Almost everyone has this virus. “Ninety-five per cent of us are infected by Epstein-Barr,” says Lawrence Young, professor of cancer biology at the institute of cancer research in Birmingham. “It doesn’t cause us any effect at all. But with certain co-factors it could cause problems.” Malaria was the co-factor in Africa.

If you have Epstein-Barr and you catch malaria while on holiday, it does not mean you will develop Burkitt’s lymphoma. None of this is quite that simple. You would have two of the risk factors — two possible triggers — but because this is mostly an African cancer, there is probably a genetic component involved too. Too little is known about the causes of cancer, for all the noise made about diagnosis and treatment. But if scientists can nail down a particular virus as a risk, they can interrupt the process that can cause disease and death.

Young calls the virus “a link in the chain of events. This is not like catching a cold. You can’t catch cancer as an acute disease. But if it is a vital link, you can break the chain.”

Epstein-Barr is also implicated in about half of Hodgkin’s lymphomas, but not the other half. In China, Epstein-Barr is in nasopharyngeal carcinoma — but fascinatingly, the extra link in the chain is the salted fish in the Cantonese diet.

Breast cancer, too, appears to have dietary links. The incidence in Japanese women who move to the US soars. “Diet is a major contributory factor to cancer,” acknowledges Young.

Diet we can change. Viruses and bacteria we live with. Epstein-Barr does most of us no harm unless our immune system is suppressed. In the early days of heart transplants, for instance, most patients died not because the heart gave out or was rejected, but of Epstein-Barr-associated lymphomas. They were being given massive doses of immuno-suppressant drugs, which meant the virus was no longer kept in check, allowing the cancer to develop.

And, in the early Eighties, the first sign that we were in trouble from a new virus that would wreak havoc across the planet was the arrival of a new cancer in the US called Kaposi’s sarcoma. It had once been a very rare disease in elderly Jewish men from the Mediterranean. Suddenly, young gay men had it, as HIV knocked out their immune systems, allowing the Kaposi’s sarcoma herpes virus to flourish.

Viruses are now thought to be implicated in up to one in five cancers. As time goes on, we may find it is more. Finding any cause of cancer is very good news as it means prevention is possible. If a virus is involved, it opens up the possibility of a vaccine to disrupt the chain of events that leads to cancer. That is, in short, a holy grail. The revelations of the excellent results in trials of the cervical cancer vaccine were greeted with euphoria. Gardasil, manufactured by Merck, was 100% effective among the 12 000, mostly young, women who took part. It knocked out the two strains of HPV, 16 and 18, that are implicated in 70% of cervical cancers.

And the vaccine could prove even more useful. The trials showed that some of the other HPV types involved in a minority of cervical cancers were also stopped in their tracks. So cervical cancer could, in theory, be wiped out. This is only achievable if every girl and boy has the jab. The vaccine is expected to be offered in the United Kingdom to sexually inexperienced girls who will not have HPV, aged around 10 to 13, but suggesting a vaccination for a young girl that will protect her from a sexually transmitted disease has not gone down well with parents.

Cancer is the scourge of our times, the most feared disease of the 21st century. It appears to come from nowhere and kill at random. The more we know of the causes, the better we will be able to protect ourselves. Finding a silent trigger such as a virus that scientists may be able to knock out of the equation with a vaccine is not a reason to panic, but a cause for hope.

January, 2006|Archive|

IMRTcancer treatment much more precise

  • 1/29/2006
  • Springield, IL
  • Dean Olsen
  • State Journal Register Online (www.sj-r.com)

Lying on his back on a hard table, Michael Robinson holds himself perfectly still, closes his eyes, quietly sings gospel songs to himself and seeks guidance from above.

During the next 10 to 15 minutes, a machine that looks like an oversized hair dryer from a beauty shop swivels around his head, buzzing and shooting high-energy X-rays into his mouth.

“I pray, ‘Lord, give me the strength to endure this, and please heal this,'” said Robinson, 56, of Jacksonville.

Robinson, an account technician for the Illinois Department of Human Services, began daily radiation treatment for cancer Jan. 9 at St. John’s Hospital. A routine checkup last year turned up what doctors later determined was a tumor on his right tonsil.

Robinson said he feels better knowing that the painless radiation therapy represents what St. John’s officials call a “giant leap” forward in treatment. For the past several months, St. John’s has treated about two dozen cancer patients with radiation beams that are mapped and focused by special equipment and computer hardware and software.

The hospital began offering intensity-modulated radiation therapy as part of radiation technology upgrades that cost St. John’s about $2.5 million, said Dr. Bruce Shevlin, a Springfield radiation oncologist.

Shevlin is working with Dr. James Wynstra, a fellow radiation oncologist, to lead the IMRT treatment team at St. John’s.

Memorial Medical Center is in the midst of a $4 million to $5 million technology upgrade that will allow it to offer IMRT by the end of the summer, according to Linda Jones, Memorial’s administrator of oncology, pulmonology and clinical research services. Dr. Saleem Mahmood, also a radiation oncologist, said he offers IMRT at his offices in Jacksonville and Litchfield.

IMRT allows doctors to be more precise in tailoring radiation treatment. They can zap certain types of cancer tumors from more angles with thousands of pencil-thin radiation beams rather than a single large beam passing through the body.

As a result, there’s less damage to surrounding tissue, Shevlin said.

The greater precision also can allow doctors to give higher radiation doses for patients with specific types of cancer, such as prostate cancer. That could increase cure rates, he said, although studies haven’t yet proven whether IMRT helps patients live longer.

At St. John’s, IMRT costs about twice as much as conventional radiation treatment, hospital spokesman Brian Reardon said.

Medicare pays hospitals and doctors between $1,790 and $1,860 for a week of IMRT treatments per patient, according to figures and estimates provided by St. John’s and Shevlin. That compares to $930 to $970 a week for conventional radiation treatment.

Dr. Stan Borg, chief medical officer for Chicago-based Blue Cross and Blue Shield of Illinois, said Blue Cross pays five to 10 times more for IMRT than conventional radiation treatment, although Reardon said the price difference isn’t as great in Springfield.

Borg said he isn’t convinced IMRT is better than conventional treatment cancer. But he said it is “at least as effective.”

Medical studies so far indicate that IMRT is most appropriate for head and neck cancers and cancers of the prostate gland, as well as cancers that require radiation treatment for curved surfaces such as the breast.

IMRT could become popular in treating other cancers if studies document success, so hospitals are keeping close tabs. One out of three Americans will be diagnosed with cancer at some point in their lives, and more than half of cancer patients will receive some form of radiation treatment.

Shevlin estimated that about 100 cancer patients will receive IMRT annually at St. John’s. He and Wynstra are part of University Radiologists, a four-member group practice that serves about 1,000 cancer patients receiving radiation treatment each year in Springfield. The group’s two other members, Drs. Parashar Nanavati and Thomas Shanahan, work at Memorial and expect to use IMRT with 100 to 150 patients annually, Jones said. The four doctors are the city’s only radiation oncologists.

Doctors need to be careful in using radiation to treat cancer in the head and neck, Shevlin said, because sensitive structures such as the spinal cord, brain, and jaw muscles can be permanently damaged by radiation. In the case of prostate cancer, he said radiation damage can cause the bladder and rectum to become more sensitive and bleed.

IMRT often can help preserve some salivary glands and prevent patients from acquiring permanent cases of dry mouth.

“It’s a major quality-of-life issue for them,” Shevlin said.

Robinson said the radiation treatment of his right tonsil and the base of his tongue probably will destroy salivary glands on his right side, but he hopes IMRT can salvage the salivary glands on his left side.

“You don’t really realize how much you need saliva,” Robinson said.

He doesn’t dwell on the fact that it’s unusual for someone like him – who hasn’t abused alcohol and hasn’t smoked in more than 20 years – to come down with a form of throat cancer.

Robinson said he has experienced some swelling at the back of his tongue from the radiation – an expected and temporary side effect. The IMRT treatments also cause fatigue but give him hope for beating the tumor.

“They think there’s an 85 to 90 percent chance of getting rid of it without surgery,” he said. “They say this is the latest technology around.”

January, 2006|Archive|

Voice therapy helpful after early throat cancer

  • 1/27/2006
  • New York, NY
  • staff
  • Reuters (today.reuters.co.uk)

A small study suggests that a few months of voice therapy may improve a person’s ability to speak after treatment of early-stage glottic cancer, a form of cancer that affects the vocal cords.

Past research has yielded mixed results on the effectiveness of voice therapy after treatment of tumors of the throat. In one study, patients who did not undergo voice therapy after their cancer treatment actually did better in terms of voice quality.

The new study, published in the journal Cancer, looked at 23 patients who had voice impairments after laser surgery or radiation therapy for early-stage glottic cancer.

Dr. Christine D. L. van Gogh and her colleagues at Vrije University Medical Center in Amsterdam randomly assigned the patients to a voice-therapy group or a comparison group that did not receive the therapy.

Those who underwent voice therapy had a maximum of 24 sessions with a speech-language pathologist, focusing on voice and breathing exercises to improve their vocal quality.

Overall, the patients who underwent therapy reported more improvements in their voice than the comparison group did. There were also improvements in certain objective measures of voice quality, such as vocal “jitter.”

Of the 177 patients approached to participate in this study, the researchers note, most refused to do so. This may be because of the fact that voice therapy is time-consuming, they speculate, but it could also reflect an assumption that vocal problems are an inevitable consequence of throat cancer treatment.

They recommend that people treated for early glottic cancer be assessed regularly for vocal problems, to see which patients might benefit from voice therapy.

Source:
Cancer, January 1, 2006.

January, 2006|Archive|

Levels of toxins in oral tobacco products in the UK

  • 1/26/2006
  • London, England
  • A. McNeill et al.
  • Tobacco Control 2006;15:64-67; doi:10.1136/tc.2005.013011

Objective:
This study examined the constituents of smokeless tobacco products available in the UK and compared them with products available in India, Sweden, and the USA

Methods:
even UK brands of smokeless tobacco, including a tooth cleaning powder, and four international brands of smokeless tobacco were tested for a range of toxins and known carcinogens, such as tobacco specific N-nitrosamines (TSNA), as well as nicotine availability.

Results:
Ten of the 11 brands tested had detectable levels of tobacco specific nitrosamines, which are proven carcinogens, and levels varied 130-fold. All had detectable levels of benzo(a)pyrene, another proven carcinogen (with around 175-fold variation) and several toxic metals (with nearly 150-fold variation). Nicotine availability varied in the UK products from 0.1 mg/g to 63.2 mg/g. All the tobacco products tested are likely to be hazardous to users’ health, but the data indicate that it should be possible to reduce key toxins to non-detectable levels.

Conclusions:
Smokeless tobacco products should be regulated and standards set for maximum levels of toxins and carcin

Authors:
A McNeill(1), R Bedi(2), S Islam(2), M N Alkhatib(2) and R West(1)

Authors’ affiliations:
(1) Department of Epidemiology and Public Health, University College London, London, UK
(2) Department of Dental Public Health, King’s College London, London, UK

January, 2006|Archive|