• 1/20/2008
  • Chicago, IL
  • Mallika Rao
  • Medill Reports (news.medill.northwestern.edu)

A military detection device designed by scientists at Illinois-based Argonne National Laboratory may soon help head-and-neck cancer patients battle the painful side effects of treatment.

The device, a thermal imaging camera able to detect temperature differences smaller than a tenth of a degree, came out of scientists’ work on a national security project. It could soon enable head-and-neck oncologists to predict individual patients’ reactions to therapy, says a team of Argonne researchers and University of Chicago doctors, and to tailor treatment accordingly.

The combined radiation/chemotherapy administered to most patients nearly always results in minor inflammation immediately, says Dr. Ezra Cohen, an oral oncologist who is heading up the University of Chicago team. “That inflammation should be accompanied by an increase in temperature,” he adds, one that the camera is equipped to sense. “Those who have a big increase, those we think are the patients that are going to have the bad side effects.”

The group has studied six patients so far, a few of whom have experienced both a dramatic early rise in temperature and severe side effects. The evidence is still too small to arrive at any significant conclusions, cautions Cohen, but the findings are encouraging.

While head-and-neck cancer accounts for only 3 to 5 percent of nationwide cancer incidence and is usually treatable, according to the National Institute of Health website, side effects from the most common therapies can be emotionally devastating and physically unbearable.

Radiation therapy, in which energy in the form of waves is used to destroy cells, is often the most effective treatment for head-and-neck cancers. It is not however, precise, and the radiation beam injures healthy as well as malignant cells. Though normal cells can eventually heal, the temporary damage leaves nearly 75 percent of patients with a short-lived condition known as mucositis, where sores in the mouth sometimes larger than 4 centimeters in diameter can render a patient unable to talk and reliant on a feeding tube, says Cohen. There are currently no products on the market that alleviate the symptoms of mucositis, according to an Argonne press release.

“The base of your tongue to the top of your mouth is pretty much just riddled with sores,” explains Cindy Bajda, a data manager at the University of Chicago Cancer Research Center. Bajda was diagnosed with buccal cancer nearly three years ago; her treatment brought on four months of mucositis. Because of her knowledge of head-and-neck cancer from work, however, she knew to expect it.

“My family was who I was concerned about,” she said. “I accepted it more than they did.”

Bajda’s intolerance for the combination radiation/chemotherapy was high, leaving her unable to eat even ice cream. “I could taste the salt in it,” she explains. She sustained herself on protein drinks and pain medications that induced her to “sleep through the pain”, and lost fifty pounds during the process.

The severity of reactions like Bajda’s could be lessened, Cohen says, if there is indeed a connection between temperature changes in radiation-treated areas and a susceptibility to mucositis. “There may be some patients where we can scale back on treatment,” he says. “Chances are a small reduction in treatment doesn’t affect the outcome.”

Though a therapy’s intensity does not necessarily correlate to its success, Cohen says starting every patient at a reduced level of treatment is not an option. “The paradigm of oncology is to try and use the highest amount possible, especially in a curative setting,” he explains.

Currently, patients who develop dangerously high toxicity or serious infections from radiation must simply delay treatment. If the camera identifies those patients before their reactions begin, that kind of upset could become avoidable, Cohen says.

For Bajda, who was the study’s first subject, the camera only echoed a possibility she already knew to be highly likely. But she says for those not familiar with the disease, it will provide a valuable service by helping them to prepare for a potentially disturbing experience.

“If you have colon cancer you don’t see what’s going on down there,” she says. “But mucositis is visible. It’s scary.”

And importantly, says Cohen, it attacks the body parts most significant in how people interact with the world.

“Speaking, eating – which is really a social endeavor, our sense of smell. When you begin to impair those things, it really has a profound impact on a patient’s sense of self.”