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Archaeologists discover human remains that provide earliest complete example of a human with cancer

Thu, Mar 27, 2014

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Source : Durham University
Author: Staff & Students

 

Archaeologists have found the oldest complete example in the world of a human with metastatic cancer in a 3,000 year-old skeleton.

The findings are reported in the academic journal PLOS ONE today (17 March).

The skeleton of the young adult male was found by a Durham University PhD student in a tomb in modern Sudan in 2013 and dates back to 1200BC.

Analysis has revealed evidence of metastatic carcinoma, cancer which has spread to other parts of the body from where it started, from a malignant soft-tissue tumour spread across large areas of the body, making it the oldest convincing complete example of metastatic cancer in the archaeological record.

The researchers from Durham University and the British Museum say the discovery will help to explore underlying causes of cancer in ancient populations and provide insights into the evolution of cancer in the past. Ancient DNA analysis of skeletons and mummies with evidence of cancer can be used to detect mutations in specific genes that are known to be associated with particular types of cancer.

Even though cancer is one of the world’s leading causes of death today, it remains almost absent from the archaeological record compared to other pathological conditions, giving rise to the conclusion that the disease is mainly a product of modern living and increased longevity. These findings suggest that cancer is not only a modern disease but was already present in the Nile Valley in ancient times.

Lead author, Michaela Binder, a PhD student in the Department of Archaeology at Durham University, excavated and examined the skeleton. She said: “Very little is known about the antiquity, epidemiology and evolution of cancer in past human populations apart from some textual references and a small number of skeletons with signs of cancer.

“Insights gained from archaeological human remains like these can really help us to understand the evolution and history of modern diseases.

“Our analysis showed that the shape of the small lesions on the bones can only have been caused by a soft tissue cancer even though the exact origin is impossible to determine through the bones alone.”

The skeleton is of an adult male estimated to be between 25-35 years old when he died and was found at the archaeological site of Amara West in northern Sudan, situated on the Nile, 750km downstream of the country’s modern capital Khartoum. It was buried extended on his back, within a badly deteriorated painted wooden coffin, and provided with a glazed faience amulet as a grave good.

Previously, there has only been one convincing, and two tentative, examples of metastatic cancer predating the 1st millennium BC reported in human remains. However, because the remains derived from early 20th century excavations, only the skulls were retained, thus making a full re-analysis of each skeleton, to generate differential (possible) diagnoses, impossible.

Co-author, Dr Neal Spencer from the Department of Ancient Egypt and Sudan at the British Museum, said: “From footprints left on wet mud floors, to the healed fractures of many ancient inhabitants, Amara West offers a unique insight into what it was like to live there – and die – in Egyptian-ruled Upper Nubia 3200 years ago.”

The skeleton was examined by experts at Durham University and the British Museum using radiography and a scanning electron microscope (SEM) which resulted in clear imaging of the lesions on the bones. It showed cancer metastases on the collar bones, shoulder blades, upper arms, vertebrae, ribs, pelvis and thigh bones.

The cause of the cancer can only be speculative but the researchers say it could be as a result of environmental carcinogens such as smoke from wood fires, through genetic factors, or from infectious diseases such as schistosomiasis which is caused by parasites.

They say that an underlying schistosomiasis infection seems a plausible explanation for the cancer in this individual as the disease had plagued inhabitants of Egypt and Nubia since at least 1500BC, and is now recognised as a cause of bladder cancer and breast cancer in men.

Michaela Binder added: “Through taking an evolutionary approach to cancer, information from ancient human remains may prove a vital element in finding ways to address one of the world’s major health problems.”

The tomb, where the skeleton was found, appears to have been used for high-status individuals from the town, but not the ruling elite, based on the tomb architecture and aspects of funerary ritual.

The tomb’s architecture is evidence of a hybrid culture blending Pharaonic elements (burial goods, painted coffins) with Nubian culture (a low mound to mark the tomb).

The well preserved pottery recovered from the tomb provides a date within the 20th Dynasty (1187-1064BC), a period when Egypt ruled Upper Nubia, endured conflicts with Libya and while pharaohs such as Ramses III were being buried in the Valley of the Kings.

The research was funded by the Leverhulme Trust and the Institute of Bioarchaeology Amara West Field School, with the permission of the National Corporation of Antiquities and Museums in Sudan.

 

 *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

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Unilateral radiation benefited patients with advanced tonsil cancer

Wed, Mar 26, 2014

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Source: www.healio.com
Author: staff

Unilateral radiotherapy was associated with effective regional control in patients with advanced tonsil cancer, according to study results presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium. Additionally, the results supported previous findings that suggest the primary tumor location, not the extent of ipsilateral neck lymph node involvement on the tumor side of the neck, governs the disease risk in the contralateral side of the neck.

Researchers evaluated 153 consecutive patients diagnosed with squamous cell carcinoma of the tonsil who were treated with surgical removal and postoperative intensity-modulated radiation therapy.

Forty-six of the patients underwent unilateral radiotherapy. Of these patients, 72% were male. The average patient age was 59 years. Current or former smokers comprised 61% of the study population.

Lateralized primary tumors were confirmed in 40 (87%) of the patients. Two (4%) patients had non-lateralized tumors. Lateralization could not be retrospectively ascertained in four patients (9%).

The cancer stages for these patients were distributed as follows: TX, 2%; T1, 44%; T2, 41%; and T3, 13%. Lymph node involvement stages were as follows: N0, 11%; N1, 13%; and N2, 76%.

The patients underwent radiation doses of 60 Gy to 66 Gy to the postoperative bed and involved neck, and 52 Gy to 54 Gy to the elective region in 30 to 33 fractions using a simultaneous integrated boost technique. Concurrent chemotherapy was administered to 30 of the 46 patients. The median follow-up period was 2.8 years (range, 0.4-8.7 years).

Researchers reported no local or regional recurrences. Four patients (9%) developed distant metastasis, and two developed second primary cancers.

The findings suggest that, for suitable patients, radiation volume can be safely reduced, sparing these patients adverse effects and potential toxicity, according to study investigator Wade Thorstad, MD, chief of head and neck cancer services and associate professor of radiation oncology at Washington University School of Medicine.

“All treatments for cancer — surgery, radiation therapy, chemotherapy — although effective, can cause temporary and/or permanent toxicity that can affect long-term quality of life,” Thorstad said in a press release. “Our research indicates that for appropriately selected patients with tonsil cancer, the volume of radiation therapy necessary to control the cancer can be significantly reduced, therefore reducing the side effects and toxicity of radiation while maintaining a high rate of tumor control.”

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New study shows a rise in smokeless tobacco sales, especially among youth

Mon, Mar 24, 2014

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Source: UMass Medical School Communications (http://www.umassmed.edu/news)
Author: Sandra Gray

 

The number of smokeless tobacco products sold in Massachusetts is soaring, as are the levels of nicotine packed into many of them, according to a new analysis from UMass Medical School and the Massachusetts Department of Public Health (DPH).

“Nationwide, cigarette smoking control has been very successful and we have experienced a steady decline, but that success is being offset by the increased use of smokeless tobacco products, especially by youth,” said UMMS statistical scientist Wenjun Li, PhD. Dr. Li, associate professor of medicine in the Division of Preventive and Behavioral Medicine, co-authored the paper with colleagues from the DPH.

Published in the journal Tobacco Control, the study examines ten years of product data (from 2003 to 2012) that Massachusetts law requires tobacco manufacturers provide to the DPH. Notable findings include a nearly 30 percent increase in the number of moist snuff products and a nearly sixfold increase in the number of snus products sold in Massachusetts; these increases correlate with rising use among high school students.

Nationwide, more than one in eight males in the 12th grade uses smokeless tobacco. In Massachusetts, use among high school students has more than doubled since 2001. A wide variety of smokeless tobacco products on the market include newer inventions like dissolvable lozenges, snus and moist snuff, many of them flavored and colorfully packaged to appeal to youth, along with more traditional forms used by adults including chewing tobacco and dry snuff.

Researchers were particularly interested in unionized, or free nicotine, the form that is most easily absorbed in the mouth. The amount of free nicotine and how it is delivered in both smokable and smokeless tobacco products is associated with a product’s addictive potential—and is determined by modifiable design features as well as the amount of nicotine contained naturally in the tobacco leaf.

They found that while nicotine levels varied, free nicotine increased for several manufacturers. Li and DPH lead author and research analyst Doris Cullen,MA, believe that these as-yet inexplicable variations in nicotine content support the argument that free nicotine levels are controlled in the manufacturing process, and suggests that manufacturers are manipulating products’ addictive potential.

“The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products,” said Cullen.

“Smokeless products are easier for youth to access and use than cigarettes, and harder for parents to monitor,” said Li. “Even though they have less nicotine than cigarettes, more of that nicotine is readily absorbed, making snus and moist snuff a gateway to nicotine addiction and, possibly, future smoking.”

While the study did not focus on smokeless tobacco marketing, he noted that packaging products to look like candy also suggests that the tobacco industry is specifically targeting youth.

“This study supports that the tobacco industry’s manipulation of product design extends to smokeless products,” said corresponding author Lois Keithly, PhD, director of the DPH’s Massachusetts Tobacco Cessation and Prevention Program. “Considering the potential risk for nicotine addiction associated with the use of smokeless tobacco products, and the aggressive marketing of these products, it is critical to continue and expand surveillance of smokeless products at the state and national levels.”

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy. 

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Humidifying mouth, throat during radiotherapy cuts mucositis

Sun, Mar 23, 2014

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Source: www.drbicuspid.com
Author: staff

Head and neck cancer (HNC) patients who received daily humidification of the mouth and throat during radiation therapy treatment spent nearly 50% fewer days hospitalized to manage their side effects, such as mucositis, according to research presented at the recent Multidisciplinary Head and Neck Cancer Symposium in Scottsdale, AZ.

Mucositis, inflammation and ulceration of the mouth and throat, is a painful side effect of radiation therapy that can negatively affect patients’ quality of life. Using humidification is based on the fact that moisturizing wounds generally helps them heal faster, according to the researchers.

The study by the Trans Tasman Radiation Oncology Group (TROG) evaluated 210 HNC patients in New Zealand and Australia from June 2007 to June 2011.

Patients in the phase III trial were randomized to institutional standard of care (control group) or humidification. The humidified air was delivered through the nose via a plastic interface (mask-type apparatus) that can be worn by patients while sleeping or sitting.

Patients began humidification on the first day of radiation therapy and continued until the ulceration in their mouth and throat had resolved. On average, humidification patients spent 57% as many days in the hospital to manage side effects, compared with the controls (control = 4.1 days, humidification = 2.3 days).

The humidifier group also resumed close-to-normal eating patterns at significantly higher rates three months after radiotherapy.

Only 43 patients (42%) of the patients in the humidification group met the defined benchmark of humidification compliance and were able to contribute to the per protocol analysis; the mean average use of humidification for these patients was 3.6 hours per day (range of use = 0 to 14 hours/day).

The functional mucositis score — based on clinician assessment of patients’ mucositis symptoms — was reduced among patients who met humidification compliance benchmarks. The proportion of compliant humidification patients who didn’t require a feeding tube also increased.

The results are encouraging because humidification was favored across clinician-reported outcomes, patient-reported outcomes, and independent data such as hospitalizations, the researchers noted.

The next step is to work at increasing the number of patients who use humidifiers effectively, they said.

Note:
The 2014 Multidisciplinary Head and Neck Cancer Symposium was sponsored by the American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO), and the American Head & Neck Society (AHNS).

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App for cancer patients puts rehabilitation at their fingertips

Wed, Mar 19, 2014

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Source: globalnews.ca
Author: staff

A new app will make therapy more accessible for survivors of head and neck cancers. Developed at the Misericordia hospital and the University of Alberta, the portable swallowing therapy unit will help patients with swallowing impairments complete their rehab in the comfort of their own home. Video available here.

The technology will help patients understand what their muscles are doing while they swallow. The app will take two years to develop and test, and the Alberta Cancer Foundation has agreed to fund it – $1.9 million over the next five years.

Dr. Jana Rieger, the lead researcher on the project, said it will give patients more independence in their rehabilitation, in contrast to traditional therapy. Traditional swallowing therapy requires patients come to the hospital three to four times a week to use the large rehabilitation equipment.

“What ends up happening is probably only about 10 per cent of patients who could benefit from this type of therapy actually come in and get it,” said Rieger.

“There’s lots of people out there living with swallowing disorders that we aren’t getting to as clinicians.”

The app is combined with an adhesive sensor under the jaw and a pendant that rests on the patient’s chest. The pendant speaks wirelessly to the app and it can send the patient’s data to health-care professionals anywhere in the province. The technology has a few settings that the patient can set to motivate them to complete the therapy.

“Things like progress bars, goal-setting, how many times a day you’ve practiced, how many swallows you’ve done, were your swallows today as good as the ones you did yesterday,” Reiger said

“The progress bar might tell them that you’re only at about 55 per cent so you need to try a little harder. Or maybe you need to hold the swallow for a little longer.”

Linda Neill, a mouth cancer survivor, thinks the app has a lot of potential.

“I think it would be super beneficial,” she said, highlighting the privacy provided by using the app.

The app is being funded through the Alberta Cancer Foundation.

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Experimental EGFR inhibitor added nothing but rash

Wed, Mar 19, 2014

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Source: www.oncologypractice.com
Author: Neil Osterweil, Oncology Report Digital Network

The addition of the experimental targeted agent zalutumumab to primary curative chemoradiation for head and neck cancers did not improve locoregional control, disease-specific survival, or overall survival at 3 years of follow-up.

The only thing that zalutumumab added to therapy was a skin rash in the large majority of patients who received it, reported Dr. Jens Overgaard, of the department of experimental clinical oncology at Aarhus University, Denmark.

Response to zalutumumab, a monoclonal antibody targeted to the epidermal growth factor receptor (EGFR), was not related to tumor human papillomavirus 16 (HPV/p16) status or to chemoradiotherapy, Dr. Overgaard reported at the Multidisciplinary Head and Neck Cancer Symposium.

The results of the DAHANCA 19 trial echo those of the RTOG (Radiation Oncology Therapy Group) trial 0522, which found no benefit from the addition of the EGFR inhibitor cetuximab (Erbitux) to accelerated cisplatin-based chemoradiotherapy, said Dr. Paul Harari, an invited discussant from the University of Wisconsin, Madison.

“Where I think we have a lot of unanswered questions is acknowledging how little we actually understand about EGFR biology, despite now 40 years of progressive knowledge,” Dr. Harari said.

“We’re now seeing very clearly in molecular and clinical correlate studies that the more we suppress the EGFR, the more we see collateral overexpression of additional RTKs [receptor tyrosine kinases], including members of the HER family, such as HER-3, that enable an escape mechanism for tumors that become resistant to EGFR inhibition,” he said.

Dr. Overgaard and his colleagues in the Danish Head and Neck Cancer Group conducted an open-label, phase III trial in which 619 patients with nonmetastatic squamous cell carcinomas of the larynx, oropharynx, hypopharynx, or oral cavity were randomly assigned to received 66-68 Gy of accelerated radiotherapy with or without zalutumumab 8 mg/kg weekly, with the first dose given a week before the start of radiation. The radiation was given concomitantly with the radiosensitizer nimorazole and, in patients with involved lymph nodes, cisplatin.

A total of 301 patients who received zalutumumab and 307 controls were included in the final intention-to-treat analysis.

At 3-year follow-up, there were no significant differences in either the primary endpoint of locoregional control (76% in zalutumumab-treated patients and 77% of controls) or in the secondary endpoints of disease-specific survival (82% and 85%, respectively) or overall survival (72% and 79%), Dr. Overgaard reported at the symposium, cosponsored by the American Society for Radiation Oncology and the American Society of Clinical Oncology.

Overall, patients who were positive for the HPV/p16 biomarker fared better than p16-negative patients, with an odds ratio for the probability of local control in negative patients of 0.52 (95% confidence interval, 0.36-0.73; P value not reported).

However, regardless of HPV 16 status, the addition of zalutumumab made no difference in the primary endpoint.

In a proportional hazard analysis, factors significantly associated with worse outcomes included worse World Health Organization performance status, higher disease stage, nodal involvement, and HPV/p16 negative status.

Although zalutumumab was generally well tolerated, 94% of patients who received it developed a rash, and of this group, 29% had grade 3 or 4 rash. In all, 11% of patients assigned to zalutumumab had to stop the drug because of rash.

Note:
The trial was sponsored by the Danish Head and Neck Cancer Group. Dr. Overgaard reported having no financial disclosures. Dr. Harari has received research funding from Amgen.

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Chemoradiation offered better survival than accelerated radiation in head and neck squamous cell carcinomas

Wed, Mar 19, 2014

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Source: www.oncologypractice.com
Author: Neil Osterweil, Oncology Report Digital Network

Concurrent chemoradiation offered better overall survival and disease-free survival than accelerated radiotherapy in patients with moderately advanced squamous cell carcinomas of the head and neck, investigators reported at the Multidisciplinary Head and Neck Symposium.

Actuarial rates of 2-year overall survival and disease-free survival in patients treated with concurrent chemoradiation (CCR) were significantly better than for patients treated with accelerated radiotherapy alone, reported Dr. Krzysztof Skladowski of the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Gliwice, Poland.

“CCR with conventional 7 weeks of fractionation and at least two courses of high-dose cisplatin is more effective than 6 weeks of accelerated radiotherapy alone,” he said.

Even if patients can tolerate only a single course of cisplatin, CCR is still superior to accelerated radiation, he added.

The findings suggest that accelerated radiation protocols should be reserved for patients with more favorable prognosis, such as those with stage T2 disease with limited nodal involvement, and those who are positive for the human papillomavirus (HPV) p16 protein, Dr. Skladowski said at the symposium cosponsored by the American Society for Radiation Oncology and the American Society of Clinical Oncology.

The findings are “concordant with data that has been emerging now over approximately 10-14 years of the value of concurrent chemoradiation in head and neck cancer for a substantial cohort of patients over radiation alone,” said Dr. Paul Harari of the University of Wisconsin, Madison, and the invited discussant.

Although a previous meta-analysis (Lancet 2006; 368:843-54) suggested that accelerated or hyperfractionated radiotherapy was associated with a 3.4% advantage in overall survival, compared with conventional radiotherapy over 5 years, there have been no randomized studies comparing accelerated radiotherapy protocols with concurrent chemoradiation in this population, Dr. Skladowski said.

He and colleagues compared the two modalities in 101 patients with moderately advanced cancers of the oropharynx (46 patients), hypopharynx (19), and larynx (36).

They defined moderately advanced cancers as stage T2N1-2, T3N0-2, or T4AN0-2 if the involved nodes are not larger than 3 cm in diameter. Patients with oropharyngeal cancers were tested for expression of the human papillomavirus (HPV) p16 protein.

Patients were randomly assigned to receive either concurrent chemoradiation with intensity-modulated radiation therapy–delivered doses of 66-70 Gy divided into 33-35 daily fractions over 45-49 days plus cisplatin 100 mg/m2, delivered on days 1, 2 and 43, or to accelerated radiotherapy delivered via intensity-modulated radiation therapy in 1.8 Gy fractions 7 days/week to a total dose of 66.2-72 Gy.

Five patients in the CCR arm received only one dose of cisplatin, 30 received two doses, and 13 received the planned three doses.

At a median follow-up of 30 months, actuarial rates of 2-year overall survival of patients treated with CCR were 81%, compared with 62% for patients treated with accelerated radiation (P = .02). Disease-free survival rates were 75% and 60%, respectively (P = .05).

Acute adverse events were similar, with approximately 80% of patients in each treatment arm experiencing confluent mucositis, and about 10% having grade 3 dysphagia. There were no grade 4 toxicities.

The majority of treatment failures in each group were local, occurring in 21 of 52 patients treated with radiation alone, and in 11 of 49 patients treated with CCR (P = .03).

Significantly more deaths occurred in the radiation alone arm: 20 vs. 9 (P =.02).

The 2-year disease-free survival rate among patients in the CCR arm was dose dependent, at 60% of patients who received one course of cisplatin, 77% of those who received two courses, and 79% for those who received all three.

At the time of the analysis, all patients with oropharyngeal cancer who were positive for HPV p16 (five treated with accelerated radiation and six with CCR) were alive with no treatment failure. The overall survival rate for HPV-positive patients was 60% in the radiation only arm, and 80% in the CCR arm.

Note:
The study was supported by the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology. Dr. Skladowski reported having no financial disclosures. Dr. Harari has received research funding from Amgen.

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Recurrent mouth and throat cancers less deadly when caused by HPV

Wed, Mar 19, 2014

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Source: www.oncologynurseadvisor.com
Author: Kathy Boltz, PhD

People with late-stage cancer at the back of the mouth or throat that recurs after chemotherapy and radiation treatment are twice as likely to be alive 2 years later if their cancer is caused by the human papillomavirus (HPV), suggests new research. This study was presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, held in Scottsdale, Arizona.

Previous studies have found that people with so-called HPV-positive oropharyngeal cancers are more likely to survive than those whose cancers are related to smoking or whose origins are unknown.

The new study shows that the longer survival pattern holds even if the cancer returns. Oropharyngeal cancers, which once were linked primarily to heavy smoking, are now more likely to be caused by HPV, a virus that is transmitted by oral and other kinds of sex. The rise in HPV-associated oropharyngeal cancers has been attributed to changes in sexual behaviors, most notably an increase in oral sex partners.

For the study, the researchers used data provided by the Radiation Therapy Oncology Group on 181 patients with late-stage oropharyngeal cancer whose HPV status was known and whose cancer had spread after primary treatment.

There were 105 HPV-positive participants and 76 HPV-negative ones. Although the median time to recurrence was roughly the same (8.2 months vs 7.3 months, respectively), some 54.6% of those with HPV-positive cancer were alive 2 years after recurrence, whereas only 27.6% of those with HPV-negative cancers were still alive at that point in time.

The researchers also found that those whose cancers could be treated with surgery after recurrence—regardless of HPV status—were 52% less likely to die than those who did not undergo surgery. Surgery has typically been done in limited cases, as doctors and patients weigh the risks of surgery against the short life expectancy associated with recurrent disease.

“Historically, if you had a recurrence, you might as well get your affairs in order, because survival rates were so dismal. It was hard to say, yes, you should go through surgery,” said study leader Carole Fakhry, MD, MPH, an assistant professor in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine in Baltimore, Maryland. “But this study shows us that surgery may have a significant survival benefit, particularly in HPV-positive patients.”

Although it remains unclear why patients with HPV-positive tumors have better outcomes than those with HPV-negative tumors, researchers speculate that it may be due to biologic and immunologic properties that render HPV-positive cancers inherently less malignant or better able to respond to radiation or chemotherapy treatment.

“Until this study, we thought that once these cancers came back, patients did equally poorly regardless of whether their disease was linked to HPV,” she said. “Now we know that once they recur, HPV status still matters. They still do better.”

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Impact of percutaneous endoscopic gastrostomy (PEG) tube placement on Head and neck cancer patients

Tue, Mar 18, 2014

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Source: Sage Journals 
Authors: Scott Kramer, Matthew Newcomb, Joshua Hessler, Farzan Siddiqui MD, PhD

Abstract 

Objective: To understand the impact of percutaneous endoscopic gastrostomy (PEG) tube placement timing on tube duration, weight loss, and disease control in patients with head and neck cancer (HNC).

Setting: A tertiary academic center.

Study: Design Historical cohort study.

Subjects and Methods: Seventy-four patients with HNC were reviewed. Patients underwent cisplatinum-based chemoradiation therapy with or without surgical resection. They received a PEG tube either before radiation therapy began (prophylactic) or after (reactive). Patients were matched on the basis of age, gender, TNM stage, tumor subsite, human papillomavirus (HPV) status, and chemoradiation dose.

Results: Patients receiving reactive PEG tubes had them in place for fewer days than those placed prophylactically (227 vs 139 days, P < .01). There was no difference in percentage weight loss at 2, 6, or 12 months. There was no difference in survival or disease control between the groups.

Conclusions: Reactive PEG tube placement may afford patients a shorter duration of usage without incurring greater weight loss or poorer oncologic outcomes.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy. 

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Global trends suggest HPV positive oral cancer greatly increased in young males

Sun, Mar 16, 2014

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Source: www.zawya.com
Author: staff

While the incidence of smoking-related oral squamous cell carcinoma has decreased in many parts of the world, cases of human papilloma virus (HPV) positive oropharyngeal cancer (OPSCC) have greatly increased. Otolaryngologists are finding that the majority of their patients are male and a lot younger in age than their counterparts. This “new” head and neck cancer patient differs in several ways from the “traditional” head and neck cancer patients who were older, had significant tobacco and alcohol exposure, and potential tumours throughout the upper aerodigestive tract. The significance of this global trend suggests that more attention needs to be paid to the phenomena here in the Middle East.

Dr Marilene Wang, Professor, Chief of Otolaryngology, UCLA Department of Head and Neck Surgery, will be discussing the increasing incidence of young cancer patients who are non-smokers, but happen to be HPV positive and how these cases should be managed in the Middle East at the 11th Middle East Update in Otolaryngology Conference & Exhibition – Head and Neck Surgery (ME-OTO) from the 20-22 April 2014 at the Madinat Jumeirah Arena, Dubai, UAE.

According to Dr Wang, “Currently, the most common head and neck cancer patients are younger, primarily male, and have no or relatively minimal exposures to tobacco and alcohol. Yet, they often have histories of notable increased sexual encounters. Although HPV positive OPSCC demonstrates an alarming increasing incidence, this is balanced by a significant response to treatment regardless of advanced stage.

“Cases of OPSCC associated with HPV have increased 225% in the US from 1988-2004. HPV infection is ubiquitous, as up to 85% of adults may have an HPV infection at some point from any of the over 120 subtypes. Only a small percentage of these subtypes develop malignancy and these are primarily related to the HPV-16 subtype. There is also an increased risk of OPSSC in husbands of women with cervical cancer and in situ cancer.”

The majority of epidemiological studies on HPV positive OPSCC have been done in the Western hemisphere, where there is a documented rise in the incidence of both HPV infection and HPV positive OPSCC. The impact of HPV in other parts of the world is less clear.

“A recent study from Turkey did document an increase in the incidence of HPV positive OPSCC between 1996 and 2011, from 33% to 70% (Dural et al. Asian Pac J Cancer Prev. 2013; 14(10):6065-8). Further studies will need to be done to determine the incidence of HPV-positive OPCC in the Middle East,” says Dr Wang.
“Vaccination against HPV is recommended for adolescents and young adults, boys and girls, ages 9 -25, ideally prior to onset of sexual activity. This commonly utilized vaccine provides protection against the 4 strains of HPV most associated with cervical and OPSCC, including HPV-16. However, there is no evidence to support efficacy of the vaccine to treat HPV-related cancers,” concludes Dr Wang.

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