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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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Identification and characterization of cancer stem cells in human head and neck squamous cell carcinoma

Sun, Mar 16, 2014

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Source: 7thspace.com
Author: staff

Current evidence suggests that initiation, growth, and invasion of cancer are driven by a small population of cancer stem cells (CSC). Previous studies have identified CD44+ cells as cancer stem cells in head and neck squamous cell carcinoma (HNSCC).

However, CD44 is widely expressed in most cells in HNSCC tumor samples and several cell lines tested. We previously identified a small population of CD24+/CD44+ cells in HNSCC.

In this study, we examined whether this population of cells may represent CSC in HNSCC.

Methods:
CD24+/CD44+ cells from HNSCC cell lines were sorted by flow cytometry, and their phenotype was confirmed by qRT-PCR. Their self-renewal and differentiation properties, clonogenicity in collagen gels, and response to anticancer drugs were tested in vitro.

The tumorigenicity potential of CD24+/CD44+ cells was tested in athymic nude mice in vivo.

Results:
Our results show that CD24+/CD44+ cells possessed stemness characteristics of self-renewal and differentiation. CD24+/CD44+ cells showed higher cell invasion in vitro and made higher number of colonies in collagen gels compared to CD24-/CD44+ HNSCC cells.

In addition, the CD24+/CD44+ cells were more chemo-resistant to gemcitabine and cisplatin compared to CD24-/CD44+ cells. In vivo, CD24+/CD44+ cells showed a tendency to generate larger tumors in nude mice compared to CD24-/CD44+ cell population.

Conclusion:
Our study clearly demonstrates that a distinct small population of CD24+/CD44+ cells is present in HNSCC that shows stem cell-like properties. This distinct small population of cells should be further characterized and may provide an opportunity to target HNSCC CSC for therapy.

Source: BMC Cancer 2014, 14:173
Author: Jing HanToshio FujisawaSyed R HusainRaj K Puri

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Throat cancer survivor celebrates life after trans-oral robotic surgery

Fri, Mar 7, 2014

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Source: www.newswise.com
Author: staff

When Charlie Guinn sits down to eat with his lovely wife of 39 years, he thoroughly enjoys each bite. It’s not just the food; the entire experience is a celebration. Just over a year ago, Mr. Guinn learned that he had stage IV throat cancer. For him, just surviving would have been an accomplishment — so swallowing again at a meal with a loved one is truly something special.

The American Cancer Society estimates that in 2013 over 41,000 people in the U.S. were diagnosed with cancer of the oral cavity and pharynx and almost 8,000 died from the disease. But Mr. Guinn would be the first to say that he is one of the lucky ones. He is one of the first patients to undergo trans-oral robotic surgery (TORS) at the University of New Mexico Hospital. And the results have been stunning.

Mr. Guinn first discovered the lump in his throat while shaving. When it was still there a week later, he went to an urgent care center where he was immediately referred to an Ear, Nose and Throat physician. The physician ran a number of tests including a biopsy. When the results came back, the physician referred Mr. Guinn to Nathan Boyd, MD, at the University of New Mexico Cancer Center. It had been only a week and a half from that fateful visit to urgent care.

Mr. Guinn recalls, “When I first got there to see Dr. Boyd, one of the nurses told me, ‘You really hit the lottery because you have some of the finest doctors working on you.’ And I agree. Dr. Boyd is one of the most fantastic people I’ve ever met.” Dr. Boyd, an Assistant Professor in the Department of Surgery, Division of Otolaryngology at the UNM School of Medicine, is one of the first two physicians in New Mexico to offer TORS. The other physician, Andrew Cowan, MD, PhD, is also an Assistant Professor in the Department of Surgery, Division of Otolaryngology at the UNM School of Medicine and initiated and launched the surgical program in early 2013.

After his initial consultation with Dr. Boyd, in which he learned about his surgical options, Mr. Guinn consulted with two other physicians at the UNM Cancer Center that same day. He met with his oncologist, Elizabeth McGuire, MD, an Associate Professor in the Department of Internal Medicine, Division of Hematology/Oncology; and with his radiation therapy physician, William Thompson, MD, a Staff Physician in the Department of Internal Medicine, Division of Hematology/Oncology.

The physician team took Mr. Guinn’s preferences into account and agreed to offer him the TORS procedure. Dr. Boyd explained to Mr. Guinn that they would need to complete at least one exploratory surgery first. Mr. Guinn agreed. He recalls that meeting with a laugh and says, “Dr. Boyd told me, ‘My goal for you is, in one year, to have a [Blake’s] Lotaburger with cheese and green chile.’”

Three weeks later, Dr. Boyd completed three TORS procedures on Mr. Guinn and the tumor was out. But because the tumor cells had spread to the lymph nodes, even bursting one of them, Mr. Guinn’s UNM Cancer Center physician team decided to recommend chemotherapy and radiation as a preventive measure to make sure no cancer cells were lurking. Mr. Guinn did not like the additional treatments but knew they were necessary. “The worst experience for me was the radiation,” he says. He experienced some third-degree burning during his course of treatment, but has healed now. He shrugs off the experience saying it’s nothing compared to what burn victims go through.

His chemotherapy experience was a little better. Mr. Guinn didn’t feel like eating very much and he lost weight. “That was the positive of all this,” he laughs. “I do not recommend the diet, but it was the greatest thing.” Another side effect was his hair changing color. “I didn’t lose my hair. I’ve been silver and grey since my late 20s and now my hair is black. At first, I was mad.” But, he’s now accustomed to the darker hair.

Mr. Guinn reflects on what the experience of the past year has brought him. “It’s made me understand what other people go through and what their families go through,” he says. “And I realize that it’s not talking about it but just asking: How are you feeling? What can I do for you?”

Additionally, he and wife have gotten closer. “We’ve been married for 39 years. And we never thought we could get closer.” They are planning a celebratory vacation together.
Finally, Mr. Guinn credits his recovery to his faith, positive attitude, and the people around him who helped him keep that positive attitude. His family was with him at every single appointment. His family and friends sent their prayers and cards, meals, and other helpful items. And his entire treatment team at the UNM Hospital and the UNM Cancer Center gave him the confidence that he would pull through. “Ever since I met Dr. Boyd, not once did I think I was going to die,” he says. “I tell people, you don’t need to go anywhere. These people will take good care of you.”

At his latest visit recently, Mr. Guinn gave Dr. Boyd a gift card to Blake’s Lotaburger. He laughs as he recalls the look on his surgeon’s face. “I told him, ‘Have one on me!’

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Brits call for smoking in films to be stubbed out

Fri, Mar 7, 2014

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Source: www.economicvoice.com
Author: staff

After a record night of success for British talent at the Oscars, a new poll reveals a majority of us would like to stub out smoking in films watched by children.

In a survey conducted by oral health charity the British Dental Health Foundation, more than two thirds (67 per cent) said they thought films featuring actors smoking should receive the highest classification rating, suitable only for adults. According to the British Board of Film Classification, rated-18 films currently allow scenes of drug-taking, provided ‘the work as a whole must not promote or encourage drug misuse’. The film board makes no reference to smoking or alcohol misuse, two of the leading risk factors for mouth cancer.

Rita-Hayworth

Rita Hayworth

One in five people in the UK smoke, and the habit is still considered the leading cause of mouth cancer. But while many of us are aware of the damage that smoking does to our lungs, the danger to our mouths remains relatively unknown. Smoking helps to transforms saliva into a deadly cocktail that damages cells in the mouth and can turn them cancerous. As alcohol aids the absorption of tobacco into the mouth, those who smoke and drink to excess are up to 30 times more likely to develop the disease.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, urged the film board to consider its policy on films depicting smoking. Dr Carter said: “The risks of smoking have been well documented for many years, yet for many young people the message still isn’t getting through. Children see movie stars as role models. If they are smoking, children are more likely to take up the habit. The same applies to sports stars, people we see on every day TV and even parents. By re-classifying films containing smoking scenes, it could lead to a drop in the number of young children taking up the habit.

“Tobacco use is still the leading cause of mouth cancer, a disease that claims more lives than cervical and testicular cancer combined. Through campaigns such as Mouth Cancer Action Month in November and No Smoking Day on Wednesday 12 March, it is vital people take the warnings about smoking on board. Mouth cancer is the most severe outcome, but it can lead to many oral health problems such as tooth staining, gum disease and tooth loss.

“It is really important that everyone knows the warning signs for mouth cancer. They include mouth ulcers which do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the mouth. Our message to everyone is ‘If in doubt, get checked out’.”

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Protein Deters Head, Neck Cancer Growth, Study Shows

Mon, Mar 3, 2014

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Source: JADA (Journal of the American Dental Association)

Scientists at the National Institute of Dental and Craniofacial Research found that blocking a certain protein inhibited the proliferation of head and neck squamous cell carcinoma, according to a study published in the February issue of Molecular Oncology.

In an experiment involving tissue samples of hundreds of head and neck cancer patients, an NIDCR team led by Silvio Gutkind, PhD, chief of NIDCR’s Oral and Pharyngeal Cancer Branch, found that p38 kinase was active in most samples. They reported that the most malignant tissue samples had the highest activity of p38, and the least malignant samples had the lowest p38 activity. The normal oral tissue used as a control had no p38 activity.

When researchers turned off p38 activity in human oral cancer cells and transplanted these cells into laboratory mice, they found that the oral cancer cells without p38 activity were smaller than those with p38 activity. In addition, turning off p38 activity lessened the growth of new blood vessels, which cancers rely on for growth and the ability to spread to other parts of the body.

In the next phase of the study, they tested SB203580—a drug that is known to block p38 activity. SB203580 reduced the growth of head and neck cancer cells in the laboratory. When the NIDCR team then used SB203580 to treat human head and neck cancers that had been transplanted into lab mice, they found that SB203580 made the cancers smaller.

The next step, Dr. Gutkind says, is to test a new generation of drugs that inhibit p38.

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

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Improving QOL in head and neck cancer as survival improves

Fri, Feb 28, 2014

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Source: www.medscape.com
Author: Zosia Chustecka

In patients undergoing radiation treatment for head and neck cancer, reducing the radiation to organs not affected by cancer is key to improving quality of life post-treatment.

Several studies presented here at the 2014 Multidisciplinary Head and Neck Cancer Symposium described new approaches to sparing radiation delivered to the salivary glands and to the voice box, without any loss of cancer control, but with a reported reduction in adverse effects, such as xerostomia (dry mouth), and an anticipated reduction in loss of voice and speech quality.

Improvements in such outcomes are becoming increasingly important as the epidemiology of head and neck cancer is changing, and the increase in human papillomavirus-positive disease means that patients are being diagnosed their 50s and will, in many cases, go on to live for decades after their definitive cancer treatment, researchers commented at a press briefing.

Xerostomia can make it difficult to speak, as well as chew and swallow, and can lead to dental problems. “Dry mouth might seem trivial, but it actually has a significant effect on quality of life,” commented Tyler Robin, PhD, an MD candidate in his final year at the University of Colorado Medical School in Denver.

To reduce this adverse effect, intensity-modulated radiation techniques are already directing the beam away from the parotid gland, which is responsible for stimulated saliva production, for example during eating. But for the rest of the time, saliva is produced unstimulated from the submandibular gland. “This gland actually produces the majority of saliva for the majority of the day,” he said.

“Historically, however, there had been hesitation to spare the submandibular gland from radiation because there are lymph nodes near the gland that also end up not getting treated,” he said. “While this seems worrisome because head and neck cancer spreads through the lymph nodes, it is well established that the risk of cancer involvement in the lymph nodes near the submandibular gland is exceedingly low, yet the benefit of sparing the gland for a patient’s quality of life is high.”

Dr. Robin presented data from 71 patients with advanced head and neck cancer who were treated with radiation that spared the contralateral submandibular gland in a collaborative study conducted at the University of Colorado and the Memorial Sloan-Kettering Cancer Center in New York City. The mean radiation dose delivered to the contralateral gland was 33.04 Gy./p>

At a median follow-up of 27.3 months, none had had cancer recurrences in the spared area.

This is preliminary evidence that submandibular gland-sparing radiotherapy is feasible technically, and that it is safe even in advanced-stage node-positive cancers, the researchers conclude. They suggest that these outcomes data “offer significant promise for decreasing morbidity.”

More data on this submandibular gland-sparing approach were presented at the meeting by Moses Tam, BS, an MB candidate in his final year at New York University School of Medicine in New York City, who was also an author on the previous presentation.

He reported data from 125 patients (median age, 57 years) with oropharyngeal cancer (53% base of tongue, 41% tonsil, 6% other), all of whom had node involvement (16% N1, 8% N2A, 48% N2B, and 28% N2C).

All patients underwent chemoradiation, but some patients had sparing radiation, with a reduction of radiation treatment volume to the submandibular (level 1B) lymph nodes, while the remainder had radiation without sparing.

The sparing approach significantly reduced the dose of radiation to the submandibular salivary glands (from 70.5 Gy to 63.9 Gy in the ipsilateral gland, and from 56.2 Gy to 43.0 Gy in the contralateral gland), and also to the oral cavity (from 45.2 Gy to 36.1 Gy; all P < .001).

Both groups of patients had a similar 2-year local regional control rate — 97.5% with sparing radiation and 93.8% with nonsparing radiation — indicating a low rate of tumor recurrence at the original tumor site.

However, those who received the sparing radiation had significant improvement in both patient-reported xerostomia summary scores ( P = .021) and observer-rated xerostomia scores ( P = .006), compared with the other group.

“Our data show that it is safe to spare the lymph nodes in oropharyngeal cancer from radiation,” Tam commented. This approach reduces the radiation dose to several nearby salivary organs, and therefore causes less damage to a patient’s post-treatment salivary function.

Effects on Voice and Speech Under-recognized

In contrast to the attention that has been focused on chronic mouth dryness and swallowing difficulties as complications of radiotherapy, relatively little attention has been paid to treatment-related changes in voice and speech quality, commented Jeffrey Vainshtein, MD, chief resident in the Department of Radiation Oncology at the University of Michigan in Ann Arbor.

In fact, physicians tend to underestimate the detrimental effects of head and neck radiation on this aspect of patients’ quality of life, he commented, and presented data showing a wide discrepancy between the reports from patients as compared to physicians on a voice and speech quality assessment tool.

The finding comes from a study conducted in 91 patients with stage III or IV oropharyngeal cancer who had participated in trials at the University of Michigan and been treated with definitive concurrent chemotherapy (weekly carboplatin and paclitaxel) and organ-sparing intensity-modulated radiation therapy (IMRT).

Patient-reported results show a maximal decrease in voice and speech quality at 1 month, with 41% to 68% of patients (using 2 different questionnaires) reporting worse quality than pretreatment baseline levels. Voice and speech quality returned to baseline levels by 12 to 18 months, but not in all patients. At 12 months, 28% to 33% of patients continued to report lower voice and speech quality.

In contrast, physicians reported that larynx toxicity was rare, and reported grade 1 toxicity in 5% of patients at 6 months, and in none at 1 and 2 years.

“It’s interesting to see this physician and patient disconnect,” commented Mitchell Machtay, MD, chair of radiation oncology at Case Western Reserve University in Cleveland, who moderated the press conference.

Dr. Vainshtein said that the degree of disconnect was “quite surprising,” but added that this is not unique to this study or to oncology, and indeed is seen throughout medicine. He suggested that physicians may miss the subtleties of changes in quality of life, and also some patients may not mention symptoms when talking with their doctor, but once they are asked in detail in a structured questionnaire, the results can be quite informative. He also said that more emphasis should be, and in fact is already being, placed on patient-reported outcomes in clinical trials.

Further analysis showed that the mean radiation dose to the voice box (glottic larynx) was independently associated with poor voice quality, while patient-perceived speech difficulties were related to the radiation dose received by both the voice box and the oral cavity.

These findings, from the largest prospective study of this issue to date, support limiting the mean radiation dose to the glottic larynx to less than 20 Gy during whole-neck IMRT for head and neck cancer when the larynx is not a target, the researchers conclude.

Minimizing the radiation dose is likely to reduce voice and speech problems, and thus improve post-treatment quality of life, Dr. Vainshtein commented.

Notes: The authors have disclosed no relevant financial relationships.
Source: 2 2014 Multidisciplinary Head and Neck Cancer Symposium (MHNCS): Abstracts 12 (Robin), 121 (Vainshtein), 139 (Tam). Presented February 21, 2014.

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Mouth bacteria trigger oral cancer

Fri, Feb 28, 2014

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Source: www.digitaljournal.com
Author: Tim Sandle

Chemicals released from two bacteria that cause gum disease can incite the growth of deadly lesions and tumors in the mouth, trigger oral cancer. This is according to a new study carried out by Case Western Reserve University.

High levels of certain bacteria found in the saliva of people are associated with the risk of oral cancer. The researchers were keen to understand why most people never develop oral cancer and what it is that protects them. Their answer related to most people not carrying a certain type of bacteria in their mouths.

The cancer of concern is Kaposi’s sarcoma-related (KS) lesions and tumors in the mouth. The bacteria associated with this are the species Porphyromonas gingivalis and Fusobacterium nucleatum. These species are associated with gum disease.

For the research, scientists recruited 21 patients, dividing them into two groups. All participants were given standard gum-disease tests. The first group of 11 participants had an average age of 50 and had severe chronic gum disease. The second group of 10 participants, whose average age was about 26, had healthy gums. The bacteria were common to those with gum disease.

By carrying out further tests, the researchers found that the bacteria produce fatty acids and these fatty acids then allowed oral cancer causing viruses to grow. The discovery could lead to early saliva testing for the bacteria. When such bacteria are found the mouth of a patient could be treated and monitored for signs of cancer and before it develops into a malignancy.

The findings have been reported in The Journal of Virology, in a paper titled “Short Chain Fatty Acids from Periodontal Pathogens Suppress HDACs, EZH2, and SUV39H1 to Promote Kaposi’s Sarcoma-Associated Herpesvirus Replication.”

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