Medical Mysteries: How a sore throat led to life-threatening bleeding

Source: www.washingtonpost.com Author: Sandra G. Boodman A Florida man spent months consulting doctors baffled by stabbing pain that radiated to his neck and shoulder. For more than a year, Arthur L. Kimbrough had done everything he could think of to find out what was causing the stabbing sensation that radiated from his throat to his neck and down his left shoulder. He had seen anesthesiologists, an ear, nose and throat doctor, a neurologist and neurosurgeons in Florida and Maryland; undergone tests and scans; and taken a variety of drugs that failed to alleviate the intensifying pain that baffled his doctors. It wasn’t until February 2022, after Kimbrough suffered a life-threatening hemorrhage in a hospital waiting room, that the cause was finally identified. Two years later, Kimbrough, now 76, attributes his survival to being in the right place at the right time. He says he feels lucky to be alive and is not angry his illness wasn’t diagnosed earlier. Doctors “missed some things clearly, [but] it wasn’t because they weren’t looking,” said Kimbrough, an executive coach who lives in the Florida Panhandle and owns funeral homes and cemeteries in Florida and Mississippi. “They were very responsive.” “The blinders we had on was that it turned out to be the fundamentally wrong place to be looking,” he said. Unusual sore throat Kimbrough first noticed the pain — a tender spot under the left side of his tongue in the back of his mouth — in mid-December 2020. It didn’t seem like a [...]

2024-02-18T13:41:55-07:00February, 2024|Oral Cancer News|

Dr Jennifer Choe discusses head and neck dancer relapse, new treatment trials, promising responses

Source: www.ajmc.com Author: Brooke McCormick Jennifer Choe, MD, PhD, shared her thoughts on why head and neck cancer patients relapse after radiation therapy, new head and neck cancer treatment trials, and promising responses from these trials. Choe is a head and neck oncologist at Vanderbilt University Medical Center and was a presenter at The American Journal of Managed Care®’s Institute for Value-Based Medicine® held in Nashville, Tennessee on August 17, 2023. Transcript Can you explain some of the thought behind why there is disease relapse in head and neck cancers after radiation treatment? There's a lot of theoretical basis as to why we think this is the case. A lot is driven by just aggressive biology; it's really not known. Head and neck cancers are considered immune responsive, technically speaking, but the response rates still are pretty low, in general, and whether or not the immune system and head and neck cancer patients are depressed compared to other cancers. I, in theory, think that a part of it is actually the radiation creating an environment where there could be a reduction in the body's ability to regulate the immune system. There's an immune suppressed state for these patients that could be due to radiation of the lymph nodes that's decreasing the ability for the immune system to respond, but also the local radiation induced immune suppression effects that may be producing a more conducive environment for the cancer to return. What are some of the trials evaluating new treatment regimens [...]

2023-09-02T07:41:01-07:00September, 2023|Oral Cancer News|

In head and neck cancer, better outcomes seen in patients with overweight

Source: www.mdedge.com Author: Jennie Smith Patients with head and neck cancer and overweight saw better treatment response and survival after chemoradiation, compared with patients with the same type of cancer but a normal weight, a new study finds. The findings, published in JAMA Network Open, are the latest to parse the complex relationship between body mass index (BMI) and treatment in cancers that is sometimes called the “obesity paradox.” The researchers compared outcomes among patients with normal weight, overweight, and obesity. While higher BMI is an established risk factor for many types of cancer and for cancer-specific mortality overall, studies in some cancers have shown that patients with higher BMI do better, possibly because excess BMI acts as a nutrient reserve against treatment-associated weight loss. Methods and results For their research, Sung Jun Ma, MD, of Roswell Park Comprehensive Cancer Center, Buffalo, N.Y., and colleagues looked at records for 445 patients (84% men, median age 61) at Dr. Ma’s institution with nonmetastatic head and neck cancer who underwent chemoradiotherapy between 2005 and 2021. Patients were followed up for a median 48 months, and those with underweight at treatment initiation were excluded. The researchers found that overweight BMI (25-29.9 kg/m2) was associated with improved overall survival at 5 years (71% vs. 58% of patients with normal weight), as well as 5-year progression-free survival (68% vs. 51%). No overall or progression-free survival benefit link was seen in patients with a BMI of 30 or higher, in contrast to some previous studies of [...]

Two markers help predict head and neck cancer prognosis

Source: labblog.uofmhealth.org Author: news release, University of Michigan Health Rogel Cancer Center A new study from the University of Michigan Health Rogel Cancer Center finds circulating tumor DNA, or ctDNA, levels can predict as early as two weeks after starting treatment which patients are likely to have good outcomes. At the same time, specialized MRI and PET scans two weeks after starting chemoradiation also correlated with outcomes. “Rates of throat cancer have steadily increased in recent years, driven by HPV infections, fueling the need for biomarkers to help guide treatment decisions, especially for locally advanced disease,” said senior study author J. Chad Brenner, Ph.D., associate professor of otolaryngology at Michigan Medicine. “Quantitative imaging of metabolism, local blood volume density and cell density from PET and MRI scans have shown both prognostic value in predicting treatment outcome as well as utility in selecting patients for additional focal radiation treatment,” said study author Yue Cao, Ph.D., professor of radiation oncology and radiology at Michigan Medicine. The researchers conducted a randomized trial of patients with stage 3 oropharyngeal squamous cell carcinoma. In total, 93 patients had imaging and 34 also had blood tests before starting chemoradiation and again at two, four and seven weeks after treatment. The study found that HPV ctDNA clearance at two weeks, but not at four weeks, predicted outcomes. The metabolism, local blood density and cell density before radiation therapy or at two weeks after starting treatment predicted outcomes as well. These early predictor biomarkers could help determine which [...]

2021-11-17T07:43:52-07:00November, 2021|Oral Cancer News|

Robotics surgery may improve outcomes in mouth and throat cancer

Source: eandt.theiet.org Author: E&T editorial staff Robotic surgery may improve the health outcomes in mouth and throat cancer patients, including better long-term survival, new research suggests. The method used for the study focused on oropharyngeal cancer that occurs in the back of the throat and includes the base of the tongue and tonsils. In transoral robotic surgery, a surgeon uses a computer-enhanced system to guide an endoscope – a flexible tube with a light and camera attached to it – to provide high-resolution, 3D images of the back of the mouth and throat. Naturally, this is an area that is difficult to reach with conventional tools; therefore, robots can be used during this procedure. Here, two robotically guided instruments, acting as a surgeon’s arms, work around corners to safely remove tumours from surrounding tissue. The observational study, conducted by non-profit Los Angeles hospital Cedars-Sinai, used data from the US National Cancer Database and included 9,745 surgical patients – 2,694 of whom underwent transoral robotic surgery between 2010 and 2015. “At a minimum, robotic surgery for oropharyngeal cancer patients seems safe and effective compared to what’s been the standard of care for many years,” said Zachary S Zumsteg, assistant professor of Radiation Oncology at Cedars-Sinai, referring to standard surgery, radiation therapy, and chemotherapy. The researchers found that the five-year overall survival rate for patients with early-stage disease who underwent robotic surgery was 84.5 per cent, compared with 80.3 per cent for patients who had non-robotic surgery. They adjusted for differences in [...]

NSAID use may improve overall survival during chemoradiation for patients with HNSCC

Source: www.cancernetwork.com Author: Hannah Slater This study demonstrated a possible advantage in overall survival for patients taking NSAIDs during chemoradiation for head and neck squamous cell carcinoma. A study published in JAMA Network Open suggested a possible advantage in overall survival (OS) for patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) during chemoradiation for head and neck squamous cell carcinoma (HNSCC). However, researchers suggested that future studies evaluating this association are warranted. “This large, retrospective cohort study suggests a significant association with improved OS for patients with HNSCC taking NSAIDs during definitive CRT,” the authors wrote. “While the change in LC with NSAID use was not significant, future studies should continue to evaluate this possibility.” Overall, 460 patients with HNSCC who were treated with chemoradiation therapy (CRT) at a single institution between January 1, 2005 and August 1, 2017 were included in the study, including 201 patients (43.7%) who were taking NSAIDs during treatment. Patient and tumor characteristics included age, race/ethnicity, smoking status, alcohol use, comorbidities (respiratory, cardiovascular, immune, renal, endocrine), disease stage, human papillomavirus (HPV) status, and treatment duration. On univariate analysis, NSAID use (hazard ratio [HR], 0.63; 95% CI, 0.43-0.92; P = 0.02) was associated with better OS. Moreover, on Cox regression analysis, after backward selection adjustment for possibly confounding factors such as age, smoking status, primary tumor site, human papillomavirus status, diabetes, stroke, and hyperlipidemia, NSAID use continued to be significantly associated with better OS (HR, 0.59; 95% CI, 0.38-0.90; P = 0.02). Even further, at 5 years NSAID [...]

Fewer side effects with proton beam vs traditional radiotherapy

Source: www.medscape.com Author: Roxanne Nelson, RN, BSN One of the main advantages claimed for proton beam radiotherapy is that it has fewer adverse effects than traditional radiotherapy. A new study suggests that that is so. The retrospective comparative effectiveness study involved 1483 patients with nonmetastatic cancer (various types, including brain, head and neck, lung, gastrointestinal, gynecologic) who were treated with curative intent. Slightly less than a third of these patients (n = 391) were treated with proton beam radiotherapy; the remaining patients (n = 1092) underwent traditional radiotherapy. The results show that among the patients who were treated with proton therapy, there was a significantly lower risk for serious side effects: 11.5% experienced events of grade 3 or higher within 90 days of treatment, compared to 27.6% of patients in the traditional radiotherapy group. "We know from our clinical experience that proton therapy can have this benefit, but even we did not expect the effect to be this sizeable," said senior author James Metz, MD, chair of radiation oncology, leader of the Roberts Proton Therapy Center at the University of Pennsylvania, and a member of Penn's Abramson Cancer Center. Importantly, there was no difference in cancer outcomes between the two groups; both disease-free and overall survival were similar. "It shows that proton therapy offers a way for us to reduce the serious side effects of chemoradiation and improve patient health and well-being without sacrificing the effectiveness of the therapy," said lead author Brian Baumann, MD. He is an adjunct assistant [...]

Chemotherapy + radiation may improve survival for some elderly

Source: journals.lww.com Author: Carlson, Robert H., Oncology Times Because the toxicity of concurrent chemoradiation is greater than radiation therapy alone for definitive head and neck cancer treatment, many clinicians have reservations about offering chemoradiotherapy for elderly head and neck cancer patients. But a new study shows that combining chemotherapy with radiation therapy improves survival rates for those head and neck cancer patients ages 71 to 79 years who have low comorbidity scores and advanced disease stage, with survival rates similar to that of younger patients. The study, which used data from the National Cancer Data Base (NCDB), suggests elderly patients are being underrepresented in prospective clinical trials that have defined standards of care for head and neck cancer. “In the era of improved radiation techniques, improved systemic therapy, and better supportive care, we found that chemoradiotherapy does, in fact, improve survival for a large segment of this population,” said Sana Karam, MD, PhD, Assistant Professor of Radiation Oncology at the University of Colorado School of Medicine in Aurora, and senior author on the study.“ "These findings challenge historical data demonstrating no benefit of chemoradiotherapy for patients older than 70 years,” Karam said. The study was presented at the 2016 Multidisciplinary Head & Neck Cancer Symposium, sponsored by the American Society for Radiation Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO). First author is Arya Amini, MD, a fourth-year resident in the Department of Radiation Oncology at the University of Colorado School of Medicine. Before the meeting, Karam discussed [...]

Cetuximab plus RT linked with high toxicity in head and neck cancer

Source: www.cancernetwork.com Author: Anna Azvolinsky, PhD The combination of radiation therapy plus the EGFR inhibitor cetuximab had higher rates of acute toxicity among patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) compared with radiation therapy plus the chemotherapy cisplatin, according to results of a phase II trial based in Italy. Efficacy was similar with both combination therapies. According to Stefano Maria Magrini, MD, professor of radiotherapy at the Università degli Studi di Brescia in Italy, and colleagues, this is the first clinical trial to directly compare radiation therapy plus cetuximab to a chemoradiation regimen for SCCHN. The results of the randomized trial are published in the Journal of Clinical Oncology. Cetuximab was approved in combination with radiation therapy by the US Food and Drug Administration in 2006 for the treatment of unresectable SCCHN. Despite a goal of recruiting 130 patients, only 70 patients were recruited between 2011 and 2014. The 1- and 2-year overall survival rates were 75% and 68% in the cetuximab arm compared with 78% in the cisplatin arm. The 1- and 2-year local control rates were 64% and 53% in the cetuximab arm and 84% and 80% in the cisplatin arm, yet the differences between arms were not statistically significant (P = .073), reflecting the inadequate statistical power of the relatively small trial. Compliance in both treatment arms was relatively low. Only 28% of patients in the cetuximab arm and 20% of patients in the cisplatin arm received at least 7 cycles [...]

2015-12-13T09:06:40-07:00December, 2015|Oral Cancer News|

Time to treatment increasing with head, neck cancer

Source: medicalxpress.com Author: staff Time to treatment initiation (TTI) is rising for patients with head and neck squamous cell carcinoma, according to a study published online Dec. 9 in Cancer . Colin T. Murphy, M.D., from the Fox Chase Cancer Center in Philadelphia, and colleagues analyzed data from the National Cancer Database to identify head and neck cancer sites (oral tongue, oropharynx, larynx, and hypopharynx) and to determine TTI (the number of days from diagnosis to the initiation of definitive treatment). The researchers found that based on 274,630 patients from 1998 to 2011, the median TTI for all patients was 26 days, and increased from 19 to 30 days (P

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