Multidisciplinary treatment approaches for oral cavity cancer

Source: dailynews.ascopubs.org Author: Mindy Tanzola, PhD An Education Session at the 2023 ASCO Annual Meeting will focus on the treatment of oral cavity cancer, one of the most common types of head and neck cancer worldwide. The session will feature experts from medical, radiation, and surgical oncology to address all 3 treatment modalities, said Session Chair Ali Hosni, MBBCh, MSc, PhD, of Princess Margaret Cancer Center in Canada. The session will take place on June 4. Although oral cavity cancer is diagnosed in more than 300,000 individuals worldwide each year,1 it receives less attention than other subsets of head and neck cancer, Dr. Hosni said, highlighting a need for education. In addition, oral cavity cancer often involves all 3 treatment modalities, which means there is a need for collaborative multidisciplinary care that also integrates the patient into treatment planning. Role of Sentinel Lymph Node Biopsy In his update on surgical approaches for oral cavity cancer, Stephen Y. Lai, MD, PhD, FACS, a head and neck cancer surgeon at The University of Texas MD Anderson Cancer Center, will first discuss the role of sentinel lymph node biopsy (SLNB) for these patients. Dr. Lai explained that lymph node metastases are sometimes found in patients with early-stage oral cavity cancer (T1-2) who are thought to be node-negative based upon imaging studies and clinical examination. However, evidence has shown that active management through elective neck dissection is associated with higher rates of overall survival and disease-free survival versus “watchful waiting” and therapeutic neck dissection.2 [...]

Ten year results of landmark neck cancer trial published

Source: www.modernmedicine.com Author: Gabriel Miller The latest data from a trial that opened in 1992 confirm that for locally advanced laryngeal cancer, sequential and concomitant chemoradiotherapy each produce similar survival rates, but the concomitant approach more often allows the larynx to be preserved. When the results of RTOG 91-11 were first published in 2003. "they changed the standard of care treatment for preserving the larynx from the sequential use of chemotherapy then radiotherapy to giving both together," said lead investigator Dr. Arlene Forastiere of Johns Hopkins University in an email to Reuters Health. "The results have held up over the last decade," she said, "...and this exact treatment remains the standard of care today because on average, 15% will ultimately require laryngectomy with the concomitant approach, compared to double that, or 30%, with either giving chemotherapy and radiation in sequence or giving radiotherapy alone." "There's no question that this study has changed the way we approach and treat this disease, so it is truly a landmark study," said Dr. Chris Holsinger, a head and neck cancer surgeon at MD Anderson Cancer Center in Houston, Texas who wasn't involved in the research. Between 1992 and 2000, 547 patients were randomly assigned to three treatment groups: induction chemotherapy followed by radiation; concomitant chemoradiotherapy; and radiotherapy alone. The induction group received up to three cycles of cisplatin 100 mg/m2 on day one and fluorouracil 1,000 mg/m2 per day for five days, every three weeks. Responders then received up to 70 Gy of radiotherapy [...]

2012-11-30T05:39:25-07:00November, 2012|Oral Cancer News|

Larynx preservation studies should consider treatment impact

Source: www.internalmedicinenews.com Author: Sara Freeman, Internal Medicine News Digital Network Almost one-quarter of patients who had been given induction chemotherapy before radiotherapy for head and neck cancer experienced long-term swallowing difficulties, with another 15% experiencing voice disabilities that correlated with the mobility of the vocal cords. Long-term data from the GORTEC (Groupe Oncologie Radiothérapie Tête et Cou) 2000-01 larynx preservation trial also show that approximately two-thirds of long-term head and neck cancer survivors experienced severe problems with sticky saliva and dry mouth, which were in turn linked to nutritional problems. These findings, reported May 9 at the European Society for Therapeutic Radiation Oncology (ESTRO) Anniversary Conference, further confirm that studies looking at the effects of chemoradiotherapy on the larynx in head and neck cancer need to consider prospective assessment of laryngeal function, rather than just looking at anatomical preservation, according to a French radiation oncologist. Dr. Gilles Calais of the Centre Hôpitalier Régional et Universitaire de Tours (France) presented data from a prospective analysis of 61 patients who had participated in the original 213-patient GORTEC 2000-01 trial. He also presented updated results from the trial using a recently developed composite end point. "Larynx preservation can be achieved for most of our [head and neck] patients by using three different strategies: induction chemotherapy, concomitant [chemoradiotherapy], or alternating chemoradiotherapy," Dr. Calais observed. Indeed, larynx preservation is a possibility in approximately 80% of patients, he said. However, anatomical preservation does not mean that laryngeal function is maintained, especially with respect to the ability [...]

Head and neck cancer guidelines ‘streamlined’

Source: www.medscape.com Author: Fran Lowry Modest changes in the 2011 National Comprehensive Cancer Network (NCCN) Head and Neck Cancers Guidelines will refine and improve the treatment of these complex, challenging, and relatively rare cancers, according to the panel chief reporting here at the NCCN 16th Annual Conference. One of the main changes is a new "suggestion" that the workup for cancer of the oropharynx include testing of the tumor for human papillomavirus (HPV). "Immunohistochemical testing for HPV p16 is recommended," said David G. Pfister, MD, from Memorial Sloan-Kettering Cancer Center in New York City, and chair of the NCCN Head and Neck Cancers Guidelines Committee. "Although not used to guide treatment, HPV testing is valuable prognostically. The results should not change management decisions," he emphasized. HPV-related oropharyngeal cancer appears to be a new and distinct disease entity, and is associated with better survival than non-HPV head and neck cancers, Dr. Pfister noted. HPV Has a Clear Impact on Prognosis "Our understanding of the human papillomavirus as a risk factor for head and neck cancer has evolved. Now we see that it has a clear impact on prognosis," Dr. Pfister said in an interview with Medscape Medical News. Because of their improved prognosis, these patients might require different treatment, he said. "There is a great interest in better understanding HPV-related cancers and how we treat the disease down the road. Right now we have insufficient data to change how we treat these patients, but clinical trials are being designed to assess the optimal treatment [...]

Induction chemotherapy for head and neck cancer: recent data

Source: The Oncologist By: Everett E. Vokes The addition of chemotherapy to radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) patients improves survival. Meta-analyses of randomized trials have indicated that the benefit of this approach is associated with the timing of chemotherapy administration. It has been demonstrated that the greatest survival benefit over locoregional treatment alone is seen with the concurrent administration of chemotherapy and radiotherapy. However, sequential chemotherapy administration, in the form of induction chemotherapy followed by radiotherapy or concurrent chemoradiotherapy, has been successful as a strategy for organ function preservation in patients with potentially resectable SCCHN. In addition, a meta-analysis of trials using platinum and 5-fluorouracil (PF)-containing induction regimens demonstrated a significant survival benefit for this approach over locoregional treatment alone in locally advanced disease. In recent years, the introduction of the taxanes into induction chemotherapy has provided physicians with more active regimens. The triplet combination induction regimen of docetaxel, cisplatin, and 5-fluorouracil has been shown to be more effective in prolonging survival than the doublet PF. Current trials are testing whether the addition of induction chemotherapy to standard concomitant chemoradiotherapy is superior to concomitant chemoradiotherapy alone.

2010-11-07T08:24:33-07:00November, 2010|Oral Cancer News|

Organ preservation for advanced resectable cancer of the base of tongue and hypopharynx: a Southwest Oncology Group trial

Source: J Clin Oncol 23:88-95 Author: Susan G. Urba et al. Purpose: The Southwest Oncology Group designed a phase II trial for patients with base of tongue or hypopharyngeal cancer to evaluate the complete histologic response rate at the primary site after induction chemotherapy followed by chemoradiotherapy for responders. Secondary end points were the rate of organ preservation and the need for salvage surgery. Patients and Methods: Fifty-nine eligible patients were enrolled; 37 had base of tongue cancer, and 22 had hypopharynx cancer. Forty-two percent had stage III disease, and 58% had stage IV disease. Induction chemotherapy was two cycles of cisplatin 100 mg/m2 and fluorouracil 1,000 mg/m2/d for 5 days. Patients who had a greater than 50% response at the primary site were treated with radiation 72Gy and concurrent cisplatin 100 mg/m2 for three cycles. Patients with less than partial response at the primary had immediate salvage surgery. Results: Forty-five patients (76%) had a greater than 50% response at the primary after induction chemotherapy; 43 went on to receive definitive chemoradiotherapy. Thirty-two patients (54%) achieved a histologic complete response at the primary site, and an additional nine patients had a complete clinical response, but biopsy was not done. Seventy-five percent of patients did not require surgery at the primary tumor site. The 3-year overall survival was 64%. The 3-year progression-free survival with organ preservation was 52%. Conclusion: Patients with base of tongue or hypopharyngeal cancer treated with this regimen of induction chemotherapy followed by definitive chemoradiotherapy have a good [...]

2010-09-07T07:46:33-07:00September, 2010|Oral Cancer News|

Induction chemotherapy followed by chemoradiotherapy increased time-to-treatment failure compared to chemoradiotherapy alone in patients with unresectable locally advanced head & neck cancer

Source: news.prnewswire.com Author: press release The Spanish Head and Neck Cancer Cooperative Group (TTCC) announced today that Induction Chemotherapy (IC) delivered prior to standard ChemoRadiotherapy (CRT), a treatment paradigm defined as sequential therapy, compared to upfront CRT alone, significantly prolonged Time-to-Treatment Failure (TTF) for patients with unresectable Locally Advanced Head and Neck Cancer (LAHNC). The endpoint of Time-to-Treatment Failure was defined as a composite of time-to-disease progression, -to-surgery or other cancer-related treatments, -to-drop-out due to an adverse event, and to death from any cause. Final results (abstract #6009) from the Phase 3 randomized study were presented by Prof. Ricardo Hitt, of the University Hospital 12 de Octubre, Madrid, in an oral presentation at the 2009 annual meeting of the American Society of Clinical Oncology (ASCO). The results of this study have also been selected for inclusion in the Best of ASCO(R) program. The Best of ASCO(R) is an educational initiative that condenses highlights from ASCO's Annual Meeting, with the objective of increasing global access to cutting-edge science that is relevant and significant in oncology today. This study enrolled 439 patients with Locally Advanced Head and Neck Cancer with good performance status, who were randomly assigned to receive standard CRT (cisplatin and fractionated radiation) versus the same treatment preceded by IC, which consisted of cisplatin plus 5-fluorouracil (5-FU) with or without Taxotere(R) (docetaxel) Injection Concentrate. The study was designed to compare the results of those patients who received IC prior to CRT (sequential therapy) and patients who received CRT alone. The [...]

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