Reducing RT toxicity in head and neck cancer: recent research context

Source: www.medpagetoday.com Author: Kristin Jenkins, contributing writer, MedPage Today In patients with head and neck malignancies, studies show that the significant acute and long-term toxicities and poor quality of life (QOL) associated with postoperative radiation therapy (PORT) can be improved by selectively reducing larger radiotherapy volumes. This includes treating just one side of the neck. In patients with locally advanced head and neck squamous cell carcinoma (HNSCC), however, locoregional failure rates with the omission of PORT to the pathologically uninvolved neck (PN0) have been less clear. As a result, PORT has historically been delivered to the PN0 neck, with several studies showing high rates of regional control ranging from 95% to 100%. Notably, consensus clinical practice guidelines continue to recommend the use of bilateral irradiation of node-negative necks. However, results from a prospective phase II study in 72 patients with primary HNSCC and high-risk pathology features now suggest that PORT to the PNo neck can be eliminated without sacrificing excellent disease control or QOL. At a median follow-up of 53 months, absolute regional control in the unirradiated neck was 97%, even though 67 patients (93%) had stage III/IV disease and 71% of tumors involved or crossed midline. No patient received contralateral neck PORT, and 17 patients (24%) were treated for the primary neck tumor only, said Wade Thorstad, MD, of Washington University in St. Louis, and colleagues. The 5-year rates of local control, regional control, progression-free survival, and overall survival (OS) were 84%, 93%, 60%, and 64%, respectively, they reported [...]

2019-11-21T12:57:43-07:00November, 2019|Oral Cancer News|

Palifermin reduces severe mucositis in head and neck cancer

Source: http://www.medscape.com/ Author: Janis C. Kelly Palifermin (Kepivance), which is currently approved for preventing mucositis associated with total-body irradiation and stem-cell transplantation in hematologic malignancies, also prevents oral mucositis in patients with head and neck cancer undergoing radiation and chemotherapy, according to 2 randomized trials published online June 13 in the Journal of Clinical Oncology. Michael Henke, MD, who led both studies, told Medscape Medical News that "this shows for the first time that radiation-induced mucositis can be ameliorated — and this in a phase 2/3 design!" Dr. Henke is from the Department of Radiation Oncology at University Clinic in Freiburg, Germany. The multicenter studies included researchers from Austria, France, Germany, Hungary, Italy, Poland, Spain, the United Kingdom, and the United States. The first study was a double-blind randomized placebo-controlled trial of 186 patients with stage II to IVB carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Treatment included radiation, 60 or 66 Gy, after complete or incomplete resection, delivered at 2 Gy per fraction and 5 fractions per week. Treatment also included cisplatin 100 mg/m2 on days 1 and 22 (and on day 43 with incomplete resection). Patients were randomized to weekly palifermin 120 μg/kg or placebo from 3 days before and throughout radiochemotherapy. The primary end point was the incidence of severe oral mucositis (World Health Organization [WHO] grades 3 to 4). Palifermin reduced oral mucositis incidence to 51% (41 of 92), compared with 67% (63 of 94) with placebo (P = .027), shortened median mucositis from [...]

Taste and smell disorders caused by cancer or treatments add to patients’ problems

Source: www.oncologynursingnews.com Author: Delicia Yard Although the mechanisms underlying abnormalities in the senses of taste and smell in cancer patients are unknown, such disturbances clearly decrease quality of life for the majority of cancer patients—and clinicians need to be aware of the problem in order to help a person's recovery. This is the word from a study recently published in The Journal of Supportive Oncology (2009;7:58-65). Jae Hee Hong, PhD, Pinar Omur-Ozbek, PhD, Brian T. Stanek, and coinvestigators from Wake Forest University Comprehensive Cancer Center and Virginia Tech's food science and technology department and biomedical engineering school conclude, “Oncologists who understand the types and causes of taste and olfactory abnormalities may be better prepared to discuss and empathize with these negative side effects.” Altered sensory perception can undermine a person's struggle against cancer by causing malnutrition and anxiety. One study cited by Dr Hong and colleagues found that malnutrition, not malignancy, was the primary cause of morbidity in 20% of cancer patients. Dr Hong and colleagues explain that disorders of taste and odor can result from cancer itself or from cancer treatments, with 68% of chemotherapy patients reporting such problems. But the specific causes of these alterations often remain unidentified. How Senses Go Bad According to the researchers, problems with taste and smell break down into 3 categories: loss of sensitivity, distorted perception, and hallucination. The abnormalities may take the following forms: • absence of taste perception (ageusia) or odor perception (anosmia) • reduced sensitivity to taste perception (hypogeusia) or [...]

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