Prognostic factors linked with poor locoregional control in tongue cancer

Source: www.cancernetwork.com Author: Gina Mauro Depth of invasion, lymphovascular space invasion, and positive glossectomy specimen margins were all found to be linked with inferior locoregional control (LRC) in patients with pT1-2N0 oral tongue squamous cell carcinoma who were treated with partial glossectomy and elective neck dissection alone. The retrospective findings, which were presented during the 2024 ASTRO Multidisciplinary Head and Neck Cancers Symposium, were seen even with final negative tumor bed margins. Results showed that, at a median follow-up of 45.6 months, the 3-year LRC and overall survival (OS) rates were 88.0% and 92.5%, respectively, in the all-comer patient population. In patients with pT1 disease, these rates were 92.0% and 95.2%, respectively; they were 85.0% and 90.5% in those with pT2 disease. However, upon the multivariate analysis, those with positive glossectomy margins had worse LRC (HR, 6.66; 95% CI, 1.60-27.78; P = .009). Lymphovascular space invasion (HR, 6.90; 95% CI, 1.42-33.65; P = .02) and depth of invasion (HR, 1.31; 95% CI, 1.06-1.63; P = .01) were also associated with inferior LRC. “Patients with these risk factors may be considered for adjuvant radiotherapy to optimize disease control,” lead study author Michael Modzelewski, MD, of Kaiser Permanente Bernard J. Tyson School of Medicine, in Pasadena, California, and coinvestigators wrote in a poster presented at the meeting. Patients who have early-stage tongue squamous cell carcinoma do not typically receive adjuvant radiation because they are often at low risk for recurrence. Following surgery, the status of main glossectomy specimen margin has been shown [...]

Primary Transoral Surgery Yields Good Swallowing Outcomes Despite Increased Risk of Death in HPV-related OPSCC

Author: Hayley Virgil Source: www.cancernetwork.com Despite an increased risk of grade 5 toxicities, patients with human papillomavirus–related oropharyngeal squamous cell carcinoma who received primary transoral surgery and neck dissection vs radiotherapy experienced good swallowing outcomes at 1 year. Good swallowing outcomes were observed at 1 year among patients with human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma who were treated with primary transoral surgery (TOS) and neck dissection vs radiotherapy despite an increased risk of developing grade 5 toxicities, according to findings from the phase 2 ORATOR2 trial (NCT03210103). At a median follow up of 17 months, investigators reported 3 deaths in both the TOS and neck dissection arm, 2 of which were treatment related and 1 due to myocardial infarction at 8.5 months. The 2 treatment-related deaths were reported following TORS and were due to oropharyngeal hemorrhage and cervical vertebral osteomyelitis. Moreover, investigators reported 4 progression-free survival (PFS) events in this arm, 3 of which were mortality events and 1 due to local recurrence. As such, overall survival (OS) and PFS data were considered immature at the time of study. In total, 67% of patients in the radiotherapy arm and 71% in the TOS and neck dissection arm experienced grade 2 to 5 toxic effects. The study included patients who were 18 years or older with T1 to T2 disease and N0 to N2 staging. Those who enrolled were randomized 1:1 to either the primary radiotherapy group, including 60 Gys followed by concurrent weekly cisplatin chemotherapy at 40 mg/m2 in [...]

2022-06-29T15:19:48-07:00June, 2022|Oral Cancer News|

Oral cancer pain linked to disease spread

Source: www.docwirenews.com Author: Robert Dillard Oral cancer is more likely to spread in patients who experience high levels of pain, according to a study published in the journal Scientific Reports. When oral cancer spreads to lymph nodes in the neck, a patient’s chance of survival is cut by half, the researchers noted. However, it’s often unclear through imaging and physical assessment if oral cancer has spread, leaving surgeons struggling with whether to preemptively perform prophylactic neck dissection to remove the cancer when research shows that up to 70% are unnecessary. Researchers documented the pain experienced by 72 oral cancer patients before surgery by way of an oral cancer pain questionnaire developed by the investigators. While most patients reported some pain, researchers observed that patients with the most pain were more likely to have cancer that spread to lymph nodes in the neck. This observation suggests that patients with less pain are at low risk of metastasis, and will rarely benefit from a neck dissection. “I have been investigating the underlying cause of oral cancer pain for two decades. This is the first time that we have demonstrated a correlation between a patient’s pain and the clinical behavior of the cancer,” said Brian L. Schmidt, DDS, MD, PhD, director of the NYU Oral Cancer Center and one of the study’s authors via a press release. Aditi Bhattacharya, PhD, an assistant professor in the Department of Oral and Maxillofacial Surgery at NYU College of Dentistry added: “While we need to undertake a [...]

Sentinel node biopsy proves mettle in H&N cancer

Source: www.medpagetoday.com Author: Ed Susman, Contributing Writer, MedPage Today Sentinel node biopsy achieved "oncological equivalence" with neck dissection in patients with operable T1-T2N0 oral and oropharyngeal cancer, researchers reported. In a head-to-head trial, the 2-year neck-relapse free survival (RFS) was 90.7% in the sentinel node (SN) biopsy group versus 89.4% in the neck dissection group, according to Renaud Garrel, MD, PhD, of Montpellier University Hospital Center in France. That 1.1% difference fell well within the pre-specified 10% difference to determine if there was non-inferiority of SN biopsy to neck dissection, which is considered the standard of care for treatment of early stage head and neck cancers (P=0.008 for equivalence), he reported at the American Society of Clinical Oncology virtual meeting. At 5 years, 89.4% of the SN biopsy group achieved neck-RFS versus 89.6% in the neck dissection group, he said in a pre-recorded oral presentation on the Senti-MER study. Overall, there were 14 neck recurrences in 139 patients in the neck dissection group and 13 neck recurrences in 120 patients in the SN biopsy group. Also, overall survival was 82.2% in the SN biopsy group and 81.8% in the neck dissection group. Hisham Mehanna, MBChB, PhD, of the University of Birmingham and the Warwickshire Head and Neck Clinic in England, commented that "Elective neck dissection is the standard, especially for oral cancer. Sentinel node biopsy is an accepted technique as there have been large series that show benefit, but there has never been a head-to-head study with the standard of [...]

Beating HPV-positive throat cancer

Source: www.huffingtonpost.com Author: Pamela Tom, Contributor National Oral, Head, and Neck Cancer Awareness Week is April 12-18, 2017 For at least two years, 47 year-old Rob Clinton of Rochester, NY, would choke on post nasal drip in the shower. He knew something was wrong in his throat but he didn’t feel any pain. Did he have cancer? Clinton smoked cigarettes for 30 years and worked in an auto body shop where he was regularly exposed to carcinogens, but he wasn’t experiencing the typical symptoms of throat cancer. These include hoarseness or a change in the voice, difficulty swallowing, a persistent sore throat, ear pain, a lump in the neck, cough, breathing problems, and unexplained weight loss. In November 2015, Clinton went to the dentist to have his teeth cleaned. His dentist felt Clinton’s swollen neck and recommended that he visit a medical doctor. Clinton heeded the advice and sought the opinion of an ear, nose, and throat specialist at Strong Memorial Hospital in Rochester, NY. The ENT doctor sent Clinton to have a CAT scan and when he scoped Clinton’s throat, the doctor said, “I see something in there.” What he saw was a tumor and there were a few other things going on too. The Diagnosis The biopsy showed that Clinton had Stage IVa oral squamous cell carcinoma (OSCC) at the base of his tongue—and the cancer was HPV positive. HPV stands for the human papillomavirus and a recent survey found that more than 42% of Americans are infected [...]

Nonsurgical surveillance safe, cost-effective for head, neck cancer

Source: www.healio.com Author: Mehanna H, et al. Patients with head and neck cancer who underwent PET/CT–guided surveillance achieved similar survival outcomes as those who underwent planned neck dissections, according to the results of a prospective, randomized controlled trial. However, surveillance led to fewer surgical operations and complications and appeared more cost-effective than neck dissection, results showed. Patients with head and neck cancer frequently undergo invasive surgery following treatment to remove remaining cancer cells, according to study background. “After treatment, remaining cancer cells play something akin to hide and seek,” Hisham Mehanna, MBChB, PhD, FRCS, chair of head and neck surgery at University of Birmingham and director of the Institute of Head and Neck Studies and Education, said in a press release. “Our study shows that we can hunt them down, find them and remove them effectively.” Mehanna and colleagues sought to define the role of image-guided surveillance compared with planned neck dissection for the management of patients with advanced, nodal head and neck squamous cell carcinoma previously treated with primary chemoradiotherapy. The analysis included data from 564 patients (mean age, 58 years; 82% men) who researchers randomly assigned to PET/CT–guided surveillance (n = 282) performed 12 weeks after the end of treatment or planned neck dissection (n = 282). Oropharyngeal cancer served as the most common cancer subtype (84%). Seventy-five percent of patients had HPV-16–positive disease. Patients assigned surveillance only underwent neck dissection if their PET/CT scans showed incomplete or equivocal response to chemoradiotherapy. The trial was designed to assess [...]

Factors linked with better survival in oral cancer identified

Source: www.cancertherapyadvisor.com Author: staff Factors associated with improved survival in oral cavity squamous cell cancer (OCSCC) include neck dissection and treatment at academic or research institutions, according to a study published in JAMA Otolaryngology-Head & Neck Surgery. Alexander L. Luryi, from the Yale University School of Medicine in New Haven, Conn., and colleagues analyzed correlations between treatment variables and survival in patients with stages I and II OCSCC. Data were included for 6,830 patients. The researchers found that five-year survival was 69.7 percent. Treatment factors that correlated with improved survival on univariate analysis included treatment at academic or research institutions, no radiation therapy, no chemotherapy, and negative margins (all P < 0.001). Improved survival was also seen in association with neck dissection (P = 0.001). Treatment at academic or research institutions correlated with increased likelihood of receiving neck dissection and decreased likelihood of receiving radiation therapy or having positive margins. Neck dissection and treatment at academic or research institutions correlated with improved survival on multivariate analysis (hazard ratios, 0.85 and 0.88, respectively), while compromised survival was seen for positive margins, insurance through Medicare, and adjuvant radiation therapy or chemotherapy (hazard ratios, 1.27, 1.45, 1.31, and 1.34, respectively). "Overall survival for early OCSCC varies with demographic and tumor characteristics but also varies with treatment and system factors, which may represent targets for improving outcomes in this disease," the authors write. Reference Luryi, Alexander L., BS, et al. "Treatment Factors Associated With Survival in Early-Stage Oral Cavity Cancer: Analysis of 6830 Cases [...]

Many throat cancer patients can skip neck surgery

Source: medicalxpress.com Author: Fox Chase Cancer Center A new study shows that patients with human papillomavirus (HPV) – the same virus associated with both cervical and head and neck cancer – positive oropharyngeal cancer see significantly higher rates of complete response on a post-radiation neck dissection than those with HPV-negative oropharyngeal cancer. Fox Chase Cancer Center researchers presented the findings at the American Society for Radiation Oncology's 56th Annual Meeting on Wednesday, September 17. "For patients that achieve a complete response, neck surgery is probably unnecessary," says Thomas J. Galloway, MD, Attending Physician and Director of Clinical Research at Fox Chase and lead author on the study. After radiation and chemotherapy to remove tumors from the tonsils or back of the tongue, many head and neck cancer patients still have persistent lumps in their neck, albeit perhaps smaller than when they were first diagnosed. "The question is: Do we need to remove those lumps, as well, or can we just let them dissolve on their own?" asks Dr. Galloway. To investigate, he and his colleagues reviewed the medical records from 396 patients whose oropharyngeal tumors had spread to at least one lymph node. Within 180 days after completing radiation therapy, 146 patients underwent neck surgery. For 99 patients, their records indicated whether or not their tumors had likely been triggered by HPV. Interestingly, patients with HPV often respond better to treatment for their oropharyngeal tumors than those without. The researchers noted the same trend here – people who tested positive [...]

2014-09-17T18:59:34-07:00September, 2014|Oral Cancer News|

PET/MRI detects head/neck lymph node metastases

Source: www.drbicuspid.com Author: DrBicuspid Staff PET/MRI outperformed diffusion-weighted MRI (DWI-MRI) for detecting lymph node metastases in the staging of head and neck cancer patients, according to a study presented November 25 at the Radiological Society of North America (RSNA) annual meeting in Chicago. Researchers from the University of Düsseldorf found that PET/MRI achieved accuracy of 93%, compared with 88% for DWI-MRI. PET/MRI also reached sensitivity of 72%, compared with 36% for DWI-MRI. Lymph node status has prognostic value in head and neck cancer because patients with metastases need neck dissection and adjuvant treatment. Therefore, precise lymph node staging is a necessity, noted lead author Christian Buchbender, MD. "Currently available imaging modalities are restricted in their diagnostic performance for lymph node metastases detection," he added. "For example, CT and MRI fall short in sensitivity when compared to FDG-PET or FDG-PET/CT. On the other hand, FDG-PET/CT suffers from a large amount of false-positive results." Thus, new modalities or a combination of modalities are needed to improve lymph node metastases detection in these cancer patients, he said. The prospective study included 14 head and neck cancer patients with a mean age of 67 years. Prior to surgery, the patients received both FDG-PET/CT and 3-tesla MRI, including diffusion-weighted imaging. The patients then underwent bilateral neck dissection. Using image fusion software, the researchers created two sets of images. One set consisted of PET/MR images, which were created by fusing FDG-PET results with contrast-enhanced, T1-weighted, fat-saturated MR images. The second set consisted of DWI-MR images, created [...]

2012-11-28T10:25:22-07:00November, 2012|Oral Cancer News|

Good speaking, swallowing after chemoradiotherapy for head/neck cancer

Source: www.medscape.com Author: Fran Lowry Most patients with locoregionally advanced head and neck cancer who were successfully treated with intensive chemoradiotherapy had no residual deficits in speaking or swallowing after their treatment, according to the results of a study done by University of Chicago researchers. The study appears in the December issue of the Archives of Otolaryngology–Head & Neck Surgery. Of 163 patients with head and neck cancer who were assigned a speaking score an average of 35 months after completing treatment, 84.7% were found to have no lasting difficulties and were given a score of 1 on a scale of 1 to 4, with 1 being the best and 4 being the worst function. In addition, among 166 patients who were assigned a swallowing score an average of 35 months after treatment, 63.3% were found to have no lasting difficulties swallowing and were given a score of 1. "We weren't surprised by our findings," senior author Joseph K. Salama, MD, told Medscape Medical News. "However, it was nice to quantify formally our clinical impressions—that most patients in the long run do well." Dr. Salama was with the University of Chicago, Illinois, at the time the study was conducted and is now at Duke University Medical Center in Durham, North Carolina. Expert Disagrees However, Robert L. Ferris, MD, PhD, professor and vice chair of the Department of Otolaryngology at the University of Pittsburgh Medical Center in Pennsylvania, disagreed with the view that so many patients with head and neck cancer [...]

2010-12-27T21:20:46-07:00December, 2010|Oral Cancer News|
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