Positron Emission Tomography – Oral Cancer News

Treatment paradigms are shifting for locally advanced HPV-positive head and neck cancers

Source: www.onclive.com Authors: Kaveh Zakeri, MD, MAS, Nancy Y. Lee, MD The standard of care for patients with locally advanced head and neck squamous cell carcinomas does not substantially differ according to human papillomavirus (HPV) status in the National Comprehensive Cancer Network guidelines.1 Resectable tumors can be treated with surgery followed by adjuvant therapy. Alternatively, definitive chemoradiation therapy with cisplatin is the other dominant treatment paradigm. Incidence of HPV-associated oropharyngeal squamous cell carcinoma has increased rapidly and is associated with higher overall survival (OS) compared with cancers caused by smoking and alcohol.2,3 Given the unique biology of HPV-associated oropharyngeal disease, a separate staging system was developed for these tumors.4 HPV-associated oropharyngeal cancers are more radiosensitive and chemosensitive than cancers caused by smoking and alcohol, yet the traditional treatment paradigms—including high doses of radiation and chemotherapy—were developed prior to the epidemic of HPV-associated disease. De-escalation of therapy has been proposed for HPV-associated oropharyngeal cancer based on data demonstrating high OS and progression-free survival (PFS).5 De-escalation of therapy has been investigated for both definitive surgical and chemoradiation therapy paradigms. Most de-escalated approaches focus on selecting patients according to clinical features, such as disease stage and smoking status, whereas personalized de-escalation reduces treatment intensity for patients according to treatment response. Transoral Robotic Surgery Followed by Adjuvant Radiotherapy Transoral robotic surgery (TORS) is a minimally invasive approach that reduces morbidity compared with traditional, open surgery for patients with oropharyngeal cancers. TORS is a standard of care option for patients with resectable tonsil or base [...]

Oral Cancer Foundation News Team - A2021-11-23T08:16:08-07:00November, 2021|Oral Cancer News|

Liquid biopsy accurately detects HPV+ oropharyngeal cancer recurrence

Source: www.medpagetoday.org Author: Zeena Nackerdien PhD, CME Writer, MedPage Today In general, HPV-positive OPSCC has a favorable prognosis as compared with HPV-negative disease, which has supported efforts to de-intensify treatment regimens to reduce exposure to potentially toxic therapies. Positron emission tomography/computed tomography (PET/CT) imaging 3 months after definitive treatment is standard for response assessment in many cases. However, the disease will recur in up to 25% of patients, depending on clinical risk factors and tumor biology. The latency period prior to OPSCC recurrence is 2 years for many patients, but rare case reports have described latency periods exceeding 5 years. Currently, National Comprehensive Cancer Network (NCCN) guidelines recommend surveillance of patients with HPV-associated OPSCC every 1 to 3 months for the first year, every 2 to 6 months for the second year, every 4 to 8 months for years 3 to 5, and then once a year thereafter. Because the oropharynx can be a difficult anatomic location to evaluate -- a process that may be further obscured by treatment-related tissue changes -- radiologic imaging studies have been used in cancer surveillance for this disease. According to study findings published in the Journal of Clinical Oncology, a blood test for tumor-associated HPV-DNA had near-perfect accuracy for identifying OPSCC patients at high risk of recurrence after treatment. The findings have clear and immediate implications for clinical practice, including earlier initiation of salvage therapy for patients with recurrent disease, reported Bhishamjit S. Chera, MD, of the UNC Lineberger Comprehensive Cancer Center in Chapel [...]

Oral Cancer Foundation News Team - A2020-04-30T08:53:02-07:00April, 2020|Oral Cancer News|

Living with cancer in the country: Many Wyoming residents must leave home to seek the care they need

Source: trib.com Author: Katie King Bob Overton is all too familiar with the 140-mile stretch of land between Thermopolis and Casper. He and his wife, Sherry, made the two-hour trip in their white pickup dozens of times while Bob was undergoing treatment for lymphoma in 2015. Even with the help of Alan Jackson and Martina McBride’s music, the hours still lagged, with nothing to stare at except endless grassy plains. “That trip is pretty monotonous, and it doesn’t get any better with time,” he recalled. But the couple didn’t have a choice. Their hometown of Thermopolis, population 3,009, doesn’t offer the care Bob needed. And the Overtons aren’t alone. As the least populated state in the country, Wyoming appeals to those in search of space and wilderness. But the peace and quiet comes with drawbacks: Services that urban residents may take for granted, like advanced medical care, aren’t readily available for thousands of people living in small towns and rural areas. Many of those battling cancer in Wyoming subsequently end up seeking treatment in Casper, according to Rocky Mountain Oncology’s Patient Navigator Sam Carrick. She said the center is the only medical facility in the state that offers radiation, chemotherapy and Positron emission tomography scans. Other areas may offer one or two of those services, but many prefer the convenience of a one-stop shop, she said. About 15 percent of their patients are from out-of-town, added Carrick, who is responsible for guiding all patients through the treatment process. She said [...]

Oral Cancer Foundation News Team - A2018-02-04T09:47:02-07:00February, 2018|Oral Cancer News|

Imaging technique identifies early metastasis in lymph nodes

Source: www.newswise.com Author: National Institute of Biomedical Imaging and Bioengineering NIBIB-funded researchers have developed a highly sensitive and accurate imaging technique for non-invasive screening of lymph nodes for metastatic cancer. Current practice calls for invasive surgical biopsies to determine whether deadly metastatic cancer cells have invaded the lymph nodes. The new imaging technique – so far tested in mice – offers a rapid and effective tool to noninvasively identify very small numbers of these cells, known as micrometastases, thus detecting cancer’s spread at its earliest stages, which is critical for timely treatment. The work, developed at the University of Texas at Austin and the University of Texas MD Anderson Cancer Center, is reported in the October issue of Cancer Research. The technique uses an imaging approach known as ultrasound-guided photoacoustics combined with nanosensors designed to target and identify metastatic cells in lymph nodes. Richard Conroy, Ph.D., Director of the NIBIB Program in Molecular Imaging elaborates on the technology’s potential: "This work is an excellent example of the development of a cutting edge technology that works very well in an experimental system but also has great potential to change the way we monitor and diagnose cancer metastasis. Identifying the accumulation of cells early in the process with some molecular characterization offers the opportunity for more targeted and effective treatment and fewer side effects.” More than 90% of cancer deaths can be attributed to metastases either directly or indirectly. In current clinical practice, an invasive surgical procedure called sentinel lymph node (SLN) [...]

Oral Cancer Foundation News Team - A2015-05-24T08:48:05-07:00May, 2015|Oral Cancer News|

PET may artificially boost HNC survival rates

Source: www.drbicuspid.com Author: Donna Domino, Features Editor The use of positron emission tomography (PET) is associated with a stage migration phenomenon in locally advanced head and neck cancer (HNC) patients, according to a recent report in JAMA Otolaryngology -- Head & Neck Surgery. Multiple studies have shown the increased sensitivity of fluorodeoxyglucose (FDG)-PET over computed tomography (CT) for detecting primary tumors, regional nodal disease, and distant metastases. Because of potential treatment changes and prognostic information, as well as patient and physician preference, FDG-PET has been rapidly adopted for managing head and neck cancers. Because FDG-PET is more sensitive than CT, it often leads to patients being assigned a higher stage than if they were staged with CT alone, the study authors noted. In this retrospective study, the researchers sought to confirm whether the increased use of FDG-PET over time is associated with the appearance of improved stage-specific survival due to stage migration (JAMA Otolaryngol Head Neck Surg, July 1, 2014, Vol. 140:7, pp. 654-661). Results In the study's model of clinically important variables, PET scan use was associated with a higher stage of disease. In addition, oropharyngeal cancers were more likely to be assigned a higher stage than oral cavity cancers. Within the PET era, no statistically significant survival difference was found between those who underwent FDG-PET and those who did not. However, a significant increase in stage-specific survival was detected for patients with locally advanced disease. No stage-specific survival differences were found in patients with local disease or metastatic [...]

Oral Cancer Foundation News Team - A2014-08-12T08:29:46-07:00August, 2014|Oral Cancer News|

Another Side Effect Of Chemotherapy: ‘Chemo Brain’

Source: NPR Date: December 28, 2012 Author: Patti Neighmond It's well-known that chemotherapy often comes with side effects like fatigue, hair loss and extreme nausea. What's less well-known is how the cancer treatment affects crucial brain functions, like speech and cognition. For Yolanda Hunter, a 41-year-old hospice nurse, mother of three and breast cancer patient, these cognitive side effects of chemotherapy were hard to miss. "I could think of words I wanted to say," Hunter says. "I knew what I wanted to say. ... There was a disconnect from my brain to my mouth." Before getting treated for cancer, Hunter led a busy, active lifestyle. But the effects of chemotherapy on her brain made it difficult for her to do even the most basic things. "I couldn't even formulate a smile. I had no expression," she says. "I might feel things on the inside, but it didn't translate to the outside. ... It literally felt like you were trying to fight your way through fog." Some cancer patients call this mental fog "chemo brain." And now researchers are trying to quantify exactly what chemo brain really is. Oncologist Jame Abraham, a professor at West Virginia University, says about a quarter of patients undergoing chemotherapy have trouble processing numbers, using short-term memory and focusing their attention. Using positron emission tomography, or PET, scans to measure blood flow and brain activity, Abraham looked at the brains of 128 breast cancer patients before they started chemotherapy and then again, six months later. On [...]

Charlotte Parker2013-01-10T13:00:01-07:00January, 2013|Oral Cancer News|

IMRT provides better QOL in head and neck cancers

Source: www.oncologyreport.com/ AUthor: Miriam E. Tucker Intensity-modulated radiotherapy is more expensive than 3-D–conformal radiotherapy is and has not been shown to improve standard outcomes in patients with head and neck cancer. But it results in better quality of life. These findings from two studies presented at the Multidisciplinary Head and Neck Cancer Symposium raise the question: Does improved quality of life justify the greater expense of intensity modulated radiotherapy (IMRT), which has been rapidly adopted for the treatment of head and neck cancer? Because IMRT spares surrounding tissues, it reduces the likelihood of developing xerostomia, noted Dr. Nathan C. Sheets, who presented data on billing charges associated with IMRT, compared with 3-D–conformal radiotherapy (CRT). IMRT is reimbursed at a substantially higher level than CRT, however, and it is unclear how to assess this cost relative to other aspects of care in this population, said Dr. Sheets, a radiation oncology resident at the University of North Carolina, Chapel Hill. A separate study presented by Dr. Allen M. Chen compared quality of life in patients who received IMRT vs. CRT. "There’s very little data to suggest IMRT is better than non-IMRT using traditional end points. But the question is: How do you define ‘better’?" said Dr. Chen, director of the radiation oncology residency training program at the University of California, Davis in Sacramento. "IMRT might not particularly involve better cure rates, but it could make a difference in terms of other end points, such as quality of life, which we all know [...]

Oral Cancer Foundation News Team - A2012-02-12T09:20:40-07:00February, 2012|Oral Cancer News|

Combined CT, FDG-PET improves head/neck cancer treatments

Source: www.drbicuspid.com Author: staff Combining CT with fluorodeoxyglucose positron emission tomography (FDG-PET) imaging results in significantly more defined tumor outlines and potentially different treatment options in head and neck cancer patients compared with using CT alone, according to research presented April 29 at the Cancer Imaging and Radiation Therapy Symposium in Atlanta. In this trial, conducted at Utrecht University Medical Center, 327 patients were treated with intensity-modulated radiation therapy for head and neck cancer. Based on the combined approach of the CT scan and FDG-PET, the researchers noticed a change in the delineation of the tumor in one out of three patients, resulting in 10% of patients' treatment being changed and 33% of patients having their treatment adjusted. In 17% of the patients, the primary tumor was not visible on the CT scan alone, mostly due to dental inlays. "We expected there to be an improved delineation of the tumor," said Homan Dehnad, MD, study author and radiation oncologist at Utrecht University Medical Center. "However, we never expected it to have such an influence on the treatment options for patients. Each dedicated institute dealing with head and neck cancer should be equipped with multi-imaged facilities."

Oral Cancer Foundation News Team - A2011-04-30T15:34:38-07:00April, 2011|Oral Cancer News|

FDG-PET staging and importance of lymph node SUV in head and neck cancer

Source: 7thspace.com Author: staff Objectives: The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC. Methods: Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on to receive radiotherapy. Results: The median follow-up time for all patients was 469 days. The PPV and NPV of PET imaging to correctly identify lymph node status was 94% and 89% respectively. Lymph nodes with extracapsular extension (ECE) had higher SUVs than nodes without ECE, 11.0 vs. 5.0 (p <0.0007). Maximum SUV for the primary tumor >8.0 was predictive of worse overall survival (p <0.045), while the SUV of the lymph nodes was predictive for distant recurrence at one year--with a mean SUV value of 10.4 for patients with distant failure vs. 7.0 without (p <0.05). Conclusions: FDG-PET staging in head and neck cancer has good positive and negative predictive values in determining lymph node status. The maximum SUV of the primary tumor is predictive of overall survival. This is the first report to find that the SUV of a lymph node is predictive for ECE [...]

Oral Cancer Foundation News Team - A2010-07-18T06:52:58-07:00July, 2010|Oral Cancer News|

Metabolic activity of head and neck cancer may help guide treatment

Source: www.oncologystat.com Author: Staff The metabolic activity of head and neck squamous cell carcinoma on pretreatment imaging independently predicts outcomes in patients who undergo intensity-modulated radiation therapy, new data show. This imaging information can be used to tailor treatment, especially to reduce the risk of distant metastases, lead investigator Dr. Min Yao said at a head and neck cancer symposium sponsored by the American Society for Radiation Oncology. Higher standardized uptake value (SUV) of the primary tumor and of the lymph nodes predicted worse outcomes in multivariate analyses presented by Dr. Yao, a radiation oncologist at the Case Western Reserve University, Cleveland. "Several papers have shown that the standardized uptake value (SUV) is a prognostic factor in head and neck cancer," Dr. Yao told attendees. Most of these studies were small series, involved patients receiving conventional radiation therapy, and did not evaluate SUV of the primary tumor and lymph nodes separately. Dr. Yao and his colleagues analyzed outcomes in 177 patients treated for head and neck squamous cell carcinoma with intensity-modulated radiation therapy (IMRT) between 1999 and 2006. The patients had a pretreatment positron emission tomography scan using fluorodeoxyglucose as the tracer (FDG-PET), and the maximal SUV was determined for both the primary tumor and the involved lymph nodes. The patients then underwent IMRT with curative intent. Seventy-seven percent of the patients were male. Twenty-nine percent were receiving IMRT postoperatively, whereas the rest were receiving it as definitive therapy. The cancer was most commonly located in the oropharynx (49%) and [...]

Oral Cancer Foundation News Team - A2010-04-18T10:24:49-07:00April, 2010|Oral Cancer News|