New treatment for HPV-associated oropharynx cancer leads to excellent disease control, less side effects

Source: www.news-medical.net Author: Emily Henderson, B.Sc., Mayo Clinic Mayo Clinic researchers have found that a new, shorter treatment for patients with HPV-associated oropharynx cancer leads to excellent disease control and fewer side effects, compared to standard treatment. The new treatment employs minimally invasive surgery and half the standard dose of radiation therapy, compared to current treatments. The new treatment also lasts for two weeks, rather than the standard six weeks. Results of a study of the new treatment were presented Tuesday, Oct. 20, at the American Society for Radiation Oncology's Annual Meeting. Dr. Ma says that while the standard treatment for this type of cancer leads to high cure rates, it may also result in many short-term and long-term treatment toxicities, including dry mouth, problems swallowing, neck stiffness and jawbone problems. "Many of these side effects are directly linked to the amount of radiation used for treatment," says Dr. Ma. Dr. Ma and his colleagues developed an initial clinical trial looking at a new treatment using minimally invasive surgery and half the standard dose of radiation. The initial clinical trial demonstrated that well-selected patients could have excellent disease control with much lower toxicity using the new treatment. "Our findings suggest that in select patients with HPV-associated oropharynx a shorter course treatment, compared to the standard of care, yields a similar result," says Dr. Ma. Based on these phase 3 results, Mayo Clinic has adopted this shorter course treatment as its standard of care for well-selected patients. Dr. Ma and his [...]

Factors identified for poor long-term survival in RT-treated patients with oropharyngeal cancer

Source: www.cancertherapyadvisor.com Author: Susan Moench, PhD, PA-C Specific patient- and treatment-related factors were identified as potential survival detriments for patients with a history of oropharyngeal cancer (OPC) who received radiation therapy (RT) and were alive for at least 5 years following diagnosis, according to findings from a retrospective database review published in Cancer. Specifically, older age at diagnosis (≥55 years; standardized mortality ratio [SMR], 3.68), status as a current or former smoker (SMR, 3.28 vs 7.43), and the presence of tonsil (SMR, 4.39) or base of tongue tumors (SMR, 3.10) or category T4 tumors (SMR, 5.43) correlated with a higher risk for death. Previous research has demonstrated that patients with head and neck cancers who remain recurrence-free for 5 years following diagnosis have a very low risk of disease recurrence. However, less is known about the conditional long-term survival of this group of patients, represented by the 2-, 5- and 10-year overall survival (OS) probabilities for those without evidence of disease recurrence 5-years post-diagnosis. Furthermore, patient, disease-, and treatment-related factors associated with long-term survival in these patients are also not well understood. Of the 1699 patients included in this analysis, all were newly diagnosed with squamous cell carcinoma OPC between 1980 and 2012, had no cancer event for the 5 years that followed OPC diagnosis, and had been treated with RT without surgery at the University of Texas MD Anderson Cancer Center in Houston, Texas. Baseline characteristics of this patient cohort included a median age of 60 years. Most of [...]

Ask the Doctors: Dysphagia common in elderly

Source: journalstar.com Author: [email protected] Dear Doctor: Why do the elderly often have a hard time swallowing, and sometimes experience a feeling that food is stuck in their throats? I heard there's a procedure to stretch the throat. Does it help? Dear Reader: The condition you're asking about is known as dysphagia, which refers to difficulty in swallowing. Patients may have trouble starting a swallow, or problems with the esophagus, which is the muscular tube that connects the throat with the stomach. The origins of the disorder fall into several basic categories. There are neurological causes, such as stroke, Parkinson's disease, multiple sclerosis, dementia and head injury. Certain muscular conditions can affect the proper functioning of the esophagus. So does obstruction, which can result from a narrowing of the esophagus, or from inflammation. These can be caused by head and neck cancers, radiation therapy, tuberculosis and chronic acid reflux. Although dysphagia can affect people of all ages, you're correct that it's seen more often in older adults. This is commonly due to age-related changes in the body, such as loss of muscle tone, mass and strength, and changes to nerve function. Still, dysphagia is not considered to be a normal sign of aging. Understanding dysphagia starts with the mechanics of swallowing. We tend to think of it as the "gulp" that empties the mouth. But that's just the first step of a complex process. A successful swallow moves the contents of your mouth through the throat, and all the way down [...]

New cancer treatment delivers weeks of radiation therapy in a second

Source: New Atlas Date: January 9th, 2020 Author: Michel Irving Radiation therapy is currently our best shot at treating cancer, but it’s far from a perfect solution. It takes a course of weeks or even months, during which time healthy cells often become unfortunate collateral damage. But what if the whole course of treatment could be over in under a second? Researchers at the University of Pennsylvania have now shown just how this might be feasible. With the right tools, cancer cells on their own aren’t all that difficult to kill. Radiation or drugs can be administered to kill them off relatively easily – the problem is tumors like to hide in crowds, and whatever weapons we fire at them also tend to hit healthy cells around them. Because radiation therapy takes weeks, there are more opportunities for those healthy cells to be affected, leading to all kinds of health problems even if the cancer is destroyed. That’s where FLASH radiotherapy comes in. This emerging form of treatment involves giving a patient in one second a similar amount of radiation as they would normally receive over weeks. Previous experiments have shown that the effect on the cancer itself is basically the same, but the collateral damage to healthy tissue is drastically reduced. For the new study, researchers at Pennsylvania University found that by changing the type of fundamental particle used, they could make FLASH radiotherapy far more effective. Normally, electrons are the particles of choice for this method, but they [...]

2020-01-10T10:50:29-07:00January, 2020|Oral Cancer News|

Which feeding tubes do head and neck cancer clinicians prefer to use in patients undergoing radiotherapy?

Source: www.oncologynurseadvisor.com Author: Susan Moench, PhD, PA-C A study of the perceptions of health care professionals involved in the care of patients with head and neck cancer undergoing radiation therapy regarding optimal feeding tube practices showed no consensus; however, feeding tube placement was considered important for some patients. This study was published in JPEN Journal of Parenteral Enteral Nutrition. Patients with head and neck cancer frequently undergo intensive treatment that may include a long course of radiation therapy in addition to surgery and chemotherapy. Treatment-related toxicity can involve severe dysphagia and mucositis, as well as reduced food intake and unintentional weight loss; these clinical sequelae can also lead to treatment delays and an increased risk of hospitalization. Clinical practice guidelines include recommendations for early enteral feeding in patients with stage IV disease or hypopharyngeal tumors who are receiving chemoradiotherapy, as well as other patients with head and neck cancer, “depending on factors including their treatment, nutrition status, dysphagia, social support, and food intake.” However, there is no conclusive evidence as to which of the most commonly used feeding tubes — a nasogastric tube (NGT) placed when additional nutritional support is needed or a prophylactic gastrostomy tube (PGT) placed before radiation therapy — is preferable. In this qualitative study, in-depth interviews were conducted with interdisciplinary health care professionals from 4 radiation therapy departments (2 in the United States and 2 in Australia) to evaluate their perspectives and experiences regarding feeding tube practices in patients with head and neck cancer. Of the [...]

2019-09-14T09:13:13-07:00September, 2019|Oral Cancer News|

Drug Target in Rare, Lethal Glandular Cancer Discovered

Source: www.dddmag.comAuthor: Yale University  Using a novel cell culture approach, Yale Cancer Center researchers have discovered critical vulnerabilities in adenoid cystic carcinoma (ACC), a rare and lethal glandular cancer with a high recurrence rate and few treatment options. The findings, published April 15th in the journal Clinical Cancer Research, offer data that ACC and similar cancers could be treated with already available drugs. ACC most often occurs in the salivary glands but can originate in the breast, trachea, skin, or other sites. Survival rates at five years are close to 90percent but drop significantly after that with just 40percent surviving at 15 years after diagnosis. It is a slow-growing cancer that affects about 1,200 people each year, with few symptoms in early stages. Aside from surgery, there are few treatments for ACC, which until now has proven largely resistant to radiation therapy. It is this resistance that prompted Yale researchers to develop a novel cell culture technique to isolate and study ACC cancer stem cells, known to be the root of tumor growth, aggressiveness, and resistance to chemotherapy and radiation, said co-senior author Sergey Ivanov, research scientist in surgery (otolaryngology). “Within ACC cells, we found the especially aggressive cancer stem cells. As important, we found the Achilles heel of these cells, which is their addiction to NOTCH1, a signaling molecule that helps these cells to survive therapy and multiply,” Ivanov said. “Fortunately, cancer stem cells can be killed by blocking NOTCH1 production.” The similarities between the ACC stem cells and [...]

2016-04-21T10:12:16-07:00April, 2016|Oral Cancer News|

Minimizing Imaging for Recurrence of HPV-Associated Head & Neck Cancer

Source: www.journals.lww.com/oncologytimesAuthor: Robert H. Carlson  SCOTTSDALE, ARIZ.—Most recurrences of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) can be found through imaging and physical exams within six months after treatment, according to a study from the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla. “For most patients with HPV-associated oropharyngeal cancer who have had a negative three-month PET scan, physical exams with history and direct visualization are sufficient to find recurrences,” said Jessica M. Frakes, MD, Assistant Member of the Department of Radiation Oncology at the institute and lead author on the study, in a presentation at the 2016 Multidisciplinary Head & Neck Cancer Symposium. “Minimizing the number of exams that do not compromise outcomes not only helps decrease anxiety and stress for our patients, but also eases the financial burden of cancer care,” she said.    The study also supports the effectiveness of specialist teams in treating HPV-positive OPSCC with definitive radiation therapy. Frakes said local control at three years was 97.8; regional control 95.3 percent; locoregional control 94 percent; and freedom from distant metastases 91.4 percent. Three-year overall survival was 91 percent. “The number of OPSCC patients and survivors is growing, so there is a great need to determine the general time to recurrence and the most effective modes of recurrence detection in order to guide optimal follow-up care,” Frakes said. But National Comprehensive Cancer Network (NCCN) guidelines for treatment of OPSCC are “one size fits all,” she said, with the same follow-up recommendations whether the disease [...]

2016-04-18T17:27:00-07:00April, 2016|Oral Cancer News|

Imaging, physical examination find most recurrences of HPV-positive oropharyngeal cancer

Source: www.oncologynurseadvisor.com Author: Kathy Boltz, PhD Posttreatment imaging at 3 months and physical examinations during the 6 months following treatment can detect most recurrences in patients treated with definitive radiation therapy for oropharyngeal cancer caused by human papillomavirus (HPV).1 This research was presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium. A dramatic increase in oropharyngeal squamous cell carcinoma (OPSCC) cases associated with HPV has been reported by the American Cancer Society. Survival rates after definitive radiation therapy have also increased. This has led to the need to determine general time to recurrence and the most effective modes of recurrence detection, to guide standards for optimal follow-up care by oncology teams. This study examined 246 cases of HPV-positive or p16-positive non-metastatic OPSCC treated with definitive radiation therapy at a single, large-volume cancer center between 2006 and 2014. Follow-up care included a PET/CT scan 3 months after completing treatment and physical examinations every 3 months in the first year following treatment, every 4 months in the second year and every 6 months in years 3 through 5. Median follow-up care length for all patients was 36 months. Patient outcomes, including recurrence and survival rates, were calculated using the Kaplan-Meier method from the end of radiation therapy. Most recurrences were detected either by persistent disease appearing on 3-month post-treatment imaging or by patients presenting with symptoms at follow-up examinations. Disease characteristics that increase the likelihood of recurrence include presenting with 5 or more nodes or having level 4 lymph nodes (P [...]

Laser Treatment Halts Oral Mucositis in Its Tracks

Source: www.medscape.com Author: Fran Lowry   Spa-like treatment with a cool, low-level laser, similar to that use for wrinkles, vanquishes oral mucositis, one of the most debilitating toxicities of cancer therapy.   "I have been an oncology nurse for over 25 years, and in those 25 years, there has been nothing that helps prevent or is effective against the treatment for oral mucositis, until now," said Annette Quinn, RN, MSN, from the University of Pittsburgh Cancer Institute.   "Patients say they rank it higher than nausea and vomiting when it comes to adverse side effects, especially because we have good medications to control nausea and vomiting. But the low-level laser works better than we could have hoped," Quinn told Medscape Medical News.   She presented results from a pilot project at the Oncology Nursing Society (ONS) 40th Annual Congress in Orlando, Florida.   Oral mucositis affects virtually all head and neck cancer patients undergoing chemo and radiation therapy, and about 75% to 100% of patients undergoing stem cell transplantation with whole-body irradiation experience some degree of oral mucositis.   Low-level laser therapy (LLLT) has been used to treat oral mucositis for a decade in Europe and South America, but it has not made its way to the United States because there is no mechanism for reimbursement, Quinn reported.   She hopes this study will change that.   "Reimbursement is the main obstacle to its use in the United States, but for this study, I was able to secure the treatment [...]

2015-05-04T10:29:44-07:00May, 2015|Oral Cancer News|

Experience counts with radiation for head and neck cancer

Source: www.oncologynurseadvisor.com Author: Kathy Boltz, PhD When it comes to specialized cancer surgery, the more experienced the surgeon, the better the outcome is generally true. The same might hold true for radiation therapy used to treat head and neck cancer, according to a new study. Published in the Journal of Clinical Oncology(1) with an accompanying editorial(2), the study compared survival and other outcomes in 470 patients treated with radiation therapy at 101 treatment centers through a clinical trial held from 2002 to 2005. The trial was sponsored by the National Cancer Institute and organized by the Radiation Therapy Oncology Group (RTOG). It was conducted by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital in Columbus. The findings indicated that patients treated at the less-experienced centers were more likely to have cancer recurrence compared with highly experienced centers (62% vs 42%, respectively, at 5 years) and had poorer overall survival compared with those at the highly experienced centers (51% vs 69% 5-year survival, respectively). “Our findings suggest that institutional experience strongly influences outcomes in patients treated with radiation therapy for head and neck cancer,” said first author Evan Wuthrick, MD. “They indicate that patients do better when treated at centers where more of these procedures are performed versus centers that do fewer.” Radiation therapy for head and neck cancer requires complex treatment planning that can vary considerably between institutions and physicians. In addition, significant short-term and long-term side effects can occur that require management [...]

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