radiation therapy

Skin from her arm gives woman a new tongue

Source: www.wptv.com
Author: Amanda Kahan

Getting her kids out the door, in the car, and to school is a daily mission for mom Lisa Bourdon-Krause. It’s also one she doesn’t take for granted. A few years ago, Lisa was diagnosed with tongue cancer. Doctors said surgery would mean removing half of Lisa’s tongue. One of her doctors told her she might not ever talk again. At the time, Lisa’s son was just two. She didn’t know if he’d hear his mom’s voice again, so she recorded herself.

Thanks to surgeon, Douglas Chepeha, Lisa never had to give her son those recordings. In a 10-hour surgery, surgeons cut out the cancerous part of Lisa’s tongue. Then, doctor Douglas Chepeha took skin from her own forearm and attached it to her tongue — using a pattern as a guide.

The result: A tongue that looked and felt much like the real thing. Lisa was able to talk a few days after her surgery. After a couple of weeks, she could eat. It was a relief — but not the biggest one for Lisa. A mom who’s grateful for every moment — and every word she can speak.

Background:
According to the Mayo Clinic, tongue cancer is a serious type of head and neck cancer. It usually appears as squamous cells (a lump, white spot or ulcer) on the outer layer of the tongue. When it’s caught early, tongue cancer is highly curable. When the cancer forms in the front two-thirds of the tongue, it is classified as “oral tongue cancer.” When it develops in the remaining third of the tongue it is classified as “tongue base cancer” and is considered a form of throat cancer.
People with a history of smoking and alcohol dependence have a greater risk for developing this type of cancer. More than 10,000 Americans are diagnosed with tongue cancer each year.

Treatment:
Treatment for tongue cancer typically depends on the type and stage of the cancer. Oral tongue cancer is usually treated with surgery and is often followed by radiation therapy. Tongue base cancer is often treated with a combination of chemotherapy and radiation therapy and is sometimes followed by surgery.

Effects of surgery:
Sometimes, surgeons have to remove a large portion of the tongue when they cut out the cancer. This can affect a person’s speech and ability to eat and swallow. Some patients that can speak after surgery are not comfortable doing so in public. “Patients were really limiting their social activities,” Douglas Chepeha, M.D., M.S.P.H., from the University of Michigan Medical School, told Ivanhoe. “They would often say they did things that they really couldn’t do.”

Rebuilding tongues:
Dr. Chepeha and his team have developed several techniques for reconstructing tongues. They use innovative patterns, which are much like dress patterns, to help them determine the size and shape of the skin tissue they’ll cut for transplanting. The tissue is taken from another part of the patient’s body (often the forearm), so there isn’t a risk of rejection. The procedure typically involves removing a portion of the tongue and reconstructing a new tongue. It requires surgeons to dissect and reattach blood vessels. The vessels are sewn together with tiny sutures. The result is a tongue that is not a muscular organ but looks and feels much like the real thing. “In the past, patients who have undergone tongue reconstruction would be very concerned about social interaction,” Dr. Chepeha was quoted as saying in a University of Michigan press release. “With the type of reconstruction we’re performing now, our patients tell us that they’re willing to go into a restaurant and order a meal. They have no hesitation whatsoever in asking strangers for directions. They are also able to maintain their employment status and their interactions with family and friends.”

April, 2011|Oral Cancer News|

New-generation radiation treatment, a first-line therapy for patients with large head and neck tumours

Source: Medical News Today

Biologically targeted BNCT treatment is based on producing radiation inside a tumour using boron-10 and thermal neutrons. Boron-10 is introduced into cancer cells with the help of a special carrier substance (phenylalanine), after which the tumour is irradiated with lowenergy neutrons. The latter react with the boron to generate high-LET radiation, which may destroy the cancer cells. One to two BNCT treatment sessions may be sufficient to destroy a tumour, while keeping the impact of radiation on surrounding healthy tissue to a minimum.

A research reactor is currently used as the neutron source, but dedicated neutron accelerators being designed for BNCT.

Clinical trials to assess the efficacy and safety of BNCT in the treatment of locally recurrent head and neck cancer have been carried out at the Department of Oncology at Helsinki University Central Hospital (HUCH). OCF Apart from palliative chemotherapy, conventional treatment was no longer considered possible for the patients treated in the BNCT trials.

A total of 30 patients referred to HUCH’s Department of Oncology from hospitals around Finland took part in the trial. 76% of patients responded well to the treatment and 30% were still alive two years after treatment; although only one patient has survived 55 months. The results of the study, conducted by Professor Heikki Joensuu, have recently been published in the International Journal of Radiation Oncology, Biology, Physics.

BNCT treatment is provided by Boneca Corporation, which is based at the main campus of Helsinki University Central Hospital and is the world’s only provider of radiation safetyaudited BNCT treatment. Owned by Clinical Research Institute HUCH Ltd, Sitra, Finnish Innovation Fund, and VTT Ventures Ltd., Boneca works closely with HUCH’s Department of Oncology, and treatment-related decisions are taken jointly with the hospital’s otolaryngology, radiation therapy and oncology specialists. Boneca is responsible for administering the treatment, which is given at a special facility adjacent to the research nuclear reactor used at the VTT Technical Research Centre of Finland.

“The positive results that we have achieved in treating head and neck tumours have convinced us of the benefits of further developing BNCT treatment and the services needed to administer it,” says the Chairman of Boneca’s Board of Directors, Seppo Pakkala, MD, PhD.

“As BNCT saves healthy tissue, this promises to make it a good choice as a first-line therapy for patients with large head and neck tumours, avoiding the need for extensive surgery. Additional studies will be needed, however, before BNCT can be adopted for this use. We would also like to extend the use of BNCT to treating tumours in other anatomical areas for which there are no forms of treatment currently available.”

BNCT treatment has been given to over 200 patients to date, the majority of whom had recurred head and neck cancer or malignant brain tumour. Approximately 6% of patients have come from abroad as a result of international interest in BNCT.

“We have sufficient capacity to treat more patients and are very interested in collaborating with hospitals outside Finland that would like to offer the option of BNCT treatment for their patients,” says Boneca’s CEO, Markku Pohjola.

March, 2011|Oral Cancer News|

Longitudinal changes over 2 years in parotid glands of patients treated with preoperative 30-Gy irradiation for oral cancer

Source: jjco.oxfordjournals.org
Authors: Etsushi Tomitaka et al.

Objective:
To evaluate longitudinal changes in parotid volumes and saliva production over 2 years after 30 Gy irradiation.

Methods:
We retrospectively evaluated 15 assessable patients treated for advanced oral cancer. Eligibility criteria were a pathologic diagnosis of squamous cell carcinoma, preoperative radiation therapy with a total dose of 30 Gy delivered in 15 fractions, and the availability of longitudinal data of morphological assessments by computed tomography and functional assessments with the Saxon test spanning 2 years after radiation therapy. In the Saxon test, saliva production was measured by weighing a folded sterile gauze pad before and after chewing; the low-normal value is 2 g/2 min. Repeated-measures analysis of variance with Bonferroni adjustment for multiple comparisons was used to determine the longitudinal changes.

Results:
The normalized ipsilateral parotid volumes 2 weeks and 6-, 12- and 24 months after radiation therapy were found to be 72.5, 63.7, 66.9 and 78.1%, respectively; the normalized contralateral volumes were 69.8, 64.6, 72.2 and 82.0%, respectively. The bilateral parotid volumes were significantly decreased after radiation therapy (P < 0.01). The nadir appeared at 6 months post-radiation therapy and the volumes substantially recuperated 24 months after radiation therapy (P < 0.01). Mean saliva production before radiation therapy was 3.7 g; the longitudinal changes after radiation therapy were 31.3, 38.0, 43.3 and 69.6%, respectively. Substantial recuperation of saliva production was observed 24 months after radiation therapy (P = 0.01). Conclusions: Although parotid volumes and saliva production were decreased after 30 Gy irradiation, we observed the recuperation of morphological and functional changes in the parotid glands 2 years after radiation therapy. Authors: 1. Etsushi Tomitaka1, 2. Ryuji Murakami2,*, 3. Keiko Teshima3, 4. Tomoko Nomura3, 5. Yuji Nakaguchi2, 6. Hideki Nakayama3, 7. Mika Kitajima4, 8. Toshinori Hirai4, 9. Yushi Araki1, 10. Masanori Shinohara3 and 11. Yasuyuki Yamashita4 Authors' affiliations: 1Department of Radiology, National Hospital Organization Kumamoto Medical Center 2Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University 3Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University 4Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

January, 2011|Oral Cancer News|

Hospital Performs Area’s First Robotic Surgeries on Oral Cancers HEALTH CARE: Technique Could Reduce the Length Of Patients Hospital Stay

Source: San Diego Business Journal

By: Steve Sinovic

The first transoral robotic surgeries in San Diego have been performed at Sharp Chula Vista Medical Center and all three patients who underwent those procedures are recovering well, said the surgeon who is leading up the effort to help patients beat early-stage oral cancer.

Advances in robotic surgery prompted the hospital to look for ways to apply that technology to treat tumors of the mouth and throat. And thanks to a local benefactor, the institution hopes to be performing more procedures on local patients.

The hospital is one of fewer than a dozen in the U.S. to offer the procedure, which was launched thanks to a $1.2 million anonymous donation to Sharp Chula Vista. The donation helped fund the acquisition of Intuitive Surgical Inc.’s da Vinci Surgical System, said Dan Dredla, vice president of business development for the 343-bed hospital in south San Diego County.

“We were fortunate that a donor helped us purchase the da Vinci,” said Dredla. “It’s a costly system, and it was challenging to find the capital to acquire it on our own.”

The da Vinci robot, which combines enhanced 3-D views with precise incision capabilities, is already being used for various surgeries at hundreds of hospitals throughout the country and around the world. However, it was just recently that the U.S. Food and Drug Administration approved using the da Vinci for the transoral surgeries, or TORS, procedures on head and neck cancers.

While Dredla didn’t have exact figures on how many patients the hospital admits with head and neck cancers, it’s probably 3 percent to 5 percent of all patients with cancer. Not all of these patients will have surgery. Sharp Chula Vista admits about 400 inpatients per year with a primary diagnosis of cancer. That’s just inpatient admissions — hospital staff also treats many more on an outpatient basis.

Technological Forefront

Dr. Albert McClain, an ear, nose and throat specialist affiliated with Sharp Chula Vista, said acquisition of the TORS system is significant.

“This is going to allow us to be at the very forefront of technology when it comes to giving our patients the very best possible outcomes,” he said.

Based on McClain’s estimate of the number of procedures he expects to perform, the institution may see a modest increase in the number of surgeries for oral cancer at Sharp Chula Vista.

Oral cancer is the only head and neck cancer for which the FDA approves the use of the robotic surgical system. Other types of head and neck cancers affect the salivary glands, sinuses, pharynx, larynx, and lymph nodes in the upper neck.

The most common robotic surgical procedures at Sharp Chula Vista are for urological and gynecological conditions, especially prostate cancer, uterine fibroids and endometriosis.

In terms of revenue stream, insurance companies do pay hospitals for treating patients with the robotic system.

“We’re not generating more revenue with each case that uses a robotic system,” said Dredla. “In fact, the cost of the robotic system actually erodes our profit margin.

“Where we (hospitals) benefit financially is by using a surgical technique that reduces overall length of stay and complications. That helps with downstream revenue and expense.”

Innovative Automation

Named after the famous Italian artist Leonardo da Vinci for his intricate engineering designs, the da Vinci Surgical System was approved by the FDA in 2000 and was the first robotic equipment allowed in U.S. operating rooms. Other San Diego hospitals use the da Vinci as well.

TORS, a minimally invasive endoscopic technique, targets removal of early-stage tumors of the tongue base, throat, larynx and skull base. Traditionally, those cancers have been removed through either an incision in the neck or through the mouth, which often requires splitting the lower lip and dividing the jaw.

According to the American Cancer Society Inc., nearly 40,000 new diagnoses of oral cancer are made every year, but they’re usually not discovered until they have advanced significantly.

“Oral cancer can be hard to catch because the symptoms vary,” said McClain. “Some patients experience ear pain or have difficulty swallowing, while others have no symptoms at all.”

Treatment for oral cancer typically includes a combination of radiation therapy, chemotherapy and surgery, but traditional surgery involves large incisions which can have devastating side effects like facial disfigurement and permanently impaired speech, eating and swallowing.

Pioneers in Surgical Procedure

McClain received his TORS training at the University of Pennsylvania from the physicians who founded the new procedure and set up the world’s first TORS program in 2004.

The three initial cases he has treated were not very difficult cases, but gave McClain and his team an opportunity to work with the technology. The cases were a benign palate tumor and early-stage tonsil cancers.

“TORS isn’t for everyone, but it’s an important option to have,” McClain said. “It’s amazing how treatment for oral cancer is advancing.”

December, 2010|Oral Cancer News|

Michael Douglas Fights Oral Cancer

Source: The Science of Dentistry

Actor Michael Douglas‘ recent revelation that he has stage IV oral cancer has highlighted the growing incidence of oral cancer, and experts say dentists can help stem the alarming increase of the disease by checking for it during routine examinations.The actor’s cancer includes a walnut-sized tumor at the base of his tongue, and he will require radiation therapy, chemotherapy, and surgery. Douglas says his doctors told him he has an 80% survival rate if it hasn’t spread to his lymph nodes.

While tobacco was the prime cause of oral cancer in the past, recent studies have attributed the steady increase of the disease to the human papillomavirus (HPV). HPV are common viruses that cause warts. There are approximately 130 versions of HPV but only nine cause cancers, and the HPV16 version causes almost half of the oral cancers in the U.S., said Brian Hill, executive director of the Oral Cancer Foundation.

“Tobacco is no longer the only bad guy,” he told DrBicuspid.com. “HPV16 is increasing in incidence as the causative etiology, and if it continues on this trend line, it will replace tobacco as the primary cause of oral cancers.”

Dentists can play a key role in catching the disease in its early stages if they check for it during examinations.  Most Americans have never even heard of oral cancer, but it’s not as rare or uncommon as people would like to think it is. This is why an opportunistic screening by the dental community is so important.

Hill, a nonsmoker, got the same diagnosis as Douglas in 1998 and underwent radiation therapy, chemotherapy, and surgery. Since Hill’s oral cancer had metastasized to both sides of his neck by the time it was discovered, surgeons removed the right side of his neck to remove the lymph nodes there. He has been cancer-free for 10 years and said there are a lot of stage IV survivors out there.

Changing demographics

In the last decade, the demographics of oral cancer have changed dramatically, according to Hill and other experts, pointing to the sexual revolution and accompanying increase in the prevalence of oral sex. Today almost half of those diagnosed with the disease are younger than 50 years old — with some as young as 20, according to Hill — and they are usually nonsmokers. According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims more lives than melanoma or cervical cancer. The incidence in oral cancer patients younger than age 40 has increased nearly fivefold, with many patients with no known risk factors, according to the ADA.

“Social and sexual behaviors have changed,” Hill said. “Oral sex is more common. The virus is spreading, especially among young people because sexual contact is more common, and this virus is not only ubiquitous in our society, but the mechanism of transfer is very simple.”

Until 2000, scientists were unsure if HPV caused oral cancer, Hill said, but definitive research in 2000 revealed it as a distinct etiology for the disease, and more recent studies have supported this finding.

The disease is dangerous because often there are no symptoms in the early stages that a person might notice. “It’s a very insidious disease,” Hill explained. He recalled that it was not until a lymph node became swollen that Hill realized something was wrong. Even then, it was not painful, he said. Typically there are no physical signs of oral cancer.

But an alert dentist will notice subtle signs and symptoms of oral cancer in a simple three to five minute visual and tactile exam, Hill noted. “There will be things he’ll pick up on, and that’s why we’re urging that the dental community to become more involved in oral cancer screening,” he said.

Approximately 36,000 new cases of oral cancer are diagnosed each year in the U.S., according to the ADA, and some 25% of those people will die of the disease. Only 57% of all diagnosed oral cancer patients will be alive five years after their diagnosis, Hill said. Approximately 100 people in the U.S. will be diagnosed with oral cancer every day, he added, and one person will die every hour from it.

And unfortunately, celebrities with cancer helps bring about much needed public awareness about the disease, said Hill, noting that, in addition to Michael Douglas, such luminaries as Sigmund Freud and Ulysses S. Grant have been among its victims.

“When somebody famous gets the disease, it finally gets the world’s attention,” he noted.

Oral Cancer Foundation founder named Survivor Circle Award winner by ASTRO

The American Society for Radiation Oncology (ASTRO) has named Brian Hill of Newport Beach, Calif., as its 2010 Survivor Circle Award winner. Hill will be recognized with a trophy and a $1,000 prize during the Awards Ceremony on Tuesday, November 2, 2010, during ASTRO’s 52nd Annual Meeting in San Diego. He has chosen to donate the funds from the award to benefit The Oral Cancer Foundation, the nonprofit he started a decade ago.

The Survivor Circle Award recognizes a cancer survivor who has given back to the community by devoting his or her time to helping others with cancer. Hill was diagnosed with Stage 4 metastatic tonsil cancer in 1997. When he was going through treatment, he had many questions about side effects and realized there was a lack of information and awareness about head and neck cancer even though the disease has a very high death rate, due to it being caught at a late stage in most cases.
“There was a huge lack of information available, and I was desperate to find someone to talk to who had gone through the same thing I was experiencing,” Hill said. “I knew that if I was feeling this way, there had to be others feeling my frustrations too. I then became a student of the disease. ”

After Hill completed his grueling but successful radiation treatments at M.D. Anderson Cancer Center in Houston, he and his wife Ingrid founded The Oral Cancer Foundation in 1999, which is now a national non-profit charity. Besides its original mission of patient support and information dissemination, it is involved in advocacy issues, sponsorship of research, and increasing public awareness and early discovery of the disease.

“Being chosen by ASTRO in this way is a huge honor. I feel as if this is the second time I am the beneficiary, as I owe my being here today to the doctors and radiation technology, which saved my life.” He said. As the pro bono director of the foundation, Hill spends his time speaking at symposia and universities worldwide. He has also worked as an advocate with congressmen and senators on issues as varied as the tobacco bill, Medicare issues of post-treatment patients, the HPV vaccine, and the issues of early cancer detection.

Hill was inducted as the first non-doctor member of the American Academy of Oral Medicine in recognition of contributions to oral cancer public literacy and awareness programs and the promotion of early diagnosis of oral cancer via free public screenings. He has also received awards from the NIH/NIDCR and the Chicago Dental Society, and is a recipient of NYU’s prestigious Strusser award for public service. He sits on oral cancer work groups from the CDC to numerous professional dental and medical society organizations.

“Congratulations to Brian Hill for winning this prestigious award,” Anthony Zietman, M.D., ASTRO president and a radiation oncologist at Massachusetts General Hospital in Boston, said. “Brian embodies everything that the Survivor Circle Award stands for. He beat the odds with his own cancer and has worked tirelessly to promote awareness for an under-recognized type of cancer. I’m proud to have him as a part of the Annual Meeting.”

The ASTRO Annual Meeting is the premier scientific meeting in radiation oncology and attracts more
than 11,000 attendees of various disciplines, including oncologists, physicists, biologists, nurses and other healthcare professionals from all over the world. The theme of this year’s meeting is “Gathering Evidence, Proving Value” and the program will examine the realities of practicing medicine in 2010.

Provided by American Society for Radiation Oncology

October, 2010|OCF In The News|

Radiation safety a priority at Johns Hopkins

Source: www.nccn.org
Author: Megan Martin, Communications Manager

Recent media coverage surrounding treatment errors that have occurred in radiation therapy has only intensified discussions about the need to improve safety for patients with cancer.

Joseph Herman, MD, a radiation oncologist at The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and a featured panelist at the upcoming NCCN 2010 Patient Safety Summit, recently spoke with NCCN about policies Hopkins has implemented to ensure the safety of their radiation therapy patients.

Radiation safety, an issue that has always received great attention at Hopkins, came to the forefront a few years ago as Hopkins was looking to develop a new program for high dose rate intraoperative radiation therapy (IORT) – delivered through brachytherapy – and discovered that there were no clear standard guidelines or quality indicators for how to develop such a program.

“Safety is of particular concern in this type of treatment because due to the high dose of radiation being emitted, clinicians cannot remain in the same room as the patient, a specific cause of anxiety for anesthesiologists,” said Dr. Herman.

Using a patient simulator, the team walked through a variety of practice scenarios, identified areas for concern, and developed strategies to address potential safety issues. For example, Hopkins now uses cameras to monitor patient vital signs in the room and also has pre-measured medications available that can be delivered via a pole from another room – basically a “long-distance” method of treatment.

Furthering their aim to identify points in the process where potential errors may arise, Hopkins constructed a map listing each person who is currently in contact the patient, from consultation to treatment to follow-up, and created nodes pinpointing where an error may occur. Each node was then assigned a score based on Failure Mode and Effect Analysis (FMEA). FMEA ranks any weak points using a calculation that is based on the frequency of the occurrence, the detectability, and the severity. Utilizing these scores, Stephanie Terezakis, MD, Eric Ford, PhD, and Peter Pronovost, MD, at Johns Hopkins Department of Radiation Oncology created a list of top-ranked failure modes and strategies to address issues within each node.

Another relatively simple, yet effective, tactic designed to eliminate giving radiation to the wrong part of a person’s body was also initiated several years ago. “Before treatment can commence, we circulate a diagram of the human body with the area receiving treatment clearly marked. This diagram must be acknowledged and signed off-on by each member of the treatment team,” Dr. Herman stated.

According to Dr. Herman, there have been no cases of the misadministration of therapy since Hopkins implemented this approach.

To reduce the risk of bringing up the incorrect treatment plan for a patient, perhaps due to the confusion of a common name, Hopkins instituted a card reading system. The system does not allow a treatment plan to be accessed until the team scans the patient’s individual barcode on his or her ID bracelet.

Although great strides have been made at Hopkins, Dr. Herman stressed that patient quality and safety is a continuous process.

For example, Dr. Herman recently conducted an informal poll of his staff to determine what they thought could be improved upon and what might have a significant impact on quality and patient safety. The overwhelming response was related to tumor contouring for radiation therapy planning. The staff felt that it was imperative that contours be as accurate as possible in order to avoid a ripple effect of erroneous decisions being made by physicists and other clinicians who use the contour as a point of reference. To address this issue, the Hopkins Radiation Oncology Department is developing formal checklists to further improve the quality of tumor contouring.

Dr. Herman emphasized the importance of forums such as the NCCN 2010 Patient Safety Summit for allowing his colleagues to gain a more in-depth understanding of the role of radiation oncologists and the complexity of the treatments.

“Sometimes there is the perception that radiation oncologists simply ‘press the button’ to deliver treatment, which certainly is not the case,” said Dr. Herman. “We often want to slow down the implementation process of treatment to ensure the safety of the treatment and utilize the best technology available. It’s vitally important that oncologists learn about radiation therapy and how to work with their colleagues to guarantee the safety of their patients.”

The NCCN 2010 Patient Safety Summit is being held on October 14, 2010 in Bethesda, MD and will address issues such as radiation safety, infection control, oral chemotherapeutics, and safety and accountability. Peter J. Pronovost, MD, PhD, ScD, will provide the keynote address.

August, 2010|Oral Cancer News|

Fluoroscopically guided balloon dilation for pharyngoesophageal stricture after radiation therapy in patients with head and neck cancer

Source: AJR 2010; 194:1131-1136
Authors: Hong-Tao Hu et al.

Objective:
The purpose of this article is to assess the safety and long-term efficacy of fluoroscopically guided balloon dilation for pharyngoesophageal strictures after radiation therapy in patients with head and neck cancers.

Materials and methods:
From April 1997 to February 2009, fluoroscopically guided balloon dilation was performed in 17 patients with pharyngoesophageal strictures caused by radiation therapy. Technical success, clinical success (decrease of at least one grade in dysphagia score and good contrast passage on 1-month follow-up esophagogram), recurrence of dysphagia, and complications related to the procedure were retrospectively evaluated.

Results:
All 17 patients underwent 41 balloon dilation procedures, with each patient undergoing one to seven procedures (mean, 2.4 procedures). The technical success rate was 100%, and clinical success was achieved in 64.7% (11/17) of the patients. Five patients (29.4%) showed no recurrence of dysphagia after one session of balloon dilation. Of 12 patients (70.6%) with recurrence of dysphagia, 10 underwent repeat balloon dilation and two underwent gastrostomy after the first session of balloon dilation. The maximum balloon diameters were 15 mm (n = 22), 20 mm (n = 16), and 25 mm (n = 3). As minor complications, three cases of type 1 esophageal rupture occurred in two patients (11.8%). There were no major complications.

Conclusion:
Although the recurrence rate was high with repeat balloon dilation, fluoroscopically guided balloon dilation seems to be a simple and safe primary treatment technique for pharyngoesophageal stricture due to radiation therapy in patients with head and neck cancer.

Authors:
Hong-Tao Hu1, Ji Hoon Shin2, Jin Hyoung Kim2, Jung-Hoon Park2, Kyu-Bo Sung2 and Ho-Young Song2

Authors’ affiliations:
1 Department of Radiology, Henan Tumor Hospital, Zhengzhou, Henan Province, People’s Republic of China.
2 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.

March, 2010|Oral Cancer News|

Radiation was the cure, and the killer

Source: nytimes.com
Author: Walt Bogdanich

As Scott Jerome-Parks lay dying, he clung to this wish: that his fatal radiation overdose — which left him deaf, struggling to see, unable to swallow, burned, with his teeth falling out, with ulcers in his mouth and throat, nauseated, in severe pain and finally unable to breathe — be studied and talked about publicly so that others might not have to live his nightmare.

Sensing death was near, Jerome-Parks summoned his family for a final Christmas. His friends sent two buckets of sand from the beach where they had played as children so he could touch it, feel it and remember better days.

Jerome-Parks died several weeks later in 2007. He was 43.

A New York City hospital treating him for tongue cancer had failed to detect a computer error that directed a linear accelerator to blast his brain stem and neck with errant beams of radiation. Not once, but on three consecutive days.

Jerome-Parks experienced the wonders and the brutality of radiation. It helped diagnose and treat his disease. It also inflicted unspeakable pain.

Yet while Jerome-Parks had hoped that others might learn from his misfortune, the details of his case have until now been shielded from public view by the government, doctors and the hospital.

Americans today receive far more medical radiation than ever before. The average lifetime dose of diagnostic radiation has increased sevenfold since 1980, and more than half of all cancer patients receive radiation therapy. Without a doubt, radiation saves countless lives, and serious accidents are rare.

But patients often know little about the harm that can result when safety rules are violated and ever more powerful and technologically complex machines go awry. To better understand those risks, The New York Times examined thousands of pages of public and private records and interviewed physicians, medical physicists, researchers and government regulators. The Times found that while this new technology allows doctors to more accurately attack tumors and reduce certain mistakes, its complexity has created new avenues for error — through software flaws, faulty programming, poor safety procedures or inadequate staffing and training. When those errors occur, they can be crippling.

“Linear accelerators and treatment planning are enormously more complex than 20 years ago,” said Dr. Howard I. Amols, chief of clinical physics at Memorial Sloan-Kettering Cancer Center in New York. But hospitals, he said, are often too trusting of the new computer systems and software, relying on them as if they had been tested over time.

In June, The Times reported that a Philadelphia hospital gave the wrong radiation dose to more than 90 patients with prostate cancer — and then kept quiet about it. In 2005, a Florida hospital disclosed that 77 brain cancer patients had received 50 percent more radiation than prescribed because one of the most powerful — and supposedly precise — linear accelerators had been programmed incorrectly for nearly a year.

“My suspicion is that maybe half of the accidents we don’t know about,” said Dr. Fred A. Mettler Jr., who has written books on medical radiation.

Identifying radiation injuries can be difficult. Organ damage and radiation-induced cancer might not surface for years or decades, while underdosing is difficult to detect because there is no injury. While the worst accidents can be devastating, most radiation therapy “is very good,” Mettler said. “And while there are accidents, you wouldn’t want to scare people to death where they don’t get needed radiation therapy.”

In December 2004, New York state health officials issued a special alert, asking hospitals to be more vigilant when using radiation. As this warning circulated, Jerome-Parks was dealing with what he thought was a nagging sinus infection. He would not know until two months later that cancer had been growing at the base of his tongue. It was a surprising diagnosis for a relatively young man who rarely drank and did not smoke.

In time, his doctors and family came to suspect that his cancer was linked to the neighborhood where he had once worked, in the shadow of the World Trade Center. Several years before, he had taken a job there as a systems analyst at CIBC World Markets. His starting date: September 2001.

What Jerome-Parks most remembered about Sept. 11, his friends say, were bodies falling from the sky. He was particularly haunted by the memory of a man dressed in a suit and tie, plummeting to his death. In the days and weeks that followed, Jerome-Parks donated blood, helped a family search for a relative and volunteered at the Red Cross, driving search-and-rescue workers back and forth from what became known as “the pile.” Whether toxic dust caused his cancer may never be known, though his doctor would later say he believed there was a link.

He approached his illness as any careful consumer would, evaluating the varied treatment options in a medical mecca like New York. Yet in the end, what led him to St. Vincent’s Hospital, the primary treatment center for Sept. 11 victims, was a recommendation from an acquaintance at his church, which had become an increasingly important part of his life.

The Church of St. Francis Xavier in Manhattan, known for its social advocacy, reflected how much Jerome-Parks had changed from his days in Gulfport, Miss., where he was raised in a conservative family, eventually moving to Toronto and then New York, where he met his Canadian-born wife, Carmen.

In turning to St. Vincent’s, Jerome-Parks selected a hospital that had been courting cancer patients as a way to solidify its shaky financial standing. Its cancer unit, managed by Aptium Oncology, a unit of one of the world’s leading pharmaceutical companies, AstraZeneca, was marketing a new linear accelerator as though it had Jerome-Parks specifically in mind. Its big selling point was “smart-beam technology.”

“When the CFO of a New York company was diagnosed with a cancerous tumor at the base of his tongue,” promotional material for the new accelerator stated, “he also learned that conventional radiation therapy could potentially cure him, but might also cause serious side effects.”

The solution, the ad said, was a linear accelerator with 120 computer-controlled metal leaves, called a multileaf collimator, which could more precisely shape and modulate the radiation beam. This treatment is called Intensity Modulated Radiation Therapy, or IMRT. The unit St. Vincent’s had was made by Varian Medical Systems.

Dr. Salvatore M. Caruana, then a head and neck surgeon at St. Vincent’s, gave Jerome-Parks another option: surgery. In the end, Jerome-Parks chose radiation, with chemotherapy.

The investigation into what happened to Jerome-Parks quickly turned to the Varian software that powered the linear accelerator. Government investigators ended up blaming both St. Vincent’s, for failing to catch the error, and Varian, for its flawed software.

Jerome-Parks appreciated the irony of his situation: that someone who earned a living solving computer problems would be struck down by one.

Carmen Jerome-Parks, who was providing her husband round-the-clock care, refused to surrender.

“Prayer is stronger than radiation,” she wrote in the subject line of an e-mail to friends. Prayer groups were formed, and Mass was celebrated in his hospital room on their wedding anniversary. Linda Giuliano, one of the couple’s friends, believed that Jerome-Parks knew prayer would not be enough.

“At some point, he had to turn the corner, and he knew he wasn’t going to make it,” Giuliano said. “His hope was, ‘My death will not be for nothing.’ He didn’t say it that way, because that would take too much ego, and Scott didn’t have that kind of ego, but I think it would be really important to him to know that he didn’t die for nothing.”

Friends say the couple sought and received assurances that his story would be told.

Jerome-Parks’ parents were in Gulfport in February 2007, waiting for their house to be rebuilt after it was destroyed by Hurricane Katrina, when they got the news that their son had died.

In July, Jerome-Parks’ father stood across from the beach in Gulfport where his son’s friends had scooped up the sand they sent for his final Christmas.

“He taught us how to die,” Parks said. “He did it gracefully and thoughtfully and took care of everything. Most of us would lose it. He didn’t. He just did everything that he had to do, and then he let himself die.”

Parks said he had thought about starting a campaign to make medical mistakes public — but he never did. Nothing would ever come of it, he concluded.

January, 2010|Oral Cancer News|

FDA clears transoral robotic surgery – developed at Penn –for tumors of mouth, throat and voice box

Source: www.healthcanal.com
Author: staff

A minimally invasive surgical approach developed by head and neck surgeons at the University of Pennsylvania School of Medicine has been cleared by the U.S. Food and Drug Administration (FDA). The da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California) has been cleared for TransOral Otolaryngology surgical procedures to treat benign tumors and selected malignant tumors in adults.

Drs. Gregory S. Weinstein and Bert W. O’Malley, Jr. of the University of Pennsylvania School of Medicine’s Department of Otorhinolaryngology: Head and Neck Surgery founded the world’s first TransOral Robotic Surgery (TORS) programat Penn Medicine in 2004, where they developed and researched the TORS approach for a variety of robotic surgical neck approaches for both malignant and benign tumors of the mouth, voice box, tonsil, tongue and other parts of the throat. Since 2005, approximately 350 Penn patients have participated in the world’s first prospective clinical trials of TORS. These research trials compromise the largest and most comprehensive studies of the technology on record.

“TORS has dramatically improved the way we treat head and neck cancer patients, completely removing tumors while preserving speech, swallowing, and other key quality of life issues,” said Bert O’Malley, Jr., MD, professor and chairman of Penn Medicine’s Department of Otorhinolaryngology:Head and Neck Surgery. “It is very exciting that a concept conceived at PENN, evaluated in pre-clinical experimental models at Penn, tested in clinical trials at Penn, and then taught to key surgeons and institutions both within the U.S. and internationally has been officially recognized by our federal governing agencies and peers around the world as a new and improved therapy for select neck cancers and all benign tumors.”

45,000 Americans and approximately 500,000 people worldwide are diagnosed with head and neck cancers each year. Head and neck tumor treatments often involve a combination of surgery, radiation therapy, and chemotherapy. In many cases, surgery offers the greatest chance of cure; yet conventional surgery may require an almost ear-to-ear incision across the throat or splitting the jaw, resulting in speech and swallowing deficits for patients. In comparison, the minimally invasive TORS approach, which accesses the surgical site through the mouth, has been shown to improve long term swallowing function and reduce risk of infection while speeding up the recovery time. When compared to traditional surgeries, after their cancers have been removed successfully, patients have been able to begin swallowing on their own sooner and leave the hospital earlier. TORS outcomes are markedly improved when compared to standard chemotherapy, radiation or traditional open surgical approaches for oropharyngeal cancer.

“Based on our data and patient outcomes, coupled with the national and international enthusiasm and interest for TORS, we are changing the way oropharyngeal cancer and tumors will be treated now and in years to come,” noted Gregory Weinstein, MD, FACS, professor and vice chair of the University of Pennsylvania School of Medicine’s Department of Otorhinolaryngology: Head and Neck Surgery, director of the Division of Head and Neck Surgery and current president of The Society of Robotic Surgery. “We are already collaborating with colleagues in Penn Neurosurgery to investigate TORS for the treatment of other conditions, such as sleep apnea, skull base tumors and cervical spine disease.”

The Penn TORS program developed an international training program that has trained numerous surgical teams from 12 different countries, many of whom have started establishing TORS programs at their respective institutions. With the FDA clearance of the da Vinci System for transoral otolaryngology, Penn Medicine will immediately expand its well established training program to include surgical teams from the United States.

December, 2009|Oral Cancer News|