radiation

Smarter cancer treatment: AI tool automates radiation therapy planning

Source: news.engineering.utoronto.ca
Author: Brian Tran

Aaron Babier (MIE PhD candidate) demonstrates his AI-based software’s visualization capabilities. (Credit: Brian Tran)

Beating cancer is a race against time. Developing radiation therapy plans — individualized maps that help doctors determine where to blast tumours — can take days. Now, Aaron Babier (MIE PhD candidate) has developed automation software that aims to cut the time down to mere hours.

He, along with co-authors Justin Boutilier (MIE PhD 1T8), supervisor Professor Timothy Chan (MIE) and Professor Andrea McNiven (Faculty of Medicine) are looking at radiation therapy design as an intricate — but solvable — optimization problem.

Their software uses artificial intelligence (AI) to mine historical radiation therapy data. This information is then applied to an optimization engine to develop treatment plans. The researchers applied this software tool in their study of 217 patients with throat cancer, who also received treatments developed using conventional methods.

The therapies generated by Babier’s AI achieved comparable results to patients’ conventionally planned treatments. — and it did so within 20 minutes. The researchers recently published their findings in Medical Physics.

“There have been other AI optimization engines that have been developed. The idea behind ours is that it more closely mimics the current clinical best practice,” says Babier.

If AI can relieve clinicians of the optimization challenge of developing treatments, more resources are available to improve patient care and outcomes in other ways. Health-care professionals can divert their energy to increasing patient comfort and easing distress.

“Right now treatment planners have this big time sink. If we can intelligently burn this time sink, they’ll be able to focus on other aspects of treatment. The idea of having automation and streamlining jobs will help make health-care costs more efficient. I think it’ll really help to ensure high-quality care,” says Babier.

Babier and his team believe that with further development and validation, health-care professionals can someday use the tool in the clinic. They maintain, however, that while the AI may give treatment planners a brilliant head start in helping patients, it doesn’t make the trained human mind obsolete. Once the software has created a treatment plan, it would still be reviewed and further customized by a radiation physicist, which could take up to a few hours.

“It is very much like automating the design process of a custom-made suit,” explains Chan. “The tailor must first construct the suit based on the customer’s measurements, then alter the suit here and there to achieve the best fit. Our tool goes through a similar process to construct the most effective radiation plan for each patient.”

Trained doctors, and often specialists, are still necessary to fine-tune treatments at a more granular level and to perform quality checks. These roles still lie firmly outside the domain of machines.

For Babier, his research on cancer treatment isn’t just an optimization challenge.

“When I was 12 years old, my stepmom passed away from a brain tumour,” Babier shares.

“I think it’s something that’s always been at the back of my head. I know what I want to do, and that’s to improve cancer treatment. I have a family connection to it. It adds a human element to the research,” says Babier.

August, 2018|Oral Cancer News|

Silent no more: Woman lends voice to hope after cancer

Source: health.ucsd.edu
Author: Yadira Galindo

Singing hymns in church has always brought Cynthia Zamora joy. Today, her once sharp intonation has given way to a raspy voice. But Zamora is thankful that she has a voice at all after spending three months without the ability to utter even one syllable.

“I miss going to church and singing with people,” said Zamora. “Although, if I am in the back I’m still singing. I’m just hoping they don’t hear what sounds like a 13-year-old pubescent boy back there, because that’s how I sound. I know God thinks it’s beautiful, so I don’t worry about it. I just go on with life.”

In 2017, Zamora bit her tongue while sleeping, splitting her tongue nearly in half. She was referred to a specialist when her wound would not heal. They found a 5.4-centimeter tumor that enveloped more than half of her tongue. To save her life, her surgeon, Joseph Califano, MD, delivered grim news: Zamora would have to undergo a glossectomy — the surgical removal of all or part of the tongue.

“By the time I saw her she was really having a hard time speaking and swallowing,” said Califano, director of the Head and Neck Cancer Center at UC San Diego Health. “With Cynthia that was a difficult discussion because it was unclear how much tongue we would save and how good the function would be with the remaining tongue that would be preserved.”

A multidisciplinary team of experts that included medical oncology, surgical oncology, reconstructive surgery, radiation oncology, speech therapy, nutrition, psychiatry and a host of others came together to design a comprehensive plan to eradicate an aggressive, stage IV squamous cell carcinoma and deliver the best quality of life for a woman who was about to undergo a catastrophic surgery.

“The tongue is critical. It’s one of the strongest muscles we have in our body. In speech, our tongue is moving so rapidly within the confines of our mouth in order to generate and make certain sounds in conversation that we find it’s hard to grasp how complex that action is,” said Liza Blumenfeld, speech-language pathologist at Moores Cancer Center at UC San Diego Health. “Without a tongue you’re having to compensate for all of that movement with other structures, your lips, your cheeks and your jaw.”

During a 12-hour surgery, Califano would remove a large portion of Zamora’s tongue and place a breathing tube and feeding tube before a reconstructive microsurgeon would step in to replace the portion of tongue that was removed.

“The primary goal of surgery is to remove the cancer as best we can while sparing as much normal tissue as possible,” said Califano. “It was a challenging surgery in that we had to cut just right to save enough tongue so that she would have some function and we could still get well around the tumor. We were able to save less than half her oral tongue. That wasn’t a lot.”

Ahmed Suliman, MD, a plastic surgeon who specializes in reconstruction after cancer treatment, was tasked with reconstructing her tongue.

“When you remove the majority of the tongue you can’t really function,” said Suliman. “You can’t swallow and articulation is limited. We had to rebuild a tongue to provide bulk so that Cynthia could move food in her mouth in order to swallow and to speak.”

He used a method called anterolateral thigh perforator flap (ALT). Suliman cut a 6 by 8 centimeter tissue of skin and fat from Zamora’s leg to shape and create a new tongue. The replacement tongue does not move, but because Califano was able to spare the base of her original tongue, Suliman was able to reconstruct using the remaining tongue base to preserve some movement for Zamora. Suliman sutured the new tongue, attaching one artery and a vein from the neck using a microscope.

The reconstructive surgery and dissection of cancerous tissue in her tongue and lymph nodes left Zamora temporarily unable to walk, talk or eat. One of the advantages of performing an ALT is that minimal thigh muscle, or none at all, is cut when extracting tissue for the new tongue. This allows for a faster recovery because Zamora did not lose leg muscle function, so with physical therapy Zamora was on her feet fairly quickly.

Skin and fat tissue are more resilient to radiation therapy than muscle, said Suliman, making this tissue more ideal for someone like Zamora, who received treatment following surgery.

“The success of management of these advanced cancers rely on the coordinated efforts of a multi-disciplinary oncologic team,” said Suliman. “This leads to better planned surgery, good preoperative and post-operative care, and follow up. The success of complex cases is higher and outcomes are better, as demonstrated by Cynthia.”

While Zamora was undergoing physical therapy and speech therapy, she was also undergoing chemotherapy, radiation and was receiving an experimental immunotherapy called Pembrolizumab (Keytruda), an antibody that inhibits the abnormal interaction between the molecule PD-1 on immune cells and the molecule PD-L1 on cancer cells, allowing the immune cells to recognize and attack tumors. Pembrolizumab is FDA-approved for some cancers, such as melanoma but is still under a clinical trial for squamous cell carcinoma of the head and neck .

While Zamora continued aggressive treatment and attended physical therapy, she also met with Blumenfeld.

“Teaching somebody to regain their speaking and swallowing abilities during head and neck cancer treatment is really difficult,” said Blumenfeld. “Being able to understand what their abilities were like before, and being able to understand what their new normal looks like, helps us play on their strengths and their ability to compensate with other structures.”

Blumenfeld and Zamora worked together targeting the sounds that she had problems expressing. Zamora had to slow her speech and exaggerate each sound, compensating with her vocal chords for sounds she can no longer make with her tongue.

It is a tedious process but in three months Zamora was speaking well again.

“Previously, I was well pronounced with an expansive vocabulary. I had to be patient with myself and use more expressions in my eyes, hands and face. Sometimes I have to pick words I wouldn’t normally use because I can’t use my original vocabulary. Quality is better than quantity,” said Zamora.

“You have to want to be able to communicate in order to talk, and I wanted that more than anything, because I am a person who loves to communicate. I haven’t got singing down yet, but hopefully that will come.”

Zamora’s vocal chords are healthy and with time, patience and modifying her technique, Blumenfeld thinks that Zamora will be singing “proudly, loudly sometime soon.”

“There are people that come into your life as patients and your mind is blown by their strength of character, their humor, their wisdom, and their willingness to fight. Cynthia really embodies all of those things,” said Blumenfeld. “From the first day she was insistent that she was going to come out of this as a stronger, better person. She has really shown me, even in my own personal life, to never give up and to set your mind on a set target, and you simply do not deviate from that.”

In addition to regaining her speech, Zamora would need to relearn to eat. This was her last hurdle to recovery. It was only in early 2018 that she began to eat without a feeding tube.

“I would encourage everybody to think for a moment of what life would be like. Grab your tongue with your teeth and try to talk without a tongue. Try to think about, when you take a bite of a sandwich, everything that’s going on in your mouth,” said Blumenfeld. “In order for us to be able to chew, we have to be able to manipulate food, move it from one side of our mouth to the other side of the mouth. We have to be able to organize all that food on top of our tongue and propel that food backwards in order to swallow it. Without a tongue that becomes almost an impossible task.”

Thankfully, Zamora mastered the ability to eat again and laughs when recalling eating half a lava cake in front of her shocked family during a restaurant outing. She eats crispy fried chicken and just about anything she wants.

“With a little patience and care, and one step, baby steps, along the way, you can do anything,” said Zamora. “Look at me. I had no tongue, and I’m talking. I’m eating. I’m drinking. I’m doing great. There is life after this surgery. Don’t give up. Keep going. Be strong. Be stubborn. You can do it, you can.”

State not allowed to investigate death at cancer center

Source: kdvr.com
Author: Rob Low

Lakewood, Colo. – When 80-year-old Virginia Cornelius died at a Rocky Mountain Cancer Care Centers’ location in Lakewood on February 27, the on-site doctor insisted it must’ve been a heart attack.

But the adult children of Cornelius aren’t convinced and tell the FOX31 Problem Solvers their efforts to find the truth have been stymied, partly because cancer centers generally aren’t regulated by the Colorado Department of Public Health and Environment.

Cornelius was receiving radiation treatment for cancer of the larynx in her throat. But her daughter, Susan Hutt, says her mother’s general health on February 27 was fine.

“They took her vital signs. They were better than mine,” Hutt said.

She said she was later told by a radiation tech that her mother was having trouble swallowing just before the procedure began but the treatment was allowed to continue anyway, when something went very wrong inside the patient room.

“All the sudden the door flies open and a curtain and the therapist is screaming in the hall, somebody call 911, somebody find the doctor,” remembered Hutt.

Hutt and her brother Gary Cornelius always sat in a waiting area next to the radiation room for all of their mother’s treatments having no idea that during every procedure their mother’s hands were strapped to a bed.

“We walk in and there is our mother on the table, hands restrained, the mask for radiation therapy with the oxygen that goes into it is up on a table, is hanging up above her. And there is no one in there. She is not responsive, but no one is doing CPR,” said Hutt.

Hutt said it appeared the radiation tech ran out of the room without ever performing CPR.

“Minutes are passing before the tech returns with not a code cart, which I would expect as I’m a nurse in a hospital and they are readily available, but what looked like a fishing tackle box. She puts it on the floor and can’t open it,” Hutt said.

By the time paramedics arrived her mother was dead.

According to the 911 call obtained by the Problem Solvers, a dispatcher is heard advising paramedics, “They (Rocky Mountain Cancer Care Centers) are asking that you not walk through the main lobby, they don’t want that, they want you to go through the back door. I’m not sure why.”

Hutt says she found that suspicious but what she said was even more concerning was learning the “Code Blue” panic button on the wall, which meant to summon emergency help, didn’t work. Plus, the radiation tech who had been treating her mother left before the Jefferson County Coroner arrived.

“Extremely suspicious, that the person present that finds a person down is not able to be interviewed by the coroner,” said Hutt.

The coroner’s report listed the final cause of death as “Acute Heart Failure.” But no autopsy was done.

Minutes after their mother’s death and in a state of shock, Hutt and her brother Gary Cornelius said the cancer care center’s on-site doctor convinced them no autopsy was needed. It’s a decision they now regret.

Several weeks after their mother’s death, Hutt and her brother were able to obtain their mother’s radiation logs.

According to the logs shared with the Problem Solvers, Virginia Cornelius’ treatments normally lasted three to four minutes. But on the day of her death, the treatment appeared to have lasted ten minutes.

Hutt and her brother wonder if their mother received too much radiation at once, or worse was forgotten about and possibly left to choke to death, unable to sit up and remove her oxygen mask.

“A side effect of head and neck radiation is a mucus that is so thick you don’t just clear your throat and get rid of it,” said Hutt.

More than three hours after Virginia died, her radiation log shows someone made new entries at 6:03 p.m., 6:05 p.m., and 6:07 p.m.

Hutt and her brother wonder if someone was attempting to recreate their mother’s chart after the fact. The siblings filed a complaint with the Colorado Department of Public Health and Environment but were shocked to learn the agency was powerless to investigate.

“We have no jurisdiction,” confirmed Dr. Randy Kuykendall. He’s the Director of Health Facilities and Emergency Medical Services for CDPHE.

Dr. Kuykendall says the state can investigate potential wrong-doing inside a hospital because CDPHE licenses hospitals. But he admits all 20 Rocky Mountain Cancer Centers in Colorado aren’t licensed or accredited by anyone.

It’s easy to be confused.

After all there’s a sign outside St. Anthony’s Hospital with an arrow that states “St. Anthony’s Cancer Center,” but it’s really pointing to Rocky Mountain Cancer Centers which isn’t owned or operated by the hospital even though they’re physically connected.

Rocky Mountain Cancer Centers is owned by U.S. Oncology and leases space inside the medical complex but faces none of the regulations of an actual hospital, like having a cardiac crash cart on site or a defibrillator.

“So this cancer care center doesn’t have to have a panic button, doesn’t have to have any of these emergency procedures or policies in place?” asked investigative reporter Rob Low to Kuykendall, who responded, “That would be correct, Rob.”

“We cannot allow these centers just to focus on profits over patient safety. Unfortunately, that`s a real concern,” said Hollynd Hoskins a medical malpractice attorney, who added, “If you have a facility that is not accredited and has no oversight by the state, they could be cutting corners and they could be hiring just techs at a cheaper wage rate than you would have to pay a qualified registered nurse and unfortunately that is a threat to patient safety.”

The Problem Solvers had lots of questions for Rocky Mountain Cancer Centers but Executive Director Glenn Balasky would only release a statement, that reads in part, “For a number of reasons, we cannot discuss the care provided to any particular patient treated at Rocky Mountain Cancer Centers. We can however assure you that patient care remains one of our highest priorities.”

Hutt finds it curious that Rocky Mountain Cancer Centers won’t discuss her mother’s care with the Problem Solvers when she’s willing to sign a consent form releasing RMCC from patient confidentiality restrictions.

“What’s really hard for me, I picture my mother restrained on a table with no monitor, choking to death and they brush it off like she was 80 she had a heart attack. It`s over and done. We`ll report what we want to,” said Hutt.

After repeated phone calls from FOX31, Rocky Mountain Cancer Centers had its attorney call Hutt and her brother Gary Cornelius.

The siblings told the Problem Solvers the attorney and an office manager for the cancer center told them safety changes have been made because of their mother’s death.

As for regulating cancer centers, that would take state legislation and so far lawmakers have no appetite to regulate them.

An AI oncologist to help cancer patients worldwide

Source: www.sciencedaily.com
Author: staff, University of Texas at Austin, Texas Advanced Computing Center

Comparison between predicted ground-truth clinical target volume (CTV1) (blue) and physician manual contours (red) for four oropharyngeal cancer patients. The primary and nodal gross tumor volume is included (green). From left to right, we illustrate a case from each site and nodal status (base of tongue node-negative, tonsil node-negative, base of tongue node-positive, and tonsil node-positive).
Credit: Carlos E. Cardenas, MD Anderson Cancer Center

Before performing radiation therapy, radiation oncologists first carefully review medical images of a patient to identify the gross tumor volume — the observable portion of the disease. They then design patient-specific clinical target volumes that include surrounding tissues, since these regions can hide cancerous cells and provide pathways for metastasis.

Known as contouring, this process establishes how much radiation a patient will receive and how it will be delivered. In the case of head and neck cancer, this is a particularly sensitive task due to the presence of vulnerable tissues in the vicinity.

Though it may sound straightforward, contouring clinical target volumes is quite subjective. A recent study from Utrecht University found wide variability in how trained physicians contoured the same patient’s computed tomography (CT) scan, leading some doctors to suggest high-risk clinical target volumes eight times larger than their colleagues.

This inter-physician variability is a problem for patients, who may be over- or under-dosed based on the doctor they work with. It is also a problem for determining best practices, so standards of care can emerge.

Recently, Carlos Cardenas, a graduate research assistant and PhD candidate at The University of Texas MD Anderson Cancer Center in Houston, Texas, and a team of researchers at MD Anderson, working under the supervision of Laurence Court with support from the National Institutes of Health, developed a new method for automating the contouring of high-risk clinical target volumes using artificial intelligence and deep neural networks.

They report their results in the June 2018 issue of the International Journal of Radiation Oncology*Biology*Physics.

Cardenas’ work focuses on translating a physician’s decision-making process into a computer program. “We have a lot of clinical data and radiation therapy treatment plan data at MD Anderson,” he said. “If we think about the problem in a smart way, we can replicate the patterns that our physicians are using to treat specific types of tumors.”

In their study, they analyzed data from 52 oropharyngeal cancer patients who had been treated at MD Anderson between January 2006 to August 2010, and had previously had their gross tumor volumes and clinical tumor volumes contoured for their radiation therapy treatment.

Cardenas spent a lot of time observing the radiation oncology team at MD Anderson, which has one of the few teams of head and neck subspecialist oncologists in the world, trying to determine how they define the targets.

“For high-risk target volumes, a lot of times radiation oncologists use the existing gross tumor disease and apply a non-uniform distance margin based on the shape of the tumor and its adjacent tissues,” Cardenas said. “We started by investigating this first, using simple distance vectors.”

Cardenas began the project in 2015 and had quickly accumulated an unwieldy amount of data to analyze. He turned to deep learning as a way of mining that data and uncovering the unwritten rules guiding the experts’ decisions.

The deep learning algorithm he developed uses auto-encoders — a form of neural networks that can learn how to represent datasets — to identify and recreate physician contouring patterns.

The model uses the gross tumor volume and distance map information from surrounding anatomic structures as its inputs. It then classifies the data to identify voxels — three-dimensional pixels — that are part of the high-risk clinical target volumes. In oropharyngeal cancer cases, the head and neck are usually treated with different volumes for high, low and intermediate risk. The paper described automating the target for the high-risk areas. Additional forthcoming papers will describe the low and intermediate predictions.

Cardenas and his collaborators tested the method on a subset of cases that had been left out of the training data. They found that their results were comparable to the work of trained oncologists. The predicted contours agreed closely with the ground-truth and could be implemented clinically, with only minor or no changes.

In addition to potentially reducing inter-physician variability and allowing comparisons of outcomes in clinical trials, a tertiary advantage of the method is the speed and efficiency it offers. It takes a radiation oncologist two to four hours to determine clinical target volumes. At MD Anderson, this result is then peer reviewed by additional physicians to minimize the risk of missing the disease.

Using the Maverick supercomputer at the Texas Advanced Computing Center (TACC), they were able to produce clinical target volumes in under a minute. Training the system took the longest amount of time, but for that step too, TACC resources helped speed up the research significantly.

“If we were to do it on our local GPU [graphics processing unit], it would have taken two months,” Cardenas said. “But we were able to parallelize the process and do the optimization on each patient by sending those paths to TACC and that’s where we found a lot of advantages by using the TACC system.”

“In recent years, we have seen an explosion of new projects using deep learning on TACC systems,” said Joe Allen, a Research Associate at TACC. “It is exciting and fulfilling for us to be able to support Carlos’s research, which is so closely tied to real medical care.”

The project is specifically intended to help low-and-middle income countries where expertise in contouring is rarer, although it is likely that the tools will also be useful in the U.S.

Cardenas says such a tool could also greatly benefit clinical trials by allowing one to more easily compare the outcomes of patients treated at two different institutions.

Speaking about the integration of deep learning into cancer care, he said: “I think it’s going to change our field. Some of these recommender systems are getting to be very good and we’re starting to see systems that can make predictions with a higher accuracy than some radiologists can. I hope that the clinical translation of these tools provides physicians with additional information that can lead to better patient treatments.”

Story Source:

Materials provided by University of Texas at Austin, Texas Advanced Computing Center. Note: Content may be edited for style and length.

Journal Reference:

1. Carlos E. Cardenas, Rachel E. McCarroll, Laurence E. Court, Baher A. Elgohari, Hesham Elhalawani, Clifton D. Fuller, Mona J. Kamal, Mohamed A.M. Meheissen, Abdallah S.R. Mohamed, Arvind Rao, Bowman Williams, Andrew Wong, Jinzhong Yang, Michalis Aristophanous. Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function. International Journal of Radiation Oncology*Biology*Physics, 2018; 101 (2): 468 DOI: 10.1016/j.ijrobp.2018.01.114

Supportive care for patients with head and neck cancer

Source: www.oncnursingnews.com
Author: Melissa A. Grier, MSN, APRN, ACNS-BC

Supporting a patient during cancer treatment is a challenge. From symptom management to psychosocial considerations, each patient’s needs vary and must be reevaluated frequently. This is especially true for patients with head and neck cancer.

Head and neck cancers often result in serious quality of life issues. Surgical resection of the affected area can cause disfigurement that not only affects function (eating, drinking, speaking, etc) but also leads to self-image concerns and depression. Radiation therapy and chemotherapy may cause a variety of unpleasant adverse effects, including burns, xerostomia, dental caries, and mucositis. Below are some considerations to help guide nursing care for this patient population.

CALL FOR REINFORCEMENTS
National Comprehensive Cancer Network guidelines recommend early involvement of a dentist, a dietitian, and a speech therapist to help address pre- and posttreatment concerns and preserve quality of life for people with head and neck cancer. The benefits of multidisciplinary collaboration for these complex cases are many but may also result in confusion and information overload for your patient. As the healthcare team provides care, you can help explain the rationale for interventions and assist them with keeping track of recommendations. Additionally, you have a team of experts you can call on when specific issues present themselves during treatment.

KEEP AN EYE OUT
A lot goes on in the life of a patient with head and neck cancer, which means everyday activities like oral and skin care may fall a little lower on their priority list. Performing frequent assessments and assisting with hygiene is vital to preserving and improving quality of life, for example:

  • Help your patients use a handheld mirror to examine their mouth and throat.
  • Ensure that oral care products don’t contain alcohol or other ingredients that can irritate sensitive tissue.
  • Educate your patients about self-care, and guide them toward performing independent dressing changes and surgical site care.
  • Encourage your patients to report any new adverse effects or concerns so they can be addressed promptly.

MEET IN THE MIDDLE
Several factors contribute to malnutrition associated with head and neck cancers. Pain related to mucositis or radiation burns decreases the likelihood that a patient will maintain adequate oral intake. Functional changes following surgery can lead to dysphagia that impairs a patient’s ability to safely receive nutrition and medication by mouth.

To ensure adequate nutrition, many patients with head and neck cancer receive a percutaneous endogastric (PEG) tube prior to beginning treatment. It’s imperative that the patient, the dietitian, and the nursing staff maintain an open line of communication and work together to meet nutritional needs. The patient will likely struggle with losing the ability to taste food and the satisfaction of choosing what they want to eat, so it’s important to allow them to control when they want to receive tube feedings and to follow up frequently to ensure the feedings are being tolerated.

When administering medication via PEG, pay close attention to administration instructions and drug interactions. Extended-release and sustained-release medications should never be crushed and given via PEG. Each medication should be crushed and administered individually, followed by a flush of room-temperature or lukewarm water. If a patient has several medications scheduled at the same time, assess whether administration times can be changed or allow enough time to administer them slowly to avoid patient discomfort related to a high volume of fluid. Lastly, pay attention to whether medication should be administered on a full or empty stomach and coordinate medication administration with tube feedings accordingly.

Although nurses can’t eliminate the hardship that patients will face during treatment for head and neck cancer, we can support them by providing compassionate and thorough care.

Melissa A. Grier, MSN, APRN, ACNS-BC, is a clinical content developer for Carevive Systems, Inc.

Restaging raises hope against HPV oral cancer

Source: atlantajewishtimes.timesofisrael.com
Author: Cady Schulman

Jason Mendelsohn was diagnosed with Stage 4 tonsil cancer from HPV in 2014 after finding just one bump on his neck. He survived thanks to a variety of treatments, including a radical tonsillectomy and neck dissection to remove 42 lymph nodes, seven weeks of chemotherapy, radiation and a feeding tube.

But if Mendelsohn’s cancer had been discovered today, just four years later, it would have been classified as Stage 1. That’s because HPV-related oral cancers now have a high survival rate through a better response to treatment, said Meryl Kaufman, a speech pathologist specializing in head and neck cancer management who worked for Emory University’s department of head and neck surgery for 10 years.

“Cancer staging is taking into account the HPV-related cancers,” said Kaufman, who now owns her own practice. “It was kind of all lumped together. The survival rates for people who have HPV-related cancers are much higher than the typical head and neck cancers associated with smoking and drinking.”

For Mendelsohn, finding out that patients with HPV-related cancers likely face easier treatments and higher success rates made him extremely happy.

“If I was diagnosed and I heard Stage 1 instead of Stage 4, while it’s still cancer, it would make me feel like I could beat it,” said Mendelsohn, who made a video for his children a month after his diagnosis with advice for their lives after he was gone. “When I hear Stage 4 to Stage 1, I think people have hope they can beat it. My hope is that it will give people hope that they can beat this.”

As a cancer survivor, the Florida resident wants to give hope to other patients. He talks to people throughout the world every month and is creating a worldwide survivor patient network to connect cancer survivors with patients.

“While cancer is scary, Stage 1 is a lot less scary than Stage 4,” Mendelsohn said. “Stage 4 was overwhelming. When I was looking for information, there was nothing out there that made me feel like I was going to be OK. What I’m trying to do is give people hope and let them know that it’s all temporary.”

Another way Mendelsohn is trying to reach those affected by cancer is through his website, supermanhpv.com. He shares his story, news articles featuring him and oral cancer caused by HPV, and information for survivors, patients and caregivers.

The site also features Mendelsohn’s blog, putting himself out there so people can see that someone who, just four years ago, was diagnosed with Sage 4 cancer is now a Peloton-riding, travel-loving cancer advocate.

“People see me and say (they) can’t believe (I) had cancer three to four years ago,” Mendelsohn said. “I was in bed 18 hours a day for a month. I was choking on my saliva for a month. I was consuming five Ensures a day and two Gatorades a day through a feeding tube in my stomach. If people going through that can see me working out, going on the bourbon tour in Louisville. I’ve been on an Alaskan cruise. I’ve been to the Caribbean. I’ve been to the Grand Canyon.”

Mendelsohn, who started his campaign to raise awareness of HPV and oral cancer by raising money for the Ride to Conquer Cancer in Washington, now serves on the board of the Head and Neck Cancer Alliance. The organization’s goal is to advance prevention, detection, treatment and rehabilitation of oral, head and neck cancers through public awareness, research, advocacy and survivorship.

“I feel like it’s gone from me raising money for a bike ride to me on two boards helping create awareness and raise inspiration and creating a survivor patient network,” Mendelsohn said. “Now it’s not about me and my three doctors. Now it’s about helping people with diagnosis globally. There are great doctors. I think we’re going to do great things.”

One way to help prevent children from getting cancer caused by HPV when they grow up is the Gardasil vaccine, which protects against HPV Strain 16, which causes oral cancer. Mendelsohn said 62 percent of college freshmen and three-quarters of adults by age 30 have HPV.

But he doesn’t tell people to get the vaccine. Instead, he advises parents to talk to their kids’ doctors about the benefits and risks.

“I talk about the importance of oral cancer screenings when they’re at the dentist,” he said. “And if you feel a bump on your neck, go to your ENT. I had no symptoms and just a bump on my neck, but I was diagnosed with Stage 4. I’ve had so many tell me that they didn’t know the vaccine is for boys. They thought it was just for girls.”

Kaufman said that the HPV vaccine is recommended for use in boys and girls and that it’s important for the vaccine to be given before someone becomes sexually active. The vaccine won’t work if a person has already been exposed to HPV, as most sexually active adults have been, she said.

Men are much more likely to get head and neck cancer from HPV.

“Usually your body fights off the virus itself, but in some people it turns into cancer,” Kaufman said. There hasn’t been specific research that the HPV vaccine will protect you from head and neck cancer, she said, “but if you’re protected against the strains of HPV that cause the cancer, you’re probably less likely to get head and neck cancer.”

Treatment for this cancer isn’t easy, Kaufman said. Radiation to the head and neck can affect salivary glands, which can cause long-term dental and swallowing issues. Treatment can affect the skin, taste and the ability to swallow.

“A lot of people have tubes placed,” she said. “It’s not easy. It depends on how well you respond to the treatment.”

While getting the vaccine can help protect against various cancers, awareness about head and neck cancer is the key. And knowing the signs and symptoms — such as sores in the mouth, a change in voice, pain with swallowing and a lump in the neck — is important.

“If one of those things lasts longer than two weeks, you should go to your doctor,” Kaufman said. “This can affect nonsmokers and nondrinkers. It’s not something that people expect. The more commonplace it becomes and the less stigma, the better.”

Positioning during cancer radiation may be key to heart risks

Source: health.usnews.com
Author: Mary Elizabeth Dallas, HealthDay Reporter

If you have lung or throat cancer, exactly how you are positioned during your radiation treatments may alter your chances of beating the disease.

New research suggests that even tiny shifts can mean the radiation may harm organs around tumors in the chest, most notably the heart.

“We already know that using imaging can help us to target cancers much more precisely and make radiotherapy treatment more effective,” said researcher Corinne Johnson, a Ph.D. student at the Manchester Cancer Research Center in England.

“This study examines how small differences in how a patient is lying can affect survival, even when an imaging protocol is used,” Johnson explained. “It tells us that even very small remaining errors can have a major impact on patients’ survival chances, particularly when tumors are close to a vital organ like the heart.”

When cancer specialists prepare to perform radiation therapy, they scan the patient’s body to determine the exact position and size of the tumor, the researchers explained. Before every treatment that follows, more images are used to ensure that the patient and the tumor are in the same position.

For the study, the researchers recruited 780 patients undergoing radiation therapy for non-small cell lung cancer. For each treatment, patients were positioned on the machines and an image was taken to ensure they were lying within 5 millimeters (mm) of their original position.

The researchers used the images to assess how precisely the radiation was delivered, and to determine if it shifted closer or farther away from the heart.

The patients whose radiation shifted slightly towards their heart were 30 percent more likely to die than those who experienced a similar shift away from their heart, the investigators found.

When the analysis was repeated with 177 throat cancer patients, the researchers noted an even larger difference — about 50 percent — even after they took other factors, such as the patients’ ages, into account.

The findings were scheduled for presentation Sunday at the European Society for Radiotherapy and Oncology (ESTRO) annual meeting, in Barcelona, Spain. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

“By imaging patients more frequently and by reducing the threshold on the accuracy of their position, we can help lower the dose of radiation that reaches the heart and avoid unnecessary damage,” Johnson said in a news release from the meeting.

April, 2018|Oral Cancer News|

Early phase clinical trial shows promise for advanced head and neck cancer

Source: www.fredhutch.org
Author: Rachel Tompa / Fred Hutch News Service

For many survivors of head and neck cancer, the disease — and its treatment — leave a lifelong, unmistakable mark. Surgeries to remove tumors in the mouth, neck or throat often leave patients with disfiguring scars and difficulty speaking or swallowing. Some may not even be able to perform these tasks at all.

Carla Stone participated in a clinical trial run by Fred Hutch’s Dr. Eduardo Méndez for her advanced head and neck cancer. The experimental approach shrank her tumor down to nothing, sparing her what is typically a disfiguring surgery.
Photo by Robert Hood / Fred Hutch News Service

When you look at Carla Stone, you might not guess that she was diagnosed with stage 4 head and neck cancer just two years ago. The only visible sign of her disease and treatment — and you have to know what you are looking for — is the tiny dot tattooed on her chest, the marker for the radiation she received to her throat.

Stone, a 66-year-old bookkeeper from Monroe, Washington, had ongoing symptoms for nearly two years before her doctors finally detected the tumor that had been growing on the base of her tongue. Her primary care physician dismissed the lump in her neck she found in 2014, Stone said, and a series of doctors kept giving her different antibiotics for the chronic sore throat she developed in early 2016.

Eventually, when the antibiotics didn’t work, Stone sought out an ear, nose and throat specialist, or ENT. This doctor didn’t dismiss the lump.

When Stone’s CT scan results came back, the ENT said, “’I went to a lecture last week by a doctor at Fred Hutch about this new treatment he has,’” Stone recounted. “’I want you to call him as soon as you get out of here.’”

That doctor was the late physician-scientist Dr. Eduardo Méndez, an expert on head and neck cancer at Fred Hutchinson Cancer Research Center. And that “new treatment” was a recently launched early-phase clinical trial testing a new cancer drug that Méndez hoped could shrink advanced head and neck tumors to the point where surgeries for his patients wouldn’t be nearly so disfiguring.

Reducing surgery’s side effects
“Part of Eddie’s desire in designing this study was to take patients who would otherwise require a very large, very deforming surgery that could leave them with minimal function at the end of their treatment and see what we could do, not only to boost their chances of being cured, but to leave them with the best functional outcome at the end,” said Dr. Cristina Rodriguez, a clinical research colleague of Méndez and fellow oncologist at Seattle Cancer Care Alliance, the Hutch’s clinical care partner.

Méndez became Stone’s oncologist and she became the seventh participant enrolled in his clinical trial.

“I said, ‘OK, I want to try it,’ because I’m a gambler,” she said. “So let’s have at it.”

For Stone, the gamble paid off. The drug, AZD1775, in combination with two chemotherapies, shrunk her tumor to the point that it was undetectable, she said. She had a minimally invasive surgery to remove some of her lymph nodes and a course of radiation to her throat after that, but there was no sign of the original tumor.

The 30 days she spent taking the experimental drug and undergoing chemotherapy were no picnic, Stone said. She had pretty severe gastrointestinal side effects. But she could also tell that the treatment was doing something.

“My sore throat was gone in about two weeks, which was amazing to me,” she said.

A promising first step
Méndez’s research team published the results of that clinical trial last month in the journal Clinical Cancer Research. Including Stone, 10 people with advanced head and neck cancer were treated with the experimental drug combination. All the participants were either ineligible for surgery or, like Stone, their tumors were such that surgery would have been significantly disfiguring.

Nine of the 10 participants had a partial or complete response to the drug, seven of whom were able to go on to a successful surgery. The 10th patient’s cancer progressed in the middle of the experimental treatment and died soon after.

Méndez himself passed away from another cancer in January, but he was able to see the results of the trial through, said Fred Hutch head and neck cancer researcher and SCCA oncologist Dr. Laura Chow, senior author on the study.

The Phase 1 study was small and designed to figure out the drug’s safety as well as its most tolerable dose, Chow said. The next step would be a much larger, Phase 2 trial with more patients to nail down whether the experimental combination therapy — AZD1775, made by the pharmaceutical company AstraZeneca, plus two chemotherapies, cisplatin and docetaxel — really works for many patients with this cancer.

But of the nine patients who did respond, the responses were much more dramatic than she and her colleagues had anticipated. Of the nine, several were able to have much less invasive surgeries than usually warranted.

“The interesting thing is it had more of an effect than we expected. People actually had dramatic shrinkage of their cancers to the point that they didn’t have cancer left at time of surgery,” Chow said. “It changed the outcomes more than we thought it would.”

‘When basic science and clinical research come together’
The study was born on Méndez’s own laboratory bench, through a series of preclinical studies spearheaded by Méndez and Fred Hutch colleague Dr. Christopher Kemp.

The research team used a technique termed “functional genomics,” which sifts through hundreds or thousands of genes to find cancer cells’ weak spots. The genes the researchers are looking for are those which, when shut off, kill cancer cells but not healthy cells. Those are promising new targets for drugs that could selectively kill cancer without harming the rest of the patient.

When Méndez and Kemp applied the functional genomics technique to head and neck cancer cells with mutations in a gene known as p53, which is mutated in approximately two-thirds of head and neck cancers, their screen identified a gene known as Wee1 as a potential Achilles heel for these tumor cells. Luckily for the researchers, there was already a drug — AZD1775 — that targets Wee1.

When Méndez and Chow designed the clinical trial, they allowed patients with or without mutations in p53 to join — additional preclinical data from Méndez’s team had found that the drug also seemed to work on cancerous cells without a p53 mutation but where the cancer was triggered by HPV infection, a cancer-linked virus that inactivates p53 in a different way.

Indeed, three of the trial participants who had a good response to the drug did not carry p53 mutations in their tumors but were HPV-positive.

“I think the trial is really a great example for what can happen when basic science research and clinical research come together,” said Rodriguez, who is also one of the study authors. “This turned out to be a successful approach both in the petri dish and in human beings.”

National Institutes of Health, the American Cancer Society, philanthropic donations to Fred Hutch and SCCA, and AstraZeneca funded the clinical trial.

Rachel Tompa, a staff writer at Fred Hutchinson Cancer Research Center, joined Fred Hutch in 2009 as an editor working with infectious disease researchers and has since written about topics ranging from nanotechnology to global health. She has a Ph.D. in molecular biology from the University of California, San Francisco and a certificate in science writing from the University of California, Santa Cruz. Reach her at rtompa@fredhutch.org or follow her on Twitter @Rachel_Tompa.

Note:
1. Original article published in Fred Hutch News. Available here.

April, 2018|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 it’s often devastating for people to learn that they can’t get the care they need at home.

“First you are hit over the head with a diagnosis that you didn’t want, and then you can’t get treatment at home, so you have to travel and be away from your family members or pets,” she said.

Some patients drive back-and-forth, but temporarily relocating often becomes necessary during the more intensive treatment phases.

And that was the case with Bob. The 75-year-old initially remained in Thermopolis, only traveling to Casper for intermittent doses of chemotherapy. But he said that wasn’t possible while he was undergoing radiation, which he needed daily for 30 days.

Sherry remembers breaking down into tears when she realized they had to leave home. Already faced with the possibly of losing her husband, not to mention mounting medical bills, the thought of relocating for a month was overwhelming.

“That was just more than I could handle … I just thought, ‘How are we going to do this?’” she said.

***
Battling cancer is difficult for anyone, but those living far away from treatment centers need extra help, said Wyoming Foundation for Cancer Care treasurer Kara Frizell. Finding the money for gas and hotel accommodations can quickly become a serious problem.

“It’s not something you can just come up with,” she explained.

Frizell said the Casper-based charity annually spends between $20,000 and $30,000 assisting patients with necessary travel expenses. The nonprofit also oversees a network of volunteers, called Angels, who help out-of-towners feel at home by delivering meals or dropping off gift baskets.

***
Robert Rasmussen also lives in Rawlins, but he hasn’t had much of a chance to grow attached to the town. He moved from Tuscon, Arizona, in search of peace and quiet. But about a year after moving, he was diagnosed with stage four throat cancer last fall. It quickly became apparent that traveling back and forth to Casper for treatment wasn’t a safe option.

Sitting in his bed in January at the Shepherd of the Valley Healthcare Community — where he’s recovering from surgery — the emaciated 50-year-old removed his oxygen mask and explained that intense radiation and chemotherapy treatments left him far too nauseous and exhausted to drive.

Rasmussen temporarily relocated to Casper in October and brought along his dog, Piggy. The Australian Shepherd is family, and he couldn’t bear to be without her.

“She’s the only thing that keeps me together,” he explained.

Although Rasmussen was worried hotels wouldn’t allow animals, Carrick arranged for both patient and pet to stay at the Sleep Inn in Evansville. The patient navigator also connected him with the cancer foundation to help with the bill.

The hotel staff has since fallen in love with Piggy, according to general manager Carmen Bartow. Employees walk her each day, sneak her treats from the breakfast buffet and even take her to visit her dad.

“She’s our mascot,” said Bartow.

The manager said the inn annually receives about 15 guests who are in town for cancer treatments, likely because of their close proximity to the oncology center. The hotel offers discounted rates for its sick visitors and employees try to help them out in any way possible.

“If we can’t help one another out then there is something wrong with us,” she said.

Rasmussen greatly appreciates everyone who made it possible for Piggy to stay in Casper.

His condition is serious, and distracting himself from the possibly of death isn’t easy, he explained. Surrounded by feeding tubes and beeping monitors, it’s impossible to forget his situation.

“I try to read or watch TV or just focus on something different, but when I’m just sitting here by myself, it’s hard,” he said.

But Rasmussen said he can manage with Piggy by his side for support.

Although his former home in Tuscon was closer to advanced medical care, Rassmussen said he prefers living in small towns because its safer and more peaceful.

“I don’t have any regrets [about moving],“ he said. “City life isn’t for everybody.”

February, 2018|Oral Cancer News|

Cancer survivors are transforming their radiation masks into art

Source: www.artsy.net
Author: Ryan Leahey

Photos by Ulf Wallin Photography

In a Baltimore basement, behind foot-thick walls, there is a room, and in that room there is a table. Every morning, Monday through Friday for seven weeks, my dad entered the room at 7:40 a.m. sharp. I accompanied him there on a few occasions, sitting outside in the waiting room as the door closed behind him. A minute or two would pass, followed by a barely audible buzz, then the door would slide open again and he’d walk out, another radiation treatment X’d off the calendar.

My dad’s experience in that room, one of many in the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, will be familiar to other throat cancer patients. A radiation technician bolted him down to the table with the help of a white mesh mask perfectly molded to the contours of his face. Wrapped tightly around his head and neck, the bizarre-looking armature ensured that powerful radiation beams targeted his cancer in the exact same position each session, even as his skin deteriorated and his body mass dropped.

Before his first treatment, he had been measured and fitted for his own custom mask. Plastic mesh was draped over his face until it hardened, forming a new face—what some patients call their second skin. For my dad, the object came to symbolize something, just as it symbolizes something for me, our family, and for the countless other people who have survived or helped someone survive head and neck cancer, or HNC.

My dad isn’t exactly the sentimental type, but on his last day of radiation, he rang the bell—a rite of passage for patients who make it through treatment—put the mask in his car trunk, and took it home.

 

Photo by Ulf Wallin Photography

The mask worn by Ryan Leahey’s father during radiation treatment. Courtesy of the author.

Just as cancers and treatments are unique, however, the meaning of the mask is unique to every patient and to every person who comes into contact with it. Among those searching for that meaning are hundreds of artists, some of them survivors themselves, who have transformed radiation masks into works of art that seek to capture, or at least confront, the struggle and, for the lucky ones, the survival of HNC.

Groups across the U.S. and other parts of the world have come together to create new lives for these masks. One such group, Courage Unmasked, has, through a series of auctions and books, shown off an incredible array of masks, all while raising awareness of HNC and funds for patients in need.

Courage Unmasked is the brainchild of Cookie Kerxton, an artist and HNC survivor. In 2009, Kerxton felt lucky. She was fortunate to have had the finances and good health to survive her radiation treatment for cancer of the vocal cords. As Kerxton convalesced, she realized that not everyone is quite so lucky. Some HNC patients face a permanent loss of saliva, destroyed taste buds, digestive issues, and an inability to talk, eat, swallow, or breathe. And when it comes to the cost of covering incidentals like specialty foods, commuting, and the many small but crucial steps toward recovery, health insurance is often insufficient.

Kerxton had an idea. She inquired at the treatment center about the leftover radiation masks, the ghostly white shells of former patients. With permission from the center’s radiation therapists, she took home the discarded masks and called upon her artist friends to help transform them into works of art. She then auctioned off the finished objects, using the proceeds to support HNC patients by sending applicants a $500 check through a Maryland-based nonprofit called 9114HNC (Help for Head and Neck Cancer).

Since the first Courage Unmasked event in 2009, held at American University’s Katzen Arts Center in Washington, D.C.—which featured 108 masks, decorated by more than 100 artists—other such events have followed, each raising more money for 9114HNC.

Photo by Ulf Wallin Photography.

Carol Kanga, an artist and HNC survivor, co-chaired the inaugural Courage Unmasked event and created a mask for the auction. “My attitude toward my mask was gratitude for the safety it represented,” she told me. “It meant precise treatment, the best available. When I walked into the radiation room and looked up at the shelves, scores of masks looked back at me. They signaled that I was not alone, that hundreds of people get through this, that each of us is a distinct individual receiving excellent treatment tailored exactly to each contour of our bodies.”

Her mask, she has said, “is designed to entice viewers to rejoice with me that life is and that we all are part of it.” And the range of other artist-adorned masks testifies to that life-affirming attitude. Some of the works are celebratory, like totemic symbols of victory over incalculable odds, while others are somber and severe, like fragile reminders of death. Flowers in bloom are a recurring theme, as are birds and their delicate, multicolored feathers.

Barbara Kerne created a mask inspired by Athena, the Greek goddess of arts and crafts who is said to have taken the form of an owl. Athena also happens to be the goddess of wisdom and strength, and thus, Kerne says, a symbol of “heroic endeavor and patron of those who need help.”

For artist Jeanne Heifetz, the mask, as an artifact of radiation, carried twin burdens of fear and hope. “I wanted to transform the emotional connotations of the mask, using alternative meanings of ‘radiation’ and ‘radiance,’” she says. Lacework and reflective copper turn the mask into what she calls a “protective armor for the wearer.”

Several artists sought to maintain the thread from mask wearer to mask reimagined. “This radiation mask came to me from a woman’s daughter in Colorado, who had tenderly sent it off in a box with pictures of mountains on it,” writes artist Anita Hinders in a catalogue that accompanied one Courage Unmasked event. “I think of this mask, Shades of Colorado, as a love letter continued.”

Photos by Ulf Wallin Photography

Allen Hirsch, a throat cancer survivor who recently became a board member for Courage Unmasked, hasn’t decided what to do with his mask just yet. “I have it in my living room,” he told me. “Each day I walk past the mask and it reminds me of the treatment experience and the other patients and family members I met at the radiation clinic and the infusion center. The mask is a reminder that life has changed.”

My dad hasn’t decided what to do with his mask, either. When I was home for the holidays, the mask was sitting on the dining room floor, our last name scrawled across the top. In unadorned white, it was bright like a halogen light. Later, I asked if he had any plans for it. He wasn’t sure. I showed him images of the artist-decorated masks in the Courage Unmasked catalogue, which he’d seen in the waiting room at Hopkins.

He liked some of the artwork, he told me, though he wasn’t too impressed by all the birds. He liked the stories, the book’s personal narratives from survivors and from artists trying to comprehend what he and others had been through, the most.

Dad was only a few days into radiation treatment when he first thumbed through the book at Hopkins, before he lost weight, his sense of taste, his hair, his voice. As those things come back to him, however slowly, he has come to appreciate those stories more. His trophy, as he calls his mask, is a symbol of his own story and how he was lucky, too.

January, 2018|Oral Cancer News|