‘Paradoxical’ data show routine imaging lacks benefit for head and neck cancer survivors

Source: www.healio.com Author: Matthew Shinkle Key takeaways: Researchers saw no statistical difference between patient groups with respect to treatment outcomes. Larger studies are needed to further evaluate this study’s findings. Compared with expectant management, imaging-based surveillance did not improve outcomes among patients in remission after completion of primary radiation therapy for head and neck cancer, according to data published in JAMA Network Open. Although imaging “in the context of clinical suspicion” for this specific patient population is common and typically beneficial, according to researchers, the results of this study show that such a practice is not valuable for asymptomatic patients. “The results of the present study, while seemingly paradoxical, are consistent with those of others which have failed to demonstrate a benefit to surveillance imaging among patients who have successfully completed treatment for head and neck cancer,” Allen M. Chen, MD, MBA, professor and chair of the department of radiation oncology at University of California, Irvine, Chao Family Comprehensive Cancer Center, and researchers wrote. Researchers conducted a retrospective, comparative effectiveness review to evaluate the potential benefit of surveillance imaging among asymptomatic patients with head and neck cancer currently in remission following completion of chemoradiation. The study included 340 adults (59% men; 43% white) who had achieved a complete metabolic response to initial treatment for newly diagnosed squamous cell carcinoma of the head and neck between January 2014 and June 2022. Researchers defined surveillance imaging as the acquisition of a PET with CT, MRI or CT of the head and neck [...]

Novel therapy promising for radiation-induced oral mucositis

Source: www.medpagetoday.com Author: Mike Bassett, Staff Writer, MedPage Today The first-in-class uridine phosphorylase inhibitor TK-90 almost completely eliminated severe oral mucositis (SOM) in patients with non-metastatic squamous cell carcinoma of the head and neck who underwent radiation therapy, a small randomized study showed. None of the 12 patients treated with TK-90 developed SOM by the end of treatment at week 7, compared with six of 12 treated with placebo (0% vs 50%, P=0.14), reported Nabil F. Saba, MD, of the Winship Cancer Institute of Emory University in Atlanta. At week 9 follow-up after the end of dosing, just one patient treated with TK-90 had developed SOM compared with nine in the placebo group (8.3% vs 75%, P=0.003). The duration of SOM in the patient treated with TK-90 was 12 days compared with a mean duration of 35 days in patients who developed SOM in the placebo arm (P=0.026). "Parenteral administration of TK-90 appears to be an effective strategy for preventing radiation-induced mucositis," Saba said during a session at the Multidisciplinary Head and Neck Cancers Symposiumopens in a new tab or window in Phoenix. "These results merit additional validation in larger trials." Mucositis is a debilitating complication of radiotherapy or chemotherapy, leading to weight loss, mouth ulcers, abdominal pain, vomiting, diarrhea, and potentially fatal infections. "Uridine is essential to the preservation of the health of the normal mucosa," Saba explained. "By inhibiting uridine phosphorylase, uridine levels are restored in the mucosa, basically reducing the leakage in the mitochondria and, by doing [...]

FDA clears oral stent solution for radiotherapy in head and neck cancer

Source: www.cancernetwork.com Author: Russ Conroy The FDA has granted clearance to Stentra, an oral stent solution, for use in the treatment of patients with head and neck cancer, according to a press release from Kallisio.1 The solution combines patient oral data with advanced 3D printing to redirect radiation to the target tumor area and limit toxicity to surrounding tissue. Stentra was designed for use in combination with radiotherapy strategies including intensity-modulated radiation therapy (IMRT). The tool is believed to keep the patient’s tongue, lips, and other organs safe from the high-dose radiation target zone by immobilizing them. According to its developers, Stentra makes use of a “patient-customized solution for precise and targeted radiation therapy,” and manages toxicity effectively by protecting surrounding healthy tissue from intense radiation doses. Additionally, its mechanism allows patient-tailored oral stents to be formed in less than 5 days. “Designed to address each patient's unique treatment and anatomical needs, Stentra delivers an unmatched level of customization and effectiveness in addressing the critical need to safeguard healthy tissue during radiation therapy,” Rajan Patel, co-founder and chief executive officer at Kallisio, said in the press release.1 “FDA clearance is an exciting milestone in our journey to improve patient experiences and quality of life.” Eugene Koay, MD, PhD, an associate professor of Gastrointestinal Radiation Oncology at The University of Texas, MD Anderson Cancer Center, developed Stentra’s foundational technology. Investigators of a prospective observational study published in Clinical and Translational Radiation Oncology reported that administering oral stents to survivors of oropharyngeal [...]

Dr Jennifer Choe discusses head and neck dancer relapse, new treatment trials, promising responses

Source: www.ajmc.com Author: Brooke McCormick Jennifer Choe, MD, PhD, shared her thoughts on why head and neck cancer patients relapse after radiation therapy, new head and neck cancer treatment trials, and promising responses from these trials. Choe is a head and neck oncologist at Vanderbilt University Medical Center and was a presenter at The American Journal of Managed Care®’s Institute for Value-Based Medicine® held in Nashville, Tennessee on August 17, 2023. Transcript Can you explain some of the thought behind why there is disease relapse in head and neck cancers after radiation treatment? There's a lot of theoretical basis as to why we think this is the case. A lot is driven by just aggressive biology; it's really not known. Head and neck cancers are considered immune responsive, technically speaking, but the response rates still are pretty low, in general, and whether or not the immune system and head and neck cancer patients are depressed compared to other cancers. I, in theory, think that a part of it is actually the radiation creating an environment where there could be a reduction in the body's ability to regulate the immune system. There's an immune suppressed state for these patients that could be due to radiation of the lymph nodes that's decreasing the ability for the immune system to respond, but also the local radiation induced immune suppression effects that may be producing a more conducive environment for the cancer to return. What are some of the trials evaluating new treatment regimens [...]

2023-09-02T07:41:01-07:00September, 2023|Oral Cancer News|

Hollings head-and-neck team leads trial to reduce delays in care

Source: web.musc.edu Author: Leslie Cantu Beginning radiation therapy on time is critical for people with head and neck cancer. Delays in starting radiation therapy after surgery are associated with worse outcomes – and yet half of patients across the country don’t start radiation therapy when they should. A multidisciplinary team at MUSC Hollings Cancer Center has spent the last five years bringing this issue to light. Now, the team, led by Evan Graboyes, M.D., has been awarded a $3.5 million grant to test an approach for reducing those delays, which should improve outcomes. Called ENDURE, for Enhanced Navigation for Disparities and Untimely Radiation thErapy, the approach addresses the issue at three levels: organization, team and patient. New benchmark Reducing delays in moving to radiation from surgery has become a focus for cancer centers since November 2021, when the Commission on Cancer added a quality measure that grades centers on how many patients with head and neck squamous cell carcinoma begin radiation within six weeks of surgery. The commission accredits cancer programs, and this is the first time it’s included a head and neck cancer benchmark in its quality measures. The work of the Hollings team, which began when Hollings awarded Graboyes a K12 Paul Calabresi Career Development Award for Clinical Oncology in 2018, has been instrumental in providing the rationale for this new benchmark. Since that first grant award to Graboyes, the team has published 10 peer-reviewed publications showing that the time to starting radiation is a key measure, and [...]

Novel agent may improve dry mouth resulting from radiation treatment

Source: www.curetoday.com Author: Colleen Moretti Treatment with AAV2-hAQP1 demonstrated clinically meaningful improvements for patients experiencing symptoms of radiation-induced dry mouth, according to positive results of a phase 1 trial. Radiation-induced xerostomia, or oral dryness, can be a result of treatment with radiotherapy to the oral cavity and neck region – common in patients treated for oral, or head and neck cancers. When this happens, the salivary glands in a patient’s mouth do not make enough saliva to keep it wet. Researchers conducting the AQUAx trial AQUAx evaluated AAV2-hAQP1 in one (unilateral group) or both parotid glands (bilateral group) of 24 patients with radiation-induced salivary hypofunction and moderate to severe dry mouth. “We are very encouraged by the clinical data in both unilateral and bilateral cohorts demonstrating the safety, efficacy and durability of AAV2-hAQP1 in grade 2/3 radiation-induced xerostomia,” said Alexandria Forbes, president and chief executive officer of MeiraGTx, the drug’s manufacturer, in a press release. “Not only does this therapy continue to be safe and well tolerated, but we are seeing durability of effect at two and even three years for patients who have reached those timepoints.” In both groups, 75% of patients reported their dry mouth symptoms as “better” following treatment and rated these improvements as “important” or “very important,” according to the release. Although both groups had improvements, those observed in the bilateral group were greater. Of the 12 patients in the bilateral group, 10 reported “better” dry mouth symptoms after six months. Additionally, these 10 patients rated [...]

A strange anomaly on scans turned out to be an entirely new organ, hidden within your face

Source: www.iflscience.com Author: James Felton, Senior Staff Writer Image Credit: Valstar et al., Radiotherapy and Oncology, 2020 (CC BY-NC-ND 4.0) You'd think after centuries of cracking open humans and taking a poke around inside we'd have discovered every organ there is to be found in there, but you'd be wrong. In fact, they seem to be popping up all the time. In 2018, researchers discovered the largest organ in the body, interconnected fluid-filled sacs that run through the collagen and elastin structures in the areas beneath our skin and between other organs and tissues in our bodies. Well, wouldn't you know it, scientists have just found another new organ inside us. It's getting pretty crowded in here. Oncologists at the Netherlands Cancer Institute were using a new kind of scan as part of their research into patients with head and neck cancer. They used positron emission tomography/computed tomography with prostate-specific membrane antigen ligands (PSMA PET/CT) scans, which have been shown to be an effective way of tracking the spread of prostate cancer around the body. Patients are injected with radioactive glucose before the scan, which highlights tumors within the patient by glowing brightly. While using this scan on patients, however, the team noticed two areas in the head unexpectedly lit up. As they kept scanning patients, they kept finding the same area lighting up. It turned out all 100 people scanned had bright spots. It wasn't an anomaly, it was potentially an entirely new organ. The new discovery, [...]

2022-12-29T16:44:33-07:00December, 2022|Oral Cancer News|

Oral health professionals promote ‘value of having a dentist on the cancer care team’

Source: www.healio.com Author: Jennifer Byrne When planning their next steps after a cancer diagnosis, most patients don’t put a trip to the dentist at the top of their to-do list. “When patients are diagnosed with cancer, they just want to put out the fire; they want to address the cancer,” Dalal Alhajji, DMD, MSD, clinical instructor of oral and maxillofacial pathology, radiology and medicine at NYU College of Dentistry, said in an interview with Healio. “That’s when I say, ‘the reason you need to see a dentist is, we want to put out another potential fire — one you might not know about yet.” Alhajji and her colleagues at NYU College of Dentistry are part of a small but growing movement among oral health professionals seeking to close the gap between medical and dental care for patients with cancer. They see dentists as a vital component of any multidisciplinary oncology care team, offering infection treatment, protection of teeth during head and neck radiation treatments, and quality-of-life care for issues such as dry mouth and mouth sores. “I’ve been lucky — the oncologists I work with have been great about referring patients to me because they see the impact it has,” Alhajji said. “They see the value of having a dentist on the cancer care team.” Addressing preventable issues There are several reasons for a patient with cancer to see a dentist prior to initiating cancer treatment, but patients with head and neck cancers and those slated to undergo bone marrow [...]

The potential of e-learning interventions for AI-assisted contouring skills in radiotherapy (E33046)

Source: www.iaea.org Author: Kamal Akbarov The International Atomic Energy Agency (IAEA) is launching a new Coordinated Research Project (CRP) aimed at investigating the potential of artificial intelligence (AI) to enhance contouring skills in radiotherapy, especially focusing on increasing accuracy of delineation of organs at risk in head and neck cancers. Radiation oncology has evolved rapidly in recent decades in terms of innovations in treatment equipment, volumetric imaging, information technology and increased knowledge in cancer biology. New delivery technologies and associated imaging modalities have enabled highly optimized precision radiation therapy and contributed to improvements in tumor control and cancer patient cure. The selection and contouring of target volumes and organs at risk (OARs) has become a key step in modern radiation oncology. Concepts and terms for definition of gross tumor volume, clinical target volume and OARs have been continuously evolving and have become widely disseminated and accepted by the international radiation oncology community. However, clinical research from single institutions and multicentre experiences has provided evidence for major variations in contouring for both target volumes and OARs. In recent years, AI-based methods, such as deep learning, have improved auto-segmentation drastically. It is generally believed that the use of such tools will lead to lower the inter-observer variation and time savings for clinical staff. A wide palette of commercial deep learning-based auto-segmentation solutions are emerging with the promise of leveraging the aforementioned benefits. While the objective performances for deep learning-based auto-segmentation in retrospective studies are very promising, the actual clinical benefit is largely [...]

Throat cancer survivors don’t have to sacrifice ability to swallow and taste

Source: southfloridahospitalnews.com Author: staff Tamarac resident Kenneth Goff was home shaving morning when he felt a small lump on the left side of his neck. “There was no pain, no nothing, but I could feel it by the way the razor moved,” said the 58-year-old father of five and grandfather of eight. “It wasn’t visible at all, but I could feel it right below the jaw line.” After a CT scan at Broward Health Medical Center in August 2020, Goff was diagnosed with HPV-mediated squamous cell carcinoma, a type of throat cancer. This cancer is similar to what actors Michael Douglas and Stanley Tucci have battled. The treatment of HPV-related oropharyngeal squamous cell carcinoma may include surgery, radiation, chemotherapy or combination of the treatments. Ryan H. Sobel, M.D., a head and neck surgical oncologist at Broward Health Medical Center, prescribed radiation to treat Goff’s isolated neck mass. Prior to radiation treatment, Dr. Sobel performed a submandibular, or saliva gland transfer, an intricate surgery only a handful surgeons across the country are skilled at performing. He is currently the only surgeon utilizing this technique in Broward and Palm Beach counties. Dr. Sobel strategically relocated one of Goff’s saliva glands. It was moved about three inches from the right side of his throat to under the chin to place it out of direct range of the damaging effects of radiation. Patients diagnosed with throat cancer face a difficult choice: treat the cancer with radiation and risk losing their ability to swallow and [...]

2022-02-24T15:03:37-07:00February, 2022|Oral Cancer News|
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