FDA clears IND application for cell therapy to treat radiotherapy-induced dry mouth

Source: www.healio.com
Author: staff

The FDA cleared an investigational new drug application for a mesenchymal stromal cell therapy to treat radiotherapy-induced xerostomia, also known as dry mouth.

Researchers at University of Wisconsin Carbone Cancer Center developed the therapy, which uses the patient’s interferon-gamma activated marrow stromal cells.

Xerostomia is a one of the most common adverse effects of radiation therapy for head and neck cancers and may cause difficulties eating, speaking and sleeping, in addition to oral health complications.

“There is a critical need for improved treatments for this condition,” Randy Kimple, MD, PhD, associate professor of human oncology at University of Wisconsin School of Medicine, said in a press release. “For most patients, the best care we can provide currently is to encourage them to eat specially prepared food, suck on hard sugar-free candies and carry a water bottle with them all day.”

Kimple told Healio the therapy process involves the patient undergoing a bone marrow biopsy to harvest mesenchymal stromal cells.

Kimple — who will lead the forthcoming phase 1 trial for the therapy — said the cells will be prepared by the Program for Advanced Cell Therapy’s lab at UW Health’s University Hospital. Patients will receive the therapy via injection into the submandibular gland after completion of radiation therapy.

The phase 1 trial soon will begin enrolling up to 30 patients and will be conducted by University of Wisconsin School of Medicine and Public Health as a single-center study of patients treated at Carbone Cancer Center.

Study participants will be monitored for safety and development of adverse effects after receiving the cell therapy injection.

“Patients will also provide samples of their saliva and complete quality-of-life questionnaires to help determine if the treatment is effective,” Kimple said.

Researchers hope to complete the first phase of the trial within a year, according to Kimple.

Print Friendly, PDF & Email
September, 2020|Oral Cancer News|

Mouth cancer rates set to go ‘through the roof’ following missed dental appointments

Source: www.dentistry.co.uk
Author: staff

Mouth cancer rates are set to skyrocket in the UK following millions of missed dental appointments as a result of lockdown. This is according to the Association of Dental Groups (ADG), which is calling on ministers to take urgent action.

Dentists have warned that thousands of cases may have gone undetected. This could be due to the public avoiding dental practices, as well as the two and a half month pause on face-to-face dental appointments.

For example, 49% of households have at least one adult who has missed or decided against visiting the dentist. Considering there are 27.8 million households across the UK, these figures suggest 13 million adults have missed an appointment.

Calls for urgent action
Part of a major campaign urging ministers to rescue the worsening dentistry crisis in the UK, the ADG poll revealed:

  • 17% of households have someone who missed a visit because they struggled to get an appointment
  • 13% of households have someone who decided against making an appointment
  • 11% of households have someone who decided not to go in for a scheduled check up
  • 12% of households have someone who did not go to the dentist for another reason.

The latest figures show that more than 8,300 people in the UK are diagnosed with mouth cancer every year. Additionally, an estimated 2,700 people lost their life to mouth cancer last year. And over the last year, new cases have increased by 10%.

Deeply alarming
‘The fact that so many people are either failing to get dental appointments, or simply deciding against them, is deeply alarming,’ said ADG chair Neil Carmichael.

‘It suggests that a whole host of oral health problems are being bottled up during lockdown. And that dentists will be overwhelmed when routine appointments restart.

‘Dentists are especially concerned about mouth cancer as routine check-ups are the key to early diagnosis. If this is not happening and the early warning signs are not being detected, then mouth cancer rates could soon go through the roof.

‘Ministers must now take urgent action to ensure that we have the NHS dentists we need to deal with what’s around the corner.’

Print Friendly, PDF & Email
September, 2020|Oral Cancer News|

Need another reason not to vape? Your oral health is at risk

Source: www.health24.com
Author: Healthday staff

The warnings about vaping – inhaling the vapour of electronic cigarettes – tend to focus on the potential dangers to the heart and lungs. But an increasing amount of research shows the chemicals in e-cigarettes start to inflict damage right where they enter the body: your mouth.

Because e-cigarettes are a recent phenomenon, said Dr Crystal Stinson, assistant professor at Texas A&M College of Dentistry in Dallas, “Studies on their impact are really new. But now we have a solid amount of evidence that shows the link between e-cigarettes and poor oral health.”

Nicotine, whether smoked or vaped, restricts blood flow to the gums, which can contribute to periodontal disease. The fluid in e-cigarettes, which can include propylene glycol, benzene, formaldehyde and other chemicals, only increases the risks.

Irreversible issues
A study published earlier this year in the journal iScience showed that 43% of people using e-cigarettes had gum disease and oral infections. That figure was higher among smokers – 73% – but only 28% among people who neither smoked nor vaped.

“The oral cavity is really resilient tissue that heals faster than other parts of the body,” Stinson said. “But we also know that when you repeatedly traumatise it, that’s when you end up having issues that are irreversible.”

Those issues, she added, range from inflammation and tooth cavities to loss of bone that anchors teeth to the jaw, called periodontitis, and oral cancer.

Another study published in May in Science Advances concluded the oral microbiome – the vast collection of friendly bacteria, viruses and other microbes that live in the mouth – of e-cigarette users without gum disease looked a lot like the microbiome of people with periodontitis.

“It’s absolutely scary stuff,” said Dr Purnima Kumar, professor at the Ohio State University College of Dentistry and the study’s senior author. “E-cigarettes stress the bacterial communities that live in your mouth, and they encase themselves in slime. So they’re no longer good bacteria and the inflammatory response is through the roof. People are walking around thinking they’re healthy, but they are just primed for disease.”

‘We’ve just scratched the surface’
Oral health is a critical element of whole-body health. Two preliminary studies presented in February at the American Stroke Association’s International Stroke Conference linked gum disease with a higher rate of strokes caused by hardening of large arteries in the brain and also with severe artery blockages. A 2018 study in the American Heart Association journal Hypertension found that gum disease appears to worsen high blood pressure and interferes with medications to treat hypertension.

Last December, the American Dental Association issued a statement urging a ban on e-cigarettes not approved by the Food and Drug Administration to help people quit smoking, as well as more research on the effects of vaping on oral health.

“We’ve just scratched the surface,” Kumar said. “We know it’s detrimental. We need to start looking at which chemical components of vape really cause this, why does it cause this, how long does it take to start, and how long does the body need to recover once you quit.”

Not enough time has passed since vaping became popular to assess the long-term dangers, Stinson said. “Unfortunately, everybody’s an experiment right now.”

But Stinson doesn’t need to wait for more studies to be convinced of the dangers of vaping. One look inside a vaper’s mouth usually tells the story.

More cavities
“Periodontal disease is normally an adult disease, and we’re seeing it in younger people,” she said. “Younger people normally have more saliva than they need, so when they present with dry mouth, periodontal disease or increased complaints of mouth ulcers, our next question is, ‘Do you vape?’ These symptoms are all tied to components in e-cigarettes.”

She also notices more cavities in her younger patients who vape, which she believes may be due to the acidity of the components in vape liquid and an increase in cavity-causing bacteria.

Stinson attributes the high rate of nicotine dependence to the sweet flavourings that helped attract adolescents to e-cigarettes. In February, the FDA banned many flavoured e-cigarettes in hopes of reducing the rise in vaping among young people, but health experts fear many are already hooked on nicotine.

“Phasing out the flavours is going to help, but we still have a population that is struggling to let go of the habit,” she said.

Both Stinson and Kumar are involved in education and cessation programmes aimed at convincing young people not to start vaping and helping those who do to stop.

‘It’s not a vapour’
The first lesson: Don’t be fooled into thinking that what looks like steam is a safe alternative to cigarette smoke.

“You hear ‘vapour’ and you think steam facials or a tea kettle,” Kumar said. “It’s not a vapour. It’s an aerosol, like hairspray or what you use to kill ants and cockroaches. When I teach young kids, I take little cans of hairspray and say, ‘I want you to spray this in your mouth.’

“They say, ‘Ew, no.’ So, I say, ‘Then why would you vape?'”

Print Friendly, PDF & Email
September, 2020|Oral Cancer News|

Scientists have combined two potent immunotherapies to eliminate big tumors

Source: www.drewreportsnews.com
Author: Drew Simms

City of Hope researchers have actually combined two potent immunotherapies– an oncolytic infection and chimeric antigen receptor (CAR) T cell therapy– to target and remove solid growths that are otherwise difficult to treat with CAR T treatment alone, according to a brand-new Science Translational Medication study.

In pre-clinical research that could lead to a medical trial for clients with intractable solid tumors, City of Hope scientists genetically crafted an oncolytic virus to go into growth cells and require their expression of CD19 protein on their cell surface area. Scientists were then able to use CD19-directed CAR T cells to recognize and attack these solid tumors.

CD19-CAR T cell therapy is authorized by the U.S. Fda to treat particular types of blood cancers, specifically B cell lymphomas and intense lymphoblastic leukemia. This brand-new research might broaden using CD19-CAR T cells for the treatment of patients with possibly any strong tumor.

“Our research demonstrates that oncolytic viruses are a powerful and promising approach that can be combined strategically with CAR T cell therapy to more effectively target solid tumors” said Saul Priceman, Ph.D., the study’s senior author and an assistant professor in City of Hope’s Department of Hematology & Hematopoietic Cell Transplantation.

“In addition, this therapeutic platform addresses two major challenges that make solid tumors so difficult to treat with immunotherapy. There are limited, established solid tumor targets that T cells can be redirected against with CARs,” Priceman added. “Furthermore, solid tumors are surrounded by a brick wall — a so-called immunosuppressive tumor microenvironment. When a CAR T cell attempts to enter the tumor, survive, and kill cancer cells, it can’t effectively because of this barrier.”

Yuman Fong, M.D., the Sangiacomo Family Chair in Surgical Oncology at City of Hope and a leading researcher who is developing oncolytic infections for cancer treatment, included that the virus had the ability to break through that barrier.

“We designed this oncolytic virus to do what it does so well,” Fong said. “It entered the cancer cell and used the cell’s own machinery to replicate itself, and engineer the cancer cells to express a truncated form of the well-known CAR T cell target, CD19.”

Researchers first produced an oncolytic infection (OV19t) in Fong’s lab to enter into tumor cells and start producing truncated CD19 (CD19t). They did this successfully in triple-negative breast cancer lines, along with in pancreatic, prostate, ovarian, and head and neck cancer, as well as brain growth cells. CD19-CAR T cells were then integrated with OV19t in vitro and in healing studies in mice.

Scientists found several crucial findings
“When we infected tumor cells with the virus, we observed the first signal that this may work. CD19t was being expressed by tumor cells much sooner than the virus was able to kill them, giving us a window of opportunity to be targeted by CD19-CAR T cells,” said Anthony Park, Ph.D., a postdoctoral fellow in Priceman’s lab. “The combination of the two had a powerful, synergistic effect.”

Researchers also revealed that mice already treated of their cancer with the oncolytic infection and CAR T cell combination showed extended protective anti-tumor resistance.

“The immune system built a memory response to the tumor,” Park added. “Once it eradicated tumors, following the initial combination treatment, the mice were shielded against tumor recurrences.”

Solid growths are frequently immunologically cold, which implies they are not usually responsive to therapies that utilize the body’s own immune system to eliminate cancer, Park said. Introducing the virus reversed the tumor’s harsh microenvironment, making it more receptive to receiving CAR T cell treatment.

The research study shows City of Hope’s collective technique to finding much better immunotherapy cancer treatments. A couple of years back, Priceman, Fong and Stephen Forman, M.D., leader of City of Hope’s Hematologic Malignancies Research Institute, satisfied to conceptualize how they might integrate their know-how, namely oncolytic infection and CAR T cell treatments, to target solid growths.

“It was a simple concept but one that took many steps to get us to where we are today — we are now designing a clinical trial to test this combination in patients,” said Priceman.

The trial would initially check the safety of OV19t in clients with solid growths. If that is found to be safe and effective, the oncolytic virus and CAR T cell treatment could then be checked in sequence. The trial is anticipated to begin in 2022.

City of Hope, an acknowledged leader in CAR T cell treatments for blood cancers and strong growths, has actually dealt with more than 500 clients because its CAR T program begun in the late 1990s. The organization continues to have among the most comprehensive CAR T cell clinical research study programs on the planet. It currently has 30 ongoing CAR T scientific trials, consisting of CAR T trials for blood cancers and several strong growth types such as primary and metastatic brain growths, metastatic castration resistant prostate cancer, and more.

Print Friendly, PDF & Email
September, 2020|Oral Cancer News|

UCM computer science professor researches use of AI in cancer treatment

Source: www.dailystarjournal.com
Author: Sara Lawson

New research by a University of Central Missouri faculty member uses an innovative Artificial Intelligence (AI) technique to allow physicians to predict which patients are at low risk of distant metastasis in order to help minimize severe side effects from radiation treatment. The research conducted by Zhiguo Zhou, assistant professor of computer science, is titled “Multifaceted radiomics for distant metastasis prediction in head-and-neck cancer.” Zhou’s research was published in the journal, Physics in Medicine and Biology, and subsequently reported in the July 2020 issue of Physics World.

Zhou, who has explored AI in medicine for 10 years, joined the UCM faculty in 2019. He began working on this recently published study more than three years ago while serving in the Department of Radiation in oncology at the University of Texas Southwestern Medical Center in Dallas. One of his UT colleagues, Jing Wang, served as co-author on the journal article.

Zhou said the research proposes a novel model for predicting metastasis in head-and-neck cancer after radiotherapy with “outstanding results.” It is a study he believes could provide a general framework which could be extended to predict treatment outcomes for primary cancers in other parts of the human body. While the research now undergoes a validation process that involves a multi-institutional prospective study, Zhou is hopeful that it can be applied in clinical settings within the next two to three years.

“Nowadays, radiotherapy has become one of the most important treatment methods in cancer therapy,” Zhou said. “The basic principal is to use radiation to kill the (primary) tumor and minimally deliver the dose (of radiation) to the surrounding normal organs. However, radiation is also harmful to the human body and it is very difficult to achieve this ideal situation.”

In fighting cancer, one of the challenges doctors face is how to effectively use radiotherapy to control the metastasis or spread of the disease without harming the patient in other ways. Physicians working with cancer patients must weigh different outcomes to address an optimal treatment plan, Zhou said.

“We think the solution is, if we can accurately predict the treatment outcome or response before radiotherapy, we can optimally make the treatment plan,” Zhou said. “This is the basic idea of why we need to do this research.”

As noted in the Physics World article, “As with cancers elsewhere in the body, early-stage cancers of the head and neck are treated using radiotherapy with increasing success. When treatment fails, it is often down to the growth of new tumors far from the site of the initial disease.

Predicting which patients are most likely to develop distant metastasis is vital so that low-risk patients can be spared the severe side effects that accompany the systemic treatments used to control cancer proliferation.”

In seeking to develop a reliable model to predict distant metastasis, Zhou and his research collaborators utilized PET and CT diagnostic and treatment planning images of 188 patients with head-and-neck cancer that were obtained from different institutions. These patients had received follow-up consultations with their care providers and the images were already seen by physicians. The researchers were able to extract from each patient 257 features that included intensity, geometric and textural characteristics in addition to other data related to patient age, gender and progression of the disease.

Zhou said since 2012 a prediction model called radiomics has existed, which uses a characterization algorithm to extract data to help further understanding of a patient’s likelihood of experiencing the spread of cancer from the initial tumor to other organs or lymph nodes. His research, called “M-radiomics,” takes a multifaceted approach to radiomics in order to produce a more reliable and accurate prediction model. Three different algorithms are used in this process to help address challenges related to the integration of data from multiple imaging modalities, sensitivity-specificity optimization and use of multiple data machine learning classifiers simultaneously.

“In M-radiomics we can integrate these three challenges into one framework,” Zhou said. “The results are very promising for distant metastasis prediction in head-and-neck cancer.”

Zhou is continuing his research in M-radiomics, in addition to pursuing other interests related to artificial intelligence in medicine. His work at UCM also involves teaching an undergraduate introduction to biomedical informatics course and a graduate-level course on artificial intelligence. Supportive of student research, Zhou mentors and instructs five graduate students who work with him on research, each of whom is also doing their own research project. He said he is looking forward to getting more undergraduate students involved in research as his career as UCM progresses.

Print Friendly, PDF & Email
September, 2020|Oral Cancer News|

There has to be more to dental hygiene than this: A systemic approach

Source: www.dentistryiq.com
Author: Michelle Strange, MSDH, RDH

Due to the COVID-19 pandemic, there will be added pressure on dental hygienists as patients return to our practices. During the lockdown, patients did not have access to our services. Now that the doors have reopened, patient treatments have begun with a renewed focus on protection from the virus.

Even though practices will be extra busy, now is a great time to make some changes to our services. What if we stop simply reacting to the apparent problems and instead make the shift from purely corrective to a preventive dental service, and from oral health to holistic health?

A holistic approach
Dentistry has the potential to assimilate and integrate into the holistic health approach. Until now, patients and other health professionals have considered a visit to a dental office as totally separate from other health care. Patients often view their twice-a-year visits as mandatory checkups and “cleanings” but fail to grasp the entire value we provide. Dental health is connected to our entire well-being and is even thought to be related to heart health.1

Poor dental hygiene may lead to a higher susceptibility to the human papillomavirus that can contribute to mouth and throat cancers.2 In 2013, a study from the University of Central Lancashire School of Medicine and Dentistry pinpointed a specific oral bacteria, Porphyromonas gingivalis, as present in the brains of four out of 10 participants with dementia.3 Research has found that erectile dysfunction,4 type 2 diabetes,5 irritable bowel syndrome,6 and sleep apnea7 may also be connected to poor oral hygiene.

This intertwined relationship between dental care and overall health care must carry through to the relationship between patients and dental professionals, both dentists and hygienists. Imagine the impact we could have if hygienists take up our deserved role as holistic health specialists!

The mouth is one of the mirrors of patient health, just like the skin, and we must use this information to guide our patients in their search for optimal well-being. We should take time to inform our patients about these connections with health and become client educators. If we take the holistic approach and help them become healthier, they will understand there is more to the role of the dental hygienist than just scaling their teeth.

Start the conversation
In a 2017 study, 64% of respondents between the ages of 18 and 64 visited the dentist in the last year,8 meaning that 36% did not. Moreover, of those who did, the majority walked in for their annual health insurance-covered prophies. In reality, dental hygienists offer and do so much more, including providing treatment of early-onset periodontal disease. We want the best for patients, but sometimes we don’t provide them with information and treatments that can help them become truly healthy. We might think they are not interested or they are only interested in a “free cleaning” from their insurance coverage. However, by not offering a more comprehensive package, a patient’s health journey may be compromised.

Instead, start a conversation with clients outlining the importance of dental health for their overall health and consider offering a set of standard tests. Implementation of tests similar to those provided by physicians, including blood pressure screening, heart rate, oxygen[KB2] , and checking other vital signs are all within the purview of hygienists. Include charting bleeding sites (using currently available software),9 oral cancer screenings,10 airway assessment, nutritional counseling, and salivary testing to help prevent patients from being susceptible to illnesses such as cardiovascular disease, dementia, and oral cancers through early diagnosis.11 Doing all this before picking up a scaler offers an unprecedented level of care.

Not only is this time in history an opportunity for us to expand our roles as health practitioners, but it is also our duty. Our patients have a right to an accurate, complete diagnosis and treatment plan. The American Dental Hygienists’ Association Standards for Clinical Dental Hygiene Practice outlines the importance of considering all aspects of a patient’s health.12 Hygienists are already highly trained and have the skills and access to procedures to offer the highest quality of care, but unfortunately, many fail to embrace this opportunity to provide comprehensive care adequately.

By offering such a high level of care, patients will see that dental hygienists are professionals who are a crucial part of their health journey, and they will feel more cared for, too.

References
1. Gum Disease and Heart Disease — What You … – WebMD. 25 Sep. 2009, https://www.webmd.com/oral-health/features/healthy-teeth-healthy-heart. Accessed Jun. 23, 2020.

2. Norton A. Poor oral hygiene tied to cancer-linked virus. WebMD. Aug. 21, 2013. https://www.webmd.com/oral-health/news/20130821/poor-oral-hygiene-tied-to-cancer-linked-virus-study-finds. Accessed Jun. 23, 2020.

3. Locke T. Can poor dental health cause dementia? WebMD. Jul. 31, 2013. https://www.webmd.com/oral-health/news/20130731/dental-health-dementia. Accessed Jun. 23, 2020.

4. Men’s sexual health may be linked to periodontal health. American Academy of Periodontology. Dec. 4, 2012. https://www.perio.org/consumer/erectile_dysfunction. Accessed Jun. 23, 2020.

5. Leite RS, Marlow MN, Fernandes JK. Oral health and type 2 diabetes. Am J Med Sci. 2013;345(4):271-273. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623289/. Accessed Jun. 23, 2020.

6. Fourie NH, Wang D, Abey SK, et al. The microbiome of the oral mucosa in irritable bowel syndrome. Gut Microbes. 2016;7(4):286-301. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988452/. Accessed Jun. 23, 2020.

7. Huang Y-S, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Front Neurol. 2013 Jan 22;3:184. ttps://pubmed.ncbi.nlm.nih.gov/23346072. Accessed Jun. 23, 2020.

8. Table 37. Dental visits in the past year, by selected characteristics: United States, selected years 1997-2017. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hus/2018/037.pdf. Accessed Jun. 23, 2020.

9. Dental practice software. Capterra. https://www.capterra.com/dental-software/. Accessed Jun. 23, 2020.

10. Froum S. 10 steps to perform an oral cancer screening. Dentistry iQ. May 28, 2015. https://www.dentistryiq.com/dentistry/oral-cancer/article/16350620/10-steps-to-perform-an-oral-cancer-screening. Accessed Jun. 23, 2020.

11. LeBeau J. Dentistry’s proactive role in preventing disease. Compend. 2013;34(1). https://www.aegisdentalnetwork.com/cced/2013/01/dentistrys-proactive-role-in-preventing-disease. Accessed Jul. 13, 2020.

12. Standards for clinical dental hygiene practice – revised 2016. American Dental Hygienists’ Association. https://www.adha.org/resources-docs/2016-Revised-Standards-for-Clinical-Dental-Hygiene-Practice.pdf. Accessed Jul. 13, 2020.

Print Friendly, PDF & Email
September, 2020|Oral Cancer News|

Blood marker may reduce cancer burden: Progress with microRNA biomarker

Source: www.eurekalert.org
Author: Flinders University

Researchers at Flinders University are expanding work on a promising blood test model to help predict or diagnose head and neck cancer, a difficult cancer to pick up early and treat.

With cancer accounting for almost 10 million a year, the Global Burden of Disease report (2017) attributed more than 380,000 deaths to head and neck cancer.

The Australian research at Flinders University has discovered a blood serum microRNA biomarker signature for oropharyngeal squamous cell carcinoma, recently reported in a new study in the Journal of Translational Medicine (BMC Springer Nature).

The signature might have potential for the detection of other squamous mucosal Head and Neck cancers, the researchers say, adding the latest development, flowing from previous NHMRC Australian Government funding for developing blood biomarkers for oesophageal cancer, is encouraging.

“MicroRNAs are potential biomarkers for early head and neck squamous cell cancer diagnosis, prognosis, recurrence, and presence of metastatic disease. However, there is no widespread agreement on a panel of miRNAs with clinically meaningful utility for head and neck squamous cell cancers,” says Flinders University researcher Dr Damian Hussey.

“If our test can be translated to clinic, then it could facilitate surveillance, earlier diagnosis and treatment – including for identifying people with early stage, or at increased risk of developing, Head and Neck cancer,” says fellow researcher Associate Professor Eng Ooi.

The latest study used a novel approach to produce a biomarker signature with good cross validated predictive capacity. Researchers say the results warrant further investigations.

Note:
The new publication, ‘Cross validated serum small extracellular vesicle microRNAs for the detection of oropharyngeal squamous cell carcinoma’ (2020) by GC Mayne, CM Woods, N Dharmawardana, T Wang, S Krishnan, JC Hodge, A Foreman, S Boase, AS Carney, EAW Sigston, DI Watson, EH Ooi and DJ Hussey has been published in the Journal of Translational Medicine (BMC Springer Nature) DOI: 10.1186/s12967-020-02446-1

Print Friendly, PDF & Email
September, 2020|Oral Cancer News|

Robotics surgery may improve outcomes in mouth and throat cancer

Source: eandt.theiet.org
Author: E&T editorial staff

Robotic surgery may improve the health outcomes in mouth and throat cancer patients, including better long-term survival, new research suggests.

The method used for the study focused on oropharyngeal cancer that occurs in the back of the throat and includes the base of the tongue and tonsils.

In transoral robotic surgery, a surgeon uses a computer-enhanced system to guide an endoscope – a flexible tube with a light and camera attached to it – to provide high-resolution, 3D images of the back of the mouth and throat.

Naturally, this is an area that is difficult to reach with conventional tools; therefore, robots can be used during this procedure. Here, two robotically guided instruments, acting as a surgeon’s arms, work around corners to safely remove tumours from surrounding tissue.

The observational study, conducted by non-profit Los Angeles hospital Cedars-Sinai, used data from the US National Cancer Database and included 9,745 surgical patients – 2,694 of whom underwent transoral robotic surgery between 2010 and 2015.

“At a minimum, robotic surgery for oropharyngeal cancer patients seems safe and effective compared to what’s been the standard of care for many years,” said Zachary S Zumsteg, assistant professor of Radiation Oncology at Cedars-Sinai, referring to standard surgery, radiation therapy, and chemotherapy.

The researchers found that the five-year overall survival rate for patients with early-stage disease who underwent robotic surgery was 84.5 per cent, compared with 80.3 per cent for patients who had non-robotic surgery. They adjusted for differences in health and other characteristics of the two patient groups.

The study indicated that the proportion of patients undergoing transoral robotic surgery for early-stage oropharyngeal cancer increased dramatically after the US Food and Drug Administration (FDA) approved the surgery for that cancer in 2009.

The nationwide increase in transoral robotic surgery for oropharyngeal cancer prompted the investigators to assess whether the theoretical benefits of robotic surgery for oropharyngeal cancer patients actually provide outcomes that are superior or equivalent to the standard treatments for that cancer type and others.

As well as increased overall survival rates, the researchers found that robotic surgery was associated with lower rates of positive surgical margins (cancer cells left behind at the edge of the tissue) – 12.5 per cent, compared with a rate of 20.3 per cent for non-robotic surgery in patients with oropharyngeal cancer.

Furthermore, the researchers said that robotic surgery was associated with less use of postoperative chemoradiation, at 28.6 per cent, compared with 35.7 per cent for patients who had non-robotic surgery.

“Our purpose in doing this study was to see how this new technology, which has never been tested in a randomised, controlled trial, has influenced patterns of treatment and outcomes since its FDA approval,” Zumsteg said. “There is a learning curve with any new surgical technique, and new ones don’t always translate into equal or improved outcomes.”

Anthony Nguyen, a resident in the department of radiation oncology at the centre, said he hopes the research will inform future randomised, controlled clinical trials. “Meanwhile, it’s reassuring to our patients that their survival rate is the same if not better with robotic surgery and they have the potential for a better quality of life,” he added.

Print Friendly, PDF & Email
August, 2020|Oral Cancer News|

Fighting cancer in the pandemic means fighting cancer alone

Source: The Washington Post
Date: August 12, 2020
Author: Laura B. Kadetsky

 

A doctor pointed out to me at a recent appointment that my latest bout with oral cancer tracked the first spikes of the coronavirus pandemic. On that beautiful, cancer-free day in late May, workers chatted over lunch outside the hospital entrance, and I gawked at their carefree togetherness while I hurried by wearing my mask and gloves. It was a world apart from March, when I hastily scheduled a biopsy in case the hospital canceled ENT procedures entirely, and April, when I had the surgery in an abnormally quiet hospital, where coronavirus precautions were expanding daily.

In March, horror stories were flooding in, and the threat of the virus hung over everything. Waiting for the biopsy results only heightened that pandemic-induced anxiety: How do you deal with cancer when no one knows what’s safe anymore? Although it felt like the pandemic put most of life on hold, serious health issues don’t wait for a worldwide crisis to end. After I had spent 10 years fighting oral cancer on and off, the cancer was back, and I had to deal with it.

At the hospital, which already had covid-19 patients, the danger of infection seemed everywhere. I focused on ways to try to control my risk — maybe because having cancer makes everything else feel squarely out of control. I parked on the street to avoid having a stranger park my car in the hospital garage and contaminate it. I wore my homemade dish-towel mask, because masks hadn’t yet become widely available. I covered the driver’s seat with a sheet in case my clothes picked up the virus and transferred it to the car, as this was before we learned more about surface transmission. Those things won’t stop cancer, I reasoned, but maybe they’d block the virus.

Walking the halls, I kept my eyes down to avoid sending — or receiving — accusatory looks: Did you cough near me? Why are you in the hospital? Do you have the virus? I tallied door handles: three to get in and out of the building, each one a potential germ site. It felt bizarre to be this hyper-alert and yet entirely reasonable.

I needed a coronavirus test before the surgery, well before drive-through testing sites popped up. As much as I feared getting the virus, the medical workers rightly worried that they might get it from me. In ENT surgeries especially, working in or near the respiratory system risks the virus spreading throughout the operating room. I understood, but I obsessed about it. It sounded barbaric, adding insult to injury: I already have cancer, and now you have to jam a cotton swab up my nose, too?

In good-for-coronavirus news, the test was negative, and surgery was on — and at the start of Oral, Head and Neck Cancer Awareness Week, no less (a reminder: I don’t smoke, and I rarely drink alcohol, so everyone thinking this happens to “someone else” should have their oral cancer screening as soon as they can get to the dentist). Having been through this before, my husband and I thought we knew how to get ready. But preparing for surgery in a pandemic comes with new complications. With quarantines and the dangers of infection for our elderly parents, no family members could come to help. Physical distancing norms left us worried about asking friends for anything. I’d been having groceries delivered for years, but suddenly, I couldn’t get a slot. I found myself staying awake for hours refreshing the overwhelmed delivery website in the middle of the night, funneling my stress into obsession about how to feed my family safely and find food I could eat after surgery.

We agonized about how to tell our 5-year-old son. The anxiety of the pandemic had ratcheted up my distraction, and I’d been mixing up words for weeks. I tried to explain bandages to him and compared them to zombies. “No, Mommy,” he corrected me, giggling, “you’ll be a mummy, not a zombie.” Of course, he was right. He decided I needed one of his stuffed animals to take with me. In the face of his generosity, I hesitated, wondering how we could clean germs off a stuffed giraffe.

Between the placement of the tumor, and the multiple prior surgeries, I faced an uncertain outcome. Only after surgery started would we find out how intense it would be. No matter what, though, I would be staying in the hospital, where covid-19 numbers were increasing daily. All the controls I’d put in place to stay safe were gone. Although I was tested, the medical staff was not all tested before touching me — let alone operating on me. I couldn’t wash my hands while sedated or wear a mask during the surgery. No one wants to stay in the hospital, but now I was bucking all the directives; not only would people not be six feet away, they would actually have their hands in my mouth and all over my face. Everything I had been told not to do was turned on its head.

And no matter what, I would be alone. Because of the coronavirus, my family was barred from visiting me in the hospital. The doctors suggested that my husband not stay in the surgical waiting room, or anywhere on the hospital campus, to find out what happened, in case anyone there carried it (although in the end, he refused to leave until the procedure was done). When they wheeled me out of pre-op, we didn’t know when we would see each other again or in what condition I would be. I couldn’t comprehend how I would manage on my own. He couldn’t comprehend not being there for me.

When we are sick, those closest to us provide a vital source of healing. Yet the pandemic makes that physically impossible. When I was hospitalized, the distance between my family and friends and me was not just six feet, but absolute. My family couldn’t act on a basic human need to provide comfort through their presence. Instead, my son made colorful, glittery drawings, and my husband covered them with cheering messages, such as, “Sending you healing powers from your #1 fans.” But notes and video calls can’t replace someone at your bedside. It is a terrible loss when those of us at our most vulnerable cannot be fully present with those who love us most; the pandemic exacerbates patients’ suffering by making that impossible.

In one version of this story, I was lucky. My surgery was one of the serious cases still allowed to proceed when many hospitals had been turned into covid wards (shortly after waking up, I overheard someone tell another patient, “Congratulations, you have a new kidney!”). The surgeons and medical staff worked magic, and I made it through the surgery with the best possible outcome. I had access to a hospital system that saw what happened in New York and prepared before cases rose, so the medical staff caring for both me and the covid patients there knew how to stay protected.

But in the other version, being a patient right now is a nightmare. It means having to ask things such as, “Will a ventilator be available if I need it?” “Will the hospital allow my care to proceed?” “How will my husband take me to the hospital when our son is at home with no child care?” “How will I get through this alone?” Or, “When I can’t speak post-surgery and am alone in the hospital, when I can’t advocate for myself, who will advocate for me?”

People are desperate to be done with restrictions; I get it. They’re tired of being stuck at home. They want to hang out with their friends without worrying about killing them. But the virus is still out there. And the longer we let it linger, the more people will have to go through what I went through.

Print Friendly, PDF & Email
August, 2020|Oral Cancer News|

Doctors diagnose advanced cancer—in a dinosaur

Source: Science Mag
Date: August 3rd, 2020
Author: Gretchen Vogel

 

This deformed bone is the first clear example of a malignant tumor diagnosed in a dinosaur. The partial fibula—a bone from the lower leg—belonged to a horned, plant-eating Centrosaurus that lived roughly 76 million years ago in what is now Dinosaur Park in southern Alberta in Canada.

Paleontologists initially thought the bone’s strange shape was due to a fracture that hadn’t healed cleanly. But a new study, published today in The Lancet Oncology, compares the internal structure of the fossil (above) with a bone tumor from a human patient to seek a diagnosis. The conclusion: The dinosaur suffered from osteosarcoma, a cancer that, in humans, primarily attacks teens and young adults. The disease causes tumors of immature bone tissue, frequently in the long bones of the leg.

This isn’t the first time cancer has been found in fossil remains. Scientists have identified benign tumors in Tyrannosaurus rex fossils and arthritis in duck-billed hadrosaurs, as well as an osteosarcoma in a 240-million-year-old turtle. But the researchers say their study is the first to confirm a dinosaur cancer diagnosis at the cellular level.

Scientists, including paleontologists, pathologists, a surgeon, and a radiologist, examined the full fossil with high-resolution computerized tomography scans and examined thin sections under the microscope to evaluate the structure of the cells. They found that the tumor was advanced enough that it had probably plagued the animal for some time. A similar case in a human, left untreated, would likely be fatal, they write. However, because the fossil was found in a bone bed with lots of other Centrosaurus specimens, the dinosaur likely died in a flood with the rest of its herd and not from the cancer.

The researchers say their diagnosis shows a more careful look at unusual fossil malformations using modern imaging and diagnostic techniques can pay off, leading to new insights about the evolutionary origins of diseases.

Print Friendly, PDF & Email
August, 2020|Oral Cancer News|