Head and neck cancer patients paying tens of thousands for unnecessary imaging and radiologist reads

Source: radiologybusiness.com
Author: Marty Stempniak

Head and neck cancer patients are paying tens of thousands of dollars for unnecessary imaging surveillance and radiologist professional charges, according to a new single-center analysis published Thursday.

The National Comprehensive Cancer Network recommends follow-up imaging within six months after treatment for the disease, with further scans necessary only if patients show any signs of recurrence. Yet, providers often subject asymptomatic individuals to repeated rounds of costly imaging anyway, experts noted in JAMA Otolaryngology–Head & Neck Surgery.

Wanting to understand this concern at their own institution, NorthShore University HealthSystem looked to the data. Across 136 patients treated for head and neck cancer, the average individual received 14 imaging studies during a surveillance period of 3.2 years at an average cost of $36,800. Patients who lacked any symptoms received four imaging exams each year at an annual cost of $9,600, the authors concluded. Only 10.3% of patients developed a recurrence.

“One could argue that such examinations were unnecessary and clearly not cost-effective,” Cheryl Nocon, MD, an otolaryngologist who worked with NorthShore at the time of the study but now practices in Los Angeles, and co-authors wrote May 13. “The amount of money spent on imaging in patients who ultimately proved to be disease free is substantial and should be carefully considered in the context of the current healthcare financial setting.”

The Evanston, Illinois-based hospital system certainly isn’t alone. One recent study pegged annual U.S. spending on head and neck cancers at $4.2 billion, with per-individual expenditures similar to cancers such as lung and colon that are far more prevalent, Nocon et al. noted.

For their study, researchers retrospectively reviewed records for adult patients newly diagnosed with and treated for mucosal and salivary gland malignant tumors between 2010 and 2016. The initial scan found 435 patients, whittled down to 136 when excluding those with incomplete medical records, metastatic disease, or who left the system. Nocon and co-authors targeted CPT codes for neck imaging using ultrasound, CT and MRI, along with chest and maxillofacial computed tomography, among others.

NorthShore patients who remained disease-free received an average of 13 imaging studies during the surveillance period at a cost of $35,000. Those without symptoms had four studies per year at an average annual cost of $9,600. Patients who developed a recurrence had more studies per year of follow-up (average difference of five) and higher associated average costs (difference of $10,600) than those who remained disease free.

“These costs included not only the ordered imaging examinations but also the associated expenses of ordering and interpreting the examination findings, such as laboratory charges for required blood tests, hospital charges, and professional charges of the radiologists who read the images,” the authors noted. “To the best of our knowledge, this is the first study of the direct costs associated with surveillance imaging in this population, and it sheds light on the potential for cost savings in the current health care environment,” they added.

The study is limited by its retrospective nature and possible inaccurate documentation of indications for imaging exams, which could artificially inflate cost estimates. Read the rest of the study in JAMA here.

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New therapy shortens treatment for HPV-related cancers of the tonsils, tongue

Source: medicalxpress.com
Author: From Mayo Clinic News Network, Mayo Clinic News Network

Patients with HPV-related oropharyngeal cancer who undergo surgery and are treated with chemotherapy, may be able to forgo significant radiation therapy without increasing the risk of their cancer spreading, according to the results of a clinical trial led by researchers at Mayo Clinic.

“We found that decreasing the amount of radiation therapy after a minimally invasive robotic surgery improved the quality of life of patients with HPV-related oropharyngeal cancer while delivering excellent cure rates,” says Dr. Eric Moore, a Mayo Clinic otolaryngologist. “In essence, we found exactly the right amount of treatment to deliver without over-treating these patients.”

Dr. Moore and his colleagues compared 79 patients treated at Mayo Clinic for HPV-related tonsil and tongue cancer with surgery and two weeks of radiation therapy to a group of 115 patients with the same cancer who were treated with surgery, and the standard six weeks of radiation therapy and chemotherapy.

Dr. Moore and his colleagues found no decrease in survival or cancer recurrence in the group that received two weeks of radiation therapy, compared to the group that received six weeks of radiation therapy. He says that by decreasing the amount of radiation therapy after minimally invasive robotic surgery, physicians were able to improve the quality of life of patients and achieve excellent cure rates.

“In essence, we found exactly the right amount of treatment to deliver without overtreating,” says Dr. Moore.

Dr. Moore says Mayo Clinic now offers dose de-escalation radiation therapy to appropriately selected patients with HPV-related cancers of the tonsils and tongue.

“This approach shortens the treatment time for these patients by several weeks and reduces side effects without sacrificing the effectiveness of the treatment,” Dr. Moore says.

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HPV vaccine leads to more than 80% drop in infections: What parents need to know

Source: Good Morning, America
Date: April 2nd, 2021
Author: Katie Kindelan

 

A new study has shown the effectiveness of the HPV vaccine, and found a dramatic decline in human papillomavirus infections in both vaccinated and unvaccinated teen girls and young women in the United States.

“This study shows that the vaccine works very well against a common virus, HPV,” Dr. Hannah Rosenblum, lead author of the study and medical epidemiologist at the Centers for Disease Control and Prevention (CDC), told “Good Morning America.”

“HPV can cause serious health problems later in life, including some cancers in both women and men,” she said. “HPV vaccination is cancer prevention — by vaccinating children at age 11 or 12, we can protect them from developing cancers later in life.”

HPV is the most common sexually transmitted infection in the United States and can cause health problems like genital warts in addition to cancer, which are most commonly cervical cancer in women and throat cancer in men, according to the CDC.

The HPV vaccine was first authorized in the U.S. for females in 2006, and for males in 2011. There has since been a more than 80% decline in HPV infections nationally, according to the CDC study.

The newly-released data from the CDC shows an 88% decrease in HPV infections among 14 to 19-year-old females and an 81% decrease among 20 to 24-year-old females.

There has also been a drop in unvaccinated females, according to Rosenblum, who warned that does not mean people should let their guard down.

“We also see an effect among unvaccinated females in these age groups due to less spread of the virus, however, unvaccinated persons are not immune and are still at risk of getting HPV,” she said. “They should talk to their doctor about getting vaccinated if they are 26-years-old or younger.”

HPV viruses are found in 80 million people in the United States, according to the CDC. There are hundreds of subtypes of HPV, and 1 in 4 people in the U.S. are infected with HPV at some point in their lives.

The CDC recommends two doses of the HPV vaccine, taken six to 12 months apart, for all girls and boys ages 11 to 12, but says the vaccine can be given to children as young as 9.

Teens and older who are not vaccinated are encouraged to do so by the age of 26. People ages 15 and older need three doses of the vaccine, according to the CDC.

The timing of the vaccine has to do with the state of children’s immune systems and also trying to vaccinate pre-teens before they are sexually active, Dr. Laura Riley, chair of obstetrics and gynecology at Weill Cornell Medicine and New York-Presbyterian in New York City, told “GMA.”

“Your immune system [at ages 11 and 12] is such that you have a robust response to this vaccine, and it lasts for a really long time,” she said. “But if you haven’t had it, still continue talking to your doctor about getting it up to age 26.”

Riley said she hopes the CDC’s new data — which stands out for being a 10-year study — combined with the safety of the HPV vaccine eases any remaining concerns parents may have about getting their children vaccinated against HPV.

“When [the HPV vaccine] first rolled out, the message wasn’t quite clear, so instead of people recognizing that you were going to prevent your kid from getting cancer, people were focused on the fact that HPV is a sexually transmitted disease,” she said. “The education has to continue so that parents can understand the real benefit of this vaccine.”

“The real benefit is to prevent your child from getting cervical cancer,” Riley said. “The fact that you can prevent [cervical cancer] with a vaccine that has been used for years and has shown to be safe, why wouldn’t you do it?”

Long-lasting infection with certain types of HPV is the main cause of cervical cancer, which has the best survival rates if detected early according to the CDC. Doctors routinely screen for cervical cancer with the Pap test and HPV DNA testing depending on age and risk factors.

“We need to make sure that the teenagers and pre-teens are getting the benefit of the HPV vaccine, because it really is an anti-cancer vaccine,” said Riley. “[Cervical cancer] is a really devastating disease.”

Globally, a woman loses her life to cervical cancer every two minutes, according to a 2019 article published in the medical journal The Lancet.

In the U.S., doctors on the frontlines like Riley said more must continue to be done to educate parents about the HPV vaccine and make sure that all children across the country have access to the vaccine. As of 2018, nearly 40% of adults ages 18 to 26 reported receiving one or more doses of the HPV vaccine, according to the CDC.

“We need to make sure that we work on access to this vaccine and make sure that all girls of all races and ethnicities have the access,” said Riley. “And we need to be sure that the message is clear so that everyone gets the two doses of the vaccine, because that’s what is associated with the best protection.”

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2021-05-11T10:31:22-07:00May, 2021|Oral Cancer News|

New saliva oral and throat cancer diagnosis test receives FDA approval

Source: medicalxpress.com
Author: Rose Trapnell, Queensland University of Technology

A QUT researcher’s identification of saliva as an early detection liquid biopsy for oral and throat cancer has been realized by the development and commercialization of a diagnostic device by US-based biotech company Viome.

Viome’s early detection device has been designated a Breakthrough Device by The Food and Drug Administration (FDA) in the US.

QUT Associate Professor Chamindie Punyadeera has spent a decade researching the possibility of saliva being the optimum diagnostic liquid for the early detection of oral and throat cancer.

Professor Punyadeera was driven to this field of research after her young brother-in-law passed away within six months of being diagnosed with oral cancer.

Her systematic collection of saliva samples from oral and throat cancer patients, establishment of saliva collection and optimisation protocols, identification of a key unmet-clinical need and work with clinicians provided the foundations for the commercialisation of the new device.

“This test could save many lives because until now early-stage oral cancer has been hard to detect because effective diagnostic tools have not been available,” Professor Punyadeera said.

“This has led to late diagnosis, a poor prognosis and low survival rates.”

Professor Punyadeera said the risk of oral cancer increased with age and increased more rapidly after the age of 50.

“The salivary metatranscriptome as an accurate diagnostic indicator of oral cancer” has been accepted for publication in npj Genomic Medicine.

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How Big Pharma Finds Sick Users on Facebook

Source: The MarkUp
Date: May 6th, 2021
Author: Colin Lecher

If you’re a drug manufacturer looking for patients, one company has become a major destination in the past few years: Facebook.

The social media giant, through its power to target users based on their interests, is especially attractive to pharmaceutical companies looking to sell drugs to potential patients. The Washington Post reported last year that health and pharmaceutical companies spent almost $1 billion on just Facebook mobile ads in 2019. The draw? Unlike a traditional TV or radio ad, Facebook’s ad categories help those companies target their drug ads at users who likely suffer from a specific illness the drug treats.

And data from The Markup’s Citizen Browser project—which collects Facebook data from thousands of users—shows how precise and wide-ranging that targeting is.

Though Facebook does not offer advertisers categories that explicitly identify people’s health conditions, The Markup identified dozens of ads for prescription pharmaceuticals targeted at people with “interests” in topics like “bourbon,” “oxygen,” and “Diabetes mellitus awareness.”

Indeed, The Markup found, “awareness” of a disease is a frequent proxy for illness in targeting decisions made by advertisers.

Zejula, a drug manufactured by pharmaceutical giant GlaxoSmithKline, for example, is prescribed to treat advanced ovarian cancer. We found the drug targeted at users who Facebook determined had shown an interest in “cancer awareness.”

Piqray, another cancer treatment, manufactured by Swiss company Novartis, was shown to users with an interest in “National Breast Cancer Awareness Month.” Several drugs were targeted at either “Diabetes mellitus awareness” or “Diabetes mellitus type 2 awareness.”

“Stroke awareness?” Brilinta, from AstraZeneca. “Multiple sclerosis awareness?” Mayzent and Kesimpta, two other products from Novartis. “Chronic obstructive pulmonary disease awareness?” Trelegy, another GSK product.

We also found drugs targeted by close proxies for other health conditions.

Ads for Latuda, an antipsychotic from the company Sunovion used in the treatment of bipolar depression, were shown to users with an interest in the Depression and Bipolar Support Alliance, a nonprofit support group. We also found it targeted at users interested in therapy and the National Alliance on Mental Illness.

Anoro, a GSK drug also used to treat chronic obstructive pulmonary disease, an inflammatory lung disease caused by emphysema and chronic bronchitis, was targeted at users interested in cigarettes, or just “oxygen.”

Ads for Nurtec, a Biohaven Pharmaceuticals product used for treating migraines, were targeted at users who showed an interest in the “international classification of headache disorders,” a medical scale of headaches.

The cancer treatment Keytruda, from Merck, was targeted at an especially wide array of users, including those interested in the chemical industry, Corona beer, and bourbon.

In at least one case, we found, the interest targeted was barely even a proxy. Syprine, a Bausch Health drug used to treat a rare genetic condition called Wilson’s disease, was targeted at users who’d signaled an interest in “genetic disorder.”

It’s not clear exactly how Facebook decides that a person is interested in topics such as “oxygen” or “genetic disorder.” The company only places some very specific limits on how users can target health conditions. Advertisers can’t use “sensitive” personal health data to target their ads, meaning a pharmacy, for example, couldn’t upload a list of customers with a specific illness to market to them on Facebook.

The company has also broadly defended its health privacy practices, releasing a statement in 2019 that said that “privacy and safety are particularly important for people dealing with health conditions.”

“We do not use medical history to inform the interest categories we make available to advertisers,” Facebook spokesperson Tom Channick said in a statement to The Markup. “Instead, people are placed into interest categories based on their activity on Facebook, including the pages they like or the ads they click on.”

GSK, AstraZeneca, Bausch Health, Merck, Biohaven, and Sunovion, manufacturers of some of the drugs we saw ads for, didn’t respond to requests for comment on their Facebook advertising practices. Jamie Bennett, a spokesperson for Novartis, said the company’s “goal is to reach audiences where it matters” and that it follows all regulations, both legal and those set by services like Facebook.

The potential audience size for these ads can be massive. Facebook’s ad-buying system says the number of users who have shown an interest in cancer awareness, for example, is nearly 203 million.

Other categories are more narrow. Facebook’s system said the audience for users with an interest in the depression and bipolar support alliance was a relatively slim 250,000 users.

Kirsten Ostherr, director of the Medical Futures Lab at Rice University, said there are both practical and moral problems with advertising around such medical conditions. If a work colleague walks by your computer screen and sees a targeted ad for a lung cancer drug, for example, he or she could deduce you have the condition.

“Even if the advertiser doesn’t know exactly who you are,” Ostherr said, “if these ads are popping up on your screens everywhere, that potentially exposes information about you.”

Beyond that, targeting products by surveilling the sick inherently exploits vulnerable users’ privacy, Ostherr said.

“One of the things that is most insidious about this to me is it’s really targeting and exploiting people who are in this vulnerable state and who have found real benefit from online patient communities,” she said.

Legally, aside from providing a way for advertisers to disclose side effects, Facebook is under little obligation to shield its users’ health information. The United States’ health privacy law, the Health Insurance Portability and Accountability Act, or HIPAA, only applies to a handful of entities that directly deal with patient health information.

Ostherr said the vagueness of Facebook’s targeting could be a “legally defensive maneuver” protecting it from liability in the future by keeping them as distant from protected health data as possible.

In 2016, a lawsuit filed against Facebook claimed that the company had unlawfully invaded users’ privacy by tracking their visits to sensitive health-related websites. The suit included a now-outdated list of health targeting options on Facebook, which included options like “cardiac arrest,” “renal failure,” and “West Nile virus.” (Facebook denied the allegations, calling the suit “an attack on the way the Internet works.”)

Courts have so far sided with Facebook in the dispute, saying its users must agree to its advertising practices when they sign up for the service and that health information isn’t necessarily more private than other types of data.

But the data Facebook does have can be enormously sensitive, as some independent researchers have shown. In 2019, researchers from the University of Pennsylvania and Stony Brook University reported that they were able to predict whether a Facebook user had any of 21 health conditions through language in status updates alone.

Many patients may have looked to Facebook for community and help in the past year of pandemic-enforced isolation. When someone finds support for an illness on social media, Ostherr said, it’s unlikely that the health data they’re giving away is at the forefront of their minds.

“Their priority really is not being tracked from one website to another,” Ostherr said. “Their priority is surviving.”

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Study: Secondhand smoke exposure significantly increases risk of developing mouth cancer

Source: www.studyfinds.org
Author: Stephen Beech, SWNS writer

When most people think about the dangers of smoking, they probably consider the risks of cancer for the smoker. Although it’s common knowledge secondhand smoke is also dangerous, a new study is revealing just how devastating that exposure can be. Researchers say exposure to secondhand smoke can increase the risk of oral cancer by a staggering 51 percent.

Oral cancer, or cancers of the mouth, include those affecting the lip, oral cavity, and throat. These cancers account for almost 450,000 new disease cases and more than 228,000 deaths every year globally.

Scientists say that significant risk factors for these forms of cancer include tobacco smoking and use of smokeless tobacco products. Drinking alcohol can also increase the risk of oral cancer. Tobacco smoke represents the largest amount of human exposure to chemical carcinogens and causes a fifth of cancer-related deaths worldwide.

However, active smokers are not the only people who suffer from these chemicals. Researchers examining data from 192 countries find 33 percent of male non-smokers, 35 percent of female non-smokers, and 40 percent of children have experienced exposure to involuntary smoking through inhaling secondhand tobacco smoke.

Previous research also shows that inhaling secondhand smoke can cause several other diseases, including lung cancer. Although tobacco smoking can cause oral cancer, there is less evidence proving whether or not secondhand smoke also leads to the disease.

Long-term smoke exposure doubles cancer risks
A team from Britain, Portugal, Spain, and the United States evaluated the potential association between secondhand smoke exposure and the risk of oral cancer. Their review analyzed five existing studies involving more than 6,900 people. Among those participants — from Asia, Europe, North America, and Latin America — 3,452 had been exposed to secondhand smoke and 3,525 had not.

Their analysis, appearing in the journal Tobacco Control, reveals the more than 50-percent greater risk of mouth cancer due to secondhand smoke exposure. Additionally, exposure lasting more than 10 to 15 years increases the risk of oral cancers by more than twice the rate in comparison to people with no exposure to tobacco smoke.

“This systematic review and meta-analysis supports a causal association between secondhand smoke exposure and oral cancer,” researchers write in a media release. “Moreover, the analyses of exposure response, including by duration of exposure (more than 10 or 15 years) to secondhand smoke, further supports causal inference.”

“The identification of the harmful effects of secondhand smoke exposure provides guidance to public health professionals, researchers, and policymakers as they develop and deliver effective secondhand smoke exposure prevention programs and adopt appropriate measures to implement guidelines in Article 8 of the World Health Organization’s Framework Convention on Tobacco Control,” the team concludes.

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Genetic changes in head and neck cancer, immunotherapy resistance identified

Source: MedicalXPress
Date: April 26th, 2021
Author: University of San Diego-California

A multi-institutional team of researchers has identified both the genetic abnormalities that drive pre-cancer cells into becoming an invasive type of head and neck cancer and patients who are least likely to respond to immunotherapy.

“Through a series of surprises, we followed clues that focused more and more tightly on specific genetic imbalances and their role in the effects of specific immune components in tumor development,” said co-principal investigator Webster Cavenee, Ph.D., Distinguished Professor Emeritus at University of California San Diego School of Medicine.

“The genetic abnormalities we identified drive changes in the immune cell composition of the tumors that, in turn, dictates responsiveness to standard of care .”

Reporting in the April 26, 2021 online issue of the Proceedings of the National Academy of Sciences, researchers describe the role of somatic copy-number alterations—abnormalities that result in the loss or gain in a copy of a gene—and the loss of chromosome 9p in the development of human papillomavirus (HPV)-negative and .

The loss of chromosome 9p and the deletion of JAK2 and PD-LI, two neighboring genes found on chromosome 9p, was associated with resistance to immune checkpoint inhibitors, a type of cancer immunotherapy that uses antibodies to make tumor cells visible to a patient’s immune system.

“Although programmed death-1 (PD-1) immune checkpoint inhibitors represent a major breakthrough in , only 15 percent of patients with HPV-negative head and neck cancer respond to treatment,” said co-principal investigator Scott M. Lippman, MD, senior associate dean, associate vice chancellor for and care and Chugai Pharmaceutical Chair in Cancer at UC San Diego School of Medicine.

“The ability to predict a patient’s response or resistance to this class of therapies, a major unmet clinical need, is a unique and novel discovery. Knowing who will not respond avoids losing several months to ineffective therapy with huge financial costs and impacts to quality of life,” said Lippman, director of UC San Diego Moores Cancer Center and medical oncologist who specializes in the treatment of patients with head and neck cancer at UC San Diego Health, San Diego’s only National Cancer Institute-designated comprehensive cancer center.

For this study, co-led by New York University Langone Health’s Teresa Davoli, Ph.D., and The University of Texas MD Anderson Cancer Center’s William N. William, MD, with co-investigator Steve Dubinett, MD, of UCLA Jonsson Comprehensive Cancer Center, researchers prospectively followed 188 patients at MD Anderson Cancer Center to study genomic and immune drivers of the transition to invasive HPV-negative head and neck cancer. They reviewed comprehensive genomic and transcriptomic data of 343 HPV-negative head and neck cancer patients from The Cancer Genome Atlas and 32 HPV-negative head and neck cancer cell lines from the Cancer Cell Line Encyclopedia project, and analyzed patient survival after immunotherapy in real-world evidence cohort data from Caris Life Sciences.

In 2021, the National Cancer Institute estimates approximately 54,000 new cases of head and neck cancers will be diagnosed in the United States, with 10,850 deaths. HPV-negative head are the most common, increasing and lethal subtype of this malignancy worldwide, said Lippman.

“The data serves as a powerful predictive marker, transforming standard of care for precision immunotherapy for patients with advanced, recurrent head and ,” said Lippman. “And, while we focused in an unprecedented extensive interrogation of the most globally lethal form of head and neck squamous cancer, accounting for more than 300,000 deaths annually, the application may be useful in a wide variety of solid tumors for which immune checkpoint inhibitors comprises standard of care.”

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Sentinel node biopsy makes case in oral cavity cancer

Source: www.medpagetoday.com
Author: Charles Bankhead

Patients with early-stage oral cavity cancers had similar survival with less neck disability with a less invasive approach to lymph node assessment, a multicenter randomized study showed.

The 3-year overall survival (OS) rate was 87.9% with sentinel lymph node biopsy (SLNB) and 86.6% with elective node dissection (ND). The 3-year disease-free survival (DFS) rate was 78.7% versus 81.3% in the SLNB and ND groups. Both outcomes met statistical criteria for noninferiority of the two approaches to lymph node assessment.

The SLNB group had significantly better scores on a test of neck function, reported Yasuhisa Hasegawa, MD, PhD, of Asahi University Hospital in Gifu, Japan, and co-authors.

“SLNB-navigated ND is noninferior and less invasive than elective ND,” the authors wrote in the paper online in the Journal of Clinical Oncology. “The results of this study may promote a widespread use of SLNB (for early-stage OCSCC [oral-cavity squamous cell carcinoma]) worldwide.”

The results added to a growing volume of evidence suggesting similar outcomes between SLNB and the more-invasive ND. Last year a randomized study from France showed a 2-year relapse-free survival rate of 89-91% with the two approaches to lymph node assessment in oral and oropharyngeal cancer. A large retrospective cohort study resulted in similar OS and a shorter hospital stay as compared with ND. Multiple studies have demonstrated improved functional outcomes and lower complication rates with SLNB, the authors noted.

Optimal management of clinically node-negative early-stage OCSCC remains controversial. Advantages have been reported for observation, ND, and SLNB. A randomized trial demonstrated superior OS and DFS with elective ND versus observation followed by therapeutic neck dissection at relapse.

SLNB has an established role in staging for node-negative breast cancer and melanoma, and might help determine appropriate use of ND, the authors continued. Prior reports of SLNB for OCSCC remain limited in number and employed variable methods of SLN detection. Hasegawa and colleagues conducted a randomized trial using standardized methodologies to compare outcomes with SLNB and elective ND in patients with clinically node-negative OCSCC.

The investigators enrolled patients with untreated stage T1/2, N0, OCSCC (minimum depth ≥4 mm) with no cervical lymph node metastasis by contrast-enhanced computed tomography. Patients were randomly assigned to SLNB or ND, balanced by stage and primary tumor subsite. The team previously described the standardized methods for SLNB.

The primary outcome was 3-year OS, and secondary endpoints included postoperative neck function, adverse events, and 3-year DFS. The statistical margin for noninferiority of SLNB to ND was -12%. Median follow-up was 37 months, overall and in each of the two groups.

Data analysis included 271 randomized patients. Pathologic metastasis-positive lymph nodes were observed in 33.6% of the SLNB and 24.8% of the ND groups (P=0.190). The difference in 3-year OS met criteria for noninferiority, as did the difference in 3-year DFS (P<0.001 for both comparisons), the researchers reported.

The mean overall score for neck functionality was significantly higher in the SLNB group at 1, 3, 6, and 12 months after surgery. Separate scores for constriction, pain, numbness, shoulder-drop, reach-above, neck appearance, and arm abduction test all favored the SLNB group.

Recurrence rates were 18.2% with ND and 21.6% with SLNB, a nonsignificant difference. Most recurrences were local or regional and did not differ significantly between the two patient groups.

Hasegawa and co-authors acknowledged the 12% noninferiority margin as a potential limitation of the study and that a smaller margin might have been more appropriate for proving noninferiority. However, prior studies suggested an expected difference in 3-year OS of 20-35% between ND and nondissection.

“Taking these results and the improved prognosis into consideration, the noninferiority of margin of 12% in the 3-year survival rate might be a clinically acceptable difference,” the team stated.

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A new method for fighting ‘cold’ tumors

Source: www.eurekalert.org
Author: news release University of Colorado Anschutz Medical Campus

Not all cancerous tumors are created equal. Some tumors, known as “hot” tumors, show signs of inflammation, which means they are infiltrated with T cells working to fight the cancer. Those tumors are easier to treat, as immunotherapy drugs can then amp up the immune response.

“Cold” tumors, on the other hand, have no T-cell infiltration, which means the immune system is not stepping in to help. With these tumors, immunotherapy is of little use.

It’s the latter type of tumor that researchers Michael Knitz and radiation oncologist and University of Colorado Cancer Center member Sana Karam, MD, PhD, address in new research published this week in the Journal for ImmunoTherapy of Cancer. Working with mouse models in Karam’s specialty area of head and neck cancers, Knitz and Karam studied the role of T cells in tumor treatment.

“What we found is that the cells that normally tell the T cell, ‘Hey, here’s a tumor — come and attack it,’ are being silenced,” Karam says.

She and her team found that regulatory T cells (Tregs), a specialized T cell type that suppresses immune response, are essentially telling the T cells to stop fighting the cancer.

“Tregs normally serve as an important balance in a healthy immune system,” Knitz says. “They prevent autoimmune disease and put the brakes on the T cells when needed. However, in many tumors, Tregs are too numerous or overly suppressive, bringing the T cell response to a halt.”

Using medication that deactivates the Tregs can help boost the immune response in patients with cold tumors, the researchers found, as can radiation treatment that causes enough injury that the immune cells known as dendritic cells work to put the regular T cells into fight mode.

But this is only part of the story. The T cells need to know what to attack. “You need the radiation to create injury and bring in the immune cells so that the tumor can be recognized and targeted,” says Karam, also an associate professor of radiation oncology at the University of Colorado School of Medicine. “That way, the dendritic cells trigger the immune system to produce a lot of T cells, similar to what a vaccine does. Those T cells then go back to the tumor to kill cancer cells. The pieces are already in place; they just need the proper signals. Activating the dendritic cells is a crucial step in allowing radiation to heat up these cold tumors.”

Importantly, Karam and her team, which includes post-doctorate fellow Thomas Bickett, found that the radiation must be administered in a specific way.

“A specific dosing is needed,” Karam says. “You have to pulse it. You can’t just give one dose. You have to give it again and combine it with things that remove the suppression — the Tregs — while simultaneously keeping those antigen-presenting dendritic cells active and on board.”

Karam says the next step in her research is clinical trials she hopes will eventually change the treatment paradigm from surgery and weeks of chemotherapy and radiation to just three sessions of radiation and immunotherapy, then surgery. She is driven to change the standard of care for cold tumors, she explains, because of the horrendous effects they have on patients.

“These tumors resemble those in patients who are heavy smokers,” she says. “They’re very destructive to bone and muscle, infiltrating the tongue, jaw, gum, and lymph nodes. It’s horrible. We have very high failure rates with them, and the treatment often involves removing the tongue and weeks of radiation and chemotherapy, only for the patient to fail. I’m confident that we can do better for our patients.”

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Oral cancer awareness poster for dental practices

Source: www.dentistryiq.com
Author: staff

Eva Grayzel was diagnosed with stage IV oral cancer in her thirties. She survived and went on to develop the Six-Step Screening and speak about her experience around the United States. Learn more about her experience and its relevance to dental professionals here.

The poster can be downloaded here.

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