Monthly Archives: September 2003

New protocol improves prognosis for advanced head/neck cancer

  • 9/20/2003
  • New York
  • Reuters Health

Induction chemotherapy appears to reduce distant disease failure rates following intensive concomitant chemoradiotherapy when administered to patients with advanced head and neck cancer.

Physicians at a Chicago-area network of hospitals observed high locoregional control, organ preservation, and overall survival rates when they treated patients with intensified concomitant chemoradiotherapy. The biggest problem appeared to be distant failure.

To eradicate systemic micrometastases, Dr. Everett E. Vokes, of the University of Chicago, and colleagues added an inductive regimen of carboplatin and paclitaxel administered in 6 weekly cycles. According to their report in the Journal of Clinical Oncology for January 15, three patients presented with stage III disease and 66 with stage IV disease.

After 6 weeks, 87% of 61 patients with remaining disease following initial organ-preserving surgery exhibited a response and 35% a complete response.

Beginning 2 to 3 weeks later, the patients underwent five cycles of treatment with paclitaxel, fluorouracil, hydroxyurea and twice-daily radiation therapy administered every other week. The patients were then followed for a median of 28 months.

Fifty patients survived until the end of the study period in 2002, for an overall survival rate of 70%, the report indicates. Ten had died of disease persistence or recurrence and three of complications related to therapy. Five died of unrelated causes and one of a second malignancy. “The great majority of patients were treated without disabling surgery,” the physicians note.

The 3-year progression-free rate among those who survived was 80%. Systemic progression occurred in five subjects. These rates “are among the highest published in the literature,” Dr. Vokes and his associates write.

They suggest that the combined protocol reduced distant disease failure rates, but that a randomized trial is needed for “definitive proof.” They recommend further studies to define the optimal regimen for increasing disease control, reducing toxicity or both.

September, 2003|Archive|

HPV Test Catching On as the More Definitive Cervical Cancer Screening

  • 9/20/2003
  • Associated Press

A more definitive cervical cancer-screening test that helps reduce uncertainty in diagnosing the disease is gaining support from doctors and health insurers. Aetna, the nation’s largest health insurer, on Wednesday became the latest plan to cover the new DNA test that checks for the presence of a virus that studies show causes more than 99 percent of cervical cancers. The test is used when a Pap smear proves inconclusive, which happens about 5 percent of the time. Kaiser Permanente, United Healthcare and most Blue Cross and Blue Shield plans already cover the test for human papillomavirus, or HPV, according to the test’s maker, Digene Corp. of Gaithersburg, Maryland. About 400,000 U.S. women had the HPV test in the past year, a Digene spokeswoman said. If the test shows no sign of HPV, a woman is assured she doesn’t have cancer. If the HPV virus present, there is a greater likelihood the woman has cancer and she is sent for additional testing which most likely include a biopsy. “Aetna is a bellwether for the adoption of HPV testing as a standard of care in cervical cancer screening,” said Evan Jones, Chairman and CEO of Digene Corporation.

About 50 million Pap smears are performed annually in the United States. Before the HPV test was approved by the Food and Drug Administration in 1999, women who had an inconclusive Pap test would have to get another Pap test or an outpatient procedure that would likely include a biopsy. The results of a biopsy could take two weeks, a period in which the woman would not know if she had cancer. An HPV test can be done typically in a lab the same day as a Pap test, and it is done using the same Pap smear. Aetna is working with its clinical labs for them to automatically do the HPV test when the Pap test proves inconclusive, or mildly abnormal. “For the patient this is a tremendous value, because the anxiety of being told you have an abnormal Pap is taken away,” said Dr. Arnold Cohen, Aetna’s medical director for women’s health. Cohen estimated that about 60 percent of HPV tests done after an inconclusive Pap test will show no signs of the virus that causes cervical cancer. Thus, for Aetna and other health insurers, the HPV test eliminates the cost of paying for further office visits and a biopsy. According to the American Cancer Society, an estimated 12,800 cases of cervical cancer will be diagnosed this year and 4,600 women will die of the disease. Some experts say the HPV test can help make sure women are diagnosed earlier when the disease is more easily treated. “This is a real breakthrough, a great advance in cervical cancer screening,” said Dr. Mark Schiffman, who is studying the impact of HPV testing at the National Cancer Institute But how widely the screening is used will depend on whether Digene makes the price affordable, especially for public health clinics, he said. The cost for the HPV test to check for cancer is about $50. In comparison, the conventional Pap test costs about $10. Another type of cervical cancer screening test, which was approved in the mid 1990s, is the ThinPrep or Prep Pap test. In those tests, which cost about $30, a computer rather than a laboratory technician scans the Pap smear slide for abnormalities. Studies show this test typically can better identify abnormal cells than the conventional Pap test.

September, 2003|Archive|

Accelerated radiotherapy improves head and neck cancer outcomes

  • 9/19/2003
  • New York
  • Reuters Health

An accelerated course of radiotherapy that involves six fractions per week instead of five improves survival and offers other benefits for patients with head and neck cancer, new research indicates.

The findings, which are published in the September 20th issue of The Lancet, are based on a randomized trial of 1476 patients with squamous-cell cancer of the head and neck.

Regardless of whether patients were randomized to six or five fractions per week, most received a total of 66 to 68 Gy in 33 to 34 fractions, lead author Dr. Jens Overgaard, from Aarhus University in Denmark, and colleagues note. The exception was patients with well differentiated T1 glottic tumors, who received a total dose of 62 Gy.

Median treatment times for the six- and five-fraction regimens were 39 and 46 days, respectively, the authors note.

Disease-specific survival at 5 years in the six-fraction group was 73%, while the rate in the five-fraction group was significantly lower–66% (p = 0.01). Overall survival was comparable for both groups, a finding that may reflect the general poor health that typifies head and neck cancer patients.

The locoregional control rate with the six-fraction regimen was 70%, significantly higher than the 60% rate seen with the five-fraction regimen (p = 0.0005). Similarly, the corresponding primary tumor control rates were 76% and 64% (p = 0.0001). In contrast, neck-node control did not differ significantly between the groups.

Another benefit of the six-fraction regimen was improved voice preservation among patients with laryngeal cancer, the researchers state. The preservation rate in the six-fraction group was 80%, about 12% higher than the rate in the five-fraction group (p = 0.007).

Although acute morbidity was more common with the six-fraction regimen, these effects were transient, the authors point out. Severe late morbidity did not differ between the groups.

The results indicate that “moderately accelerated radiotherapy in head and neck cancer with a 1-week reduction in overall treatment time, but with no change to total dose and number of fractions, is better than a conventional treatment schedule,” Dr. Overgaard’s team notes.

“We recommend that modified fractionation schedules should constitute a new baseline for further exploration of radiotherapy in head and neck cancer,” they add.

September, 2003|Archive|