11/16/2004 Arlene A. Forastiere Journal of the National Cancer Institute, Vol. 96, No. 22, 1647-1649, November 17, 2004 Editorial The majority of deaths from locally advanced head and neck cancer are due to complications of uncontrolled locoregional disease, and this pattern of failure must be altered to improve patient survival. Over the past 25 years, thousands of patients with head and neck cancer have been enrolled in clinical trials to test whether the addition of platinum-based chemotherapy to local treatment modalities of surgery and radiotherapy improves overall survival. These studies have taken two approaches. In the first approach, several cycles of neoadjuvant or induction chemotherapy (most commonly cisplatin and infusional 5-fluorouracil) precede definitive locoregional therapy (i.e., surgery). The second approach is chemoradiotherapy, the concurrent administration of radiotherapy and chemotherapy. Of the two approaches, only chemoradiotherapy has succeeded in changing outcomes. Numerous phase III trials that have compared radiotherapy alone to chemoradiotherapy have shown that the latter statistically significantly improved locoregional control and that the magnitude of improvement is sufficient to have an impact on overall survival (1–5). As a consequence of these findings, over the last decade, chemoradiotherapy has become the standard of care for the management of unresectable head and neck cancers and nasopharyngeal cancers (i.e., stage T3, stage T4, or lymph node–positive cancers) and for the nonoperative management of locally advanced oropharyngeal cancers. By contrast, only two (6,7) of more than 30 randomized trials have demonstrated that induction chemotherapy confers a survival advantage. In addition, induction chemotherapy has [...]

11/16/2004 Laura McMahon Medical News Today The addition of neoadjuvant chemotherapy to concurrent chemoradiation may be a promising approach for treating patients with inoperable advanced head and neck cancer, according the authors of a 10-year follow-up of a randomized trial. In 1986, a randomized phase III trial began in which 237 patients with nonmetastatic stage III or IV head and neck squamous cell carcinoma were treated with either four cycles of neoadjuvant chemotherapy followed by locoregional treatment (surgery and radiotherapy or radiotherapy alone) or locoregional treatment alone. Two years after treatment began, there was no difference in survival between the two groups. In a follow-up at 5 and 10 years after treatment, Adriano Paccagnella, M.D., of SS Giovanni and Paolo Hospital in Venice, and colleagues report again that there was no difference in survival between the two groups. However, among patients who did not receive surgery because their tumors were inoperable, those who received neoadjuvant chemotherapy had a higher rate of survival than patients who did not receive chemotherapy. In an editorial, Arlene A. Forastiere, M.D., of the Johns Hopkins Kimmel Cancer Center in Baltimore, notes that these promising follow-up results bolster soon-to-be activated trials of chemoradiotherapy--the current standard of treatment for advanced head and neck cancer--with and without neoadjuvant chemotherapy.

11/16/2004 Renee Twombly EurekAlert.com Nowadays, a vial of blood taken by a family physician can sometimes forecast a person's risk of heart disease, and cholesterol-lowering drugs as well as a daily baby aspirin may be recommended to curb the threat. But in the future, a simple finger prick also may predict which cancers are destined to develop in an individual, years, even decades, down the road. And based on a person's unique genetics - the milieu of factors that repair DNA damage, or push cells to grow - the patient of tomorrow also may be given a recipe of drugs that will prevent or delay those cancers from ever developing. Their cocktail of cancer preventives might include refined forms of aspirin to prevent colon and breast cancer, trace minerals to protect against prostate cancer, or proven versions of ancient remedies, such as turmeric spice for breast cancer and good ole' cups of green tea daily, to repress oral cancer. At the moment, a complete "chemoprevention" strategy - the use of a natural or synthetic substance to reduce the risk of developing cancer - is a goal to be reached in the future. By all accounts, routine use of such agents won't be here for a long time because much more needs to be understood about the changes that push a cell to become cancerous before that process can be stalled or reversed. Still, more and more of the research effort at The University of Texas M. D. Anderson Cancer Center [...]

11/16/2004 Dr. Gifford-Jones CalgarySun.com "Stick out your tongue," my dentist invariably requests during my regular dental checkup. I know that shortly he'll examine my teeth. But for the moment he's looking for any sign of cancer of the tongue. Cancer of the tongue is one of the more common types of mouth cancer. It's curable in about 80% of cases when diagnosed early. Most tongue cancers are treated by surgery, which may include post-operative radiation and/or chemotherapy. Usually, however, treatment of advanced cancers of the tongue necessitate a radical surgical resection requiring some reconstruction of the tongue, a demanding eight-hour operation. And that's why I'm writing this particular column. I recently attended a meeting of head and neck surgeons to hear about new treatments for oral cancers. Several of Canada's most distinguished Professors of Head and Neck Surgery made this remark to me, 'I used to get more applications for training in head and neck surgery than I could accept. Now I can't find enough doctors to fill the training program. It won't be too long before there are not enough specialists to treat oral cancers.' " I asked the reason why there should be such a dramatic shift. He replied, "Young doctors today are more practical about the economics of medicine. So they are lining up to go into cosmetic surgery. They realize that in a couple of hours they can charge $20,000 for a face-lift operation. Or thousands doing nose jobs or quick nip and tucks on the [...]

11/16/2004 New Delhi, India no attribution indianexpress.com Biotech major Biocon Limited today said its first cancer drug will be ready to hit the Indian market late next year. The drug is currently in advanced second-phase clinical trials at Bangalore’s Kidwai Oncology Institute. "Our cancer antibody, Thera HR3, is expected to launch late next year in India. It is currently in phase II B clinical trials and has demonstrated very good tumour regression. It has displayed none of the skin reactions common in patients undergoing chemotherapy," said Biocon CMD Kiran Mazumdar-Shaw at its launch of Insugen, a new insulin product. Thera HR3 is the first of six cancer drugs in Biocon’s product pipeline. The drug will target head and neck cancer, which afflicts 90 per cent of India’s cancer patients. "Head and neck cancer includes mouth, tongue, jaws, pharynx and other parts affected by tobacco chewing, cigarette smoking and poor dental hygiene," said Dr AS Arvind, CEO, Clinigene International Ltd, a division of Biocon. Thera HR3 trials are the first of their kind in India, with the EGF-receptor based drug being paced through development in collaboration with Cuba’s C Map. It is to be used in combination with radiology and chemotherapy, said Arvind. Biocon’s five other oncology drugs include three vaccines to suppress relapses in cancer patients and two that target colon, breast, chest and other forms of cancer. No timelines were discussed for these drugs.

11/16/2004 Sweden IARC Meeting report The Local, Swedens news in English Visitors to Scandinavia could be forgiven for thinking that a significant number of the men have a congenital malformation of the upper lip. Actually they're just stuffing small pouches of chewing tobacco, or 'snus' under it. As if the horrific breath and stained teeth aren’t argument enough to stop, researchers have now sounded a new cancer warning bell about the snus habit. A study carried out by the World Health Organisation and released this week followed 10,000 Norwegians, of whom two-thirds were snus-lovers. The results show that users of the popular chewing tobacco increase their risk of contracting mouth or pancreatic cancer by 67%. At the same time a study has been commissioned by Sweden's National Institute of Public Health to assess the risk of using the small tobacco pouches under the lip. "Chemical substances such as nitrosamines, as well as the way the snus is used, the frequency and the level of mouth hygiene all contribute to the risk of cancer," says Anders Ahlbom, Professor of Epidemiology at the Karolinska Institute and the Swedish delegate to the International Agency for Research on Cancer. Chewing tobacco of the snus type is also widely used in the United States, with other forms of chewing tobacco prevalent in Asian and African countries. "In earlier studies it was difficult to establish a link between mouth cancer and the type of chewing tobacco we use in Sweden," continued Anders Ahlblom. Consequently in 2001, [...]

11/16/2004 Donna De La Cruz, Associated Press 365gay.com About 30,000 Americans each year contract oral cancer, and 8,000 of them will die, but people remain ignorant of a disease that can be cured if caught in the early stages, a University of Medicine & Dentistry of New Jersey official says. "This is not a disease that strikes just old men anymore," said Arnold Rosenheck, assistant dean at UMDNJ's dental school, before he was to speak to health care professionals about oral cancer at the American Public Health Association annual meeting in Washington. Oral cancer can strike anyone, even people who don't smoke or drink, which are two of the risk factors, Rosenheck said, adding that his goal is to educate Americans and health care professionals on how to prevent the disease. Oral cancer once struck mainly men in their 60s, but the largest increase in cases now is seen in people under 40 years of age, and in women. The survival rate remains unchanged from 50 years ago — about 50 percent for someone diagnosed with the disease in its later stages. Women began developing oral cancer when smoking became chic, said Rosenheck, referring to the well-known Virginia Slims ad campaign, "You've Come a Long Way, Baby," that ran from 1968 to 1986. "As a result, women have taken their place alongside their male counterparts in developing the diseases that are prevalent to tobacco use," Rosenheck said. "And I think women are drinking more openly now, going out with the [...]

11/15/2004 Seungtaek Choi, MD. et al. Arch Otolaryngol Head Neck Surg. 2004;130:1308-1312 Objective: To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction. Design: Retrospective cohort study. Setting: University of Washington Medical Center, Seattle, a tertiary care hospital. Patients: A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months). Main Outcome Measures: Rate and severity of local postoperative complications. Results: Fifty-four patients (54%) had at least 1 postoperative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54%] of 28 patients in the no XRT group, 24 [65%] of 37 patients in the preoperative XRT group, and 16 [46%] of 35 patients in the postoperative XRT group; P = .26, 2 analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, [...]

11/14/2004 Houston, TX Todd Ackerman HoustonChronicle.com William Poole lies face down, his upper back peppered with small jars that suck up skin turned red underneath them. One by one, Dr. Joseph Chiang removes the jars, lights a quickly extinguished flame in them and swiftly applies the jars to other spots. He does it effortlessly, like a master illusionist performing sleight of hand. "That feels better," says Poole at the end. "I feel looser already." The therapy is an ancient Chinese one called cupping, but if the scene conjures up images of a dark room in an unfamiliar neighborhood, think again. It occurred at the University of Texas M.D. Anderson Cancer Center, epitome of the conventional cancer-care establishment. Place ... of Wellness, M.D. Anderson's integrative medicine program, offers unconventional care, from meditation to yoga to aromatherapy. But for many people, cupping has become a therapy of choice, suddenly trendy after actress Gwyneth Paltrow's high-profile use of it earlier this year. Used by acupuncturists in China since the third century B.C., cupping is considered most beneficial for back pain and stiff shoulders because it increases circulation and the mobility of affected areas. But it's also pronounced good for digestive and respiratory disorders and sports injuries. For cancer patients such as Poole, it eases the discomfort that can come with chemotherapy and radiation. Massagelike effects Cupping may look like medieval alchemy, but its effect is similar to that of an intense, vigorous massage. Suction created by the cups pulls the skin up and [...]

11/14/2004 Liz Szabo USA Today Supreme Court Chief Justice William Rehnquist's diagnosis of thyroid cancer, announced late last month, comes at a time when research in the malignancy -- which experts say was stalled for many years -- is suddenly taking off. In the past year or so, scientists have initiated at least 10 new studies of thyroid cancer, and a dozen more will soon be up and running, says Steven Sherman, an associate professor at M.D. Anderson Cancer Center in Houston. "There's been an explosion," Sherman says. "Before that, there was almost nothing." Thyroid cancer research has suffered partly because its most common variety is usually curable, making the disease seem less threatening. Yet the most aggressive form of thyroid cancer, anaplastic carcinoma, is one of the most lethal of all tumors. Anaplastic cancers afflict so few people -- just a few hundred a year -- that experts long doubted that it was possible to even start clinical trials, says Manisha Shah, a thyroid cancer specialist at Ohio State University Comprehensive Cancer Center. Recent research has been sparked by the discovery of genetic mutations involved in thyroid tumors, as well as progress in the growing field of "targeted" cancer therapies that affect the tumors but not the surrounding, healthy tissue. Last year, a team of scientists at Johns Hopkins University School of Medicine discovered a genetic mutation that is present in most papillary thyroid cancers, the most common sort. Earlier this year, the same team showed that the mutation [...]