Monthly Archives: December 2008

Help requested to research early oral cancer detection

Source: British Dental Journal 205, 586 (2008)
Author: staff

A research group at the University of Sheffield are inviting dentists to participate in a study investigating how general dental practitioners working in primary care screen and refer suspicious oral soft tissue lesions.

Professor Paul Speight, Dr Sarah Baker and Paul Brocklehurst from the School of Clinical Dentistry in Sheffield are investigating the cues or factors which GDPs take into account when deciding whether or not to refer a lesion to secondary care. The information will be used to prepare guidelines which may result in more rapid referral of appropriate lesions.

Oral cancer affects almost 4,500 Britons every year and 50% of these will die of their disease. The team say that the main reason for this high mortality is that many patients present to secondary care with large lesions, when it is already too late to initiate curative treatment. There are many reasons for delay in presentation, but one possible reason is that lesions are not identified and referred to hospital specialists.

Colleagues are invited to participate in this study by completing a short web-based questionnaire, which comprises ten clinical cases histories. The task is to decide which of the lesions practitioners would refer and to record the factors that influenced the decision.

Full details of the project and access to the questionnaire can be found on

December, 2008|Oral Cancer News|

Robotic tongue cancer surgery

Author: staff

Fighting cancer is not easy. Chemotherapy, radiation and surgery can be very hard on your body. Take head and neck cancers, for example. These tumors are often hard to reach. Doctors have to cut through bones such as your jaw to reach them.

Now, doctors at Mayo Clinic are using robots to access these cancers leaving face bones intact. Roger Combs may be having a tough time beating his wife Gloria at a game of gin rummy. But he’s winning a much tougher battle; a fight against cancer that formed at the base of his tongue.

“I really didn’t feel badly. I had some difficulty swallowing,” he says.

Roger’s doctors told him the cancer had to be removed.

“But the tongue and tonsillar area is a very hard area to get to,” says Dr. Eric Moore.

Dr. Moore says traditional surgery often involves splitting the jawbone open to access the tumor.

“And obviously that’s disfiguring, interferes with speech and swallowing and it takes a lot of time to recover, ” he says.

So instead, Dr. Moore used a robot to remove Roger’s cancer.

The operation involves lowering the robotic equipment through Roger’s mouth to the site of the tumor.

While seated at a control panel Dr. Moore then guides the robot as it removes the cancer without damaging surrounding structures.

After Roger healed from the operation, he went through radiation and chemotherapy – both of which were not easy.

“We’ve had some ups and downs as you might expect,” says Roger.

But having had a minimally invasive surgery first made the process much more tolerable.

Now, about eight months after surgery, Roger continues to win his fight against cancer. Roger says the only major issue after his operation is that it’s taken him a while to be able to eat everything he likes. He says he’s looking forward to gaining back the weight he lost.

December, 2008|Oral Cancer News|

Oral cancer patients could be diagnosed earlier, study suggests

Author: staff

Worldwide, more than 500,000 new cases of cancer of the mouth are diagnosed each year. The majority of these cancers are found too late, causing many people to die within five years of finding out they have cancer. There exists much information addressing issues related to the patient who has undergone surgery or chemotherapy but little information related to early diagnosis and referral.

A new article in the Journal of Prosthodontics describes the epidemiology of oral cancer and the diagnostic tools currently available to prosthodontists to ensure that their patients are diagnosed at the earliest possible time.

Although the need for prosthodontics was expected to decline with the promotion of preventive measures, it is actually increasing with the aging population. The highest risk of developing oral cancer is in adults over 40 who use both tobacco and alcohol. However, these cancers can develop in anyone, so annual prosthodontist visits are increasingly important.

The majority of oral, head and neck cancer are initially diagnosed in a late stage, which has a five year prognosis of less than 50 percent. If these tumors are found in their earliest stage, the five year prognosis is 95 percent.

All dentists, including prosthodontists, are specifically trained to detect these tumors in an early stage. Only 28 percent of patients reported ever having had an oral cancer examination. Patients who have lost their teeth must be specifically counseled about returning for prescribed, regular recall examinations. They may wrongly think that, as they do not have all or any of their teeth, they do not need to be regularly followed by a prosthodontist.

Recently, several companies have marketed simple tests intended to aid the dentist in the early detection and diagnosis of oral lesions even before they turn into cancer; these tests are painless and relatively inexpensive. Any sore, lump, or bump in the mouth that bleeds, is enlarging, or will not heal should be evaluated at the earliest possible time.

“If prosthodontists, and other dentists, are more vigilant in performing oral cancer screening examinations on all of their patients, the quality of life and survivability from these cancers will be greatly improved, whereby morbidity and mortality will be greatly reduced,” the researchers conclude.

Journal reference:
1. Michael A. Siegel et al. Oral Cancer: A Prosthodontic Diagnosis. Journal of Prosthodontics, Online October 21, 2008 DOI: 10.1111/j.1532-849X.2008.00373.x

Adapted from materials provided by Wiley-Blackwell.

December, 2008|Oral Cancer News|

Cancer to be world’s top killer by 2010, WHO says

Author: Mike Stobbe

Cancer will overtake heart disease as the world’s top killer by 2010, part of a trend that should more than double global cancer cases and deaths by 2030, international health experts said in a report released Tuesday.

Rising tobacco use in developing countries is believed to be a huge reason for the shift, particularly in China and India, where 40 percent of the world’s smokers now live.

So is better diagnosing of cancer, along with the downward trend in infectious diseases that used to be the world’s leading killers.

Cancer diagnoses around the world have steadily been rising and are expected to hit 12 million this year. Global cancer deaths are expected to reach 7 million, according to the new report by the World Health Organization.

An annual rise of 1 percent in cases and deaths is expected – with even larger increases in China, Russia and India. That means new cancer cases will likely mushroom to 27 million annually by 2030, with deaths hitting 17 million.

Underlying all this is an expected expansion of the world’s population – there will be more people around to get cancer.

By 2030, there could be 75 million people living with cancer around the world, a number that many health care systems are not equipped to handle.

“This is going to present an amazing problem at every level in every society worldwide,” said Peter Boyle, director of the WHO’s International Agency for Research on Cancer.

Boyle spoke at a news conference with officials from the American Cancer Society, the Lance Armstrong Foundation, Susan G. Komen for the Cure and the National Cancer Institute of Mexico.

The “unprecedented” gathering of organizations is an attempt to draw attention to the global threat of cancer, which isn’t recognized as a major, growing health problem in some developing countries.

“Where you live shouldn’t determine whether you live,” said Hala Moddelmog, Komen’s chief executive.

The organizations are calling on governments to act, asking the U.S. to help fund cervical cancer vaccinations and to ratify an international tobacco control treaty.

Concerned about smoking’s impact on cancer rates in developing countries in the decades to come, the American Cancer Society also announced it will provide a smoking cessation counseling service in India.

“If we take action, we can keep the numbers from going where they would otherwise go,” said John Seffrin, the cancer society’s chief executive officer.

Other groups are also voicing support for more action.

“Cancer is one of the greatest untold health crises of the developing world,” said Dr. Douglas Blayney, president-elect of the American Society of Clinical Oncology.

“Few are aware that cancer already kills more people in poor countries than HIV, malaria and tuberculosis combined. And if current smoking trends continue, the problem will get significantly worse,” he said in a written statement.

December, 2008|Oral Cancer News|

Type of alcoholic beverage and risk of head and neck cancer—a pooled analysis within the INHANCE consortium

Source: American Journal of Epidemiology, doi:10.1093/aje/kwn306
Authors: Mark P. Purdue et al.

The authors pooled data from 15 case-control studies of head and neck cancer (9,107 cases, 14,219 controls) to investigate the independent associations with consumption of beer, wine, and liquor. In particular, they calculated associations with different measures of beverage consumption separately for subjects who drank beer only (858 cases, 986 controls), for liquor-only drinkers (499 cases, 527 controls), and for wine-only drinkers (1,021 cases, 2,460 controls), with alcohol never drinkers (1,124 cases, 3,487 controls) used as a common reference group.

The authors observed similar associations with ethanol-standardized consumption frequency for beer-only drinkers (odds ratios (ORs) = 1.6, 1.9, 2.2, and 5.4 for ≤5, 6–15, 16–30, and >30 drinks per week, respectively; Ptrend < 0.0001) and liquor-only drinkers (ORs = 1.6, 1.5, 2.3, and 3.6; P < 0.0001). Among wine-only drinkers, the odds ratios for moderate levels of consumption frequency approached the null, whereas those for higher consumption levels were comparable to those of drinkers of other beverage types (ORs = 1.1, 1.2, 1.9, and 6.3; P < 0.0001). Study findings suggest that the relative risks of head and neck cancer for beer and liquor are comparable. The authors observed weaker associations with moderate wine consumption, although they cannot rule out confounding from diet and other lifestyle factors as an explanation for this finding. Given the presence of heterogeneity in study-specific results, their findings should be interpreted with caution. Abbreviations: CI, confidence interval; HNC, head and neck cancer; INHANCE, International Head and Neck Cancer Epidemiology; OR, odds ratio Authors: Mark P. Purdue, Mia Hashibe, Julien Berthiller, Carlo La Vecchia, Luigino Dal Maso, Rolando Herrero, Silvia Franceschi, Xavier Castellsague, Qingyi Wei, Erich M. Sturgis, Hal Morgenstern, Zuo-Feng Zhang, Fabio Levi, Renato Talamini, Elaine Smith, Joshua Muscat, Philip Lazarus, Stephen M. Schwartz, Chu Chen, Jose Eluf Neto, Victor Wünsch-Filho, David Zaridze, Sergio Koifman, Maria Paula Curado, Simone Benhamou, Elena Matos, Neonilia Szeszenia-Dabrowska, Andrew F. Olshan, Juan Lence, Ana Menezes, Alexander W. Daudt, Ioan Nicolae Mates, Agnieszka Pilarska, Eleonora Fabianova, Peter Rudnai, Debbie Winn, Gilles Ferro, Paul Brennan, Paolo Boffetta and Richard B. Hayes Authors' affiliation: National Cancer Institute 6120 Executive Boulevard, EPS 8111, Rockville, MD 20852

December, 2008|Oral Cancer News|

‘Mama!’ First word of boy with tongue built out of his tummy muscles

Author: Angela Epstein

A child’s first words are memorable for any parent. But when Daniel Sewell said ‘mama’ for the first time, his parents had more reason than most to rejoice.

Just 12 weeks earlier, their then 19-month-old son had undergone pioneering surgery to rebuild his tongue after first having an operation to remove a cancerous tumour. The family had been warned he might never be able to speak.

So Daniel’s first word was a monumental achievement.

‘I just couldn’t believe it,’ says his mother Alison. ‘That single word meant there was hope that the horrors of the previous months might finally be behind us.’
Daniel Sewell and mum Alison

Nearly 5,000 people are diagnosed with mouth cancer annually. While other cancers have seen a drop in mortality rates, those for mouth cancer have remained at more than 1,500 deaths a year for a decade. It is often triggered by smoking and drinking – alcohol and nicotine damage the mouth lining, causing cell changes – and is almost unheard of in children. So when Daniel, the youngest of the couple’s five children, began having trouble sucking on a bottle, cancer was the furthest thing from his parents’ mind.

‘With the benefit of hindsight, it was clear that something was bothering him,’ remembers Alison, 43, a housewife, who lives with her husband Richard, 42 a shop fitter in Crook, County Durham. ‘But at the time we just put it down to teething. I’ll always feel terribly guilty about that.’

As well as taking ages to feed – on one occasion, when he was just ten months, he spent an entire evening having his bottle – it also seemed a strain for him to cry.

‘One morning, about a month later, Richard found blood all over his face and cot sheets. It was horrifying, and we panicked. Yet when we washed his mouth out there was nothing there. When we took him to our GP he said Daniel had probably had a nose bleed during the night.’

But when Daniel was just 13 months it was clear something was seriously wrong.

‘Richard offered Daniel a spoonful of food and when he opened his mouth, noticed that his tongue was very swollen in the middle, although the end of it appeared pinched and narrow, as if it had been tied with a piece of cotton.

‘We were frantic that he’d swallowed something, so phoned our GP. He told us to call an ambulance since there was a risk that Daniel could choke on his tongue, whatever the cause.’
Daniel Sewell

Doctors at the hospital suspected an infection triggered by something small embedded in Daniel’s tongue. He was put on antibiotics and kept in overnight.

With no sign of improvement, the following morning he was transferred to the Freeman Hospital in Newcastle Upon Tyne, where an ear, nose and throat surgeon performed a precautionary tracheotomy – a procedure where an incision is made on the neck in order to make a direct airway to the windpipe – to allow time for further investigation.

The family prayed his problems were down to a treatable virus.

But during the tracheotomy surgeons found a swelling on his tongue. Suspecting it was cancer, they transferred Daniel to another hospital in the city, the Royal Victoria, for a biopsy.

‘We still didn’t allow ourselves to suspect it could be anything serious,’ says Alison.

But it was there that paediatric oncologist Dr Juliet Hale delivered the shattering news.

‘Part of me wanted to scream, yet part of me felt numb,’ says Alison. ‘I looked at Richard, who was crying his eyes out. But I couldn’t cry – I needed answers. All I could think of was that my baby could lose his speech or even die.’

Daniel was diagnosed with a rhabdomyosarcoma, a rare form of soft-tissue cancer.

Fewer than 60 children are diagnosed with the condition in the UK each year.

As the Sewells struggled to come to terms with the diagnosis, Dr Hale recommended chemotherapy to shrink the tumour.

The cancer was the size of a small grapefruit, running from the bottom half of his tongue to the epiglottis. But because it grew from deep in the tongue, it had only just become visible.

Daniel had nine sessions of chemotherapy over a seven-month period. Alison moved into the hospital while Richard and his parents looked after Daniel’s sister Rachel, 13, and brother Thomas, six.

The side-effects were brutal – Daniel lost his hair, suffered sickness and developed ulcers on his swollen tongue, which protruded from his mouth.
Daniel Sewell His appearance was so distressing that he was given a side room so he couldn’t be seen by other visitors and children.

‘But Daniel was incredible,’ says Alison. ‘He had this sense of acceptance. His courage stopped me caving in – if Daniel could cope, then I had to, too.’

After the chemotherapy had killed off most of the tumour, Daniel had the rest removed by surgery – cutting away part of his tongue and making speech almost impossible.

‘The thought of this destroyed me,’ says Alison. ‘How could my baby – who hadn’t even learnt to speak yet – face a future without being able to talk?

But my mother had read a story in the Daily Mail about a man who’d had mouth cancer and had his tongue reconstructed using a muscle from his back.

‘And while this kind of operation was unheard of in such a young child, Dr Hale eventually found someone willing to do it.’ That someone was Peter Hodgkinson, a consultant cleft-palate and plastic surgeon at the hospital. The eight-hour operation took place in September 2005.

‘I knew this was a pioneering operation for such a young child – one of the main concerns was the anaesthetic because he would be under it for so long. But there was no other way to save his speech,’ says Alison.

‘I remember Daniel sitting on my knee outside the operating theatre as the doctors gave him the anaesthetic. As he went limp in my arms it was heartbreaking. And when they took him away, I fell apart.’

To access the site where thee tumour had been, and not disturb the healthy part of his tongue, Mr Hodgkinson operated by cutting through the lower jawbone. While this was happening, a separate team removed one of the ‘abs’ on the inner wall of his stomach.

This muscle, along with a blood vessel, was selected as it is about the size – around 10cm long and 4cm wide – of the removed tongue. Because it’s muscle, it also has bulk and tone like an ordinary tongue.

It was attached micro-surgically – every nerve and blood vessel was joined to ensure it would continue to grow as normal. Finally, ten dissolvable stitches on the surface of the tongue – finer than a human hair – completed the job.

Mr Hodgkinson said that although the muscle looked different, this would change over time because the moist tissue that covered the tongue would soon grow over the transplanted muscle – in fact, this started the very next day.

However, the transplant would never be a perfect match – indeed, Daniel’s sense of taste and sensitivity to temperature have both been affected, and he now tests his food by touching it with his fingers.

After the op, all that was visible was a small – now faint – vertical scar running down Daniel’s chin and under his neck.

‘When he opened his eyes he didn’t cry, he just attempted this wobbly smile,’ recalls his mother with tears in her eyes. But within days Daniel was displaying characteristic toddler energy. Three days after surgery, he was riding a bike in the ward.

Ten days after his surgery, a lab report confirmed that the operation, combined with chemotherapy, had been so successful that there was no need for radiotherapy – the cancer was gone. This was important as the treatment can stunt growth, and might have affected the development of Daniel’s tongue.

Daniel went home the following day, and that evening managed a bowl of chicken soup. As the days passed, Alison introduced food that was carefully cut up.

‘It was such a joy to have a family meal together. I think we’d all forgotten how special it was for us all to be together with Daniel.’

The little boy continued to make a rapid recovery and by Christmas day managed to eat turkey, roast potatoes and pudding. Then, in early January 2006, he finally uttered the word ‘mama’.

Within a few weeks of the operation, Daniel began weekly speech-therapy sessions.

‘Before he was diagnosed, Daniel was already making the usual baby sounds,’ says Alison.

‘The specialists said there was no reason why he wouldn’t learn to speak.’

Two years on, his speech is pretty clear. ‘He can’t stick his tongue out or lick a lolly because it doesn’t have the same range of movement as his old tongue. But he manages. He’s so cheerful. He’s always singing.’

Two months ago, Daniel started school. There is little sign that his experience is in anyway compromising his progress, and Alison continues to relish each day.

‘You dread the cancer recurring. Halfway through the chemotherapy I thought we are never going to get out of this. But he did – much to everyone’s amazement, even the doctors’. Now he’s back with us and every day is like a miracle.’

December, 2008|Oral Cancer News|

Impact of PET scanning consistent across all cancer types

Authors: Zosia Chustecka, Désirée Lie, MD

Scanning with positron emission tomography (PET) scanning has an impact on the intended management of patients with cancer in approximately one third of cases, and new data suggest that this impact is consistent across all cancer types.

The results come from the National Oncologic PET Registry (NOPR), and the latest data are reported in the December issue of the Journal of Nuclear Medicine.

“Although the effectiveness of PET may differ somewhat between individual cancers, it’s in the same ballpark,” says coauthor Barry Siegel, MD, professor of radiology at Mallinckrodt Institute of Radiology in St. Louis, Missouri. “This result was a little unexpected, but it leads us to believe that a continual parsing of PET’s usefulness, cancer by cancer and indication by indication, for purposes of reimbursement does not make clinical sense.”

At present in the United States, the Centers for Medicare & Medicaid Services (CMS) restricts the reimbursement of PET scans for only 9 cancer types. The cancers that are covered include non–small-cell lung cancer, esophageal cancer, colorectal cancer, head and neck cancer, lymphoma and melanoma (all for diagnosis, staging, and restaging), breast cancer (for restaging and treatment monitoring), thyroid cancer (for restaging under very specific circumstances), and cervical cancer (for initial staging if conventional imaging result is negative for extrapelvic metastasis).

NOPR was launched in 2006 in response to a proposal from the CMS to expand coverage for PET to other cancers. In this registry, patients are covered under the CMS evidence development program to undergo PET scans for many other cancers and indications, including cancers of the ovary, uterus, prostate, pancreas, stomach, kidney, and bladder. The latest results show that PET has a similar impact across all of these cancer types. Although there was some variation, particularly a high impact on multiple myeloma, the differences across the cancer types were not statistically significant, and overall there was an impact in 38% of cases.

“We found that it did not vary significantly, and that the changes in treatment plans for rare cancers — such as stomach cancer — clustered around the same one-third mark as the more common cancers,” said lead author Bruce Hillner, MD, professor of medicine at Virginia Commonwealth University in Richmond. “As a result, we believe that the coverage for PET in the staging, restaging and detection of recurrent cancer should be handled the same across the board,” he said in a statement.

“The data from NOPR as well as from other studies, the totality of the PET literature in cancer, show that it is a very effective tool for imaging in cancer, and that it should be approved broadly,” Dr. Siegel said in an interview with Medscape Oncology. There is no restriction on the use of computed tomography or magnetic resonance imaging by cancer type, he pointed out, and the use of PET scanning across all cancer types “is just as logical,” he added.

“Basically, what we were trying to do is to inform CMS policy,” he explained. “We wanted to collect data to show that, if you were thinking of picking and choosing, then you should cover this cancer and maybe not this one, but the truth of the matter is that when you look at the data it’s hard to say what to include or exclude,” he said. “Our recommendation is to include all cancers. PET is as mature a cancer imaging tool as CT and MRI, and I just don’t understand why we don’t have a level playing field.”

The CMS is expected to decide on the reimbursement of PET scans in other cancers soon. A draft is expected on January 10, 2009, and after another public comment period, the final National Coverage Determination will be made on April 9, 2009.

Dr. Siegel told Medscape Oncology that he was cautiously optimistic. “Our sense is that the CMS has a good understanding of our data, and I think there will be some additional coverage, and I have my fingers crossed for global coverage.”

Changes in Intended Management After PET Scans

The latest report assessed the impact of PET for 18 cancer types, none of which are currently on the list for CMS reimbursement. This study looked at 3 distinct indications: initial staging, restaging, and detection of suspected recurrence. Only patients who had pathologically confirmed cancer were included; hence, this study excluded the use of PET for diagnosis. It also excluded patients in whom PET was being used to monitor response to chemotherapy or radiotherapy (this indication has also been studied in NOPR, and results have recently been published online in Cancer).

Table. Impact of PET Scanning on Intended Management of Cancer

Type of Cancer No. of PET Scans % Cases With Change in Intended Management
Prostate 5309 35.1
Ovary 4509 41.4
Bladder 3578 37.8
Pancreas 3314 39
Stomach 2025 36.9
Small-cell lung cancer 2983 41.2
Kidney 2877 35.8
Uterus 2869 36.5
Myeloma 1784 48.7
Connective tissue 1350 36.4
Nonmelanoma skin 1057 31.4
Liver and intrahepatic bile ducts 1038 42.9
Cervix 984 32.7
Gallbladder 806 39.7
Other female genitalia 709 37.1
Thyroid 629 35.6
All other 4042 36.6
TOTAL 40,863 38.0

As a result of seeing the PET scans, clinicians changed their intended management of the cancer as follows:

* From nontreatment to treatment in 30% of cases
* From treatment to nontreatment in 8% of cases
* Change in goal from curative to palliative (or vice versa) in 14% of cases
* Change to supportive care or observation in 15.1% of cases
* Major change (eg, from surgery to chemotherapy) in 8.6% of cases
* Minor change (eg, addition or deletion of a mode of therapy) in 23.3% of cases

“We believe that the NOPR results show the impact of PET to be strikingly consistent for a wide range of cancers,” the researchers conclude. “Accordingly, the use of PET in management for patients with known cancer should not be restricted by cancer type or testing indication.”

Several recent publications have confirmed and validated these findings, Dr. Siegel commented to Medscape Oncology. In particular, several multicenter prospective trials have been conducted in Australia (J Nucl Med. 2008;49:1451-1457, 1593-1600) that provide “very strong process validation” of our data from the registry, he said.

Funding for development of NOPR was provided by the Academy for Molecular Imaging, but the registry is otherwise self-supported by fees paid by participating PET facilities. Dr. Siegel has disclosed equity ownership and serving on the medical advisory board of the Radiology Corporation of America and has received lecture honoraria from PETNET Pharmaceuticals Inc and Philips Medical Systems Puerto Rico.

Source:  J Nucl Med. 2008;49:1928-1935.

Clinical Context

PET assesses regional glucose metabolism and has been used widely for imaging in patients with cancer. Currently, the CMS in the United States provides coverage for its use for 9 malignant tumors.

The NOPR was developed to collect data on the clinical usefulness of PET to meet requirements for evidence-based coverage of PET. This is a report of data collected during 2 years from the NOPR to examine the frequency of change in cancer management associated with PET use.
Study Highlights

* The NOPR collected data from the PET facility, treating clinicians, and interpreting clinicians during 2 years, including indication for testing, patient’s cancer type, patient’s performance status, and the clinician’s management.
* Clinician’s intended management was dichotomized as either treatment (such as surgery, radiation, or chemotherapy) or no treatment (such as observation, biopsy, or supportive care).
* A change in management was defined as change from treatment to nontreatment or vice versa.
* These approaches also assessed how often the intent of planned therapies changed from curative to palliative or vice versa, or in the type or number of therapies planned.
* Only patients with histologically confirmed cancers were included, who were undergoing PET for initial staging, restaging, or detection of suspected recurrences.
* Excluded were cases for which PET was used for cancer diagnosis or monitoring therapy.
* Primary outcome was the impact of PET on clinician management overall and by cancer type.
* The final cohort consisted of 40,863 scans performed on 34,536 patients.
* 14,365 were for initial staging of newly diagnosed cancer, 14,584 for restaging of cancer after treatment completion, and 11,914 for the evaluation of suspected recurrence of a previously treated cancer.
* Mean patient age was 72.4 years, 50% were men, and 88.2% had a performance status of 0 or 1.
* The summary cancer stage before PET was judged as no evidence of disease in 12.0%, locoregional disease in 33.5%, metastatic disease in 29.4%, and unknown in 25.1%.
* Overall, PET led to a change in intended management from treatment to nontreatment or vice versa in 38.0%.
* Among the 13.6% with 2 PET scans, the frequency of change in intended treatment was slightly higher vs the second scan (39.2% vs 36.2%).
* Among those with 3 or more scans, the value for the third and other scans was 34%.
* There were 16 cancer types.
* The frequency of a change in intended management by cancer type ranged from a low of 31.4% for nonmelanoma skin cancer to a high of 48.7% for myeloma.
* The change in management differed significantly for 7 of 16 cancer types.
* The cancer-specific values varied little, from a low of 9.6% for nonmelanoma skin cancers to 16.2% for ovarian cancer.
* Only for myeloma did PET have a significantly greater impact on intended management vs other cancers.
* Myeloma was the only cancer type among those 7 with an OR notably different from 1.0.
* Change from nontreatment to treatment was substantially more likely than the converse (30.0% vs 8.0% overall).
* A change in goal of treatment, from curative to palliative or vice versa, occurred in 14.1% overall with limited variation by cancer type.
* In 15.1% of cases, when treatment was planned before PET, change to supportive care or observation occurred most frequently after cancer of the kidney and least often after female genital cancers.
* A major change in planned treatment occurred in 8.6% of cases overall, most often in tumors of the liver and intrahepatic bile ducts and least often in myeloma and nonmelanoma skin cancers.
* The impact of PET was greater for detection of suspected recurrences (OR, 1.56) vs initial staging or restaging.
* Patients with myeloma and ovarian cancer were more likely and those with kidney cancer and stomach cancer were less likely to have a change in management after PET.
* The authors concluded that the impact of PET on intended management was consistent for a wide range of cancers and recommended that use of PET not be restricted to some cancer types.

Pearls for Practice

* Use of PET for patients with confirmed cancer is associated with change in intended management in 38% of cases.
* Frequency of change in management after PET does not vary by cancer type and is highest for myeloma and for cancer recurrences.

December, 2008|Oral Cancer News|

Saliva-test pioneer David Wong named to endowed chair in dentistry

Author: Sandra Shagat

The UCLA School of Dentistry has named oral biology professor David Wong, a pioneer in the use of saliva for diagnosing cancer and other diseases, as the first holder of the Felix and Mildred Yip Endowed Professorship in Dentistry.

The new chair, created by a $1 million gift from Dr. Felix Yip and his wife, Mildred, will support research on oral and head and neck cancers, an area of particular emphasis at the School of Dentistry. Wong has made major advances in the fight against oral cancer, having developed with colleagues the first standardized saliva-based test for the disease. His ongoing research in saliva diagnostics has helped build UCLA’s reputation as a center for excellence in oral fluid research.

“Felix and Mildred Yip are visionary donors who saw an opportunity to help advance a promising area of scientific research that ultimately could save lives,” said No-Hee Park, dean of the UCLA School of Dentistry. “Their generous gift supports our efforts to make salivary diagnostics a new clinical paradigm for disease detection.”

The Yips are noted philanthropists within the Asian American community in Southern California and have been generous supporters of UCLA and the School of Dentistry. They are among a small group of Chinese-American philanthropists who have established chairs at UCLA.

Felix Yip has served as a member of the School of Dentistry’s board of counselors since 2003, and since 2002, the Yips have funded a scholarship program at the school that enables foreign scholars to obtain UCLA training in the remedy of craniofacial defects.

“Mildred and I have long been impressed with the quality of the research being conducted by the UCLA School of Dentistry, especially for those patients who suffer from cancer and related maladies,” said Felix Yip, a practicing urologist. “It is gratifying that our gift will help many generations to come by supporting the research activities of a distinguished faculty member. We are proud to play a vital role in fulfilling UCLA’s mission of research, education and public service.”

The Felix and Mildred Yip Endowed Professorship in Dentistry is the fifth endowed professorship to be established at the dental school.

Wong serves as the school’s associate dean of research and director of the Dental Research Institute. He is also a member of UCLA’s Jonsson Cancer Center.

Working at the frontier of the science of using saliva — rather than blood or other bodily fluids — to detect illness, Wong and his colleagues in 2006 standardized a saliva-based test for the early detection of oral cancer, a debilitating and often fatal disease. Wong’s lab is currently engaged in perfecting salivary diagnostics for a wide range of illnesses, including pancreatic and lung cancers and Type 2 diabetes, and is also involved in a multidisciplinary effort to create a point-of-care device for analyzing the biological markers of disease in saliva. Wong is the author of the premiere textbook of his field, “Salivary Diagnostics,” published this fall.

Wong obtained his degree in dentistry from the University of British Columbia and completed doctoral training in molecular biology and clinical training in oral pathology at Harvard University. Formerly a member of the faculty of Harvard’s School of Dental Medicine, Wong joined the UCLA School of Dentistry in 2002.

Wong’s research is supported by grants from the National Institute of Dental and Craniofacial Research and the National Cancer Institute. His new chair title will become effective Jan. 1, 2009.

The UCLA School of Dentistry is dedicated to improving the oral health of the people of California, the nation and the world through its teaching, research, patient care and public service initiatives. The school provides education and training programs that develop leaders in dental education, research, the profession and the community; conducts research programs that generate new knowledge, promote oral health, and investigate the cause, prevention, diagnosis and treatment of oral disease; and delivers patient‑centered oral health care to the community and state.

December, 2008|Oral Cancer News|

Cetuximab approved for first-line treatment of head and neck cancer in Europe

Author: staff

The European Commission has approved a new indication for the use of cetuximab (Erbitux) to include first-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck.

The approval is based primarily upon the results of the Erbitux in First-Line Treatment of Recurrent or Metastatic Head and Neck Cancer (EXTREME) study, published in the September issue of the New England Journal of Medicine.

The EXTREME study established that adding cetuximab to platinum-based chemotherapy significantly prolonged median overall and progression-free survival, and also significantly increased response rate.

Patients treated with cetuximab plus chemotherapy experienced the following improvements, compared with chemotherapy alone:

· Median overall survival increase of nearly 3 months (10.1 vs 7.4 months; P = .04), equating to a 20% reduction in the risk of death (hazard ratio [HR]: 0.80) during the study period

· 70% increase in median progression-free survival (5.6 vs 3.3 months; P < .001)

· 80% relative increase in response rate (36% vs 20%; P < .001)

The most commonly reported side effect with cetuximab is an acne-like skin rash that seems to be correlated with a good response to therapy. In approximately 5% of patients, hypersensitivity reactions may occur during treatment with cetuximab; about half of these reactions are severe.

1. Source: Merck

December, 2008|Oral Cancer News|