Monthly Archives: September 2009

Evaluation of parotid gland function following intensity modulated radiation therapy for head and neck cancer

Source: Cancer Res Treat, April 1, 2006; 38(2): 84-91
Authors: SH Lee et al.

This study was undertaken to determine the parotid gland tolerance dose levels following intensity modulated radiation therapy (IMRT) for treating patients who suffered with head and neck cancer.

Materials and Methods:
From February 2003 through June 2004, 34 head and neck patients with 6 months of follow-up were evaluated for xerostomia after being treated by IMRT. Their median age was 59 years (range: 29~78). Xerostomia was assessed using a 4-question xerostomia questionnaire score (XQS) and a test for the salivary flow rates (unstimulated and stimulated: USFR and SSFR, respectively). The patients were also given a validated LENT SOMA scale (LSS) questionnaire. Evaluations were performed before IMRT and at 1, 3 and 6 months after IMRT.

All 34 patients showed significant changes in the XQS, LSS and Salivary Flow rates (USFR and SSFR) after IMRT. No significant changes in the XQS or LSS were noted in 12 patients who received a total parotid mean dose of 3,100 cGy, significant increases in the XQS and LSS were observed. The USFR and SSFR from the parotid glands in 7 patients who received 2,750 cGy were significantly lower than the baseline values at all times after IMRT.

We suggest that the total parotid mean dose should be limited to

September, 2009|Oral Cancer News|

IsoRay announces Cornell Medical Center adopts Cesium-131 to treat head and neck cancer

Author: press release

IsoRay, Inc. (Amex: ISR) announced today that on August 5, 2009, Dr. Bhupesh Parashar from the Department of Radiation Oncology, Dr. David Kutler of the Department of Otorhinolaryngology, and Dr. Jason Spector of the Department of Plastic Surgery at Weill Cornell Medical Center performed the world’s first Cesium-131 implant for a recurrent head and neck cancer (buccal mucosa).

The implant was performed using Vicryl®-embedded seeds on a 66-year-old patient who had received a full course of radiation to the head and neck several years ago. Cesium-131 was chosen for its short half-life and the higher dose rate. The patient tolerated the implant procedure well, and has had no adverse effects that can be attributed to the use of Cs-131 seeds. There is no evidence of cancer recurrence to date.

Dr. Parashar stated, “We are very pleased to date with this patient’s progress. Having Cs-131 with its combination of short half-life and high energy gave us another option for treating this patient’s recurring buccal mucosa cancer.”

Dr. Dattatreyudu Nori, the Chairman of the Department of Radiation Oncology at Weill Cornell Medical Center, and a pioneer in the field of brachytherapy, performed some of the initial Cesium-131 prostate implants in 2005.

Until now clinical experience with Cesium-131 has been focused on prostate cancer and ocular melanoma. However, Cesium-131 has been cleared by the FDA for use in the treatment of malignant disease (e.g., prostate, ocular melanoma, head and neck, lung, brain, breast, etc.) and may be used in surface, interstitial, and intracavitary applications for tumors with known radiosensitivity.

Dwight Babcock, IsoRay’s CEO, stated, “This is another example supporting our strategy to expand the use of Cesium-131 seeds to a larger population of patients with varying cancers. The use of Cs-131 is a very attractive alternative to other treatment options, and physicians continue to broaden the scope of this isotope for use in minimally invasive treatments.”

About IsoRay
IsoRay, Inc., through its subsidiary, IsoRay Medical, Inc., is the sole producer of the Cesium-131 brachytherapy seed.

The Cesium-131 seed offers a significantly shorter radiation half-life than the two other isotopes commonly used for brachytherapy, which results in a substantially faster delivery of therapeutic radiation, a theoretically improved radiation delivery against aggressively replicating cancer(a), and the potential for a reduced longevity of common brachytherapy side effects(b).

Cesium-131 is currently used in the treatment or prostate cancer(c) and ocular melanoma(d), among other cancerous conditions.

(a) Armpilia CI, Dale RG, Coles IP, et al. The Determination of Radiobiologically Optimized Half-lives for Radionuclides Used in Permanent Brachytherapy Implants. International Journal of Radiation Oncology, Biology, and Physics 2003;55(2):378-385.

(b) DeFoe SG, Beriwal S, Smith R, Benoit R. Is there decreased duration of acute urinary and bowel symptoms after prostate brachytherapy with cesium 131 isotope? International Journal of Radiation Oncology, Biology, and Physics 2008;72(S1):S317.

(c) Bice WS, Prestidge BR, Kurtzman SM, Beriwal S, Moran BJ, Patel RR, Rivard, MJ. Recommendations for permanent prostate brachytherapy with (131)Cs: a consensus report from the cesium advisory group. Brachytherapy 2008;7(4):290-6.

(d) Melhus CS, Rivard MJ. COMS eye plaque brachytherapy dosimetry simulations for 103Pd, 125I, and 131Cs. Medical Physics 2008;35(7):3364-71.

September, 2009|Oral Cancer News|

Tips on managing the rash associated with EGFR inhibitors

Source: OncologySTAT (
Author: OncologySTAT Editorial Team

Nurses at Duke University Hospital in Durham, NC, have developed a treatment algorithm for the rash that frequently occurs with use of epidermal growth factor receptor (EGFR) inhibitors. “We want to help sustain patients so they can continue to get their therapy and maintain their quality of life,” Kimberly Bishop, RN, BSN, OCN, said at the Oncology Nursing Society 34th Annual Congress.

For mild rash that doesn’t affect activities of daily living or quality of life, the algorithm recommends a topical cream—hydrocortisone and/or clindamycin or metronidazole. “At our institution, we use MetroCream [metronidazole cream] as our primary topical agent,” Ms. Bishop said. For moderate rash, an oral antibiotic is added, most commonly doxycycline 100 mg twice daily.

“We reassess [patients] every 2 weeks to see what the rash looks like, and encourage patients to call to let us know if there is a change in the rash,” she said.

Ms. Bishop described the rash as very red, often starting as a macular reaction and progressing to a pustular abscess-like rash that becomes ulcerated. “The rash itself is not infectious but can lead to a secondary superinfection from scratching. That’s why antibiotic therapy is important,” she said.

For severe rash, the recommendation is to hold the EGFR inhibitor therapy and reassess within 1 to 2 weeks, continue with the antibiotic, and also add a Medrol Dosepak (oral methylprednisolone packaged to provide a tapering dose).

Ms. Bishop warned that “any time you put steroid cream on the face, you have to be very careful because it causes thinning of the skin, and the skin on the face is already very thin. That’s why we chose to use the MetroCream and not the steroid cream. When you get to the severe phase, you need systemic therapy to decrease the cytokines that are causing an inflammatory response, and the best way is with the Medrol Dosepak instead of topical steroids.”

Along with the algorithm, nurses are provided with a “tip sheet” that offers patients advice on how to prevent or manage the rash. These tips include staying hydrated (1 to 2 liters of noncaffeinated fluids daily), applying sunscreen of at least SPF 15, using alcohol-free skin creams, and avoiding hot showers, tight-fitting shoes, and going barefoot outside. Ms. Bishop said that women who experience the rash can still wear makeup so long as it is hypoallergenic.

“And obviously you want patients to have the ability to call you if they have increased symptoms or the rash spreads or changes in color. So we include the physician’s number and the after-hours on-call number in the patient’s information sheet,” she said.

When asked about prophylaxis for patients taking EGFR inhibitors, Ms. Bishop pointed to a promising study by Lacouture et al presented at the 2009 ASCO GI Cancers Symposium.

Metastatic colon cancer patients receiving panitumumab (Vectibix) were treated either reactively after skin toxicity developed or preemptively with a regimen of moisturizers, PABA-free sunscreen with SPF of 15 or higher, a topical steroid cream, and doxycycline 100 mg twice daily. With prophylaxis, the incidence of grade 2 or higher skin toxicities was reduced by half (29% for the preemptive group vs 62% for the reactive group).

Also during the ONS Congress, Amgen and ONSEdge, a subsidiary of the society, launched an educational program for oncology nurses about the skin-related side effects of EGFR inhibitors called “Coping with Cancer from the Outside In.” The program booklet includes beauty advice for patients taking EGFR inhibitors from Jan Ping, an Emmy Award-winning make-up artist and cancer survivor. For more information, call ONSEdge at 877-588-3343 or visit the ONSEdge website.

September, 2009|Oral Cancer News|

Brave dad has face rebuilt with bones from own body following cancer fight


Dad Tim Gallego feels like a new man after having his face rebuilt from different parts of his body. Financial adviser Tim, 46, had 16 operations to reshape his face after he was hit with disfiguring mouth cancer. Bones from his ribs and hips were used to form a new nose and jaw. Arteries from his legs were moved to his neck and skin from his wrists was grafted on to his lower face.


The father of three joked yesterday: “I seem to be running out of a supply of body parts. And because of the changes people I know don’t recognise me.

“They just look at me and wonder what happened but the only people who actually come forward to to ask are young children.”

Tim, supported by wife Katie, has now made a full recovery after his eight-year ordeal. He was unable to talk for a year and could not eat or drink for two weeks after one operation. He was first diagnosed when he went to his doctor with sinus problems.

Tests revealed he had a large tumour behind his nose. He underwent a 21-hour operation and his head ballooned to the size of a basketball.

Months of radiotherapy followed before he started the long process of rebuilding his face bit by bit. And within a week of being diagnosed Katie found out she was pregnant with their first child, Imogen.

Tim, from Poundbury, Dorset, said: “I looked like a monster but I’ve always been positive and believed I’d get back to normal. It’s just that normal has ended up being a bit different.”

“The radiotherapy made me feel sick as a dog. “But I was just so determined at that stage to
be well enough to look after Imogen.”

He added: “It was only when I was well enough that I could actually understand just how sick I was, if that makes any sense.”

September, 2009|Oral Cancer News|

Speaking and swallowing seems to be possible post tonsil cancer surgery

Author: staff

Cancer of the tonsil is said to be one among the head and neck cancers. It apparently develops in the part of the throat just behind your mouth, called the oropharynx. Smoking and consuming alcohol may increase the risk for tonsil cancer.

After a tonsil cancer surgery, it is believed that patients cannot speak or eat properly. But a new method for reconstructing the palate post surgery for tonsil cancer apparently preserved the capability of the patients to speak clearly and devour majority of the foods. This technique was developed at the University of Michigan Comprehensive Cancer Center.

Tonsil cancer apparently develops in the back of the throat, which could mean that surgery could contain parts of the palate, the tongue and the jaw. In conventional reconstruction efforts, a huge round piece of tissue was apparently taken to plug the hole left when the tumor is supposedly detached. But this apparently damages the way the palate and tongue function, and may not reinstate the intricate mechanism of the throat that may enable an individual to speak and swallow.

Study author Douglas Chepeha, M.D., M.S.P.H., associate professor of otolaryngology head and neck surgery and director of the microvascular program at the University of Michigan Health System, commented, “This is the area that triggers swallowing, that separates the mouth from the nasal cavity. It affects speech and eating – typically, patients have difficulty eating when they have this kind of tumor and undergo surgery. We can remove the cancer, but there are major quality of life issues.”

With the new method, surgeons first formed a tube from the rest of the palate by joining the palate to the back part of the throat, next to where the tumor was detached. This tube may isolate the mouth from the nasal cavity and shuts at the time of swallowing, thereby letting patients eat and speak.

Then the surgeons apparently stitch up the defect in the base of the tongue to detach the tongue from the rest of the reconstruction. This may ensure that the tongue could shift, which supposedly enhances swallowing and speech. The form of the left over defect is apparently uneven, so a pattern is supposedly planned for using transplanted tissue to fill in any other holes left by the surgery.

The tissue used in the reconstruction is claimed to be a transplant from the arm or a different part of the patient’s own body. L-shaped patterns, akin to dress patterns, might aid the surgeon to find the size and shape of the skin tissue they may eliminate for transplant.

About 25 patients with tonsil cancer were analyzed by the study. Apparently based on how much palate was removed during the surgery, the patients were thus grouped. For instance, more than half or less than half was apparently removed by the surgery. For an average of five years post surgery, the patients were apparently followed.

Both groups apparently accounted for some issues with speech. Patients who had more than half their palate removed supposedly ate less and also informed about a few limitations to eating out in public. It was seen that in both the groups, the emotional scores appeared to be high. This apparently proposed overall satisfaction with their lives.

Chepeha commented, “In particular, patients who have less than half their palate removed do very well with this reconstruction. We’re trying to make sure the remaining tongue and palate they have really work. Our goal is to get patients eating in public and back to work.”

In recent years due to HPV, or human papillomavirus, the virus that is claimed to be associated with cervical cancer, the amount of tonsil cancers diagnosed has apparently increased quite a bit.

This technique has been described in the Archives of Otolaryngology .

September, 2009|Oral Cancer News|

Lilly Erbitux cancer drug not worth price, U.S. scientists say

Author: Lisa Rapaport

Eli Lilly & Co.’s tumor-fighter Erbitux doesn’t prolong lung cancer patients’ lives enough to justify its $80,000 cost, U.S. scientists said in commentary published today.

Erbitux added to other cancer drugs extends survival about 1.2 months more than chemotherapy alone, making the price too high for a “marginal benefit,” commentary in the Journal of the National Cancer Institute said. Erbitux, which Lilly markets with Bristol-Myers Squibb Co., generated $1.3 billion last year as treatment approved for other malignancies.

The high price of some of the newest cancer medicines are coming under scrutiny as part of an effort by lawmakers and health officials to rein in overall medical costs. President Barack Obama has set aside $1.1 billion in the U.S. economic stimulus bill to study the comparative effectiveness of treatments for cancer and other diseases.

“We must avoid the temptation to tell a patient that a new drug is available if there is little evidence that it will work better than established drugs that could be offered at a miniscule fraction of the cost,” wrote the commentators, Tito Fojo with the National Cancer Institute and Christine Grady at the National Institutes of Health.

Lilly, of Indianapolis, and marketing partner Bristol- Myers, of New York, withdrew an application to extend the Erbitux’s use to lung tumors in February after the Food and Drug Administration questioned differences in American and European versions of the treatment.

$10,000 a Month

The authors projected that Erbitux costs $80,000 based on a typical course of treatment for lung tumors, 18 weeks. If all 550,000 U.S. patients who die of cancer each year took 12 months of Erbitux, the total cost would be $440 billion, 100 times the annual budget of the National Cancer Institute, the authors said.

Bristol-Myers estimated Erbitux’s cost to be lower, at about $10,000 a month, according to company spokesman Brian Henry. The drug is approved to treat head, neck and colon cancer. A Lilly spokeswoman referred questions to Bristol-Myers.

“Erbitux isn’t indicated for all cancer patients, nor would all cancer patients for which Erbitux is indicated necessarily receive the medicine for one year,” Henry said in an e-mailed statement.

Lilly gained Erbitux in its $6.5 billion purchase of ImClone Systems Inc. last year. German drugmaker Merck KGaA markets Erbitux outside the U.S.

Cancer medicines are the best-selling and fastest-growing group of drugs in the U.S., and sales will surge 12 to 15 percent each year to top $75 billion by 2012, according to IMS Health Inc., a pharmaceutical industry research company in Norwalk, Connecticut.

About 220,000 people will be diagnosed with lung cancer in the U.S. this year, and 160,000 will die, according to the National Cancer Institute.

September, 2009|Oral Cancer News|

New tool helps dentists detect oral cancer

Author: Ashante Blaize


Nationwide, an average of one person dies every hour from oral cancer, which is called a silent killer because it is difficult to detect and advances quickly, a Plano dentist said.

Just two short months ago, Janet Kiser’s relationship with her dentist, Dr. Frank Rabinowitz, changed. He’s now more than just a D.D.S. to Kiser. After he detected a tumor growing inside the roof of her mouth, Kiser calls him a lifesaver.

“The description of people who would typically have that kind of tumor was someone who chewed tobacco, or smoked a pipe, or at least smoked something,” said Kiser.

Kiser said she didn’t do any of those things. The fear was she could have oral cancer.

“Its a very invasive cancer. It’s very fast growing and it’s not always looked for,” said Rabinowitz.
Thanks to a new device called VELscope, Rabinowitz was able to take a more in depth look at Kiser’s growth.

“We got it and then we called Janet and asked her to come in, if I could look at her growth in her mouth with the VELscope,” said Rabinowitz. “We are looking for tissues that may have changed.”
After using the device’s ultraviolet light, Rabinowitz was able to pin point the size and growth of the tumor, take a picture of it, and send it to the oral surgeon who would remove Kiser’s tumor.

“The surgeon told me that he could actually see better margins and determine how much of the tumor he needed to remove,” said Kiser.

The VELscope costs about $7,000 and the scope itself weighs less than a pound. The scanning process takes about 2 to 3 minutes for a dentist to complete.

For Kiser VELscope is a portable device she’s thrilled her dentist invested in. The return is good health and a little peace of mind.

“My whole family comes here,” she said. “We’ll all get that check every year.”

Insurance does not cover the use of the VELscope, but Rabinowitz said they only charge their patients $35 per scan. He suggested patients get a VELscope scan once a year.

September, 2009|Oral Cancer News|

37% of U.S. teen girls got HPV vaccine

Author: Daniel J. DeNoon

More than one in three U.S. teen girls has had at least one shot of Gardasil, a CDC survey shows, but only 18% of girls got the three shots needed for protection.

The survey includes girls vaccinated through 2008, two years after Gardasil’s approval. A second HPV vaccine, GlaxoSmithKline’s Cervarix, is expected to be approved this year.

Gardasil, from Merck, protects against the four strains of the sexually transmitted human papillomavirus (HPV) that cause most cases of cervical cancer and genital warts. But other HPV strains also cause these diseases, so even vaccinated women still need regular Pap exams.

Gardasil’s acceptance varied widely by state. More than half of all teen girls aged 13 to 17 had at least one shot of the HPV vaccine in six states: Arizona, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont.

Fewer than one in five girls got the vaccine in three states: Georgia, Mississippi, and South Carolina.

Coverage was highest in Rhode Island (54.7%) and New Hampshire (54.4%) and lowest in Mississippi (15.8%) and Georgia (18.5%).

Cervical cancer is more common in women of Hispanic descent and in people living below the poverty level. Perhaps because the Vaccines for Children (VFC) program provides the expensive vaccine to uninsured children, girls in these groups had higher rates of coverage than other girls.

The CDC reported results of the survey in today’s issue of Morbidity and Mortality Weekly Report.

MMWR, Sept. 17, 2009; vol 58: pp 997-1001.

September, 2009|Oral Cancer News|

Port Coquitlam dentist hopes to save a life with a Velscope

Author: Diane Strandberg

A Port Coquitlam dentist is offering to do more than fix cavities and polish teeth. Dr. Glenn Keryluk wants to save a life.

He’s purchased an oral cancer screening device he expects will shortly become standard equipment in all dentist offices and he is offering to screen patients referred to by local doctors.

“It’s the latest and greatest in cancer detection,” Keryluk says of the Velscope, a hand-held device that shines a blue light on oral lesions that could be cancerous.

Manufactured by a White Rock-based company, the Velscope can show abnormal tissue below the surface, even before it becomes apparent to the clinicians’ eye. Healthy tissue glows green under the light but cancerous tissue looks black. Being able to detect oral cancer early is key to surviving the disease because the longer the cancer is around the more likely it will spread to nearby organs.

Keryluk held a free screening day for patients at his office at 2099 Lougheed Highway recently and is cutting standard fees for the procedure or waving them entirely for people without dental coverage. The procedure is painless, takes only a few minutes and a photograph of the lesion taken by the machine can be sent to a physician for follow-up.

“If you catch it early it could be that a person’s life is saved. I just want people to be aware of the technology out there,” Keryluk said.

He’s only seen two cases of oral cancer in 20 years as a dentist but the Velscope may increase his chances of spotting the disease.

Oral cancer is more common in men than women and age, tobacco use and heavy drinking are risks. But Keryluk said younger people have been diagnosed with oral cancer and the disease is on the rise. Human papillomavirus associated with cervical cancer has also been linked to oral cancer so it’s not just a disease of older people who drink and smoke.

“The day I save somebody’s life for early detection, I’ll give you a call,” Keryluk said.

September, 2009|Oral Cancer News|

Identification of highly radiosensitive patients may lead to side effect-free radiotherapy

Author: staff

An international group of scientists has taken the first step on the road to targeting radiotherapy dosage to individual patients by means of their genetic characteristics, a radiation oncologist told Europe’s largest cancer congress, ECCO 15 – ESMO 34, in Berlin today. Professor Dirk de Ruysscher, from Maastricht University Medical Centre, Maastricht, The Netherlands, said that his team’s work might provide the basis for personalised radiotherapy in which, with a simple blood test, doctors may be able to select the optimal radiation dose for a particular patient.

The team of scientists from The Netherlands, Belgium, Germany, and Canada studied a group of patients with hypersensitivity to radiation therapy, drawn from the largest world-wide database available – the European Union-funded Genetic pathways for the prediction of the effect of irradiation (GENEPI) study, which integrates biological material with patient data and treatment specifications. The database included information from more than 8000 European patients.
“Part of this project is the establishment of a sub-database in which very rare patient characteristics are brought together with the hypothesis that their genetic traits will enable the characterisation of molecular pathways related to radio-sensitivity,” explained Professor de Ruysscher. “A major problem for radiation oncologists at present is that we are bound by the need to avoid damage to normal tissues. This means that the dose of radiation generally used is governed by the response of the most radiosensitive patients, and this may lead to many patients receiving lower than optimal doses, hence affecting the ability to deliver a higher dose that may result in better local tumour control.”

A tissue bank including skin fibroblasts (the structural framework of skin cells), whole blood, lymphocytes (white blood cells involved in the immune system), plasma, and lymphoblastic (immature lymphocyte) cell lines from patients who were known to be hypersensitive to radiation was established from patients in Europe and Canada.

When compared with a control group, also drawn from the GENEPI study, the hypersensitive patients showed either severe side effects occurring at very low radiation levels, or severe side effects lasting for more than four weeks after the end of radiotherapy and/or requiring surgery, or severe late side effects occurring or persisting more than 90 days after the end of radiotherapy.

The scientists identified 33 such patients, 10 males and 23 females, of whom 11 (two males and nine females) ultimately proved to be really hypersensitive to radiation, underlining the rarity of this condition. Their mean age was 61.6 plus or minus 8.5 years (range 49 – 74). One patient had non-small cell lung cancer, six breast cancer, two head and neck cancer and one lymphoma. The radiation doses, the overall treatment times, and the follow-up times all fell within the usual parameters.

“The severe side effects included acute skin reactions, extreme skin thickening or fibrosis, lung tissue inflammation and blindness due to optical nerve damage,” said Professor de Ruysscher. “Although radiotherapy is a highly effective way of treating cancer, it is important that we are able to identify the patients who will react badly to it and adjust their dosage accordingly.”

Radiotherapy works by causing DNA damage in cells in a particular area so that they destroy themselves. Because cancer cells reproduce more and are undifferentiated (lacking the ability to become a more specialised cell type), they are less able to repair the damage caused by radiotherapy than are differentiated, normal cells which can usually repair themselves. However, some of the normal cells surrounding the treatment site may also be damaged during radiotherapy, and it is this damage that leads to side effects.

Scientists already know that different types of tumours respond differently to radiotherapy; highly radiosensitive cancer cells such as leukaemias can be killed by quite low radiation doses, whereas melanomas need such a high dose that it would be unsafe to use radiation therapy in this case. The finding that individuals, as well as tumours, react differently will enable doctors in the future to target doses even more carefully, taking into account not just the radiosensitivity of the tumour type but also the potential reaction of the particular patient to treatment.

“We hope that the EU will fund a successor project to elucidate genetic pathways in combination with other patient data so that we can make predictive models that can be implemented in standard clinical practice,” said Professor de Ruysscher. “We believe that, if we can understand what it is going on at a molecular level, we may be able to develop a blood test that will allow us to know precisely how an individual patient will react to radiotherapy, and to target the dose accordingly. Such personalised treatment will be a major advance, allowing us to minimise both radiotherapy doses and unpleasant side effects, while treating the tumour in the most effective way possible. Perhaps even more importantly, it will enable us to give higher doses to many patients and hence improve control of their tumours.”

September, 2009|Oral Cancer News|