ASCO 2020: New optimized precision radiotherapy can reduce swallowing difficulties for head and neck cancer patients

Source: Author: staff A new optimized intensity-modulated radiation therapy (IMRT) pioneered at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, has been shown to spare head and neck cancer patients’ adverse life-long side effects post treatment. The initial results from the Dysphagia-Aspiration Related Structures (DARS) trial, funded by Cancer Research UK and the National Institute for Health Research, were presented at the American Society for Clinical Oncology (ASCO) virtual conference this week. The randomized study found patients with head and neck cancer experienced less adverse side effects with the new precision radiotherapy technique optimized to reduce the risk of swallowing difficulties, known as dysphagia. Half of newly diagnosed patients with oropharyngeal and hypopharyngeal cancers (tumors of the throat) recruited to the trial received standard IMRT radiotherapy and the other half received IMRT optimized to reduce the radiation dose to the structures related to swallowing and breathing. The trial recruited 112 patients across 23 UK cancer centres. Difficulties eating and drinking Patients with head and neck cancer have a 90 percent survival rate but can be left with life changing side effects including swallowing problems, making it difficult to eat and drink. The self-reported measure of swallowing ability as perceived by patients themselves was better in the optimised IMRT group. Twelve months after treatment, 40 percent of patients given the optimized form of precision radiotherapy reported their swallowing was as good as ever in comparison to just 15 percent on the standard treatment. The DARS [...]

Sentinel node biopsy proves mettle in H&N cancer

Source: Author: Ed Susman, Contributing Writer, MedPage Today Sentinel node biopsy achieved "oncological equivalence" with neck dissection in patients with operable T1-T2N0 oral and oropharyngeal cancer, researchers reported. In a head-to-head trial, the 2-year neck-relapse free survival (RFS) was 90.7% in the sentinel node (SN) biopsy group versus 89.4% in the neck dissection group, according to Renaud Garrel, MD, PhD, of Montpellier University Hospital Center in France. That 1.1% difference fell well within the pre-specified 10% difference to determine if there was non-inferiority of SN biopsy to neck dissection, which is considered the standard of care for treatment of early stage head and neck cancers (P=0.008 for equivalence), he reported at the American Society of Clinical Oncology virtual meeting. At 5 years, 89.4% of the SN biopsy group achieved neck-RFS versus 89.6% in the neck dissection group, he said in a pre-recorded oral presentation on the Senti-MER study. Overall, there were 14 neck recurrences in 139 patients in the neck dissection group and 13 neck recurrences in 120 patients in the SN biopsy group. Also, overall survival was 82.2% in the SN biopsy group and 81.8% in the neck dissection group. Hisham Mehanna, MBChB, PhD, of the University of Birmingham and the Warwickshire Head and Neck Clinic in England, commented that "Elective neck dissection is the standard, especially for oral cancer. Sentinel node biopsy is an accepted technique as there have been large series that show benefit, but there has never been a head-to-head study with the standard of [...]

Less intense treatment safe for HPV+ throat cancer

Source: Author: public release, University of Pittsburgh School of Medicine A less intense treatment for human papillomavirus positive (HPV+) throat cancer—using robotic surgery followed by low-dose radiation—could provide as much benefit as standard higher-dose radiation and chemotherapy while preserving a patient’s throat function, and with potentially less toxicities, according to researchers at UPMC Hillman Cancer Center and Yale Cancer Center. The results of their randomized phase two clinical trial will be presented virtually this week at the American Society of Clinical Oncology (ASCO) annual meeting during the Head and Neck Oral Abstract Session (Abstract 6500). “These results present a promising deintensification approach that has proven to be safe in patients with intermediate risk, locally advanced oropharynx cancer,” said Robert Ferris, M.D., Ph.D., director, UPMC Hillman Cancer Center and a surgical oncologist specializing in head and neck cancer, who was lead investigator of the trial. The results are not yet published in a peer-reviewed journal. About 60% of oropharynx cancer, in which cancer cells form in the back of the throat, base of the tongue and tonsils, is associated with HPV infection. The incidence has been increasing in recent years, especially in individuals under the age of 45. Following robotic surgery, patients with HPV-associated throat cancer would typically undergo high dose radiation and chemotherapy. While robotic surgery allows for more precise and optimal preservation of the organs and surrounding tissue, there is still concern with the toxicities from the chemotherapy and consequences of tissue damage from radiation therapy, particularly in [...]

Vaping e-cigarettes could increase the risk of oral disease, study finds

Source: Author: staff New American research has found that individuals who use e-cigarettes could be at risk of developing oral diseases in the future, which could range from gum disease to cancer. Carried out by researchers at The Ohio State University, the new study looked at a group of 123 people with no signs of oral disease. The group included 25 smokers, 25 non-smokers, 20 e-cigarette users, 25 former tobacco smokers who used e-cigarettes and 28 people who smoked both tobacco cigarettes and e-cigarettes. The team collected plaque samples taken from under the gums of the participants to analyze the bacteria in this part of the mouth; bacteria here is the last line of defense against disease as it is the least likely to be disrupted by environmental changes in the mouth, such as food, toothpaste and tobacco. The researchers then carried out DNA deep sequencing of the bacteria’s genomes to identify what types of microbes were living in participants’ mouths and what their functions were. The findings, published in the journal Science Advances, showed that although the e-cigarette users didn’t have signs of active disease, their oral bacteria composition was similar to that of people with severe periodontitis, a severe gum infection that can lead to health problems such as tooth loss, and, if left untreated, is a risk factor for serious conditions such as heart and lung disease. The effect of e-cigarette smoking was also seen with or without nicotine, which the researchers say suggests that it [...]

Deintensification of Treatment in HPV-Associated Cancers Holds Promise, But With Caveats

Source: Targeted Oncology Date: May 17th, 2020 Author: Tony Berberabe   De-escalating therapy has the potential to dramatically reshape the treatment of patients with HPV-associated oropharyngeal cancers, but only if a number of key trials come back with positive long-term data with 3 cycles of cisplatin at 100 mg/m2 times 3, given every 3 weeks, Sue Yom, MD, PhD, a professor in the Departments of Radiation Oncology and Otolaryngology-Head and Neck Surgery atthe University of California, San Francisco, said in an interview with Targeted Therapies in Oncology (TTO). Sure, there were some minor variations over the years, small alterations made on a case-by-case basis. “But long story short, that’s fundamentally what was happening: 70 Gy with 3 cycles of high-dose cisplatin,” Yom said. The story began to change a little over a decade ago, with the introduction of a variable that could potentially change the course of therapy for a large percentage of patients with head and neck cancers. Today, the operative word remains potentially. In 2008, Maura L. Gillison, MD, PhD, of Johns Hopkins University, and colleagues found that whether head and neck squamous cell carcinoma tumors were associated with the human papillomavirus (HPV) turned out to be a major prognostic indicator.1 “When that finally came to be reported, there was a very, very striking result,” said Barbara Burtness, MD, a professor of medicine (medical oncology), Disease-Aligned Research Team leader of the Head and Neck Cancers Program, and coleader of Developmental Therapeutics at Yale Cancer Center in New Haven, [...]

2020-05-26T12:41:45-07:00May, 2020|Oral Cancer News|

An Occult HPV-Driven Oropharyngeal Squamous Cell Carcinoma Discovered Through a Saliva Test

Source: Frontiers in Oncology Date: March 31st, 2020 Authors: Kai Dun Tang, Sarju Vasani, Touraj Taheri, Laurence J. Walsh, Brett G. M. Hughes, Lizbeth Kenny, and Chamindie Punyadeera Oropharyngeal cancer (OPC) caused by human papillomavirus (HPV) is a rising global concern. Early lesions are small and are often located in difficult to access areas (such as the crypts of the tonsils or base of tongue). Unlike cervical cancer, there is no standard or routine screening program for HPV-driven OPC. HPV DNA from OPC tumors may shed directly into saliva, and this can be used as a biomarker for early diagnosis. In this study, we report the first-ever clinically occult OPC in an asymptomatic patient discovered through a saliva test. This case relied upon serial measurements of HPV-16 DNA in saliva, which fell to undetectable levels following low morbidity, curative treatment. Introduction The incidence of high-risk human papillomavirus (HR-HPV−16,-18,-33) driven oropharyngeal cancer (OPC) is rapidly increasing in developed countries (1–3). HPV-driven OPCs have surpassed cervical cancer as the most common HPV-driven cancer in the USA. The prevalence of HR-HPV has been reported as 3.7% of the USA population, with a bimodal age distribution of incidence (4). It remains unclear why some individuals go on to develop OPC, while others clear the initial HPV infection (5). The strong association between HR-HPV infection and cervical cancer has led to screening programmes in primary healthcare settings, resulting in earlier diagnosis and a reduction in cancer deaths (6). Unlike cervical cancer, no screening test is [...]

2020-05-26T11:07:07-07:00May, 2020|Oral Cancer News|

Revealed: How cancer unit kept theatres open and saved lives despite coronavirus lockdown

Source: Author: Janet Boyle Patients with head and neck malignancies have continued to get vital surgery at Queen Elizabeth University Hospital in Glasgow under strict infection vigilance set up by its maxillofacial surgery unit. More than 40 patients have been treated for head and neck ­cancer during lockdown. Others have undergone procedures for facial skin cancer and facial injuries. The Royal College of Surgeons Edinburgh says 87% of its members in cancer surgery had stopped operating altogether or significantly reduced the number of procedures due to the danger of patients contracting the virus. And experts fear deaths from cancer could rise by a fifth over the next year as a result of scores of treatments and consultations being cancelled. Now it is hoped the protocols ­followed by the Glasgow team can be adopted to allow more surgery to resume. Critical to the safety of the operations is that the patients are tested for coronavirus twice before the procedure – once 48 hours beforehand, and then again immediately before surgery begins. Patients are also asked to ­self-isolate for two weeks before surgery, the surgical team works in a separate building to the main hospital and some surgical techniques have been modified to reduce the risk of infection. Operating on head and neck malignancies poses considerable risk to theatre teams because the work is closely associated with patients’ faces and respiratory systems, making the virus easily transmissible. Further risk lies in the head and neck surgeon having to abandon a face [...]

Study: Regular drinkers can curb chance of getting alcohol related diseases with exercise

Source: Author: Richard Percival The scientists revealed that heavier drinkers needed to produce greater physical output to offset other deadly diseases associated with drink. Meanwhile, people who recently gave up alcohol could also reduce their chances of getting sick if they exercised more too. Researchers from the University of Sydney used data from participants aged 30 years and over in ten British population-based health surveys. They then compared this with death rates of alcohol-related cancers which included oral cavity, throat, larynx, oesophagus, liver, colorectal, stomach and additionally pancreas and lung Using models, they discovered a strong direct association between alcohol consumption and mortality risk of alcohol-related cancers, with a significantly higher risk among ex-drinkers. They discovered people who drank excessive amounts of alcohol every week (more than 14 units for women and 21 for men) but who did at least seven hours of exercise were less likely to die from these cancers. The study published in the International Study of Cancer last week added: “Engaging in a recommended level of physical activity attenuated the negative effects of alcohol consumption on alcohol-related cancer mortality. “This provides valuable evidence of the potential of promoting physical activity as an adjunct risk minimisation measure for alcohol-related cancer prevention.” It is the first time analysts have looked at the link between exercise and surviving cancers linked with alcohol. Anne McTiernan, a cancer prevention expert at the Fred Hutchinson Cancer Research Centre, said that the evidence between exercise and alcohol “was clear”.

A new tool to predict delays in post-surgical radiotherapy for head and neck cancer

Source: Author: Medical University of South Carolina news release More than 65,000 Americans are diagnosed annually with head and neck cancer, which most often occurs inside the mouth and throat. For patients who undergo surgery to treat this cancer, guidelines recommend that prompt initiation of radiotherapy -- within six weeks -- is critical for best outcomes. Unfortunately, delays in initiating post-operative radiotherapy (PORT) are far too common. Patients do not always understand the importance of prompt initiation of radiotherapy and may have to overcome other barriers, such as lack of social support and insurance. In addition, health care providers do not always communicate with one another or coordinate care. These avoidable delays have a negative impact on outcomes in a disease that claims almost 15,000 lives in the U.S. each year. To ameliorate this crisis, a research team at the Medical University of South Carolina has developed and validated tools known as nomograms to help predict treatment delays in high-risk patients based on individualized risk factors. The team was led by Evan Graboyes, M.D., an assistant professor in the Department of Otolaryngology-Head & Neck Surgery at MUSC and a member of the Cancer Control Program at Hollings Cancer Center. The results of the nomogram study were reported in JAMA Otolaryngology-Head & Neck Surgery. "A nomogram is a graphical representation of a mathematical model that we are using to predict how likely it is that a patient with head and neck cancer may have a treatment delay," explained Graboyes. "We [...]

World-first saliva test detects hidden throat cancer

Source: Author: staff A simple saliva test developed by Queensland University of Technology (QUT) biomedical scientists has detected early throat cancer in a person who had no symptoms, and no clinical signs of cancer. QUT researchers Associate Professor Chamindie Punyadeera and Dr Kai Tang. A series of saliva HPV tests detected an asymptomatic throat cancer during a trial of a new saliva diagnostic Further validation studies are needed to confirm this finding It is a world-first discovery, previously there was no screening test for HPV-DNA oropharyngeal cancers The patient had surgery in which a 2mm cancer was removed and has had no recurrence of HPV-DNA in his saliva. In what is believed to be a world-first, the non-invasive test picked up HPV-DNA in a saliva sample from an infected healthy person. Persistent human papillomavirus (HPV) infection is now the leading cause of cancers in the oropharynx (tonsils and tongue base area of the throat). “The series of saliva tests raised the alert and detected an early cancer before the person had any symptoms,” said QUT Faculty of Health’s Associate Professor Chamindie Punyadeera, who, with Dr Kai Tang developed the test. “This enabled removal of the tonsil which had a 2mm cancer in it, by straightforward local surgery alone. “The incidence of high-risk human papillomavirus (HPV)-driven throat cancers is on the rise in developed countries and, unfortunately, it is often discovered only when it more advanced, with patients needing complicated and highly impactful treatment. “In the US, HPV-driven throat cancers [...]

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