10/28/2006 Pennsylvania, PA Matthew T Moyer et al. Gastrointest Endosc, November 1, 2006; 64(5): 789-792 BACKGROUND: Esophageal occlusion is typically caused by cancer or postradiation changes; it is difficult to treat, with poor surgical outcomes. The combined antegrade retrograde dilation (CARD) method has been used to endoscopically restore the esophageal lumen after complete occlusion by cancer or postradiation changes, with good preliminary results. Reproducing this technique and improving its speed and convenience would be advances in treating this difficult clinical problem. Objective: A demonstration of 2 alternative endoscopic techniques for treating complete esophageal obstructions. Design: The CARD method was performed in 2 patients with unresectable cancer and complete esophageal occlusion. In the first patient, a needle knife was used to cut through the obstruction, instead of removing it piecemeal with biopsy forceps before over-the-wire dilation. In the second patient, an EUS needle was used to cross a particularly long obstruction, which allowed subsequent dilation and recanalization. Setting: A tertiary referral center. Patients: Two patients with complete esophageal obstruction secondary to head and neck cancer, with associated radiation therapy. Results: In both cases, this method resulted in successful recanalization of the occluded lumen in a relatively short amount of time, without complications. Limitations: The small number of patients in this series. Conclusions: The CARD needle-knife method may be a safe, effective, and efficient approach to complete esophageal occlusion. In addition, the CARD-EUS needle method may be an preferable technique to cross long obstructions quickly; however, more experience will be required. Authors: [...]

10/28/2006 Belgium D Dequanter et al. Acta Otolaryngol, December 1, 2006; 126(11): 1225-8 Background: We retrospectively reviewed the outcome of 28 patients with N2-N3 disease treated initially with chemotherapy and radiotherapy. Patients and methods: A neck dissection was performed for all patients with residual disease in the neck. Results: A CCRR in the neck was achieved in 25 of 28 patients. The remaining three patients with residual neck mass underwent a salvage neck dissection: the pathological examination confirmed the persistence of tumoral disease. No regional failure was observed in these three patients. In 25 patients considered to have CCRR in the neck, 5 patients (20%) developed regional recurrence. Successful salvage approach was not possible for any of these patients. Conclusion: A complete clinical and radiological response observed following chemotherapy and radiotherapy is not predictive of the absence of residual disease. Moreover, salvage neck surgery does not always seem to be an effective strategy. Consequently, early neck dissection should be advised for patients with complete clinical and radiological response (CCRR) after chemoradiotherapy for tumors with N2-N3 disease. Authors: D Dequanter, P Lothaire, A Awada, Y Lalami, T Hien Nguyen, M Lemort, L Vandevelde, and G Andry Authors' affiliation: Institut Jules Bordet, Bruxelles, Belgium.

10/28/2006 Seoul, Korea HY Kim et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, November 1, 2006; 102(5): 625-31 Objectives: To assess knowledge of oral and pharyngeal cancer (OPC) clinical signs and risk factors, the association between the risk factors and OPC, and the experience with OPC screening between newly diagnosed OPC patients and controls among a population of veterans in North Carolina. Study Design: A case-control study with 31 OPC cases and 30 frequency-matched controls recruited from 2003 to 2004. Bivariate analysis using chi-square statistics and multivariate logistic regression was implemented to estimate the association with OPC. Results: Only 34% of respondents knew 1 clinical sign and 4 or 5 risk factors for OPC. The lifetime accumulation of tobacco had a significant relationship with OPC (>20 pack-years; OR, 3.2; 95% CI, 1.01-10.3). Many respondents had not had an oral cancer examination within 3 years, mostly through ignorance. Most VA OPC patients were diagnosed by physicians, rather than by dentists. Conclusions: A considerable knowledge deficit on OPC was found among North Carolina veterans. Use of tobacco was a risk factor for OPC in this population. Authors: HY Kim, JR Elter, TG Francis, and LL Patton Authors' affiliation: Dental Research Institute, Seoul National University, Seoul, Korea

10/28/2006 Philadelphia, PA Amy F Ziober et al. Clin. Cancer Res., October 15, 2006; 12(20): 5960-5971 Purpose: Oral cancer is a major health problem worldwide and in the U.S. The 5-year survival rate for oral cancer has not improved significantly over the past 20 years and remains at approximately 50%. Patients diagnosed at an early stage of the disease typically have an 80% chance for cure and functional outcome, however, most patients are identified when the cancer is advanced. Thus, a convenient and an accurate way to detect oral cancer early will decrease patient morbidity and mortality. The ability to noninvasively monitor oral cancer onset, progression, and treatment outcomes requires two prerequisites: identification of specific biomarkers for oral cancers as well as noninvasive access to and monitoring of these biomarkers that could be conducted at the point of care (i.e., practitioner's or dentist's office) by minimally trained personnel. Experimental Design: Here, we show that DNA microarray gene expression profiling of matched tumor and normal specimens can identify distinct anatomic site expression patterns and a highly significant gene signature distinguishing normal from oral squamous cell carcinoma (OSCC) tissue. Results: Using a supervised learning algorithm, we generated a 25-gene signature for OSCC that can classify normal and OSCC specimens. This 25-gene molecular predictor was 96% accurate on cross-validation, averaging 87% accuracy using three independent validation test sets and failing to predict non-oral tumors. Conclusion: Identification and validation of this tissue-specific 25-gene molecular predictor in this report is our first step towards developing [...]

10/28/2006 Seattle, WA JC Kois and E Truelove Dent Today, October 1, 2006; 25(10): 94, 96-7 The VELscope is an important aid in patient assessment, and when added to a well-thought out clinical assessment process that takes into consideration the age of the patient and risk factors that include tobacco, alcohol, and immunologic status, it increases the clinician's ability to detect oral changes that may represent premalignant or malignant cellular transformation. False positive findings are possible in the presence of highly inflamed lesions, and it is possible that use of the scope alone may result in failure to detect regions of dysplasia, but it has been our experience that use of the VELscope improves clinical decision making about the nature of oral lesions and aids in decisions to biopsy regions of concern. Where tissue changes are generalized or cover significant areas of the mouth, use of the scope has allowed us to identify the best region for biopsy. As with all clinical diagnostic activities, no single system or process is enough, and all clinicians are advised to use good clinical practice to assess patients and to recall and biopsy lesions that do not resolve within a predetermined time frame. Lesions that are VELscope-positive and absorb light need to be followed with particular caution, and if they do not resolve within a 2-week period, then further assessment and biopsy are generally advised. It is much better to occasionally sample tissue that turns out to be benign than to fail to diagnose [...]

10/25/2006 Philadelphia, PA Amy F. Ziober et al Clinical Cancer Research Vol. 12, 5960-5971, October 15, 2006 Purpose: Oral cancer is a major health problem worldwide and in the U.S. The 5-year survival rate for oral cancer has not improved significantly over the past 20 years and remains at 50%. Patients diagnosed at an early stage of the disease typically have an 80% chance for cure and functional outcome, however, most patients are identified when the cancer is advanced. Thus, a convenient and an accurate way to detect oral cancer early will decrease patient morbidity and mortality. The ability to noninvasively monitor oral cancer onset, progression, and treatment outcomes requires two prerequisites: identification of specific biomarkers for oral cancers as well as noninvasive access to and monitoring of these biomarkers that could be conducted at the point of care (i.e., practitioner's or dentist's office) by minimally trained personnel. Experimental Design: Here, we show that DNA microarray gene expression profiling of matched tumor and normal specimens can identify distinct anatomic site expression patterns and a highly significant gene signature distinguishing normal from oral squamous cell carcinoma (OSCC) tissue. Results: Using a supervised learning algorithm, we generated a 25-gene signature for OSCC that can classify normal and OSCC specimens. This 25-gene molecular predictor was 96% accurate on cross-validation, averaging 87% accuracy using three independent validation test sets and failing to predict non–oral tumors. Conclusion: Identification and validation of this tissue-specific 25-gene molecular predictor in this report is our first step towards developing [...]

10/24/2006 Marietta, GA Will Boggs, MD CancerPage.com Blacks under 20 years face higher rates of nasopharyngeal carcinoma (NPC) than do whites and even Asians, according to a report in the October Archives of Otolaryngology--Head and Neck Surgery. "NPC in the U.S. is not a disease affecting only Asians," Luke M. Richey from University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina told Reuters Health. "NPC is a relatively rare neoplasm, and in younger age groups, it occurs in blacks at a rate more than twice that of whites." Richey and colleagues used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry to investigate incidence and survival rates for cases of NPC in blacks, whites, and Asians younger than 30 years between 1973 and 2002. Among individuals under age 20 years, NPC incidence rates ranged from 1.61 per million for blacks to 0.95 per million for Asians and 0.61 per million for whites, the authors report. In the age 20 to 29 group, incidence rates were much higher for Asians (7.18/million) than for blacks (1.87/million) and whites (0.96/million), the results indicate. Survival rates in younger patients diagnosed with NPC did not differ significantly among blacks, whites, and Asians, the report indicates. "The higher incidence of NPC in young blacks in the U.S. has multiple causes," Richey said. "Genetic and/or environmental factors lead to cellular or immune alterations, which in the setting of EBV viral infection, give rise to NPC." "As we [...]

10/24/2006 Raleigh, NC staff Biocompare Life Science News (news.biocompare.com) Scientists at Duke University's Institute for Genome Sciences & Policy have developed a panel of genomic tests that analyzes the unique molecular traits of a cancerous tumor and determines which chemotherapy will most aggressively attack that patient's cancer. In experiments reported in the November 2006 issue of the journal Nature Medicine, the researchers applied the genomic tests to cells derived from tumors of cancer patients. They found that the tests were 80 percent accurate in predicting which drugs would be most effective in killing the tumor. The Duke team plans to begin a clinical trial of the genomic tests in breast cancer patients next year. The new tests have the potential to save lives and reduce patients' exposure to the toxic side effects of chemotherapy, said Anil Potti, M.D., the study's lead investigator and an assistant professor of medicine in the Duke Institute for Genome Sciences & Policy. The tests are designed to help doctors select and initiate treatment with the best drug for a patient's tumor instead of trying various drugs in succession until the right one is found, Potti said. "Over 400,000 patients in the United States are treated with chemotherapy each year, without a firm basis for which drug they receive," said Joseph Nevins, Ph.D., the study's senior investigator and a professor of genetics at the Duke Institute for Genome Sciences & Policy. "We believe these genomic tests have the potential to revolutionize cancer care by identifying the [...]

10/24/2006 Tokyo, Japan Takeshi Nishioka et al. Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyl111 Objective: This study sought to evaluate the efficacy and safety of a novel treatment regimen, intra-arterial cisplatin infusion plus external/high-dose-rate radiotherapy. Methods: Superselective intra-arterial infusion of cisplatin (100-120 mg) was performed concomitantly with external radiotherapy in four patients with locally advanced carcinoma of the tongue. A high-dose-rate brachytherapy boost was performed after combination therapy in all patients. Brachytherapy was performed after external radiotherapy, and the treatment schedule was twice daily, with a fraction of 600 cGy up to a total of 30-48 Gy. Results: All patients completed the therapy as scheduled. There were no vascular or neurological complications. Grade III acute radiation mucositis developed in all patients but this did not necessitate a treatment break. With a mean follow-up period of 35 months, loco-regional control was obtained for all patients. Conclusions: The combination of weekly administration of intra-arterial cisplatin plus external/high-dose-rate radiotherapy seems effective for advanced carcinoma of the tongue. Authors: Takeshi Nishioka 1, Akihiro Homma 2, Yasushi Furuta 2, Hidefumi Aoyama 3, Fumiyuki Suzuki 2, Keiichi Ohmori 4, Takeshi Asano 3, Daisuke Yoshida 3, Hiroki Shirato 3, and Satoshi Fukuda 2 Authors' affiliations: 1 Laboratory of Radiation Therapy, Department of Health Science, School of Medicine, Hokkaido University, N12 W5, Kita-ku, Sapporo, Japan. 060-0812 2 Department of Otolaryngology, Head and Neck Surgery, School of Medicine 3 Department of Radiology, School of Medicine 4 Department of Radiology, School of Dentistry, Hokkaido University, Sapporo, Japan

10/23/2006 United Kingdom press release Medical News Today (www.medicalnewstoday.com) In its September meeting 2006, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMEA) gave a positive opinion to include the use of docetaxel in combination with the current standard treatment - cisplatin and 5 - fluorouracil - for the induction treatment of patients with inoperable locally advanced squamous cell carcinoma of the head and neck. On October 18, the US Food and Drug Administration (FDA) gave its approval to the new treatment as well. According to Steven Galson, M.D., director of FDA's Center for Drug Evaluation and Research, it will “provide prescribers with a new treatment option that has been shown to help slow the spread of the disease and prolong patients' survival.” This drug - label extension of Taxotere (docetaxel) was possible due to the EORTC 24971 phase III, open label randomized trial, involving 358 patients, evaluating the benefit derived from docetaxel - based combination in inoperable locally advanced head and neck cancer. Patients treated with the regimen prior to surgery or radiation had significantly longer median overall survival compared to a standard treatment of cisplatin and 5-fluorouracil; with a 28 percent risk reduction of the, 18.6 vs 14.5 months (p=0.0128). Patients receiving the docetaxel-based regimen also had a significantly longer time-to-disease progression of 11.4 months, compared with 8.3 months (P=0.015) for the patients receiving standard therapy. These results have been associated to an improvement of the safety profile. ”Very few treatment options [...]