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Tobacco use linked to worse outcomes In HPV-positive head and neck cancer, U-M study finds

Source: www.medicalnewstoday.com Author: Nicole Fawcett, University of Michigan Health System Patients with head and neck cancer linked to high risk human papillomavirus, or HPV, have worse outcomes if they are current or former tobacco users, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center. High-risk HPVs are the same viruses that are associated with cancers of the uterine cervix. The research suggests that current or former tobacco users may need a more aggressive treatment regimen than patients who have never used tobacco. Past research shows that HPV-positive head and neck cancers tend to be more responsive to current treatments and these patients overall tend to have better outcomes than patients with HPV-negative tumors. However, the new study found that current tobacco users with HPV-positive tumors were five times more likely to have their cancer recur. Even former smokers had an increased risk of recurrence. "Because the effect of HPV is so strong in giving a very good prognostic picture, we were surprised to find that smoking remained a huge issue, and it actually affected the outcome in patients who smoked," says senior study author Thomas Carey, Ph.D., professor of otolaryngology and pharmacology, and co-director of the Head and Neck Oncology Program at the U-M Comprehensive Cancer Center. Results of the study appear in the Feb. 15 issue of Clinical Cancer Research. The study looked at 124 patients with advanced oropharyngeal cancer, which is cancer of the tonsils or the base of the tongue. Most [...]

2010-02-17T21:51:15-07:00February, 2010|Oral Cancer News|
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PET-FDG improves staging, management of head, neck cancer

Source: helathimaging.com Author: staff Adding whole-body PET-FDG to the pre-therapeutic conventional staging of head and neck squamous cell carcinoma improved the TNM [tumor, node and metastasis] classification of the disease and altered the management of 13.7 percent of patients, according to a study published in the February issue of the Journal of Clinical Oncology. Max Lonneux, MD, from the departments of nuclear medicine, head and neck surgery, radiation oncology and maxillofacial surgery, Cliniques Universitaires Saint-Luc in Brussels, and colleagues included his 233 patients in this multicenter, prospective study with newly diagnosed and untreated head and neck squamous cell carcinoma. Researchers first determined the TNM stage and therapeutic decision based on the conventional work-up (including physical exam, CT/MRI of the head and neck region, and thoracic CT) and sealed in envelope. They then performed whole-body PET-FDG, and subsequently wrote TNM stage and therapeutic decision in a sealed envelope. The investigators also recorded changes in TNM stages and in patient management as a result of PET-FDG imaging. Clinical outcome and histopathology were used as gold standards to validate the TNM stage. Conventional and PET stages were compared using the McNemar test. According to the authors, conventional and PET stages were discordant in 43 percent of the patients. PET proved to be accurate in 47 patients and inaccurate in 13 patients. TNM status was left unconfirmed in 40 patients because no therapeutic change was expected from the stage difference. The researchers found that conventional plus PET TNM classification (envelope two) was significantly more [...]

2010-02-17T08:18:31-07:00February, 2010|Oral Cancer News|
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HPV-linked head and throat cancers easier to treat unless patient is a smoker, University of Michigan study finds

Source: annarbor.com Author: Tina Reed A growing incidence of head and throat cancers have been traced back to the human papillomavirus, or HPV, rather than smoking. With that in mind, University of Michigan researchers recently decided to examine the difference in outcomes between smokers with HPV-linked head and throat cancer and those who had never smoked. Turns out, the HPV-linked tumors were easier to treat than non-HPV associated cancers. That is, unless the patient was a smoker. Those with HPV-linked cancers who smoked were six times as likely to recur than those who had never smoked. According to a Los Angeles Time health blog, treatments for head and neck cancers include harsh treatments such as radiation, chemotherapy and surgery. The researchers from U-M's Comprehensive Cancer Center said they planned to begin a clinical trial to milder treatments later this year.

2010-02-17T08:13:44-07:00February, 2010|Oral Cancer News|
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Determination of malnourishment in the head and neck cancer patient: assessment tools and nutrition education of radiation oncologists

Source: Support Care Cancer, January 14, 2010 Authors: PV Decicco, SM Wunderlich, and JS Emmolo Purpose: The purpose of this study is to evaluate current assessment practices of malnourishment by radiation oncologists among the head and neck cancer patient population. Methods: A cross-sectional descriptive study was conducted. A 14-question survey was mailed to 333 radiation oncologists self-identified as "interested in the treatment of head and neck cancer." Results: About 87% of radiation oncologists indicated that they used bodyweight as the sole determinant of malnourishment in head and neck cancer patients at initial consultation. Radiation oncologists with 0 to 10 years experience were found to have a higher level of formal nutrition education than those with 11 to 20 years (p = 0.0052). A significant difference was found between radiation oncologists with formal nutrition education vs. those without, in answering whether nutrition interventions play a significant role in the prognosis of such cancer patients (p = 0.0013). In addition, a significant difference was noted in methods used to determine proper caloric intake when the oncologists were stratified by their beliefs about nutrition being a significant variable affecting the prognosis of head and neck cancer patients (p = 0.0024). Conclusion: Assessment or screening for malnourishment in the head and neck cancer patient should be a routine part of the initial consultation. Radiation oncologists and their medical team, including nutritionists, should use an appropriate nutrition screening and assessment tool in addition to the body weight as an indicator of malnourishment. Nutrition education provided [...]

2010-02-13T18:57:06-07:00February, 2010|Oral Cancer News|
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Oral cancer preventive practices of South Carolina dentists and physicians

Source: J Cancer Educ, January 16, 2010 Authors: SG Reed et al. The purpose of this study was to assess the South Carolina (SC) dentists' and physicians' oral cancer knowledge and practices and interest in training in oral cancer screening and tobacco cessation counseling. Method used was a cross-sectional survey of SC dentists and selected physician specialties with responses to mailed questionnaires summarized by descriptive statistics and chi-square tests for comparisons. Overall response rates were 58%for dentists and 44% for physicians. Dentists (81%) and 13% of the physicians reported conduct of oral cancer examinations at least half of the time over the past 12 months. Dentists (41%) and 83% of physicians assisted patients to quit smoking. Few dentists (19%) and 53% of physicians were aware of SC tobacco cessation resources. Dentists (40%) and physicians (37%) were interested in receiving training in oral cancer screening, and 36% and 49%, respectively, in training in tobacco cessation counseling. Results support the development of tailored education for SC dentists and physicians to achieve Healthy People 2010 Oral Health Objectives for Oral Cancer. Authors: SG Reed, KB Cartmell, NG Duffy, AE Wahlquist, D Sinha, A Hollinger, A Bode, AJ Alberg, and TA Day Author's affiliation: Department of Craniofacial Biology, Medical University of South Carolina, 173 Ashley Avenue, MSC 507, Charleston, SC, 29425-5070, USA

2010-02-13T18:51:29-07:00February, 2010|Oral Cancer News|
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Human papillomavirus, p16 and p53 expression associated with survival of head and neck cancer

Source: 7thspace.com Author: staff P16 and p53 protein expression, and high-risk human papillomavirus (HPV-HR) types have been associated with survival in head and neck cancer (HNC). Evidence suggests that multiple molecular pathways need to be targeted to improve the poor prognosis of HNC. Purpose: This study examined the individual and joint effects of tumor markers for differences in predicting HNC survival. P16 and p53 expression were detected from formalin-fixed, paraffin-embedded tissues by immunohistochemical staining. HPV DNA was detected by PCR and DNA sequencing in 237 histologically confirmed HNC patients. Results: Overexpression of p16 (p16+) and p53 (p53+) occurred in 38% and 48% of HNC tumors, respectively. HPV-HR was detected in 28% of tumors. Worse prognosis was found in tumors that were p53+ (disease-specific mortality: adjusted hazard ratios, HR=1.9, 95% CI: 1.04-3.4) or HPV (overall survival: adj. HR=2.1, 1.1-4.3) but no association in survival was found by p16 status. Compared to the molecular marker group with the best prognosis (p16+/p53/HPV-HR: referent), the p16/p53+/HPV group had the lowest overall survival (84% vs. 60%, p<0.01; HR=4.1, 1.7-9.9) and disease-specific survival (86% vs. 66%, p<0.01; HR=4.0, 1.5-10.7). Compared to the referent, the HRs of the other six joint biomarker groups ranged from 1.6-3.4 for overall mortality and 0.9-3.9 for disease-specific mortality. Conclusion: The p16/p53/HPV joint groups showed greater distinction in clinical outcomes compared to results based on the individual biomarkers alone. This finding suggests that assessing multiple molecular markers in HNC patients will better predict the diverse outcomes and potentially the type of treatment [...]

2010-02-13T10:22:17-07:00February, 2010|Oral Cancer News|
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Incidence of oral cancer in relation to nickel and arsenic concentrations in farm soils in Taiwan

Source: 7thspace.com Author: staff Purpose: To explore if exposures to specific heavy metals in the environment is a new risk factor of oral cancer, one of the fastest growing malignancies in Taiwan, in addition to the two established risk factors, cigarette smoking and betel quid chewing. Methods: This is an observational study utilized the age-standardized incidence rates of oral cancer in the 316 townships and precincts of Taiwan, local prevalence rates of cigarette smoking and betel quid chewing, demographic factors, socio-economic conditions, and concentrations in farm soils of the eight kinds of heavy metal. Spatial regression and GIS (Geographic Information System) were used. The registration contained 22,083 patients, who were diagnosed with oral cancer between 1982 and 2002. The concentrations of metal in the soils were retrieved from a nation-wide survey in the 1980s. Results: The incidence rate of oral cancer is geographically related to the concentrations of arsenic and nickel in the patients'residential areas, with the prevalence of cigarette smoking and betel quid chewing as controlled variables. Conclusions: Beside the two established risk factors, cigarette smoking and betel quid chewing, arsenic and nickel in farm soils may be new risk factors for oral cancer. These two kinds of metal may involve in the development of oral cancer. Further studies are required to understand the pathways via which metal in the farm soils exerts its effects on human health. Notes: 1. Authors: Che-Chun SuYo-Yu LinTsun-Kuo ChangChi-Ting ChiangJian-An ChungYun-Ying HsuIe-Bin Lian 2. Source: BMC Public Health 2010, 10:67

2010-02-13T10:17:43-07:00February, 2010|Oral Cancer News|
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New vaccine against HPV approved in Canada

Source: www.ctv.ca Author: staff Canadian women have a choice of two vaccines against HPV, the family of viruses that can cause cervical cancer, now that Health Canada has approved GlaxoSmithKline's vaccine, Cervarix. The vaccine, which is expected to be available by the end of the month, will compete against Gardasil, a product of Merck Canada, which has been on the Canadian market since 2006. Cervarix has been available in Europe since 2007, and was approved in the U.S. this past fall. Health Canada said its approval was based on a review of clinical trials on nearly 30,000 women. The competing vaccines will be similarly priced, at about $400. Each vaccine requires three doses and are meant for girls and women aged 10 to 25, ideally before they become sexually active. While there are differences between the two vaccines, each offers good protection against infection with the most dangerous strains of HPV, the Society of Gynecologic Oncology of Canada (GOC) said in a statement Tuesday. The GOC added that each vaccine has had an excellent safety profile both in pre-market testing and after extensive use worldwide. Cervarix is designed to protect against two human papillomavirus strains: HPV 16 and 18. Those strains are responsible for more than 70 per cent of cases of cervical cancer. It also offers some protection against three other cancer-causing strains HPV 31, 33 and 45. Between them, the four strains account for more than 80 per cent of cervical cancer cases. Gardasil also prevents infection with [...]

2010-02-11T09:55:32-07:00February, 2010|Oral Cancer News|
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Sentinel nodes predict spread in oral cancer

Source: www.medpagetoday.com Author: Michael Smith, North American Correspondent, MedPage Today In early oral squamous cell carcinoma, a sentinel node biopsy correctly predicted an absence of lymphatic metastasis in all but 4% of patients, researchers said. For T1 and T2 lesions that were clinically node-negative, the procedure -- combined with additional sectioning and immunohistochemistry -- yielded a negative predictive value of 96%, according to Francisco Civantos Jr., MD, of the University of Miami, and colleagues. For T1 lesions, the value was 100%, while for T2 cancers it was 94%, the researchers reported online in the Journal of Clinical Oncology. The finding may position the procedure as an intermediate option between watchful waiting and selective neck dissection, the researchers said, asserting that it's now "reasonable" to conduct a head-to-head trial of sentinel node biopsy and neck dissection. The procedure has significantly increased the sensitivity for detecting lymphatic metastasis in melanoma and breast cancer patients, Civantos and colleagues noted. But in oral cancer, many surgeons prefer a completion neck dissection, they added, despite the "measurable morbidity" that's associated with the procedure. On the other hand, because of that morbidity, other specialists prefer watchful waiting and elective neck irradiation. To investigate the issue, Civantos and colleagues conducted a multicenter trial in which patients with early invasive oral cancers were treated with both procedures -- a sentinel node biopsy, followed by completion selective neck dissection. The primary goal was to see if a negative hematoxylin and eosin finding on the sentinel node biopsy accurately predicted [...]

2010-02-09T21:42:01-07:00February, 2010|Oral Cancer News|
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F.D.A. to increase medical radiation oversight

Source: nytimes.com Authors: Walt Bogdanich & Rebecca R. Ruiz The federal Food and Drug Administration said Tuesday that it would take steps to more stringently regulate three of the most potent forms of medical radiation, including increasingly popular CT scans, some of which deliver the radiation equivalent of 400 chest X-rays. With the announcement, the F.D.A. puts its regulatory muscle behind a growing movement to make life-saving medical radiation — both diagnostic and therapeutic — safer. Last week, the leading radiation oncology association called for enhanced safety measures. And a Congressional committee was set to hear testimony Wednesday on the weak oversight of medical radiation, but the hearing was canceled because of bad weather. The F.D.A. has for weeks been investigating why more than 300 patients in four hospitals were overradiated by powerful CT scans used to detect strokes. The overdoses were first discovered last year at Cedars-Sinai Medical Center in Los Angeles, where patients received up to eight times as much radiation as intended. The errors occurred over 18 months and were detected only after patients lost their hair. In making the announcement, the F.D.A. said it hoped to reduce unnecessary radiation exposure from three medical imaging procedures: CT scans, which provide three-dimensional images; nuclear medicine studies, in which patients are given a radioactive substance and doctors watch it move through the body; and fluoroscopies, in which a radiation-emitting device provides a continuous internal image on a monitor. “These types of imaging exams expose patients to ionizing radiation, a [...]

2010-02-09T21:34:45-07:00February, 2010|Oral Cancer News|
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