10/3/2003 Florida Ed Susman American Academy of Otolaryngology-Head and Neck Surgery Foundation Identifying and locating the sentinel node in head–and-neck cancer surgery is feasible, and the results of careful dissection of the nodes appears to correlate with full neck dissection, researchers said here September 21st at the Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. In describing findings from a recent study, lead author Peter Zbaeren, MD, department of otorhinolaryngology–Head and Neck Surgery, University of Bern–Inselspital, Switzerland, said, "Accurate localisation of the sentinel nodes was possible in all cases by using lymphoscintigraphy and by use of a gamma probe." Dr. Zbaeren and colleagues found 82 sentinel nodes in 36 patients -- about 2.2 nodes per patient. Using a radionuclide-labeled colloid, preoperative lymphoscintigraphy and intraoperative sentinel lymph-node identification by a gamma probe, doctors located the sentinel lymph node, excised the node or nodes and performed frozen section analysis. The study sought to assess the accuracy of sentinel lymph node identification in patients with a Stage NO neck in squamous-cell carcinoma of the oral cavity and oropharynx. Dr. Zbaeren said the pathology analysis located one occult cancer in a sentinel lymph node. To correlate these findings, the surgeons carried out a complete neck dissection in the patients, removing an average of 36 nodes from each patient. In the 1,295 nodes analysed, just one positive node was found. Dr. Zbaeren said the sensitivity of sentinel lymph-node biopsy in the series was 93%, and the negative predictive value was 94%. [...]

9/20/2003 New York Reuters Health Induction chemotherapy appears to reduce distant disease failure rates following intensive concomitant chemoradiotherapy when administered to patients with advanced head and neck cancer. Physicians at a Chicago-area network of hospitals observed high locoregional control, organ preservation, and overall survival rates when they treated patients with intensified concomitant chemoradiotherapy. The biggest problem appeared to be distant failure. To eradicate systemic micrometastases, Dr. Everett E. Vokes, of the University of Chicago, and colleagues added an inductive regimen of carboplatin and paclitaxel administered in 6 weekly cycles. According to their report in the Journal of Clinical Oncology for January 15, three patients presented with stage III disease and 66 with stage IV disease. After 6 weeks, 87% of 61 patients with remaining disease following initial organ-preserving surgery exhibited a response and 35% a complete response. Beginning 2 to 3 weeks later, the patients underwent five cycles of treatment with paclitaxel, fluorouracil, hydroxyurea and twice-daily radiation therapy administered every other week. The patients were then followed for a median of 28 months. Fifty patients survived until the end of the study period in 2002, for an overall survival rate of 70%, the report indicates. Ten had died of disease persistence or recurrence and three of complications related to therapy. Five died of unrelated causes and one of a second malignancy. "The great majority of patients were treated without disabling surgery," the physicians note. The 3-year progression-free rate among those who survived was 80%. Systemic progression occurred in five subjects. [...]

9/20/2003 Associated Press A more definitive cervical cancer-screening test that helps reduce uncertainty in diagnosing the disease is gaining support from doctors and health insurers. Aetna, the nation's largest health insurer, on Wednesday became the latest plan to cover the new DNA test that checks for the presence of a virus that studies show causes more than 99 percent of cervical cancers. The test is used when a Pap smear proves inconclusive, which happens about 5 percent of the time. Kaiser Permanente, United Healthcare and most Blue Cross and Blue Shield plans already cover the test for human papillomavirus, or HPV, according to the test's maker, Digene Corp. of Gaithersburg, Maryland. About 400,000 U.S. women had the HPV test in the past year, a Digene spokeswoman said. If the test shows no sign of HPV, a woman is assured she doesn't have cancer. If the HPV virus present, there is a greater likelihood the woman has cancer and she is sent for additional testing which most likely include a biopsy. ``Aetna is a bellwether for the adoption of HPV testing as a standard of care in cervical cancer screening,'' said Evan Jones, Chairman and CEO of Digene Corporation. About 50 million Pap smears are performed annually in the United States. Before the HPV test was approved by the Food and Drug Administration in 1999, women who had an inconclusive Pap test would have to get another Pap test or an outpatient procedure that would likely include a biopsy. The results [...]

9/19/2003 New York Reuters Health An accelerated course of radiotherapy that involves six fractions per week instead of five improves survival and offers other benefits for patients with head and neck cancer, new research indicates. The findings, which are published in the September 20th issue of The Lancet, are based on a randomized trial of 1476 patients with squamous-cell cancer of the head and neck. Regardless of whether patients were randomized to six or five fractions per week, most received a total of 66 to 68 Gy in 33 to 34 fractions, lead author Dr. Jens Overgaard, from Aarhus University in Denmark, and colleagues note. The exception was patients with well differentiated T1 glottic tumors, who received a total dose of 62 Gy. Median treatment times for the six- and five-fraction regimens were 39 and 46 days, respectively, the authors note. Disease-specific survival at 5 years in the six-fraction group was 73%, while the rate in the five-fraction group was significantly lower--66% (p = 0.01). Overall survival was comparable for both groups, a finding that may reflect the general poor health that typifies head and neck cancer patients. The locoregional control rate with the six-fraction regimen was 70%, significantly higher than the 60% rate seen with the five-fraction regimen (p = 0.0005). Similarly, the corresponding primary tumor control rates were 76% and 64% (p = 0.0001). In contrast, neck-node control did not differ significantly between the groups. Another benefit of the six-fraction regimen was improved voice preservation among patients with [...]

8/25/2003 New York Reuters Health / Arch Otolaryngol Head Neck Surg 2003;129:709-711. Photodynamic therapy (PDT) utilizing meta-tetra(hydroxyphenyl)chlorin (mTHPC) is a feasible alternative to surgery or radiotherapy in patients with early-stage squamous cell carcinoma of the oral cavity and oropharynx, a study suggests. Second-generation photosensitizers such as mTHPC (Foscan; Scotia Pharmaceuticals, Stirling, Scotland) are "more effective and less phototoxic to the skin than their forerunners," Dr. Marcel P. Copper, and colleagues from the Netherlands Cancer Institute in Amsterdam note in the July issue of Archives of Otolaryngology - Head and Neck Surgery. They prospectively evaluated the long-term outcome of PDT using mTHPC in 25 patients with 29 T1-T2 NO tumors of the oral cavity and/or oropharynx. Follow-up lasted a mean of 37 months. In all patients, necrosis of the illuminated area occurred within 24 hours but subsided within 4 to 6 weeks after treatment. Complete remission of the primary tumor was achieved in 25 (89%) of 29 tumors. The complete remission rate was 95% for T1 tumors and 57% in T2 tumors. Surgery and/or radiotherapy effectively salvaged all four patients that developed recurrent local disease. Five patients who developed lymph node metastasis were treated by radical (modified) neck dissection and four underwent postoperative radiotherapy. None of the patients in the study experienced any long-term functional or cosmetic deficits. In comments to Reuters Health, Dr. Copper said: "The most important findings of this study are that mTHPC PDT gives excellent cure rates in small cancers of the mouth and pharynx, without the [...]

8/13/2003 Chicago Journal of Hem / Onc Adding paclitaxel to a cisplatin and 5-fluorouracil (5-FU) regimen led to significantly longer survival in patients with locally advanced head and neck cancer, according to a phase-3 study presented here at the 39th Annual Meeting of ASCO. “This new chemotherapy combination may soon become the standard treatment option for some patients with head and neck cancer,” said lead researcher Ricardo Hitt, MD, from the Hospital ‘12 de Octubre’ in Madrid. The expanded combination also halted tumor progression more effectively than the standard regimen, and patients who received the three-drug combination were more likely to retain the ability to speak and swallow, as well as exhibit less mucocitis. The study involved 384 patients who had various types of head and neck cancer, particularly tumors of the oropharynx, larynx and oral cavity. All patients were treatment naive. In the standard arm, patients received 100 mg/m2 of cisplatin daily, and 1 gm/m2 of 5-FU on days 1 through 5 of a 21-day cycle. In the expanded regimen, patients received 100 mg/m2 of cisplatin daily, 500 mg/m2 of 5-FU on days 1 through 5, and 175 mg/m2 of paclitaxel on the first day of a 21-day cycle. The trial “appeared to demonstrate a superior outcome and far better tolerability by adding paclitaxel to 5-FU and cisplatin for head and neck cancer in a dose schedule associated with less toxicity,” said Robert Mayer, MD, the director of the Center for Gastrointestinal Oncology at Dana-Farber Cancer Institute in Boston.

8/11/2003 New York Reuters Health In patients with squamous cell carcinoma of the oral tongue (SCCOT), pathologic lymph node staging based on neck dissection is more reliable in predicting treatment outcomes than clinical lymph node staging based on physical examination and/or radiographic studies. That's according to Dr. Jeffrey N. Myers from M.D. Anderson Cancer Center in Houston and others who retrospectively reviewed all 266 patients who underwent surgical resection for SCCOT including a neck dissection. In analyses comparing clinical outcomes with respect to clinical and pathologic lymph node stages, statistically significant differences in survival emerged for both clinical (cN0-N2) and pathologic (pN0-N2) stages. However, the differences in survival and disease-free interval reached a higher level of statistical significance for pathologic lymph node staging (p < 0.0001) than for clinical lymph node staging (p < 0.002). "This disparity can be explained by stage migration," according to the team. That is, patients with cN0-1 disease had a more advanced lymph node stage at the time of pathologic review, they explain in the August 1 issue of the journal Cancer. Neck dissection identified occult lymph node disease in 34 percent of the cN0 group, with extracapsular spread in 19 percent. Moreover, 43 percent of cN1 patients had greater than pN2b disease and 50 percent had extracapsular spread on pathologic review. "For patients with tongue cancer, we can more accurately determine their prognosis by performing a neck dissection and analyzing the pathology specimen than we can by assessing the lymph node status purely on [...]

8/7/2003 Washington Stacie Crozier ADA The ADA joined some 40 national health and other organizations in signing a Feb. 25 letter urging the Federal Trade Commission to reject a smokeless tobacco manufacturer’s request to make positive health claims in its product advertising. The coalition letter, coordinated by the Campaign for Tobacco-Free Kids, says that the smokeless tobacco company’s request is, in essence, asking that the Federal Trade Commission “review, revise and overturn the scientific conclusions of the U.S. Surgeon General, the National Cancer Institute and every other major scientific and public health agency that has examined the health effects of smokeless tobacco.” On Feb. 5, The U.S. Smokeless Tobacco Co. petitioned the FTC for an advisory opinion that would allow it to claim through advertising that its products offer less of a health risk than smoking cigarettes. A company statement says “there is considerable agreement among researchers that use of smokeless tobacco involves significantly less risk of adverse health effects than cigarette smoking, and there is growing support in the public health community that cigarette smokers who have not quit should be encouraged to switch to smokeless tobacco. Such a harm reduction strategy is being debated in the public health community as representing a pragmatic component of a comprehensive public health policy on cigarette smoking.” “I suppose you could argue that shooting yourself in the leg poses less of a health risk than shooting yourself in the head,” says ADA President D. Gregory Chadwick in a statement available online. “But [...]

8/6/2003 Chicago Associated Press Pulitzer Prize winning film critic Roger Ebert will undergo radiation treatment for cancer next month. The treatment will be for a cancerous tumor in Ebert's salivary gland, the Chicago Sun-Times reported in its Wednesday editions. The 61-year-old critic underwent surgery twice in February 2002 for cancer in his thyroid and salivary gland. He said treatment for the malignant tumor will begin later this month after he returns from a family trip to France. "I will, however, continue to see movies, write reviews and do the 'Ebert & Roeper' television show," Ebert wrote in an e-mail message to friends on Tuesday. The treatments are a follow up to earlier surgery, and I look forward to a complete recovery; this is not considered to be a life-threatening form of cancer. "P.S. By the way, my thyroid cancer has been completely vanquished." Ebert said he has had a tumor in his salivary gland "in one form or another" for 16 years. He said the treatments will take 20 minutes a day, five days a week for eight weeks. Ebert has been a film critic at the Chicago Sun-Times since 1967. He won the Pulitzer Prize for criticism in 1975, the same year he teamed up with the late Gene Siskel of the rival Chicago Tribune to launch their movie-review show.

7/23/2003 Vienna, Switzerland Tara Womersly Doctors have carried out what is believed to be the first tongue transplant on a human being. The operation was carried out in Vienna on a 42-year old man with a malignant tumor. Surgeons spent 14 hours on the operation - one team worked for four hours removing the tongue from the donor while a second team reconnected the tongue’s muscle tissue, nerve endings, arteries and veins into the recipient’s mouth. The team was led by Dr Rolf Ewers, of the cranio-maxillofacial surgery department at the General Hospital in Vienna. He said: "Because of the carcinoma, we needed to remove the tongue. "We had been planning to do this transplant for some time but we needed both a patient and a donor. The patient was young, 42 years of age, and removing a tongue at that age is very cruel. But the cancer was at a very late stage, he was a heavy smoker. "You only deal with about two or three cases a year where the whole tongue needs to be removed." Dr. Ewers said that surgeons would normally remove the tongue and replace it with tissue from the small bowel, or duodenum. He said: "This meant that there was no muscle, just soft tissue coverage. But with the transplant, we hope that the tongue will be able to move and the patient will be able to speak and taste. If the operation is a success we will be planning it again. "While we [...]