9/7/2007 web-based article PM Specenier et al. Annals of Oncology, doi:10.1093/annonc/mdm346 Background: Radiotherapy (RT) with concurrent chemotherapy is the current standard of care for patients with unresectable locally advanced squamous cell carcinoma of the head and neck (SCCHN). Gemcitabine (GEM) is a potent radiosensitizer and in addition has activity as an anticancer agent in SCCHN. Patients and methods: Twenty-six patients with locally far advanced SCCHN were enrolled in a chemoradiation feasibility study between November 1998 and September 2003. Use was made of conventionally fractionated RT and GEM 100 mg/m2, which was given within 2 h prior to radiotherapy on a weekly basis starting on day 1 of RT. Response was assessed according to WHO criteria, toxicity according to NCI-CTC version 2. Results: The patients received a median of 7 (2–8) weekly cycles of gemcitabine and a median cumulative RT dose of 70 Gy (66–84.75). Hematologic toxicity was mild, but non-hematologic toxicity was severe: grade 3–4 stomatitis occurred in 85% of patients, dermatitis in 69%, pharyngitis/esophagitis in 81% and 80% of the patients needed a feeding tube during treatment. All 22 evaluable patients responded (50% complete, 50% partial). Median follow up of the surviving patients is 46 months. Median disease-free and overall survival is 13 months and 19 months, respectively; 27% of the patients are alive without evidence of recurrence beyond 3 years. Conclusions: Conventionally fractionated RT in combination with GEM 100 mg/m2 weekly is feasible and highly active in the treatment of locally advanced SCCHN. In particular, long-term local control [...]

9/7/2007 Lyon, France Neela Guha et al. Am. J. Epidemiol., August 30, 2007 Poor oral health has been reported as a risk factor in the etiology of head and neck cancer. Data on oral health were ascertained as part of two multicenter case-control studies comprising 924 cases and 928 controls in central Europe and 2,286 cases and 1,824 controls in Latin America. Incident cases of squamous cell carcinoma of the head and neck (oral cavity, pharynx, larynx) and esophagus, as well as age (in quinquennia)- and sex frequency-matched controls, were enrolled from 1998 to 2003. Poor condition of the mouth (central Europe: odds ratio (OR) = 2.89, 95% confidence interval (CI): 1.74, 4.81; Latin America: OR = 1.89, 95% CI: 1.47, 2.42), lack of toothbrush use (Latin America: OR = 2.36, 95% CI: 1.28, 4.36), and daily mouthwash use (Latin America: OR = 3.40, 95% CI: 1.96, 5.89) emerged as risk factors for head and neck cancer, independent of tobacco use and alcohol consumption. Missing between six and 15 teeth was an independent risk factor for esophageal cancer (central Europe: OR = 2.84, 95% CI: 1.26, 6.41; Latin America: OR = 2.18, 95% CI: 1.04, 4.59). These results indicate that periodontal disease (as indicated by poor condition of the mouth and missing teeth) and daily mouthwash use may be independent causes of cancers of the head, neck, and esophagus. Authors: Neela Guha, Paolo Boffetta, Victor Wunsch Filho, Jose Eluf Neto, Oxana Shangina, David Zaridze, Maria Paula Curado, Sergio Koifman, Elena [...]

9/7/2007 web-based article K Mystakidou et al Int J Nanomedicine, January 1, 2007; 2(1): 49-54 Pain is experienced by most cancer patients and represents an important issue in the clinical setting. Breakthrough pain is a transitory flare of pain that occurs in most cancer patients on a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate, a new opioid formulation with a unique delivery system, utilizing the advantages that nanotechnology offers, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), which makes it an effective treatment to cancer patients who are already receiving opioids and continue to experience such flares of pain. Oral transmucosal fentanyl citrate is specifically developed and approved for the management of breakthrough pain in cancer patients and it has the potential to be a useful tool for clinicians. Authors: K Mystakidou, E Tsilika, M Tsiatas, and L Vlahos Authors' affiliation: Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Greece

9/6/2007 web-based article press release Scoop Health (www.scoop.co.nz) Shocking pictures of smoking's health effects appearing on Australian cigarette packets have increased requests for quitting help by 91 percent. This dramatic increase was revealed to the Oceania Tobacco Control Conference in Auckland today by researcher Jacqueline Hickling of The Cancer Council South Australia. "Although graphic pictorial warnings have been introduced elsewhere, no one has researched their effect upon help lines," Ms Hickling told the 370 international delegates. “We monitored the number of calls to Quitline in Australia as the graphic images campaign was rolled out from February to July last year. During that time, the number of calls increased by 91 percent.” The close up images included a gangrenous foot, the contrast between a healthy lung and one with emphysema, a cancerous mouth and lips, a brain bleeding as a result of a stroke and a pair of cancerous lungs. The images were divided into two series which were rotated so the shock value would not be reduced. "The images were accompanied by a series of confronting television advertisements showing the little-known link between smoking and mouth cancer, and smoking and peripheral vascular disease which causes gangrene," Ms Hickling said. Countries planning to introduce such warnings should expect similar impact and flow on benefits to quitting. Ms Hickling said. Helen Glasgow, Executive Director of the Quit Group in New Zealand, said the Quit Group is gearing up for a busy year in 2008 when similar graphic warnings are introduced here, and [...]

9/6/2007 web-based article staff BBC News (news.bbc.co.uk) Almost one in 10 people in Wales referred for urgent cancer treatment by their GP wait longer than two months to be seen by specialists, figures show. But those seen within the two-month target rose from 86% in January to March to 91% during April to June. The Welsh Assembly Government said it was disappointed targets were not fully achieved, but noted improved figures. Simon Blackburn, of Macmillan Cancer Support, said the headline figures may be misleading. He told BBC Radio Wales: "I've noticed that the figure being released of 91% is actually an average and Macmillan and others would share the concern that behind that average are some more worrying figures. "Of particular concern for Macmillan are the lung, head-and-neck neurological figures. "The head-and-neck figure is actually 66%, which is pretty poor, and for cancers where the survival rates and the journey that the cancer patients go on can be more problematic, it's clearly vital that people receive treatment as soon as possible." However, the cancer charity Tenovus said it was "encouraged" by the overall results of the latest waiting times, despite them "falling short of the ideal". Tenovus said: "With the number of cancer cases diagnosed rising each year and the current limited resources available for cancer services, these figures have to be commended. "As with any patient-related issues there will always be room for improvement and these figures highlight the need for further funding into cancer screening and diagnostic facilities, [...]

9/3/2007 web-based article Ralph W. Moss, PhD Sage Journals Online (ict.sagepub.com) Despite recent comprehensive review articles concluding that supplemental antioxidants do not undermine the effectiveness of cytotoxic therapies, the use of antioxidants during cancer treatment remains controversial. Many oncologists take the position that antioxidants by their nature undermine the free radical mechanism of chemotherapy and radiotherapy and should therefore generally be avoided during treatment. For their part, many integrative practitioners believe that antioxidants taken during cancer treatment not only alleviate some of the adverse effects of that treatment but also enhance the efficacy of cancer therapy. Until recently, research attention has focused primarily on the interaction of antioxidants with chemotherapy; relatively little attention has been paid to the interaction of antioxidants with radiotherapy. This article reviews the clinical literature that has addressed whether antioxidants do in fact interfere with radiation therapy. Studies have variously investigated the use of -tocopherol for the amelioration of radiation-induced mucositis; pentoxifylline and vitamin E to correct the adverse effects of radiotherapy; melatonin alongside radiotherapy in the treatment of brain cancer; retinol palmitate as a treatment for radiation-induced proctopathy; a combination of antioxidants (and other naturopathic treatments) and external beam radiation therapy as definitive treatment for prostate cancer; and the use of synthetic antioxidants, amifostine, dexrazoxane, and mesna as radioprotectants. With few exceptions, most of the studies draw positive conclusions about the interaction of antioxidants and radiotherapy. Although further studies are needed, the preponderance of evidence supports a provisional conclusion that dietary antioxidants do not conflict [...]

9/3/2007 Atlanta, GA press release DentalPlans.com The National Cancer Institute has awarded a five-year, $12.5 million Specialized Program of Research Excellence (SPORE) grant in head and neck cancer to Emory University's Winship Cancer Institute. This is the first SPORE grant ever received in the state of Georgia. SPORE grants are large, multidisciplinary federal grants that fund scientific research aimed at bringing new laboratory findings quickly to the clinic. They are highly competitive grants and are sought after by the most prestigious research and medical facilities across the country. With an expected 40,000 new cases and 11,500 deaths in 2007, squamous cell carcinoma of the head and neck accounts for four percent to five percent of all newly diagnosed cancers in the U.S. When the more than two-thirds of head and neck cancer patients first receive a diagnosis it is considered a locally advanced disease, which has a poor five-year survival rate after treatment with surgery, radiation or chemotherapy. According to recent National Cancer Institute statistics, southeastern states rank among the highest in the nation in head and neck cancer incidence. "Head and neck cancer can be a devastating disease," says Dong Moon Shin, MD, professor of hematology and oncology at Emory Winship and principal investigator of the grant. "Our focus on this grant is to facilitate, critically review and rapidly move new discoveries to patients. Our goal is to decrease the morbidity, suffering, disability and death caused by this disease. "Because of the large number of aging smokers and ex-smokers [...]

9/1/2007 Little Falls, NJ Neil Osterweil MedPageToday.com A star chef with advanced squamous cell carcinoma of the oral tongue is undergoing aggressive chemoradiation hoping to avoid a resection that would cripple his sense of taste. Grant Achatz, the nationally known chef, who is just 33, announced his condition a few weeks ago. He is owner of Alinea, a restaurant named as the best in the country by Gourmet. According to Janet Adamy, a food writer in the Chicago bureau of the Wall Street Journal. Achatz is renowned for his meticulous plate preparations, audacious food pairings, and meals consisting of up to 30 tiny portions that can last up to seven hours and set diners back more than $200 each. But when he was diagnosed with stage IVb squamous cell carcinoma of the oral tongue -- a lesion most often treated by surgical resection, reconstruction, and irradiation, or in advanced cases palliative radiation alone -- Achatz feared that he would lose his sense of taste. For an artist of the palate, it was unthinkable. Instead, Achatz pinned his hopes on an investigational protocol in phase II trials at the University of Chicago. "We take an organ-preservation or primary non-surgical approach to treating these patients, because even if you're not a chef who needs to preserve your taste, many patients want to preserve their ability to speak and swallow, for obvious reasons," said Ezra Cohen, M.D., a member of the University of Chicago team treating Achatz. Achatz is one of about 40 [...]

9/1/2007 Little Falls, NJ Crystal Phend MedPageToday.com Human papillomavirus infections are likely buoying up oropharyngeal cancer rates while other head and neck cancers decline, researchers said. Cancer-causing HPV strains have been implicated in half of oropharyngeal cancers, and 90% of HPV-related cases have been pinpointed to HPV-16 in studies, said Erich M. Sturgis, M.D., M.P.H., and Paul M. Cinciripini, M.D., both of the M.D. Anderson Cancer Center here, in a review published online in the journal Cancer. One of the reasons, the researchers suggested is the "changing sexual practices, such as more frequent oral sex in adolescents and young adults." To hasten throat cancer's decline, vaccination of boys and and men against oncogenic strains HPV-16 and HPV-18 should be considered, they suggested. "The current vaccination strategy [suggested for girls and young women ages nine to 26] will only benefit men secondarily as the cohort of vaccinated women age and the incidence of chronic oncogenic HPV infection in the sexually active female population declines," the investigators wrote. This effect may take a generation to achieve, they said. To speed up the potential benefit in the prevention of HPV-related oropharyngeal cancers, Drs. Sturgis and Cinciripini recommended "the rapid study of the efficacy and safety of these vaccines in males and, if successful, the recommendation of vaccination in young adult and adolescent males." Tobacco smoking has been the major cause of head and neck cancers overall. But when smoking prevalence started to slide in the 1970s, the incidence of head and neck cancers [...]

9/1/2007 Boston, MA Marshall Posner The Oncologist, Vol. 12, No. 8, 967-974, August 2007 Introduction: Head and neck cancers account for 3%–5% of all cancer cases in the U.S., annually [1]. The American Cancer Society estimated that 34,360 new cases of oral cavity and pharynx cancers will be diagnosed in the U.S. in 2007, and approximately 7,550 deaths will be attributed to these diseases [2]. While therapeutic options for head and neck cancers have evolved over the past 30 years, the prognosis and disease-free survival interval for patients with locally advanced head and neck cancers, those patients presenting with stage III or stage IV disease, have remained less than optimal [3]. Treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) is complicated by disease site and volume, prognosis, functional deficits associated with therapeutic choices, therapy-associated toxicities, and the needs and condition of individual patients. Initially, standard therapy focused on surgical resection with or without radiation or radiation therapy alone for technically unresectable cancers. However, in an effort to increase the probability of organ preservation, locoregional control, and survival, advanced clinical studies were directed toward refining the use of chemotherapy and radiotherapy in a combined-modality setting. Emerging data on the benefits of induction, concurrent, and sequential therapy regimens now suggest the possibility of better prognosis and organ preservation, with less morbidity [4–14]. These data offer new insights into optimal treatment regimens for SCCHN. COMBINED-MODALITY REGIMENS While SCCHN is potentially curable in its early stages, >60% of patients [...]