8/4/2007 Pittsburgh, PA SS Agarwala et al. Annals of Oncology 2007 18(7):1224-1229 Background: Our goal was to evaluate long-term efficacy outcomes of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with carboplatin, paclitaxel (Taxol) and radiotherapy. Patients and methods: We conducted a phase II trial in inoperable patients with locally advanced SCCHN. Carboplatin 100 mg/m2 and paclitaxel 40 mg/m2 were administered i.v. once a week during external beam radiation therapy (180 cGy per fraction) for 6–7 weeks. Interstitial brachytherapy was used as a boost in selected patients with primary malignancies of the oral cavity and the oropharynx. Results: Fifty-five patients were enrolled. Fifty-two patients (95%) had stage IV and 51 (93%) had technically unresectable disease; 62% had an oropharyngeal primary site. Twenty-one patients underwent brachytherapy boost. Grade 3 or 4 mucositis occurred in 30% of patients. One death occurred during treatment that was related to complications of gastrostomy tube placement. Forty of 50 assessable patients (80%) had an objective response, with a complete response rate of 52%. With a median follow-up of 69 months for surviving patients, the 5-year progression-free survival was 36% and the 5-year overall survival was 35%. Two of the 18 long-term survivors of >50 months were gastrostomy tube feeding dependent. Patients undergoing brachytherapy boost (n = 21) had similar outcomes compared with the rest of the patients. In multivariate analysis, baseline hemoglobin levels and N stage were predictive of survival. Conclusion: Treatment with concurrent carboplatin, paclitaxel and radiation is safe and offers [...]

8/4/2007 Kansas City, MO staff www.myfoxkc.com An ugly trend is starting to show itself in Kansas City. The painkiller fentanyl is so strong, just a little bit can kill you. Fentanyl is usually prescribed for cancer patients in severe pain, but across the country, people are getting their hands it and overdosing. So far it's not as prevalent in Kansas City, but that may be changing. The drug is prescribed at the Kansas City Cancer Center, to patients with severe pain. "When you start these medications you really do start at a low dose and work your way up," Dr. Marcus Neubauer said. That's because it's so strong: 100 times more potent than morphine. "So if someone's used to using say 15 milligrams of morphine, 15 milligrams of this, excellent potential they'll overdose," Don Mendrala, assistant Special Agent in charge with the DEA said. Prescribed most commonly as a patch, Mendrala, says it's easily abused. "It can be cut up and just put under the tongue like a lozenge," Mendrala said. The drug is strictly regulated because it's so strong, so only patients and doctors have access. "It's in the hospitals, it's in legitimate use, the problem we've encountered here is diversion of the regular pharmaceutical fentanyl, it's not been a big problem, but it happens," Mendrala said. Problem is, Mendrala says, users don't know how strong the drug is. "It's just so potent," he said. "When we have to deal with it, we'll deal with it like it's a [...]

8/2/2007 Seattle, WA Leslie Helm www.washingtonceo.com Expensive new equipment adds fuel to hospital rivalries The Swedish Cancer Institute (SCI) announced Wednesday it is has signed a contract to buy a $22 million system that uses the latest technology to help treat cancer. But the purchase may trigger a costly "arms race" between competing hospitals and medical centers to see who can provide the most technologically advanced care. To avoid such a costly race in the field of medical equipment, Swedish says it is speaking with other medical providers in the area to partner in employing the revolutionary technology. But there are other plans already in the works. The new system is the latest generation of proton beam radiotherapy equipment, known as the Clinatron 250, built by Still River Systems of Littleton, Mass. Swedish argues it will be the first center in the Pacific Northwest to offer proton beam radiation therapy (PBRT) when it receives the equipment sometime in 2010. But the Seattle Cancer Care Alliance, made up of several medical institutions affiliated with the University of Washington, announced plans last year that it would build its own center using similar technology for $100 million. Rod Hochman, who became CEO of Swedish Medical Center in April, says Swedish wants to create a consortium with other hospitals and universities to share both the cost and use of the new machine. "It will be great for the community," says Hochman. Compared to the way hospitals have approached the acquisition of such cutting-edge equipment [...]

8/1/2007 New York, NY Marilyn Chase Wall Street Journal Online (ww.wsj.com) Advocates Beat Back Effort To Limit Use of Popular Drugs That May Carry Heart Risks The Centers for Medicare and Medicaid Services -- amid pressure from patient advocacy groups, medical societies and legislators -- released new rules on its coverage of anemia drugs that are significantly less stringent than what the agency had originally planned. The proposed changes, aimed at improving patient safety, had caused a public uproar for the past two months. More than 2,600 public comments were filed, many complaining that the proposals were Draconian and threatened to compromise patients' quality of life by withholding needed treatment. The new guidelines apply mostly to people with cancer who are receiving chemotherapy that causes anemia -- a lack of red blood cells that ferry oxygen around the body. They also apply to myelodysplasia, a disorder of the bone marrow. Anemia can cause crushing fatigue, shortness of breath and cardiac arrhythmia. The anti-anemia drugs -- Amgen Inc.'s Epogen and Aranesp and Johnson & Johnson's Procrit -- were hailed a decade ago as alternatives to blood transfusions, which despite improved screening still carry a small risk of infections and immune reactions. But recent research has suggested that overuse of these drugs -- known medically as erythropoiesis-stimulating agents, or ESAs -- may carry serious risks. A number of studies show increased cardiovascular risks among patients on the drugs, and raise questions about whether they fuel the growth of tumors in cancer patients. [...]

8/1/2007 Seattle, WA Tom Paulson Seattlepi.com Virus found under men's fingernails, pointing to more ways of it spreading. Controversy continues to plague efforts to protect young women against cervical cancer by vaccinating them against HPV, the human papillomavirus, but one leading scientist's discovery could throw a monkey wrench into the debate. "We found HPV under the fingernails of young men," said Dr. Laura Koutsky, a University of Washington epidemiologist. Koutsky led some of the pioneering research and clinical trials that resulted in an HPV vaccine, Merck's Gardasil, recently approved for use in girls and young women. The reason her fingernail finding is a potential bombshell has to do with why the vaccine is controversial. HPV, which is the leading cause of most cervical cancers, is primarily a sexually transmitted disease. Opponents of HPV vaccines believe that immunizing girls against this virus sends the message that engaging in sex at a young age is acceptable behavior. The presence of HPV under fingernails, she said, at the very least suggests another possible route of transmission. It's an additional route of infection, she said, that could explain some previous apparent anomalies such as HPV infection in infants and young girls who had not yet engaged in sexual activity. Koutsky's not quite sure what to make of the finding, which has yet to be reported in a journal, but she said it is certainly "a surprise." "In spite of (the debate), a considerable amount of the vaccine has been distributed already," said Dr. Lauri [...]

8/1/2007 Boston, MA E. Burke et al Journal of Clinical Oncology, Vol 25, No 18S (June 20 Supplement), 2007: 6054 Background: We examined the impact of chemoradiotherapy (CRT) on swallowing function in a group of patients treated for locally advanced head and neck cancer in an ongoing randomized phase II study with concurrent CRT, with or without Ethyol. Methods: Chemotherapy consisted of weekly carboplatin AUC 1.5 and paclitaxel at 45 /m2 for 4 weeks. Radiation was delivered using a 3 field technique with a concomitant boost schedule to a total dose of 72 Gy. Patients were randomized to receive or not receive daily subcutaneous Ethyol. Patients had video swallow studies at the start of radiation and 8, 12, 24 and 52 weeks post chemoradiotherapy. Dysphagia and weight loss were monitored. Video swallow study reports were collected and the incidence of penetration, aspiration, pharyngeal residue and upper esophageal narrowing analyzed. Results: Baseline data were available for 31 patients out of 43 enrolled. 29% of the patients penetrated, 6.4% aspirated and 29% had pharyngeal residue. Patients on both arms of the study had a steady decline in swallowing function from onset until 24 weeks post radiation. Penetration, aspiration and pharyngeal residue were consistently noted at all time points and improvements in deglutition were seen on the 52-week post radiation video swallow. Forty percent of the patients (17/43) had narrowing in the upper esophagus. On average, a third of the patients examined required dilations. The remaining patients with esophageal narrowing were able to [...]

7/30/2007 Norway staff www.aftenposten.no Three out of four Norwegians think the tobacco product known as snus, or snuff, can cause cancer. Its popularity has been soaring, though, especially among young men. Snuff's rise in popularity has followed Norway's introduction of laws that ban smoking in offices, restaurants, bars and other public places. Many smokers, denied their cigarettes, turned to snuff instead, and producers responded by boosting production of snuff in small packets that now are often found under the lips of many young Norwegian men. And women. Studies show that around 6 percent of the Norwegian population aged 16-74 use snuff daily. Three times as many in the age group 16 to 24 are believed to use snuff daily. Researcher think the figures will soon reach 35 percent of the population aged 16 to 24, despite cancer fears. A new survey conducted by polling firm Norsk Respons for a state public health program in Østfold County found that 84 percent of women and 66 percent of men questioned believe snuff can cause cancer. Medical researchers are split on the issue, with some downplaying the risk. Others subscribe to the cancer warnings. "We have strong indications that snuff can lead to cancer, especially cancer in oral cavities and the stomach," said Professor Tore Sanner at the leading Norwegian cancer hospital Radiumhospitalet. The World Health Organization and American health authorities have also classified snuff as cancer-causing.

7/29/2007 Tallahassee, FL staff www.local10.com Florida's once-heralded youth anti-smoking program is coming back. Lawmakers had gutted the program's budget in recent years, but last year voters forced the program back into relevancy. Voters in November changed the constitution to require the Legislature to put 15 percent of the state's tobacco settlement dollars into the program each year, just under $58 million in the current year. "We have restored an effective youth tobacco prevention program, which includes a substantial appropriation for smoking cessation," said Don Webster, CEO of the American Cancer Society's Florida Division. In the late 1990s Florida's effort to convince kids that smoking wasn't cool was widely praised, partly for its original TV ads that had lots of teens - and young adults - talking about them, and partly because it seemed to work. The number of kids who said in surveys that they smoke dropped off fairly dramatically during the time the program was in full swing. Later, when the program was no longer being used, the decreases leveled off. The program featured a teen-oriented ad campaign that didn't bother with subtlety, squarely taking on the tobacco industry, and portraying industry officials as outright killers. One ad compared tobacco company executives to Hitler, Stalin and the Ku Klux Klan. Another featured a boy getting his tongue bitten off by a dog he was taunting. The ad, which targeted smokeless tobacco, asked "how attached are you to your tongue?" The pinstripe suit-crowd wasn't amused, and many lawmakers also didn't [...]

7/29/2007 web-based article press release CNNMoney.com Myriad Genetics, Inc. announced today that it has introduced a new product, TheraGuide 5-FU(TM), to help predict which cancer patients are likely to suffer serious toxic reactions to the drug 5-Fluorouracil (5-FU) or the oral form of the drug, capecitabine. More than 500,000 Americans with breast cancer, colon cancer, skin cancer or head and neck cancer are treated with 5-FU each year. Approximately 30% of those patients experience severe toxicity. TheraGuide 5-FU is a comprehensive analysis of the genetic variations in two genes, DPYD and TYMS, which increase a patient's risk for toxicity to 5-FU chemotherapy. With the TheraGuide 5-FU test results, oncologists and their patients can take steps to reduce the risk of avoidable toxicity, including using alternative therapies, reducing the size of the dose and increasing patient monitoring for side effects. TheraGuide 5-FU provides the critical guidance oncologists need to personalize chemotherapy for their cancer patients who are being considered for chemotherapy regimens. "TheraGuide 5-FU is a new personalized medicine test that has the potential to save many cancer patients from serious toxic reactions to the medicine that is supposed to help them," said Greg Critchfield, M.D., President of Myriad Genetic Laboratories, Inc. "TheraGuide 5-FU points the way to the future promise of personalized medicine, where tests can guide the therapeutic choice for improved patient care, while limiting the side effects of otherwise efficacious drugs." Approximately one third of all patients given 5-FU will experience dose-limiting toxicity that can be severe to [...]

7/27/2007 web-based article S Subramanian et al Acta Otorhinolaryngol Ital, December 1, 2006; 26(6): 309-16 In spite of advancement in science, molecular medicine and target therapies, surgical treatment of metastases using different techniques, from selective neck dissection to extended radical neck dissections, form a major part in the management of neck metastases. This is due to the fact that, so far, there is no treatment more effective for resectable neck metastases, than surgery. Since most head and neck cancer patients die due to loco-regional progression of disease, and a very large majority of them do not live long enough to develop distant metastases, the status of neck lymph nodes remains the single most important prognostic factor, in these cases. In the 100 years since George Washington Crile described Radical Neck Dissection, we now have a much better understanding of the biological and clinical behaviour of neck metastases. This has ultimately led to the conservative approaches of selective neck dissections depending on the primary site of the tumour, type of tumour and the characteristic features of the metastases themselves. A search of the literature on neck lymph nodes and neck dissections, on the internet and in old publications, not available in the electronic media, has been carried out. Using this as the basis, we arranged, in sequence, the dates of various landmarks in the treatment of head and neck cancer related to neck dissections to emphasize the overall process of evolution of neck dissection thereby showing how the field of head [...]