7/19/2005 Chicago, IL Marina Boruk, MD et al. Arch Otolaryngol Head Neck Surg. 2005;131:605-609 Objective: To determine if age alone is a prognostic indicator of surgical outcomes for major head and neck procedures. Design: Retrospective cohort study over a 4-year period. Setting: Academic referral center, institutional practice, hospitalized care. Patients: Included in this study were patients who had undergone ablative, reconstructive, and other major surgical procedures of the head and neck, including neck dissection, laryngectomy, maxillectomy, thyroidectomy with lymphadenectomy, and composite resection of the oral cavity with reconstruction, for both malignant and benign disease. Main Outcome Measures: Patient data and intraoperative and postoperative course factors were recorded. Comorbidity was graded using an Adult Comorbidity Evaluation 27 test, Charlson Comorbidity Index, and American Society of Anesthesiology score. Postoperative complications were dichotomized, and multiple logistic regression was used for data analysis. Results: Medical chart review identified 157 cases. Analysis of data revealed that time under general anesthesia was the only factor consistently related to complications (P<.006), and it was the only factor consistently related to length of stay (P<.001). Analysis of major complications (6% incidence) as an outcome using univariate analysis resulted in a strong positive correlation with both comorbidity indexes: Adult Comorbidity Evaluation 27 (P = .002) and Charlson Comorbidity Index (P = .005). Multiple logistic regression showed no significant relationship between age 70 years or older (20% of patients) and either complications or hospital length of stay. Conclusions: Patient’s age alone is not a prognostic indicator of surgical outcome for [...]

7/19/2005 Chicago, IL Frank R. Miller, MD et al. Arch Otolaryngol Head Neck Surg. 2005;131:626-629 Objective: To assess the role of positron emission tomography (PET) in the management of unknown primary carcinoma of the head and neck region. Design and Setting: Prospective case series at an academic medical center. Patients: Twenty-six patients with an open excisional biopsy or a fine-needle aspiration biopsy finding that confirmed squamous cell carcinoma of the cervical lymph nodes and no visible primary tumor (as determined by results of a comprehensive physical examination and computed tomography and/or magnetic resonance imaging) underwent PET. The standard evaluation consisted of a comprehensive head and neck examination that included fiberoptic laryngoscopy/nasopharyngoscopy, computed tomography and/or magnetic resonance imaging, and PET followed by panendoscopy with selected biopsies and tonsillectomy. Main Outcome Measures: Sensitivity, specificity, and positive and negative predictive values of PET to detect an occult primary tumor. Results: The PET detected 8 occult primary tumors in 26 patients (detection rate, 30.8%). Four occult primary tumors (2 at the base of the tongue and 2 in the tonsil) were detected during routine panendoscopy with negative PET findings. The sensitivity of PET was 66.0%, with a specificity of 92.9%. The positive predictive value was 88.8%, and the negative predictive value was 76.5%. Conclusions: Positron emission tomography can be a valuable tool to identify a subset of patients with an occult primary tumor in the head and neck region. In addition, it can be used to screen for primary tumors below the clavicle. Early [...]

7/19/2005 Bethesda, MD Lisa M. McShane, Douglas G. Altman, Willi Sauerbrei Journal of the National Cancer Institute, Vol. 97, No. 14, 1023-1025, July 20, 2005 The number of cancer prognostic markers that have been validated as clinically useful is pitifully small, despite decades of effort and money invested in marker research (1–3). For nearly all markers, the product has been a collection of studies that are difficult to interpret because of inconsistencies in conclusions or a lack of comparability. Small, underpowered studies; poor study design; varying and sometimes inappropriate statistical analyses; and differences in assay methods or endpoint definitions are but a few of the explanations that have been offered for this disappointing state of affairs (4–11). Researchers attempting to conduct meta-analyses of prognostic marker studies encounter many difficulties (12–14). In this issue of the Journal, a meta-analysis by Kyzas et al. (15) of the tumor suppressor protein TP53 as a prognostic factor in head and neck cancer provides compelling empirical evidence that selective reporting biases are a major impediment to conducting meaningful meta-analyses of prognostic marker studies. These biases have serious implications, not only for meta-analyses but also for interpretation of the cancer prognostic literature as a whole. Kyzas et al. demonstrate bias in the estimated association between TP53 status and mortality relating to a number of factors. The prognostic importance of TP53 decreased as the pool of included studies increased from published and indexed studies to any published studies, and then to the full set of all published [...]

7/19/2005 Bethesda, MD Elana Hayasaka Journal of the National Cancer Institute, Vol. 97, No. 14, 1019, July 20, 2005 Selective reporting biases may taint many published studies of so-called prognostic factors—biologic or genetic markers that may predict how a patient may fare during or after treatment, according to a new study in the July 20 issue of the Journal of the National Cancer Institute. In recent years, researchers have raced to discover and publish papers on prognostic factors for cancer and other diseases. For example, at least 116 published studies alone have focused on a single tumor suppressor protein (TP53) that may predict the outcome of a patient with head and neck cancer. As researchers attempt to make sense of the growing mountains of information, some are beginning to question the validity and possible biases in many of the studies. To examine the question of selective reporting bias, Panayiotis A. Kyzas and colleagues from the University of Ioannina in Greece analyzed information from studies that investigated the association between TP53 and mortality or survival rates. They collected three levels of information about the studies. The first level included studies that were indexed in the scientific databases MEDLINE and EMBASE using the key words "mortality" or "survival." The other two levels of collected information include published studies not indexed under "mortality" or "survival", and unpublished data retrieved from researchers. The authors found that the association between TP53 status and head and neck cancer mortality weakened as they expanded their analyses from [...]

7/19/2005 Bethesda, MD Panayiotis A. Kyzas, Konstantinos T. Loizou, John P. A. Ioannidis Journal of the National Cancer Institute, Vol. 97, No. 14, 1043-1055, July 20, 2005 Background: Nonreported and selectively reported information and the use of different definitions may introduce biases in the literature of prognostic factors. We probed these biases in a meta-analysis of a prognostic factor for head and neck squamous cell cancer (HNSCC) mortality that has drawn wide attention—the status of the tumor suppressor protein TP53. Methods: We compared results of meta-analyses that included published data plus unpublished data retrieved from investigators; published data; and only published data indexed with "survival" or "mortality" in MEDLINE/EMBASE, with or without standardized definitions. We also evaluated whether previously published meta-analyses on mortality predictors for various malignancies addressed issues of retrieval and standardized information. All statistical tests were two-sided. Results: For the 18 studies with 1364 patients that included published and indexed data, we obtained a highly statistically significant association between TP53 status and mortality. When we used the definitions preferred by each publication, the association was stronger (risk ratio [RR] = 1.38, 95% confidence interval [CI] = 1.13 to 1.67; P = .001) than when we standardized definitions (RR = 1.27, 95% CI = 1.06 to 1.53; P = .011). The addition of 13 studies with 1028 subjects that included published but not indexed data reduced the observed association (RR = 1.23, 95% CI = 1.03 to 1.47; P = .02). Finally, when we obtained data from investigators (11 [...]

7/19/2005 Washington, DC Eva A. Sylwester ScienceDaily (www.sciencedaily.com) New research reaffirms the potential value of green tea as a natural substance able to stop cancer before it starts. "What we do in our conference every year is focus on what the scientists are talking about," said Jeffrey Prince, vice president for education and communications of the American Institute for Cancer Research. Prince and others spoke at a news briefing at AICR's annual International Research Conference on Food, Nutrition and Cancer in Washington. He said this year's conference includes six separate presentations on the benefits of green tea -- and no tea companies were involved in the research. The AICR also released the "New American Plate Cookbook," featuring recipes designed to promote smaller portion sizes and increased consumption of fruits and vegetables. "The American Institute for Cancer Research recommends a mostly plant-based diet to people concerned with reducing cancer risk," Prince said. Many plant-based foods are rich in anti-oxidants, which limit damage to cells and tissues that toxins and pollutants cause by slowing the rate of certain chemical reactions. The active ingredient in green tea is a compound called epigallocatechin gallate, or EGCG, a stronger anti-oxidant than is contained in either vitamin C or E, according to an AICR fact sheet. Green tea is made from the same plant as black tea and oolong tea, but the leaves are not fermented during processing, which apparently preserves the plant's cancer-fighting compounds. In a study using cancer cells in mice, Thomas Gasiewicz, a [...]

7/19/2005 Germany S Rohde et al. Radiologe, July 15, 2005 Background: Modern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time. Patients and Methods: A total of 289 patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60 years, and 71% of the patients were male. Results: After the first cycle 19.3% of the patients presented with complete remission (grade I); 35.4% and 41.5% showed partial remissions (grade II) or stable disease (grade III), respectively. The mean observation time after treatment was 28 months (median: 24.2 months). Of the 137 patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72,5% of these patients were still alive. Conclusion: Intra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer. Authors: S Rohde, A F Kovacs, F E Zanella, J Berkefeld, and B Turowski Authors' affiliation: Institut für Neuroradiologie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt/Main,

7/17/2005 Chicago, IL John Easton Medical News Today (medicalnewstoday.com) Adding low doses of angiostatin -- a naturally produced substance that inhibits the formation of new blood vessels -- to standard radiation therapy dramatically improves the response to cancer treatment in animal models without increasing toxicity, report researchers from the University of Chicago Medical Center, Harvard Medical School and Northwestern University in the July 16 issue of Nature. Human angiostatin alone produced only a modest decrease in tumor growth when given to mice with large tumors. Radiation therapy alone produced a slightly greater response. The combination of angiostatin and radiation, however, caused significant growth inhibition, demonstrating a powerful synergistic effect, even in mice with very large tumors. "Our finding suggests that radiation therapy, already a standard of cancer care, could be dramatically improved by simultaneous administration of relatively small doses of angiostatin," said Ralph Weichselbaum, M.D., professor and chairman of radiation oncology at the University of Chicago and director of the study. "This combination could make radiation much more effective at providing local control of cancer, a crucial part of treatment for many tumors, including prostate, brain, head and neck and other cancers. It could even expand the use of radiation therapy to some forms of metastatic disease without requiring high doses." The researchers also studied the combination of radiation plus mouse angiostatin against human cancers of the brain, head and neck, and prostate that had been transplanted into mice. Once again, the combination was far more effective than the combined [...]

7/17/2005 Middleton, PA Jo Ciavaglia Bucks County Courier Times The mouth pain was so easily ignored that Jerold Wilck doesn't remember when he first noticed it. He saw the sore, but figured he had bitten his tongue. Weeks passed; the sore didn't heal. Strange, Wilck thought. As a longtime dentist, he knew oral abnormalities are fairly rare and usually are nothing troubling. Colleagues looked at his mouth, and none suspected a problem. "That is what happens with most people," he said. It's the reason most people with oral cancer die. Wilck could have been one of them, but a doctor in his Middletown dental practice suggested he get a biopsy. Now, he's spreading the word about the importance of early detection of this common, yet often ignored, cancer. An oral cancer screen should be part of every routine dentist visit, he and other medical experts say. Every year, 30,000 new cases of oral cancer are diagnosed - more cases than leukemia and cancers of the stomach, pancreas and kidney. At 8,000 deaths a year, oral cancer kills more people than melanoma, the most serious form of skin cancer. If caught early, as Wilck's was, the survival rate is 80 percent to 90 percent, according to the Oral Cancer Foundation, based in Newport Beach, Calif. But about 75 percent of oral cancers are diagnosed in the advance stages - a year or two after the symptoms are noticed. By that time, survival rates drop to less than 20 percent. "It's much [...]

7/16/2005 Washington, DC Denise Grady New York Times The government warned yesterday that painkilling skin patches could cause drug overdoses and said it was investigating reports of serious side effects and 120 deaths that might have resulted. The patches, containing the narcotic fentanyl, are marketed under the name Duragesic by Janssen, a company owned by Johnson & Johnson. A generic version was put on the market in February by Mylan Laboratories. Duragesic had sales of more than $2 billion in 2004. The patches are intended for people with moderate to severe chronic pain that requires treatment around the clock for an extended period of time and that cannot be controlled by other narcotics alone, the F.D.A. and the manufacturer say. Only those already tolerant of narcotics, as some cancer patients are, should use the patches. People recovering from surgery, or suffering from short-term pain for other reasons, should not. A spokeswoman for the Food and Drug Administration said the 120 deaths had occurred since Duragesic was first approved in 1990 and added that the investigation was still going on and that it was not known whether the product actually caused the deaths and other problems reported in users. Describing fentanyl as a "very strong narcotic," the F.D.A. issued a public health advisory stating that some patients and doctors might not be fully aware of its dangers. An overdose can cause a person to stop breathing; taking off the patch will not reverse the effects because the drug has already built [...]