3/21/2005 www.cancerconsultants.com Researchers from Duke University have reported that anemic patients with advanced head and neck cancers treated with radiation therapy have poorer outcomes than comparable patients without anemia. The details of this retrospective analysis were reported in the March 15, 2005 issue of the International Journal of Radiation Oncology Biology Physics.[1] Hypoxia is known to interfere with the therapeutic effectiveness of radiation therapy and chemotherapy. It has been suggested that clinical anemia can reduce responses to radiation therapy and chemotherapy. In the current study, researchers evaluated outcomes of 159 patients with head and neck cancer treated with a standardized radiation and chemotherapy regimen. Radiation was hyperfractionated and the chemotherapy drug was cisplatin. This group of patients had a median hemoglobin of 13.6 g/dL. The researchers compared outcomes of patients who had hemoglobin levels of 13.0 g/dL with those who had levels below 13.0 g/dL. The five-year failure-free survival was 75% for patients with a hemoglobin of 13.0 g/dL or higher, compared to 50% for those with a lower hemoglobin level. However, patients with anemia appeared to have on average more extensive disease at the time of treatment. These authors concluded that anemia was associated with a worse outcome, but that the cause was unknown. They proposed prospective trials of erythropoietin (Procrit® or Aranesp®) to determine if correction of anemia improves outcome. Comments: Preliminary results from a Radiation Therapy Oncology Group (RTOG) study indicated that erythropoietin improved hemoglobin levels in anemic patients with head and neck cancers receiving only radiation [...]

3/21/2005 National Cancer Institute Clinical Trial Results As reported at the American Society of Clinical Oncology annual meeting, New Orleans, LA, 2004 Background: Head and neck cancers account for three percent of all cancers in the United States. Most of these cancers begin in squamous cells found in the lining of structures in the head and neck. Initial treatment options for patients with advanced head and neck cancer include radiation therapy, chemotherapy combined with radiation treatment, or surgery followed by radiation and/or chemotherapy plus radiation for patients whose tumors can be surgically removed. Many head and neck cancer cells overexpress (make too much of) a protein called the epidermal growth factor receptor (EGFR), which may help cancer cells to grow more aggressively. Cetuximab is a monoclonal antibody that attaches to and blocks EGFRs. Early studies suggested that treatment with cetuximab would boost the effectiveness of radiation therapy in patients with head and neck cancer. The Study: A total of 424 patients in the United States and Europe were enrolled in this study. All had tumors in their tonsils, tongue, or voicebox that may have involved lymph nodes, but had not spread to other parts of the body. Patients were randomly assigned to receive either radiation therapy alone or radiation plus weekly cetuximab. Patients were followed up for a median of just over three years. The study’s principal investigator was James A. Bonner, M.D., of the University of Alabama at Birmingham. (See the protocol summary.) Results: Median survival for patients treated [...]

3/18/2005 M. Hashibe et al. Cancer Lett, April 8, 2005; 220(2): 185-95 Radiation exposure, known to cause DNA damage, may be a potential source of field cancerization of the upper aerodigestive tract. Radiotherapy for head and neck cancers has been examined as a possible risk factor for second primary cancers, but the results have been equivocal. We evaluated the impact of therapeutic radiation for oral cancer on the risk of second primary cancers with data from the Surveillance, Epidemiology, and End Results (SEER) program for 1973-1999. Among 30,221 first primary oral squamous cell carcinoma patients, 6163 (20.4%) patients developed a second primary cancer, 5042 of which were metachronous. Patients treated with radiation only (RR=1.64, 95%CI=1.18-2.29) or radiation with surgery (RR=1.49, 95%CI=1.07, 2.06) had elevated risks of developing a second primary tumor, whereas patients treated with surgery only did not appear to be at increased risk (RR=1.28, 95%CI=0.93, 1.76). Consistent with an expected latent period between radiation exposure and tumor occurrence, radiation became a risk factor after 10 years of follow-up for solid cancers of the oral cavity (RR=2.8, 95%CI=1.5, 5.2), pharynx (RR=5.9, 95%CI=1.7, 20.7), esophagus (RR=3.9, 95%CI=1.1, 13.4) and lung (RR=1.5, 95%CI=1.0, 2.4), and after 1-5 years of follow-up for second primary leukemia (RR=2.5, 95%CI=1.0, 6.7). Radiotherapy for oral cancer appears to be a risk factor for second primary tumors. Further studies that account for chemotherapy and examine frequency and duration of radiotherapy would be of interest in confirming the observed. Authors: M Hashibe, B Ritz, AD Le, G Li, [...]

3/18/2005 Jon Sudbø et al. Journal of Clinical Oncology, Vol 23, No 9 (March 20), 2005: pp. 1927-1933 Purpose: Quitting smoking may prevent oral cancer. Behavioral intervention to quit smoking may be more efficient if persons are assigned an individual risk of cancer. Patients and Methods: In this prospective study, we provided counseling and behavioral intervention toward smoking cessation, supplemented by genetic analyses in clinically normal oral mucosa of heavy smokers. Measurement of serum cotinine was used to assess changes in smoking habits. Results: In cytologic scrapings from 275 heavy smokers with clinically normal mucosa, we found tetraploidy in four and aneuploidy in 19 persons (23 of 275; 8%). Twenty one (91%) of 23 persons with aneuploidy had quit or reduced their smoking habits at the 3-month follow-up, 20 (87%) of 23 persons had done so at 12 months, and 21 (91%) of 23 persons had done so at 24 months. Fifty-one (20%) of the 252 persons without genetic changes in their mucosa had quit or reduced their tobacco habits at the 3-month follow-up, 23 (9%) had done so at 12 months, and 17 (7%) had done so at 24 months (P < .001). After 24 months, normalization of DNA content to diploidy was observed in two of four persons with tetraploid (50%), and in 11 of 19 persons (58%) with aneuploid scrapings. One patient developed an oral carcinoma in the floor of the mouth: this patient had an aneuploid scraping obtained 43 months earlier and developed a leukoplakia 28 [...]

3/18/2005 M Dimitrijevic, A Mikic, Z Petrovic, I Pendjer, S Jesic, and A Trivic Acta Chir Iugosl, January 1, 2004; 51(1): 77-81 Despite new approaches to treatment and lower mortality, malignant tumors of the head and neck, including the malignant tumors of the oral cavity, still represent significant oncological problem because long-term survival has not been significantly prolonged. The growth of tumors of this localization is fast and infiltrative, while early metastases of regional lymph nodes are rather frequent. Malignant tumors of the oral cavity account for 1.1% of population in our community (Dimitrijvic, 2001). The objective of the study was to analyze regional metastases of the cancers of the tongue and the floor of mouth in 101 patients with planocellular cancers treated in the period 1991 to 1995. Clinically positive regional lymph nodes were found in 67.3% of patients, while the most commonly involved regions were submandibular (47.4%) and upper jugular region (46.1%). They were more frequent in localization of the floor of mouth than in case of tongue cancer. Three types of neck dissections were used for surgical treatment of patients. In the group of patients with clinically negative results of the neck (N0) who underwent neck dissection, occult metastases of regional lymph nodes were verified pathohistologically in 19.2% of the time. Malignant tumors of the oral cavity are always the indication for neck dissection, even in N0 category, on account of high proportion of occult metastases. Authors' Affiliation: Institut za Otorinolaringologiju i maksilofacijalnu hirurgiju, Klinicki centar Srbije, [...]

3/17/2005 Rebecca Walsh NZ Herald (nzherald.co.nz) Grisly picture warnings of the damage smoking can do to people's bodies could start appearing on cigarette packets in New Zealand in two years. The country must increase the size of health warnings on tobacco products to meet standards set by the World Health Organisation's Convention for Tobacco Control. A briefing on the preferred options will go to Health Minister Annette King within three months. Anti-smoking lobby group Action on Smoking and Health (Ash) has released graphic pictorial warnings it would like to see on all cigarette packets. The pictures show lung diseases such as emphysema, mouth disease and throat cancer and are similar to those used in several countries, including Australia, Canada and Brazil. Ash director Becky Freeman said people might initially feel fear and disgust but Canadian research had found that 47.4 per cent of adult smokers who had seen and read the pictorial warnings tried to quit smoking or reduced their cigarette consumption. About 4500 New Zealanders die each year as a result of smoking and Ms Freeman said even small changes in the total consumption of tobacco had enormous public health implications. The protection of corporate trademarks and business rights must not be given priority over the protection of human health and life, she said. Ash wanted the remaining portion of the cigarette packet not allocated to picture and text health warnings to be white with black text only. Ms Freeman said the tobacco industry had disguised the dangers of [...]

3/17/2005 Vicki Brower Journal of the National Cancer Institute, Vol. 97, No. 6, 414-416, March 16, 2005 The controversy surrounding human embryonic stem cells has captured headlines in the mainstream media in the last few years; meanwhile, the pages of the scientific literature have recently revealed some groundbreaking findings with adult stem cells. Scientists have shown that certain adult stem cells— neural, mesenchymal, and endothelial stem cells—have an uncanny ability to home to cancer cells and tumors, even moving through large areas of the body. Researchers hope to exploit this "attraction" to kill cancer by using the cells as Trojan horses to attach and deliver deadly payloads to cancer cells as an adjunct to other treatments. Stem cells play a key role in development and repair, and like cancer cells, they are self-renewing. "That stem cells and brain tumor cells behave very, very similarly gave rise to two areas of investigation," said Evan Snyder, M.D., Ph.D., director of stem cell research at the Burnham Institute in San Diego. "First, it made us ask whether the tumors had stem cells in them, and second, if they migrate to cancer cells, could we use them to treat tumors?"

3/17/2005 BBC World News The obsession with cosmetic surgery is obscuring the real work plastic surgeons do treating cancer patients and burn victims, leading doctors say. They said the demand for cosmetic surgery fuelled by the media's coverage of celebrities and TV programmes was having a negative effect. The British Association of Plastic Surgeons even said some people saw them in a similar vein as hairdressers. Instead, the surgeons said they were doctors who were there to heal people. To stress their point, they gave examples at a London press briefing of people who had benefited from their work. In one case, a club bouncer who had had his nose cut off in a sword attack was given a new nose through nasal reconstruction. Understanding A man who developed tongue cancer had part of his tongue removed and rebuilt, hardly impairing his speech. And two children, born with cleft palates, were almost indistinguishable from their peers by the age of two. Association chairman Chris Khoo said: "One of the things that comes across in the TV programmes is that there is a quick fix for anything, but sometimes we have to say no to treatment and people don't understand. "This obsession tends to trivialise what the speciality can do. "Our members treat cancer patients, burn victims and babies with cleft palates. They enable people to live full and active lives, but this does not always come across. " "We are not saying cosmetic surgery is not important, because it is [...]

3/16/2005 Houston, TX NBC Local 2 (click2houston.com) Every year, nearly 300,000 people are diagnosed with a form of oral or throat cancer. About 8,000 die. In order to educate the public about the disease, Local 2 launched Buddy Check: On Guard for Oral Cancer on Monday, in partnership with M.D. Anderson Hospital. Oral cancer does not just affect those over 50 who smoke, Local 2 reported Tuesday. At the age of 44, George Timmons became part of a disturbing trend. "Certainly, we know tobacco and alcohol and age are sort of co-factors in the cancer, but we are seeing more cancer in the oral cavity and throats of younger individuals, if they're in their 30s and 40s and 50s," said Rhonda Jacob, an M.D. Anderson dental oncologist. In Timmons' case, doctors believe years of using smokeless tobacco led to the tumor in his tongue. After chemotherapy, surgery took lymph nodes from his neck, as well as half of his tongue. "I wish I would have been more receptive to the information and I was, like, hard-headed, like, 'That is not going to happen to me.' But you know what? It can. It will," Timmons said. "There is literature that says, and nationally based databases that have found, that head and neck cancer in young people seems to be increasing," said Dr. Erich Sturgis, M.D. Anderson's head and neck surgeon. The young age is not the only trend catching young people off guard. More oral cancer patients have little to no [...]

3/16/2005 Miranda Hitti WebMD Medical News Blood Pressure, Adrenalin Also Increase Smokeless tobacco boosts heart rate, blood pressure, and adrenalin. The results have "potential implications" for heart risk, the study notes. The study was small and short, so it's not the final word on smokeless tobacco. But the findings indicate cigarettes may not be the only tobacco product that affects the heart. Smokeless tobacco, also called snuff or "spit" tobacco, is used by more than 5 million adults and more than 750,000 adolescents, say researchers. With more young men -- especially athletes -- using smokeless tobacco, the researchers were curious about its impact. Experts have already tied smokeless tobacco to oral cancer and dental problems such as receding gums, bone loss, and bad breath. In 1986, the U.S. Surgeon General concluded that smokeless tobacco isn't a safe alternative for cigarettes or cigars, according to the American Cancer Society (ACS). Smokeless tobacco may also lead to nicotine addiction, says the ACS. Not as much is known about how smokeless tobacco affects the heart. But doctors do know that cigarettes are a heart hazard. Quitting smoking is widely regarded as one of the best things a smoker can do for his heart. Studying Smokeless Tobacco Participants were 16 healthy young men who habitually used smokeless tobacco. They were about 22 years old, on average. The men were asked not to use smokeless tobacco or smoke for 12 hours before each of two study sessions. They were randomly given either 1.5 grams of [...]