10/5/2004 Andre A. Konski et al. Fox Chase Cancer Center Intensity-modulated radiation therapy (IMRT)--the newest generation of precision-targeted, conformal radiation therapy--permits delivery of powerful radiation doses with extremely high precision while reducing radiation side effects on surrounding healthy tissue. However, because the technology is much more expensive to deliver than the previous conformal therapy, three-dimensional conformal radiation therapy (3-D CRT), there have been concerns about cost-effectiveness. A Fox Chase Cancer Center study presented today at the 46th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Atlanta, Ga., looked at prostate cancer treatment with IMRT and found it cost-effective because of the reduction in side effects and extended disease-free survival, requiring fewer additional treatments with either hormone therapy or chemotherapy. "Although more expensive, our study found IMRT to be cost-effective for men with intermediate-risk prostate cancer because it improved the quality-adjusted survival," said lead author Andre A. Konski, M.D., M.B.A., M.A., a radiation oncologist and clinical director of the Prostate Cancer Risk Assessment Program at Fox Chase. To determine if the benefits to patients are worth the cost from a payer's point of view, Fox Chase Cancer Center researchers developed a model to compare 3-D CRT to IMRT for a 70-year-old man with prostate cancer who has an intermediate-risk that the cancer would recur or progress. The disease states modeled included (1) no disease progression; (2) disease progression that responded to hormone therapy; (3) disease progression that did not respond or stopped responding to hormone therapy and [...]

10/4/2004 Athanassios Argiris, Yi Li, and Arlene Forastiere Cancer, September 27, 2004 Background: The current study was conducted to identify prognostic factors and report the characteristics of long-term survivors in patients with recurrent or metastatic carcinoma of the head and neck who were treated with cisplatin-based combination chemotherapy in two randomized, Phase III trials conducted by the Eastern Oncology Cooperative Group (ECOG) (E1393 and E1395). Methods: The authors analyzed prognostic factors for response and survival by combining data from the E1393 trial, which compared cisplatin plus paclitaxel at two dose levels, with data from the E1395 trial, which compared cisplatin plus paclitaxel with cisplatin plus 5-fluorouracil (5-FU), using logistic regression and Cox regression models. Results: A total of 399 eligible patients were included. The median follow-up was 4.7 years. The 1-year overall survival (OS) rate for all patients was 32%, the median OS was 7.8 months, and the objective response rate was 32%. On multivariate analysis, the following were found to be independent unfavorable predictors of objective response: weight loss of > 5%, an ECOG performance status of 1 (vs. 0), residual disease at the primary tumor site, a primary tumor site other than the oropharynx, prior radiation therapy (RT) (P = 0.056), and well/moderate tumor cell differentiation (P = 0.067). Independent unfavorable prognostic factors for OS were weight loss, an ECOG performance status of 1 (vs. 0), well/moderate tumor cell differentiation, a primary tumor in the oral cavity or hypopharynx, and prior RT. The following were found to be [...]

10/4/2004 TL Chow, TK Chow, TT Chan, NF Yu, SC Fung, and SH Lam J Oral Maxillofac Surg, October 1, 2004; 62(10): 1225-8 Purpose Contralateral neck failure after therapy for squamous cell carcinoma of the oral cavity and oropharynx has rarely been studied in detail. We aimed to examine the pattern and outcome of contralateral neck relapse and possible predictive clinicopathologic factors. Patients and methods Seventy-three patients undergoing surgery for cancer of oral cavity/oropharynx with curative intent were recruited from the hospital head and neck cancer registry. The age, gender, tumor site, primary tumor laterality, TNM status, clinical N status, pathologic T status, ipsilateral pathologic N status, tumor stage, status of residual disease, histopathologic differentiation, postoperative radiotherapy, local relapse, distant relapse, extracapsular spread of lymph node metastasis and neck dissection were evaluated for association with contralateral neck relapse. Results Seven patients developed ipsilateral, 5 patients developed contralateral, and 3 patients developed bilateral neck recurrence after therapy. Only 1 patient with contralateral or bilateral neck relapse survived after salvage therapy. Ipsilateral positive nodal status was the only significant clinicopathologic parameter associated with contralateral neck relapse, which occurred rather commonly in well-lateralized tumors. Conclusion Contralateral and ipsilateral neck relapses are similar in occurrence. Pathologic positive nodal status is associated with a higher incidence of contralateral neck relapse. Aggressive and comprehensive adjuvant radiotherapy to the neck plus close surveillance in the first 2 years postoperatively might curtail the frequency and mortality due to contralateral neck failure.

10/4/2004 Russell W. Hinerman et al. Head Neck, September 30, 2004 Background: The purpose of this study was to analyze factors influencing outcome in patients who received postoperative irradiation for advanced squamous cell carcinoma of the oral cavity. Methods: Between October 1964 and November 2000, 226 patients with 230 previously untreated primary invasive squamous cell carcinomas of the oral cavity were treated postoperatively with continuous-course external beam irradiation. All patients had a minimum follow-up of 2 years (analysis, November 2002). No patient was lost to follow-up. Results: The 5-year actuarial rates of locoregional control by pathologic American Joint Committee on Cancer stage were: stage I, 100%; stage II, 84%; stage III, 78%; and stage IV, 66%. Recurrence of cancer above the clavicles developed in 55 patients (24%). In multivariate analysis of locoregional control, positive margins, vascular invasion, perineural invasion, extracapsular extension, and T classification remained significant. Conclusions: This article provides additional data defining relatively favorable and unfavorable groups of patients in the postoperative setting. Dose recommendations are re-examined and selectively increased for high-risk patients. Russell W. Hinerman, William M. Mendenhall, Christopher G. Morris, Robert J. Amdur, John W. Werning, and Douglas B. Villaret Department of Radiation Oncology, University of Florida Shands Cancer Center, PO Box 100385, Gainesville, FL 32610-0385

10/4/2004 Diana C. G. et al. J Biomed Opt, September 1, 2004; 9(5): 940-950 Autofluorescence spectroscopy shows promising results for detection and staging of oral (pre-)malignancies. To improve staging reliability, we develop and compare algorithms for lesion classification. Furthermore, we examine the potential for detecting invisible tissue alterations. Autofluorescence spectra are recorded at six excitation wavelengths from 172 benign, dysplastic, and cancerous lesions and from 97 healthy volunteers. We apply principal components analysis (PCA), artificial neural networks, and red/green intensity ratio's to separate benign from (pre-)malignant lesions, using four normalization techniques. To assess the potential for detecting invisible tissue alterations, we compare PC scores of healthy mucosa and surroundings/contralateral positions of lesions. The spectra show large variations in shape and intensity within each lesion group. Intensities and PC score distributions demonstrate large overlap between benign and (pre-)malignant lesions. The receiver-operator characteristic areas under the curve (ROC-AUCs) for distinguishing cancerous from healthy tissue are excellent (0.90 to 0.97). However, the ROC-AUCs are too low for classification of benign versus (pre-)malignant mucosa for all methods (0.50 to 0.70). Some statistically significant differences between surrounding/contralateral tissues of benign and healthy tissue and of (pre-)malignant lesions are observed. We can successfully separate healthy mucosa from cancers (ROC-AUC>0.9). However, autofluorescence spectroscopy is not able to distinguish benign from visible (pre-)malignant lesions using our methods (ROC-AUC<0.65). The observed significant differences between healthy tissue and surroundings/contralateral positions of lesions might be useful for invisible tissue alteration detection. Diana C. G. De Veld, Marina Skurichina, Max J. H. [...]

10/2/2004 LONDON, UK Associated Press Rolling Stones drummer Charlie Watts has been given the all clear after undergoing radiation therapy for throat cancer. Rolling Stones drummer Charlie Watts has won a battle with throat cancer, lead singer Mick Jagger was quoted as telling a newspaper Saturday. Watts, 63, was diagnosed with cancer four months ago and recently finished a successful six-week chemotherapy treatment at the Royal Marsden Hospital near his home in London's Chelsea district. "Charlie has had all his treatments and he's now been cleared and is free of any illness," Jagger told the Daily Mirror. Watts learned of the disease after finding a lump on the side of his neck. In June, a biopsy confirmed the tumour was malignant, and Watts began preparing for radiation treatment. The chemotherapy left Watts weak, and he will spend time recovering with his wife, Shirley, at their manor house in Devon in western England before going back to work, the Mirror reported. The drummer has recently split his time between the Stones and his jazz band, Tentet. Jagger told the newspaper that he hoped to record new material and schedule a tour in the near future. "Keith Richards and I have been writing lots of songs for the new Rolling Stones album," Jagger said. "We haven't booked the tour yet and when we do we'll let you know, but there will definitely be another one."

10/2/2004 Baltimore, MD Tom Dunkel Baltimore Sun (online edition) Life is full of surprises, and Karen Ulmer got a well-deserved one this week when about 30 family members and colleagues ambushed her at Greater Baltimore Medical Center. There were hugs. There were flowers. There was - oh, no! - Ulmer's 5-year-old son, Joshua, prematurely poking his finger into a sheet cake decorated with pink-icing script that read "Congratulations Karen." The cause for celebration was hospital director Larry Merlis' announcement that Ulmer is one of 15 nurses nationwide who've been selected for outstanding service awards by apparel manufacturer Cherokee Uniforms. "I'm very touched and honored," said Ulmer, who had that familiar, glazed-eye look of somebody whose doorbell had just been rung by the Publishers Clearing House Prize Patrol. Unfortunately, Karen Ulmer couldn't eat a piece of her own cake. She was recognized by the company for her devotion to head and neck cancer patients. It is an empathy that comes, in part, from first-hand experience: Ulmer, 36, was diagnosed with thyroid cancer 17 years ago and has undergone more than a dozen operations and surgical procedures. She sometimes attends the same cancer-survivor support groups as her patients. "Anyone who has read or heard her story knows she's an inspiration," said KerriAnn Schenck, nursing supervisor for the fifth-floor surgical in-patient unit where Ulmer works. Her vocal chords have been damaged by radiation treatments. She has had several tracheostomies done on her throat, inserting tubes to relieve breathing problems. She can nibble some [...]

10/1/2004 ANN ARBOR, MI By Sheri Hall The Detroit News Americans listen to stars' pitches, U-M scientist says. — A University of Michigan researcher says he’s found a magic potion that may convince Americans to quit smoking, get regular check-ups and take their medicine: Stardom. Jack Klugman for oral cancer detection Dr. A. Mark Fendrick — who studies factors that influence health behavior — found that while people often ignore their spouses and even their doctors when it comes to health issues — they will listen to celebrities. “Americans are star-struck,” Fendrick said. “They buy the shoes that stars wear, they drink the soft drinks they drink, so it follows that they’ll go ahead and follow their healthy lifestyles.” Blythe Danner for oral cancer screening Fendrick’s initial study, published last year, tracked colon cancer screenings after NBC’s “Today Show” host Katie Couric underwent an on-air colonoscopy test in 2001. She became an advocate for the screenings after her husband died of colon cancer in 1998. “The second she went on TV, I thought of the idea,” Fendrick said. For nine months after Couric’s on-air test, Fendrick and his fellow researchers surveyed 400 gastrointestinal doctors in 22 states to find out how many colonoscopies they performed weekly. And the researchers tracked the tests among 44,000 patients in a Michigan health maintenance organization. Researchers found a 20 percent increase in the screenings in both groups. “Before Katie, there had been a tremendous effort in encouraging people to get colon cancer screenings, and [...]

9/30/2004 Kristen B. Pytynia et al. Journal of Clinical Oncology, Vol 22, No 19, 2004: pp. 3981-3988 PURPOSE To compare survival rates between patients with squamous cell carcinoma of the head and neck (SCCHN) without a history of smoking (never smokers) and those with a current or previous history of smoking (ever smokers). PATIENTS AND METHODS Fifty never smokers with newly diagnosed SCCHN were matched to 50 ever smokers according to sex, age, tumor site, overall stage, nodal stage, and treatment. Survival analysis was performed using Kaplan-Meier estimates. Matched-pair survival was compared using the Cox proportional hazards model. RESULTS The never smokers had a greater overall survival (P = .020), disease-specific survival (P = .022), and recurrence-free survival (P = .016). Furthermore, matched-pair analysis demonstrated smoking was associated with a significant increase in risk of overall death (relative risk [RR] = 3.50; 95% CI, 1.14 to 10.77; P = .029), risk of death owing to disease (RR = 3.98; 95% CI, 1.11 to 14.33; P = .034), and risk of disease recurrence (RR = 3.29; 95% CI, 1.18 to 9.14; P = .023). Smoking was associated with three-fold increases in risk for overall death, death owing to disease, and recurrence after adjustment for cancer-associated symptom severity and alcohol use, but the 95% CI for these adjusted risk estimates each included the null. CONCLUSION Survival differed significantly between never smokers and ever smokers with SCCHN. These results are not substantively explained by differences in cancer-associated symptoms or alcohol use, but the [...]

9/30/2004 Adorján F. Kovács, Natascha Döbert, Jochen Gaa, Christian Menzel, Klaus Bitter Journal of Clinical Oncology, Vol 22, No 19 , 2004: pp. 3973-3980 PURPOSE To assess the impact of a diagnostic ladder including [18F]fluorodeoxyglucose positron emission tomography (PET) and lymphoscintigraphy guided sentinel node biopsy (LS/SNB) on neck treatment in patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). PATIENTS AND METHODS Prospectively, 62 patients with resectable T1-3 OOSCC underwent computed tomography (CT) and PET. Patients without neck uptake in PET were defined as cN0 and were accrued for LS/SNB. Results were correlated with histopathology. The traditional guidelines according to CT findings were compared to the actual regimen and the outcome. RESULTS Sensitivity, specificity, validity, and positive and negative predictive value of PET versus CT were 72% v 89%, 82% v 77%, 79% v 80.5%, 62% v 61.5%, and 88% v 94.5% (not significant). Thirty-eight PET negative patients underwent LS/SNB. Sentinel lymph nodes were found in all 38 patients. Five patients had positive nodes (PET false-negatives) and underwent neck dissection (ND). Fifty-one neck sides in 36 patients who were CT-negative would have been treated with selective ND according to the guidelines, and at least 45 neck sides would have had to undergo extensive ND because of positive CT findings (96 of 124 neck sides). In contrast, PET in combination with LS/SNB spared 59 neck sides, and 41 of 124 neck sides actually underwent ND as a result of PET staging, LS/SNB, and intraoperative decision. After a median follow-up of 35 [...]