dysphagia – Page 3 – Oral Cancer News

New Guidelines for Reirradiation of Head and Neck Cancer

Source: Medscape News Today When head and neck cancer recurs and surgery is not an option, reirradiation provides the only potentially curative option. However, because the tumor often recurs in the same place or very close to tissue that has already been irradiated, this treatment approach represents a "significant challenge." For this reason, it should be handled at a tertiary-care center, according to a new guideline issued by the American College of Radiology. Specifically, it stipulates that the tertiary center should have a head and neck oncology team that is equipped with the resources and the experience to manage the complexities and toxicities of retreatment. In the guideline, published in the International Journal of Radiation Oncology, Biology and Physics, a panel of experts outline appropriateness criteria for various clinical scenarios that arise with such patients. It provides a consensus on how patients should be managed. "This is an important document because it is the first set of guidelines for the potentially curative treatment of patients who have regrowth of head and neck tumors. It provides a consensus on how patients should be managed," coauthor Madhur Kumar Garg, MD, said in a statement. Dr. Garg is from the Department of Radiation Oncology at Montefiore Medical Center, in the Bronx, New York, where about a dozen reirradiation procedures are performed annually. Commitment to Retreatment Retreatment is justified because clinical trial results have shown that local treatment improves overall survival, the panel of experts notes. However, they emphasize that, before a commitment to [...]

Oral Cancer Foundation News Team - A2011-10-18T10:35:08-07:00October, 2011|Oral Cancer News|

Two Elements Predict Swallowing Difficulties after Radiotherapy

Source: International Medicine News LONDON – Nonglottic cancer and the presence of dysphagia before treatment are highly predictive for severe acute and late swallowing difficulties after radiotherapy for head and neck cancer, according to new data from the DAHANCA 6&7 randomized trial. Patients with nonglottic cancer were more likely than those with other cancer types to experience severe dysphagia at both 6 and 12 months. Dysphagia before treatment was also associated with both acute and late severe swallowing difficulties. "The peak incidence of dysphagia is seen during the first 6 months after radiotherapy," Hanna Rahbek Mortensen, Ph.D., reported in an analysis of the DAHANCA (Danish Head and Neck Cancer Group) 6&7 trial findings at the European Society for Therapeutic Radiation Oncology Anniversary Congress. "After 1 year, however, there is no further increase in severity or prevalence," said Dr. Mortensen of the department of experimental clinical oncology at Åarhus (Denmark) University Hospital. The trial involved 1,478 patients with squamous cell carcinomas of the glottic larynx, supraglottic larynx, pharynx, or oral cavity who were who were treated with five or six weekly fractions of radiotherapy in 1992-1999. The total dose of radiotherapy delivered was 66-68 Gy in 33-34 fractions. Efficacy data from the trial have already been published; they showed improved disease-specific but not overall survival of five vs. six fractions of radiotherapy (Lancet 2003;362:933-40). The aim of the present analysis was to use prospectively collected data from the trial to determine whether any factors could be used to establish which patients [...]

Oral Cancer Foundation News Team - A2011-05-18T13:29:04-07:00May, 2011|Oral Cancer News|

Study IDs dysphagia risk after head/neck cancer treatment

Source: www.DrBicuspid.com February 28, 2011 -- A team of Danish researchers has developed a predictive model for determining which head and neck cancer patients are at risk of developing dysphagia (swallowing disfunction) following intensity-modulated radiotherapy (IMRT). Hanna Rahbek Mortensen, PhD, and colleagues presented results from a large prospective trial, the DAHANCA 6 & 7 study, at last week's International Conference on Innovative Approaches in Head and Neck Oncology in Barcelona, Spain. "We followed 1,476 patients with squamous cell carcinoma of the head and neck, and found out the existence of factors related to the cancer itself, to the patient and to the treatment influencing the development of dysphagia," Mortensen said in a press release. Dysphagia may be acute or late. Risk factors for developing severe acute dysphagia were large tumors, spreading of cancer cells to the lymph nodes, swallowing problems at the time of diagnosis, six treatments per week, and tumor location other than the vocal cords, the researchers noted. Risk factors for developing late dysphagia were large tumors, swallowing problems at the time of diagnosis, and tumor location other than the vocal cords. Although 83% of all head and neck cancer patients develop some kind of dysphagia, this predictive model will have a major impact on patient quality of life, the researchers noted. "These results are very important," said Dr. J.A. Langendijk from the University Medical Center of Groningen. "Today, with the increasing use of IMRT, the dose to the salivary glands is reduced, resulting in lower risks on xerostomia. [...]

Oral Cancer Foundation News Team - A2011-02-28T16:49:12-07:00February, 2011|Oral Cancer News|

Radiation planning reduces dysphagia in oropharyngeal cancer

Source: www.medscape.com Author: Nick Mulcahy In patients with oropharyngeal cancer, modifying radiotherapy to spare swallowing structures appears to be an effective strategy to reduce the long-term dysphagia that accompanies chemoradiotherapy, according to a small longitudinal study. Importantly, the strategy did not come at the expense of locoregional control, report investigators in a study published online April 26 in the Journal of Clinical Oncology. Dysphagia has emerged as perhaps the most important late adverse effect in this setting, supplanting xerostomia, said the study's senior author, Avraham Eisbruch, MD, professor of radiation oncology at the University of Michigan Medical School and Comprehensive Cancer Center in Ann Arbor. "Aggressive chemoradiotherapy approaches produce more dysphagia than in the past," he told Medscape Oncology. Meanwhile, the late adverse effect of xerostomia is on the wane, because the use of intensity-modulated radiotherapy (IMRT) has allowed radiation oncologists to spare most patients' salivary glands from radiation, he said. To address the problem of dysphagia, Dr. Eisbruch and colleagues at the University of Michigan used IMRT in combination with chemotherapy. Their treatment planning for 73 patients with stages III to IV oropharyngeal cancer included sparing any swallowing structure that did not have tumor involvement. The structures included pharyngeal constrictors, glottic and supraglottic larynx, and esophagus. One year after concurrent chemotherapy and IMRT, all 73 of the patients had either absent or minimal observer-rated dysphagia (scores, 0 to 1), with the exception of 4 people: 1 who was feeding-tube dependent and 3 who required a soft diet. The results [...]

Oral Cancer Foundation News Team - A2010-05-19T20:47:25-07:00May, 2010|Oral Cancer News|

Fluoroscopically guided balloon dilation for pharyngoesophageal stricture after radiation therapy in patients with head and neck cancer

Source: AJR Am J Roentgenol, April 1, 2010; 194(4): 1131-6 Author: HT Hu et al. Objective: The purpose of this article is to assess the safety and long-term efficacy of fluoroscopically guided balloon dilation for pharyngoesophageal strictures after radiation therapy in patients with head and neck cancers. Materials and method: From April 1997 to February 2009, fluoroscopically guided balloon dilation was performed in 17 patients with pharyngoesophageal strictures caused by radiation therapy. Technical success, clinical success (decrease of at least one grade in dysphagia score and good contrast passage on 1-month follow-up esophagogram), recurrence of dysphagia, and complications related to the procedure were retrospectively evaluated. Results: All 17 patients underwent 41 balloon dilation procedures, with each patient undergoing one to seven procedures (mean, 2.4 procedures). The technical success rate was 100%, and clinical success was achieved in 64.7% (11/17) of the patients. Five patients (29.4%) showed no recurrence of dysphagia after one session of balloon dilation. Of 12 patients (70.6%) with recurrence of dysphagia, 10 underwent repeat balloon dilation and two underwent gastrostomy after the first session of balloon dilation. The maximum balloon diameters were 15 mm (n = 22), 20 mm (n = 16), and 25 mm (n = 3). As minor complications, three cases of type 1 esophageal rupture occurred in two patients (11.8%). There were no major complications. Conclusion: Although the recurrence rate was high with repeat balloon dilation, fluoroscopically guided balloon dilation seems to be a simple and safe primary treatment technique for pharyngoesophageal stricture due [...]

Oral Cancer Foundation News Team - A2010-04-04T08:58:07-07:00April, 2010|Oral Cancer News|

Weekly radiation of more than 10 gy improves local control in head and neck cancer patients

Source: www.docguide.com Author: John Otrompke Patients with head and neck squamous cell carcinoma who receive an average weekly fractionated radiation dose of more than 10 gy experience significantly better local control at 2 years, unless they are receiving chemotherapy at the same time, according to a study presented here at the American Society of Therapeutic Radiology and Oncology (ASTRO) 51st Annual Meeting. "We're not seeing the benefit in those who also receive chemotherapy with the radiation," said Alek F. Dragovic, MD, Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama. If they have low-stage cancer, they may not necessarily need chemotherapy along with radiation. Also, patients are often not healthy enough to receive chemotherapy if they can't tolerate the side effects, Dr. Dragovic explained in his presentation on November 3. In the study, 601 patients who received definitive radiotherapy were divided retrospectively into those who received more or less than an average weekly dose of 10 gy. Patients who received the traditional schedule of once per day made up 45.1% of the patient population, those who received concomitant boost radiation, in which patients get treated twice per day during the last 2 weeks of radiotherapy, were 17.6% of the population; while 17.5% were treated with simultaneous integrated boost, 15.1% received radiation twice daily, and other received other schedules. Overall, patients who received on average more than 10 gy per week experienced 77.4% local regional control at 2 years, compared with 71.4% who received less than 10 gy per week. For [...]

Oral Cancer Foundation News Team - A2009-11-11T07:50:14-07:00November, 2009|Oral Cancer News|

Routine Oesophageal Screening Recommended for Patients Previously Treated for Head and Neck Cancer: Presented at AAO-HNSF

Source: Docguide.com By Kristina Rebelo SAN DIEGO -- October 12, 2009 -- Patients who have been treated for head and neck cancer (HNCA) should be screened for oesophageal pathologies about 3 months out whether they are symptomatic or not, according a poster presentation here October 4 at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009. Oesophageal pathology is extremely common in patients who have been treated for HNCA, according to the researchers. "When we talk about HNCA, the 5-year survival rate for this cancer is 50%," Peter C. Belafsky, MD, Head and Neck Oncological Surgery, University of California at Davis, and the Voice and Swallowing Center, Davis, California, told DocGuide. "We took a look at the oesophagus in patients after treatment for head and neck cancer and we did oesophagoscopy and biopsy, as indicated, on all of them. We successfully performed the oesophagoscopy on all 100 patients without complication and we had only 13% of the entire cohort who had a normal examination." The study included 100 patients who had chemoradiation and underwent follow-up oesophagoscopy. Patient demographics, symptom surveys, treatments received, reflux medications prescribed and oesophageal findings were prospectively determined. Findings on oesophagoscopy included stricture (22%), candidiasis (9%), peptic oesophagitis (67%), Barrett's (8%), and new primary tumours -- 1 hypopharynx, 2 oesophageal, and 1 stomach (4%); 13% had a normal oesophagoscopy. The mean age of the cohort was 64 years and 74% were male. The mean time between the cessation of treatment and endoscopy was 40 [...]

Charlotte Parker2009-10-13T10:26:11-07:00October, 2009|Oral Cancer News|

Routine oesophageal screening recommended for patients previously treated for head and neck cancer

Source: www.docguide.com Author: Kristina Rebelo Patients who have been treated for head and neck cancer (HNCA) should be screened for oesophageal pathologies about 3 months out whether they are symptomatic or not, according a poster presentation here October 4 at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009. Oesophageal pathology is extremely common in patients who have been treated for HNCA, according to the researchers. "When we talk about HNCA, the 5-year survival rate for this cancer is 50%," Peter C. Belafsky, MD, Head and Neck Oncological Surgery, University of California at Davis, and the Voice and Swallowing Center, Davis, California, told DocGuide. "We took a look at the oesophagus in patients after treatment for head and neck cancer and we did oesophagoscopy and biopsy, as indicated, on all of them. We successfully performed the oesophagoscopy on all 100 patients without complication and we had only 13% of the entire cohort who had a normal examination." The study included 100 patients who had chemoradiation and underwent follow-up oesophagoscopy. Patient demographics, symptom surveys, treatments received, reflux medications prescribed and oesophageal findings were prospectively determined. Findings on oesophagoscopy included stricture (22%), candidiasis (9%), peptic oesophagitis (67%), Barrett's (8%), and new primary tumours -- 1 hypopharynx, 2 oesophageal, and 1 stomach (4%); 13% had a normal oesophagoscopy. The mean age of the cohort was 64 years and 74% were male. The mean time between the cessation of treatment and endoscopy was 40 months and 77% of the HNCA [...]

Oral Cancer Foundation News Team - A2009-10-12T12:05:11-07:00October, 2009|Oral Cancer News|

Analysis of factors influencing dysphagia severity following treatment of head and neck cancer

Source: Anticancer Res, August 1, 2009; 29(8): 3299-304 Authors: NP Nguyen et al. The aim was to assess the influence of treatment, tumor stages and sites on the severity of dysphagia following treatment. Sequential modified barium swallow (MBS) examinations were performed in patients who complained of chronic dysphagia following treatment of their head and neck cancer. Patients were selected if they were cancer free at their last MBS and had 2 or more MBS studies. Dysphagia severity was graded on a scale of 1 to 7. Dysphagia grade was compared between the first and last MBS to assess its evolution. Between 1996 and 2005, 63 patients with chronic dysphagia underwent MBS to assess dysphagia severity for nutritional support. Twenty-one patients (33%) had improvement of their dysphagia. Two of these patients (3%) achieved normalization of the swallowing. Twenty-five patients (40%) had no change of the dysphagia severity. Dysphagia grade increased in 17 patients (27%). Analysis of patient characteristics did not show any significant difference between these three groups of patients. MBS is a useful tool to monitor dysphagia severity and to identify aspiration risk. Stages of disease and treatment modality do not seem to impact on the course of dysphagia. Authors: NP Nguyen, C Frank, CC Moltz, U Karlsson, PD Nguyen, HW Ward, P Vos, HJ Smith, S Huang, LM Nguyen, C Lemanski, A Ludin, and S Sallah Authors' affiliation: Radiation Oncology Department, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85724-5081, US

Oral Cancer Foundation News Team - A2009-09-01T20:53:44-07:00September, 2009|Oral Cancer News|

Radiological balloon dilatation of post-treatment benign pharyngeal strictures

Source: J Laryngol Otol, July 16, 2009; 1-4 Author: L R Williams et al. Aims: To assess the technical success, clinical outcomes and complications of radiologically guided balloon dilatation of benign strictures developing after treatment for head and neck cancer. Materials and methods: Forty-six balloon dilatations were performed in 20 patients. All dilatations were performed over a guidewire. Results: Technical success was 100 per cent. Fifteen of the 20 patients demonstrated clinical improvement in dysphagia scores. Improvement in dysphagia was temporary in all patients (median 102 days), with multiple dilatations usually required (total dilatations ranged from one to seven). Immediate complications were encountered in six of the 46 (13 per cent) dilatations and were all minor. Late complications occurred after two procedures (4 per cent): localised perforation (later complicated by secondary infection) and recurrence of a previous, small, pharyngo-cutaneous fistula. Conclusion: Radiologically guided balloon dilatation is straightforward to perform and is well tolerated, but there is a small risk of perforation. Relief of symptoms is likely to be temporary, requiring multiple subsequent dilatations. A minority of patients will obtain no symptomatic relief.

Oral Cancer Foundation News Team - A2009-07-24T12:49:39-07:00July, 2009|Oral Cancer News|