neck dissection

Ipsilateral radiation controls tonsil cancer

Source: www.medpagetoday.com Author: Charles Bankhead, Staff Writer, MedPage Today Patients with newly diagnosed tonsillar cancer can have long-term disease control and minimal risk of contralateral recurrence with ipsilateral (same side) radiation therapy, data from a large patient series showed. Only two of 102 patients had contralateral failure during a treatment experience dating back to 1970. Ipsilateral radiation therapy resulted in 100% locoregional control at the primary site and ipsilateral neck. "In properly selected patients, ipsilateral radiotherapy to the involved primary site and neck provides excellent local control with a low risk of contralateral nodal failure," Gregory Chronowski, MD, of M.D. Anderson Cancer Center in Houston, reported at the Multidisciplinary Head and Neck Cancer Symposium. "High neck, nonbulky, N2b neck disease does not appear to be a contraindication to ipsilateral radiotherapy in patients with T1-T2 primary tumors. Neck dissection appears to offer reasonable salvage therapy in the event of isolated contralateral neck failure." Limiting radiation therapy to the ipsilateral primary site and neck offers potential advantages over more extensive irradiation. Limiting the treated area minimizes the risk of xerostomia and avoids complications related to exposure of the uninvolved contralateral vasculature, dentition, and musculature. A retrospective review of a large case series from Toronto provided the first evidence that a limited approach to radiation therapy offers good local control and minimal risk of contralateral failure (Int J Radiat Oncol Biol Phys 2001; 51: 332-43). That analysis showed a three-year local control rate of 77%, cause-specific survival of 76%, and contralateral failure rate [...]

Oral Cancer Foundation News Team - A2010-03-01T19:21:16-07:00March, 2010|Oral Cancer News|

Sentinel nodes predict spread in oral cancer

Source: www.medpagetoday.com Author: Michael Smith, North American Correspondent, MedPage Today In early oral squamous cell carcinoma, a sentinel node biopsy correctly predicted an absence of lymphatic metastasis in all but 4% of patients, researchers said. For T1 and T2 lesions that were clinically node-negative, the procedure -- combined with additional sectioning and immunohistochemistry -- yielded a negative predictive value of 96%, according to Francisco Civantos Jr., MD, of the University of Miami, and colleagues. For T1 lesions, the value was 100%, while for T2 cancers it was 94%, the researchers reported online in the Journal of Clinical Oncology. The finding may position the procedure as an intermediate option between watchful waiting and selective neck dissection, the researchers said, asserting that it's now "reasonable" to conduct a head-to-head trial of sentinel node biopsy and neck dissection. The procedure has significantly increased the sensitivity for detecting lymphatic metastasis in melanoma and breast cancer patients, Civantos and colleagues noted. But in oral cancer, many surgeons prefer a completion neck dissection, they added, despite the "measurable morbidity" that's associated with the procedure. On the other hand, because of that morbidity, other specialists prefer watchful waiting and elective neck irradiation. To investigate the issue, Civantos and colleagues conducted a multicenter trial in which patients with early invasive oral cancers were treated with both procedures -- a sentinel node biopsy, followed by completion selective neck dissection. The primary goal was to see if a negative hematoxylin and eosin finding on the sentinel node biopsy accurately predicted [...]

Oral Cancer Foundation News Team - A2010-02-09T21:42:01-07:00February, 2010|Oral Cancer News|

Neck response to chemoradiotherapy

Source: Arch Otolaryngol Head Neck Surg. 2009;135(11):1133-1136 Author: Alexander Langerman, MD et al. Complete Radiographic Response Correlates With Pathologic Complete Response in Locoregionally Advanced Head and Neck Cancer Objective: The role of neck dissection following chemoradiotherapy (CRT) for locoregionally advanced head and neck cancer is an area of active debate. Patients who have a complete radiographic response may not need dissection, and the extent of neck dissection necessary for those patients with residual disease is unclear. Design: Retrospective review of data from a prospectively collected database of patients with locoregionally advanced head and neck cancer treated as part of a phase 2 study of induction chemotherapy followed by concurrent CRT. The results of post-CRT neck computed tomography (CT) imaging and pathologic analysis of the neck dissection specimens were compared to evaluate correlation between radiographic and pathologic response. Results: Forty-nine patients underwent 61 hemineck dissections. Overall, 209 neck levels were dissected. Radiologic complete response in the neck was achieved in 39 patients, all of whom had pathologic specimens negative for tumor cells. Ten patients (20%) had a total of 14 neck levels with residual disease on CT imaging. Five (50%) of these 10 patients were found to have residual tumor cells on pathologic analysis. Tumor cells were contained only to those levels found positive on CT imaging; they were present in 7 (50%) of the 14 positive levels. Conclusions: Neck levels with residual disease on post-CRT CT imaging warrant removal. However, neck levels without evidence of disease on post-CRT CT imaging [...]

Oral Cancer Foundation News Team - A2009-11-17T19:34:20-07:00November, 2009|Oral Cancer News|

Biovex agrees to Special Protocol Assessment (SPA) with the FDA for a pivotal phase III study with Oncovexin head and neck cancer

Source: www.pressreleasepoint.com Author: press release BioVex Inc, a biotechnology company developing clinical stage treatments for cancer and the prevention of infectious disease, announced today that the U.S. Food and Drug Administration (FDA) has approved the design of a single, pivotal, Phase III clinical trial evaluating its lead product, OncoVEXGM-CSF for the first line treatment of patients with squamous cell cancer of the head and neck. The study is the second the Company has agreed with the FDA under the Special Protocol Assessment (SPA) procedure and highlights the broad potential utility of BioVex’s first-in-class cancer destroying virus technology. The first SPA was in melanoma under which BioVex is currently conducting a pivotal Phase III trial. Patients with head and neck cancer often present with locally advanced, bulky disease that is too large, or too close to vital organs, to remove surgically. These patients typically undergo combination radiation and chemotherapy treatment, with in some cases additional surgery. Patients who present with tumor containing lymph nodes are particularly difficult to treat and approximately half of these patients relapse within two years. Philip Astley-Sparke, President & CEO, for BioVex said: "The announcement of our second SPA governing a Phase III study demonstrates the breadth of the commercial opportunity with OncoVEXGM-CSF. In addition to treating metastatic disease as is the intention in our ongoing Phase 3 study in melanoma, following multiple systemic responses in Phase II, OncoVEXGM-CSFalso has considerable potential utility in treating discrete solid tumor masses across multiple indications including those that are poorly [...]

Oral Cancer Foundation News Team - A2009-11-04T12:54:36-07:00November, 2009|Oral Cancer News|

Planned neck dissection unnecessary in some patients with advanced stage oropharyngeal cancer

Source: www.docguide.com Author: Louise Gagnon The use of a neck dissection is not always necessary in patients with advanced stage oropharyngeal cancer, according to a retrospective study presented here at the 2nd World Congress of the International Academy of Oral Oncology (IAOO). "Our message is that you don't have to do a planned neck dissection," said John Yoo, MD, Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre/University of Western Ontario, London, Ontario. Chemoradiation is now the standard of care in most centres for patients with advanced oropharyngeal cancer, noted Dr. Yoo. "You can follow those patients to see if they relapse or have persistent disease," he explained in an interview on July 10. "You can salvage them if that occurs. The trend is towards not doing a planned neck dissection, but to follow the patients." Patients received external beam irradiation in addition to platinum-based chemotherapy. They were staged pathologically and radiologically. They were reassessed at 6 to 8 weeks after treatment for residual disease. Neck dissections were performed only if clinicians had clinical or radiological evidence of residual disease. Dr. Yoo and colleagues retrospectively analysed 62 patients (49 males, 13 females) treated at the London Regional Cancer Centre between 1999 and 2005. The mean age of patients was 56, and the median follow-up was 32 months. A total of 15 patients were N3 staged, and 47 were N2 stage. Specifically, 18 were stage N2a, another 18 were stage N2b, and 11 were stage N2c. There was a complete [...]

Oral Cancer Foundation News Team - A2009-07-15T04:11:30-07:00July, 2009|Oral Cancer News|

Long-term neck control rates after complete response to chemoradiation in patients with advanced head and neck cancer

Source: Am J Clin Oncol, October 1, 2008; 31(5): 465-9 Author: R Rengan et al. Objectives: To examine the long-term neck failure outcome in patients with advanced head and neck cancer treated on larynx/organ preservation protocols at Memorial Sloan-Kettering Cancer Center. Materials and methods: Two hundred thirteen patients were enrolled from 1983 through 1995 on larynx/organ preservation protocols receiving induction chemotherapy followed by radiotherapy alone or with concomitant chemotherapy. Eighty-six patients with node-positive disease received definitive chemoradiotherapy at Memorial Sloan-Kettering Cancer Center. A median dose of 70 Gy was delivered. The median follow-up of the surviving patients was 9 years. Results: Sixty-five patients with node-positive disease achieved a clinical complete response and were observed after chemoradiation without immediate neck dissection. The crude rate of subsequent neck failure among those patients according to initial nodal classification was: N1 14% (3 of 21), N2: 15% (6 of 40), N3: 0% (0 of 4). The median overall survival of these patients was: N1: 12.2 years; N2: 6.5 years; N3: 0.8 years. Patients who experienced a complete response to induction chemotherapy in the neck had improved overall survival (53% vs. 29%; P = 0.005) and a lower incidence of neck failure (10% vs. 24%; P = 0.14) when compared with those patients who had less than a complete response. Conclusions: Our data suggests that in patients with advanced neck disease who have a clinical complete response in the neck to chemoradiation long-term neck control is 85% or greater without neck dissection. Whether functional imaging [...]

Oral Cancer Foundation News Team - A2008-10-12T17:29:57-07:00October, 2008|Oral Cancer News|

New York Presbyterian Hospital showcases latest advances and techniques in head and neck surgery

Source: www.marketwatch.com Author: staff Head and neck surgery is a diverse regional subspecialty, whose central focus is treatment of oncologic disorders of the neck. "Neck dissection is relevant to treatment of such disorders as squamous cell cancers of the upper aerodigestive tract, tongue cancer, laryngeal cancer, thyroid cancer, salivary gland cancer, and skin cancers of the head/neck region, including melanoma," explained William I. Kuhel, MD, the Director of the Head and Neck Service, Department of Otorhinolaryngology, at NewYork-Presbyterian/Weill Cornell Medical Center, and Associate Professor of Clinical Otorhinolaryngology at Weill Cornell Medical School. "For many years, the radical neck dissection was the standard operation for removal of metastatic disease involving the lymph nodes in the neck, but that operation evolved into what are referred to as modified and selective neck dissections, which spare some of the important structures in the neck," said Dr. Kuhel. Salvatore M. Caruana, MD, the Director of the Division of Head and Neck Surgery at NewYork-Presbyterian/Columbia University Medical Center, and Assistant Clinical Professor of Otolaryngology and Head and Neck Surgery at Columbia University College of Physicians and Surgeons, explained further. "The trend these days is to do smaller operations to get the same effect. Over the years it has become clear that certain areas of a radical neck dissection do not have to be included for diseases at specific levels. Our knowledge base has allowed us to make smaller operations to address the same problems." Greater experience has also allowed for more common use of adjuvant therapies, [...]

Oral Cancer Foundation News Team - A2008-10-06T12:35:45-07:00October, 2008|Oral Cancer News|