Prognostic Significance of HPV Status in Oropharyngeal Cancer

OncologySTAT Editorial Team Dr. Maura Gillison is Professor of Medicine, Epidemiology, and Otolaryngology at Ohio State University in Columbus. OncologySTAT: The results of the Radiation Therapy Oncology Group (RTOG) 0129 trial showed that the human papillomavirus (HPV) is an independent prognostic factor in oropharyngeal cancer. Could you tell us about the rationale for this study? Dr. Gillison: Over the last 10 years, our research has shown that cancers of the oropharynx are actually 2 completely different diseases that can look quite similar. One subset is caused HPV infection, and the other is more closely associated with long-term use of alcohol and tobacco. Initial studies suggested that the presence of HPV in a patient’s tumor had prognostic significance, but study limitations made that conclusion dubious. We set out to determine whether or not HPV was indeed an independent prognostic factor in head and neck cancer. To show whether there was a direct relationship between HPV infection and head and neck cancer, we needed to prospectively study a uniformly treated and uniformly staged patient population. Thus, we used the study population from the trial conducted by the RTOG. We divided the patients into 2 groups—those whose tumors were caused by HPV and those whose tumors were not—and we compared survival outcomes for the 2 groups. The results showed that HPV status was the single most important predictor of patient outcome, even more so than disease stage and other well-known prognostic factors such as performance status and presence of anemia. In fact, after [...]

2012-04-18T10:16:03-07:00April, 2012|Oral Cancer News|

Nobel Laureate Makes Strong Case for Vaccinating Young Males Against HPV to Prevent Cervical Cancer in Females

Source: Therapeutics Daily AUSTIN, Texas, March 26, 2012 /PRNewswire-USNewswire/ -- Nobel Prize winner Harald zur Hausen called for vaccinating both young males and females for human papilloma virus (HPV) in an achievable quest to eradicate cervical cancer, which is the second leading type of women's cancer worldwide. Zur Hausen made his remarks at a gathering of more than 1,600 members of the Society of Gynecologic Oncology during its 43rd Annual Meeting on Women's Cancer® in Austin. "If we wish to eradicate these types of infections – then theoretically we can do it," zur Hausen said. "And if we wish to achieve this (eradication of HPV) in a foreseeable period of time, then we should vaccinate both genders globally." He pointed out that educational, cultural and religious barriers contribute to the lack of knowledge or willingness to address or discuss the subject by public health officials, teachers, parents and even some physicians. Zur Hausen also said that if society were to vaccinate just one gender to prevent the spread of cervical-cancer causing HPV, it would be more effective to vaccinate just males, highlighting the potential medical value of male HPV vaccinations. Zur Hausen also noted that research shows that early fears of the side effects of the HPV vaccine were overblown, and Australian research shows that there is about one adverse reaction in 100,000 vaccinations, which confirms the safe nature of the vaccine. Keynote speaker for this year's Annual Meeting on Women's Cancer, Harald zur Hausen was awarded the Nobel Prize [...]

2012-03-27T09:45:37-07:00March, 2012|Oral Cancer News|

Oral Complications After Head/Neck Radiation ‘Underreported’

Source: Elsevier Global Medical News Late oral effects of head and neck cancer therapy are "multiple, underreported, and under-appreciated. "That is the perspective of Joel Epstein, D.M.D., who has worked extensively with head and neck cancer patients experiencing severe dental and other oral problems following radiation therapy. "The acute complications of head and neck cancer therapy are pretty well known, but the late complications are underappreciated," Dr.  Epstein, director of oral medicine at City of Hope National Medical Center, Duarte, Calif., told attendees at the symposium. As head and neck cancer treatments have advanced and patients are living longer, the spectrum of treatment complications has shifted, he explained. In a 5-year, prospective longitudinal study of 122 patients with oral carcinoma, dry mouth, sticky saliva, speech changes, dental problems, and sleep disturbance were reported by all patients except those treated only with surgery. These complications persisted at 1 and 5 years and affected quality of life (Head Neck 2008;30:461-70). According to Dr. Epstein, the data illustrate the need for better collaboration between oncologists and dentists. "While people discuss  the concept of multidisciplinary [and] interdisciplinary teams for the benefit of our patients, it is unfortunate that dentistry developed  separately from physicians and surgeons. So while we need to interact, we're not really well prepared to do so, particularly in the  community," he said. Clinically, it's important to evaluate oral care, including brushing, flossing, fluoride, and tobacco abstinence, at all head and neck cancer treatment follow-up visits. Patients should be assessed for xerostomia, speech, swallowing, mucosal sensitivity, and taste. Head and neck and oral exams should include assessments for [...]

2012-03-26T11:58:14-07:00March, 2012|Oral Cancer News|

Connected nodes in throat cancer signal poor prognosis

Source: The presence of “matted” lymph nodes in persons with oropharyngeal squamous cell carcinoma (SCC)—that is, nodes that are connected together—was associated with a 3-year survival rate of 69%, compared with 94% among patients without matted nodes. Such a marker could help clinicians identify patients who are at heightened risk for metastasis and who might benefit from additional systemic therapy. Conversely, a person without matted nodes could be a candidate for less therapy, which would in turn reduce uncomfortable side effects. The study, led by Matthew E. Spector, MD, a resident in the department of otolaryngology – head and neck surgery at the University of Michigan Health System in Ann Arbor, focused on 78 previously untreated persons with stage III or IV oropharyngeal SCC. All patients were undergoing chemotherapy in combination with intensity-modulated radiation therapy (IMRT) as part of a clinical trial. The 3-year disease-specific survival rate for the 16 patients presenting with matted nodes was 69%, compared with 94% among the 61 other patients. Matted nodes were found to be a poor prognostic factor independent of tumor classification, human papillomavirus (HPV) status, epidermal growth factor receptor (EGFR), and smoking status. Matted nodes did appear to be an especially strong indicator of increased risk among HPV-positive persons, despite the fact that these patients had better overall outcomes than did those who were HPV-negative. The best outcomes were seen among HPV-positive nonsmokers. The investigators, who reported their findings in Head & Neck, say the reasons for the survival differences between [...]

2012-02-01T17:10:52-07:00February, 2012|Oral Cancer News|

Newer radiation technology improves head and neck cancer patients’ long-term quality of life

Source: Patients treated with IMRT for head and neck cancer report an increasingly better quality of life post-treatment when compared to patients receiving other forms of radiation therapy, according to a study presented at the Multidisciplinary Head and Neck Cancer Symposium, sponsored by AHNS, ASCO, ASTRO and SNM. Intensity modulated radiation therapy, or IMRT, is a highly specialized form of external beam radiation therapy that allows the radiation beam to better target and conform to a tumor. It is a newer treatment that has become widely adopted for treating head and neck cancer. Prior studies have shown that IMRT decreases the probability of radiation therapy related side effects, including dry mouth and chewing and swallowing problems, but no study has been conducted to measure long-term quality of life in head and neck cancer patients treated with various forms of radiation therapy. Investigators from the University of California, Davis, School of Medicine, prospectively administered the University of Washington Quality of Life instrument, a standardized, previously validated questionnaire that patients complete after radiation therapy, to 155 patients undergoing treatment for cancers of the head and neck and analyzed the scores over time. Fifty-four percent of patients were initially treated with IMRT and 46 percent were treated with non-IMRT techniques. The researchers showed that the early quality of life gains associated with IMRT not only are maintained but become more magnified over time. At one-year post-treatment, 51 percent of IMRT patients rated their quality of life as very good or outstanding compared [...]

2012-01-27T11:29:03-07:00January, 2012|Oral Cancer News|

Gold nanorods could improve radiation therapy of head and neck cancer

Source:National Cancer Institute Radiation therapy is an important part of head and neck cancer therapy, but most head and neck tumors have a built-in mechanism that makes them resistant to radiation. As a result, oncologists have to deliver huge doses of X-rays to the patient, damaging surrounding tissues and producing significant side effects. To overcome this resistance, researchers at the State University of New York (SUNY) at Buffalo and the University of Southern California (USC) have developed a nanoparticle formulation that interferes with the resistance mechanism, and as a result, increases the efficacy of radiation therapy in a mouse model of head and neck cancer. Reporting its work in the journal Integrative Biology ("Gold nanorod–sphingosine kinase siRNA nanocomplexes: a novel therapeutic tool for potent radiosensitization of head and neck cancer"), a research team headed by Paras Prasad of SUNY Buffalo and Rizwan Masood of USC's Keck School of Medicine describes how it used gold nanorods to deliver a small interfering RNA (siRNA) molecule to head and neck tumors. This siRNA molecule blocks the production of a protein known as sphingosine kinase 1 (SphK1). Previous work by the USC team had shown that this protein prevents radiation-damaged cells from undergoing apoptosis, the cell death program triggered in healthy cells when they age or experience major damage. RNA interference, which uses siRNAs to reduce the production of specific proteins, has shown promise for treating cancer and other diseases, but these molecules are readily degraded in the blood stream. To overcome this problem, [...]

2012-01-19T17:08:52-07:00January, 2012|Oral Cancer News|

Third Head and Neck Indication for Erbitux

Source: The ASCO Post, January 1, 2012, Volume 3, Issue 1, Matthew Stenger   In the Clinic provides overviews of novel oncology agents, addressing indications, mechanisms, administration recommendations, safety profiles, and other essential information needed for the appropriate clinical use of these drugs.Cetuximab (Erbitux) was recently approved by the FDA for use in combination with platinum-based therapy plus fluorouracil (5-FU) for the first-line treatment of patients with recurrent locoregional disease or metastatic squamous cell carcinoma of the head and neck.1-3 Cetuximab has prior indications in combination with radiation therapy in locally or regionally advanced squamous cell head and neck cancer and in recurrent or metastatic head and neck cancer that has progressed after platinum-based therapy. It also has indications in colorectal cancer. The most recent approval is based primarily on results of a study conducted outside the United States in 442 patients with metastatic or locally recurrent squamous cell carcinoma of the head and neck who were not suitable for curative treatment with surgery or radiation. The study used a European Union (EU)-approved cetuximab rather than the U.S.-approved cetuximab (Erbitux). Erbitux provides approximately 22% higher exposure than the EU-approved cetuximab; these pharmacokinetic data, together with the results of the study conducted in Europe and other data using Erbitux establish the safety and efficacy of Erbitux at the recommended dose.In this trial, the addition of cetuximab (n = 222) to platinum-based therapy plus 5-FU (n = 220) significantly increased median overall survival from 7.4 to 10.1 months, representing a 20% reduction in risk of death [...]

Tongue and tonsil cancer patients surviving longer

Source: The five-year survival rate for U.S. patients with cancer of the base of the tongue or tonsils doubled between 1980 and 2002, according to a new study in Cancer Causes & Control (January 2012, Vol. 23:1, pp. 153-164). In addition, patients with human papillomavirus (HPV)-related cancers had greater survival rates than those with other oral cancers, and survival was greater for male patients than females regardless of age, according to the study authors, from the New York Eye and Ear Infirmary, the University of Utah School of Medicine, and the University of California, Los Angeles School of Public Health. However, patients with subsequent multiple cancers showed no overall survival improvement. The incidence rates of tongue and tonsil cancers have increased significantly in recent decades in the U.S., particularly among younger patients, the researchers noted. At the same time, a number of studies have shown a strong association between HPV infection and tongue and tonsil cancers. For this study, they used data from the Surveillance, Epidemiology, and End Results (SEER) 1973-2006 registry system to examine changes in survival rates among patients with base of tongue, tonsil, and other tongue cancers in recent decades. The study included 10,704 patients with squamous tongue or tonsil cancer who were at least 20 years old. The researchers separated the patients into those with one primary cancer and those with subsequent multiple cancers, then compared trends using three nonoverlapped periods: 1980-1982, 1990-1992, and 2000-2002. The first group included those with only one primary base of tongue, [...]

Quality-of-Life Outcomes in Transoral Robotic Surgery

Source: SAGE Journals Online Abstract Objective. To report long-term, health-related quality-of-life (HRQOL) outcomes in patients treated with transoral robotic surgery (TORS). Study Design. Prospective, longitudinal, clinical study on functional and HRQOL outcomes in TORS. Setting. University tertiary care facility. Subjects and Methods. Patients who underwent TORS were asked to complete a Head and Neck Cancer Inventory before treatment and at 3 weeks and 3, 6, and 12 months postoperatively. Demographic, clinicopathological, and follow-up data were collected. Results. Sixty-four patients who underwent TORS were enrolled. A total of 113 TORS procedures were performed. The mean follow-up time was 16.3 ± 7.49 months. The HRQOL was assessed at 3 weeks and at 3, 6, and 12 months, with a response rate of 78%, 44%, 41%, and 28%, respectively. TORS was performed most frequently for squamous cell carcinoma (88%). There was a decrease from baseline in the speech, eating, aesthetic, social, and overall QOL domains immediately after treatment. At the 1-year follow-up, the HRQOL scores in the aesthetic, social, and overall QOL domains were in the high domain. Patients with malignant lesions had significantly lower postoperative HRQOL scores in the speech, eating, social, and overall QOL domains (P < .05). Patients who underwent adjuvant radiation therapy or chemotherapy and radiation therapy had lower postoperative scores in the eating, social, and overall QOL domains (P < .05). Conclusion. The preliminary data show that patients who undergo TORS for malignancies and receive adjuvant therapy tend to have lower HRQOL outcomes. TORS is a promising, minimally [...]

2011-12-27T10:58:43-07:00December, 2011|Oral Cancer News|

Lymphedema Common After Head and Neck Cancer

Source: Elsevier Global Medical News   SAN FRANCISCO (EGMN) - Lymphedema is highly common and a source of considerable morbidity among patients who undergo treatment for head and neck cancer, finds a cross-sectional study among 103 survivors. Fully three-fourths had developed some degree of lymphedema, according to results presented at the annual Oncology Congress presented by Reed Medical Education. The more severe it was, the more likely patients were to have symptoms, functional impairments, and poorer quality of life. Disease and treatment-related factors such as high radiation dose and combined surgery and radiation therapy were risk factors for the development of lymphedema. "This is the first study that we are aware of in the United States of this depth to systematically examine lymphedema" in this population, noted lead investigator Jie Deng, Ph.D., R.N., O.C.N., a postdoctoral fellow at the Vanderbilt University, Nashville, Tenn. "Health care professionals should be aware that lymphedema is a frequent late effect in the head and neck cancer population," she advised. "We need to educate patients about the risk of lymphedema prior to treatment, during treatment, and posttreatment, and we need to conduct external and internal examinations to evaluate related signs and symptoms at each clinic visit." Patients found to have any signs or symptoms should be referred for lymphedema assessment. Furthermore, "it's very important we have very detailed documentation so we can follow up on patients' treatment effect and also identify potential issues in this population," Dr. Deng stressed. "An interdisciplinary approach is needed to [...]

2011-12-06T10:29:30-07:00December, 2011|Oral Cancer News|
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