radiation

Gabapentin shows efficacy as opioid alternative for patients with head and neck cancer

Source: www.healio.com
Author: Jennifer Byrne

For many patients with head and neck cancer, treatment-associated oral mucositis is a source of severe pain. Managing this pain is a priority for physicians and interdisciplinary care teams.

Although opioid painkillers historically have been used for this purpose, researchers at Roswell Park Comprehensive Cancer Center investigated the use of gabapentin, a drug used to alleviate nerve pain, as an alternative to narcotics for this patient population.

“Virtually all patients will require some type of pain relief or analgesic medication during the course of chemotherapy and radiation,” study author Anurag K. Singh, MD, professor of oncology and director of radiation research at Roswell Park, told Healio. “We’ve been studying better ways to improve pain control in this population because standard narcotics just don’t work that well. Patients tend to use a lot and they still experience pain, but they are sleepier.”

A dose-dependent effect
In their study, published in Cancer, Singh and colleagues randomly assigned 60 patients with head and neck squamous cell carcinoma to one of two treatment regimens: high-dose gabapentin (2,700 mg daily), progressing sequentially to hydrocodone-acetaminophen and fentanyl when needed (n = 31), or low-dose gabapentin (900 mg daily) progressing to methadone as needed (n = 29).

Safety and toxicity served as the study’s primary endpoints. Pain, opioid requirement and quality of life served as secondary endpoints.

Results showed no difference in pain between the treatment groups, but more patients in the high-dose gabapentin group did not need an opioid while receiving treatment (42% vs. 7%; P = .002). Patients whose treatment progressed to methadone rather than hydrocodone and fentanyl had significantly better quality-of-life outcomes in terms of general health (P = .05), physical functioning (P = .04) role functioning (P = .01) and social functioning (P = .01).

“The bottom line is there was a dose-dependent effect of gabapentin,” Singh told Healio. “When you go from 7% in the lower-dose arm, or 0% if you weren’t giving gabapentin at all, to 42% in the higher-dose arm, that’s a really obvious difference.”

‘Potential arrow in our quiver’
The team at Roswell Park has begun using gabapentin as a first-line approach to pain for patients with head and neck cancer, Singh said.

“We use even higher-dose gabapentin now. We go up to 3,600 mg and follow it with methadone when needed,” he told Healio. “We’re having excellent results. Currently, we’re studying whether we can add something to the gabapentin to get narcotics even further out of the equation.”

Singh and study first author Gregory Hermann, MD, MPH, resident physician in radiation medicine at Roswell Park, have started to evaluate use of the antidepressant venlafaxine (Effexor, Pfizer), which was shown in a study conducted in Europe to enhance the effects of gabapentin.

“Venlafaxine is an SNRI [serotonin-norepinephrine reuptake inhibitor] that is similar to other drugs like duloxetine (Cymbalta, Eli Lilly) that have been used for neuropathic pain in diabetes. It’s a very common medication that is used in primary care,” Hermann told Healio. “At the end of the study, we’ll be able to say whether 3,600 mg is more effective than 2,700 mg and whether venlafaxine adds anything.”

Although opioid painkillers are known for their addictive potential, opioid abuse is less likely among patients with head and neck cancer, provided they are used properly, according to Heath Skinner, MD, PhD, associate professor of radiation oncology at UPMC Hillman Cancer Center. improve significantly within a few weeks of treatment completion,” Skinner told Healio. “In that situation, the goal is to manage pain to allow for eating and drinking as much as possible. Once the acute event leading to the pain is at least partially resolved, we start to wean those medications down. So, in the acute setting, I think these medications have a very limited addiction potential.”

However, if improperly prescribed for long-term use, opioid painkillers could become addictive, Skinner said. Moreover, narcotic painkillers are associated with significant toxicities for an already sick population.

“Constipation is a common effect with opioids and can be particularly challenging for [patients with head and neck cancer] because they’re not drinking a lot of fluids or eating much food,” Skinner told Healio. “That could exacerbate a problem known to happen with narcotic-based pain medications.”

Skinner said gabapentin is a promising alternative to opioids that is readily accessible to clinicians.

“It’s available in the setting of pain control and easily prescribed,” he said. “It’s not something that’s proprietary that a clinician couldn’t acquire. It’s nice to have another potential arrow in our quiver.” – by Jennifer Byrne

Reference:
Hermann GM, et al. Cancer. 2020;doi:10.1002/cncr.32676,

March, 2020|Oral Cancer News|

Absent p53, oral cancers recruit and reprogram nerves to fuel tumor growth

Source: medicalxpress.com
Author: by University of Texas M. D. Anderson Cancer Center

Loss of an important tumor-suppressing gene allows head and neck cancer to spin off signals to nearby nerves, changing their function and recruiting them to the tumor, where they fuel growth and cancer progression, researchers from The University of Texas MD Anderson Cancer Center report in the journal Nature today.

By cracking the mechanism that launches neuronal invasion of tumors, a known marker of poor prognosis for patients, the team has uncovered possible avenues to block the process, including the use of drugs commonly used to treat blood pressure and irregular heartbeat.

“Tons of studies show that patients who have lots of nerves in their tumor are doing worse—recurrence rates are higher, survival is shorter,” says co-first author Moran Amit, M.D., Ph.D., assistant professor of Head and Neck Surgery. “Nerve endings found in surgically removed tumors can’t be easily characterized or tracked back to their source, so it’s been a neglected field, a neglected hallmark of cancer.”

“When surgeons remove head and neck cancers and find a high degree of nerve invasion, post-surgical radiation sometimes is effective,” said co-senior author Jeffrey Myers, M.D., Ph.D., chair of Head and Neck Surgery. “But we really haven’t understood whether the tumor was growing into the nerves or the nerve growing into the tumor and what signaling drove those interactions.”

Co-senior author George Calin, M.D., Ph.D., professor of Experimental Therapeutics and an expert on non-coding RNAs added that the paper “puts together for the first time the mechanism of involvement of neurons in tumor generation, a new hallmark of cancer.”

The team found that the neurons that invade the tumor are adrenergic nerves, which are involved in stress response. These nerves’ neurotransmitters—adrenaline (epinephrine) and noradrenaline (norepinephrine) – are susceptible to drugs known as alpha and beta blockers, long used to treat high blood pressure and irregular heartbeats.

In the study, mice with oral cancer treated with the adrenergic blocker carvedilol had sharply lower tumor growth and cancer cell proliferation. Myers says the team is working to develop clinical trials of adrenergic blockers, most likely in combination with other drugs.

“We used to think that nerves are just randomly growing into the tumor, and that’s completely wrong,” Amit says.

Loss of p53 flips a microRNA switch to re-program neurons
Damage to the p53 gene is a major characteristic of head and neck cancers. A tumor-suppressing master transcriptional gene that governs the expression of many other genes, p53 is also mutated in a variety of cancers.

The team found high density of neurons in p53-deficient mouse models and human xenograft tumors of oral cavity squamous cell carcinoma (OCSCC) as well as increased neural growth in clusters of nerves exposed to p53-deficient OCSCC.

The researchers also discovered that oral cancer communicates with nerves by launching extracellular vesicles—membrane balls that carry various molecules—packed with microRNAs to connect with the nerves. The miRNA cargo varied depending on p53 status of the tumors.

“When you have intact p53, you have specific types of microRNAs that keep neurons in a quiescent state,” Amit says. “Once you lose p53, the micro RNA population within the exosomes changes and then you get positive signals to induce nerve growth.”

Investigators identified adrenergic nerves extending into the tumors and suspected they were extensions of pre-existing nerves. However, when they cut adrenergic nerves before inducing tumors in mice, adrenergic nerves still appeared in the tumor and the tumors still grew.

Subsequent experiments showed the miRNAs in vesicles from p53-deficient tumors were connecting instead with existing sensory nerves, a different nerve type, and actually changing them into the adrenergic type. These neo-adrenergic nerves then invaded the tumor.

To confirm this finding, they cut sensory nerves ahead of inducing p53-deficient tumors in mice. Without the sensory nerve targets for the vesicles, the tumor shrank.

Impact of adrenergic nerve density on patients
To validate the impact of their findings on people with OCSCC, the researchers analyzed the presence of adrenergic nerves in the tumors of 70 patients who were treated at MD Anderson. Adrenergic nerve density in the tumors was associated with lower recurrence-free survival and overall survival.

The statistical significance of the adrenergic nerve densities held up in multivariable analysis after adjustment for other variables, such as age, sex, cancer stage, surgical margin status, overall neuronal invasion and treatment type. They suggest nerve density measurements merit exploration as a predictive marker of oral cancer aggressiveness. Myers, Calin, Amit and colleagues believe the paper opens up a new area for cancer researchers.

“Neurons control everything that we do in everyday life,” Amit says. “They control our voluntary and involuntary bodily functions, so it’s intuitive that they are involved in cancer.”

February, 2020|Oral Cancer News|

Study: Healthy diet may avert nutritional problems in head, neck cancer patients

Source: news.illinois.edu
Author: Sharita Forrest

At least 90% of head and neck cancer patients develop symptoms that affect their ability or desire to eat, because of either the tumor itself or the surgery or radiation used to treat it. These problems, called nutrition impact symptoms, have wide-ranging negative effects on patients’ physical and mental health and quality of life.

However, patients who eat foods high in antioxidants and other micronutrients prior to diagnosis may reduce their risks of developing chronic nutrition impact symptoms up to one year after being diagnosed with head or neck cancer, according to a recent study led by researchers at the University of Illinois.

The scientists analyzed the dietary patterns of 336 adults with newly diagnosed head and neck cancers and these patients’ problems with eating, swallowing and inflammation of the digestive tract. This painful inflammatory condition, called mucositis, is a common side effect of radiation treatment and chemotherapy.

The mitigating effects of a healthy diet were particularly significant in people who had never smoked and in patients who were underweight or normal weight at diagnosis, who often experience the greatest eating and digestive problems during treatment, said Sylvia L. Crowder, the paper’s first author.

Crowder is a research fellow in the Cancer Scholars for Translational and Applied Research program, a collaborative initiative of the U. of I. and Carle Foundation Hospital in Urbana, Illinois.

“While previous work has established that the presence of nutrition impact symptoms is associated with decreased food intake and weight loss, no studies have examined how pre-treatment dietary intake may influence the presence of these symptoms later in the course of the disease,” Crowder said.

In the early 2000s, researchers hypothesized that consuming antioxidant supplements might protect patients’ normal cells from damage during radiotherapy, enabling them to better tolerate treatment and higher dosages.

Accordingly, prior research by Anna E. Arthur, a professor of food science and human nutrition at the U. of I. and the current study’s corresponding author, indicated that eating a diet of whole foods abundant in antioxidants and phytochemicals improved recurrence and survival rates in head and neck cancer patients.

Like Arthur’s prior research, the new study was conducted with patients of the University of Michigan Head and Neck Specialized Program of Excellence.

Data on patients’ tumor sites, stages and treatment were obtained from their medical records. More than half of these patients had stage 4 tumors at diagnosis.

Prior to starting cancer treatment and again one year post-diagnosis, the patients completed a questionnaire on their diet, tobacco and alcohol use, and quality of life. Patients reported whether they experienced any of seven nutrition impact symptoms – such as pain or difficulty chewing, tasting or swallowing foods and liquids – and rated on a five-point scale how bothersome each symptom was.

In analyzing the patients’ eating habits, the scientists found that they followed either of two major dietary patterns – the Western pattern, which included high amounts of red and processed meats, fried foods and sugar; or the prudent pattern, which included healthier fare such as fruits and vegetables, fish and whole grains.

Patients who ate healthier at diagnosis reported fewer problems with chewing, swallowing and mucositis one year after treatment, the scientists found.

“While the origin and development of nutrition impact symptoms are complex and varied, they generally share one common mechanism – cell damage due to inflammation,” said Arthur, who is also an oncology dietitian with the Carle Cancer Center. “The prudent dietary pattern has the potential to reduce inflammation and affect the biological processes involved in the pathogenesis of these symptoms.”

The scientists hypothesized that some patients may begin eating healthier after being diagnosed with cancer, potentially counteracting the pro-inflammatory effects of their previous dietary habits.

Reverse causation was possible too, they hypothesized – patients’ lack of symptoms may have enabled them to consume a broader range of foods, including healthier whole foods, before their cancer was discovered.

Notes:
Alison M. Mondul, Laura S. Rozek, Dr. Gregory T. Wolf and Katie R. Zarins, all of the University of Michigan, were co-authors of the study.

Additional co-authors were Kalika P. Sarma of the Carle Illinois College of Medicine, M. Yanina Pepino of the U. of I., and Zonggui Li and Yi Tang Chen, both then-graduate students at the U. of I.

In addition to the C-STAR program, an Academy of Nutrition and Dietetics Colgate Palmolive Fellowship in Nutrition and Oral Health, and the U.S. Department of Agriculture National Institute of Food and Agriculture supported the research.

December, 2019|Oral Cancer News|

Acupuncture prevents radiation induced dry mouth

Source: www.healthcmi.com/
Author: staff

Acupuncture reduces the frequency and severity of xerostomia (dry mouth). University of Texas MD Anderson Cancer Center (Houston) and Fudan University Cancer Center (Shanghai) researchers conducted a randomized controlled clinical trial. The phase-three patient and assessor blinded investigation of acupuncture’s effects on head and neck cancer patients receiving radiation therapy demonstrated groundbreaking results. The researchers concluded that acupuncture “resulted in significantly fewer and less severe RIX [radiation-induced xerostomia] symptoms 1 year after treatment vs SCC [standard care control].” [1]

Salivary glands may be temporarily or permanently damaged by radiation therapy. There is a high-incidence of RIX, which may lead to complications including difficult or painful swallowing, impairment of the sense of taste (dysgeusia), and dental problems. Other RIX complications may include insomnia and difficulty speaking.

The study compared true acupuncture, sham acupuncture, and standard care control groups. True acupuncture produced significantly greater positive patient outcomes than the other groups. Outcome measures were based on a questionnaire, salivary flow, incidence of xerostomia, salivary contents, and quality of life scores. One year after completion of all acupuncture treatments, the true acupuncture group maintained significantly higher patient outcome rates over the standard care and sham groups.

All acupuncture treatments were provided by credentialed acupuncturists. The researchers note that their findings are consistent with several prior investigations. True acupuncture patients that received acupuncture three times per week during their six to seven week course of radiation therapy had significantly less dry mouth a year after completion of treatments than standard care control patients. No adverse effects occurred at University of Texas MD Anderson. One adverse effect was reported at the Fudan study location.

The researchers find that acupuncture is superior to standard care for the relief of radiation induced xerostomia. They comment that acupuncture is “minimally invasive” and “has a very low incidence of adverse effects.” [2] Based on the evidence, further research is warranted.

All participants in the study were at least 18 years of age, provided informed consent, had a diagnosis of head and neck carcinoma, and were scheduled for radiation therapy at a mean dose of 24 Gy to a minimum of one parotid gland. An extensive list of exclusion criteria was used to prevent variables created by comorbidity.

All acupuncturists providing treatment during the course of the study were licensed and were prepared and trained at the University of Texas MD Anderson Cancer Center. The acupuncture point prescription chosen for the study was the following:

  • CV24
  • LU7
  • KD6
  • Auricular: Shenmen, Point Zero, Salivary Gland 2 Prime, Larynx

Standard needle depths were used and the elicitation of deqi at the acupoints was at the discretion of treating acupuncturists. Notably, once deqi was elicited, needles were no longer manually stimulated (with the exception of displaced needles). Electroacupuncture was not used at any point.

Body-style acupuncture needles were of 0.25 mm diameter and 40 mm length. Auricular acupuncture needles were of 0.16 diameter and 15 mm length. Acupuncture treatments were provided a total of three times per week for the duration of the 6-7 week radiation treatment period.

The researchers chose to avoid the use of local points other than CV24 with the intent of preventing disturbance of tissues damaged by radiation. All patients were treated on the day of radiation therapy in a semisupine or supine position. Acupuncture was applied either before or after radiation therapy. Based on the data, the researchers note that acupuncture “should be considered for the prevention of radiation-induced xerostomia.” [3]

The investigators note that prior research indicates that acupuncture regulates blood flow at the parotid glands. In addition, a variety of other studies find acupuncture effective for the treatment of xerostomia. One of the studies cited in the investigation finds acupuncture effective for up to three years after treatment. Two pilot studies by the research group prior to this phase three clinical trial find acupuncture effective for the prevention of RIX if provided with radiation therapy.

The study employed strict controls and researchers monitored treatment facilities and licensed acupuncturists during the investigation. Further research will help to support standardization of acupuncture protocols for the prevention and treatment of RIX for inpatient and outpatient settings.

References:
1. Garcia, M.K., Meng, Z., Rosenthal, D.I., Shen, Y., Chambers, M., Yang, P., Wei, Q., Hu, C., Wu, C., Bei, W. and Prinsloo, S., 2019. Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer: A Randomized Clinical Trial. JAMA Network Open, 2(12), pp.e1916910-e1916910.
2. Ibid.
3. Ibid.

December, 2019|Oral Cancer News|

Survivorship clinic helps patients with what comes after head and neck cancer

Source: www.pittwire.pitt.edu/
Author: Gavin Jenkins, excerpted from the fall 2019 issue of Pitt Med magazine

Jonas Johnson presses his hand on Edward Christopher’s neck. The examination room at the UPMC Head and Neck Cancer Survivorship Clinic is chilly on this June morning as Johnson, chair of the University of Pittsburgh Department of Otolaryngology, glides his fingers along the left side of Christopher’s throat.

“Your skin is stiff,” Johnson says. “Scar tissue doesn’t go away.”

Five years ago, Christopher was diagnosed with human papillomavirus (HPV) positive cancer on the base of his tongue, left tonsil and the lymph nodes on the left side of his neck. After undergoing surgery to remove the tumors, he received radiation treatment and chemotherapy, followed by another procedure to remove his lymph nodes.

When he completed the treatment, he posted a picture on Facebook holding a sign that read “cancer free!” That night, he and his family celebrated with dinner at an Italian restaurant. Christopher felt lucky to be alive and grateful to Pitt doctors. He had no idea how difficult the years to come would be. He credits Marci Lee Nilsen, a nurse who is an assistant professor in Pitt’s School of Nursing, with opening his eyes.

In 2016, Johnson and Nilsen created the Survivorship Clinic to help patients like Christopher improve their quality of life after beating head and neck cancer. Most patients grapple with dysphagia—difficulty swallowing—and trismus, commonly known as lockjaw. They might experience a loss of taste, tooth decay, dry mouth and mouth sores. The side effects from radiation and chemotherapy can often cause patients to struggle to talk, hear and sleep, as well. The combination of these treatments with surgery can also lead to mobility issues; many patients end up on disability. Insomnia and sleep apnea can exacerbate anxiety and depression, which also are common issues.

Getting care for these conditions can place a financial strain on patients who have already spent tens of thousands of dollars to overcome cancer.

Survivorship clinics for head and neck cancer are sprouting up across the country. Some of those clinics have more than a few specialists. UPMC’s clinic patients see an otolaryngologist, audiologist, dentist, speech pathologist and physical therapist in one day. And unlike any other survivorship clinic in the United States, they are charged just one co-pay.

The Survivorship Clinic also sets itself apart by how it monitors patients from the start. Nilsen and Johnson meet with patients before they receive radiation and chemotherapy, and then again a month after treatment is completed. After that, patients visit the clinic at least once a year, and depending on their needs, Johnson and Nilsen will coordinate with the appropriate primary care physician, dentist or physical therapist.

Historically, the struggles of head and neck cancer survivors have been approached as an afterthought by many hospitals and primary care physicians. That’s changing as providers recognize the fallout from treatments, which can be lifesaving but also life hobbling. Johnson and Nilsen have seen more than a thousand patients in their three years at UPMC’s Survivorship Clinic. Their work has highlighted the importance of long-term care.

For Johnson, a renowned head and neck cancer surgeon who has been with Pitt since 1977, the Survivorship Clinic represents a new chapter in his career.

“I’ve reinvented myself,” he says. “I say to my residents: Don’t think I’ve repudiated the last 40 years of my career. I still believe in surgery. But I’ve embraced the notion that we must recognize the trouble we cause (treating cancer), and we have to help people with it.”

There’s more to this story. Continue reading about Johnson and Nilsen’s partnership and more patients benefiting from their work.

November, 2019|Oral Cancer News|

Oral mucositis: preventing the side effect before undergoing cancer treatment

Source: www.curetoday.com/
Author: Katie Kosko

Oral mucositis can be painful and, in some cases, require hospitalization of patients being treated for cancer with chemotherapy and other radiation therapies. However, along with your care team, you can take steps to prevent this uncomfortable side effect.

In an interview CURE®, Dr. Alessandro Villa, assistant professor in oral medicine and dentistry at the Harvard School of Dental Medicine, Brigham and Women’s Hospital in Boston, spotlighted the number of patients with cancer who are affected by oral mucositis, explained the benefits of two agents approved by the Federal Drug Administration (FDA) for intervention and explored how patients can control the side effect from the comfort of their homes.

CURE®: Can you explain what types of cancer treatment cause oral mucositis?
Villa: Oral mucositis is an iconic toxicity of cancer therapy and remains one of the most painful and disrupting side effects of radiation therapy and chemotherapy. When I talk about radiation therapy, I talk about patients with head and neck cancer. In these patients, usually 100% receiving radiation therapy develop oral mucositis. We also see mucositis in approximately 60% to 80% of patients who undergo bone marrow transplants. And finally, we see it in 20% to 40% of patients who receive conventional chemotherapy for any cancer.

What are the consequences of oral mucositis?
Oral mucositis is one of the most painful toxicities in patients receiving radiation therapy to the head and neck. It’s the number one cause of hospitalization in these patients. It can sometimes be so severe and painful that patients can’t speak, swallow or eat. It’s a very debilitating toxicity. If they are not able to eat, they may end up receiving a feeding tube. The cost associated with oral mucositis is higher than $17,000 per patient. There is still a huge unmet need out there for patients.

What questions should patients and/or caregivers ask their health care team about oral mucositis?
The first question I would have them ask is, what can I expect? Because it can be different between radiation and chemotherapy. And as we have discussed, they can also ask: What can I do at home to minimize this risk? And what are the preventative measures?

How can oral mucositis be prevented?
The FDA has approved two agents for mucositis intervention. One is called palifermin, which is approved for the prevention of severe oral mucositis in patients who receive certain treatment in preparation for bone marrow transplant. The second agent, which is for mitigation of mucositis in patients treated with radiation for head and neck cancer, is a rinse called benzydamine hydrochloride.

Cryotherapy is recommended by the American Society of Clinical Oncology in patients who receive a specific chemotherapy, 5-fluorouracil or more commonly 5FU. Patients can swish on ice chips for about 30 minutes starting about five minutes before the drug is administered. And to control mucositis pain, morphine may be used in patients who undergo stem cell transplantation.

What can patients do at home to help avoid the side effect or reduce its severity?
There are specific recommendations that patients should follow to minimize oral mucositis. One of them is maintaining good oral hygiene using a soft toothbrush. Patients can also use a saline solution 3-4 times a day, then rinse and spit. Cleansing of the mouth and good lubrication of the inside of the cheeks and lips can help with the pain and inflammation. The reason behind it is that, from a scientific standpoint, the microbiome (the bacteria and all the bugs that we have in the mouth) can contribute in the development and worsening of the mucositis. The cleaner the mouth, the better it is. Of course, patients may be sensitive to certain toothpastes, so it’s important to use mild-flavored fluoridated toothpaste when brushing. In some cases, patients should avoid spicy, acidic or hot foods because these may trigger symptoms for the patient.

How is the side effect monitored?
This depends on the type of treatment they are receiving. If they are receiving radiation, they come in the hospital Monday through Friday, so they are monitored daily.

For those with chemotherapy, most of these drugs are administered through IV in the hospital. However, there are some new chemotherapies given by mouth and patients take these at home, but they can give different side effects.

Is there anything else that you would like to add about oral mucositis?
Right now, this is a huge unmet clinical problem for patients and a devastating toxicity, but the development for oral mucositis is pretty robust with a wide range of new agents. This is promising, and there are some good results in current clinical trials with some of these new agents in progress. If I’m being optimistic, I think that there should be new options ready for approval in the next 5-10 years. There is a lot in the pipeline.

November, 2019|Oral Cancer News|

Radiation for head and neck cancer may cause problems years later

Source: www.usnews.com
Author: Steven Reinberg

Ten years after radiation treatment for head and neck cancer, some patients may develop problems speaking and swallowing, a new study finds.

These problems are related to radiation damage to the cranial nerves, the researchers explained. The condition is called radiation-induced cranial neuropathy.

“We had always thought that radiation did not damage cranial nerves because they get treated in every patient with head and neck cancer, and we do not see cranial neuropathy that commonly,” said Dr. Thomas Galloway, of the department of radiation oncology at the Fox Chase Cancer Center in Philadelphia.

“What our data is suggesting is that a small percentage of people do get cranial nerve damage from treatment, but it occurs after a long latency period,” Galloway said.

For the study, the researchers collected data on 1,100 patients who had radiation for head and neck cancer between 1990 and 2005. Among these patients, 112 were followed for at least 10 years.

Of the 112 patients, 14% developed at least one cranial neuropathy. The median time until the condition was seen was more than seven years. It took some patients more than 10 years to develop the problem, the findings showed.

Curing the initial cancer is the most important concern, Galloway said. But these patients need to be followed for the rest of their lives, if possible, he added.

The report was published recently in the journal Oral Oncology.

October, 2019|Oral Cancer News|

Researchers: Favorable survival, fewer side effects after reduced therapy for HPV-linked head and neck cancer

Source: medicalxpress.com
Author: University of North Carolina at Chapel Hill School of Medicine

University of North Carolina Lineberger Comprehensive Cancer Center researchers reported that reducing the intensity of radiation treatment for patients with human papillomavirus-associated head and neck cancer produced a promising two-year progression-free survival rate and resulted in fewer side effects.

The findings, published in the Journal of Clinical Oncology, were drawn from a phase II clinical trial that included 114 patients with HPV-linked head and neck cancer and a limited smoking history. The researchers reported that they saw a similar progression free survival rate, and that patients experienced fewer long-term side effects in the study compared with patients who received standard intensity treatment in previous studies.

“A simple de-intensification strategy of reducing radiation and chemotherapy appears to be as effective at cancer control as the standard seven-week regimen,” said UNC Lineberger’s Bhishamjit S. Chera, MD, associate professor in the UNC School of Medicine Department of Radiation Oncology. “Furthermore, there were fewer toxicities.”

For the trial, patients received six weeks of treatment, including a reduced intensity of radiation therapy of 60 Gray with weekly low-dose chemotherapy of cisplatin. The standard of care regimen is seven weeks of treatment 70 Gray and high-dose chemotherapy.

The main outcome that the researchers were studying was two-year progression-free survival. On the reduced regimen, researchers found that the two-year progression free survival was 86 percent, compared to a two-year progression free survival reported from other studies using standard treatment doses of 87 percent.

Chera said the major long-term side effects of radiation treatment are related to swallowing and dry mouth. Previous studies have shown the majority of patients treated with standard intensity chemoradiotherapy require a temporary feeding tube and some have significant long-term swallowing dysfunction.

Notably, in this study, patients reported that their swallowing returned to baseline after de-intensified treatment, and only 34 percent required a temporary feeding tube.

The results need to be validated in larger, randomized clinical trials, Chera said, and studies are ongoing to investigate this.

He added that while this study included patients with a limited smoking history, other current studies include patients with more extensive smoking histories.

Chera said that researchers want to continue to improve two-year progression free response rates while achieving better side effect results. They want to do that by identifying additional biomarkers to drive precision medicine strategies.

Although traditional clinical risk help clinicians predict outcomes and select patients for clinical trials of de-intensified treatments, Chera said that these risk factors are imprecise. He and his colleagues are currently evaluating additional novel biomarkers that they believe could be used to better predict a patient’s prognosis and outline a course of treatment.

Specifically, they have shown in a previous study how levels of circulating HPV DNA in the blood, and how quickly patients clear this from the blood, were linked to outcomes.

September, 2019|Oral Cancer News|

Oral rinse could improve mouth pain associated with radiation therapy

Source: www.specialtypharmacytimes.com
Author: staff

An oral rinse containing diphenhydramine, lidocaine, and antacids, was found to significantly decrease pain caused by oral mucositis in patients undergoing radiation therapy for head and neck cancer compared with placebo, according to a study published in JAMA.

The multi-institution, randomized, double-blind, placebo-controlled phase 3 clinical trial was led by Robert Miller, MD, an emeritus Mayo Clinic radiation oncologist.

“Our group published a study in 2012 showing that an oral rinse of doxepin reduced oral mucositis-related pain compared to placebo,” Miller said in a press release. “However, there were no large randomized controlled trials studying the potential benefits of magic mouthwash.”

The researchers evaluated 275 patients between November 2014 and May 2016. The study revealed that treatment with both doxepin and the mouthwash combination significantly reduced pain associated with oral mucositis compared with placebo.

The doxepin and mouthwash combination treatment was also well-tolerated by patients, according to the study.

“Radiation therapy may cause mouth sores because it is designed to kill rapidly growing cells, such as cancer cells,” co-author, Terence Sio, MD, a Mayo Clinic radiation oncologist, said in a press release. “Unfortunately, healthy cells in your mouth also divide and grow rapidly, and may be damaged during radiation therapy, which can cause discomfort. We’re glad to have identified a proven method to help treat the discomfort of this side effect.”

How do speech-language pathologists support cancer patients?

Source: syvnews.com
Author: Aundie Werner

Question: What are speech-language pathologists and how do they support cancer patients?

It is estimated that about 100,000 people will be diagnosed with a head, neck or thyroid cancer this year.

Although this does not grab headlines as often as many other cancers, for those affected the disease and treatment can have a significant impact on their lives. In general, most people survive head and neck cancer; however, side effects of treatment can sometimes be a long-term problem.

The support and guidance of a speech-language pathologist (SLP) can do much to help promote recovery and cope with the difficult symptoms of treatment. Ideally, the SLP becomes involved when the patient has been identified as having head and neck cancer before their surgery or before their chemotherapy/radiation protocol. Counseling and education are provided as to the functions of voice, speech and swallowing. Assessment is made to determine the patient’s baseline and to provide guidance as to the patient’s role in their rehabilitation.

Frequently, the SLP works with patients who have difficulty eating and drinking. Treatment is based on the cause of the problem: anatomical changes from surgery, decreased saliva, changes in taste, difficulty opening the mouth due to trismus, and problems protecting the airway, which can result in coughing and choking during meals.

Maintaining nutrition after surgery and during treatment is necessary to help the body heal. At times, the patient may need to have a feeding tube to help with nutrition when it becomes too difficult to swallow. The SLP assesses the patient’s current needs, instructs the patient in specific swallowing exercises, compensatory swallowing strategies or diet modification recommendations. The goal is for patients to continue to eat and drink during and after treatment.

Following radiation therapy, patients may experience lymphedema and/or fibrosis of the radiated tissue. These effects can persist long after the treatment concludes. Difficulties can include problems opening the mouth to eat from a spoon or fork, or decreased ability of the throat muscles to protect the airway while eating or drinking. In these cases, specific testing and exercises are instructed by the SLP.

Voice changes may also occur after surgery or radiation. The SLP instructs patients how to use their voice efficiently so as not to strain the muscles. Patients who have had their voice box removed are instructed in alternative methods to produce voicing to communicate.

Additionally, articulation and resonance changes can occur from surgery and/or radiation. Patients who have had sinus, palatal, jaw or tongue cancer are instructed how to articulate more clearly through customized treatment or prosthetic devices, if needed.

Each patient’s cancer is unique, as is the plan of care developed by the SLP. The Central Coast has excellent speech-language pathologists who are trained to provide their expertise to facilitate your road to recovery.

March, 2019|Oral Cancer News|