Dr Jennifer Choe discusses head and neck dancer relapse, new treatment trials, promising responses

Source: www.ajmc.com Author: Brooke McCormick Jennifer Choe, MD, PhD, shared her thoughts on why head and neck cancer patients relapse after radiation therapy, new head and neck cancer treatment trials, and promising responses from these trials. Choe is a head and neck oncologist at Vanderbilt University Medical Center and was a presenter at The American Journal of Managed Care®’s Institute for Value-Based Medicine® held in Nashville, Tennessee on August 17, 2023. Transcript Can you explain some of the thought behind why there is disease relapse in head and neck cancers after radiation treatment? There's a lot of theoretical basis as to why we think this is the case. A lot is driven by just aggressive biology; it's really not known. Head and neck cancers are considered immune responsive, technically speaking, but the response rates still are pretty low, in general, and whether or not the immune system and head and neck cancer patients are depressed compared to other cancers. I, in theory, think that a part of it is actually the radiation creating an environment where there could be a reduction in the body's ability to regulate the immune system. There's an immune suppressed state for these patients that could be due to radiation of the lymph nodes that's decreasing the ability for the immune system to respond, but also the local radiation induced immune suppression effects that may be producing a more conducive environment for the cancer to return. What are some of the trials evaluating new treatment regimens [...]

2023-09-02T07:41:01-07:00September, 2023|Oral Cancer News|

Hollings head-and-neck team leads trial to reduce delays in care

Source: web.musc.edu Author: Leslie Cantu Beginning radiation therapy on time is critical for people with head and neck cancer. Delays in starting radiation therapy after surgery are associated with worse outcomes – and yet half of patients across the country don’t start radiation therapy when they should. A multidisciplinary team at MUSC Hollings Cancer Center has spent the last five years bringing this issue to light. Now, the team, led by Evan Graboyes, M.D., has been awarded a $3.5 million grant to test an approach for reducing those delays, which should improve outcomes. Called ENDURE, for Enhanced Navigation for Disparities and Untimely Radiation thErapy, the approach addresses the issue at three levels: organization, team and patient. New benchmark Reducing delays in moving to radiation from surgery has become a focus for cancer centers since November 2021, when the Commission on Cancer added a quality measure that grades centers on how many patients with head and neck squamous cell carcinoma begin radiation within six weeks of surgery. The commission accredits cancer programs, and this is the first time it’s included a head and neck cancer benchmark in its quality measures. The work of the Hollings team, which began when Hollings awarded Graboyes a K12 Paul Calabresi Career Development Award for Clinical Oncology in 2018, has been instrumental in providing the rationale for this new benchmark. Since that first grant award to Graboyes, the team has published 10 peer-reviewed publications showing that the time to starting radiation is a key measure, and [...]

Novel agent may improve dry mouth resulting from radiation treatment

Source: www.curetoday.com Author: Colleen Moretti Treatment with AAV2-hAQP1 demonstrated clinically meaningful improvements for patients experiencing symptoms of radiation-induced dry mouth, according to positive results of a phase 1 trial. Radiation-induced xerostomia, or oral dryness, can be a result of treatment with radiotherapy to the oral cavity and neck region – common in patients treated for oral, or head and neck cancers. When this happens, the salivary glands in a patient’s mouth do not make enough saliva to keep it wet. Researchers conducting the AQUAx trial AQUAx evaluated AAV2-hAQP1 in one (unilateral group) or both parotid glands (bilateral group) of 24 patients with radiation-induced salivary hypofunction and moderate to severe dry mouth. “We are very encouraged by the clinical data in both unilateral and bilateral cohorts demonstrating the safety, efficacy and durability of AAV2-hAQP1 in grade 2/3 radiation-induced xerostomia,” said Alexandria Forbes, president and chief executive officer of MeiraGTx, the drug’s manufacturer, in a press release. “Not only does this therapy continue to be safe and well tolerated, but we are seeing durability of effect at two and even three years for patients who have reached those timepoints.” In both groups, 75% of patients reported their dry mouth symptoms as “better” following treatment and rated these improvements as “important” or “very important,” according to the release. Although both groups had improvements, those observed in the bilateral group were greater. Of the 12 patients in the bilateral group, 10 reported “better” dry mouth symptoms after six months. Additionally, these 10 patients rated [...]

A strange anomaly on scans turned out to be an entirely new organ, hidden within your face

Source: www.iflscience.com Author: James Felton, Senior Staff Writer Image Credit: Valstar et al., Radiotherapy and Oncology, 2020 (CC BY-NC-ND 4.0) You'd think after centuries of cracking open humans and taking a poke around inside we'd have discovered every organ there is to be found in there, but you'd be wrong. In fact, they seem to be popping up all the time. In 2018, researchers discovered the largest organ in the body, interconnected fluid-filled sacs that run through the collagen and elastin structures in the areas beneath our skin and between other organs and tissues in our bodies. Well, wouldn't you know it, scientists have just found another new organ inside us. It's getting pretty crowded in here. Oncologists at the Netherlands Cancer Institute were using a new kind of scan as part of their research into patients with head and neck cancer. They used positron emission tomography/computed tomography with prostate-specific membrane antigen ligands (PSMA PET/CT) scans, which have been shown to be an effective way of tracking the spread of prostate cancer around the body. Patients are injected with radioactive glucose before the scan, which highlights tumors within the patient by glowing brightly. While using this scan on patients, however, the team noticed two areas in the head unexpectedly lit up. As they kept scanning patients, they kept finding the same area lighting up. It turned out all 100 people scanned had bright spots. It wasn't an anomaly, it was potentially an entirely new organ. The new discovery, [...]

2022-12-29T16:44:33-07:00December, 2022|Oral Cancer News|

Oral health professionals promote ‘value of having a dentist on the cancer care team’

Source: www.healio.com Author: Jennifer Byrne When planning their next steps after a cancer diagnosis, most patients don’t put a trip to the dentist at the top of their to-do list. “When patients are diagnosed with cancer, they just want to put out the fire; they want to address the cancer,” Dalal Alhajji, DMD, MSD, clinical instructor of oral and maxillofacial pathology, radiology and medicine at NYU College of Dentistry, said in an interview with Healio. “That’s when I say, ‘the reason you need to see a dentist is, we want to put out another potential fire — one you might not know about yet.” Alhajji and her colleagues at NYU College of Dentistry are part of a small but growing movement among oral health professionals seeking to close the gap between medical and dental care for patients with cancer. They see dentists as a vital component of any multidisciplinary oncology care team, offering infection treatment, protection of teeth during head and neck radiation treatments, and quality-of-life care for issues such as dry mouth and mouth sores. “I’ve been lucky — the oncologists I work with have been great about referring patients to me because they see the impact it has,” Alhajji said. “They see the value of having a dentist on the cancer care team.” Addressing preventable issues There are several reasons for a patient with cancer to see a dentist prior to initiating cancer treatment, but patients with head and neck cancers and those slated to undergo bone marrow [...]

The potential of e-learning interventions for AI-assisted contouring skills in radiotherapy (E33046)

Source: www.iaea.org Author: Kamal Akbarov The International Atomic Energy Agency (IAEA) is launching a new Coordinated Research Project (CRP) aimed at investigating the potential of artificial intelligence (AI) to enhance contouring skills in radiotherapy, especially focusing on increasing accuracy of delineation of organs at risk in head and neck cancers. Radiation oncology has evolved rapidly in recent decades in terms of innovations in treatment equipment, volumetric imaging, information technology and increased knowledge in cancer biology. New delivery technologies and associated imaging modalities have enabled highly optimized precision radiation therapy and contributed to improvements in tumor control and cancer patient cure. The selection and contouring of target volumes and organs at risk (OARs) has become a key step in modern radiation oncology. Concepts and terms for definition of gross tumor volume, clinical target volume and OARs have been continuously evolving and have become widely disseminated and accepted by the international radiation oncology community. However, clinical research from single institutions and multicentre experiences has provided evidence for major variations in contouring for both target volumes and OARs. In recent years, AI-based methods, such as deep learning, have improved auto-segmentation drastically. It is generally believed that the use of such tools will lead to lower the inter-observer variation and time savings for clinical staff. A wide palette of commercial deep learning-based auto-segmentation solutions are emerging with the promise of leveraging the aforementioned benefits. While the objective performances for deep learning-based auto-segmentation in retrospective studies are very promising, the actual clinical benefit is largely [...]

Throat cancer survivors don’t have to sacrifice ability to swallow and taste

Source: southfloridahospitalnews.com Author: staff Tamarac resident Kenneth Goff was home shaving morning when he felt a small lump on the left side of his neck. “There was no pain, no nothing, but I could feel it by the way the razor moved,” said the 58-year-old father of five and grandfather of eight. “It wasn’t visible at all, but I could feel it right below the jaw line.” After a CT scan at Broward Health Medical Center in August 2020, Goff was diagnosed with HPV-mediated squamous cell carcinoma, a type of throat cancer. This cancer is similar to what actors Michael Douglas and Stanley Tucci have battled. The treatment of HPV-related oropharyngeal squamous cell carcinoma may include surgery, radiation, chemotherapy or combination of the treatments. Ryan H. Sobel, M.D., a head and neck surgical oncologist at Broward Health Medical Center, prescribed radiation to treat Goff’s isolated neck mass. Prior to radiation treatment, Dr. Sobel performed a submandibular, or saliva gland transfer, an intricate surgery only a handful surgeons across the country are skilled at performing. He is currently the only surgeon utilizing this technique in Broward and Palm Beach counties. Dr. Sobel strategically relocated one of Goff’s saliva glands. It was moved about three inches from the right side of his throat to under the chin to place it out of direct range of the damaging effects of radiation. Patients diagnosed with throat cancer face a difficult choice: treat the cancer with radiation and risk losing their ability to swallow and [...]

2022-02-24T15:03:37-07:00February, 2022|Oral Cancer News|

Improving head and neck cancer treatment

Source: www.uc.edu Author: Tim Tedeschi, University of Cincinnati News When the medical community finds a treatment for a particular cancer, the work doesn’t stop. Researchers continue to study how treatments can be improved in order to reduce side effects and the possibility of the cancer recurring. University of Cincinnati researchers are leading a new clinical trial to examine if the combination of a more localized radiation treatment and immunotherapy can be a better treatment for patients with recurrent head and neck cancer. Chad Zender, MD, said head and neck cancers include cancers of the tongue, throat, tonsil and larynx, and about 30%-50% of patients treated through surgery and radiation will have their cancer return. Patients often then undergo additional surgery and/or radiation treatments, which can lead to side effects like problems with speech and swallowing. “The quality of life is significantly less in the patients that require [subsequent] surgery and then radiation with or without chemo,” said Zender, professor in the Department of Otolaryngology in UC’s College of Medicine, director of head and neck surgery and principal investigator for the new trial. Precision radiation Zender said the trial will test a more localized radiation delivery method through a radioactive seed, about the size of a grain of rice that emits an intense amount of radiation to the cancer and only minimal radiation outside to other areas. The radioactive Cesium-131 seeds are implanted directly into the operative site during surgery. This approach in early studies appears to give more localized radiation [...]

2022-02-03T10:44:13-07:00February, 2022|Oral Cancer News|

New MSK radiation approach means fewer side effects for more patients with HPV-related head and neck cancer

Source: www.mskcc.org Author: Memorial Sloan Kettering Cancer Center Robert Rosenfeld thought the lump he felt in his neck in late 2018 was just a symptom of a cold that wouldn’t go away. He visited an ear, nose, and throat specialist who saw nothing upon first examination, but Robert knew something was wrong and asked for a CT scan. The specialist called him with the bad news: It was almost certainly cancer. A biopsy confirmed he had stage 2 cancer at the base of his tongue and 2 nearby lymph nodes. The tumor was positive for the human papillomavirus (HPV). Robert, then a 69-year-old car salesman on Long Island, met with cancer doctors near his hometown of Hauppauge, New York, to learn about treatment options. He realized he faced a tough road: Standard treatment would be 7 weeks of radiation, during which he also would receive 3 rounds of chemotherapy. The standard radiation dose would likely cause mouth sores, difficulty swallowing, dry mouth (from damage to salivary glands), loss of taste, and nausea. Robert wanted a second opinion, and his medical oncologist strongly recommended Memorial Sloan Kettering Cancer Center. When Robert called, he was able to get in to see radiation oncologist C. Jillian Tsai the very next day. “When I met Dr. Tsai, she was amazing,” Robert says. “She told me what I was up against but also that the cancer I had was curable.” There was another major plus: Dr. Tsai was able to offer a significantly reduced radiation [...]

Using artificial intelligence to help cancer patients avoid excessive radiation

Source: medicalxpress.com Author: by Case Western Reserve University A Case Western Reserve University-led team of scientists has used artificial intelligence (AI) to identify which patients with certain head and neck cancers would benefit from reducing the intensity of treatments such as radiation therapy and chemotherapy. The researchers used AI tools similar to those they developed over the last decade at the Center for Computational Imaging and Personal Diagnostics (CCIPD) at Case Western Reserve. In this case, they asked the computer to analyze digitized images of tissue samples that had been taken from 439 patients from six hospital systems with a type of head and neck cancer known as human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPCSCC). The computer program successfully identified a subset of patients who might have benefited from a significantly reduced dose of radiation therapy. While that analysis was retrospective—meaning the computer analyzed data from patients in which the eventual outcome was already known—the researchers said their next step could be to test its accuracy in clinical trials. Their research was published recently in the Journal of the National Cancer Institute. The work was led by Anant Madabhushi, CCIPD director and the Donnell Institute Professor of Biomedical Engineering at the Case School of Engineering, along with Germán Corredor Prada, a research associate in the CCIPD lab. 'Overtreating patients' Although most others with HPV-driven cancer would still benefit from aggressive treatment—along with patients whose cancer was unrelated to the virus—the researchers said their study revealed a significant group was [...]

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