Primary Transoral Surgery Yields Good Swallowing Outcomes Despite Increased Risk of Death in HPV-related OPSCC

Author: Hayley Virgil Source: www.cancernetwork.com Despite an increased risk of grade 5 toxicities, patients with human papillomavirus–related oropharyngeal squamous cell carcinoma who received primary transoral surgery and neck dissection vs radiotherapy experienced good swallowing outcomes at 1 year. Good swallowing outcomes were observed at 1 year among patients with human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma who were treated with primary transoral surgery (TOS) and neck dissection vs radiotherapy despite an increased risk of developing grade 5 toxicities, according to findings from the phase 2 ORATOR2 trial (NCT03210103). At a median follow up of 17 months, investigators reported 3 deaths in both the TOS and neck dissection arm, 2 of which were treatment related and 1 due to myocardial infarction at 8.5 months. The 2 treatment-related deaths were reported following TORS and were due to oropharyngeal hemorrhage and cervical vertebral osteomyelitis. Moreover, investigators reported 4 progression-free survival (PFS) events in this arm, 3 of which were mortality events and 1 due to local recurrence. As such, overall survival (OS) and PFS data were considered immature at the time of study. In total, 67% of patients in the radiotherapy arm and 71% in the TOS and neck dissection arm experienced grade 2 to 5 toxic effects. The study included patients who were 18 years or older with T1 to T2 disease and N0 to N2 staging. Those who enrolled were randomized 1:1 to either the primary radiotherapy group, including 60 Gys followed by concurrent weekly cisplatin chemotherapy at 40 mg/m2 in [...]

2022-06-29T15:19:48-07:00June, 2022|Oral Cancer News|

Radiation alone may suffice for some nasopharyngeal cancer

Source: www.medpagetoday.com Author: Ed Susman, Contributing Writer, MedPage Today In selected patients with nasopharyngeal carcinoma, radiation alone may do as much against the disease as the combination of radiation and chemotherapy but with fewer adverse effects, researchers suggested here. About 90% of patients who received radiation alone achieved failure-free survival at 3 years versus 91.9% of patients treated with both radiation and chemotherapy (P=0.86; non-inferiority P<0.001), reported Jun Ma, MD, PhD, of Sun Yat-sen University Cancer Center in Guangzhou, China. In his virtual oral presentation at the annual meeting of the American Society of Clinical Oncology, Ma also reported that 98.2% of patients treated with radiation alone survived to 3 years compared with 98.6% of patients who got both radiation and chemotherapy (P=0.30). The multifaceted subgroup analysis almost entirely favored treatment with alone. There was no difference in distant metastasis-free survival (95% in both arms) or local-regional recurrence-free survival, with both arms hovering in the 90-92% level. And patients treated with both therapeutic modes paid a price in adverse events (AEs), Ma reported, noting that grade 3 to 4 mucositis was observed in 18.9% of patients on chemoradiation but in just 9.7% of those on radiation therapy alone. A similar story in AEs was observed for leukopenia, neutropenia, nausea (0.6% vs 13% grade 3-4), vomiting (1.2% vs 14.8%), anorexia (4.8% vs 29%), and weight loss. That differential in AEs was reflected in quality of life measurements, with better scores in the radiation-only group as far as their global health status, [...]

Revolutionary cancer tool can halve time some patients need radiotherapy

Source: www.nzherald.co.nz Author: Joe Pinkstone, Daily Telegraph UK A revolutionary cancer tool that can halve the time some patients need to be subjected to radiotherapy has been developed by British experts and is 99.9 per cent accurate. Head and neck cancers are notoriously tricky to tackle as the tumour and the patient's face often change shape during treatment due to significant weight loss. More than 12,000 people in the UK are diagnosed with head or neck cancer every year and the treatment involves being blasted with radiation to shrink a tumour while the patient lies motionless inside a mask that protects healthy tissue. "When I started training, we basically laid someone down on the bed, put a plastic mask on them and took some X-rays from the front and the side," Prof Kevin Harrington, head of radiotherapy and imaging at the Institute of Cancer Research and a consultant oncologist, told The Telegraph. "We would then blast away at them every day for six or seven weeks, treating the same area irrespective of the fact that during the treatment the patient would lose up to 10 per cent of their body weight. "Their body would shrink, the shape of the area we were radiating would shrink and as they subsided and lost weight the position of their head would slightly change and we wouldn't adjust one iota to that, we just carried on the way we were." In an ideal world, Harrington said, scans would be done every day to create [...]

Gabapentin may cut opioid needs for oral mucositis pain during radiotherapy

Source: medicalxpress.com Author: staff For patients receiving concurrent chemoradiotherapy for squamous cell carcinoma of the head and neck, higher doses of gabapentin are well tolerated and associated with delayed time to first opioid use for additional pain control during radiotherapy (RT), according to a research letter published online May 18 in JAMA Network Open. Sung Jun Ma, M.D., from the Roswell Park Comprehensive Cancer Center in Buffalo, New York, and colleagues performed a secondary analysis of two clinical trials involving 92 patients receiving concurrent chemoradiotherapy for nonmetastatic squamous cell carcinoma of the head and neck and prophylactic oral gabapentin (titrated to 900 mg versus 2,700 mg daily in one study and 3,600 mg daily in the other study). The researchers found that most patients tolerated gabapentin per protocol. The time to first opioid use for additional pain control was greatest in the 3,600-mg cohort in the multivariable competing risks model. The smallest proportion of patients requiring opioids during RT was seen in the 3,600-mg cohort compared with the 900-mg and 2,700-mg cohorts (37.5, 93.1, and 61.3 percent, respectively). Compared with the 3,600-mg cohort, the odds of feeding tube placement were significantly greater during RT in the 2,700-mg cohort; the odds were not significantly greater in the 900-mg cohort. "Although gabapentin, 3,600 mg, daily has been adopted as the standard regimen of the Roswell Park Comprehensive Cancer Center, additional studies are warranted to further investigate its role in pain control," the authors write.

Treatment Paradigms Are Shifting for Locally Advanced HPV-Positive Head and Neck Cancers

Date: November 18th, 2021 Authors: Kaveh Zakeri, MD, MAS, Nancy Y. Lee, MD Source: OncLive The standard of care for patients with locally advanced head and neck squamous cell carcinomas does not substantially differ according to human papillomavirus (HPV) status in the National Comprehensive Cancer Network guidelines.1 Resectable tumors can be treated with surgery followed by adjuvant therapy. Alternatively, definitive chemoradiation therapy with cisplatin is the other dominant treatment paradigm. Incidence of HPV-associated oropharyngeal squamous cell carcinoma has increased rapidly and is associated with higher overall survival (OS) compared with cancers caused by smoking and alcohol.2,3 Given the unique biology of HPV-associated oropharyngeal disease, a separate staging system was developed for these tumors.4 HPV-associated oropharyngeal cancers are more radiosensitive and chemosensitive than cancers caused by smoking and alcohol, yet the traditional treatment paradigms—including high doses of radiation and chemotherapy—were developed prior to the epidemic of HPV-associated disease. De-escalation of therapy has been proposed for HPV-associated oropharyngeal cancer based on data demonstrating high OS and progression-free survival (PFS).5 De-escalation of therapy has been investigated for both definitive surgical and chemoradiation therapy paradigms. Most de-escalated approaches focus on selecting patients according to clinical features, such as disease stage and smoking status, whereas personalized de-escalation reduces treatment intensity for patients according to treatment response. Transoral Robotic Surgery Followed by Adjuvant Radiotherapy Transoral robotic surgery (TORS) is a minimally invasive approach that reduces morbidity compared with traditional, open surgery for patients with oropharyngeal cancers. TORS is a standard of care option for patients with [...]

2021-12-06T11:00:39-07:00December, 2021|Oral Cancer News|

First UK clinical trial in proton beam therapy

Source: www.icr.ac.uk Author: staff Image: The Proton Beam Scanner. Credit: The Royal Christie NHS Foundation Trust The first proton beam therapy clinical trial in the UK, co-led by The Institute of Cancer Research, London, is now taking place at The Christie NHS Foundation Trust in Manchester. The trial will determine whether the use of proton beam therapy reduces long-term side effects and improves quality of life for patients treated with radiotherapy for throat cancer. The study, funded by Cancer Research UK with support from The Taylor Family Foundation started last year and, despite the Covid-19 pandemic, is recruiting ahead of target, with 37 patients so far taking part. In total 183 people will take part in the study, about two thirds will receive proton beam therapy, and a third will receive standard radiotherapy. State of the art proton beam therapy Currently all patients allocated proton treatment within the trial, which is called TORPEdO, receive this at the state of the art NHS proton beam therapy centre at The Christie in Manchester, which opened in 2018. Another centre is currently being built at University College London Hospitals. A combination of chemotherapy and radiotherapy is usually effective in curing head and neck cancers, but radiotherapy can damage the healthy surrounding tissue. This can result in severe long-term side effects including dry mouth, loss of taste, difficulty chewing and swallowing and problems with hearing. Some patients might need to use a feeding tube for the rest of their lives. Precisely target [...]

Addenbrooke’s to use Microsoft’s AI tool to speed up cancer treatment

Source: www.governmentcomputing.com Author: staff Microsoft said that Addenbrooke’s Hospital in Cambridge, UK, will use its artificial intelligence (AI) technology powered InnerEye tool for speeding up cancer treatment. Developed at its Cambridge Research Lab, the InnerEye project helps in developing AI models that leverage the hospital’s own data to automatically show tumours and healthy organs on patient scans. These are then checked and confirmed by a clinical oncologist prior to giving treatment to the patient, said Microsoft. According to the tech major, the process will reduce the otherwise lengthy treatment planning stage, which is crucial for head and neck cancers, which can multiply quickly if left untreated. Microsoft claims that InnerEye can help execute contouring process in complex cases 13 times faster than the current approach. Addenbrooke’s Hospital oncologist and InnerEye co-lead Dr Raj Jena said: “The results from InnerEye are a game-changer. To be diagnosed with a tumour of any kind is an incredibly traumatic experience for patients. “So as clinicians we want to start radiotherapy promptly to improve survival rates and reduce anxiety. Using machine learning tools can save time for busy clinicians and help get our patients into treatment as quickly as possible.” Run by Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s is a teaching hospital, research centre, and also a designated academic health science centre. Addenbrooke’s Hospital and Microsoft are said to have been collaborating over the last eight years to develop and pilot InnerEye. The hospital will become the first NHS facility to have introduced a [...]

2020-12-12T10:01:59-07:00December, 2020|Oral Cancer News|

Deep learning models for image-guided RT in head and neck and prostate cancers

Source: www.journalofclinicalpathways.com Author: Lisa Kuhns Machine learning models achieve clinically acceptable accuracy in image segmentation tasks in radiotherapy planning and reduce overall contouring time for head and neck and prostate cancers, according to a recent study in JAMA Network Open (2020;3[11]:e2027426. doi:10.1001/jamanetworkopen.2020.27426) Personalized radiotherapy planning requires large time commitments for oncologists and processes often vary among experts and institutions. Authors aimed to explore clinically acceptable autocontouring solutions that can be integrated into clinical practice and used in different radiotherapy areas. Researchers evaluated multicenter imaging data set made up of 519 pelvic and 242 head and neck computer tomography scans from 8 clinical sites. Patients in the study were diagnosed with either prostate or head and neck cancer. The models were trained to automatically delineate organs at risk and evaluated internal and external datasets. Models were compared against expert annotations in an interobserver variability (IOV) study. For 13 of the 15 structures, the models performed within the bounds of expert IOV. For internal vs external data sets, the models achieved mean [SD] Dice scores for left femur at 98.52% and 98.04% (P = .04), respectively. “In this study, the models achieved levels of clinical accuracy within expert IOV while reducing manual contouring time and performing consistently well across previously unseen heterogeneous data sets,” concluded the study authors. “With the availability of open-source libraries and reliable performance, this creates significant opportunities for the transformation of radiation treatment planning.”—Lisa Kuhns

2020-12-11T09:20:35-07:00December, 2020|Oral Cancer News|

Experts release new guidelines for studies into most effective treatments for HPV-positive throat cancer

Source: en.brinkwire.com Author: provided by University of Birmingham, United Kingdom Heightened caution is needed when considering de-escalation trials for patients with Human papillomavirus (HPV)-positive oropharyngeal cancer (OPC), to ensure minimal harm to patients, new guidelines from a group of international head and neck cancer experts have suggested. HPV-positive oropharyngeal cancer is a cancer of the throat caused by the human papillomavirus—a common, but symptomless group of sexually transmitted viruses. Instances of many throat and neck cancers have declined as smoking rates have fallen, whereas HPV-positive OPC has increased, largely affecting younger patients. The standard course of treatment for this disease is a combination of cisplatin (a common chemotherapy drug) and radiotherapy. The younger age of the patient population, significantly improved prognosis, and relatively minimal morbidities caused by the standard treatment pathway have led to the popularisation of the concept of treatment de-escalation as a way to improve the quality of life of patients by reducing dosage or frequency of treatment. These new recommendations, published today in the Journal of Clinical Oncology have been created by the Head and Neck Cancer International Group, a group of experts from nineteen countries, led by the University of Birmingham, UK. The guidelines have been prompted by the recent results of the first three randomised de-escalation trials which suggested a clear detriment in survival when cisplatin is omitted or substituted to minimise side effects. After a review of available HPV-positive OPC literature, the guidelines recommend an overall need for caution when considering de-escalation options, even [...]

A new tool to predict delays in post-surgical radiotherapy for head and neck cancer

Source: www.eurekalert.org Author: Medical University of South Carolina news release More than 65,000 Americans are diagnosed annually with head and neck cancer, which most often occurs inside the mouth and throat. For patients who undergo surgery to treat this cancer, guidelines recommend that prompt initiation of radiotherapy -- within six weeks -- is critical for best outcomes. Unfortunately, delays in initiating post-operative radiotherapy (PORT) are far too common. Patients do not always understand the importance of prompt initiation of radiotherapy and may have to overcome other barriers, such as lack of social support and insurance. In addition, health care providers do not always communicate with one another or coordinate care. These avoidable delays have a negative impact on outcomes in a disease that claims almost 15,000 lives in the U.S. each year. To ameliorate this crisis, a research team at the Medical University of South Carolina has developed and validated tools known as nomograms to help predict treatment delays in high-risk patients based on individualized risk factors. The team was led by Evan Graboyes, M.D., an assistant professor in the Department of Otolaryngology-Head & Neck Surgery at MUSC and a member of the Cancer Control Program at Hollings Cancer Center. The results of the nomogram study were reported in JAMA Otolaryngology-Head & Neck Surgery. "A nomogram is a graphical representation of a mathematical model that we are using to predict how likely it is that a patient with head and neck cancer may have a treatment delay," explained Graboyes. "We [...]

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