Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial

The Lancet Oncology, Early Online Publication, 13 January 2011

Dr Christopher M Nutting FRCR a b , James P Morden MSc b, Kevin J Harrington FRCR a b, Teresa Guerrero Urbano PhD c, Shreerang A Bhide FRCR a, Catharine Clark PhD d, Elizabeth A Miles MPhil e, Aisha B Miah FRCR a, Kate Newbold FRCR a, MaryAnne Tanay MSc a, Fawzi Adab FRCR f, Sarah J Jefferies FRCR g, Christopher Scrase FRCR h, Beng K Yap FRCR i, Roger P A’Hern MSc b, Mark A Sydenham BSc b, Marie Emson BSc b, Emma Hall PhD b, on behalf of the PARSPORT trial management group†


Xerostomia is the most common late side-effect of radiotherapy to the head and neck. Compared with conventional radiotherapy, intensity-modulated radiotherapy (IMRT) can reduce irradiation of the parotid glands. We assessed the hypothesis that parotid-sparing IMRT reduces the incidence of severe xerostomia.

We undertook a randomised controlled trial between Jan 21, 2003, and Dec 7, 2007, that compared conventional radiotherapy (control) with parotid-sparing IMRT. We randomly assigned patients with histologically confirmed pharyngeal squamous-cell carcinoma (T1—4, N0—3, M0) at six UK radiotherapy centres between the two radiotherapy techniques (1:1 ratio). A dose of 60 or 65 Gy was prescribed in 30 daily fractions given Monday to Friday. Treatment was not masked. Randomization was by computer-generated permuted blocks and was stratified by centre and tumor site. Our primary endpoint was the proportion of patients with grade 2 or worse xerostomia at 12 months, as assessed by the Late Effects of Normal Tissue (LENT SOMA) scale. Analyses were done on an intention-to-treat basis, with all patients who had assessments included. Long-term follow-up of patients is ongoing. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN48243537.

47 patients were assigned to each treatment arm. Median follow-up was 44·0 months (IQR 30·0—59·7). Six patients from each group died before 12 months and seven patients from the conventional radiotherapy and two from the IMRT group were not assessed at 12 months. At 12 months xerostomia side-effects were reported in 73 of 82 alive patients; grade 2 or worse xerostomia at 12 months was significantly lower in the IMRT group than in the conventional radiotherapy group (25 [74%; 95% CI 56—87] of 34 patients given conventional radiotherapy vs. 15 [38%; 23—55] of 39 given IMRT, p=0·0027). The only recorded acute adverse event of grade 2 or worse that differed significantly between the treatment groups was fatigue, which was more prevalent in the IMRT group (18 [41%; 99% CI 23—61] of 44 patients given conventional radiotherapy vs. 35 [74%; 55—89] of 47 given IMRT, p=0·0015). At 24 months, grade 2 or worse xerostomia was significantly less common with IMRT than with conventional radiotherapy (20 [83%; 95% CI 63—95] of 24 patients given conventional radiotherapy vs. nine [29%; 14—48] of 31 given IMRT; p<0·0001). At 12 and 24 months, significant benefits were seen in recovery of saliva secretion with IMRT compared with conventional radiotherapy, as were clinically significant improvements in dry-mouth-specific and global quality of life scores. At 24 months, no significant differences were seen between randomised groups in non-xerostomia late toxicities, locoregional control, or overall survival.

Sparing the parotid glands with IMRT significantly reduces the incidence of xerostomia and leads to recovery of saliva secretion and improvements in associated quality of life, and thus strongly supports a role for IMRT in squamous-cell carcinoma of the head and neck.

Funding – Cancer Research UK (CRUK/03/005).

January, 2011|Oral Cancer News|

When East meets West, cancer patients win

Source: www.healthzone.ca
Author: Nicole Baute

An ancient four-herb formula used in China for 1,800 years might one day be available as a prescription pill to treat side effects caused by cancer chemotherapy, thanks to research from Yale University and a growing international consortium focused on the globalization of Chinese medicine.

Huang Qin Tang (pronounced Hu-ang Chin Tong) is made with peonies, a purple flower called skullcap, licorice and fruit from a buckthorn tree. The Chinese medicine has long been used for diarrhea, nausea, vomiting and cramps, which happen to be side effects associated with certain chemotherapy drugs.

Now research led by Yung-Chi “Tommy” Cheng, the Henry Bronson Professor of Pharmacology at Yale University, suggests a Western version of this ancient medicine may reduce gut damage caused by chemotherapy in colon and rectal cancer patients.

Cheng says a capsule preparation of this formula, called PHY906, inhibits three processes that cause inflammation during chemotherapy and enhances the recovery of damage to tissue.

“This is an example of West meeting East for treatment of cancer,” Cheng said, on the phone from Taiwan.

Cheng, who has equity interest in the Yale-sponsored company that licenses the technology, is focused on getting PHY906 licensed as a prescription drug in the U.S. — not as a supplement or alternative.

A study published in Science Traditional Medicine Wednesday explains how PHY906 restored intestinal damage in mice caused by chemotherapy and also helped trigger the replacement of damaged intestinal stem cells with healthy ones.

The drug is now in preliminary clinical trials in the U.S., and Cheng says early results have been encouraging.

The research is part of a growing effort to understand and Westernize Chinese medicine. Canadian researchers are amongst those on their way to Hong Kong for the 9th annual meeting of the Consortium for Globalization of Chinese Medicine, which begins on Monday. Cheng, who grew up in Taiwan, is chairman of the consortium’s board of directors.

Michael Rieder, the CIHR-GSK Chair in Pharmacology at University of Western Ontario and the university’s representative to the consortium, has been following — and occasionally critiquing — Cheng’s groundbreaking research.

“I’m a classical Western pharmacologist skeptical of a lot of stuff, so I said, ‘I want to see the proof in the pudding,’ ” Rieder said. “And this combination seems to be very effective. It’s been subject to rigorous testing, and it seems to be very useful as an adjunct to therapy for cancer.”

McMaster University will officially join the Consortium for Globalization of Chinese Medicine next week, becoming the second Canadian university involved.

Stephen Sagar, a professor of oncology at McMaster University specializing in radiation oncology, said technology made it possible for Cheng to split the herbs up into their chemical components, which helped him understand the chemicals that make Huang Qin Tang effective while ensuring consistency and quality.

For the past 15 years Sagar and his McMaster University colleague Raimond Wong have been researching Chinese medicine and its potential implications for cancer treatment. They are currently running a cross-North America trial on the effectiveness of acupuncture on treating xerostomia or dry mouth, a common side effect of chemo for head and neck cancers.

Rieder said the consortium’s aim is adjunctive therapy — Chinese medicine and Western science working together.

“The Western medicine is providing the cutting edge in terms of cure and killing disease, but the Chinese medicine is helping the patient tolerate it better and maybe helping the Western medicine work better,” he said.

September, 2010|Oral Cancer News|

Featured clinical trial: electroacupuncture for radiation-induced chronic dry mouth

Source: www.cancer.gov/ncicancerbulletin
Author: staff

Name of the Trial
Randomized Pilot Study of Electroacupuncture for Chronic Radiation-induced Xerostomia in Patients with Head and Neck Cancer (MAYO-MCS285). See the protocol summary 1.

Why This Trial Is Important
Head and neck cancers are often treated with external-beam radiation therapy 2. Although this treatment can be effective in controlling head and neck tumors, it may cause side effects 3 that can compromise a patient’s quality of life. Chronic dry mouth, also called xerostomia, is common among patients treated with radiation to the head and neck. This condition results from damage to the glands that produce saliva. Chronic dry mouth can have a major impact 4 on quality of life by causing pain and discomfort, affecting the ability to sleep, altering taste, and/or increasing the likelihood of dental problems.

Some drugs are available for xerostomia induced by radiation therapy, but many patients experience only a partial improvement or no benefit at all. The drug amifostine 5 can help protect the salivary glands of some head and neck cancer patients from radiation damage, but this drug cannot be used in all patients.

Some studies have suggested that acupuncture 6 can help relieve the sensation of mouth dryness in cancer patients who have undergone head and neck radiation therapy. Based on these studies and other evidence, researchers at the Mayo Clinic in Scottsdale, AZ, are investigating the ability of a procedure called electroacupuncture to help improve the production of saliva and the quality of life of patients with chronic dry mouth. Electroacupuncture involves stimulating traditional acupuncture points 7 on the skin using small electrodes instead of needles inserted into the skin.

In this clinical trial, head and neck cancer patients with chronic dry mouth who completed radiation therapy at least 6 months before joining the trial and who received no benefit from treatment with the drug pilocarpine 8 (Salagen) will be randomly assigned to undergo electroacupuncture using a machine called a LISS stimulator, or a sham procedure using a similar-looking machine that does not produce electrical stimulation. Treatment will last for 4 weeks (20-minute sessions 5 days a week for the first 2 weeks, and then 3 days a week for the last 2 weeks) and will be administered at the Mayo Clinic in Scottsdale. Saliva flow, the patients’ subjective sensation of mouth dryness, and quality of life will be assessed during the first 3 weeks of treatment and then again 1, 3, and 6 months following treatment.

“Depending on the radiation techniques used and the location of the tumor, up to 90 percent of head and neck cancer patients receiving radiation therapy will experience chronic dry mouth,” said Dr. Halyard. “Electroacupuncture is a non-needle approach that uses electrical stimulation of the acupuncture points thought to control salivation. The hypothesis is that this stimulation will alter the energy flow of the acupuncture points and result in an increase in saliva production.

“To date, we have enrolled 24 of 30 patients for the study, so we have 6 slots left,” Dr. Halyard continued. “I would be happy to discuss the study with any patients who think they might be interested and who can commit a month to treatment in Scottsdale, as well as return for the three post-treatment assessments.” (See contact information link.)

1. Dr. Michele Haylard, Principal Investigator, Mayo Clinic Scottsdale
2. For more information:
See the lists of entry criteria  9 and trial contact information 10 or call the NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). The toll-free call is confidential.

Table of Links:
1 http://www.cancer.gov/clinicaltrials/NCT00623129
2 http://www.cancer.gov/dictionary/?CdrID=46751
3 http://www.cancer.gov/dictionary/?CdrID=46580
4 http://www.ncbi.nlm.nih.gov/pubmed/17618467
5 http://www.cancer.gov/dictionary/?CdrID=45250
6 http://www.cancer.gov/dictionary/?CdrID=46724
7 http://www.cancer.gov/dictionary/?CdrID=449727
8 http://www.cancer.gov/dictionary/?CdrID=45573
9 http://www.cancer.gov/clinicaltrials/NCT00623129#EntryCriteria_CDR0000583031
10 http://www.cancer.gov/clinicaltrials/NCT00623129#ContactInfo_CDR0000583031

New report compares radiation approaches in head and neck cancer

Source: MedScape Today
Author: Nick Mulcahy

June 1, 2010 — Intensity-modulated radiation therapy (IMRT) for head and neck cancer leads to fewer cases of xerostomia, but has not yet been proven to be more successful than any other kind of radiation therapy in reducing tumors or improving survival, according to a new comparative-effectiveness review funded by the federal Agency for Healthcare Research and Quality (AHRQ).

The review compares the effectiveness of 4 types of radiotherapy (IMRT, 3DCRT, 2DRT, and proton-beam therapy) in terms of tumor control, overall survival, adverse events, and quality-of-life issues.

Many scientists consider IMRT to be theoretically better able to target cancerous cells while sparing healthy tissue than either 3DCRT or 2DRT, but more research is needed, the authors of the report point out.

The report, entitled Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer, is authored by the Blue Cross and Blue Shield Association’s Technology Evaluation Center Evidence-Based Practice Center.

The late adverse effect of xerostomia, also known as dry mouth, is less common than in the past because the use of IMRT has allowed radiation oncologists to spare most patients’ salivary glands from radiation as part of treatment planning, an expert recently told Medscape Oncology.

Sparing salivary glands has become standard among clinicians who use IMRT, said Avraham Eisbruch, MD, professor of radiation oncology at the University of Michigan Medical School and Comprehensive Cancer Center in Ann Arbor.

Dr. Eisbruch’s comments came in the context of his study on the use of IMRT to reduce dysphagia in head and neck cancer. However, he also served on the technical expert panel of the new comparative-effectiveness report.

According to the report, it is not known whether IMRT is better or worse at reducing the size of tumors, or whether it improves other outcome measures.

“Inconsistent and nonsignificant results were observed between IMRT and comparators on other adverse events, overall quality of life, tumor control, and survival outcomes. Thus, the evidence is insufficient to support conclusions in these areas,” reads the report.

Overall, the report suffered from a lack of data with which to do comparisons, suggest the authors.

“A small body of randomized, controlled trials is accompanied by a larger body of poor quality observational, nonrandomized studies,” they write about the evidence on the topic.

What About Proton-Beam Therapy?

The main focus of the report was IMRT. An informal survey estimates that 30% to 60% of all patients in the United States are treated with IMRT.

The report authors note that “most of the studies in this review were based on the results of patients treated at academic medical centers.”

Because IMRT is increasingly adopted in community settings, the authors wonder whether results in head and neck cancer will continue to be the same.

“Whether similar results will be achieved as the technology diffuses to less-experienced settings has not been addressed in the comparative studies available for this review,” they write.

The authors sought to examine the evidence regarding proton beam radiation therapy, but there were no head-to-head comparisons to review.

“The strength of evidence is insufficient, as there were no studies comparing proton-beam therapy to any other radiotherapy modality. Therefore, no conclusions can be reached regarding the comparative effectiveness of proton-beam therapy,” write the authors.

Proton-beam radiation therapy is more commonly used to treat prostate cancer and pediatric tumors, the report notes.

In an AHRQ Technical Brief published last fall, researchers found limited evidence with which to determine whether proton-beam radiation therapy is safer or more effective than other types of radiation to treat cancer, according to AHRQ press materials.

The new comparative-effectiveness report is the latest research review from the AHRQ’s Effective Health Care Program, which is an effort to compare alternative treatments for health conditions and to make the findings public, to help doctors, nurses, pharmacists, and others work together with patients to choose the most effective treatments.

The authors are employees of Blue Cross and Blue Shield.

June, 2010|Oral Cancer News|

Advanced type of cancer radiation reduces side effects, but impact on controlling cancer is unclear

Source: www.sunherald.com
Author: press release

An advanced type of cancer radiation is more successful than traditional radiation in avoiding “dry mouth” when treating head and neck cancers, but it is unknown whether the treatment is better or worse at reducing the size of tumors, according to a new comparative effectiveness review funded by HHS’ Agency for Healthcare Research and Quality.

The report finds that intensity-modulated radiation therapy (IMRT) leads to fewer cases of xerostomia, commonly known as dry mouth, than other types of radiation. Xerostomia, a potential side effect to radiation when salivary glands are damaged, can affect basic functions like chewing, swallowing and breathing; senses such as taste, smell and hearing; and can significantly alter a patient’s appearance and voice.

However, the report did not find evidence that IMRT is more successful than any other kind of radiation therapy in reducing tumors. Many scientists consider IMRT to be theoretically better able to target cancerous cells while sparing healthy tissues, but more research is needed, the report said. The comparative effectiveness review, Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer, was authored by the Blue Cross and Blue Shield (BC/BS) Association, Technology Evaluation Center in Chicago.

“The development of new technologies to treat cancer has been one of the true success stories of American medical research,” said AHRQ Director Carolyn M. Clancy, M.D. “This report provides patients and their doctors with more information about these advances, which they can use to make more informed choices about their own treatment.”

The report examines treatment for cancers to the head and neck, including the mouth, larynx and sinuses. (Tumors in the brain are considered a separate type of cancer and are not discussed in this report.) Non-brain head and neck cancers account for up to 5 percent of cancers that are diagnosed in the United States, with an estimated 47,560 new cases and 11,260 deaths in 2008.

As with other cancers, head and neck cancer often is treated by radiation, which can damage both cancerous and non-cancerous cells. To limit damage to non-cancerous cells, scientists have sought ways to target high doses of radiation to cancerous cells while sparing healthy ones. This is particularly important with head and neck cancers, because tumors can reside close to vital organs.

Standard radiation therapy has evolved over the past 20 years and now provides doctors with two- or three-dimensional images that simulate a patient’s treatment area on a computer screen. IMRT, which has been implemented over the past 10 years, also employs three-dimensional imaging and further technological and treatment enhancements that tightly control and target the amount of radiation delivered to the target area.

Time-released muco-adhesive patch more effective than oral rinse for xerostomia

Source: www.news-medical.net/news
Author: press release

A newly developed time-released muco-adhesive patch for treating oral health conditions, including the widespread condition of dry mouth (xerostomia), has been shown to be more effective than a leading oral rinse, according to a newly-published study. As increasing segments of the population consume more medications (one of the leading causes of dry mouth), the results of this study could potentially help provide relief for millions of Americans. Chronic dry mouth impacts the quality of life and for some, can be debilitating. Published in the March 2010 issue of Quintessence International, the study found that chronic dry mouth sufferers can now get a statistically significant reduction of mouth dryness from a new time-released muco-adhesive patch (OraMoist Dry Mouth Patch), compared with the leading oral rinse which has been on the market for nearly two decades.

Overall, patients with xerostomia treated with the muco-adhesive patch reported a statistically significant reduction in mouth dryness sensation with elevated salivary flow rate (150%) after just 30 minutes, which was considered clinically outstanding by the study authors, since the product does not contain any cholinergic agonist, a drug often used to treat dry mouth.

OraMoist, a new time-released, non-drug formula, not only outperformed the mouthwash, one of the most often used delivery formats for treating dry mouth, but unlike dry mouth sprays, rinses or gels, which need to be applied frequently – sometimes every 20 minutes – OraMoist works to increase moisture and help restore a healthy oral environment for hours at a time, day or night, and can even be used by those with dental appliances, such as dentures. It moistens and lubricates the mouth with time-released lipids, citrus oil and sea salt, while simultaneously stimulating saliva production and inhibiting bacterial growth and promoting oral health with enzymes and xylitol.

“Oral disorders such as dry mouth and canker sores require long residence of the active remedy in the mouth or the disease site for effective treatment. Muco-adhesive patches made of safe ingredients that adhere to the oral mucosal tissue and slowly erode while releasing active remedies for two to six hours provide the desired residence time for effective therapy,” said Professor Abraham J. Domb, PhD, Institute of Drug Research, School of Pharmacy, Faculty of Medicine at the Hebrew University, co-author of the new published study, inventor of the muco-adhesive time-released patch and world-renowned for his work in biodegradable polymers. “This novel approach of time-released delivery has proven to be a successful and desirable approach to treating chronic conditions that affect millions of people, and can be disruptive to their lifestyle.”

The evolution of the muco-adhesive patch has found commercial viability in treating canker sores as well because the patch can also act as a bandage for the sores for eight to twelve hours while releasing active remedial ingredients.

Dry mouth affects upwards of 17% of the population, increasing in older adults (65 years and older) to about 30%. In fact, 34% of people taking three or more medications suffer from dry mouth, which is also a chronic symptom of numerous medical conditions, such as diabetes and Sjogren’s Syndrome.

Source: OraMoist

March, 2010|Oral Cancer News|

Advances in radiation therapy enable doctors to improve the quality of treatments for patients with head and neck cancer

Source: www.prnewswire.com
Author: press release

Noted clinical experts detail recent developments at the annual ASTRO meeting in Chicago

Clinical studies suggest that advanced treatments like intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) are enabling radiation oncologists to enhance post-treatment health-related quality of life for patients with head and neck cancer.

In an educational session for radiotherapy professionals, delivered by two noted experts during the annual meeting of the American Society for Radiation Oncology (ASTRO) in Chicago last week, Avraham Eisbruch, M.D., professor at the University of Michigan, discussed how careful implementation of IMRT in the treatment of head and neck cancer can achieve high tumor control rates while minimizing xerostomia, a dry mouth condition that occurs when salivary glands are damaged.

Citing a new report summarizing results from RTOG 0022, a multi-institutional study comparing IMRT with earlier forms of treatment for head and neck cancer, Dr. Eisbruch said that IMRT for head and neck cancer achieved important goals in reducing treatment toxicity, notably xerostomia, and in yielding a high tumor control rate of 90%.(1)

For patients enrolled in the study and treated with IMRT, only 55% experienced Grade 2 or worse xerostomia at six months after treatment, as compared with 84% of patients treated with earlier forms of radiotherapy — a reduction of 35%. For the IMRT group, the percentage of patients with Grade 2 or worse xerostomia decreased steadily, to 25% at 12 months and 16% at 24 months. “This kind of improvement over time is not something we had been seeing with conventional forms of radiotherapy,(2)” said Dr. Eisbruch, who served as chair of RTOG 0022.

“Also, emerging data is suggesting that we can get improvements in broader aspects of post-treatment quality of life by using IMRT, beyond reducing xerostomia,” Eisbruch said. “Several studies comparing IMRT with conventional radiotherapy found that the IMRT patients did better not just in terms of dry mouth, but also other quality of life dimensions, including swallowing and nutrition.”(3)(4)(5)

According to Eisbruch, RTOG 0225, another multi-institutional study looked at IMRT with or without chemotherapy for head and neck cancer, and also reached positive conclusions. “That group reproduced the excellent results that individual treatment centers had been reporting, namely, a 90% loco-regional progression-free survival with minimal grade 3 and no grade 4 xerostomia.”(6)

IMRT involves shaping radiotherapy treatment beams so that they deliver a dose pattern that matches the size and shape of a targeted tumor while minimizing exposure of surrounding healthy tissues and organs. This approach has been widely adopted by radiation oncologists for the treatment of diverse forms of cancer. Ongoing clinical studies are now maturing, allowing long term outcomes to be assessed and validating IMRT based on clinical data.

Improving IMRT Through Image-Guidance
Lei Dong, PhD, associate professor of medical physics at the MD Anderson Cancer Center in Houston, Texas, detailed how new image-guidance technologies further enhance the accuracy of IMRT treatments by enabling clinicians to correct for patient set-up uncertainties and anatomical changes over a course of treatment.

“Clinicians naturally want to take advantage of the more conformal dose distributions that IMRT makes possible by reducing the treatment margins around a tumor, to protect more healthy tissues,” said Dr. Dong. “When we do that, it is important to ensure that the treatments are targeted very precisely, so the tumor receives the high dose treatments, and the dose to surrounding tissues and organs is kept as low as possible.”

Dr. Dong discussed the issue of basing radiotherapy treatment plans on single CT scans taken during treatment simulation. “Internal motion can affect the accuracy of tumor definition if the CT scan is acquired while the patient is swallowing,” he said, referencing a study he worked on with colleagues from M. D. Anderson Cancer Center.(7)

According to Dr. Dong, stereoscopic X-ray imaging and volumetric cone-beam CT imaging, two imaging techniques enabled by Varian’s On-Board Imager® kV imaging device, make it possible to fine-tune patient positioning just prior to each daily treatment. In addition, frequent imaging can alert clinicians to changes in a patient’s anatomy over time, so that a new treatment plan can be developed part-way through a course of treatment whenever warranted–a process called adaptive radiotherapy.

“Preliminary studies have shown that combining IGRT and adaptive IMRT replanning can improve the overall quality of the treatment plan and, most importantly, reduce unnecessary doses to normal organs surrounding the tumor, such as the parotid glands and oral cavities,” Dr. Dong said.(8) “Combining IGRT with IMRT creates a powerful tool for high precision radiation therapy.”

November, 2009|Oral Cancer News|

Intensity-modulated radiation offers treatment advantages over conventional therapy for head and neck cancer

Source: www.docguide.com
Author: John Otrompke

Patients treated with simultaneously integrated boost treatment using intensity-modulated radiation therapy (IMRT) experience better overall survival, disease-free survival, and local recurrence rates, as well as decreased dermatitis and better postoperative salivary function that those treated with conventional radiation.

“IMRT treatment was described as ‘boosted’ because we use 2 different doses in the same patient, who gets a dose of 2.12 gy to 1 part of their anatomy, while another part gets 1.8 gy,” said Sebastien Clavel, MD, University of Montreal, Montreal, Quebec, on November 3 at the American Society of Therapeutic Radiology and Oncology (ASTRO) 51st Annual Meeting.

In the study, 249 patients with stage III and IV oropharyngeal carcinoma were treated between 2000 and 2007. Of these, 100 received IMRT, while 149 patients received conventional radiation therapy.

After a 33-month median follow-up, 95.4% of those treated with IMRT were still alive, compared with 75.8% of those in the conventional arm. Disease-free survival was 89.3% for the IMRT group, compared with 71.6% in the conventional radiation arm. In addition, local control was 92.4% in the IMRT patients, compared with 85.3% in the conventional group.

“With the old technique, the rays were shooting from both sides, whereas with IMRT, the rays come from all directions,” said Dr. Clavel. “When using IMRT, we also always give them a 3-mm margin with the skin, both of which result in fewer cases of dermatitis.” IMRT patients experienced a 20% decrease in dermatitis grades 3 and 4.

“If we are able to treat the tumour with IMRT while avoiding the structure of the parotid gland, which produces saliva, the patients can live better, because more saliva is useful to protect the teeth, to eat, and swallow,” he added, noting that only 8% of those treated with IMRT experience grade 3 or 4 xerostomia at 2 years following treatment, compared with 80% of those treated with conventional radiation.

Better salivary function was also associated with increased weight regain post operatively. “Patients lost 10% of their weight during treatment; while they did not gain all their weight back in the IMRT group, they were able to regain up to 50% more than those treated with conventional radiation,” said Dr. Clavel.

1. presented at American Society of Therapeutic Radiology and Oncology (ASTRO)
2. presentation title: A Comparison of Simultaneously Integrated Boost Using Intensity-Modulated Radiation Therapy and Conventional Radiation Therapy in the Setting of Concomitant Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma. Abstract 69

November, 2009|Oral Cancer News|

Cepharanthin effect on radiation-induced xerostomia and taste disorder in patients with head and neck cancer

Source: Nippon Jibiinkoka Gakkai Kaiho, September 1, 2009; 112(9): 648-55
Author: R Shimazu et al.

In evaluating the effect of cepharanthin on and taste disorder in 40 patients undergoing radiotherapy for head and neck cancer, we administered cepharanthin intravenously during chemoradiotherapy to 22 patients, with 18 others as a control group. Cepharanthin did not significantly affect salivary secretion during and after chemoradiotherapy, although taste disorder and oral discomfort were alleviated. Cepharanthin may thus be effective in maintaining the quality of life of patients with head and neck cancer.

R Shimazu, G Tanaka, R Tomiyama, Y Kuratomi, and A Inokuchi

Authors’ affiliation:
Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Saga University, Saga

November, 2009|Oral Cancer News|

Group acupuncture to relieve radiation induced xerostomia: a feasibility study

Source: Acupuncture in Medicine 2009;27:109-113
Author: Richard Simcock et al.

A distressing complication of radiotherapy treatment for head and neck cancer is xerostomia (chronic oral dryness). Xerostomia is difficult to treat conventionally but there are reports that acupuncture can help. We conducted a feasibility study to examine the acceptability of a standardised group acupuncture technique and adherence to group sessions, together with acceptability of the objective and subjective measurements of xerostomia.

12 males with established radiation induced xerostomia were treated in three groups of four. Each received eight weekly sessions of acupuncture using four bilateral acupuncture points (Salivary Gland 2; Modified Point Zero; Shen Men and one point in the distal radial aspect of each index finger (LI1)). Sialometry and quality of life assessments were performed at baseline and at the end of treatment. A semi-structured interview was conducted a week after completing the intervention.

Adherence to and acceptability of the treatment and assessments was 100%. There were objective increases in the amounts of saliva produced for 6/12 patients post intervention and the majority also reported subjective improvements. Mean quality of life scores for domains related to salivation and xerostomia also showed improvement. At baseline 92% (11/12) patients reported experiencing a dry mouth “quite a bit/very much” as compared to 42% (5/12) after the treatment. Qualitative data revealed that the patients enjoyed the sessions.

Conclusion: The pilot study shows that a standardised group technique is deliverable and effective. The tools for objective and subjective assessment are appropriate and acceptable. Further examination in a randomised trial is now warranted.

Richard Simcock1, Lesley Fallowfield2, Valerie Jenkins2

Authors’ affiliations:
1 Brighton & Sussex University Hospitals Trust, Brighton, East Sussex, UK
2 Cancer Research UK Psychosocial Oncology Group, Brighton & Sussex Medical School, University of Sussex, Brighton, East Sussex, UK

September, 2009|Oral Cancer News|