Head and Neck Cancers

Patient-Reported Health Scores May Predict Head, Neck Cancer Outcomes (HealthDay News-17/09/2008) 

Self-reported physical health changes in the year after head and neck cancer patients are diagnosed may help predict their five-year survival, says a U.S. study. It included 403 male and female patients (average age 58.7) diagnosed with head and neck cancer between 1995 and 2005. The patients completed general physical health assessment questionnaires when they were diagnosed, and again three, six, nine and 12 months later. They were then followed for up to five years. Health assessment scores decreased for all patients between diagnosis and the three-month point. Patients who died during the second or third year showed no recovery in their health scores at 12 months. Those who died within the fourth or fifth year showed some recovery, and those who survived five years or longer recovered almost to their baseline scores. The results, published in the September issue of the journal Archives of Otolaryngology -- Head & Neck Surgery, suggest that a self-reported health score "captures prognostic information related to cancer state," wrote Dr. Mark J. Jameson, of the University of Virginia Health System, Charlottesville, and colleagues. "It seems intuitive that a patient's perception of well-being would fluctuate (e.g., during intensive cancer therapy versus after recovery from successful treatment), and it seems possible that this fluctuation may be predictive of long-term outcome. This study demonstrates that the change in self-reported health status during the first year is predictive of long-term outcome (i.e., five-year survival)." The researchers concluded that it may prove useful to include a measure of general health and well-being to the care of patients with head and neck cancer, especially during the first year. "It has the benefits of refining prognosis and identifying patient needs that may not be clinically obvious in a brief encounter but may have substantial effect on quality of life," the study authors wrote. "Further study is warranted to determine how to best integrate data from patient-reported health assessment into patient care." 

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Platinum-Based Chemotherapy plus Cetuximab in Head and Neck Cancer (Yahoo News-11/9/2008)

Background Cetuximab is effective in platinum-resistant recurrent or metastatic squamous-cell carcinoma of the head and neck. We investigated the efficacy of cetuximab plus platinum-based chemotherapy as first-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck. Methods We randomly assigned 220 of 442 eligible patients with untreated recurrent or metastatic squamous-cell carcinoma of the head and neck to receive cisplatin (at a dose of 100 mg per square meter of body-surface area on day 1) or carboplatin (at an area under the curve of 5 mg per milliliter per minute, as a 1-hour intravenous infusion on day 1) plus fluorouracil (at a dose of 1000 mg per square meter per day for 4 days) every 3 weeks for a maximum of 6 cycles and 222 patients to receive the same chemotherapy plus cetuximab (at a dose of 400 mg per square meter initially, as a 2-hour intravenous infusion, then 250 mg per square meter, as a 1-hour intravenous infusion per week) for a maximum of 6 cycles. Patients with stable disease who received chemotherapy plus cetuximab continued to receive cetuximab until disease progression or unacceptable toxic effects, whichever occurred first. Results Adding cetuximab to platinum-based chemotherapy with fluorouracil (platinum–fluorouracil) significantly prolonged the median overall survival from 7.4 months in the chemotherapy-alone group to 10.1 months in the group that received chemotherapy plus cetuximab (hazard ratio for death, 0.80; 95% confidence interval, 0.64 to 0.99; P=0.04). 
The addition of cetuximab prolonged the median progression-free survival time from 3.3 to 5.6 months (hazard ratio for progression, 0.54; P<0.001) and increased the response rate from 20% to 36% (P<0.001). The most common grade 3 or 4 adverse events in the chemotherapy-alone and cetuximab groups were anemia (19% and 13%, respectively), neutropenia (23% and 22%), and thrombocytopenia (11% in both groups). Sepsis occurred in 9 patients in the cetuximab group and in 1 patient in the chemotherapy-alone group (P=0.02). Of 219 patients receiving cetuximab, 9% had grade 3 skin reactions and 3% had grade 3 or 4 infusion-related reactions. There were no cetuximab-related deaths. Conclusions As compared with platinum-based chemotherapy plus fluorouracil alone, cetuximab plus platinum–fluorouracil chemotherapy improved overall survival when given as first-line treatment in patients with recurrent or metastatic squamous-cell carcinoma of the head and neck. (ClinicalTrials.gov number, NCT00122460 [ClinicalTrials.gov] .) 

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Throat cancer increasing among white Americans (Yahoo News-26/08/2008) 

The rate of throat cancer, or adenocarcinoma of the esophagus, has risen steadily among white Americans over the past 3 decades, according to a new report. Although the rates of adenocarcinoma among white women have been lower than among white men, the 335-percent increase in new cases among women over the last three decades has been almost as fast as the 463-percent increased rate among white men, Dr. Linda Morris Brown from RTI International, Rockville, Maryland told Reuters Health. Brown and colleagues performed a detailed examination of the trends in esophageal adenocarcinoma rates among white individuals by sex, stage, and age using data collected by the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) program. Total esophageal cancer rates among white men increased steadily from 5.76 per 100,000 persons per year from 1975 to 1979, up to 8.34 per 100,000 persons per year between 2000 and 2004, the researchers report in the Journal of the National Cancer Institute. In contrast, total esophageal cancer rates among white women remained constant. A 29-percent decrease in squamous cell carcinoma rates occurred at the same time as the 335-percent increase in adenocarcinoma, the researchers note. The major risk factors for esophageal adenocarcinoma, and the condition that precedes this cancer - Barrett's esophagus -- are gastroesophageal reflux disease (GERD -- chronic heartburn) and obesity, especially abdominal obesity, Brown pointed out. "Increases in the prevalence of these risk factors may have contributed to the upward trend in incidence." Brown suggests that "primary prevention such as modifications in diet and physical activity and control of GERD symptoms may be able to slow this trend.

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Spit Sensor Spots Oral Cancer. An Ultrasensitive Optical Protein Sensor Analyzes Saliva (Yahoo News-07/08/2008)

RSS For the first time, an optical sensor, developed by researchers at the University of California, Los Angeles (UCLA), can measure proteins in saliva that are linked to oral cancer. The device is highly sensitive, allowing doctors and dentists to detect the disease early, when patient survival rates are high. A device known as a confocal microscope can detect proteins linked to oral cancer. (UCLA)The researchers are currently working with the National Institute of Health (NIH) to push the technology to clinical tests so that it can be developed into a device that can be used in dentists' offices. Chih-Ming Ho, a scientist at UCLA and principal investigator for the sensor, says that it is a versatile instrument and can be used to detect other disease-specific biomarkers. When oral cancer is identified in its early stages, patient survival rate is almost 90 percent, compared with 50 percent when the disease is advanced, says Carter Van Waes, chief of head and neck surgery at the National Institute on Deafness and Other Communication Disorders (NIDCD). The American Cancer Society estimates that there will be 35,310 new cases of oral cancer in the United States in 2008. Early forms are hard to detect just by visual examination of the mouth, says Van Waes, so physicians either have to perform a biopsy--remove tissue for testing--or analyze proteins in blood. 

Detecting cancer biomarkers in saliva would be a much easier test to perform, but it is also technically more challenging: protein markers are harder to spot in saliva than in blood. To create the ultrasensitive sensor, researchers started with a glass substrate coated with a protein called streptavidin that enables other biomolecules to bind to the substrate and to one another. The researchers then added a molecule that would catch and bind the cancer biomarker--a protein in saliva called IL-8 that previous research has proved to be related to oral cancer. They also added molecules designed to keep the glass surface free of other proteins that might muddy detection of the biomarker. To visualize the target molecules, Ho's team then added a set of fluorescently tagged proteins designed to attach to the captured IL-8 markers. Because saliva has a lower concentration of proteins than blood does, the team needed a highly sensitive method to detect the tagged proteins among the background noise, stray molecules in saliva that also fluoresce. So the researchers used a confocal microscope--an imaging system that employs a laser to collect the light generated from a sample--to analyze the saliva. Ho and his team found that focusing the laser light on a specific part of the sample resulted in a lower signal-to-noise ratio, allowing them to detect lower concentrations of the cancer biomarker. Indeed, Ho says, the device is 100 times more sensitive than the standard protein-detection technique, ELISA. A more extensive and invasive process, ELISA requires that the proteins be purified from the blood before testing. 

"The confocal microscope is a sophisticated imaging system at the heart of the UCLA researchers' work and what ultimately led to the improvement in detection," says John McDevitt, a professor of chemistry at the University of Texas, who is also working in salivary diagnostics. The main challenge now facing the UCLA group is how to use this technique outside a laboratory setting, he says. The UCLA researchers tested the optical protein sensor on 40 patients--20 healthy subjects and 20 individuals with oral cancer. The results proved 95 percent accurate, says Ho. The study was published online in the international journal Biosensors and Bioelectronics. "The new sensor is a major step in salivary diagnostics, an area that is being looked at very carefully to see where it might be better to use saliva than blood," says Spencer Redding, chair of the department of dental diagnostic science at the University of Texas Health Science Center, in San Antonio, who is working with McDevitt. Other possible applications of such technology include detection of heart disease, infectious disease, and asthma, Redding says. 

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New Drug Slows Thyroid Cancer (Yahoo News-2/07/2008)

An experimental drug that inhibits tumor blood vessel formation slows the progression of metastatic thyroid cancer in some patients, an international study finds. Of the 93 patients with rapidly progressing cancer, 49 had a positive response to treatment with motesanib diphosphate. Of those 49 patients, 14 percent had their tumors shrink and 35 had their tumors stabilize for more than 24 weeks. Median progression-free survival was about 40 weeks. Genetic analysis of 25 patients revealed that drug response was better in those with a mutation known as BRAF V600E in their tumors than in those without the mutation. Further research into this genetic connection is needed, the researchers said. "Finding that patients whose tumors bear a particular mutation were more likely to respond to the drug is an example of where we would like to head in our research," study author Dr. Steven I. Sherman, chairman and professor of the department of endocrine neoplasia and hormonal disorders at the University of Texas M.D. Anderson Cancer Center, said in a prepared statement. "This is the first of the various thyroid cancer trials to identify specific mutations that might allow us to individualize or personalize therapy," he said. The study, published in the July 3 issue of the New England Journal of Medicine, was funded by drug maker Amgen Inc. Motesanib diphosphate -- a VEGF inhibitor -- targets a protein called vascular endothelial growth factor (VEGF), which plays a critical role in the formation of new blood vessels that allow tumors to grow and spread. Currently, there are few treatment options for metastatic thyroid cancer. 
"There is no standard accepted chemotherapy for advanced metastatic differentiated thyroid cancer, and response rates have typically been 25 percent or less," Sherman said. "Most patients are not treated with systemic chemotherapy, because the limited benefit rarely justifies the side effects. Treatment of thyroid cancer has been a completely unmet need."

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Combining Radiation and Surgery Significantly Improves Survival for Head and Neck Cancer Patients (Yahoo News-19/06/2008)

Adding radiation therapy to surgery significantly improves overall survival in patients diagnosed with node-positive head and neck cancer when compared to treating with surgery alone, according to a study in the June issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Therapeutic Radiology and Oncology. Radiation therapy is commonly used after surgery to treat some head and neck cancers, but very few studies have been conducted to determine its impact on survival. Researchers at the Mount Sinai School of Medicine departments of Radiation Oncology and Otolaryngology and Head and Neck Surgery in New York sought to determine with this study the impact of radiation and surgery on a head and neck cancer patients’ overall survival.

Between 1988 and 2001, 5,297 patients with a median age of 59 who were diagnosed with node-positive head and neck squamous cell carcinoma were treated with surgery and/or adjuvant radiation therapy. The patients were surveyed approximately 4.4 years after treatment, and the researchers found that adding radiation to surgery improved patients’ chance of survival by 25 percent in all nodal stages (N1-N3), including N1 stage patients, even though radiation is typically recommended only for N2 and N3 stage patients. “This study provides evidence that radiation should be considered after surgery for most head and neck cancer patients with positive lymph nodes,” said Johnny Kao, M.D., assistant professor of radiation oncology at the Mount Sinai School of Medicine and lead author of the study. “For these patients, adding radiation improves not only locoregional control but also greatly increases their chance for overall survival. The findings of this study should serve to enhance the use of adjuvant radiation as the most effective treatment method for these types of cancer.”

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Virus -Linked Throat Cancer Easier to Treat?HPV-Positive Throat Cancers Respond Better to Treatments Than Cancers Not Associated With HPV(Yahoo News-12/05/2008)

Researchers have discovered that throat cancers linked to the human papillomavirus (HPV) respond better to cancer treatments than cancers not associated with HPV, a finding that's being lauded as a promising step toward tailored treatment. Thomas Carey, PhD, professor and distinguished research scientist at the University of Michigan Kresge Hearing Research Institute and co-director of the head and neck oncology program at the University of Michigan Comprehensive Cancer Center, and colleagues published their results in two papers in the May 12 online issue of Journal of Clinical Oncology. Most throat cancers, or oropharyngeal cancers, occur in people who smoke or chew tobacco. However, certain strains of HPV, including one known to cause cervical cancer, play a role in the development of some throat cancers. According to the American Cancer Society, people with throat cancers linked to HPV are less likely to smoke and drink, and generally have better survival rates. "The biggest challenge is how best to treat patients with tumors that stem from tobacco and alcohol use as opposed to tumors linked to HPV. We now know they're two different cancers," study researcher Francis Worden, MD, assistant professor of internal medicine at the University of Michigan Medical School, says in a news release. Scientists blame HPV infection for a recent rise in throat cancer cases, particularly among younger patients, according to background information in the journal article.

The current study involved 66 patients with advanced throat cancer. Each study participant received an initial round of chemotherapy to determine how well the tumor responded to the cancer-killing medication. If the treatment reduced the tumor by more than half its original size, the patient received radiation and a full course of chemotherapy. The first round of chemotherapy successfully shrank the tumor in 54 patients, and most of these patients went on to receive additional chemotherapy with radiation. After four years, 62% of those patients were still alive. Most of the patients had surgical treatment of their cancers if their tumor did not respond to the first round of chemotherapy. Only four of the 11 patients who did not respond to the first round of chemotherapy survived. The researchers' next step was to determine why chemoradiation failed to work in a subset of patients. They looked at tissue samples taken from patients before treatment and found that 64% tested positive for a high-risk strain of HPV (HPV 16). The team's analysis showed that most of the HPV-positive tumors responded to the first round of chemotherapy. Only four patients with HPV-negative tumors survived. The experiments also revealed that patients with tumors that give off high levels of a certain growth factor receptor called EGFR had the poorest survival rates.

"The combination of markers was an important indicator. Patients whose tumors expressed high levels of EGFR did poorly. But those who had high EGFR and were also HPV-positive had some protection. Patients with high EGFR and low HPV fared the worst," Bhavna Kumar, a research laboratory specialist and study co-author, says in a news release. Study authors say their findings have large implications for therapy. "The chemotherapy and radiation therapy we use to treat this type of cancer is very aggressive. If we can identify those patients most likely to respond, we could reduce the intensity of the therapy for those likely to have the best outcomes. At the same time, we hope to identify new treatments that specifically target those tumors that we know are not responding to current therapies," Carey s

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New Laser treatment for vocal-cord cancer. Technique targets blood vessels to remove tumor while preserving and restoring vocal quality (MGH Research-06/05/2008)

An innovative laser treatment for early vocal-cord cancer, developed at Massachusetts General Hospital (MGH), successfully restores patients’ voices without radiotherapy or traditional surgery, which can permanently damage vocal quality. This new option for patients, which has now been used in more than 25 patients, was reported on May 1 at the annual meeting of the American Broncho-Esophagological Association, and the data will soon be published as a supplement to the Annals of Otology, Rhinology, & Laryngology. “We had previously adapted lasers that target blood vessels to treat precancerous vocal-cord dysplasia and a variety of benign vascular lesions. We have now applied that experience to treat vocal-cord cancer, which is diagnosed in several thousand American patients each year,” says Steven Zeitels, MD, director of the MGH Voice Center. Zeitels’ team began applying pulsed lasers to the treatment of early vocal-cord cancer more than five years ago. After successfully treating the first eight patients with the pulsed-dye laser, Zeitels’ group switched to the more precise pulsed Potassium-Titanyl-Phosphate (KTP) laser, which is even less likely to damage delicate vocal-cord tissue. The use of specific wavelengths of laser light to target blood vessels was originally applied to the removal of vascular skin lesions like port-wine stains by Rox Anderson, MD, now director of the MGH Wellman Center of Photomedicine. In a close collaboration with Anderson, Zeitels previously developed application of these angiolytic lasers to benign and precancerous vocal-cord lesions. 

As Zeitels reported at the ABEA meeting, the first 22 patients receiving pulsed laser treatment for vocal-cord cancer are cancer-free up to 5 years after treatment, without removal of vocal-cord tissue or loss of voice quality. Some have required second or third laser treatments to remove residual disease, but another benefit of the therapy is that it does not rule out future therapeutic options. Zeitels notes that this treatment has become a standard management approach at MGH and should soon spread to other institutions in the US and abroad. He estimates that 90 percent of patients with early vocal-cord cancer would be candidates for pulsed-KTP laser treatment. “Currently the optimal angiolytic laser for vocal-cord problems, the pulsed-KTP laser is a critical innovation in the instrumentation arsenal of the laryngeal surgeon,” says Zeitels. “It has greatly enhanced the precision by which we can perform many procedures for chronic laryngeal diseases, both in the operating room, accompanied by the surgical microscope, and in the office.” Zeitels is the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School (HMS). The MGH Voice Center team has created a number of groundbreaking procedures and was the first in the world to treat vocal cords and other structures in the larynx with controlled pulses of the green KTP laser light. Zeitels has been recognized for his 2006 use of pulsed-KTP laser to treat Steven Tyler of the rock band Aerosmith for vocal-cord hemorrhage. With his unique perspective on voice restoration and preservation resulting from years of treating elite singers, Zeitels was called on to work with Julie Andrews after she lost her singing voice due to a failed surgical procedure. He subsequently has collaborated with Miss Andrews to increase awareness of voice problems and spearhead a research project investigating new voice restoration surgical procedures. 

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Oral, Head and Neck Cancer Screenings Can Save Lives (Medical News - 24/04/2008) 

When diagnosed early, oral, head and neck cancers can be easily treated, without significant complications. Pennsylvania Hospital will offer free screenings for oral, head and neck cancer on Thursday, April 24 at the Center for Head and Neck Surgery at 811 Spruce Street, as part of oral, head and neck cancer awareness week. When diagnosed early, oral, head and neck cancers can be easily treated, without significant complications. Pennsylvania Hospital will offer free screenings for oral, head and neck cancer on Thursday, April 24 at the Center for Head and Neck Surgery. 

Take Philadelphia resident Carol Jessup for example. Soon after losing a friend to throat cancer, Ms. Jessup was diagnosed with throat cancer herself, after  complaining of pain to her ear, nose and throat specialist. A fearless adventurer, Ms. Jessup’s impending trip to Machu Pichu and the Galapagos Islands had to be cancelled and replaced with cancer treatment. Jessup is a former engineer and 
certified project manager with IBM for 20 years. She had retired just five months before the diagnosis. “Had my friend not recently gone through throat cancer, I may never have brought it up to my doctor,” says Jessup of her throat pain. “We’re not conditioned to think that a sore throat can be cancer.” 

Oral, head and neck cancers are most common among those who smoke, chew tobacco and consume excessive amounts of alcohol. More than 85 percent of head and neck cancers are related to tobacco use, while others may have a relationship to viral causes such as HPV and Epstein-Barr Virus. Jessup’s treatment included six weeks of chemotherapy, followed by seven weeks of radiation treatment to shrink the tumor. She then had neck surgery to remove the remaining affected lymph nodes on the right side of her neck. Her cancer treatment plan and neck surgery was guided by Jason G. Newman, MD, head and neck surgeon at Pennsylvania Hospital. “Carol’s case was one of our easier ones to treat. Her cancer was caught early and treatment immediately followed, says Dr. Newman. “Head and neck cancers can spread quickly, and many people dismiss the symptoms as being something 
other than cancer.”  Jessup is back to normal now- with only a few reminders of her surgery. She often has dry mouth due to a loss of saliva glands during radiation. Subsequent cat scans and PET scans have shown the area to be cancer-free. Since surgery, Jessup has made the trip to the Galalopogos Islands, Machu Picchu, Buenos Aires and Patagonia-- and is planning her second trip to Australia and Southeast Asia. 

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Spit Test Spots Head and Neck Cancer. Researchers Also Working on Oral Swab Test for Lung Cancer ( WebMD Medical News- 14/04/2008) 

Researchers have developed a DNA spit test to detect the earliest signs of head and neck cancer, when it is more curable, and they say it could be available by the end of the year. Also in the works -- though not as far along -- is an oral swab test to gauge whether someone is at increased risk of developing lung cancer. If it pans out in future research, the swab test could also be used to predict who has a high probability of developing head and neck cancer and other tobacco-related cancers, the researchers say.

More than 40,000 Americans are diagnosed with head and neck cancer annually and about 12,000 die of it. A total of 215,020 Americans will be diagnosed with lung cancer in 2008, and it will kill 161,840, according to the American Cancer Society (ACS). Both new tests were discussed at the annual meeting of the American Association for Cancer Research.

"Living Like Hell' Seema Sethi, MD, tells WebMD that she "jumped into research to find a test to pick up head and neck cancer earlier" after losing her dad to a tobacco-related cancer. Sethi is a specialist in otolaryngology-head and neck surgery at Henry Ford Hospital in Detroit. "Everyone knows smoking and alcohol are associated with head and neck cancer, but no one knows who's going to get it," she says. Currently, most cases are diagnosed in advanced stages, when prognosis is poor, Sethi says. "Despite the best of treatments, outcomes are not as good as if it was picked up earlier," she says.

Head and neck cancer is one of the most horrendous of diagnoses. "You have to chop off part of the patient's face. They often can't swallow or eat solid food. There's a lot of mouth odor. So even if you're living, you're living like hell," Sethi says.

Gene Test Predicts Head and Neck Cancer

Because the development of the disease in people at high risk, such as smokers, takes many years, Sethi reasoned that this "window" period offered an opportunity for early screening. She came up with the idea of looking for two genes -- PMAIP1 and PTPN1 -- that are associated with head and neck cancer. Abnormalities in either gene signal the cancer. The researchers took saliva samples from 27 patients with head and neck cancer and 10 healthy people without cancer. "Patients just spit in a cup," Sethi says. The researchers extracted DNA from the samples and analyzed it.

"Lo and behold, we could completely separate out the cancer patients from the normal non-cancer healthy people," she says. Sethi says the next step will be to validate the test in people who come in for head and neck screening because "they are a smoker, have a family history, or other reasons. By the end of the year, we hope to have an early test for head and neck cancer," she says. 

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Race, Gender Affect Laryngeal Cancer Survival- (HealthDay- 20/12/2007) 

A patient's sex and race, along with the type of treatment they receive, can impact their survival after a diagnosis of advanced laryngeal cancer, say U.S. researchers. They analyzed data from a national cancer registry on more than 7,000 patients diagnosed with advanced laryngeal cancer between 1995 and 1998.Of those patients, 53.6 percent had a total laryngectomy (removal of the larynx), 30.6 percent had radiation therapy (radiotherapy) alone, and 15.8 percent had combined chemotherapy and radiotherapy. "Controlling for the other included factors, the radiotherapy and chemo-radiotherapy groups had lower odds of survival than did the total laryngectomy group. The increased risk associated with death is approximately 30 percent for the chemo-radiotherapy group and 60 percent for the radiotherapy group," wrote study authors Dr. Amy Y. Chen, of Emory University and the American Cancer Society, and Dr. Michael Halpern, of the American Cancer Society.

They also found that men were less likely to survive than women; patients with stage IV disease were less likely to survive than those with stage III disease; black patients were more likely to die than white patients; and uninsured patients or those with Medicaid, Medicare or other government health plan coverage were more likely to die than those with private health insurance. "We do not believe that insurance status in this analysis represents differential treatment or quality of care for patients with advanced laryngeal cancer. Rather, insurance status is likely a proxy for multiple medical issues, including usual source of medical care, participation in screening and preventive care activities and exposure to related risk factors, including alcohol and/or tobacco use and poor diet, all of which can influence overall survival," the study authors wrote.

"In conclusion, this analysis demonstrates that total laryngectomy yields the highest likelihood of survival for patients with advanced laryngeal cancer," the researchers added. The study was published in the December issue of the Archives of Otolaryngology -- Head and Neck Cancer. 

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New radiation therapy for head and neck cancer shows promising results- (ANI- 18/08/2007) 

Scientists have devised a new radiation therapy for head and neck cancer. A Phase I/II trial conducted at Helsinki University Hospital, Finland found that most head-and-neck cancers that recur locally after prior full-dose conventional radiation therapy respond to Boron Neutron Capture Therapy (BNCT). The scientific director of the research program, professor Heikki Joensuu, University of Helsinki, considers the results clinically significant and very interesting. They open a new field for BNCT, since thus far BNCT has been evaluated only in the treatment of some brain tumours. The follow-up results of 12 patients diagnosed with cancer of the head-and-neck and treated in a prospective clinical tria. All patients had cancer of the head-and-neck that had recurred locally after surgery and conventional radiation therapy. Ten out of the 12 patients had substantial tumour shrinkage following BNCT, and in 7 cases the tumour disappeared completely. Adverse effects of treatment were moderate and resembled those of conventional radiation therapy. 

Boron neutron capture therapy (BNCT) is a form of targeted radiation treatment for cancer. It is still considered experimental. In this method a boron-containing compound (boronophenylalanine) is first infused into a peripheral vein, following which the compound accumulates in cancer tissue. Cancer is subsequently irradiated with neutrons obtained from a nuclear reactor, which causes boron atoms to split within the cancerous tissue as a result from a boron neutron capture reaction. The resulting smaller particles cause a large radiation effect within the tumour tissue, which destroys cancer cells. 

The technique allows targeting of a high dosage of radiation to the tumour while allowing sparing of the adjacent normal tissues from the highest doses of radiation. Boron-mediated targeting of radiation allows treatment of patients who can no longer be treated with conventional radiation therapy. BNCT is administered as single one-day treatment that may be repeated. Boneca Corporation's clinical research program includes also a phase I/II study that evaluates BNCT in the treatment of primary glioblastoma (a highly malignant brain tumour) and another clinical trial that assesses safety and efficacy of BNCT in the treatment of glioblastomas and anaplastic astrocytomas (a type of brain tumour) that have recurred after conventional radiation therapy. 

"Our plan is to investigate BNCT in the treatment of cancers located elsewhere in the body that cannot be effectively managed by any known treatment," said professor Heikki Joensuu. "The current treatment is a result of a long period of research, a proof of academic expertise, and a model for effective collaboration between Helsinki University Central Hospital, University of Helsinki, VTT Technical Research Centre of Finland, and the company", said Boneca Corporation's managing director Markku Pohjola. The research reported in the International Journal of Radiation Oncology, Biology and Physics. (ANI)

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Fruit compound fights head and neck cancer- (Reuters- 16/10/2007) 

Lupeol, a compound in fruits like mangoes, grapes and strawberries, appears to be effective in killing and curbing the spread of cancer cells in the head and neck, a study in Hong Kong has found. An experiment with mice showed lupeol worked most effectively with chemotherapy drugs and had almost no side effects, scientists at the University of Hong Kong said in a report published in the September issue of the journal Cancer Research.

"It can suppress the movement of cancer cells and suppress their growth and it is found to be even more effective than conventional drugs (eg. cisplatin)," said Anthony Yuen, a professor at the University of Hong Kong's surgery department. "It's even more effective if we combine it with chemotherapy drugs, and has very little side effects," he said. The team plans another round of animal test and hopes to proceed eventually to human clinical trials, though it would not commit itself to a timeframe.

Head and neck cancers involve cancers of the nose, oral cavity, throat, voice box, thyroid and salivary glands and they more commonly afflict Asians than Westerners. Some of the risk factors include smoking, excessive alcohol consumption, chewing betel nut and diets rich in preserved foods, like salted fish. Such cancers are difficult to treat. Fifty percent of victims are typically diagnosed in advanced stages, when cure rates would be so low they would be considered inoperable.

Surgeries on the head and neck are always difficult because they involve the removal of large areas of diseased skin and soft tissues and surgeons need to first figure out how to cover up these open wounds before they can try to excise the tumors. Yuen said lupeol - also found in vegetables, olive seed, figs and saw palmeto - appeared to block a natural protein NFkB, which helps cells repair and grow, even cancer cells.

In the experiment, lupeol was given to mice infected with malignant head and neck cancer cells. "From the animal models, not only did it suppress the spread, the tumor got smaller. Compared to conventional drugs, lupeol reduced the size of the tumor far faster," said Terence Lee, another member of the research team.

"Conventional drugs made the mice a lot thinner, but lupeol mice retained their bulk." Emaciation is usually viewed as a bad sign in the fight against cancer. Yuen hopes lupeol can be applied to other cancers that are similarly dependent on the NFkB protein to grow and spread. "It may be possible to use (lupeol) in other cancers because it is able to suppress the NFkB protien, which is activated in many cancers like prostate cancer, breast cancer, liver cancer," Yuen said.

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At the Dentist’s: Vicious Cycle of Gum Disease, Bone Loss and Cancer (NICHOLAS BAKALAR - 22/05/2007)

The bone loss caused by gum disease is associated with an increased risk for tongue cancer, and the more the bone loss, the greater the risk, researchers report. Scientists evaluated bone loss around the teeth in 51 men with newly diagnosed tongue cancer and in 54 men without the diagnosis. X-rays were taken of the men’s jaws, and a radiologist who did not know the cancer status of the men measured the amount of bone loss. The study took place from 1999 to 2005. After adjusting for smoking status, sex, race and ethnicity, number of cavities, crowns, fillings and missing teeth, the researchers calculated that for every one millimeter of bone loss, the risk of tongue cancer increases more than fivefold. Chronic infection, the authors write in the May issue of The Archives of Otolaryngology: Head & Neck Surgery, can play a role in cancer, either directly by the effect of the toxic products of micro-organisms, or indirectly by inflammation that stimulates the formation of tumors.

“I was surprised by the magnitude of the effect,” said Frank A. Scannapieco, the senior author and a professor of oral biology at the School of Dental Medicine at the State University of New York at Buffalo. But, he added, “There have to be more population-based studies to support these conclusions.” Although chronic gum disease was the only oral variable significantly associated with oral cancer, the authors acknowledged that the number of people in the study was small and that 
the diagnoses of periodontal disease were made from X-rays rather than direct measurement.

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Betel quid chewing increases pharyngeal cancer risk( Reuters- 14/12/2006)

Betel quid chewing is a strong independent risk factor for pharyngeal cancer (cancer of the back of the throat), but not laryngeal cancer (cancer of the voice box), according to findings published in the International Journal of Cancer. Chewing betel quid, which consists of betel leaf from the Piper betle vine, is popular in many parts of Asia. Betel quid is chewed for its stimulant effects, to satisfy hunger and as a social and cultural practice.

"The risks of betel quid chewing with or without tobacco, alcohol drinking and cigarette smoking have been well explored in the oral cavity but not in the pharynx and larynx," Dr. Ying-Chin Ko, of National Health Research Institutes, Taiwan, and colleagues write. The investigators therefore examined 148 men with pharyngeal cancer, 128 men with laryngeal cancer, and 255 men without either cancer who served as "controls."

Betel quid chewing was significantly and independently associated with the risk of pharyngeal cancer, increasing the risk by nearly eight-fold. However, no significant association was observed between betel quid chewing and laryngeal cancer. Those who consumed more than 20 quid a day or swallowed the betel quid juice had an even high risk -- the investigators observed a synergistic effect of these risk factors for both pharyngeal and laryngeal cancer.

The quantity of exposure and the direct contact of the carcinogen to the mucus membrane appear to enhance the carcinogenic process, Ko and colleagues suggest. "Further studies to explore the associations between betel quid chewing and cancers of other sites of the digestive tract, for example, the esophagus and stomach, and the effects on other systems of humans are necessary."

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Calls for checks on mouth cancer-(Yahoo News- 15/12/2005)

People who smoke and drink are 30 times more likely to get oral cancer. A woman who was diagnosed with mouth cancer is backing calls for people to examine themselves for possible signs of the disease. Lorraine Bass, 36, from Denbighshire, needed major surgery on her tongue after a lump was found to be a tumour. Doctors said her life was saved because she had the lump checked early.

Mrs Bass was treated at Glan Clwyd Hospital, Rhyl, which is holding a drop-in screening clinic on Tuesday as part of Mouth Cancer Awareness Week. The campaign, run by the British Dental Health Foundation, highlights how picking up early signs of the condition, in the same way people check for breast or testicular cancer, is the best way for them to be on guard. Mrs Bass said: "Obviously early diagnosis is crucial. Mouth cancer is an insidious illness and it will just take your life.

"You have to check. By checking you can catch it early and stay alive for your loved ones." About 4,300 new cases of oral cancer are diagnosed in the UK each year. Mrs Bass, a mother-of-two who does not smoke, said the first sign she had of the trouble was in October 2002 when she was at college. She said: "I was having lunch and I bit the tumour. I didn't realise it was a tumour at the time, I thought it was my tongue. It was extremely painful - I almost went through the roof.

"But I'm not one for going to doctor very much if I can help it. I just assumed it would heal. "About two weeks later, the same thing happened. I thought I'd re-bitten the cut area." She said she bought some products from a chemist store and tried to treat what she still thought was the cut on her tongue before going to see her GP, who prescribed some tablets.

When she went back two weeks later, she saw a different GP who recommended that they had her tongue checked by a specialist. Mrs Bass went to Glan Clwyd, where a consultant diagnosed the cancer. "I was shocked because I really had it stuck in my head that it was a mouth ulcer. I was told I was diagnosed quite early. Unfortunately, there is always the fear of it returning."

She underwent 14 hours of surgery, which involved cutting away part of her tongue and rebuilding it with a flap of skin from her forearm. Mrs Bass said doctors had been unable to explain why she contracted the disease when, as a non-smoker and a light drinker, she was not in a high-risk category. The ratio of women to men suffering with mouth cancer has increased by a third over the last 10 years, though men are still twice as likely to develop the condition.

The main risk factors of mouth cancer are smoking and drinking alcohol to excess, and people who do both are up to 30 times more likely to develop mouth cancer. The drop in screening clinic at the hospital on Tuesday afternoon is open to anyone who is concerned they may be experiencing symptoms of the disease. Dr Nigel Carter, chief executive of the British Dental Health Foundation, said: "Self examination is now the norm for breast cancer and testicular cancer - it needs to be the same for mouth cancer." The Mouth Cancer Awareness Week 2005 theme is "It Could Be You" to highlight how the condition can strike anyone at any time.

There are 4,990 new mouth cancer patients a year. Mouth cancer is rising among young people and women. It is twice as common as cervical or testicular cancer and is the sixth most common globally. A third of patients with the disease die

Symptoms include:-
An ulcer that does not heal over three to four weeks
Any unexplained red or white patches in the mouth
Unexplained loss of teeth
Unexplained numbness of upper, or lower lip, or the tongue
Unexplained nose bleed from one side
Unexplained bleeding from the mouth
Persistent one sided sore throat
Persistent earache and sore throat                                                          Neck lump that does not go away

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Strategy Helps Tailor Head, Neck Cancer Treatment (HealthDay News-30/08/2005)

Scientists have discovered a way to determine which head and neck cancer patients would benefit from additional drug treatment during radiation therapy. Some tumors that have low concentrations of oxygen, or hypoxia, are resistant to radiation therapy, explain researchers from Aarhus University Hospital in Denmark. A drug called nimorazole can help in treating these tumors, but up to now there's been no way to identify people who would benefit from the drug.
Reporting in this week's Lancet Oncology, the Danish team studied whether patients' reaction to nimorazole could be predicted by measuring their blood for osteopontin, a protein associated with tumors lacking oxygen.


They found that patients with high concentrations of the protein who received a placebo did poorly compared with patients who received the drug. "This finding might help to identify patients who will benefit from treatment with a hypoxia modifiers such as nimorazole during radiotherapy," lead researcher Jens Overgaard said in a prepared statement. "By contrast, use of nimorazole was not effective in patients with low or intermediate plasma concentrations of osteopontin."

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Delta launches fight to treat oral cancer in Detroit-(Yahoo News-26/08/2005)

With city as one of top five areas for disease, dental plan, project team up to encourage tests. A test done with a device that's essentially a toothbrush can help fight oral cancer -- one of the stealthiest, deadliest and costliest cancers plaguing minorities in Metro Detroit. The simple test, called a brush biopsy, can detect oral cancer long before it takes hold, saving patients' lives and sparing them costly medical bills. Oral health care experts hope the test will become as prevalent as mammograms, which have become a key to early detection of breast cancer.

Many of those most at risk for oral cancer don't know an exam exists, however. Delta Dental Plans of Michigan and the Detroit Oral Cancer Prevention Project have teamed up on a regional campaign to encourage people, especially African-American men, who are at the highest risk for the disease, to get oral cancer tests."It's a stealth problem that no one talks about," said Amid Ismail, director of the Detroit Oral Cancer Prevention Project and University of Michigan professor of dentistry. "It is unacceptable that the problem of oral cancer is not publicly known in Detroit."

Oral cancer kills about 30,000 Americans a year and is especially prevalent in Detroit. The city each year ranks among the top five metropolitan areas for oral cancer rates. Smoking, drinking alcohol and exposure to ultraviolet rays are all risk factors for oral cancer. Donald Jones worried for weeks because his tongue was changing color. The 66-year-old Detroiter decided to get a test, which was negative, after seeing a billboard about oral cancer. "I had no idea even that oral cancer existed," Jones said.

During the test, a dentist uses a toothbrush-like device to scrape tissue from inside a patient's mouth that is then tested for cancer. Delta Dental Plans of Michigan is spending $50,000 to cover brush biopsies and other exams and treatments for uninsured Wayne County residents. Patients will receive a screening from the Detroit Dental Assessment Center. Depending on the results, patients may then be referred to volunteer dentists.

Okemos-based Delta Dental, which insures 5.1 million people in Michigan, Ohio and Indiana, is trying to promote tests among dentists, as well. The insurer is among few that reimburses patients for brush biopsies.If oral cancer is caught early, the cure is simple removal of diseased tissue. In later stages, treatment consists of disfiguring surgeries that can cost more than $200,000. The survival rate drops to 57 percent from 81 percent when the disease is not detected early.

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