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In patients with squamous cell cancer of the mouth, imaging with fluorodeoxyglucose positron emission tomography (FDG-PET) detected more hidden lymph node metastases in the neck than computed tomography (CT) or magnetic resonance imaging (MRI). These results were published in the Journal of Clinical Oncology.
Oral cancer refers to cancer that involves the mouth, lips, or tongue. A majority of cases of oral cancer are linked with tobacco use. High alcohol intake also increases the risk of oral cancer.
Because oral cancer can spread to lymph nodes in the neck, treatment of oral cancer may involve surgical removal or irradiation of these lymph nodes. While it would be optimal to reserve lymph node treatment for those patients with lymph node metastases, it can be difficult to determine in advance whether lymph node metastases are present. Some lymph node metastases are too small to be felt. They may also be missed by conventional imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI).
To determine whether an alternative imaging technique-FDG-PET-can be used to identify hidden lymph node metastases in the neck, researchers in Taiwan conducted a study among 134 patients with oral cancer. None of the patients had lymph node metastases that could be felt by palpating the neck. Before surgical removal of the lymph nodes of the neck, patients underwent imaging with FDG-PET and CT or MRI.
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Surgery detected lymph node metastases in 26% of the patients.
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FDG-PET detected more lymph node metastases than CT or MRI. FDG-PET detected 51% of patients with lymph node metastases, compared to 31% for CT or MRI.
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Overall, the probability of a false-negative result using FDG-PET was 6.7% for patients with T1 tumors (tumors smaller than 2 cm); 10.8% for patients with T2 tumors (tumors between 2 cm and 4 cm); 13.3% for patients with T3 tumors (tumors larger than 4 cm); and 25% for patients with T4 tumors (tumors that invade nearby tissue).
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The researchers conclude that FDG-PET was superior to CT or MRI for detecting hidden lymph node metastases in the neck. The performance of FDG-PET was not perfect, however; it produced false-negative results in up to 13% of patients with T1-T3 tumors. In patients with T4 tumors, it produced false-negative results in 25% of patients.
Reference: Ng S-H, Yen T-C, Chang T-C et al. Prospective Study of [18F] Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography and Magnetic Resonance Imaging in Oral Cavity Squamous Cell Carcinoma with Palpably Negative Neck. Journal of Clinical Oncology. 2006;24:4371-4376. |
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According to an article published in the American Journal of Medicine, gastroesophageal reflux disease (GERD) and smoking increase the risk of developing laryngeal cancer.
Laryngeal cancer is considered a type of head and neck cancer and occurs in the larynx, which may also be referred to as the "voice box". Smoking and alcohol are thought to increase the risk of laryngeal cancer.
GERD, also referred to as heartburn, is a condition in which the acidic contents of the stomach back up into the esophagus (the tube that connects the throat to the stomach). GERD may be responsible for the irritation of tissues of the esophagus, a condition referred to as Barrett's esophagus.
Researchers from the Cleveland Clinic recently conducted a study to evaluate potential effects of GERD on laryngeal cancer. This study included 96 patients with laryngeal cancer and 192 patients who did not have laryngeal cancer.
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Surgery detected lymph node metastases in 26% of the patients.
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FDG-PET detected more lymph node metastases than CT or MRI. FDG-PET detected 51% of patients with lymph node metastases, compared to 31% for CT or MRI.
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The researchers concluded that smoking and GERD increase the risk of developing laryngeal cancer. Only future clinical trials can determine if intervention against GERD can help reduce the risk of developing laryngeal cancer.
Patients who smoke or have GERD may wish to speak with their physician regarding their individual risks of developing laryngeal cancer, as well as potential treatments for GERD.
Reference: Vaezi MF, Sepi M, Lopez R, et al. Laryngeal cancer and gastroesophageal reflux disease: a case control study. The American Journal of Medicine. 2006;119:768-776.
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According to results presented at the 42nd annual meeting of the American Society of Clinical Oncology (ASCO), the addition of Taxotere® (docetaxel) to cisplatin (Platinol®) and fluorouracil (5-FU) as initial therapy significantly improves survival in patients with advanced head and neck cancer.
Approximately 40,000 people in the U.S. are diagnosed with head and neck cancer every year. Cancers of the head and neck include several types of cancers affecting the nasal cavity and sinuses, oral cavity, nasopharynx (upper part of throat, behind ear), oropharynx (middle part of throat, including soft palate, base of tongue, and tonsils), and other sites throughout the head and neck. In 2005 the American Cancer Society estimated that 11,000 people would die from head and neck cancer.
Advanced head and neck cancer refers to cancer that spreads from its site of origin to other sites in the body. Standard treatment for advanced head and neck cancer often includes the use of several chemotherapy agents, the targeted agent Erbitux® (cetuximab), and/or radiation therapy. Some patients are able to undergo the surgical removal of their cancer following treatment. Since long-term survival for advanced head and neck cancer remains suboptimal, researchers continue to evaluate new therapeutic and chemotherapy combinations to determine optimal treatment strategies for patients with head and neck cancer.
Researchers from Harvard Medical School reported results from a phase III trial (phase of trials prior to FDA review) comparing Taxotere/cisplatin/fluorouracil to cisplatin/fluoruracil only in patients with advanced head and neck cancer.
This trial included 538 patients with squamous cell advanced head and neck cancer. Approximately half of the patients were treated with Taxotere/cisplatin/fluorouracil and the other half received cisplatin/fluorouracil (control group). All patients were then treated with the chemotherapy agent carboplatin (Paraplatin®), radiation therapy, and in some cases, surgery. |
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Overall, patients were followed for a median of 42 months.
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Patients initially treated with the addition of Taxotere had significantly improved survival.
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At three years, 62% of patients treated with Taxotere/cisplatin/fluorouracil were alive, compared with only 48% of patients in the control group.
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The side effects were comparable between the two treatment groups.
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The most common side effects related to chemotherapy include mouth sores, nausea, vomiting, and low blood cell levels.
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The researchers concluded that the addition of Taxotere to the standard cisplatin/fluorouracil as initial therapy in advanced head and neck cancer significantly improves survival when patients undergo subsequent chemotherapy and radiation therapy. The authors stated that the addition of Taxotere as initial therapy should now be considered the standard of care in advanced head and neck cancer. However, it is important for patients to discuss their individual risks and benefits of treatment including Taxotere with their physician.
Reference: Posner MR, Herchock D, Le Lann L, Devlin PM, Haddad RI. TAX 324: a phase III trial of TPF vs PF induction chemotherapy followed by chemoradiotherapy in locally advanced SCCHN: preliminary results of GORTEC 2000-1. Proceedings from the 42nd Annual Meeting of the American Society of Clinical Oncology; June 2-6, 2006; Atlanta, Georgia. Special session.
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According to an article published in The Lancet, fractionated radiation therapy improves survival over conventional radiation therapy for patients with squamous cell head and neck cancer.
Head and neck cancer originates in sites within the head or neck. The American Cancer Society estimated that 11,000 individuals died from head and neck cancer in the United States in 2005. The most common type of head and neck cancer is squamous cell head and neck cancer, which refers to the type of cell from which the cancer originated.
Radiation therapy remains an important component in the treatment of head and neck cancer. Researchers continue to evaluate optimal types of radiation delivery and schedules for the treatment of this disease. Hyperfractionated radiation therapy refers to radiation therapy that is given two to three times per day, versus the conventional once-per-day dosing.
Hyperfractionated radiation therapy utilizes smaller doses with each administration than doses used with the once-daily administration. Accelerated radiation therapy refers to radiation that is administered over a shorter duration of time than conventional radiation. The doses with hyperfractionated or accelerated radiation therapy may be increased overall, may stay equal, or may be reduced compared to conventional radiation therapy.
Researchers on behalf of the Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck (MARCH) Collaborative Group recently compiled and analyzed data from 15 clinical trials evaluating different radiation schedules and doses for the treatment of squamous cell head and neck cancer. The majority of patients had advanced head and neck cancer.
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Hyperfractionated radiation therapy improved survival by 8% at five years compared to conventional radiation therapy.
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Accelerated radiation therapy improved survival by 2% at five years compared to conventional radiation therapy.
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The benefits achieved were greatest for youngest patients.
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The researchers concluded that hyperfractionated radiation therapy improves survival over conventional radiation therapy in the treatment of head and neck cancers. The authors state that further study is necessary to determine exactly which types and schedules of the fractionated radiation therapy provide the most benefit for these patients.
Patients diagnosed with squamous cell cancer of the head and neck may wish to speak with their physician regarding their individual risks and benefits of different types of radiation schedules.
Reference: Bourhis J, Overgaard J, Audry H, et al. Hyperfractionated or Accelerated Radiotherapy in Head and Neck Cancer: a Meta-Analysis. The Lancet. 2006. Early online publication. August 17. DOI: DOI:10.1016.
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