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Head & Neck Cancer

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TORONTO, Canada-The combination of positron emission tomography (PET) and computed tomography (CT) has proved particularly advantageous in the diagnosis and treatment of cancer of the head and neck, Carolyn Cidis Meltzer, MD, said at the 48th Annual Meeting of the Society of Nuclear Medicine (abstract 133).

SAN FRANCISCO-Interim analysis of a clinical trial of patients with inoperable head and neck cancer (locally advanced or metastatic) showed superior response rates for the combination of cisplatin (Platinol), raltitrexed (Tomudex, investigational in the United States), levofolinic acid, and 5-fluorouracil (5-FU), compared with cisplatin, methotrexate, levofolinic acid, and 5-FU.

BETHESDA, Maryland-The FDA’s Oncologic Drugs Advisory Committee (ODAC) has voted not to recommend that the agency approve IntraDose (injectable cisplatin/epinephrine gel, Matrix Pharmaceuticals). Matrix is seeking to market the drug for the treatment of recurrent or refractory squamous cell carcinoma of the head and neck in patients not considered curable with surgery or radiotherapy.

A conventional course of radiation for squamous cell carcinoma in the United States is generally 70 Gy in 7 weeks, with a once-daily dose of 1.8 to 2 Gy. This schedule has a modest success rate in curing head and neck cancer. The

ZUHL, Germany-Amifostine (Ethyol) used as cytoprotective therapy can reduce the occurrence of xero-stomia, loss of taste, and fibrosis associated with radiochemotherapy for head and neck cancer. Results of three studies were reported by Jens Buentzel, MD, PhD, vice chairman of the Department of Otolaryngology, Head and Neck Oncology, Zentralklinikum Zuhl, Germany.

ST. LOUIS-To determine whether cytoprotective amifostine (Ethyol) can reduce the incidence of hypothyroidism in patients with head and neck cancer treated with radiotherapy, a trial is set to begin at Washington University in St. Louis. The proposed trial is currently undergoing institutional review board (IRB) consideration and has not yet enrolled patients.

PHILADELPHIA-For head and neck cancer patients, subcutaneous (SC) amifostine (Ethyol) provides equal protection against radiation-induced grade 2 acute xerostomia compared to intravenous (IV) amifostine, Pramila Rani Anné, MD, reported. She cautioned, however, that SC amifostine should be used only in clinical trials until ways to prevent cutaneous toxicities are worked out.

ST. LOUIS-Intensity modulated radiation therapy (IMRT) and use of radioprotectant agents may help reduce late-appearing radiation side effects, reported K. S. Clifford Chao, MD. Dr. Chao is associated radiation oncologist, Department of Radiation Oncology at the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis.

BOSTON-By reducing radiation to the parotid glands, intensity modulated radiation therapy (IMRT) allows head and neck cancer patients to maintain more saliva flow after therapy. Clifford K.S. Chao, MD, of Washington University School of Medicine, St. Louis, reported the study results at the 42nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology.

Lamont et al have presented a very clear and concise review of current gene therapy strategies in the management of squamous cell carcinoma of the head and neck. While the presentation highlighted the most important work to date in this expanding field, it also made reference to some controversies and challenges that we are now facing. With this in mind, I would like to expand on and clarify several points raised by the authors.

Despite advances in surgery, radiotherapy, and chemotherapy, survival of patients with squamous cell carcinoma of the head and neck has not significantly improved over the past 30 years. Locally recurrent or refractory disease is particularly difficult to treat. Repeat surgical resection and/or radiotherapy are often not possible, and long-term results for salvage chemotherapy are poor. Recent advances in gene therapy have been applied to recurrent squamous cell carcinoma of the head and neck. Many of these techniques are now in clinical trials and have shown some efficacy. This article discusses the techniques employed in gene therapy and summarizes the ongoing protocols that are currently being evaluated in clinical trials. [ONCOLOGY 15(3):303-314, 2001]

ALZA Corporation and MedImmune, Inc, recently announced the results of a phase III study evaluating the use of amifostine (Ethyol) in the care of head and neck cancer patients who received radiation therapy. Recently published in the Journal of

BOSTON-Despite substantially increased acute toxicity, patients with inoperable head and neck tumors benefited from accelerated radiation therapy in a randomized clinical trial reported by Jean Bourhis, MD, PhD, at the American Society for Therapeutic Radiology and Oncology (ASTRO) annual meeting.