Head & Neck Cancer

BALTIMORE-Researchers at the Johns Hopkins School of Medicine and School of Hygiene and Public Health have found human papillomavirus (HPV) to be a likely cause of certain cancers of the head and neck, and also an indicator of improved survival.

Drs. Mark Singer and Eric Blom revolutionized the process of speech rehabilitation following total laryngectomy with their introduction of the tracheoesophageal puncture and insertion of a duck bill prosthesis.[1-5] The physiologic principles of the procedure are obvious, the surgical technique is simple, and the results in terms of fluent speech production are immediate and quite satisfactory. Dr. Blom is to be complimented for providing in this article, a succinct summary of the “current methods” available for speech rehabilitation for a patient facing total laryngectomy.

Total laryngectomy is the surgical procedure traditionally used to treat patients with advanced-stage cancer of the larynx. The impairments resulting from removal of such a small organ are, indeed, profound. They include

ALEXANDRIA, Va-Since she founded the Cancer Research Foundation of American (CRFA) in 1985, the year after her father’s death from head and neck cancer, Carolyn “Bo” Aldigé has become a persuasive and respected advocate for cancer

SAN ANTONIO-Accelerated radiation therapy given concomitantly with mitomycin C (Mutamycin) produced significantly improved results over standard radiation in patients with advanced head and neck cancer, Werner H. Dobrowsky, MD, reported at the at 41st Annual Scientific Meeting of the American Society for Therapeutic Radiology and Oncology.

Genetronics Biomedical Ltd announced interim dataand results of phase II clinical trials evaluating the company’s electroporation therapy (EPT) system, which combines an intratumoral injection of a chemotherapeutic agent with a pulsed electric field, in squamous cell carcinoma of the head and neck. Data from the trials, which were conducted in the United States and Canada, were presented at the 35th annual meeting of the American Society of Clinical Oncology (ASCO). Genetronics also announced preliminary data and results from a similar study conducted in Europe.

SAN ANTONIO-Local-regional control significantly improved with two radiotherapy fractionation variants delivering either increased total dose or shorter treatment time, compared with standard fractionation, in patients with locally advanced squamous cell carcinoma of the head and neck, Karen Fu, MD, reported at the 41st Annual Scientific Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

BUFFALO, NY-Techniques developed over the past 20 years have improved outcomes for patients with head and neck cancers. Speakers at the Surgical Oncology Symposium sponsored by Roswell Park Cancer Institute described new surgical methods that offer further improvement in quality of life and new studies of preventive agents.

SAN ANTONIO -“Extraordinary” tumor control has been achieved in patients with far advanced squamous cell carcinomas of the head and neck with the triple combination of tirapazamine (investigational), cisplatin (Platinol), and radiotherapy, Lester J. Peters, MD, reported at the 41st Annual Scientific Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

The findings of two clinical studies of C225, a monoclonal antibody (epidermal growth factor receptor inhibitor) being developed by ImClone Systems (New York City), were presented at the 1999 annual meeting of the American Society of Clinical Oncology (ASCO). The studies demonstrated the effectiveness of C225 in eliciting a clinical response in patients with advanced head and neck cancer when used in combination with standard radiotherapy and chemotherapeutic agents.

Tumors of the head and neck continue to pose challenges for afflicted patients and their treating physicians. Because the complex and vital anatomy often involved affects the ability to communicate and interact socially, head and neck tumors can have a devastating effect on the patient’s quality of life. Due to the inherently complex nature of such tumors and their rarity, a comprehensive textbook devloted to their management is certain to be useful.

Traditionally, treatment for locally advanced resectable head and neck cancer has been surgical resection followed by postoperative radiation. In unresectable patients, primary radiation has been the mainstay of

Gene therapy has the potential to provide cancer treatments based on novel mechanisms of action with potentially low toxicities. This therapy may provide more effective control of locoregional recurrence in diseases like non–small-cell lung cancer (NSCLC) as well as systemic control of micrometastases. Despite current limitations, retroviral and adenoviral vectors can, in certain circumstances, provide an effective means of delivering therapeutic genes to tumor cells. Although multiple genes are involved in carcinogenesis, mutations of the p53 gene are the most frequent abnormality identified in human tumors. Preclinical studies both in vitro and in vivo have shown that restoring p53 function can induce apoptosis in cancer cells. High levels of p53 expression and DNA-damaging agents like cisplatin (Platinol) and ionizing radiation work synergistically to induce apoptosis in cancer cells. Phase I clinical trials now show that p53 gene replacement therapy using both retroviral and adenoviral vectors is feasible and safe. In addition, p53 gene replacement therapy induces tumor regression in patients with advanced NSCLC and in those with recurrent head and neck cancer. This article describes various gene therapy strategies under investigation, reviews preclinical data that provide a rationale for the gene replacement approach, and discusses the clinical trial data available to date. [ ONCOLOGY 13(Suppl 5):148-154, 1999]

Tumors of the head and neck continue to pose challenges for afflicted patients and their treating physicians. Because the complex and vital anatomy often involved affects the ability to communicate and interact socially, head and neck tumors can have a devastating effect on the patient’s quality of life. Due to the inherently complex nature of such tumors and their rarity, a comprehensive textbook devloted to their management is certain to be useful.

Single-agent, intratumoral gene therapy that targetsthe p53 gene is well tolerated and shows evidence of antitumor activity in patients with recurrent squamous cell carcinoma of the head and neck, according to the preliminary results of phase II clinical

ROCKVILLE, Md-The FDA has approved Ethyol (amifostine for injection) as a therapy to decrease the incidence of moderate-to-severe xerostomia in patients undergoing postoperative radiation treatment for head and neck cancer. The approval came only 2 weeks after the Oncologic Drugs Advisory Committee (ODAC) recommendation.

The 14 reports in this special supplement discuss theuse of the cytoprotectant amifostine in patients withcancer of the head and neck, esophagus, lung, andcervix, as well as those with lymphoma and acutemyelogenous leukemia. Discussions focus on thepotential of this agent to both reduce radiation sideeffects such as xerostomia and permit doseescalation of chemotherapy and/or radiotherapy.Improvements in treatment outcome and quality oflife as a result of cytoprotection are examined.

n PHILADELPHIA-Vitamin supplements have been shown to have a possible protective effect against mutations of the p53 gene in head and neck cancer, Bruce J. Trock, PhD, director of Molecular Epidemiology, Georgetown University Medical Center, said at the American Association for Cancer Research annual meeting. The multicenter, collaborative study also included scientists from Fox Chase Cancer Center and Temple University Medical Center.

ASCO-Delivering normal copies of the p53 tumor-suppressor gene directly into lesions is a novel and promising approach to treating squamous cell carcinoma of the head and neck, John Nemunaitis, MD, of PRN Research Inc., said at the Annual Meeting of the American Society of Clinical Oncology.

Head and neck imaging, in its current form, really began with the development of the computed tomographic (CT) scanner in the late 1970s and early ’80s. Originally, only CT scans of the brain were performed because of constraints on gantry size.

Modern head and neck imaging has led to advances in both the diagnosis and treatment of head and neck cancers. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies provide important information

Intracranial germinomas are uncommon tumors. In the past, patients have traditionally been diagnosed with a trial of focal radiotherapy without biopsy. If the tumor was radiosensitive, it was presumed to be a germinoma.

During the past decade, federal health agencies have focused on reducing the incidence of oral and pharyngeal cancer and increasing the 5-year survival rate from these cancers in the United States. Beginning with a consortium of health agencies in

Findings that tissue levels of two proteins correlate closely with the prognosis of head and neck cancer may significantly alter the detection, staging, and treatment of this disease, according to an article published in the June 3rd issue of the Journal of

TORONTO--The use of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) offers an opportunity to improve the outcome for patients with advanced head and neck cancers. Two papers presented at the 45th annual meeting of the Society of Nuclear Medicine found that FDG-PET was more accurate than conventional imaging for the diagnosis of regional and distant recurrence.

The common clinical presentations of head and neck cancer include early (stage I or II) disease, locally or regionally advanced (stage III or IV, M0) disease, and recurrent or metastatic disease (< 5% of patients).

LOS ANGELES--A genetically engineered adenovirus that replicates in and kills tumor cells deficient in p53 tumor suppressor gene activity has shown promising results in patients with advanced head and neck cancer, David H. Kirn, MD, said at an ASCO poster session. Dr. Kirn is director of clinical research at Onyx Pharmaceuticals, Richmond, California, which is developing the new agent, known as ONYX-015.

TORONTO--Therapeutic strategy in patients with head and neck cancer is sometimes based on the staging of regional lymph nodes. However, standard imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) cannot differentiate between inflammation and metastasis in an enlarged lymph node and may not discover distant disease.

Management of patients who have head and neck cancer necessitates a multidisciplinary approach.[1,2] Comprehensive care must be initiated prior to therapy, maintained throughout course of treatment, and systematically coordinated for the rest of the patient’s life. As Dwyer and Minasian note, a multidisciplinary team that includes dental professionals, a speech/language pathologist, and a registered dietician is best suited for this complex management challenge. These individuals, working in conjunction with physicians, nurses, and other professionals, can provide patients with key preventive and therapeutic supportive care interventions.

he authors are to be commended for providing an overview of several important, though often overlooked, management issues in head and neck cancer. In their overview of nutrition, they correctly state that the nutritional status of head and neck cancer patients is frequently compromised even before cancer diagnosis and treatment. Documented reasons for this include poor oral hygiene, ill-fitting dentures, and a high incidence of alcoholism.[1] Consequently, it is imperative that patients’ pretreatment nutritional status be determined so that necessary dietary modifications can be made prior to therapy. As the authors emphasize, nutritional reassessment and intervention should continue during and after treatment.