Head & Neck Cancer

Radiation oncologist Jonathan J. Beitler, MD, MBA, offers the radiation oncology perspective on the array of treatment combinations in this complex disease.

Induction chemotherapy has led to improved survival and organ preservation. Combining induction therapy with other treatment modalities is critical for treating this complex disease and attaining optimal outcomes.

A medical oncologist, a radiation oncologist, and a surgeon share pearls and pitfalls in their specialized approaches to managing recurrent disease.

PET paired with a variety of radiotracers offers insights into the metabolic, DNA, and protein pathways.

Removing an oropharyngeal tumor through the open mouth using robotic instruments now has FDA approval, and its safety is well documented. Comparative evidence of its effectiveness is beginning to trickle in.

HOLLYWOOD, FLA.-Two speakers at the 2009 Palm Beach Cancer Symposium agreed that surgery will always play a role in the treatment of squamous-cell head and neck cancers. The question at issue: Is surgery losing ground to chemoradiotherapy as the primary treatment for head and neck cancer?

Quitting smoking during radiation treatment for lung and head and neck cancer significantly enhances treatment efficacy, yet many patients will not give up the habit even though the benefits are very obvious.

Oncologists who treat head and neck cancer face a double-edged sword-life-saving procedures often leave patients disfigured or unable to speak. For Waun Ki Hong, MD, it simply wasn’t enough to offer a cure that was saddled with too many severe consequence

Epidermal growth factor receptor (EGFR) inhibitors have emerged as important drugs in cancer therapy, providing a proven survival advantage for some patients with non–small-cell lung cancer, colorectal cancer, head and neck cancer, and pancreas cancer.

About 500,000 head and neck carcinomas are diagnosed worldwide annually. This accounts for approximately 8% of all newly diagnosed cases of cancer, ranking head and neck carcinoma the sixth most common.[1] In the United States, 47,560 new head and neck carcinomas are expected to be diagnosed in 2008,[2] and this disease accounts for 5% of all newly diagnosed cases of cancer. Approximately 90% to 95% are squamous cell carcinomas of the head and neck (SCCHNs).

In the past, locoregionally advanced head and neck cancer routinely was treated by surgery followed by adjuvant radiation therapy, unless the disease was too extensive to be resected and treatment defaulted to radiation therapy alone.

Bruce Culliney and colleagues have provided a thorough and well written summary of the literature regarding multimodality treatment of patients with locoregionally advanced or unresectable head and neck malignancies. In particular, they offer a detailed outline of recent insights into radiation dosing and fractionation and their optimal use in the combined-modality setting.

In the following sections, we will first review the radiotherapy techniques that have been investigated. We will then review the progressive advances achieved with the addition of chemotherapeutic strategies to RT in an attempt to achieve better outcomes.

BOSTON-A gene therapy agent that delivers a normal p53 gene to the tumor significantly increased survival by 4.5 months in end-stage head and neck cancer patients with p53-favorable tumor profiles, compared to those with unfavorable profiles.

Data published in the New England Journal of Medicine show that oral capecitabine (Xeloda) and oxaliplatin (Eloxatin) in combination with epirubicin (Ellence) is a comparable alternative to infused fluorouracil (5-FU) and cisplatin with epirubicin in patients with previously untreated, advanced esophagogastric cancer.

A 51-year-old man presented to the Dermatology Section at the University of Chicago Medical Center in August 2007 with a pruritic, papulopustular eruption on the face. He had been started 4 weeks ago on induction chemotherapy with paclitaxel, carboplatin, and cetuximab (Erbitux) for hypopharyngeal squamous cell carcinoma (T2N3M0). He denied any prior history of acne or rosacea.

10 notable developments and events in cancer research and care

Wedding high technology to recent advances in understanding the molecular biology of oral squamous cell carcinoma

FDA has approved Sanofi-Aventis' Taxotere (docetaxel) for use in combination with cisplatin and fluorouracil (TPF) for the induction treatment of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN)

Barrett's esophagus represents replacement of normal distal esophageal squamous epithelium with specialized columnar epithelium containing goblet cells. Typically arising in the setting of chronic gastroesophageal reflux disease, the presence of Barrett's esophagus carries a 50- to 100-fold increased risk of developing esophageal cancer. Risk factors include male sex, smoking history, obesity, Caucasian ethnicity, age > 50 and > 5-year history of reflux symptoms. Aggressive medical or surgical antireflux therapy may ameliorate symptoms, but have not yet been proven to affect the risk of developing esophageal adenocarcinoma in randomized trials. Although dysplasia is an imperfect biomarker for the development of subsequent malignancy, random sampling of esophageal tissue for dysplasia remains the clinical standard. There have been no studies to establish that endoscopic screening/surveillance programs decrease the rates of death from cancer. Fit patients with Barrett's esophagus and high-grade dysplasia should undergo esophagectomy to prevent the risk of developing esophageal adenocarcinoma. For non–operative candidates, endoscopic ablative approaches may represent a reasonable therapeutic alternative.

Taxotere gets fast track status for head and neck cancer indication

Cetuximab (Erbitux) added to standard first-line chemotherapy with cisplatin or carboplatin plus fluorouracil (5-FU) yielded a statistically and clinically significant 35% survival advantage over these regimens without cetuximab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN)

A simple oral rinse could detect head and neck squamous cell carcinoma (HNSCC) by showing elevations in CD44, a protein that is a potential biomarker for HNSCC, and also CD44 hypermethylation

In contrast to other radiosensitizers, cetuximab (Erbitux) improves radiotherapy efficacy in patients with locoregionally advanced head and neck cancer without increasing mucositis or dysphagia, and this may translate into fewer treatment breaks and longer survival

Combining chemiluminescent examination with toluidine blue staining greatly improves the accuracy of visual screening for oral cancer and could reduce the number of noninformative biopsies

ImClone Systems Incorporated and Bristol-Myers Squibb Company announced that a first-line phase III study of cetuximab (Erbitux) combined with platinum-based chemotherapy met the primary endpoint of increasing overall survival in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck.

Updated Varian Brachytherapy Applicator Receives Clearance

Patients with advanced head and neck cancer who have a clinical complete response (CCR) to chemoradiotherapy (CRT) are at low risk for recurrence in the neck, and most can be spared laryngectomy

Cetuximab (Erbitux) plus concurrent chemoradiotherapy (CRT) appears to be feasible and effective in many patients with locally advanced squamous-cell head and neck cancer, and may improve local-regional control

Preliminary findings show that the addition of cetuximab (Erbitux) to radiation therapy and chemotherapy may help some patients with head and neck cancer live longer, according to a study presented at the plenary session of the recent Multidisciplinary Head and Neck Cancer Symposium, held in Rancho Mirage, Calif, and cosponsored by the American Society for Therapeutic Radiology and Oncology, the American Society for Clinical Oncology, and the American Head and Neck Society. Researchers are recommending a larger trial to prove definitively if cetuximab combined with radiation helps improve survival for these patients.