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Survival Rate Higher for HPV-positive OPSCC patients compared to …

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Based on research presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, a retrospective analysis of oropharyngeal patients with recurrence of disease following primary therapy in the Radiation Therapy Oncology Group (RTOG) studies 0129 or 0522 discovered that HPV-positive patients had a higher overall survival (OS) rate when compared to HPV-negative patients (at two years post-treatment, 54.6 percent vs. 27.6 percent, respectively). The investigation ... Read more

Reduced RT Dose to Bilateral IB Lymph Nodes Improves …

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According to a recent study’s findings presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, for head and neck cancer patients receiving radiation therapy, a decline in the amount of radiation treatment quantity to the submandibular (level IB) lymph nodes eventually led to better patient-reported salivary function. The study’s research also found notable cutbacks in radiation dose to the salivary organs, and good local regional control. Researchers assessed 125 patients with node-positive oropharyngeal cancer who were administered chemoradiation at Memorial Sloan-Kettering Cancer Center in New York between May 2010 and December 2011. The mean patient age was 57. Fifty-one percent of patients had base of tongue lesions; 41 percent had tonsil cancer; and 6 percent were classified as "other." The breakdown of patients' cancer stage/classification was: 74 percent T1-2 and 26 percent T3-4. All patients had cancer with lymph node involvement, including 16 percent N1; 8 percent N2A; 48 percent N2B; and 28 percent N2C. Patients were split into two groups: those with sparing, or a reduction of radiation treatment volume to the region, of bilateral level IB nodes and those who underwent treatment without sparing. A potential questionnaire regarding xerostomia (dry mouth) to evaluate late xerostomia was given to patients in both groups at each patient follow-up visit; clinical evaluation (observer-rated) xerostomia scores were also documented. The participants who underwent treatment involving sparing experienced major improvement in patient-reported xerostomia summary scores (p=0.021) and observer-rated xerostomia scores (p=0.006) over the group in which there was no sparing. The two-year local regional control rate for the spared group was 97.5 percent and 93.8 percent for the group treated, demonstrating a low rate of cancer recurrence at the original tumor site. Additionally, study results revealed reductions in the average radiation doses to the mouth and neck regions of patients in the spared group over the group with no sparing, including the ipsilateral submandibular gland (63.9 Gy vs. 70.5 Gy; ... Read more

Voice and Speech Significantly Affected Following …

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According to a new study presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, oropharyngeal cancer patients treated with chemotherapy and radiation therapy concurrently, reported a significant drawbacks in their voice and speech ... Read more

Radiation Limited to Major Salivary Glands in Head and …

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According to research presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, steering clear of the contralateral submandibular gland during radiation therapy is very much a possibility and safe with advanced stage, node positive head and neck cancers and base of tongue lesions. Researchers from the University of Colorado Cancer Center and the Memorial Sloan-Kettering Cancer Center conducted a retrospective analysis of 71 patients from the two facilities. The average patient age was 55, and approximately 50 percent of the patients were current or former smokers. Forty patients had primary tonsil cancers, and 31 patients had tumors that involved the base of the tongue. Around 80 percent of patients had N2b or greater disease (translating in extensive lymph node involvement), and 90 percent of patients had overall stage IV disease (pointing to advanced cancer). The analysis only included patients who were undergoing treatment to the bilateral neck. All of the patients had been treated with radiation methods that avoided the contralateral submandibular gland (cSMG), which points out that it was on the opposite side of the neck as the cancer. Submandibular glands are major salivary glands found under the floor of the mouth and are in charge for the majority of unstimulated salivary flow. The average dose to the cSMG was 33.04 Gy, and at an average follow-up of 27.3 months, no patients had experienced recurrences in the contralateral level Ib lymph nodes (the area of the spared submandibular gland). "Sparing the submandibular gland from radiation can decrease the side effect of dry mouth, which has a substantial impact on patients' quality of life," said lead author of the study and an MD candidate in his final year at the University of Colorado School of Medicine, Tyler Robin, PhD. "Historically, however, there has been hesitation to spare the submandibular gland from radiation because there are lymph nodes near the gland that also end up not getting treated. While this seems worrisome because head and neck cancer spreads through the lymph nodes, it is well established that the risk of cancer involvement in the lymph nodes near the submandibular gland is exceedingly low, yet the benefit of sparing the gland for a patient's quality of life is high. It is important to consider treatment side effects alongside treatment benefit, and overall, our goal is to decrease side effects associated with radiation treatment without undertreating a patient's cancer. With modern advances in radiation therapy, it is possible to eloquently treat cancers while avoiding surrounding normal tissues. Our study is a prime example of how we can safely spare normal tissue in appropriate patients in order to decrease treatment side ... Read more

Promising Results Reported in Unilateral RT for …

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According to a recent study, presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, limiting radiation therapy (RT) to lymph nodes on one side of the neck for advanced tonsil cancer led to a good local regional control and no cancer recurrence on the untreated side. Moreover, the study results signify that main tumor location, rather than the amount of lymph node involvement on the tumor side of the neck, determines the risk for disease in the opposite side of the neck.   The study centered on 46 out of 153 total patients with squamous cell carcinoma of the tonsil who underwent treatment between 1997 and 2012 at Washington University in St. Louis.   Tumor location was well accounted for in the 46 patients who underwent unilateral RT, with 40 patients (87 percent) having lateralized (located on one side of the throat) primary tumors; two patients (4 percent) had non-lateralized tumors, and in four patients (9 percent), lateralization was inconclusive retrospectively. The patients received surgical resection and postoperative intensity modulated radiation therapy (IMRT), with 30 patients also undergoing simultaneous chemotherapy. Of the subset of 46 patients treated unilaterally, 72 percent were men, and the median patient age was 59. Sixty-one percent of patients were current or former smokers. The cancer stage/classification for the study group was: TX = 2 percent (1); T1 = 44 percent (20); T2 = 41 percent (19); and T3 = 13 percent (6). The patients' stages of lymph node involvement were: N0 = 11 percent (5); N1 = 13 percent (6); and N2 = 76 percent (35). The prescribed radiation doses were 60-66 Gy to the postoperative bed and involved neck; and 52-54 Gy to the elective neck in 30-33 fractions using a simultaneous integrated boost technique. The average follow-up time period was 2.8 years (range was .4 to 8.7 years). There were no local or regional recurrences reported, meaning the cancer did not recur in the neighboring nodes or the initial location of the cancer in any of the patients. Distant metastasis, meaning the cancer spread from the original tumor location to distant organs or lymph nodes, developed in four (9 percent) of the patients. Two patients developed second primary (new) cancers. "All treatments for cancer, surgery, radiation therapy, chemotherapy, although effective, can cause temporary and/or permanent toxicity which can affect long-term quality of life. Our research indicates that for appropriately selected patients with tonsil cancer, the volume of radiation therapy necessary to control the cancer can be significantly reduced, therefore reducing the side effects and toxicity of radiation, while maintaining a high rate of tumor control,” said study author, chief of Head and Neck Services, and associate professor of Radiation Oncology at Washington University School of Medicine, Wade Thorstad, ... Read more

Dense Breast Tissue No Challenge for Molecular Breast …

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According to a recent study, molecular breast imaging (MBI) has been discovered to detect cancer independently and regardless of breast tissue density. This ground-breaking data was collected from over 300 breast cancer patients who underwent the MBI/BSGI procedure. The same high rate of 95% of breast cancer detection was confirmed for women with or without breast density.  This significant discovery has since been published in the issue of the American Journal of Roentgenology by a group of radiologists and surgeons at the George Washington University Medical Center (Washington DC, USA). “This study indicates that breast tissue density is simply a non-issue for MBI/BSGI. This is great news for patients who have an inconclusive mammogram due to breast density, implants, or scarring,” said vice president for science and technology at Dilon Technologies (Newport News, VA, USA), a developer of MBI systems, Douglas Kieper. Dilon Technologies, Inc. is a developer of diagnostic imaging with the Dilon molecular imaging systems, high-resolution, small field-of-view general-use imaging cameras, optimized to perform molecular breast imaging (MBI/BSGI) and localization for MBI-guided breast biopsy. Dilon’s surgical imaging products, the Navigator probes, are one of the most widely used gamma probes for cancer surgery. The gamma probes offer an upgrade option for three-dimensional (3D) tumor imaging and navigation with SurgicEye’s (Munich, Germany) declipseSPECT (single photon emission computed tomography) camera.  Dilon is the exclusive international distributor of Digirad’s (Atlanta, GA, USA) Cardius cardiac and ergo general molecular imaging cameras that provide excellent image quality and increased patient comfort with a compact, open design.  A variety of studies has demonstrated that mammography is less effective in patients with dense breast tissue, missing as much as 50% of breast cancers. Breast MRI is known to be more sensitive than mammography or ultrasound in women with dense breasts, however at a much higher cost per scan. On the other hand, MBI, also referred as breast-specific gamma imaging (BSGI), is an imaging protocol that has been shown in several clinical studies to be more effective than mammography or ultrasound for detecting breast cancer, especially in women with dense breasts. Furthermore, the MBI/BSGI procedure can be performed at one-third of the cost of an MRI and it can be provided to patients who cannot undergo an MRI scan, such as women with pacemakers, those who are on dialysis, or are claustrophobic.  For years, women who have dense breasts were usually unaware of their breast density or of the chance that their negative mammogram might be missing cancers. That is until recently, as several states in the United States have passed legislation requiring breast centers to inform patients with dense breasts that their mammogram might be inconclusive. The state of Oregon new breast density law includes BSGI as one of the technology alternative that should be considered for patients who receive a dense-breast notification from their doctor. The state of Indiana goes beyond that by requiring state employee-health plans to cover additional medical examination for women with high breast ... Read more

Cognitive Behavioral Therapy and Hypnosis Lessens …

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Based on a study recently published in the Journal of Clinical Oncology, breast cancer patients receiving radiotherapy showed significantly reduced fatigue as a result of cognitive behavioral therapy in addition to hypnosis (CBTH). The study, titled, "Randomized Controlled Trial of a Cognitive-Behavioral Therapy Plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer," was headed by Guy Montgomery, PhD, Associate Professor and Director of the Integrative Behavioral Medicine Program in the Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai. The study’s results of a randomized controlled trial of 200 patients revealed that the treatment group had considerably decreased fatigue than a control group both during treatment and for a follow-up period of six months afterwards. The mean patient in a treatment group had less fatigue than 79 percent of patients in a control group at the end of radiotherapy (RT). Six months following the end of RT, the mean patient in a treatment group had less fatigue than 95 percent of patients in a control group. "These results support CBTH as an evidence-based complementary intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH works to reduce fatigue for patients who have few other treatment options. It is also noninvasive, has no adverse side-effects, and its beneficial effects persist long after the last intervention,” said Montgomery. Furthermore, patients also mentioned that participating in CBTH was both soothing and useful. "This study is important because it shows a new intervention that helps to improve patients' quality of life during taxing course of breast cancer radiotherapy and for long after," said ... Read more


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With bird's eye imaging, cardiologists see the earliest signs of heart disease or existing heart disease not diagnosed with other testing modalities. "With one heartbeat, within one second, we can get an entire 3-D image of the heart that allows us to look at arteries and heart anatomy with excellent detail," exclaims Steven Mottl, D.O., medical director of non-invasive cardiology at The Heart Hospital Baylor Denton. The facility started to employ its 256-slice CT scanner in January; and is the first of its kind in Denton County and the third in the Dallas/Fort Worth area. Additionally, physicians can view the heart's anatomy, the pulmonary arteries and aorta and even the coronary arteries where atherosclerosis occurs. "Patients and physicians are both frustrated that we have difficulty predicting a potential heart attack. With this type of study, it allows us to characterize the type of plaque a patient may have and use this information to predict whether a heart attack could occur. This allows us to select the patients that would benefit from more aggressive medications to lower their risk of having a heart attack, and eliminate the need for unnecessary additional testing in patients that are at low risk,” explains Mottl. The 256-slice CT scanner requires only one second to scan the whole heart offering more information with each rotation, as opposed to four rotations when using a 64-slice CT scanner, or 16 rotations when using a 16-slice CT scanner. These older generation CT scanners require longer time to capture the image of the heart and require administration of medications to slow the heart rate to an accurate picture. Another clear advantage to the 256-slice scanner is that patients are not required to hold their breath during the scan. Often, many patients struggle to maintain an adequate breath hold, which leads to un-interpretable images and possible need to repeat the scan. Some patients, especially children, sometimes require the use of sedation medications for imaging on older CT scanners. While reducing heart disease with earlier diagnoses is one objective, reducing potential radiation exposure during the imaging procedure is just as if not more important. According to Mottl, medical radiation for tests such as a CT scan are the cause for up to 50 percent of an individual's life time radiation exposure, and thought to be responsible for two percent of all cancers and much higher prevalence of cataracts. The 256-slice CT scanner can provide cardiologists a picture of the human heart with 60 percent less radiation exposure than older CT scan technology on average and in some patients greater than 90 percent reduction. "With a 64-slice CT scan, the radiation exposure can be compared to having a few thousand chest X-rays. With the newer 256-slice CT technology, the radiation exposure would be equal to 100 chest X-rays," said Mottl. The new 256-slice CT scanner also offers diagnostic uses beyond diagnosing heart disease. "This scan allows us to look at vascular disease from the head to the foot. The scanner's superior resolution allows us to more accurately look for disease in vessels like the renal arteries, carotid arteries, or arteries of the legs,” adds medical director of radiology at The Heart Hospital Baylor Denton, Steven Reiman, ... Read more

Point-of-care Ultrasound Offers Total Accuracy in …

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Based on a recent study conducted by a team of Mount Sinai researchers, utilizing portable ultrasound as a first-line imaging exam in kids with suspected appendicitis significantly helps deduct emergency room length of stay and decreases the need for CT scans. Other than ultrasound, often referred to as point-of-care ultrasonography, has a specificity of about 94%, meaning that it misses few cases, the Mt. Sinai researchers add. Results from the study have since been published online in the peer-reviewed journal Academic Emergency Medicine. "From an institutional perspective, this is the most common surgical problem that we encounter with children in the emergency department," said the study's senior author and associate professor of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai, James W. Tsung, MD, MPH. "CT scans have been the best imaging test for diagnosing appendicitis, but they expose children to radiation, which cumulatively can prove harmful, as increasing numbers of studies have shown." Numerous studies have reported lifetime risks of cancer from abdominal and pelvis CT in children between 1 fatal cancer cause for every 500 to 3,000 CT scans performed, varyingon age and sex. Efforts to try to diminish the 4 million radiation-emitting CT scans obtained in children every year are presently underway, led by front-line physicians, radiologists, and radiological professional societies. "CT scanning rate was reduced by over 35%, from a 44% CT scan rate prior to the study to a 27% rate during the study," commented assistant professor of emergency medicine and pediatrics, Icahn School of Medicine at Mount Sinai, and the study's second author, Ee Tay, MD. During the course of the study, researchers used a prospective observational convenience sample of 150 children seen uninterruptedly between May 1, 2011 and October 1, 2012 in an urban pediatric emergency department. All children were under observation for suspected appendicitis. Results were determined by surgical or pathology report in those discovered to have appendicitis and three weeks later in patients who were seen as not to have appendicitis. Operator accuracy reading the ultrasounds was reviewed in a blinded fashion by trained pediatric emergency medicine sonologists. The time to perform the point-of-care ultrasound and CT scan use was also measured. The study revealed that emergency department length of stay decreased by 2 hrs and 14 minutes (46% decrease) for those needing radiology department ultrasound and nearly 6 hours (68% decrease) for those needing CT scan when point-of-care ultrasound was uncertain as a first-line imaging study. Perhaps more significant, no cases of appendicitis were missed with the point-of-care ultrasound procedurel and no unnecessary surgeries were conducted for a normal appendix. With focused ultrasound training, pediatric emergency clinicians were able to assess ultrasound exams with the similar accuracy as radiologists (about 94% accuracy). “Surgeons are becoming more comfortable using ultrasound for decision-making and that is a big change from reliance on CT scans,” said Tsung. The Mt. Sinai Division of Emergency Ultrasound is involved with an effort to educate providers at Mount Sinai Hospital to use safer ultrasound as a faster first-line study in ... Read more

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