News Update on Neck Cancer Research: April – 2019

Eating As Treatment (EAT): A Stepped-Wedge, Randomized Controlled Trial of a Health Behavior Change Intervention Provided by Dietitians to Improve Nutrition in Patients With Head and Neck Cancer Undergoing Radiation Therapy (TROG 12.03)

Malnutrition in head and neck cancer (HNC) treatment is common and related to poorer morbidity and mortality outcomes. This trial aimed to boost organic process standing throughout therapy (RT) employing a novel technique of coaching dietitians to deliver psychological techniques to improve nutritional behaviors in patients with HNC.

Methods and Materials

This trial used a stepped-wedge, irregular controlled style to assess the efficaciousness of the ingestion As Treatment (EAT) program. supported psychological feature interviewing and psychological feature activity medical aid, EAT was designed to be delivered by medical specialty dietitians and integrated into their clinical follow. throughout management steps, dietitians provided treatment as was common, before being trained in EAT and getting into the intervention part. The coaching was principles primarily based and sought-after to boost behavior-change skills instead of offer specific scripts. Patients recruited to the trial (151 controls, 156 intervention) were assessed at four time points (the 1st and also the final weeks of RT, and four and twelve weeks afterward). the first outcome was organic process standing at the top of RT as measured by the Patient-Generated Subjective world Assessment.

Results

Patients World Health Organization received the EAT intervention had considerably higher scores on the first outcome of organic process standing at the crucial end-of-treatment time purpose (β = −1.53 [−2.93 to −.13], P = .03). Intervention patients were additionally considerably additional probably than management patients to be assessed as nourished at whenever purpose, lose a smaller share of weight, have fewer treatment interruptions, gift lower depression scores, and report a better quality of life. though results weren’t statistically important, patients World Health Organization received the intervention had fewer and shorter unplanned hospital admissions.

Conclusions

This trial is that the 1st of its kind to demonstrate the effectiveness of a psychological intervention to boost nutrition in patients with HNC World Health Organization are receiving RT. The intervention provides a way to ameliorate deficiency disease and also the necessary connected outcomes and consequently ought to be incorporated into customary take care of patients receiving RT for HNC. [1]

A Comparison of the NCDB and SEER Database for Research Involving Head and Neck Cancer

Objective

To determine whether or not structural variations in knowledge sampling between the National Cancer info (NCDB), a non-population-based cancer written account, and police investigation, medical specialty, and finish Results (SEER), a population-based cancer written account, lead to variations in patient characteristics or oncological outcomes.

Study style

Retrospective cohort study.

Setting

NCDB and SEER info.

Subjects and strategies

Patients with head and neck cancer (HNC) were enclosed from 2004 to 2014. the first outcome, weighted variations in characteristics between the databases, was evaluated for every head and neck subsite (oral cavity [OC], cavity [OP], hypopharynx [HP], and vocal organ [LX]). The secondary outcome live, overall survival (OS), was evaluated victimisation Kaplan-Meier (KM) estimates of survival and Cox proportional hazards (PH) regression modeling.

Results

In total, 112,007 and 340,420 HNC cases were registered in SEER and also the NCDB, severally. The mean age at identification for the four head and neck subsites differed by no over one.1 years between the two databases. the biggest distinction in patient or tumour characteristics was the frequency of OC subsite lip cancer (weighted proportional difference, 6.9%; ninety five confidence interval, 6.5%-7.3%). Unadjusted kilometer estimates of 5-year OS differed by no over a pair of (OP, HP, and LX subsites). On Cox pH modeling, adjusted hazard ratios ranged from zero.89 to 0.91 for patients of various head and neck subsites within the NCDB relative to SEER.

Conclusions

Patients with HNC within the SEER info and NCDB don’t greatly disagree in terms of demographics, treatment, and survival. selections to use either info ought to be driven by the info fields, that vary between the registries. [2]

Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial

Background

The incidence of human papillomavirus (HPV)-positive bodily cavity cancer, a sickness moving younger patients, is quickly increasing. Cetuximab, associate epidermic protein receptor matter, has been projected for treatment decrease during this setting to cut back the toxicity of ordinary cisplatin treatment, however no irregular proof exists for the effectiveness of this strategy.

Methods

We did associate open-label irregular controlled section three trial at thirty two head and neck treatment centres in eire, Netherlands, and the UK, in patients aged eighteen years or older with HPV-positive low-risk bodily cavity cancer (non-smokers or lifespan smokers with a smoking history of [3]

The application of ultrasound in detecting lymph nodal recurrence in the treated neck of head and neck cancer patients

Early detection of neck lymph gland (LN) return is predominate in up the prognosis of treated head and neck cancer patients. Ultrasound (US) with US-guided fine needle aspiration (FNA) and core biopsy (CNB) are shown to possess nice accuracy for LN diagnoses within the untreated neck. However, within the treated neck with pathology, their roles aren’t processed. Here, we have a tendency to retrospectively review 153 treated head and neck cancer patients United Nations agency had received U.S.A. and US-guided FNA/CNB. In variable supply regression analyses, size (short-axis diameter >0.8 cm) (odds quantitative relation (OR) four.19, P = 0.007), shape (short/long axis quantitative relation >0.5) (OR 3.44, P = 0.03), heterogeneous internal echo (OR three.92, P = 0.009) and irregular margin (OR seven.32, P [4]

Neoadjuvant Chemoradiotherapy and Chemotherapy in Patients with Locally Advanced Rectal Cancer

Aims: assess the role of neoadjuvant chemoradiotherapy (CRT) followed by an extra  cycle of therapy and total mesorectal excision (TME) in patients with regionally advanced body part cancer on the speed of pathologic complete response (pCR) and tumour downstaging, their impact on survival and analysis of treatment connected toxicity and surgical complications.

Patients and Methods: This prospective clinical test trial enclosed seventy three patients with histopathologically proved  non pathologic process body part glandular carcinoma referred from or admitted at Surgical medical specialty Department, therapy Department, South Egypt Cancer Institute, and Clinical medical specialty Department, Assiut University, Egypt, from March 2012 to Sep 2013. therapy (1.8 Gy, five days per week over 5 weeks, total dose fifty.4 Gy, three D conformational technique) was given together

with blood vessel oxaliplatin fifty mg/m2 once weekly for five weeks and oral capecitabine 825 mg/m2 double daily on on a daily basis of radiation. when completion of CRT, patients received an extra cycle of therapy consisted of oxaliplatin (130 mg/m2 on day 1) and capecitabine (825 mg/m2, double per day from day one to day 14). Surgery was performed 6–8 weeks when completion of chemoradiotherapy.

Results: Seventy patients (95.9%) underwent surgery. surgical  pathologic assessment showed AN overall downstaging rate of seventy eight.1%, whereas sixteen patients (21.9%) had stationary malady. Complete pathologic response was achieved in eleven patients (15.1%). No tumour progression has been determined. when median follow up amount of twenty six months (7-30 months), the 2-year overall survival (OS) was eighty eight, repeat free survival was eighty eight.7% and distant metastasis free survival was ninety three.9%. Lower pathologic tumour stage was considerably related to higher OS (P = .002) and recurrence-free survival (P = .001), whereas pathologic nodal stage and TRG had no important distinction in overall survival, repeat free survival or distant metastasis free survival. xli patients (56.2%) practised grade 1-2 toxicity and five patients (6.8%) practised grade three toxicity.

Conclusion: Neoadjuvant CRT and one cycle of therapy followed by TME is effective with pCR of fifteen.1% and overall downstaging rate of seventy eight.1%. additionally to favorable venomousity profile (lower grade three and four toxic effects as 3 patients developed grade 3 diarrhoea and a couple of patients developed grade 3 hematologic toxicity and  lower rate of Grade one – 2 diarrhea ; twenty eight.8%) and outcome. [5]

Reference

[1] Britton, B., Baker, A.L., Wolfenden, L., Wratten, C., Bauer, J., Beck, A.K., McCarter, K., Harrowfield, J., Isenring, E., Tang, C. and Oldmeadow, C., 2019. Eating As Treatment (EAT): A Stepped-Wedge, Randomized Controlled Trial of a Health Behavior Change Intervention Provided by Dietitians to Improve Nutrition in Patients With Head and Neck Cancer Undergoing Radiation Therapy (TROG 12.03). International Journal of Radiation Oncology* Biology* Physics, 103(2), pp.353-362. (Web Link)

[2]  Janz, T.A., Graboyes, E.M., Nguyen, S.A., Ellis, M.A., Neskey, D.M., Harruff, E.E. and Lentsch, E.J., 2019. A comparison of the NCDB and SEER database for research involving head and neck cancer. Otolaryngology–Head and Neck Surgery, 160(2), pp.284-294. (Web Link)

[3] Mehanna, H., Robinson, M., Hartley, A., Kong, A., Foran, B., Fulton-Lieuw, T., Dalby, M., Mistry, P., Sen, M., O’Toole, L. and Al Booz, H., 2019. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. The Lancet, 393(10166), pp.51-60. (Web Link)

[4] The application of ultrasound in detecting lymph nodal recurrence in the treated neck of head and neck cancer patients

Chi-Maw Lin, Cheng-Ping Wang, Chun-Nan Chen, Che-Yi Lin, Ting-Yi Li, Chen-Han Chou, Ya-Ching Hsu, Po-Yen Kuo, Tsung-Lin Yang, Pei-Jen Lou, Jenq-Yuh Ko & Tseng-Cheng Chen

Scientific Reportsvolume 7, Article number: 3958 (2017) (Web Link)

[5] M. Attia, A., I. Abdelgawad, M., Fakhry, H., Soliman, A. and M. Attia, N. (2015) “Neoadjuvant Chemoradiotherapy and Chemotherapy in Patients with Locally Advanced Rectal Cancer”, Journal of Cancer and Tumor International, 3(1), pp. 1-13. doi: 10.9734/JCTI/2016/22520. (Web Link)

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