Radiation therapy for head and neck cancer leads to gingival recession associated with dental caries

OBJECTIVE

The aim of this study was to examine effects of radiation therapy (RT) for head and neck cancer (HNC) on periodontal disease and relationships to caries.

STUDY DESIGN

A multicenter prospective observational cohort study (OraRad) was conducted in patients undergoing RT for HNC. Assessments were conducted by calibrated examiners at the pre-RT (baseline) visit (n = 533), the 12-month visit (n = 414), and the 24-month visit (n = 365).

RESULTS

The average whole mouth mean (standard error (SE)) distance from the cementoenamel junction to the gingival margin (CEJ-GM) decreased significantly from 0.43 (0.04) mm at baseline to 0.24 (0.04) mm at 12 months and 0.11 (0.04) mm at 24 months (P ≤ .001). Whole mouth mean (SE) percentage of sites with CEJ-GM distance of <0 mm increased significantly from 23.3% (1.0%) at baseline to 28.5% (1.0%) at 12 months and 30.5% (1.1%) at 24 months (P ≤ .02). Higher mean radiation dose to the mandible was associated with a greater increase in the percentage of mandibular sites with CEJ-GM distance of <0 mm (P = .003). Both mean CEJ-GM distance and the percentage of sites with a CEJ-GM distance <0 mm were strongly associated with whole mouth mean proportion of decayed, missing, and filled surfaces, as well as proportion of decayed or filled facial/buccal surfaces specifically, (P < .001), with greater gingival recession associated with increased caries.

CONCLUSIONS

RT for HNC leads to mandibular gingival recession in a dose-dependent manner. This gingival recession may contribute to increased risk for cervical caries seen in these patients.

Determination of the potential of detecting 3q gain as a valuable biomarker in the management of patients with human papilloma virus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC)

e17534

Background: The most recurrent structural chromosomal aberration in HPV associated cervical cancer is gain of the 3q26 locus testing of which has clinical utility in management of patients with cervical lesions. A significant proportion of OPSCC are HPV mediated, suggesting the possibility of a common disease mechanism. The objective of this study is to determine the potential clinical validity of assessing 3q gain as a biomarker in the management of patients with HPV associated OPSCC. Methods: An oral swab using a cytological brush was obtained of the region containing visualized tumor site in newly diagnosed HPV associated OPSCC patients following written informed consent of an IRB approved protocol at the University of Connecticut. The swabs were obtained at the diagnosis and serially after chemotherapy and/or chemo-radiotherapy as well as at 3 months after treatment completion. The specimens’ 3q gain status was determined by fluorescent in situ hybridization (FISH) analysis, utilizing robotic fluorescence microscopy for detection of rare cells demonstrating high 3q26 copy number Results: 54 specimens were collected from 13 patients, of which slides were prepared, hybridized and analyzed from 50. Data was not available in four specimens due to insufficient cells while for eight patients, multiple specimens were obtained before, during and after 3 months of treatment. Depending on the specimen’s cellularity, up to 170,969 cells were analyzed. Cells with > 4 copies of the 3q26 locus were detected in 32 of the 50 analyzable specimens. For several patients, the number of cells with more than four 3q26 signals detected in the later time points of treatment was lower than the number detected at diagnosis. Conclusions:This preliminary dataset demonstrates the ability to detect gain of the 3q26 locus in cells collected by cytological brushing of the region containing an OPSCC. The approach offers the possibility of a minimally invasive method to determine the 3q26 gain status as a reliable biomarker of HPV associated OPSCC that might have value in early diagnosis and management.

Late recurrence of gastric cancer with isolated brain metastasis

A 70-year-old woman presented to our clinic in 2007 after an evaluation for dysphagia revealed a poorly differentiated adenocarcinoma of the gastroesophogeal junction. Workup for metastatic disease was negative at presentation. She had a complete response to treatment, which was completed in November 2007. She continued to follow up regularly until 2011 when she presented again with neurologic symptoms and was found to have an isolated brain metastasis. She underwent resection of the lesion, and pathology was consistent with her originally diagnosed gastric cancer. The patient received adjuvant radiation therapy, however, unfortunately had rapid progression of disease 1 month later and was transitioned to hospice. Here, we report a rare case of late recurrence of gastric cancer with isolated brain metastasis with a review of literature.

Abstract OT2-1-01: A personalized approach to understanding the development of radiation-induced fatigue

Background

Fatigue, a common complication of radiation therapy, can impact patients’ quality of life and ability to engage in their cancer treatments. The pathogenesis of radiation-induced fatigue is unclear. This lack of clear understanding has hindered the development of treatment strategies to overcome this morbidity. The purpose of our exploratory, non-randomized, prospective study is to investigate the factors associated with development of radiation-induced fatigue in women with early breast cancer. Our study is based on the hypotheses that adjuvant radiation therapy given to women with breast cancer for local disease control causes tissue damage by apoptosis and inflammation. This leads to increased levels of inflammatory cytokines and biomarkers of apoptosis. This inflammatory cascade differentially induces fatigue in patients depending on their baseline psychological profile.

Trial design

Existing patient flow in the radiation oncology division will be utilized to screen eligible subjects. All subjects will assessed at five different time points, beginning immediately before radiation therapy through 1 year after completion of therapy. Detailed clinical evaluation of skin toxicity (RTOG acute toxicity criteria) and laboratory parameters assessing anemia, cardiac and hepatic toxicity will be performed. Comprehensive psychological assessment will be done using questionnaires for fatigue, distress, depression, sleep, quality of life and pain. Buccal mucosa swabs will be obtained for genetic analysis in future studies.

Selection criteria

Inclusion: Women with breast cancer undergoing radiation therapy for breast conservation

Exclusion: Prior non-breast malignancy with active treatment (radiation or chemotherapy) within 1 year of enrolment on the study

Specific aims

1. To measure the severity of radiation-induced tissue damage

2. To measure circulating markers of apoptosis (caspase 3 p17) and inflammation

3. To establish a baseline psychological profile for each subject prior to start of radiation and determine temporal changes during the course of radiation therapy.

4. To determine the correlation between goals 1, 2 and 3.

5. To propose interventions for reducing radiation-induced fatigue which will be evaluated in a future study.

Statistical methods

The association between fatigue and severity of tissue toxicity (Yes vs. No) will be assessed using chi-square tests (eg, row mean score test). ANOVA will be used to compare mean visual analogue scales (VAS) and psychological questionnaire scores across the levels of the tissue toxicity scale. Mean log cytokine levels will be compared across levels of the dermatitis scale using ANOVA. The association between cytokines and fatigue will be assessed using correlation (eg, VAS) and two-group t-tests (eg, Yes vs. No) depending on which fatigue outcome is used. Two statistical models will be used to assess fatigue and its relationship to dermatitis, cytokine level, and their interactive effects using logistic regression (for dichotomous) and OLS regression (for VAS) approaches.

Present accrual: 0; Study initiation planned for July 1, 2013

Target accrual : 100.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-1-01.

90Yttrium microspheres for nonresectable liver cancer: the University of Connecticut Health Center experience

PURPOSE

To determine the outcome of 90Y selective internal radiation therapy (SIRT) for primary and metastatic liver tumors at our institution and compare our results to the published literature.

PATIENTS AND METHODS

From July 2004 to November 2005 24 patients initiated SIRT therapy with 90Y microspheres at UCHC. Patient charts were reviewed for background, treatment planning, activity and dose, and toxicity information. Main outcome measures included patient survival, toxicity, and evidence of tumor response as indicated by available CT or PET scan reports.

RESULTS

The median survival for the colorectal, hepatocellular carcinoma, and "other" groups were 9.0 months, 3.5 months, and 5.8 months, respectively. Post-treatment CT or PET scans were available for 15 of the 24 patients. Of the patients for whom follow-up imaging was available, 5/15 patients (33%) had a documented response, 5/15 (33%) had stable disease, and 5/15 (33%) had disease progression.

CONCLUSION

SIRT with 90Y microspheres had antitumor activity in the majority of patients with primary or secondary liver cancer who had experienced disease progression with previous treatments.

Collett's snake (Pseudechis colletti) envenoming in snake handlers

BACKGROUND

Collett's snake (Pseudechis colletti) is a member of the black snake genus and occurs in a warm temperate to sub-tropical region of central Queensland, Australia. There are no reports of bites occurring in the wild, and bites were previously thought to cause only minor effects. They are a popular snake among zoos and exotic snake keepers.

AIM

To investigate the clinical effects of severe envenoming by Collett's snake, and possible treatment options.

DESIGN

Case series.

METHODS

Clinical and laboratory features are described for six bites, all in snake handlers.

RESULTS

All six bites were from captive snakes, resulting in severe envenoming in four. Two patients were treated early with black snake antivenom, and only developed an anticoagulant coagulopathy and mild myolysis. Two developed anticoagulant coagulopathy and severe rhabdomyolysis associated with acute renal failure, requiring haemodialysis; both received antivenom >10 h after the bite, and initially received minimal fluid replacement. Other effects included thrombocytopenia, non-immune haemolytic anaemia and a marked leukocytosis.

DISCUSSION

Collett's snake envenoming is characterized by early generalized systemic effects (nausea, vomiting, abdominal pain, diarrhoea and headache) and an anticoagulant coagulopathy, followed in some cases by rhabdomyolysis and acute renal failure in untreated patients within 24 h. Early initiation of fluid therapy and treatment with black snake antivenom should be undertaken in all envenomed patients.

The effect of 6 months of androgen deprivation therapy on muscle and fat mass in older men with localized prostate cancer

OBJECTIVE

To evaluate body composition changes, specifically skeletal muscle mass, in men receiving androgen deprivation with luteinizing-hormone releasing hormone-agonist (LHRH-A) for prostate cancer (PCa) in comparison with healthy controls.

DESIGN

Retrospective analysis of body composition changes in men with prostate cancer receiving LHRH-A therapy from 2 clinical trials compared to men without prostate cancer serving as a placebo-control in another clinical trial.

SETTING

Clinical Research Center in Connecticut.

PARTICIPANTS

Thirty men (> 60 years) receiving 6 months of LHRH-A therapy for PCa were compared to a healthy group of 25 men without PCa.

MEASUREMENTS

Appendicular skeletal muscle/height2 (ASM/ht2), lean and fat mass were assessed by dual energy x-ray absorptiometry. Total testosterone levels were assessed by enzyme immunoassay.

RESULTS

At baseline, 12/30 (40%) of the treatment group and 7/25 (28%) of the control group (p = 0.11) met criteria for sarcopenia. There were no differences between control groups in ASM/ht2 or lean mass. The LHRH-A group had a higher percent body fat than the control group, 29.8 +/- 6.3 versus 26.3 +/- 4.6 (p = 0.02). ASM/ht2 and lean mass decreased in the LHRH-A group from 7.5 +/- 0.9 kg to 7.3 +/- 0.9 kg (-2.3% +/- 0.03; p < or = 0.001) and 53.5 +/- 5.4 kg to 52.3 +/- 5.3 kg (-2.1% +/- 0.03; p < or = 0.001), respectively. There was no muscle loss in the control group. At 6 months, the LHRH-A group had increased percent body fat from 29.8 +/- 6.4 to 32.2 +/- 5.8 (9.5% +/- 0.13; p < or = 0.001), whereas the control group had decreased in percent body fat from 26.6 +/- 4.6 to 25.3 +/- 5.0 (-3.8% +/- 0.08; p = 0.02).

CONCLUSIONS

Men undergoing LHRH-A treatment for PCa decreased appendicular skeletal muscle and lean tissue and increased body fat within 6 months of initiation of therapy. Lifestyle changes or medical interventions to minimize the effects of androgen deprivation therapy for PCa deserve investigation.

Treatment of recurrent malignant gliomas with stereotactic intensity modulated radiation therapy

Malignant gliomas are usually refractory to aggressive combined-modality therapy, and the incidence of recurrence and death after treatment is very high. State-of-the-art techniques such as stereotactic intensity-modulated radiation therapy (IMRT) are now available to deliver a high dose of radiation to the tumor with relative preservation of surrounding tissues to achieve optimal tumor coverage with minimal toxicity. We report 10 patients (median age 48 years) with recurrent malignant gliomas that were treated with stereotactic directed IMRT. Initial tumor histologies included one low grade glioma (upgraded to anaplastic astrocytoma at recurrence), four anaplastic astrocytomas, and four glioblastomas multiforme. One patient was originally presumed to have a brain metastasis secondary to renal cell carcinoma but was pathologically confirmed as having glioblastoma multiforme at the time of recurrence. Before recurrence, all patients had been treated with external beam radiation therapy (median 59.7 Gy). All recurrences were confirmed by a subtotal resection (5/10) or by imaging (5/10). The median Karnofsky performance score at the time of IMRT was 80. The median tumor volume was 34.69 cm. Treatment was delivered on a 10-MV linear accelerator with a mini-multileaf collimator, MIMiC, and planned with Peacock/Corvus software. Radiation was delivered in daily fractions of 5 Gy, to a total median dose of 30 Gy at the 71% to 93% median isodose line. Median overall survival time was 10.1 months from the date of stereotactic treatment, with 1- and 2-year survival rates of 50% and 33.3%, respectively. Fractionated stereotactic intensity modulated radiation therapy is a novel technique used in the treatment of recurrent malignant gliomas, which produces results comparable to other currently used stereotactic techniques.

Sequential chemotherapy and radiotherapy for organ preservation in advanced resectable nonlaryngeal head and neck cancer

Although there is no definite survival advantage to the use of sequential induction chemotherapy (CT) followed by radiotherapy (RT) in advanced resectable laryngeal cancer, this approach does succeed in preserving the larynx in many of these patients. The authors performed this study to analyze their results using a similar approach for patients with advanced resectable cancer located outside the larynx who would have required a total laryngectomy for oncologic or functional reasons. A retrospective study was performed at a single institution that included all patients with advanced resectable nonlaryngeal head and neck cancer treated with induction CT between January 1990 and August 1995. A total of 19 patients were included, with primary cancers located in the oropharynx in 14 patients, the hypopharynx in four, and the oral cavity and oropharynx in one. Eight patients had clinical stage III disease, and 11 patients had stage IV disease. Our treatment protocol consisted of two cycles of induction CT with cisplatin and 5-fluorouracil, followed by a third cycle of CT and subsequent RT in patients who achieved at least a clinical partial response (PR) after two courses of induction CT. Eighteen of 19 patients were evaluable for response. Overall, 13 patients (72%) had a major response (PR or CR) to induction CT at the primary site, and eight patients (57%) had a major response to chemotherapy in the neck. With a mean follow-up of 53 months (range, 24-71 months), the disease-specific survival was 57% for those patients with cancer of the oropharynx and oral cavity. In the subset of patients with hypopharynx cancer, 3 of 4 patients died of cancer despite achieving major response to induction CT. Organ preservation using sequential CT and RT for advanced resectable nonlaryngeal head and neck cancer is feasible, and the results in our experience with cancer of the oropharynx were similar to those reported for primary laryngeal cancer. Our limited experience using this protocol for cancer of the hypopharynx has been disappointing.