According to research presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, being held at the JW Marriott Camelback Inn Resort & Spa in Scottsdale, Arizona, February 20 – 22, 2014, patients with head and neck cancer undergoing radiation therapy, may benefit from a reduction in the amount of radiation treatment volume to the submandibular (level IB) lymph nodes.[1] The study results showed a better patient-reported salivary function. Furthermore, the researchers also found that patients benefitted from significant reductions in radiation dose to the salivary organs, resulting and good local regional control.
Oropharyngeal cancer is uncommon and typically involves older patients between 50 – 70 years of age. Men are afflicted three to five times more often than women. Just like other cancers of the head and neck, using tobacco and alcohol are generally the most significant risk factors for the development of oropharyngeal cancer. Other risk factors may include a diet poor in fruits and vegetables, the consumption of of mat?, chewing of betel quid and infection with the human papillomavirus (HPV), especially HPV-type-16, also known as HPV-16. [2][3]
Study design
Researchers evaluated 125 patients with node-positive oropharyngeal cancer who received chemoradiation at Memorial Sloan-Kettering Cancer Center in New York between May 2010 and December 2011. The average patient age was 57. Fifty-one percent of patients had base of tongue lesions; 41% had tonsil cancer; and 6% were classified as ?other.? The breakdown of patients? cancer stage/classification was: 74% T1-2 and 26% T3-4. All patients had cancer with lymph node involvement, including 16% N1; 8% N2A; 48% N2B; and 28% N2C.
… the data [from this study] shows that it is safe to spare the tumor-free level IB lymph nodes in oropharyngeal cancer from radiation treatment…
With and without sparing
Patients were categorized 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 prospective questionnaire regarding xerostomia (dry mouth) to assess late xerostomia was given to patients in both groups at each patient follow-up visit; clinical assessment (observer-rated) xerostomia scores were also recorded.
The participants who received treatment involving sparing experienced significant 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% and 93.8% for the group treated, indicating a low rate of cancer recurrence at the original tumor site.
Additionally, study results showed reductions in the mean 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; p<.001); the contralateral submandibular gland (45.0 Gy vs 56.2 Gy, p<0.001); and the oral cavity (35.9 Gy vs 45.2 Gy; p <0.001).
Less damage
?Radiation therapy plays an important role in the treatment of head and neck cancers,? said Moses Tam, BS, lead author of the study and an MD candidate in his final year at New York University School of Medicine. ?Poor salivary function is the most common side effect of radiation treatment to the head and neck region. Our data shows that it is safe to spare the tumor-free level IB lymph nodes in oropharyngeal cancer from radiation treatment. Sparing this lymph node level will reduce radiation dose to several nearby salivary organs and therefore cause less damage to a patients post-treatment salivary function.?
For more information:
[1] A Sparing Bilateral IB in Node Positive Oropharyngeal Carcinoma Improves Xerostomia Outcomes (poster) presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium.
[2] American Cancer Society.: Cancer Facts and Figures 2004. Atlanta, GA; American Cancer Society, 2004.Available online.Last accessed February 20, 2014.
[3] Parkin DM, Bray F, Ferlay J, et al.: Estimating the world cancer burden: Globocan 2000. Int J Cancer 94 (2): 153-6, 2001.[PubMed]
[4]Mendenhall WM, Werning JW, Pfister DG: Treatment of head and neck cancer. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 729-80.ISBN-10:1451105452. [Publication/Book]
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