Reducing RT dose to bilateral IB lymph nodes results in better patient-reported salivary function

February 20, 2014

Scottsdale, Ariz., February 20, 2014--For head and neck cancer patients undergoing radiation therapy, a reduction in the amount of radiation treatment volume to the submandibular (level IB) lymph nodes resulted in better patient-reported salivary function, according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium. The study results also found significant reductions in radiation dose to the salivary organs, and good local regional control.

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 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 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 percent and 93.8 percent 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).

"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."
-end-
The abstract, "A Sparing Bilateral IB in Node Positive Oropharyngeal Carcinoma Improves Xerostomia Outcomes," will be presented in detail as a poster presentation at the 2014 Multidisciplinary Head and Neck Cancer Symposium. To speak with Mr. Tam, contact Michelle Kirkwood on February 20 - 21, 2014 in the ASTRO Press Office at the JW Marriott Camelback Inn Resort and Spa in Scottsdale, Arizona at 480-596-7085 or email michellek@astro.org.

The 2014 Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO) and the American Head & Neck Society (AHNS). The two-and-a-half day meeting includes interactive educational sessions focused on topics such as supportive care, directed therapy, new surgical and radiotherapeutic techniques, as well as 12 oral abstract presentations of the current science of relevance to the head and neck cancer community. A total of 189 abstracts will be presented including 177 posters. Keynote speakers include Jennifer Grandis, MD, of the University of Pittsburgh, to present "The Molecular Road to Defining and Targeting High-risk Head and Neck Patients;" and Julia H. Rowland, PhD, of the National Cancer Institute, to present "Cancer Survivorship: Research Opportunities on the Path to Where We Want to Be."

Embargoed until 8:00 a.m. MT, February 20, 2014

2014 Multidisciplinary Head and Neck Cancer Symposium News Briefing, Friday, February 21, 2014, 7:00 a.m. Mountain time

Poster Presentation: 139 A Sparing Bilateral IB in Node Positive Oropharyngeal Carcinoma Improves Xerostomia Outcomes

M. Tam, N. Riaz, D. Kannarunimit, A. P. Peña, K. Schupak, D. Y. Gelblum, S. L. Wolden, S. S. Rao, N. Y. Lee, Memorial Sloan Kettering Cancer Center, New York, NY

Background: The purpose of this study is to assess whether sparing bilateral level IB in node positive (N+) oropharyngeal carcinoma (OPC) can improve xerostomia without compromising local-regional control.

Methods and Materials: 125 N+ OPC patients with median age of 57 underwent chemoradiation between 5/10 and 12/11. Patient characteristics: 74% T1-2, 26% T3-4, 16% N1, 8% N2A, 48% N2B, 28% N2C; 53% base of tongue, 41% tonsil, and 6% other. Patients were divided into those who had sparing of bilateral level IB (spared) vs. no sparing (treated). A prospective xerostomia questionnaire (patient-reported) was given at each patient follow-up visit to this cohort of patients to assess late xerostomia. Clinical assessment (observer-rated) at each patient follow-up visit was also recorded.

Results: The 2-year LRC for cohort spared and cohort treated were 97.5% and 93.8%, respectively [median follow-up 23.2 months]. No local-regional failures occurred outside of treatment fields. The cohort that had sparing of bilateral IB experienced significant improvement in patient-reported xerostomia summary scores (p = 0.021) and observer-rated xerostomia scores (p = 0.006). In addition, there were significant reductions in mean doses to the ipsilateral SMG (63.9 Gy vs 70.5 Gy; p <0.001), contralateral SMG (45.0 Gy vs 56.2 Gy, p<0.001), and oral cavity (35.9 Gy vs 45.2 Gy; p < 0.001).

Conclusions: Sparing of bilateral level IB nodes in N+ OPC improves xerostomia outcomes by reducing dose to the submandibular glands and the oral cavity resulting in improvement of both patient and observer reported xerostomia without compromising loco-regional control.

Author Disclosure Block: M. Tam: None. N. Riaz: None. D. Kannarunimit: None. A.P. Peña: None. K. Schupak: None. D.Y. Gelblum: None. S.L. Wolden: None. S.S. Rao: None. N.Y. Lee: None.

American Society for Radiation Oncology

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.