Head and Neck Cancer

Background

Clinical Trials SquareCancers of the head and neck refer to a broad subset of cancers that usually begin in the squamous cells lining the moist surfaces of the mouth, throat, larynx, sinuses, nasal cavity and salivary glands. There are many other cancers that can affect parts of the head and neck (brain, eye, and esophagus) but they are not always squamous cell in origin.

There are a number of risk factors for head and neck cancer (poor oral hygiene, occupational hazards, family history) but heavy tobacco and alcohol use are the most significant. According to the National Cancer Institute, at least 75% of head and neck cancers are due to tobacco and alcohol. These cancers can be especially dangerous as they can interfere with vital functions such as eating, swallowing and breathing. Symptoms can include persistent sore throat, mouth sores, voice hoarseness and blood in the saliva.

The National Cancer Institute estimates that head and neck cancer accounts for 3 to 5 percent of all cancers in the United States. Head and neck cancer is also almost twice as likely to occur in men versus women and is most often diagnosed in people over the age of 50.

Current Treatment

In most cases, conventional surgery removes the cancer. In cases where the tumor is very small, laser beams can kill the cancer. Surgeons usually perform a lymph node dissection at the time of surgery to evaluate for spread of the tumor. This treatment option does carry an increased risk of bleeding and infection.

Chemotherapy is often combined with surgery and can help kill the primary tumor and any remaining metastatic cancerous cells. Radiation therapy is also commonly used as a treatment option.

Targeted drug therapy interferes with the growth of cancer cells by employing specially modified substances (drugs, proteins), that target the cancer’s specific genes, proteins, or tissue environment. This form of treatment limits the damage to healthy cells and therefore has fewer potential side effects than chemotherapy which attacks both normal cells and cancer cells. One promising target in head and neck cancer is epidermal growth factor receptor (EGFR). EGFR-targeted drugs can be given in cases where the cancer has stopped responding to chemotherapy or radiation therapy. er.

Focused Ultrasound

Ongoing work on the use of focused ultrasound continues to lead to clinical application. A recent preclinical study at National Yang-Ming University in Taiwan examined the ability of focused ultrasound to enhance the delivery of an anti-tumor drug (BPA-Fr) in subjects with squamous cell cancer. The study showed that focused ultrasound was successful in increasing drug delivery to the tumor. 

A single center clinical trial has opened looking at patients with undifferentiated carcinoma or squamous cell carcinoma of the head and neck region with evidence of metastatic disease and lymphadenopathy. The primary objective is to assess the feasibility, safety and toxicity on the treatment target. The secondary objective is to evaluate the impact on the tumor based on follow up MRI.

This study is located at the Sunnybrook Health Sciences Center, in Toronto, Canada, so it is only open to Canadian residents. Click here for more information. If you are interested in participating in the trial, please contact the study coordinator at Sunnybrook:

Merrylee McGuffin 
(416) 480-6100 ext. 85454

Notable Papers

Lee J, Farha G, Poon I, Karam I, Higgins K, Pichardo S, Hynynen K, Enepekides D. Magnetic resonance-guided high-intensity focused ultrasound combined with radiotherapy for palliation of head and neck cancer-a pilot study. J Ther Ultrasound. 2016 Apr 2;4:12. doi: 10.1186/s40349-016-0055-x.

Pichardo S, Köhler M, Lee J, Hynnyen K. In vivo optimisation study for multi-baseline MR-based thermometry in the context of hyperthermia using MR-guided high intensity focused ultrasound for head and neck applications. Int J Hyperthermia. 2014 Dec;30(8):579-92. doi: 10.3109/02656736.2014.981299.

Wu CY, Chan PC, Chou LS, Chang CW, Yang FY, Liu RS, Chiou SH, Chen YW, Yen SH, Wang HE. Pulsed-focused ultrasound enhances boron drug accumulation in a human head and neckcancer xenograft-bearing mouse model. Mol Imaging Biol. 2014 Feb;16(1):95-101. doi: 10.1007/s11307-013-0675-2.

Click here for additional references from PubMed.