2015 ASCO Annual Meeting Highlights on Elective Surgery for Early Oral Cancer, with Jyoti D. Patel, MD

May 31, 2015
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In today's podcast, we'll discuss one study highlighted at ASCO's 2015 Annual Meeting that examined whether a type of surgery known as elective neck dissection improves survival and reduces the risk of a recurrence for people diagnosed with early oral cancer.



ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer.

 In today's podcast, we'll discuss one study highlighted at ASCO’s 2015 Annual Meeting that examined whether a type of surgery, known as elective neck dissection, improves survival and reduces the risk of occurrence for people diagnosed with early oral cancer. This podcast will be led by Dr. Jyoti Patel who is an oncologist at the Robert H. Lurie Comprehensive Cancer Center, and, an Associate Professor in Hematology-Oncology at Northwestern University Feinberg School of Medicine in Chicago. Dr. Patel is also an Associate Editor for Cancer.Net.

The ASCO Annual Meeting is the premier educational and scientific event where physicians, researchers, and other healthcare professionals gather to discuss the latest in cancer care and treatment. This Cancer.Net podcast helps put new research findings into context, and explains what this news means for patients. ASCO would like to thank Dr. Patel for summarizing these studies.

Dr. Patel: Hello, my name is Jyoti Patel. I'm a medical oncologist at Northwestern University in Chicago. And, today I want to discuss a study that looked at whether known as elective neck dissection improve survival and reduced the risk of a recurrence for people diagnosed with early oral cancer. So early oral cancer is very common, we know that oral cancer affects 300,000 people worldwide. It's especially common in parts of the world where tobacco and alcohol use is common. In the United States we expect about 45,000 people to be diagnosed with oral cancer every year. We know it's more common in men than in women. Some oral cancers and oropharyngeal cancers are increasing because of an infection with the virus called Human Papillomavirus, or HPV, for which there is a vaccine.

This study looked at patients with early oral stage cancer. So oral cancers are cancers of the mouth, of the tongue, of the lips, of the lining, of the cheeks, of the gingiva, and really the front part of the tongue, and the mouth. This study looked at performing an elective neck dissection on patients with early oral cancers. And this is a preventative procedure in which the lymph nodes, on the side of the neck, are removed in patients who we feel have cancers that are confined to an early stage in just the immediate organ.

This study showed that there was a significant reduction in the risk of the cancer coming back, over 50%. And that also led to an improvement in overall survival. So we know that when the cancer comes back in the neck, or if the lymph nodes are involved, that's in a higher stage of disease. So it intuitively makes sense that more people survived.

The study was important for a number of reasons, and I think affects the care of patients with oral cancers worldwide. So as I said, oral cancer is extraordinarily common in many parts of the world, where alcohol use is common, we know it's in more men than women, it can cause significant problems with quality of life. It's often detected as an early lesion that doesn't heal on your tongue, or on your lips, or on your cheek. And when it grows it can cause problems with chewing, swallowing, breathing, and talking.

So finding it at an early stage, and giving the best curative therapy at that juncture, not only is important for cure but also decreases a lot of the morbidity that this cancer can cause. When patients are diagnosed with an early oral or oropharyngeal cancer, the primary surgery is removing that tumor, and the surrounding tissue around it, and that has been considered the best treatment available. For many years there's been discussion about whether there's a chance that the cancer could be involved in the lymph nodes that are not clinically enlarged. And so this procedure dissects the lymph nodes in the neck, draining the lymph nodes, from these tumors and assumes  that maybe they're microscopic cells that we can't feel, or that we don't see on a CT scan or a PET scan. And if we remove those, preventatively, will reduce the chance of occurrence.

There have been studies around the world and these have produced mixed results. This is the first large definitive study from India that shows, without a doubt, that putting a patient through a more extensive procedure improves outcome. For years we have been worried about over-operating on patients. If you look at, for example, breast cancer where we've gotten to smaller resections and trying to decrease the morbidity with surgery. This is an example of where actually more treatment is beneficial. And without a doubt, decreasing the chance of recurrence by 50% is important.

One might ask why has everyone not been doing surgery, if we felt that this would impact the outcome of our patients. And one is going to worry about the morbidity for surgery. So when you do a neck dissection, there's always a chance that you may end up with shoulder problems, or neck problems. It's important, particularly if you have an occupation that you work with your arms and your neck a lot, that could be impacted. This is important, I think, particularly in other parts of the world that may not have as many resources. So if patients have an early cancer that's operated on, and you decide not to do the neck, those patients have to be followed pretty carefully, because if they develop a lymph node, we want to take that out and remove the cancer in whole. But, in places where patients may travel long distances to go to surgeons with expertise in this kind of surgery, or who may not have access to the medical system, this would be an approach where you remove the tumor, and do all the preventative surgery in one setting. And so it's sort of one-and-done. You don't have to follow patients for risk of recurrence, or that constant need for exam and clinical outcome.

This study is certainly, I think, a game-changer for many around the world. Again, this is a common cancer, particularly in Asia. And so the impact of this kind of study, in which we show that more surgery is probably beneficial, is important. And it helps us prioritize, not only the primary dissection, but also the regional dissection because we know that we can cure patients, and that cure rate is substantially increased with more surgery. For a patient now who is found to have an early oral cancer, so this might be one that your dentist screens for in an annual exam, if you have a high risk history, meaning that you're a smoker or use alcohol. If you're screening for this and detect a lesion in your tongue, or if you come to medical attention because you find a non-healing ulcer, perhaps on your cheek, and meet the patient, and work with surgeons to decide a disease treatment plan.

But, given this data, I think, we definitely know that resecting that primary tumor, as well as performing the neck dissection, which likely adds more operative time. Maybe one or two hours extra, and more recovery time after the surgery, and may have a small risk of neck dysfunction, or shoulder dysfunction. I think the data suggests that this is the best treatment we can give for a patient with stage I or stage I oral cancer.

ASCO: Thank you Dr. Patel. More information from ASCO’s 2015 Annual Meeting can be found at www.cancer.net.

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