Interventions for the treatment of oral cavity and oropharyngeal cancer:chemotherapy

<b>Background:</b> Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients.<p></p> <b>Objectives:</b> To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes.<p></p> <b>Search strategy:</b> Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 28th July 2010. Reference lists of recent reviews and included studies were also searched to identify further trials.<p></p> <b>Selection criteria:</b> Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included.<p></p> <b>Data collection and analysis:</b> Trials which met the inclusion criteria were assessed for risk of bias using six domains: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting and other possible sources of bias. Data were extracted using a specially designed form and entered into the characteristics of included studies table and the analysis sections of the review. The proportion of participants in each trial with oral cavity and oropharyngeal cancers are recorded in Additional Table 1.<p></p> <b>Main results:</b> There was no statistically significant improvement in overall survival associated with induction chemotherapy compared to locoregional treatment alone in 25 trials (hazard ratio (HR) of mortality 0.92, 95% confidence interval (CI) 0.84 to 1.00). Post-surgery adjuvant chemotherapy was associated with improved overall survival compared to surgery +/- radiotherapy alone in 10 trials (HR of mortality 0.88, 95% CI 0.79 to 0.99), and there was an additional benefit of adjuvant concomitant chemoradiotherapy compared to radiotherapy in 4 of these trials (HR of mortality 0.84, 95% CI 0.72 to 0.98). Concomitant chemoradiotherapy resulted in improved survival compared to radiotherapy alone in patients whose tumours were considered unresectable in 25 trials (HR of mortality 0.79, 95% CI 0.74 to 0.84). However, the additional toxicity attributable to chemotherapy in the combined regimens remains unquantified.<p></p> <b>Authors' conclusions:</b> Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy is associated with a 9% increase in survival and adjuvant concomitant chemoradiotherapy is associated with a 16% increase in overall survival following surgery. In patients with unresectable tumours, concomitant chemoradiotherapy showed a 22% benefit in overall survival compared with radiotherapy alone.<p></p&gt

Deutschrechtliche Forstgenossenschaften als Common Property Regime: Eine institutionenökonomische Analyse zum Verhalten der Forstgenossen im Harmersbachtal

Die vorliegende Arbeit untersucht das Verhalten der Mitglieder von deutschrechtlichen Forstgenossenschaften (FG) im Harmersbachtal. Es gehört zum Ortenaukreis und ist ein Seitental des Kinzigtals im mittleren Schwarzwald. Bei den untersuchten FG handelt es sich um die Forstgenossenschaften Unterharmersbach, Fischerbach und Lindach. Das Harmersbachtal weist, wie der gesamte Ortenaukreis, eine bewegte Geschichte auf, die auch für die Entstehung der FG und das Verhalten der Forstgenossen von zentraler Bedeutung sind. Für ein besseres Verständnis wird auf die geschichtliche Entwicklung im Harmersbachtal in Kapitel 2.3 eingegangen. Als Untersuchungsmethode wurden Experteninterviews nach Meuser und Nagel (1991) ausgewählt (vgl. Kapitel 4.3). Hierfür wurden Mitglieder der drei FG befragt sowie drei Revierförster, die die betroffenen FG betreuten bzw. immer noch betreuen. Die Analyse des Verhaltens der Forstgenossen wird vor dem Hintergrund institutionenökonomischer Forschung betrieben. Dieser Forschungszweig der Ökonomik betrachtet das Verhalten von Menschen unter dem Einfluss sozialer Normen und restriktiver Regeln. Das Handeln der Menschen ist demnach nicht allein durch das Streben nach dem eigenen Vorteil und die Wahl der besten Alternative gekennzeichnet. Aus institutionenökonomischer Sicht wägt der Mensch seine Handlungen vielmehr anhand von bestimmten Anreizen und Restriktionen ab. Er betrachtet die möglichen Alternativen und Folgen seines Handelns und trifft seine Entscheidung anhand verschiedener Faktoren. In Bezug auf das Verhalten von Menschen bei der Nutzung von natürlichen Ressourcen gilt nach HARDINS Theorie, der Tragik der Allmende (1968), dass Menschen nicht in der Lage seien, sich zur gemeinsamen Nutzung einer Ressource zu organisieren und diese dadurch zwangsläufig übernutzt und zerstört wird. Dieser Annahme widerspricht OSTROM. In ihrer Arbeit Die Verfassung der Allmende (1999) zeigt sie anhand verschiedener Beispiele, dass Menschen durchaus in der Lage sind, gemeinsam zu handeln und Ressourcen langfristig und nachhaltig zu nutzen, anstatt sie zu devastieren. OSTROM stellt Bauprinzipien auf, die auf langlebige, gemeinschaftlich genutzte Ressourcensysteme zutreffen. In dieser Arbeit werden OSTROMS Bauprinzipien für die Analyse der FG im Harmersbachtal angewendet. Daraus lässt sich das Verhalten der Forstgenossen ableiten, wie sie unter dem Einfluss restriktiver Regeln und sozialer Normen sich innerhalb der Gemeinschaft verhalten. Es zeigt sich, dass OSTROMS Bauprinzipien zum größten Teil auf die FG im Harmersbachtal zutreffen. Über das Verhalten der Forstgenossen lässt sich sagen, dass diese sich den bestehenden Regeln unterordnen und zum langfristigen Erhalt ihrer Ressource Wald beitragen.This masterthesis analyses the behaviour of members of old German forest cooperatives in the Harmersbach Valley. The Harmersbach is a tributary river of the Kinzig River in the Middle Black Forest and belongs to the Ortenau County. The forest cooperatives discussed in this thesis are named Unterharmersbach, Fischerbach and Lindach. The history of the Harmersbach Vally, as of the hole county, was quite eventful over centuries, which also influenced the formation of the forest cooperatives and der behaviour of their members. Chapter 2.3 gives a short introduction into the historic events of the Harmersbach Valley. The research methods used in this thesis were expert interviews as described by MEUSER und NAGEL (1991)(see chapter 4.3). The interview partners were members of the three forest cooperatives in the Harmersbach Valley. Furthermore three forest officials were interviewed who were or are involved in the management of the cooperative's forests. The analysis of the member's behaviour was done before the background of the New Institutional Economics. This is a branch of economics that studies the behaviour of people under the influence of social norms and restrictive rules. The way people act does not only depend on their pursuit of personal benefit and choosing the best alternative. From an institutional point of view human action is rather based on incentives and restrictions. A person weighs the possible alternatives and results of his actions and chooses by taking many factors into account. Following HARDIN'S theory of The Tragedy of the Commons (1968) one should think that humans are not able to organise themselves to cooperatively use a natural ressource without overusing and destroying it. OSTROM contradicts this assumption. In her work Governing the Coomons (1990) she shows different examples in which groups are very well able to act cooperatively and use their ressource sustainably instead of devastating it. OSTROM created design principles that fit long-enduring, commonly used ressource systems. In this thesis OSTROM'S design principles will be used for the analysis of the forest cooperatives in the Harmersbach Valley. Afterwards OSTROM'S design principles are used to draw a conclusion on the member's behaviour under the influence of restrictive rules and social norms. It shows that the design principles match the situation in the forest cooperatives of the Harmersbach Valley in most points. The behaviour of the members can be considered positevly concerning the compliance with rules and the will to preserve the forest on a long term basis

Interventions for preventing oral mucositis for patients with cancer receiving treatment

Interventions for preventing oral mucositis for patients with cancer receiving treatmentTreatment for cancer (including bone marrow transplant) can cause oral mucositis (severe ulcers in the mouth). This painful condition can cause difficulties in eating, drinking and swallowing, and may also be associated with infections which may require the patient to stay longer in hospital. Different strategies are used to try and prevent this condition, and the review of trials found that some of these are effective. Two interventions, cryotherapy (ice chips) and keratinocyte growth factor (palifermin®) showed some benefit in preventing mucositis. Sucralfate is effective in reducing the severity of mucositis, and a further seven interventions, aloe vera, amifostine, intravenous glutamine, granulocyte‐colony stimulating factor (G‐CSF), honey, laser and antibiotic lozenges containing polymixin/tobramycin/amphotericin (PTA) showed weaker evidence of benefit. These were evaluated in patients with different types of cancer, undergoing different types of cancer treatment. Benefits may be restricted to the disease and treatment combinations evaluated

Friend or foe? The current epidemiologic evidence on selenium and human cancer risk.

Scientific opinion on the relationship between selenium and the risk of cancer has undergone radical change over the years, with selenium first viewed as a possible carcinogen in the 1940s then as a possible cancer preventive agent in the 1960s-2000s. More recently, randomized controlled trials have found no effect on cancer risk but suggest possible low-dose dermatologic and endocrine toxicity, and animal studies indicate both carcinogenic and cancer-preventive effects. A growing body of evidence from human and laboratory studies indicates dramatically different biological effects of the various inorganic and organic chemical forms of selenium, which may explain apparent inconsistencies across studies. These chemical form-specific effects also have important implications for exposure and health risk assessment. Overall, available epidemiologic evidence suggests no cancer preventive effect of increased selenium intake in healthy individuals and possible increased risk of other diseases and disorders

Magnesium in Head and Neck Cancer

We investigated the hypothesis that patients with advanced head and neck cancer exhibit a decreased serum concentration of magnesium compared to the normal population. In July 2013 we measured the magnesium serum concentration of 18 patients with squamous cell carcinoma of the head and neck region. The control group consisted of 17 patients received tonsillectomy during the same period. Overall 14/18 patients with cancer have had Magnesium serum concentrations < 0.80 mmol/l (78%). The control group showed only two patients (12%) with serum levels below the cut off. This small controlled study supports the hypothesis that decreased Magnesium serum concentrations are typical for patients with advanced head and neck cancer. We could not show, that hypomagnesaemia is prognostic biomarker in head and neck cancer treatment

Selenium and Lung Cancer: A Systematic Review and Meta Analysis

Selenium is a natural health product widely used in the treatment and prevention of lung cancers, but large chemoprevention trials have yielded conflicting results. We conducted a systematic review of selenium for lung cancers, and assessed potential interactions with conventional therapies.Two independent reviewers searched six databases from inception to March 2009 for evidence pertaining to the safety and efficacy of selenium for lung cancers. Pubmed and EMBASE were searched to October 2009 for evidence on interactions with chemo- or radiation-therapy. In the efficacy analysis there were nine reports of five RCTs and two biomarker-based studies, 29 reports of 26 observational studies, and 41 preclinical studies. Fifteen human studies, one case report, and 36 preclinical studies were included in the interactions analysis. Based on available evidence, there appears to be a different chemopreventive effect dependent on baseline selenium status, such that selenium supplementation may reduce risk of lung cancers in populations with lower baseline selenium status (serum<106 ng/mL), but increase risk of lung cancers in those with higher selenium (≥ 121.6 ng/mL). Pooling data from two trials yielded no impact to odds of lung cancer, OR 0.93 (95% confidence interval 0.61-1.43); other cancers that were the primary endpoints of these trials, OR 1.51 (95%CI 0.70-3.24); and all-cause-death, OR 0.93 (95%CI 0.79-1.10). In the treatment of lung cancers, selenium may reduce cisplatin-induced nephrotoxicity and side effects associated with radiation therapy.Selenium may be effective for lung cancer prevention among individuals with lower selenium status, but at present should not be used as a general strategy for lung cancer prevention. Although promising, more evidence on the ability of selenium to reduce cisplatin and radiation therapy toxicity is required to ensure that therapeutic efficacy is maintained before any broad clinical recommendations can be made in this context

Vitamin A and Retinoid Derivatives for Lung Cancer: A Systematic Review and Meta Analysis

Despite reported antiproliferative activity of vitamin A and its common use for cancer, there is no comprehensive synthesis of its safety and efficacy in lung cancers. To address this issue we conducted a systematic review of the safety and efficacy of vitamin A for the treatment and prevention of lung cancers.Two independent reviewers searched six electronic databases from inception to July 2009 for clinical, observational, and preclinical evidence pertaining to the safety and efficacy of vitamin A and related retinoids for lung cancers. 248 studies were included for full review and analysis. Five RCTs assessed treatment of lung cancers, three assessed primary prevention, and three looked at secondary prevention of lung cancers. Five surrogate studies, 26 phase I/II, 32 observational, and 67 preclinical studies were also included. 107 studies were included for interactions between vitamin A and chemo- or radiation-therapy. Although some studies demonstrated benefits, there was insufficient evidence overall to support the use of vitamin A or related retinoids for the treatment or prevention of lung cancers. Retinyl palmitate combined with beta carotene increased risk of lung cancer in smokers in the large CARET trial. Pooling of three studies pertaining to treatment and three studies on secondary prevention revealed no significant effects on response rate, second primary tumor, recurrence, 5-year survival, and mortality. There was a small improvement in event free survival associated with vitamin A compared to controls, RR 1.24 (95% CI 1.13-1.35). The synthetic rexinoid bexarotene increased survival significantly among a subset of patients in two RCTs (p<0.014, <0.087).There is a lack of evidence to support the use of naturally occurring retinoids for the treatment and prevention of lung cancers. The rexinoid bexarotene may hold promise for use among a subset of patients, and deserves further study