Head and Neck Non-Surgical Oncology Service

[Pages:8]Head and Neck Non Surgical Oncology Service

Head and Neck Non-Surgical Oncology Service

1

Head and Neck Non Surgical Oncology Service

Operational Structure

All new head and neck patients are discussed/assessed through three Greater Manchester Multi-disciplinary Team Meetings (2 at Christie,1 at North Manchester) each serving a catchment population of approximately 1 million (Central/NW; South; NE). There is active discussion as to whether/how greater centralisation of head and neck surgical services (15 head and neck surgeons) should occur. At present surgery takes place in North Manchester, Wythenshawe and MRI. Non-surgical management is all initiated at the main Christie site, can be complex and necessitates excellent multidisciplinary working. This includes a network of specialist nurse, SALT (speech and swallowing experts) and dietetic support across Greater Manchester and Cheshire

Personnel Consultants

Clinical Nurse Specialist Nurse Clinician

Prof Nick Slevin Dr Andrew Sykes Dr Kate Garcez Dr Lip Lee Deborah Elliott

Kathleen Mais

2

Smoking cessation

Charlotte Finchett

SALTs

Helen Rust

Paul Brown

Susi Loh

Veronica Archer

Research team

Kim Denton

John Baron

Lauren Stopford

Gastrostomy Nurse Specialist

Lynne Wilbraham

Dietician

Lorna Wilson

Dentist

Nadeem Mohammed

Mould Room Staff Tony, Nicola, Steph,

Phil. Phil & Julie

Patient support

Complementary therapy `CALMS' team

Activity

510 new patients are referred annually with the following breakdown:

Induction chemo +radical radiotherapy with systemic treatment: 55 (node positive stage 4)

Head and Neck Non Surgical Oncology Service

Radical radiotherapy with synchronous Cisplat or Cetuximab: 118 (stage 3 and 4)

Radical radiotherapy only (definitive or post op):280

Palliative radiotherapy: 15

Palliative systemic treatment; 59 (new and follow up patients)

Supportive care only: 20

Service Development 2013/14

All patients receiving systemic treatment outwith clinical trials are seen through a nurseled (KLM) chemotherapy clinic which provides for continuity of care, expert assessment and results in low drug wastage. Three monthly morbidity and mortality meetings review all deaths or serious events to examine potential relationship to treatment. A business case is in progress to appoint a first ever medical oncologist for head and neck to promote early phase work, collaboration with MCRC scientists and expand the commercial trial portfolio (currently led by AJS).

Smoking during RT doubles the mortality compared to non/ex-smokers. An active smoking cessation service has been established to address this (CF-who is also responsible for screening patients for alcohol dependency, anxiety and depression).

3

Mucositis leads to swallowing impairment, weight loss, altered treatment plans, tube feeding and debilitation which may predispose to serious infection. A head and neck dietician has been appointed(LW) to manage this toxicity proactively working closely with the SALT team.

Almost all patients(more than 90%) receive Intensity Modulated RT as standard. We have established a 3 dose volume approach (oral presentation at international meeting ASTRO 2014) which is flexible and well tolerated. An arc technique has been implemented which is more comfortable for patients (less time on treatment couch/less likely to move). The waiting time for head and neck patients to start RT is being reduced by greater flexibility in work pattern for mould room, dosimetry and medical staff.

Two national trials are led by the Christie examining tumour hypoxia modification(to reduce radiation resistance) as well as amelioration of trismus(jaw tightening). A large portfolio of trials examining novel agents is available for patients with advanced disease.

Proton beam treatment is likely to have a key role in some head and neck subsites. A clinical lead (LWL)has been identified to plan patient pathways prior to this service opening in

Head and Neck Non Surgical Oncology Service

2018. A research fellow has completed a proton planning project at UPenn (USA) which has been submitted for publication.

A multidisciplinary tracheostomy group has been formed to ensure best airway management practice is disseminated to all relevant staff groups. The head and neck RT DVD (previous version received BMA award) has been updated. A patient reported outcome measures approach (PROMs) has been adopted to prospectively document treatment toxicity.

A business case is in progress to appoint a RT Clinical Nurse Specialist which is essential to support the complex management of the RT patient group. The health promotion post (CF) has been transformational and needs to have sustained funding secured. A project to examine outcomes for head and neck patients with dementia is underway with expert input from our Psycho-oncology colleagues.

A rapid access dental service is planned (NM).

Outcomes ? Click Here

4

Head and Neck Non Surgical Oncology Service

Peer Reviewed Publications 2013/14

Dose intensified hypofractionated intensity-modulated radiotherapy with synchronous cetuximab for intermediate stage head and neck squamous cell carcinoma Thomson DJ, Ho KF, Ashcroft L, Denton K, Betts G, Mais KL, Garcez K, Yap BK, Lee LW, Sykes AJ, Rowbottom CG, Slevin NJ. Acta Oncol. 2014 Oct 3:1-11. [Epub ahead of print] PMID: 25279959 [PubMed - as supplied by publisher] Prognostic value of hypoxia-associated markers in advanced larynx and hypopharynx squamous cell carcinoma. Bernstein JM, Andrews TD, Slevin NJ, West CM, Homer JJ. Laryngoscope. 2014 Sep 17. doi: 10.1002/lary.24933. [Epub ahead of print] PMID: 25230150 [PubMed - as supplied by publisher] Adaptive and Innovative Radiation Treatment FOR Improving Cancer treatment outcome (ARTFORCE): A randomised controlled Phase II trial for individualised treatment of Head and Neck cancer. Heukelom J, Hamming O, Bartelink H, Hoebers F, Giralt J, Herlestam T, Verheij M, van den Brekel M, Vogel W, Slevin N, Deutsch E, Sonke JJ, Lambin P, Rasch C. BMC Cancer. 2013 Feb 22;13:84. doi: 10.1186/1471-2407-13-84. PMID: 23433435 [PubMed - indexed for MEDLINE] NIMRAD - A Phase III Trial to Investigate the Use of Nimorazole Hypoxia Modification with Intensity-modulated Radiotherapy in Head and Neck Cancer. Thomson D, Yang H, Baines H, Miles E, Bolton S, West C, Slevin N. Clin Oncol (R Coll Radiol). 2014 Jun;26(6):344-7. doi: 10.1016/j.clon.2014.03.003. Epub 2014 Mar 28. No abstract available. PMID: 24685344 Evaluation of an automatic segmentation algorithm for definition of head and neck organs at risk. Thomson D, Boylan C, Liptrot T, Aitkenhead A, Lee L, Yap B, Sykes A, Rowbottom C, Slevin N Radiat Oncol. 2014 Aug 3;9:173. doi: 10.1186/1748-717X-9-173.PMID: 25086641. [PubMed - in process]

5

Head and Neck Non Surgical Oncology Service

Carotid dosimetry for T1 glottic cancer radiotherapy Garcez K, Lim CC, Whitehurst P, Thomson Dr, Ho KF, Lowe M, Sykes A,, Lee L, Yap B, Slevin N. Br J Radiol. 2014 Jun;87(1038):20130754. Doi 10.1259/bjr:20130754. Epub 2014 Feb 17 PMID:2462822251 (PubMed ? in process) Phase II trial of sorafenib in advanced salivary adenoid cystic carcinoma of the head and neck Thomson DJ, Sliva P, Denton K, Bonington SpR in Clinical Oncology, Mak SK, Swindell R, Home J, Sykes AJ, Lee LW, Yap BK, Slevin NJ. Head Neck 2013 Dec 17. Doi: 10.1002;hed.23577. (Epub ahead of print) PMID: 24346857(PubMed ? as supplied by publisher) The prognostic significance of the biomarker p16 in oropharyngeal squamous cell carcinoma Oguejiofor KK, Hall JS, Mani N, Douglas C, Slevin NJ,Homer J, Hall G, West CM. Clin Oncol (R Coll Radiol). 2013 Nov;25(11):630-8. Doi: 10.1016/j.clon.2013.07.003. Epub 2013 Jul 31. PMID:23916365(PubMed ? in process) Cisplatin plus capecitabine as first-line chemotherapy for recurrent or metastatic head an d neck squamous cell cancer: experience outside of a trial setting McPartlin AJ, Mais K, Barker C, Swindell R, Mitchell K, Sykes A, Lee L, Yap B, Slevin NJ. Chemotherapy. 2013;59(1):1-7. Doi: 10.1159/000348816. Epub 2013 Apr 25 PMID 23635527(PubMed ? indexed for MEDLINE) Value of the Hospital Anxiety and Depression Scale in the follow up of head and neck cancer patients. Joseph LA, Routledge JA, Burns MP, Swindell R, Sykes AJ, Slevin NJ,Davidson SE J Laryngol Otol. 2013 Mar;127(3):285-94. Doi: 10.1017/S0022215113000078. Epub 2013 Feb 11. PMID:23398854(PubMed ? indexed for MEDLINE) Nasopharyngeal carcinoma: a retrospective review of demographics, treatment and patient outcome in a single centre. Colaco RJ, Betts G, Donne A, Swindell R, Yap BK, Sykes AJ,Slevin NJ, Homer JJ, Lee LW, Clin Oncol (R Coll Radio). 2013 Mar;25(3):171-7. Doi: 10.1016/j.clon.2012.10.006. Epub 2013 Jan18. Review PMID 23337060(PubMed ? indexed for MEDLINE) Lack of prognostic effect of carbonic anhydrase-9, hypoxia inducible factor-1 and bcl-2 in 286 patients with early squamous cell carcinoma of the glottic larynx treated with radiotherapy. Douglas CM, Bernstein JM, Ormston VE, Hall RC, Merve A, Swindel R, Galentine HR, Slevin NJ,West CM, Homer JJ

6

Head and Neck Non Surgical Oncology Service

Clin Oncol (R Coll Radiol). 2013 Jan;25(1):59-65. Doi: 10.1016/j.clon.2012.07.004. Epub 2013 July 25 PMID:22841149(PubMed ? indexed for MEDLINE)

Competitive Grant Income:

RfPB ?TRISMUS trial CTAAC/CRUK-NIMRAD trial EU/FP7-ARTFORCE trial

Trials Currently Open and Clinical Audit activity.

Randomised Pilot Study of Therabite? versus Wooden spatula in the Amelioration of Trismus in Head and Neck Cancer Patients. (Trismus Trial)

Head & Neck 5000 ? a study to evaluate the outcome of centralisation in Head and Neck cancer. A randomised placebo-controlled trial of synchronous NIMorazole versus RADiotherapy alone in patients with locally advanced head and neck squamous cell carcinoma not suitable for synchronous chemotherapy or cetuximab. (Nimrad)

A Cancer Research UK Phase Ib trial to determine the safety, tolerability and immunogenicity of extended schedule vaccination with MVA-EBNA1/LMP2 in patients with Epstein Barr Virus positive nasopharyngeal carcinoma. (MVA1b)

Phase II multicentre randomized, double blind, placebo controlled study assessing the efficacy of buparlisib (BKM120) plus paclitaxel vs. placebo plus paclitaxel in patients with platinum pre-treated recurrent or metastatic head and neck squamous cell carcinoma. (Beril-1)

7

Head and Neck Non Surgical Oncology Service

An Open Label, Randomized Phase 3 Clinical Trial of Nivolumab vs Therapy of Investigator's Choice in Recurrent or Metastatic Platinum-refractory Squamous Cell Carcinoma of the Head and Neck (SCCHN). (Checkmate) A randomised, double-blind, placebo-controlled, phase III study to evaluate the efficacy and safety of afatinib (BIBW 2992) as adjuvant therapy after chemo radiotherapy in primary unresected patients with stage III, IVa, or IVb loco-regionally advanced head and neck squamous cell carcinoma. (LUX H&N 2)

8

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download