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Head and neck squamous cell carcinomas (HNSCC) are a group of cancers that affect cells in and around our mouth and nose. With 890,000 new cases and 450,000 deaths annually, HNSCC accounts for roughly 4.5% of cancer diagnoses and deaths worldwide. Treatment options for HNSCC are very limited, so nearly half of affected patients with HNSCC die from the disease. Current therapies consist of surgery, radiotherapy and chemotherapy, which can be effective but often have limited success and significant side effects.

To meet this unmet medical need, researchers at the University of California San Diego School of Medicine are exploring new approaches to improve the effectiveness of treatments for HNSCC. In a new study of oral cancer, a type of HNSCC, they demonstrate how precisely timing two different treatments can potentially improve treatment outcomes by protecting tumor-draining lymph nodes, which are located close to tumors and have an important role in mediating the immune system’s response to the tumor.

The researchers found:

– In mice with oral cancer, delivering radiation therapy that preserves tumor-draining lymph nodes then later delivering immunotherapy resulted in a complete and durable tumor response, meaning the tumors became undetectable. This happened in 15/20 mice treated with this approach.

– The two treatments synergized to enhance migration of a specific type of immune cell, called activated CCR7+ dendritic cells, from tumors into lymph nodes. These cells helped trigger a stronger immune response to the tumor. This occurred in all treated mice.

The study’s results could have significant implications for the treatment of HNSCC, as well as other cancers that are resistant or unresponsive to current standard treatment approaches. The research also provides valuable biological insight into the role of tumor-draining lymph nodes in cancer biology, which could have further implications for developing new therapies. While it will take further research to fully explore the potential of this timed treatment approach, the findings demonstrate the importance of optimizing the sequence and timing of therapies to maximize their benefit to the patient. The researchers are now conducting clinical trials in collaboration with investigators at Providence Earl Chiles Cancer Center to leverage these strategies to improve outcomes in head and neck cancer patients.

The study, published in Nature Communications, was led by Robert Saddawi-Konefka, M.D., Ph.D.,PGY-8, fellow physician and Joseph Califano, M.D., professor and interim chair in the Department of Otolaryngology and Iris and Matthew Strauss Chancellor’s Endowed Chair in Head and Neck Surgery at UC San Diego School of Medicine. Califano is also director of the Hanna and Mark Gleiberman Head and Neck Cancer Center at Moore’s Cancer Center. The study was supported, in part by a National Cancer Institute funded R01 grant led by. Califano and Andrew Sharabi, M.D., Ph.D., associate professor and Jacobs Chancellor’s Endowed Chair in the Department of Radiation Medicine and Applied Sciences at UC San Diego School of Medicine, as well as a member of the Head and Neck Cancer Center at Moores Cancer Center. 

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RAWALPINDI, Jul 29 (APP):Member of the National Assembly (MNA) Anjum Aqeel Khan has urged the public to treat hepatitis as a serious health threat, calling it a “silent killer” that often causes irreversible damage without showing early symptoms.

He was addressing a seminar held in connection with World Hepatitis Day, aimed at raising awareness about the disease and promoting preventive measures.

The awareness event was organized by Chaudhry Muhammad Naeem, Founder of Savour Food Pakistan and Patron-in-Chief of the Restaurants, Caterers, Sweets and Bakers Association. The seminar brought together lawmakers, medical professionals, social activists, and concerned citizens at a local venue in Rawalpindi.

MNA Anjum Aqeel Khan, the chief guest, emphasized the need for continuous community engagement and awareness campaigns. “This disease does not always present symptoms early on, but it leads to severe liver damage. We must reach out to villages, schools, offices, and mosques to educate people,” he said. “This should not be seen as a one-day campaign, but as a permanent social responsibility.”

Punjab Assembly Member Mohsin Ayub Khan also attended the event and endorsed the need for sustained public health efforts.

Chaudhry Muhammad Naeem highlighted the contributions made under his personal initiative, including the establishment of a dedicated hepatitis laboratory and a modern operation theatre at Benazir Bhutto Hospital. “The objective is to ensure timely and quality treatment for the people of Rawalpindi,” he noted.

President of the Association, Muhammad Farooq Chaudhry, recalled the association’s active role during the COVID-19 pandemic and reaffirmed their commitment to the fight against hepatitis. “Just like we supported public vaccination during COVID, we are equally determined to combat hepatitis,” he said.

The event concluded with a pledge from participants to continue spreading awareness and encouraging early testing and vaccination against hepatitis. Representatives from various business, welfare, and health organizations were present in large numbers, along with concerned citizens.

The majority of liver cancer cases could be prevented by reducing levels of viral hepatitis, alcohol consumption and MASLD (metabolic dysfunction-associated steatotic liver disease – previously called non-alcoholic fatty liver disease), suggests an analysis as part of The Lancet Commission on liver cancer. The Commission highlights several ways to reduce these risks factors, including increasing the coverage of the hepatitis B vaccine and public health policies targeting obesity and alcohol consumption. 

Previous analyses have predicted that the number of new liver cancer cases will nearly double from 870,000 in 2022 to 1.52 million in 2050, primarily due to population growth and ageing populations, with the largest increases expected in Africa. The number of deaths from liver cancer are predicted to grow from 760,000 in 2022 to 1.37 million in 2050.

Liver cancer is already a major cause of death and disability. Globally, it’s the sixth most common cancer and the third leading cause of death from cancer. More than 40% of the global liver cancer cases occur in China, mostly due to relatively high rates of hepatitis B infections in the country.

Chair of the Commission, Prof. Jian Zhou, Fudan University (China) says: “Liver cancer is a growing health issue around the world. It is one of the most challenging cancers to treat, with five-year survival rates ranging from approximately 5% to 30%. We risk seeing close to a doubling of cases and deaths from liver cancer over the next quarter of a century without urgent action to reverse this trend.” 

As three in five cases of liver cancer are linked to preventable risk factors, mostly viral hepatitis, alcohol and obesity, there is a huge opportunity for countries to target these risk factors, prevent cases of liver cancer and save lives.” 

Prof. Stephen Chan, First Author, Chinese University of Hong Kong, Hong Kong, China

Changes in the causes of liver cancer 

In a novel analysis, the Commission estimates that at least 60% of liver cancers are preventable via control of modifiable risk factors, including hepatitis B virus (HBV), hepatitis C virus HCV, MASLD, and alcohol.

MASH, a severe form of MASLD, is the fastest growing cause of liver cancer globally, followed by alcohol. The Commission projects that the proportion of liver cancer cases associated with MASH are projected to increase from 8% in 2022 to 11% in 2050, and liver cancer cases associated with alcohol are projected to increase from 19% in 2022 to 21% in 2050 

In contrast, the proportion of liver cancer cases linked to HBV is expected to decrease from 39% in 2022 to 37% in 2050, while HCV-related cases are projected to drop from 29% to 26% over the same period.

A rising risk factor: MASLD

Approximately a third of the global population are estimated to have MASLD. However, only 20 to 30% of patients with MASLD develop the more severe form of the condition with liver inflammation and damage – called metabolic dysfunction-associated steatohepatitis (MASH).

The rate of MASLD-linked liver cancer is expected to rise over the next decade, particularly in the USA, Europe, and Asia, due to increasing rates of obesity. In the USA, MASLD prevalence continues to climb in parallel with the obesity epidemic; by 2040, over 55% of US adults could have MASLD. [For a case study from the USA: ‘MASLD and ALD as the new face of hepatocellular carcinoma’ – see panel 5, page 17 of the report.] 

Commission author, Prof Hashem B El-Serag, Baylor College of Medicine (USA) says, “Liver cancer was once thought to occur mainly in patients with viral hepatitis or alcohol-related liver disease. However, today rising rates of obesity are an increasing risk factor for liver cancer, primarily due to the increase in cases of excess fat around the liver. 

“One approach to identify patients at high risk of liver cancer would be to introduce screening for liver damage into routine healthcare practice for patients at high risk of MASLD, such as individuals living with obesity, diabetes, and cardiovascular disease. Healthcare professionals should also integrate lifestyle counselling into routine care to support patients to transition to a healthy diet and regular physical activity. Furthermore, policy makers must promote healthy food environments via policies such as sugar taxes and clear labelling on products with high fat, salt, and/or sugar.”

Global targets and recommendations 

The Commission estimates that if countries can reduce the incidence of liver cancer cases by 2 to 5% each year by 2050, it could prevent nine to 17 million new cases of liver cancer and save eight to 15 million lives. 

As more patients live with liver cancer than ever before, in addition to prevention efforts, there is an urgent need for increased research and attention for these patients to improve their quality of life.

The Commission suggests several strategies for reducing the global burden of liver cancer, including:

• Governments should intensify efforts to increase HBV vaccination-such as vaccine mandates in high-prevalence countries-and implement universal HBV screening for adults 18+, alongside targeted HCV screening in high-risk areas based on cost-effectiveness.
• Policy makers should enact minimum alcohol unit pricing, warning labels, and advertisement restrictions for alcoholic beverages.
• National health authorities and cancer control programmes should prioritise investments in public awareness campaigns and deployment of early detection resources.
• Professional organisations and the pharmaceutical industry should work together to reduce differences between Eastern and Western regions of the world in the clinical management of liver cancer.
• Hospitals and professional organisations should provide palliative care training, with the aim of integrating palliative care in the early phases for patients in need.
• [For a full list of the Commission’s ten recommendations for action see table 1, page 4]

Commission author, Prof Valérie Paradis, Beaujon Hospital (France) says, “There is an urgent need to raise awareness within society about the severity of the growing health issue of rising liver cancer cases. Compared with other cancers, liver cancer is very hard to treat but has more distinct risk factors, which help define specific prevention strategies. With joint and continuous efforts, we believe many liver cancer cases can be prevented and both the survival and quality of patients with liver cancer will be considerably improved.” 

New research examining the role of computed tomography colonography (CTC) in colorectal cancer (CRC) screening over the course of 20 years revealed significant correlation to subsequent optical colonoscopy (OC) findings for detection of polyps > 6 mm.

For the retrospective study, recently published in the American Journal of Roentgenology, researchers reviewed data for 15,341 CTC exams performed for 11,830 patients (mean age of 56). The cohort included 9,168 patients who had CTC exams for primary asymptomatic CRC screening, according to the study.

For patients who had primary asymptomatic CRC screening with CTC, the researchers noted a 15.9 percent rate of positive findings for polyps > 6 mm. Overall, out of 1,683 cases involving CTC-detected polyps > 6 mm, the study authors found concordant lesions on OC in 1,541 of these cases for a 91.6 percent positive predictive value (PPV).

The use of CTC also led to detection of advanced adenoma (4 percent), extracolonic malignancy (0.4 percent) and abdominal aortic aneurysm (0.3 percent). The researchers added there were no major complications or colonic perforations with CTC.

“These findings support the use of CTC as a safe non-invasive test for asymptomatic screening, providing CRC prevention and detection along with extracolonic assessment,” wrote lead study author Perry J. Pickhardt, M.D., the chief of gastrointestinal imaging in the Department of Radiology at the University of Wisconsin School of Medicine and Public Health, and colleagues.

With respect to polyp morphology, the study authors noted that CTC had a 94.1 percent PPV for sessile lesions and a 95.7 percent PPV for pedunculated polyps.

While the researchers noted a precipitous decline in CTC utilization from 2005 to 2023 for primary asymptomatic screening (1,589 CTC exams in 2005 vs. 72 CTC exams in 2023), they maintained that the study findings and the recent national coverage determination for CTC screening of Medicare beneficiaries make CTC a viable alternative for CRC screening.

“Through proper technique, CTC screening can provide noninvasive CRC prevention that is lacking with stool-based tests, avoid the complications associated with primary OC screening, and provide the unique additional benefit of extracolonic evaluation,” emphasized Pickhardt and colleagues.

(Editor’s note: For related content, see “Study: CT Colonography Screening Offers Up to 16 Percent Higher Reduction of Colorectal Cancer Incidence than Cologuard,” “Incorporating CT Colonography into Radiology Practice” and “Survey Results Reveal Doubling of CT Colonography Use During COVID-19 Pandemic.”)

Beyond the inherent limitations of a single-center retrospective study, the authors conceded a lack of systematic documentation for colorectal lesions missed by CTC and no assessment of outcomes with respect to variances among individual radiologists.

Adverse reactions to gadolinium-based contrast agents (GBCAs) in children occur at low rates, researchers have reported in a literature review.

The review suggests GBCAs are relatively safe for children — a population for which clinicians should exercise special concern when it comes to contrast agents, wrote a team led by Ok Jeong Yu, MD, of the University of Ulsan College of Medicine in Seoul, South Korea. The paper was published July 29 in Radiology.

“[Our review found that] gadolinium-based contrast agent-associated adverse reaction rates in children undergoing contrast-enhanced MRI were low for acute physiologic reactions, acute allergic-like reactions, and delayed reactions, with no nephrogenic systemic fibrosis reported,” the group noted.

Despite previous studies that show low adverse reactions to GBCAs among children, safety concerns persist, the investigators wrote. They conducted a literature review to evaluate the safety of the agents in children and adolescents undergoing contrast-enhanced MRI exams, focusing on GBCA-associated adverse drug reactions, nephrogenic systemic fibrosis (NSF), and gadolinium deposition in the brain.

The authors searched for studies from MEDLINE/PubMed, Embase, Web of Science, and the Cochrane Library published up to November 2023. Of these studies, 32 covered 112,760 exams that addressed GBCA-related adverse drug reactions; eight covered 4,895 exams that addressed nephrogenic systemic fibrosis; and six covered 787 exams that addressed brain gadolinium deposits. The researchers pooled studies that reported incidences of GBCA-associated adverse drug reactions with information on GBCA type and used a linear mixed-effects model to assess gadolinium deposits in the brain.

Overall, they reported the following:

• The acute GBCA-associated adverse drug reaction rate was 0.25% for physiologic reactions and 0.13% for allergic reactions.
• The delayed adverse drug reaction rate was 0.04%.
• No patients were reported with nephrogenic systemic fibrosis.

In an accompanying commentary, Ilya Abelev, MD, and Matthew McInnes, MD, both of Ottawa Hospital in Ontario, Canada, noted that the “absence of NSF in this large pediatric cohort, including in patients with renal insufficiency, is a particularly reassuring finding” — but they also urged more research.

“As stewards of pediatric imaging, radiologists must continue to balance the necessity of precise diagnostic information against potential safety concerns, always prioritizing patient welfare,” they wrote. “Ongoing research, adherence to established guidelines, and transparent communication will be crucial as we advance our understanding and refine our practices. Ultimately, studies such as this serve not only to inform evidence-based clinical practice but also to reinforce the importance of patient-centered care in radiology.”

The complete research can be found here.