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Initially involving only traditional treatment with surgery and radiotherapy for cancers of the head and neck region, the program now recognizes medical oncology as a third discipline, offering both novel and traditional single-modality and multidisciplinary care to the wide variety of limited and advanced head and neck cancers.
Clinically, the Center for Head and Neck Cancers is managed via the offices of participating clinicians, as well as a weekly multidisciplinary new patient clinic. The latter is staffed by medical and radiation oncologists, as well as by head and neck surgeons and oral surgeons, and by support personnel representing nursing, speech and swallowing therapy, nutrition therapy, and social services. More than 800 new patients are seen annually. These patients are offered a variety of interventions, including:
Treatment guidelines reflect nationally accepted standards of care, or investigational protocols unique to MGH/MEEI or shared with an affiliated Head and Neck Cancers center at Dana-Farber Cancer Institute (DFCI).
The Center for Head and Neck Cancers sponsors multiple educational conferences in additional to those generally available within MGH/MEEI. The center organizes a weekly surgical new patient conference at MEEI, a weekly multidisciplinary conference that reviews all patients on active treatment, two monthly didactic conferences at the Cancer Center, and a monthly pathology conference at MEEI. In addition, the Center for Head and Neck Cancers holds staff dinners every 3-4 months to organize its clinical and scientific research activities. These interactions often include affiliated members of the Center for Head and Neck Cancers from DFCI, Brigham and Women's Hospital (BWH), and the Harvard School of Public Health (HSPH).
The research activities of the Center for Head and Neck Cancers reflect the diverse nature of the diseases treated, and the spectrum of clinical and scientific interests of participating professionals. Medically, Drs. Clark and Elizabeth Lamont participate in a number of Phase I-III trials available locally via the Cancer Center or DFCI, or nationally via the Radiation Therapy Oncology Group (RTOG). The research interests of Drs. Clark and Lamont are complementary, as Dr. Clark focuses on early and intermediate outcomes associated with treatment while Dr. Lamont considers late health outcomes.
Dr. Lamont is a NCI K-07 funded investigator who uses clinical epidemiologic techniques to discover non-malignant determinants of the distribution, treatment, and outcome of malignant disease. This includes work that established associations between certain comorbidities and subsequent cancer diagnoses (e.g., thromboembolic disease as a positive predictor of subsequent colon cancer, osteoporosis as a negative predictor of subsequent breast cancer). It also includes work that describes treatment and treatment outcomes in elderly cancer patients (e.g., patterns of adjuvant chemotherapy utilization and survival from resected stage III colon cancer in Medicare beneficiaries), and research that seeks to understand the importance of referral patterns in experimental cancer treatment studies (e.g., patient travel distance as a predictor of prolonged survival). Dr. Lamont is presently defining test characteristics (i.e., sensitivity and specificity) of Medicare chemotherapy claims, a project that will facilitate work examining the interaction of comorbidity and chemotherapy treatment in the elderly. She is collaborating with Dr. Nicholas Christakis of the Department of Health Care Policy at Harvard Medical School on the development of a project examining the importance of contextual factors on the distribution, treatment and outcomes of cancer.
The surgeons of the Center for Head and Neck Cancers are led by Richard Fabian, MD, a pioneer in the use of chemotherapy in multidisciplinary treatment programs for patients with head and neck cancers. Members of his team include Daniel Deschler, MD, who maintains an active clinical practice and is a noted expert in speech and swallowing dysfunction and restoration after head and neck surgery. His associate, James Rocco, MD, PhD, an RO1-funded investigator, is active clinically while also managing a tumor bank for head and neck cancers and maintaining a research laboratory. Dr. Rocco's laboratory is involved in defining molecular pathways involved in epithelial carcinogenesis and apoptosis. He is currently investigating the p63 pathway in tumors in vivo. He has also developed a system for knocking out p16 in primary cells, and clarified the role of the p14 gene in p53 independent apoptosis. He also studies the p53 independent effects of p14 by microarray analysis, and the role of p14 in adenoviral replication.
The radiation oncologists in the Center for Head and Neck Cancers are led by Paul Busse, MD, PhD. Dr. Busse brings to the clinic more than 20 years of experience in the treatment of patients with head and neck cancers using standard and investigational therapies. He maintains a presence in RTOG, and is also developing boron neutron capture therapy as a treatment for intracranial malignancies.
Allied staff of the Center for Head and Neck Cancers include Hugh Curtin, MD, of the Radiology Department at MEEI, and Benjamin Pilch, MD, and William Faquin, MD, of the pathology departments at Massachusetts General Hospital and MEEI. All three are renowned for their expertise in imaging and describing head and neck cancers using the conventional and novel tools of their specialties.
Finally, Edward Peters, DMD, PhD, of the BWH and Center for Head and Neck Cancers brings an unusual perspective to the clinic. In addition to being an expert in dental care for patients with head and neck cancers, Dr. Peters has established a registry for all new cases seen in multiple medical settings in Boston. This registry includes an epidemiologic survey, in addition to samples of normal and malignant tissue. With his associates, Dr. Peters is positioned to eventually link patient specific environmental variables to molecular and genetic cellular phenotypes from stored tissue, and to treatment outcome.
The Center for Head and Neck Cancers is rapidly growing and has a bright future, given the motivation, collegial interactions, and combined expertise of the clinicians and the other members of the center. While functionally independent, the wealth of the center is further enhanced by a strong affiliate relationship with a sister program at DFCI. The combined forces of these programs will ensure that they will maintain local and national leadership positions in the years ahead.
1 Karakoyun-Celik O, Norris CM, Tishler R, Mahadevan A, Clark JR, Goldberg S, Devlin P, Busse PM Definitive radiotherapy with interstitial implant boost for squamous cell carcinoma of the tongue base. Head Neck. 04/25/2005; 27(5); 353-61.
2 Devlin PM, Kazakin J, Adak S, Li Y, Norris CM, Tishler RB, Clark JR, Busse PM, Posner MR Prospective phase II trial of PFL-induction chemotherapy followed by definitive local treatment for advanced squamous cell carcinoma of the head and neck: 10-year follow-up. Am J Clin Oncol. 08/03/2004; 27(4); 369-75.
3 Emerick KS, Mehta A, Pilch BZ, Deschler DG, Busse PM, Rocco JW Pathology quiz case 1. Adenocarcinoma with features of mucinous adenocarcinoma (MAC) and cystadenocarcinoma (CAC). Arch Otolaryngol Head Neck Surg. 12/20/2005; 131(12); 1120, 1122-3.
4 Karakoyun-Celik O, Norris CM, Tishler R, Mahadevan A, Clark JR, Goldberg S, Devlin P, Busse PM Definitive radiotherapy with interstitial implant boost for squamous cell carcinoma of the tongue base. Head Neck. 04/25/2005; 27(5); 353-61.
5 Devlin PM, Kazakin J, Adak S, Li Y, Norris CM, Tishler RB, Clark JR, Busse PM, Posner MR Prospective phase II trial of PFL-induction chemotherapy followed by definitive local treatment for advanced squamous cell carcinoma of the head and neck: 10-year follow-up. Am J Clin Oncol. 08/03/2004; 27(4); 369-75.
6 Cohen EE, Lingen MW, Martin LE, Harris PL, Brannigan BW, Haserlat SM, Okimoto RA, Sgroi DC, Dahiya S, Muir B, Clark JR, Rocco JW, Vokes EE, Haber DA, Bell DW Response of some head and neck cancers to epidermal growth factor receptor tyrosine kinase inhibitors may be linked to mutation of ERBB2 rather than EGFR. Clin Cancer Res. 11/21/2005; 11(22); 8105-8.
7 Furniss CS, McClean MD, Smith JF, Bryan J, Nelson HH, Peters ES, Posner MR, Clark JR, Eisen EA, Kelsey KT Human papillomavirus 16 and head and neck squamous cell carcinoma. Int J Cancer. 04/04/2007; 120(11); 2386-92.
8 Lamont EB, Hayreh D, Pickett KE, Dignam JJ, List MA, Stenson KM, Haraf DJ, Brockstein BE, Sellergren SA, Vokes EE Is patient travel distance associated with survival on phase II clinical trials in oncology? J Natl Cancer Inst. 09/17/2003; 95(18); 1370-5.
9 DeYoung MP, Johannessen CM, Leong CO, Faquin W, Rocco JW, Ellisen LW Tumor-specific p73 up-regulation mediates p63 dependence in squamous cell carcinoma. Cancer Res. 10/04/2006; 66(19); 9362-8.
10 Amrein PC, Clark JR, Supko JG, Fabian RL, Wang CC, Colevas AD, Posner MR, Deschler DG, Rocco JW, Finkelstein DM, McIntyre JF Phase I trial and pharmacokinetics of escalating doses of paclitaxel and concurrent hyperfractionated radiotherapy with or without amifostine in patients with advanced head and neck carcinoma. Cancer. 09/23/2005; 104(7); 1418-27.
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