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Oral Cancer

Oral surgery trial helps change clinical practice for early-stage mouth cancers

A five-year TFRI funded project focused on improving outcomes for Canadians diagnosed with early-stage oral cancers has wrapped up, with the lead investigator stating the work has helped to change clinical practice for patients.

“This project [was] really able to change the clinical practice, not only in Canada, but around the world,” said Dr. Catherine Poh, noting that results from the Pan-Canadian Phase III clinical trial have been very positive.

Poh, a senior scientist with BC Cancer Agency, led the five-year, TFRI-funded, Canada-wide surgical trial to remove tumours and pre-cancerous cells from the mouths of those diagnosed with early-stage oral cancers. Currently, about 30 per cent of patients who receive oral surgery have their cancer recur.

Researchers from seven different centres in five different provinces worked to counter these grim statistics through the Canadian Optically Guided Approach for Oral Lesions Surgical Trial (The COOLS Study, 2010-2015).

COOLS used fluorescence visualization (FV) or "blue light" rather than traditional white light to determine the tissue that needs to be removed during surgery. Under the hand-held blue light, normal tissue generates a fluorescence that is absent in tumour or pre-cancerous tissue. More than 400 patients took part in the trial, and hundreds of tissue samples were collected for future research.

“So many of my patients come to the clinic without knowing that mouths can even have cancer,” said Poh “Many people come in with late-stage disease, so the survival is poor - one in two patients will die within five years of diagnosis.”

The main goal of the study was to spare normal, healthy tissue from surgery while catching high-risk, pre-cancerous tissue identified through FV – all the while decreasing tumour recurrence. Each site centre has a team of pathologists, head and neck surgeons, oral specialists, and research nurses. This was the first Canadian study ever to bring together this group of clinicians to address a surgical challenge in oral cancer.

Further, the project’s cost was minimal because the light source can be reused, added Dr. Poh, noting that many surgeons of the site centers have adopted this technique and are now using the device continuously to treat their patients.

Project Title: Efficacy of optically guided surgery in the management of early-stage oral cancer: The Canadian optically guided approach for oral lesions surgical (COOLS) trial; Terry Fox Research Institute Translational Cancer Research Project (2010-2015)

Investigators: Catherine Poh, Scott Durham and Stuart Peacock, UBC; Miriam Rosin, Kitty Corbett, SFU; Calum MacAulay, BC Cancer Agency; Joseph Dort, University of Calgary; Hadi Seikaly, University of Alberta; Paul Kerr, Health Sciences Center, Winnipeg, Manitoba; Kevin Higgins, Sunnybrook Odette Cancer Center; John Yoo, London Health Sciences Center; Robert Hart, Dalhousie University.

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