Register for New standard for voice-saving care of patients introduced
Larynx CancerDecember 24, 2003
Results of a national clinical trial confirm that simultaneous treatment with chemotherapy and radiation preserves the voice of patients with advanced larynx cancer without compromising survival rates.
The findings, reported in the New England Journal of Medicine, are compelling enough to have the combination treatment become the standard of care for such patients, the study's authors reported.
"Chemotherapy and radiation together are recommended for advanced laryngeal cancer patients who are otherwise in good health and want to preserve their voice," said Arlene Forastiere, MD, professor of oncology and otolaryngology at the Johns Hopkins Kimmel Cancer Center and chair of the study. "For patients who have other significant medical problems or little support at home, we would recommend radiation alone. In all cases, patients should be followed closely during treatment by a head and neck surgeon, so that surgery can be performed if there is residual or recurrent cancer after treatment." This year, approximately 9500 Americans will be diagnosed with laryngeal cancer and 3800 will die from the disease.
Experience with combined treatment, Forastiere added, has reduced the need for complete removal of the larynx from 100% to about 15%. Removing the larynx leaves patients unable to speak with their natural voice and they typically use speaking aids such as an electronic device. Other previously studied treatment options included radiation therapy alone or several cycles of chemotherapy followed by radiation. Studies from a decade ago showed that the survival rate of patients treated with chemotherapy followed by radiation was just as good as those receiving surgery.
This new study of 547 patients showed that giving chemotherapy and radiation together instead of sequentially is more effective in preserving the voice box. Eighty-eight percent of patients receiving chemotherapy and radiation together still had their voice box after 2 years, compared to 75% receiving chemotherapy followed by radiation and 70% receiving radiation alone. For each of these three treatment options, overall survival was similar at about 75% after 2 years.
"Giving chemotherapy with radiation at the same time makes cancer cells more susceptible to radiation, so effectively more tumor cells are destroyed," explained Forastiere.
The national study was conducted through centers participating in the Radiation Therapy Oncology Group (RTOG), the Southwest Oncology Group (SWOG), and the Eastern Cooperative Oncology Group (ECOG) and was funded by the U.S. National Cancer Institute (Forastiere AA, Goepfert H, Maor M, et al., Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med, 2003;349(22):2091-8). This article was prepared by Health & Medicine Week editors from staff and other reports.
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