New standard for voice saving care of larynx cancer patients

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 November 27, 2003 issue of 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 report.

“Chemotherapy and radiation together are recommended for advanced laryngeal cancer patients who are otherwise in good health and want to preserve their voice,” says Arlene Forastiere, M.D., 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 9,500 Americans will be diagnosed with laryngeal cancer and 3,800 will die from the disease.

Experience with combined treatment, Forastiere adds, has reduced the need for complete removal of the larynx from 100 percent to about 15 percent. Removing the larynx leaves patients unable to speak with their natural voice and 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 shows that giving chemotherapy and radiation together instead of sequentially is more effective in preserving the voice box. 88 percent of patients receiving chemotherapy and radiation together still had their voice box after two years as compared to 75 percent receiving chemotherapy followed by radiation and 70 percent receiving radiation alone. For each of these three treatment options, overall survival was similar at about 75 percent after two years.

“Giving chemotherapy with radiation at the same time makes cancer cells more susceptible to radiation, so effectively more tumor cells are destroyed,” explains Forastiere.

The national study was conducted through centers participating in the Radiation Therapy Oncology Group (RTOG), the Southwest Oncology Group (SWOG), the Eastern Cooperative Oncology Group (ECOG) and was funded by the National Cancer Institute.

Other research participants included Helmuth Goepfert, M.D., Moshe Maor, M.D., Randal Weber, M.D., William Morrison, M.D., Bonnie Glisson, M.D., from the University of Texas M.D. Anderson Cancer Center; Thomas F. Pajak, Ph.D., from the RTOG; Andy Trotti, M.D., from the H. Lee Moffitt Cancer Center and Research Institute; John A. Ridge, M.D., Ph.D., from the Fox Chase Cancer Center; Glen Peters, M.D., from the University of Alabama; Andrea Leaf, M.D., from the New York Harbor Healthcare System; John Ensley, M.D., from the Karmanos Cancer Institute at Wayne State University School of Medicine; Jay Cooper, M.D., from New York University Medical Center and Ding-Jen Lee, M.D., Ph.D., from the Johns Hopkins Kimmel Cancer Center.

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