The combination of chemotherapy and radiation
offers patients with advanced cancer of the larynx greater hope of preserving vocal capabilities, according to the results of
an 8-year Radiation Therapy Oncology Group (RTOG) study presented at the annual
meeting of the American Society of Clinical Oncology (ASCO).
"Our study shows that giving chemotherapy and radiation
together is more effective in preserving the voice box than giving chemotherapy
and radiation sequentially," said Arlene Forastiere, MD, professor of
oncology and otolaryngology at the Johns Hopkins Oncology Center and director of
the study. "In this case, the chemotherapy is augmenting the effects of the
radiation, and this synergy is being studied for other head and neck cancers as
Standard treatment options for advanced laryngeal cancer include
laryngectomy (which leaves a patient unable to speak without the assistance of
an electronic device), radiation therapy alone, or chemotherapy followed by
radiation. Previous studies showed that chemotherapy followed by radiation was
as effective as a laryngectomy plus radiation in terms of survival.
In the new study, 547 patients received standard chemotherapy
followed by radiation, chemotherapy and radiation together, or radiation alone.
Researchers tracked the percentage of patients who retained
their larynx and the percentage who remained disease-free. In both cases, a
significantly higher percentage of patients who received the combination of
chemotherapy and radiation did not require laryngectomy (68%) and were
disease-free (63%) after 2 years. In total, 88% of patients preserved their
larynx after 2 years. "Using chemotherapy and radiation together, the
potential to preserve the voice box is almost 90%, as compared to 60% with
radiation alone," said Dr. Forastiere.
Overall survival was the same (76%) for all three options after
2 years. "This suggests that if patients want to preserve their voice boxes
with chemotherapy and radiation together, their chances of survival are still
very good, even if, later, they may need surgery," said Dr. Forastiere.
Researchers found the only benefit to giving chemotherapy and radiation
sequentially was in controlling metastasis to other organs. In fact, researchers
saw no significant difference when comparing chemotherapy followed by radiation
to radiation alone.
"Chemotherapy and radiation together would be recommended
for advanced laryngeal cancer patients who are otherwise in good health and want
to preserve their voice boxes," said Dr. Forastiere. "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."