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 well."
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.
Laryngeal Preservation
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."
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
