The combination of chemotherapy and radiation offers patients with advanced cancer of the larynx greater hope of preserving
The combination of chemotherapy and radiationoffers patients with advanced cancer of the larynx greater hope of preserving vocal capabilities, according to the results ofan 8-year Radiation Therapy Oncology Group (RTOG) study presented at the annualmeeting of the American Society of Clinical Oncology (ASCO).
"Our study shows that giving chemotherapy and radiationtogether is more effective in preserving the voice box than giving chemotherapyand radiation sequentially," said Arlene Forastiere, MD, professor ofoncology and otolaryngology at the Johns Hopkins Oncology Center and director ofthe study. "In this case, the chemotherapy is augmenting the effects of theradiation, and this synergy is being studied for other head and neck cancers aswell."
Standard treatment options for advanced laryngeal cancer includelaryngectomy (which leaves a patient unable to speak without the assistance ofan electronic device), radiation therapy alone, or chemotherapy followed byradiation. Previous studies showed that chemotherapy followed by radiation wasas effective as a laryngectomy plus radiation in terms of survival.
In the new study, 547 patients received standard chemotherapyfollowed by radiation, chemotherapy and radiation together, or radiation alone.
Researchers tracked the percentage of patients who retainedtheir larynx and the percentage who remained disease-free. In both cases, asignificantly higher percentage of patients who received the combination ofchemotherapy and radiation did not require laryngectomy (68%) and weredisease-free (63%) after 2 years. In total, 88% of patients preserved theirlarynx after 2 years. "Using chemotherapy and radiation together, thepotential to preserve the voice box is almost 90%, as compared to 60% withradiation alone," said Dr. Forastiere.
Overall survival was the same (76%) for all three options after2 years. "This suggests that if patients want to preserve their voice boxeswith chemotherapy and radiation together, their chances of survival are stillvery good, even if, later, they may need surgery," said Dr. Forastiere.Researchers found the only benefit to giving chemotherapy and radiationsequentially was in controlling metastasis to other organs. In fact, researcherssaw no significant difference when comparing chemotherapy followed by radiationto radiation alone.
"Chemotherapy and radiation together would be recommendedfor advanced laryngeal cancer patients who are otherwise in good health and wantto preserve their voice boxes," said Dr. Forastiere. "For patients whohave other significant medical problems or little support at home, we wouldrecommend radiation alone. In all cases, patients should be followed closelyduring treatment by a head and neck surgeon, so that surgery can be performed ifthere is residual or recurrent cancer after treatment."