Researchers at the University of Michigan Comprehensive Cancer Center found that determining early into treatment which patients would benefit from the chemoradiation treatment and which would be better off having surgery led to better survival rates than typically expected for this type of cancer.
"Approximately 30 percent to 40 percent of patients with advanced laryngeal cancer will not be cured with chemotherapy and radiation. The survival rates for such patients have traditionally been poor. That's why these patients should be identified as early as possible. When we did that, we found that the survival rate for these patients was markedly improved, as was the survival rate for the group of patients who were successfully treated with chemotherapy and radiation," says study author Gregory Wolf, M.D., professor and chair of otolaryngology at the U-M Medical School.
The study appears in the Feb. 1, 2006 issue of the Journal of Clinical Oncology.
The study looked at 97 patients with advanced-stage laryngeal cancer. The larynx, or voice box, plays a role in breathing, swallowing and talking. Traditional treatment for this type of cancer has been surgery to remove the voice box or part of the voice box, leading to significant quality of life concerns.
In this study, patients began with six days of chemotherapy, after which they were examined to see whether the cancer had shrunk. Tumors shrank by more than half in three-quarters of the patients. These patients then went on to receive radiation therapy five days a week for six to seven weeks, with additional chemotherapy administered once every three weeks.
The 25 percent of patients whose cancer did not respond to the initial chemotherapy were immediately considered for surgery at that point.
Three years later, 85 percent of all the patients in the study were still alive, and 70 percent had preserved their larynx. Traditional survival rates for advanced laryngeal cancer are usually less than 60 percent. Patients in the study who had surgery early on had similar survival to the patients who had organ preservation.
"One cycle of chemotherapy can identify a group of patients whose laryngeal cancer is highly likely to be successfully treated with chemotherapy and radiation. The excellent survival rates may be a result of identifying patients earlier for surgery if they are likely to fail the chemoradiation treatment. Timely integration of surgery may be a critical component in maintaining overall survival rates that are comparable to the results of primary surgery," says study author Susan Urba, M.D., associate professor of internal medicine at the U-M Medical School.
The researchers note that patients from this study faced half the risk of dying after three years compared to previous studies in patients with less advanced laryngeal cancer. Survival rates in this study also beat other recent studies using chemoradiation to treat this type of cancer.
"By matching the appropriate treatment to the patient based on the biology of the tumor, our study showed better cure rates," Wolf says. "While there are significant quality of life benefits to avoiding laryngectomy, intensive combinations of chemotherapy and radiation have some severe long-term quality of life problems as well that would be good to avoid if you could identify those patients ahead of time for whom chemoradiation was not going to work."
An estimated 9,880 people were diagnosed with laryngeal cancer in 2005, according to the American Cancer Society. For more information about laryngeal cancer, visit www.cancer.med.umich.edu/learn/voicebox.htm or call the U-M Cancer AnswerLine at 800-865-1125.
The researchers plan a larger, randomized multicenter trial using this approach in patients with cancers of the tongue base and tonsil.
In addition to Wolf and Urba, U-M study authors were Avraham Eisbruch, M.D., professor of radiation oncology; Francis Worden, M.D., clinical assistant professor of internal medicine; Julia Lee, research associate; Carol Bradford, M.D., professor of otolaryngology; Theodoros Teknos, M.D., associate professor of otolaryngology; Douglas Chepeha, M.D., associate professor of otolaryngology; Mark Prince, M.D., assistant professor of otolaryngology; Norman Hogikyan, M.D., associate professor of otolaryngology; and Jeremy Taylor, Ph.D., professor of biostatistics at the U-M School of Public Health and of radiation oncology at the U-M Medical School.
Funding for the study was from the U-M Specialized Program of Research Excellence (SPORE) grant, the Molecular Basis of Head and Neck Cancer Therapy and the Diane and Sinabaldo Tozzi Research Fund.
Reference: Journal of Clinical Oncology, Vol. 24, No. 4, pp. 593-598