"Save Your Voice" - new hope for laryngeal cancer patients

May 13, 2001

Results of an eight-year national clinical trial show that combining chemotherapy and radiation treatment at the same time offers patients with advanced cancer of the larynx, or voice box, better hope of preserving their voice. The findings are to be presented during the American Society of Clinical Oncology (ASCO) annual meeting on May 12, 2001. Results are published in abstract #4 in the ASCO Program/Proceedings.

"Our study shows that giving chemotherapy and radiation together is more effective in preserving the voice box than giving chemotherapy and radiation sequentially," says Arlene Forastiere, M.D., 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."

Currently, standard treatment options for advanced laryngeal cancer include removing the voice box in a surgical procedure called a laryngectomy, which leaves a patient unable to speak without the assistance of an electronic device. Other options include radiation therapy alone or several cycles of chemotherapy using two different drugs, followed by radiation. Studies from a decade ago showed that chemotherapy followed by radiation was just as effective as a laryngectomy with radiation in terms of survival.

In the new study, 547 patients received either the standard chemotherapy followed by radiation, chemotherapy (using one drug) and radiation together, or radiation alone. Researchers tracked the percentage of patients who had their larynx in place (laryngectomy-free survival) and the percentage of patients who remained disease-free (disease-free survival). In both cases, a significantly higher percentage of patients who received chemotherapy and radiation together were laryngectomy-free (68 percent) and disease-free (63 percent) after two years. A total of 88 percent of patients preserved their larynx after two years though some patients have since died from other causes. "Using chemotherapy and radiation together, the potential to preserve the voice box is almost 90 percent, as compared to 60 percent with radiation alone," explains Forastiere.

Overall survival was the same (76 percent) for all three options after two years. "This suggests that if a patient wants to preserve their voice box with chemotherapy and radiation together, their chances of survival are still very good, even if, later, they may need surgery," explains Forastiere.

Researchers found the only benefit to giving chemotherapy and radiation sequentially was in controlling spread of the cancer to other organs. In fact, researchers saw no significant difference 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 box," says 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."
Laryngeal cancer is diagnosed in approximately 10,000 patients every year, and close to 4,000 Americans will die from the disease.

This research was funded by the National Cancer Institute.

Other research participants include Brian Berkey of the Radiation Therapy Oncology Group; Moshe Maor of the University of Texas M.D. Anderson Cancer Center; Randall Weber of the University of Pennsylvania; Helmuth Goepfert,William H. Morrison and Bonnie S. Glisson of the University of Texas M.D. Anderson Cancer Center; Andy Trotti of the Moffitt Cancer Center at the University of South Florida; John A. Ridge of the Fox Chase Cancer Center; Clifford Chao of Washington University; Glenn Peters of the University of Alabama; D.J. Lee of Johns Hopkins; Andrea Leaf of the Eastern Cooperative Oncology Group; and John Ensley of the Southwest Oncology Group.

American Society of Clinical Oncology (ASCO) Program/Proceedings, Abstract #4, Volume 20, 2001.

Related Web Sites:
Johns Hopkins Oncology Center: www.hopkinscancercenter.org
American Society of Clinical Oncology: www.asco.org

Johns Hopkins Medicine

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