U-M study finds voice box can be preserved, even with the largest cancers

June 25, 2009

ANN ARBOR, Mich. -- Some patients with large tumors on their larynx can preserve their speech by opting for chemotherapy and radiation over surgery to remove the voice box.

A new study from the University of Michigan Comprehensive Cancer Center found that a single round of chemotherapy could identify those patients most likely to benefit from this approach.

"Organ preservation studies have excluded these patients because their tumors are so large. We found that if a patient's tumor does not respond to chemotherapy, the patient can be instantly referred for a laryngectomy, which is the standard of care. But if the tumor responded to the drugs, perhaps some of those people could survive the cancer with their voice box intact," says lead study author Francis P. Worden, M.D., associate professor of internal medicine at the U-M Medical School.

Researchers reviewed data from two U-M studies of advanced laryngeal cancer patients, looking specifically at patients who had the largest tumors, called T4. In addition to being large, T4 tumors have often invaded the nearby cartilage, making them particularly difficult to treat.

Study participants were given one round of induction chemotherapy, an initial dose designed to see if the cancer responds. If the tumor shrank by more than 50 percent after that first round, study participants were given three more rounds of chemotherapy, combined with daily radiation therapy.

Those whose tumors did not respond to the induction chemotherapy were referred for surgery.

Thirty-six people with T4 disease were enrolled in the two studies. Eighty-one percent responded to the induction chemotherapy and many saw their tumors shrink completely. After three years, 78 percent of the T4 study participants were still alive, and 58 percent still had an intact larynx.

Results of the study appear online in the journal Laryngoscope.

While chemotherapy and radiation come with unpleasant and serious side effects, avoiding surgery allows patients to retain their voice. The study found that people who preserved their larynx reported better quality of life and less depression than those who had surgery. Few people required a feeding tube or tracheostomy.

"If the patient failed chemotherapy up front, he or she could go straight to surgery and avoid the side effects of chemo-radiation," Worden says. "Meanwhile, a large group of patients get to preserve their voice box by avoiding laryngectomy."

"We saw no survival difference between the smallest and the largest tumors, which suggests that organ preservation is a viable alternative to surgery for some of the largest laryngeal cancers," he adds.

Laryngeal cancer statistics: 12,290 Americans will be diagnosed with laryngeal cancer this year and 3,660 will die from the disease, according to the National Cancer Institute
-end-
Additional authors: Jeffrey Moyer, M.D.; Julia S. Lee; Jeremy M.G. Taylor, Ph.D.; Susan G. Urba, M.D.; Avraham Eisbruch, M.D.; Theodoros N. Teknos, M.D.; Douglas B. Chepeha, M.D.; Mark E. Prince, M.D.; Norman Hogikyan, M.D.; Amy Anne D. Lassig, M.D.; Kevin Emerick, M.D.; Suresh Mukherji, M.D.; Lubomir Hadjiski, Ph.D.; Christina I. Tsien, M.D.; Tamara H. Miller; Nancy E. Wallace; Heidi L. Mason, N.P.; Carol R. Bradford, M.D.; and Gregory T. Wolf, M.D.

Funding: National Institutes of Health, U-M Head and Neck Cancer SPORE grant, U-M Comprehensive Cancer Center support grant

Reference: Laryngoscope, DOI: 10.1002/lary.20294

Resources:
U-M Cancer AnswerLine, 800-865-1125
U-M Comprehensive Cancer Center, www.mcancer.org

University of Michigan Health System

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.