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.
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
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
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