Chemotherapy and Radiation Together May Help Save Voicebox
People with cancer of the larynx often face laryngectomy -- surgery to remove the voicebox -- to help stop the spread of the cancer. Now, a new study shows that giving chemotherapy and radiation therapy together can put off the need for a laryngectomy and preserve use of the voicebox longer than the currently established practice of giving chemotherapy followed by radiation.
 The findings of this large, randomized trial establish a new standard of care for cancer of the larynx, said Arlene Forastiere, M.D., of Johns Hopkins Oncology Center in Baltimore, who reported the finding at the annual meeting of the American Society of Clinical Oncology in San Francisco on May 14. [Editor's note: These data were subsequently published in the Nov. 27, 2003, issue of the New England Journal of Medicine. See the journal abstract.]
The trial included 547 patients with locally advanced cancer of the larynx (Stage III and IV) who were randomly assigned to one of three groups. One group received chemotherapy (cisplatin and 5-fluorouracil) followed by radiation therapy, and one received chemotherapy and radiation given concomitantly -- over the same time period. The third group received radiation alone. (See the protocol summary.)
None of the groups survived any longer than any other. However, the time to laryngectomy was significantly greater in the concomitant-therapy group. At two years, 88 percent of these patients still had their voicebox, compared to 74 percent of those who had chemotherapy followed by radiation and 69 percent who had only radiation. The new approach cut the number of laryngectomies needed by 50 percent.
Ten years ago it was standard practice to remove the voicebox in all patients with laryngeal cancer, Forastiere said. Over the past decade, the practice of giving chemotherapy followed by radiation therapy evolved, making it possible to save the voicebox in about 75 percent of patients. The jump to 88 percent now means that many more patients will have an improved quality of life, she said.
However, one disadvantage to concurrent chemotherapy and radiation therapy is the high number and severity of side effects, said Gregory T. Wolf, M.D., a surgeon from the University of Michigan. Appointed to discuss the study following its presentation, Wolf pointed out that 80 percent of the patients who received radiation and chemotherapy together experienced moderate to severe side effects. He also emphasized that there was no survival benefit to using the more toxic therapy.
Wolf recommended continued study to find the optimum ways to improve survival, larynx preservation, and quality of life in patients with laryngeal cancer.
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