Combo Approach Saves Voice Box in Patients With Larynx Cancer
May 17, 2001 (San Francisco) -- Ten years ago there was only one treatment for cancer of the larynx, or voice box -- to completely remove the voice box. But taking this drastic step leaves patients permanently disfigured and significantly impacts their quality of life.
A new treatment described here this week at the annual meeting of the American Society of Clinical Oncology promises to brighten this dim picture. According to research presented, 88% of people taking part in a treatment that combines radiation and chemotherapy were able to keep their voice box.
When the voice box is taken out, it leaves an opening in the neck, called a stoma, through which the patient breathes, coughs, and sneezes. The patient must also learn to talk in a new way, either by forcing air out through the esophagus, called esophageal speech, or with the aide of a mechanical voice box.
People who have had this procedure must keep the stoma covered when showering and shaving, and they usually have to avoid activities like swimming or water skiing.
Being able to keep the voice box -- thereby not having to deal with a stoma -- constitutes "a significant improvement in quality of life for these patients," says researcher Arlene Forastiere, MD, a cancer specialist at Johns Hopkins University in Baltimore.
A sizeable number of people will benefit from the treatment, according to Forastiere, who says that 10,000 Americans are diagnosed with laryngeal cancer each year, and about 4,000 people die from it. Risk factors for this type of cancer include smoking and alcohol use, she says, and it is most often diagnosed in older men.
At the meeting, Forastiere reported that when laryngeal cancer patients were treated simultaneously with radiation and two powerful chemotherapy drugs, cisplatin and 5-fluorouracil, or 5-FU, only 12% required surgery to remove the voice box.
But when patients were treated sequentially -- that is, when they were given the drugs first and then the radiation -- 26% needed the radical surgery called larnygectomy.
"Patients who underwent radiation alone fared even worse, with laryngectomy required by 31% of this group," she says.
Forastiere was reporting results of a multicenter study of 547 patients with locally advanced laryngeal cancer, meaning a cancer that had spread from the initial tumor but was still confined to the larynx. The patients were randomly assigned to one of the three treatment arms. Patients who received chemotherapy were treated with three cycles of the drugs.
Forastiere says that the timing of the chemotherapy and radiation treatments appears to make the critical difference in preserving the voice box. She says the study results are so striking that "this should now become the standard treatment." The current standard treatment is chemotherapy, followed by radiation and followed by surgery if needed.
Michael S. Gordon, MD, associate dean for research at the University of Arizona Health Sciences Center, tells WebMD that patients with stomas "are always at risk for infection and have a constant risk for aspiration of food and other substances into the lungs." The difficulty they have eating can also put them at risk for anorexia, he says.
"In treating cancer patients, our goal is always to avoid any disfiguring treatment," says Gordon. A laryngectomy, he says, "often leaves a patient stigmatized with difficulties performing activities of daily living." While some patients adjust very well to living with a stoma, many do not, he says.