Concurrent Chemotherapy and Radiation Helps Spare Patients' Larynxes

Undergoing chemotherapy at the same time as radiation therapy helps patients with laryngeal cancer keep their larynxes, according to a new study presented October 7, 2002, at the American Society for Therapeutic Radiology and Oncology's Annual Meeting in New Orleans.

The larynx, also known as the voice box, is part of the respiratory tract and contains the vocal cords. One treatment for cancer of the larynx is laryngectomy, the surgical removal of the larynx. Following a laryngectomy, patients breathe through a permanent opening in the neck called a stoma and may need to learn an entirely new method of speech. To increase the quality of life of patients with this type of cancer, researchers set out to evaluate several treatment options that may help patients avoid a laryngectomy.

Patients were eligible for this study if they were newly diagnosed with stage III and IV squamous carcinoma of the glottic and supraglottic region. Patients with a T1 or a high-volume T4 tumor were excluded from the study. A total of 547 patients were randomly assigned to three treatment arms. The first arm received the chemotherapy drugs cisplatin and flourouracil, followed by radiation if the patient responded to the chemotherapy. The second arm received concurrent cisplatin along with radiation therapy. Patients in arm three received radiation only. After the completion of therapy, 517 patients (173 in the first arm, 172 in the second arm and 172 in the third arm) were analyzed.

At two years, the laryngeal preservation rate for the patients treated with concomitant chemotherapy and radiotherapy was significantly better than for patients treated with sequential chemotherapy and radiotherapy or with radiotherapy alone. Far fewer patients in that group required a laryngectomy. Loco-regional control was also better for the concomitant group. There were no significant differences between the group that received chemotherapy followed by radiation and the group that received just radiation.

"Our findings demonstrate that concurrent chemotherapy and radiation treatment is superior to chemotherapy followed by radiation and radiation alone when attempting to preserve a patient's larynx," said Moshe H. Maor, M.D., F.A.C.R., Professor in the Department of Radiation Oncology at the University of Texas M.D. Anderson Cancer Center and lead author of the study. "We can now offer patients an excellent therapy that can spare them the lifelong effects of a total laryngectomy."