A study is suggesting that some patients with large tumours on their larynx may preserve their speech by choosing chemotherapy and radiation, and avoiding surgery.
Conducted by researchers at the University of Michigan Comprehensive Cancer Center, the study has shown that a single round of chemotherapy could identify those patients who are 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 Dr. Francis P. Worden, associate professor of Internal Medicine at the U-M Medical School.
For their study, the research team reviewed data from two U-M studies of advanced laryngeal cancer patients, looking specifically at patients who had the largest tumours, called T4.
The researchers point out that besides being large, T4 tumours often invade the nearby cartilage, making them particularly difficult to treat.
They revealed that those participating in the study were administered one round of induction chemotherapy, an initial dose designed to see if the cancer responds.
If the tumour shrank by more than 50 percent after that first round, say the researchers, the participants were given three more rounds of chemotherapy, combined with daily radiation therapy.
They add that the participants whose tumours did not respond to the induction chemotherapy were referred for surgery.
The researchers revealed that 81 per cent of the 36 T4 disease patients enrolled in the two studies responded to the induction chemotherapy, and many saw their tumours 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 also showed that people whose larynx were preserved had better quality of life and less depression than those who had undergone 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. Meanwhile, a large group of patients get to preserve their voice box by avoiding laryngectomy," Worden says.
"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.
A research article describing the study has appeared online in the journal Laryngoscope.