Neoadjuvant Chemotherapy Useful in Selecting Laryngeal Cancer Treatment

Highlights

• Laryngeal cancer is a cancer that affects the throat
• Smoking and high alcohol consumption are important risk factors
• The optimal treatment for laryngeal cancer is based on neoadjuvant chemotherapy for select patients

The use of neoadjuvant chemotherapy for a selection of patients for the treatment they are most likely to respond to has been suggested by a research team from University of Michigan Comprehensive Cancer Center. Their research was published in the JAMA Otolaryngology - Head and Neck Surgery. The larynx is the voice box in the throat which contains the vocal cords that move and vibrate to produce sounds. Smoking and excessive alcohol intake particularly increase the risk for cancer of the larynx. Though surgery, radiation and chemotherapy are available for its treatment, the outcomes are not very good especially for advanced cases. The chances of survival for early stage cancers are 60 to 90%, while that for later stages are between 50 to 60%.

A partial surgical removal of the larynx preserves the voice, but a total laryngectomy results in loss of the ability to speak and affects the quality of life of the patient. Though radiotherapy and chemotherapy can preserve the larynx, the survival rates following these treatments for advanced laryngeal cancer are not as good as compared to those for primary surgery. 

There are still controversies regarding the ideal treatment for advanced laryngeal cancer. Therefore, the research team tried to find out if individualized treatments based on neoadjuvant chemotherapy could improve the outcomes for patients with advanced laryngeal cancer. Their data was based on the patients they had treated over a period of 11 years between 2002 and 2012. Neoadjuvant chemotherapy treatment refers to the chemotherapy treatment administered before the definitive treatment. It helps to reduce the size of cancer and make subsequent treatment easier and more effective. Based on the results of this treatment, further therapeutic course was decided. For example, those who improved were given chemo-radiation so that their larynx could be preserved, while those who did not undergo laryngectomy.

Among the patients with stage 3 and stage 4 laryngeal cancer:

• 71 out of the 153 patients received neoadjuvant chemotherapy with cisplatin and fluorouracil or carboplatin. The remaining patients directly opted for surgery or chemo-radiation
• If the patients had a partial response to neoadjuvant chemotherapy, that is, more than 50% reduction in the size of the tumor, they were administered definitive chemo-radiotherapy
• If they did not respond based on the size of the tumor on endoscopy and CT/MRI images, they underwent total laryngectomy followed by radiation
• The patients were followed up weekly for a period of 48 months

Some of the findings of their study were as follows:

• Following neoadjuvant treatment, 22% patients received chemo-radiotherapy while the remaining required laryngectomy
• Primary surgery and selection of patients based on neoadjuvant treatment improved overall survival (OS) and disease-specific survival (DSS) as compared to the use of primary chemo-radiotherapy
• The 5-year disease – specific survival (DSS) for advanced laryngeal cancer with neoadjuvant treatment was around 80%. It was much better than in those who underwent primary chemo-radiotherapy (66%)
• Those who underwent primary chemo-radiotherapy had the highest rate of preservation of the larynx. It must however be remembered that chemo-radiotherapy may affect the function of the larynx over a longer duration and could result in symptoms of difficulty with swallowing and chronic aspiration.
• Patients who underwent primary laryngectomy and salvage laryngectomy did well, and better than those who underwent definitive chemo-radiotherapy therefore reiterating the important role of surgery in the treatment of advanced laryngeal cancer
• Most patients experienced mild adverse effects during treatment with the neoadjuvant chemotherapy. One patient however, suffered from liver failure.

The study emphasizes the importance of carefully selecting the treatment for advanced laryngeal cancer on an individualized basis to obtain the best results. More studies in a larger number of patients will hopefully bring more clarity to the treatment of advanced laryngeal cancer.

References:

1. Wolf G et al. Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2016.3669
2. Laryngeal Cancer Treatment (PDQ®)–Patient Version - (https://www.cancer.gov/types/head-and-neck/patient/laryngeal-treatment-pdq)

Source-Medindia