Surgery or Chemo?

Determining the Best Treatment Early Improves Survival Rates for Laryngeal Cancer Patients

In the past, treating cancer of the larynx, or voice box, usually meant disfiguring surgery to remove the larynx. Chemotherapy with radiation can be an effective alternative for many patients, but it doesn’t work for everyone.

In a new study conducted at the U-M’s Comprehensive Cancer Center, researchers found that determining early in treatment which patients would benefit from chemo-radiation treatment, and which would be better off with surgery to remove the larynx, led to better survival rates than typically expected for this type of cancer.

Gregory Wolf and Susan Urba with Kathleen Glaser, a patient who participated in the study Photo: Lin Jones

“Approximately 30 to 40 percent of patients with advanced laryngeal cancer will not be cured with chemotherapy and radiation, and survival rates have traditionally been poor,” says study author Gregory Wolf (M.D. 1973), professor and chair of otolaryngology at the U-M Medical School. “That’s why these patients should be identified and treated with surgery as early as possible.”

In this study of 97 patients with advanced-stage laryngeal cancer, patients had six days of chemotherapy, after which they were examined to see whether the cancer had shrunk. Tumors shrank by more than half in three-quarters of the patients. These patients then went on to receive radiation therapy for six to seven weeks, with additional chemotherapy. The 25 percent of patients whose cancer did not respond to the initial chemotherapy were immediately considered for surgery.

Three years later, 85 percent of all patients in the study were still alive, and 70 percent still had their larynx. Traditional survival rates for advanced laryngeal cancer are usually less than 60 percent. Patients in the study who had early surgery had similar survival to patients receiving chemo-radiation treatment.

“One cycle of chemotherapy can identify patients whose cancer is likely to be successfully treated with chemotherapy and radiation,” says Susan Urba (M.D. 1983), associate professor of internal medicine. “The excellent survival rates in our study may be a result of identifying patients earlier for surgery, if they are likely to fail the chemo-radiation treatment.”

—Nicole Fawcett

Read an expanded version of the story:
www.med.umich.edu/opm/newspage/2006/laryngeal.htm

For patient information on laryngeal cancer:
www.cancer.med.umich.edu/learn/voicebox.htm