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Promise and Progress - In the News: Getting Rid of Larynx Cancer While Saving the Voice Box

Sidney Kimmel Gives Hopkins Its Biggest Gift Ever

In the News: Getting Rid of Larynx Cancer While Saving the Voice Box

Date: December 1, 2002

As recently as a decade ago, the standard method for treating advanced cancer of the larynx, or voice box, was removing the entire organ. To provide patients who no longer had their voice box with the power to speak, physicians offered two methods. One option was learning to talk through their esophagus in the strange, gruntlike sounds that characterize esophageal speech. The other, tinny, robotlike speech made possible by a small electronic speaker implanted in the neck. Both methods were far from satisfactory, and patients often ended up depressed and reluctant to communicate.

Then, in the early ’90s, the ability to shrink and kill tumors of the larynx took a giant step forward. A landmark study demonstrated that the survival rate for larynx cancer patients treated with chemotherapy or radiation was as good as for those who had their larynx removed. Suddenly, about two-thirds of patients didn’t have to face life without their voice box. A full one-third, however, still required the laryngectomy.

Now, Arlene Forastiere, M.D., has reduced that number by 50 percent. In an eight-year trial of more than 500 patients,Forastiere has shown that by giving chemotherapy and radiation therapy at the same time, many patients are able to retain their larynxes and preserve their voices. Though some of the study participants required laryngectomies, 85 percent of patients remain disease-free after receiving the combined drug-radiation therapy. The simultaneous treatment works because the chemotherapy makes the cancer cells more sensitive to radiation.

Radiation oncologist D.J. Lee, M.D., explains it this way, “If you expose 100 cells in a test tube to radiation, 50 cells will die. But, if you inject chemotherapy into the test tube at the same time, 60 or more cells will die.”

Some cells, Forastiere acknowledges, are resistant to both radiation and chemotherapy. “But by giving the treatments together, we can overcome the resistance.”  She makes clear that this new approach is not for everyone.It depends on the tumor size and location. The combination therapy is also more toxic and includes side-effects like low blood counts and swallowing problems. Patients must be evaluated by a head and neck surgeon and an oncologist. If the tumor is small, radiation alone or surgery to remove only a portion of the larynx—preserving the vocal cords—may be recommended. If the cancer is more advanced, removal of the whole organ, known as laryngectomy, may be the best option.

 “Still, we’ve gone from everyone needing their larynx out to only 15 percent,” says Forastiere.