Early evaluation of response to chemotherapy can identify patients with advanced laryngeal cancer who should have surgery rather than continue with chemoradiation, improving survival rates for both treatment types, according to an article in the February 1 issue of the Journal of Clinical Oncology.

“Approximately 30 percent to 40 percent of patients with advanced laryngeal cancer will not be cured with chemotherapy and radiation. The survival rates for such patients have traditionally been poor. That’s why these patients should be identified as early as possible. When we did that, we found that the survival rate for these patients was markedly improved, as was the survival rate for the group of patients who were successfully treated with chemotherapy and radiation,” said coauthor Gregory Wolf, MD, professor and chair of otolaryngology at the University of Michigan Medical School.

The US study evaluated 97 patients with advanced laryngeal cancer. All patients began with six days of chemotherapy, after which they were examined to see whether the tumor had shrunk. Tumors shrank by more than 50 percent in three quarters of the patients. These patients then received radiation five days a week for six to seven weeks, with additional chemotherapy administered once every three weeks.

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 were still alive, and 70 percent had preserved their larynx. Traditional survival rates for advanced laryngeal cancer are usually less than 60 percent. Patients in the study who had surgery early on had similar survival to the patients who had organ preservation.

“One cycle of chemotherapy can identify a group of patients whose laryngeal cancer is highly likely to be successfully treated with chemotherapy and radiation. The excellent survival rates may be a result of identifying patients earlier for surgery if they are likely to fail chemoradiation. Timely integration of surgery may be a critical component in maintaining overall survival rates that are comparable to the results of primary surgery,” said lead author Susan Urba, MD.

The researchers noted that this series of patients faced half the risk of death after three years compared with previous studies in patients with less advanced laryngeal cancer. Survival rates in this study also were better than those cited in other recent studies using chemoradiation to treat advanced laryngeal cancer.

“By matching the appropriate treatment to the patient based on the biology of the tumor, our study showed better cure rates,” Wolf concluded. “While there are significant quality of life benefits to avoiding laryngectomy, intensive combinations of chemotherapy and radiation have some severe long-term quality of life problems as well that would be good to avoid if you could identify those patients ahead of time for whom chemoradiation was not going to work.”

The researchers plan a larger, randomized multicenter trial using this approach in patients with cancers of the tongue base and tonsil.