Novel Approach Aims at Improving Survival in Laryngeal Cancer

Researchers at the University of Michigan are hoping to improve the survival rates for laryngeal cancer.
There is a new approach to treat patients with advanced laryngeal cancer to improve survival rates. The approach, which was developed by researchers at the University of Michigan, includes administering a single dose of chemotherapy, continuting with chemoradiotherapy for patients who respond, and referring nonresponders to immediate surgery.
“We received survival rates that were in the 80 percent range,” lead study author Gregory T. Wolf, M.D. explains. “This was so encouraging for us, that we decided to make it our standard approach for patients with advanced laryngeal cancer at the University of Michigan.”

Of the 153 patients with stages 3 and 4 advanced laryngeal cancer who were tested by Wolf et al, 71 received a single cycle of neoadjuvant chemotherapy. Partial tumor response was used to select patients for definitive chemoradiotherapy, whereas nonresponse was an indication for total laryngectomy. Patients with greater than 50 percent reduction were considered responders.

In an interview with CURE, Wolf, professor and chair emeritus of Otolaryngology, Head and Neck Surgery at Michigan Medicine, discussed this trial and his hopes for the future treatment of patients with laryngeal cancer.

Can you give an overview of your study?

What we published was a 10-year review of how we treat patients with all stages of laryngeal cancer. The focus was mainly on patients with advanced stage, that is stage 3 and 4 disease, who are traditionally facing possible total laryngectomy as their treatment. Over the past 20 years or so, we've changed the treatment paradigm for these patients to focus on trying to preserve the larynx using a combination of chemotherapy and radiation as an alternative to total laryngectomy.

Although that approach has been widely adapted and viewed as successful, it's never improved the survival rates that could be achieved with surgery alone. In fact, in some large reviews including SEER data, it looked like during this interval from the 1990s to around 2010, that survival rates for this group of patients might be decreasing and that this corresponded to the increased use of chemoradiation for organ preservation purposes.

Back when combined chemotherapy and radiation approaches were being developed, we decided to capitalize on the observation that patients who achieved a response to induction of neoadjuvant chemotherapy had a very favorable prognosis and that it predicted the success of subsequent radiation therapy. Therefore, we began using a single cycle of chemotherapy as a biological indicator of response and using that to select patients for either chemoradiation, in an attempt to preserve the patient’s larynx, or a primary definitive surgery, being total laryngectomy.

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