Cancer of the Mouth and Throat: Adding Chemotherapy to Radiation Therapy
Cancer of the mouth or throat is commonly treated with surgery and radiation therapy. When the cancer cannot be removed with surgery, radiation therapy is often used alone. Researchers in Germany now report that the use of chemotherapy with radiation therapy may be more effective than radiation therapy alone for persons with advanced mouth and throat cancer.
Cancer of the throat and mouth is characterized by the presence of cancer cells in the throat and/or the mouth, which may include the tissues of the lip, gums, the inside of the cheeks, the bottom of the mouth under the tongue, the top of the mouth, and the tongue. When the cancer is advanced, or metastasized, this means the cancer has spread to tissues outside the mouth and throat, to lymph nodes, and/or to other parts of the body. Treatment for mouth or throat cancer usually includes surgery to remove the cancer, followed by radiation therapy, the use of high-energy rays applied directly to the cancer site. The use of chemotherapy, using drugs to kill cancer, and the use of hyperthermia, the use of heat to help kill cancer, are being studied in clinical trials. If the cancer cannot be removed by surgery, a person with this type of cancer may receive radiation therapy alone or treatment with chemotherapy or hyperthermia as part of a clinical trial.
Researchers in Germany assigned 226 persons with advanced stage III and IV mouth and throat cancer to receive either radiation therapy alone or radiation therapy plus chemotherapy. The chemotherapy regimen consisted of 3 cycles of a 4-day regimen of the drugs carboplatin and fluorouracil.
The results showed that 3-year survival was 51% in the group that received chemotherapy, and only 31% in the group that did not. A recurrence of cancer (return of cancer either in the mouth and throat or in another part of the body) occurred in 58% of those who received the chemotherapy, compared with 80% of those who received radiation therapy alone. Control of local cancer (cancer cells present in the mouth and throat only) was successful in 66% of persons receiving the combination treatment, compared with only 42% in those receiving radiation therapy alone. While these findings suggest that the combination treatment is more effective, there were also some increased side effects in those who received the chemotherapy. Specifically, increased inflammation of the mouth and more frequent and profound lowering of blood counts occurred in those receiving the combination treatment. Side effects that affect the skin were the same in both groups.
These researchers concluded that, in persons for whom surgery cannot be used to remove cancer of the mouth or throat, radiation therapy plus chemotherapy should be considered as a preferred treatment. (
Journal of the National Cancer Institute, Vol 91, No 4, pp 2081-2086, 1999)
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