Sequential & Alternating Chemotherapy & Radiation Therapy Similarly Effective
Among patients with operable, advanced squamous cell cancer of the larynx or hypopharynx, two different approaches to the delivery of chemotherapy and radiation therapy produced similar rates of larynx preservation and survival. These results were published in the Journal of the National Cancer Institute.
The larynx contains the vocal cords, which vibrate to make sound when air is directed against them. Each year in the United States, there are more than 12,000 new diagnoses of larynx cancer.
Conventional treatment of patients with advanced, non-metastatic larynx cancer involves removal of the larynx (total laryngectomy). This eliminates the ability of the patient to speak. An advance in the treatment of larynx cancer has been the development of larynx-preserving therapies. Combinations of chemotherapy and radiation therapy, for example, allow some patients to avoid larynx removal without compromising survival.
Sequential therapy is one approach to the delivery of chemotherapy and radiation therapy for larynx cancer. In this approach, chemotherapy is given first and patients who respond to this treatment are given additional treatment with radiation therapy. Patients who do not respond are treated with laryngectomy.
A more recent approach is concurrent therapy. In this approach chemotherapy and radiation therapy are given at the same time. This approach appears to result in higher rates of larynx preservation but also has more side effects.
Alternating therapy refers to chemotherapy followed by radiation therapy followed by more chemotherapy, and so on. For example, chemotherapy may be given during weeks 1, 4, 7, and 10, with radiation therapy given during weeks 2-3, 5-6, and 8-9. Researchers hypothesized that this approach to treatment could provide a similar degree of local cancer control as concurrent therapy but with fewer side effects.
To evaluate alternating therapy, researchers in Europe conducted a Phase III clinical trial among 450 patients with operable, advanced, squamous cell cancer of the larynx or hypopharynx. Half the patients received alternating therapy and half the patients received sequential therapy. Chemotherapy involved cisplatin and 5-FU. In both groups, patients who did not respond to treatment underwent laryngectomy.
Patients have now been followed for over six years. Rates of larynx preservation, overall survival, and progression-free survival did not differ significantly between the two groups. Acute side effects such as mucositis appeared to be less common among patients treated with alternating therapy than among patients treated with sequential therapy.
These results indicate that sequential and alternating chemotherapy and radiation therapy are similarly effective. Given that the alternating approach did not improve outcomes, the researchers concluded: “It is clear that the optimal approach for larynx preservation has still not been identified. Several treatment options are available, each with different levels of tolerability but little difference in outcome.”
New approaches to larynx preservation continue to be explored, including new chemotherapy combinations and the use of newer targeted drugs. Patients with larynx cancer may wish to talk with their doctor about the risks and benefits of participating in a clinical trial.
Reference: Lefebvre JL, Rolland F, Tesselaar M et al. Phase 3 randomized trial on larynx preservation comparing sequential vs alternating chemotherapy and radiotherapy. Journal of the National Cancer Institute [early online publication]. January 27, 2009.