Form and Function:
Curing Head and Neck Cancer is Only Part of the Challenge, page 3
Non-Surgical Options and Tumor GeneticsCommunication was important to Chuck Coté, too. An author and motivational speaker who travels around the country making public appearances to audiences of as many as 2,000 people, Coté thought he'd surely lose his livelihood -- if not his life -- when he was diagnosed with tonsil cancer that had spread to his throat and palate. The doctor who made the initial diagnosis proposed radical surgery that would take part of Coté's jaw and throat and leave him not only disfigured but also unable to speak clearly.
Fortunately, Coté sought a second opinion at U-M, where he learned that for certain cancers, non-surgical treatments are possible. In fact, such approaches have been a major focus of the U-M Head and Neck Oncology Program since 2001, when the program was awarded one of the National Cancer Institute's first Specialized Programs of Research Excellence grants. Spore awards are intended to promote interdisciplinary research and move basic research findings from the laboratory to clinical settings. The expressed goal of the Michigan program was to further the development of organ-preserving treatments, and to personalize them to the individual patient, says gregory Wolf, M.d., professor of otolaryngology.
The first success for this approach was with laryngeal cancer patients, for whom the usual treatment was removal of the voice box. "By combining chemotherapy and radiation, we proved that there were alternatives to total laryngectomy and that cure rates were excellent," Wolf says. But Wolf and coworkers wanted to do a better job of matching treatment regimens to patient needs, and to extend these findings to patients with other types of mouth and throat cancer.
"We wanted to see if we could predict, based on the genes present in a patient's tumor, which patients would respond best to chemotherapy and radiation and which would really need to have surgery," Wolf says. Indeed, tumor genetics, along with patients' responses to chemotherapy test doses, did reveal which patients would do best with which treatment. When patients were screened in this way, some 70% were able to have their voice boxes preserved, and both groups -- those that qualified for voice box-preserving chemotherapy and radiation and those that needed laryngectomy -- did exceptionally well.
"For example, in advanced stage III and stage IV laryngeal cancer, where the traditional cure rate for five years is in the 60 to 70% range, our cure rates are in the high 80 to 90% range," Wolf says. bolstered by that success, the group went on to investigate use of the screening method for patients with other head and neck cancers, including tonsil.
That's how Coté, whose apple-sized tumor already was making breathing and swallowing difficult, was able to avoid mutilating surgery. Enrolled in a clinical trial, Coté responded well enough to a test dose of chemotherapy to be treated with radiation and chemotherapy alone.
Though not as extreme as surgery, these less radical treatments can still have debilitating effects. In particular, radiation to the head and neck can destroy salivary glands and damage muscles involved in swallowing. But advanced radiation techniques pioneered at Michigan 15 years ago precisely target tumors and tissues where the cancer may have spread while sparing normal tissue, says Avraham Eisbruch, M.D., professor of radiation oncology.
"With the combination of radiation and chemotherapy, we now cure the large majority of patients," says Eisbruch, who was Coté's radiation oncologist. "And now that we're curing more patients, the emphasis on reducing long-term complications and side effects and improving long-term quality of life becomes even more important."
Reprinted courtesy of Medicine at Michigan.