Form and Function:
Curing Head and Neck Cancer is Only Part of the Challenge, con't
Non-Surgical Options and Tumor Genetics
Communication 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.
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