Patients with tongue cancer who undergo surgery before receiving radiation therapy fare better than those who begin with chemotherapy, according to a study published online December 26 in JAMA Otolaryngology -- Head & Neck Surgery.
This is contrary to protocols for larynx cancer, in which a single dose of chemotherapy helps determine which patients fare better with chemotherapy and radiation and which patients should have surgery, according to a press release from the University of Michigan.
"To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction," said study author Dr. Douglas Chepeha, professor of otolaryngology at University of Michigan Medical School. "But patients with oral cavity cancer can't tolerate induction chemotherapy as well as they can handle surgery with follow-up radiation. Our techniques of reconstruction are advanced and offer patients better survival and functional outcomes."
The study enrolled 19 people with advanced oral cavity cancer. Patients received an initial dose of chemotherapy, and those whose cancer shrunk by half went on to receive additional chemotherapy combined with radiation. Those whose cancer did not respond had surgery followed by radiation.
Ten of the patients had a response to the chemotherapy, and of that group, only three had a complete response and were cancer-free five years later. Of the nine patients who had surgery after chemotherapy, only two were alive and cancer-free after five years.
The researchers then looked at a comparable group of patients who had surgery and sophisticated reconstruction followed by radiation therapy. This group had significantly better survival rates and functional outcomes.
"Despite the proven success of [the chemotherapy] strategy in laryngeal cancer, induction chemotherapy should not be an option for oral cavity cancer, and in fact it results in worse treatment-related complications compared to surgery," Dr. Chepeha noted.
