Patients with tongue cancer who started their treatment with a course of chemotherapy fared significantly worse than patients who received surgery first, according to a study by researchers at the University of Michigan Comprehensive Cancer Center, now online ahead of print in JAMA Otolaryngology Head and Neck Surgery (doi:10.1001/jamaoto.2013.5892).
The team note that this is contrary to protocols for laryngeal cancer, in which a single dose of chemotherapy helps determine which patients fare better with chemotherapy and radiation and which patients should elect for surgery. In laryngeal cancer, this approach, which was pioneered at that institution, has led to increased survival and improved functional outcomes.
“To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction,” the senior author, Douglas Chepeha, MD, MSPH, Professor of Otolaryngology–Head and Neck Surgery, said in a news release. “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 (first author is Steven B. Chinn, MD, MPH) enrolled 19 patients with advanced oral cavity cancer, who received an initial dose of chemotherapy. After this induction therapy, patients whose cancer shrunk by half went on to receive additional chemotherapy combined with radiation treatment; those whose cancer did not respond well had surgery followed by radiation.
Enrollment in the trial was actually stopped early because results were so poor. Ten of the patients had a response to the chemotherapy, and of that group, only three had a complete response from the treatment and were cancer-free five years later. Of the nine patients who had surgery after the induction 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 and found significantly better survival rates and functional outcomes.
“The mouth is a very sensitive area,” Chepeha said. “We know the immune system is critical in oral cavity cancer, and chemotherapy suppresses the immune system. Patients who are already debilitated don't do well with chemotherapy.
“Despite the proven success of this 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 with surgery.”