UF study finds radiation as effective as surgery for vocal cord cancer

Radiation therapy can cure throat cancer as effectively as surgery while preserving people’s vocal cords and voices, University of Florida researchers have found.

The study, published last month in the Journal of Clinical Oncology, determined that the key was avoiding the common practice of giving patients breaks in radiation therapy to ease side effects such as hoarseness, sore throat and sensitivity. Such side effects routinely occur during the course of the daily, 5 ½-week radiation therapy, in which high-dose X-rays or other high-energy rays are used to kill cancer cells and shrink tumors.

Doctors and researchers have debated extensively about the best way to treat early-stage cancer of the larynx, which contains the vocal cords and is used for breathing, swallowing and talking. The American Cancer Society estimates that each year in the United States 12,000 people are diagnosed with the disease and another 4,000 die from it.

Mainly caused by the use of tobacco, which damages squamous cells that line the inside of the larynx, this type of cancer is more common in men and usually is detected in people in later life.

While radiation therapy preserves people’s voices, some past research has found that cure rates were not as high as when the cancerous tissue was surgically removed. Surgery, however, involves removing all or part of the vocal cords, which may require the patient to learn new ways to talk or use special vocal devices.

In the UF study – one of the largest of its kind in the United States with some of the longest follow-ups on individual cases – researchers found radiation therapy to be just as effective in curing the disease as surgery without the voice consequences.

“With this treatment technique, the probability of cure is very high – over 90 percent survival from cancer – and the chance of retaining a useful larynx with good voice quality is excellent with low risk of complications,” said William M. Mendenhall, M.D., the study’s principal investigator.

“When patients don’t feel good, it’s tempting to give them some time off – a few days or even a week. But the problem is that the tumor has a chance to start to regrow when you do that. By extending the overall treatment time, your failure rate goes up,” said Mendenhall, a professor of radiation oncology with the UF College of Medicine.

The study, which followed the progress of 519 patients from two years to 35 years after they were initially treated with radiation therapy at the UF Shands Cancer Center, also determined it is unnecessary to radiate the lymph nodes of the neck in early vocal cord cancer. Median age of the patients in the study was 63, and only three, all of whom were free of laryngeal cancer, were lost in the follow-up process because of unrelated deaths.

Radiation therapy works by damaging the genetic material in cells, making it impossible for them to continue to grow. It affects both cancerous and normal cells, however, so confining the treatment area is important to reduce complications.

“There’s a debate about whether or not some early vocal cord cancers also need radiation to the lymph nodes in the neck,” Mendenhall said. “The problem with doing that is that the fields are a lot larger. If the fields are larger, the side effects are worse, so you’re more likely to have to give the patient a break and your cure rate will be lower.”

Tampa businessman John “Jack” Maurer, who completed radiation therapy for vocal cord cancer under Mendenhall’s direction at UF Shands Cancer Center about 2 ½ months ago, said he found out he had a malignant tumor after seeing a doctor for a raspy throat and voice that got progressively worse.

“I thought it was probably from the heavy pollen that was falling, but it didn’t get any better. In fact it got worse, and my voice started deteriorating to the point where I was embarrassed to talk on the phone or anything,” said Maurer, 72. “It really took my breath away. I never expected anything like that.”

On the recommendation of his son-in-law, a doctor in Atlanta, Maurer sought radiation treatment from Mendenhall, spending weekdays in Gainesville for therapy and returning home on weekends.

“No one would be able to guarantee that you would have your voice again with surgery,” Maurer said. “I didn’t want to take a chance. I like to talk.”

Though he experienced a sore throat and some difficulty swallowing that became more severe as the therapy progressed, Maurer said he received no breaks in his course of treatment. Instead, he was given medicine to numb his throat so he could continue eating and is doing fine now.

“I was examined about three weeks ago and everything was perfect. (The cancer is) gone,” he said. “Dr. Mendenhall made me say, ‘Go Gators!’”