• Home
  • Practice Focus
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
    • How I Do It
    • TRIO Best Practices
  • Business of Medicine
    • Health Policy
    • Legal Matters
    • Practice Management
    • Tech Talk
    • AI
  • Literature Reviews
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Career
    • Medical Education
    • Professional Development
    • Resident Focus
  • ENT Perspectives
    • ENT Expressions
    • Everyday Ethics
    • From TRIO
    • The Great Debate
    • Letter From the Editor
    • Rx: Wellness
    • The Voice
    • Viewpoint
  • TRIO Resources
    • Triological Society
    • The Laryngoscope
    • Laryngoscope Investigative Otolaryngology
    • TRIO Combined Sections Meetings
    • COSM
    • Related Otolaryngology Events
  • Search

Lecturer Warns Against Overuse of CRT: Says many early-stage laryngeal cancer patients overtreated

by Thomas R. Collins • June 1, 2011

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version
Dr. Johnson said data on using chemoradiation in patients with T1 and T2 disease are “interesting but not convincing, in my mind.”

You Might Also Like

  • Head and Neck Expert Dr. Jonas T. Johnson Warns Against CRT Overuse
  • Most Patients with Early Stage Glottic Carcinoma in National Cancer Database Receive Radiation as First-Line Treatment
  • Chemotherapy Alone Not Recommended for Advanced Laryngeal or Hypopharyngeal Cancer
  • Volumetric Changes After CRT for Head and Neck Tumors May Influence Posttreatment Dysphagia
Explore This Issue
June 2011
Dr. Johnson said data on using chemoradiation in patients with T1 and T2 disease are “interesting but not convincing, in my mind.”

The Case for Chemo

Dr. Johnson said data on using CRT in patients with T1 and T2 disease are “interesting but not convincing, in my mind.”

In a study of results for 519 patients by the University of Florida’s William Mendenhall, MD, in 2001, which Dr. Johnson said is still the best available data on the subject, T1 cancer cases had a 98 percent ultimate control rate with irradiation, and T2 cases had a 96 percent control rate (J Clin Oncol. 2001;19(20):4029-4036).

But only 82 percent of T2a cases and 76 percent of T2b cases preserved their larynxes after five years, Dr. Johnson noted.

“It means something between 18 and 24 percent of the larynxes were taken out … to get to this ultimate control rate,” Dr. Johnson said. “If you have a T2 patient, and you’re going to send them for irradiation, he’d better understand that there is some significant chance he will end up with a laryngectomy.”

Settling on a therapy for T2 laryngeal cancer is “a tough one,” he said. “Do you want to have a procedure that will probably leave you with anterior web and some changes in your voice and almost certain tumor control, or would you rather take a chance and go with irradiation?” he said.

Dr. Johnson discussed data from Pittsburgh showing how cancer recurrence was related to the number of nodes. Patients with four or five nodes were at great risk, although cancer can recur even with none at all.

“So the question remains: How many nodes represents indication for adjuvant therapy?” he said. “In Pittsburgh, I can tell you, we use three or more. I know others use other numbers. Here’s the problem: How much risk are you willing to accept before you add irradiation and chemotherapy? And, of course, when you add therapy you add toxicity.”

Decreased Survival Rates

The difficulties with laryngeal cancer are highlighted in stark fashion by the data from the Surveillance, Epidemiology, and End Results (SEER) database.

“Of the 24 cancers that are monitored by the SEER database, the only cancer group to experience a decline in cure is those with laryngeal cancer,” Dr. Johnson said. “So what’s wrong? How does that happen? Well, ladies and gentlemen, our therapies are not very effective. We’re uncertain about which therapy is best. And the toxicities of our treatment are not always acceptable. Pretty straightforward.”

Pages: 1 2 3 | Single Page

Filed Under: Everyday Ethics, Head and Neck, Laryngology, News, Practice Management, Tech Talk Tagged With: chemoradiotherapy, head and neck cancer, laryngology, quality of careIssue: June 2011

You Might Also Like:

  • Head and Neck Expert Dr. Jonas T. Johnson Warns Against CRT Overuse
  • Most Patients with Early Stage Glottic Carcinoma in National Cancer Database Receive Radiation as First-Line Treatment
  • Chemotherapy Alone Not Recommended for Advanced Laryngeal or Hypopharyngeal Cancer
  • Volumetric Changes After CRT for Head and Neck Tumors May Influence Posttreatment Dysphagia

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

The Triological SocietyENTtoday is a publication of The Triological Society.

Polls

Would you choose a concierge physician as your PCP?

View Results

Loading ... Loading ...
  • Polls Archive

Top Articles for Residents

  • Applications Open for Resident Members of ENTtoday Edit Board
  • How To Provide Helpful Feedback To Residents
  • Call for Resident Bowl Questions
  • New Standardized Otolaryngology Curriculum Launching July 1 Should Be Valuable Resource For Physicians Around The World
  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • 22 Symptoms Common to Patients with Superior Canal Dehiscence Syndrome

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Keeping Watch for Skin Cancers on the Head and Neck

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Complications for When Physicians Change a Maiden Name

    • Excitement Around Gene Therapy for Hearing Restoration
    • “Small” Acts of Kindness
    • How To: Endoscopic Total Maxillectomy Without Facial Skin Incision
    • Science Communities Must Speak Out When Policies Threaten Health and Safety
    • Observation Most Cost-Effective in Addressing AECRS in Absence of Bacterial Infection

Follow Us

  • Contact Us
  • About Us
  • Advertise
  • The Triological Society
  • The Laryngoscope
  • Laryngoscope Investigative Otolaryngology
  • Privacy Policy
  • Terms of Use
  • Cookies

Wiley

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1559-4939