“There’s a great tendency among doctors to generalize,” Dr. Johnson said. “I think perhaps it’s because they don’t always read the fine print. In some centers, I find, (they) are offering CRT to most patients with head and neck cancer. That’s wrong. Chemoradiation is too much therapy for early-stage disease. And, quite frankly, … T4 tumors were largely excluded in the big prospective randomized trials. You understand that when an investigator puts together a trial he tries not to hurt people…. They figured it wouldn’t work. And by the way, it doesn’t.”
Dr. Johnson said he does believe that CRT should be the standard of care in T3 laryngeal cancer. But he pointed to a review of the data in three major radiation therapy oncology group trials on chemoradiation (J Clin Oncol. 2008;26(21):3582-3589), which found that in the 230 assessable patients out of the 479 in the trial, “severe toxicities” were found in 43 percent of them.
“So what that means is that in this exuberant chase to preserve function, we’re failing,” Dr. Johnson said. “We fail because some patients are not cured. But we also fail because this treatment is in fact very toxic. It’s true that a great deal of effort is being made to find ways to avoid or prevent these toxicities, (but) they remain an issue.”