ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Selecting the Right Patients Is Key for Chemoradiation Success

by Rabiya S. Tuma, PhD • April 1, 2008

  • Tweet
  • Email
Print-Friendly Version

Head and neck cancer care has been undergoing a paradigm shift over the past decade, moving from a surgery-based approach to one that increasingly relies on chemoradiation (CRT). Few trials have directly compared the approaches, but experts agree that for some patients the two approaches can be equally efficacious. The key, they caution, is selecting the appropriate patients.

You Might Also Like

No related posts.

Explore This Issue
April 2008
Mark Wax, MD

Mark Wax, MD

Historically, most patients were treated with surgery or surgery followed by radiation. However, a landmark study published in 1991 by Veterans Administration researchers showed that for some patients with stage III or IV tumors of the larynx, chemoradiation preserved the organ and resulted in the same survival as surgery followed by radiation. Based on those data, and a few trials that have followed, many physicians now offer their patients organ preservation therapy in the form of chemoradiation.

All of a sudden there appeared to be the opportunity to treat people as effectively, or more effectively, than in the past, without them being required to have the pain suffering, cosmetic deformity, and functional deformity of the surgery, said Jonas T. Johnson, MD, Professor and Chairman of the Department of Otolaryngology and Professor of Radiation Oncology at the University of Pittsburgh School of Medicine. That sounds like wonderful news, but, in fact, it is imperfect.

At least two retrospective studies have found that the five-year survival rate in laryngeal cancer has dropped over the past decade and that the use of CRT has increased over the same time period. Although such database reviews cannot show a causal link between increased use of CRT and declining survival, the observation is reason for concern, according to Christine Gourin, MD, Associate Professor and Director of the Clinical Research Program in Head and Neck Cancer at Johns Hopkins University School of Medicine in Baltimore.

My hypothesis-and others suspect the same thing-is that the decrease in survival might be because there are some patients who are receiving CRT who are not going to do well with organ preservation therapy, she said. Those are patients with gross cartilage involvement, soft tissue or skin involvement, or very extensive tumors that have a large volume. In addition, there just are no data to support the use of CRT for oral cavity tumors. Those patients benefit more from surgery with postoperative radiation to clean up microscopic residual disease.

Moreover, Dr. Gourin does not recommend CRT for patients with T4 larynx tumors and who are dependent on a feeding tube before treatment, or those whose tumor is infiltrating nerves, because that can be a sign of more aggressive disease.

Pages: 1 2 3 4 | Single Page

Filed Under: Departments, Head and Neck, Medical Education, Practice Focus Tagged With: cancer, CT, outcomes, patient communication, patient safety, PET, Quality, radiation, surgery, treatment, tumorsIssue: April 2008

You Might Also Like:

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Is Radiofrequency Ablation a Good Alternative to Surgery for Benign Thyroid Nodules? A Look at Benefits, Risks
    • What Happens to Medical Students Who Don’t Match?
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?
    • Vertigo in the Elderly: What Does It Mean?
    • Neurogenic Cough Is Often a Diagnosis of Exclusion
    • Complications for When Physicians Change a Maiden Name
    • Smell and Taste Disorder Differences Seen Between Long-Term COVID-19 and non-COVID-19 Patients
    • The Triological Society is Growing in Ethnic and Gender Diversity as Well as Thesis Acceptance
    • No Persistent Postoperative Swallowing Dysfunction Following Pharyngeal Surgery in Patients with Obstructive Sleep Apnea
    • Do the Principles of Adult Learning Maximize Training Efficiency and Efficacy for Pediatric Otolaryngologists?
    • Prolonged Operative Time Associated with Multiple Adverse Outcomes in Endoscopic Sinonasal Surgery

Polls

Do you think that women have made large enough strides in otolaryngology leadership and gender equity?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use
  • Cookie Preferences

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2023 The Triological Society. All Rights Reserved.
ISSN 1559-4939