LARYNGECTOMY FAQ'S

 What radiation/chemotherapy options are there?
(from the American Cancer Society)

Radiation therapy uses high-energy rays (such as x-rays or gamma rays) and particles (such as neutrons and electrons) to kill cancer cells. External beam radiation therapy uses radiation delivered from outside the body that is focused on the cancer. This type of radiation therapy is most often used to treat laryngeal and hypopharyngeal cancer. External beam radiation therapy for laryngeal and hypopharyngeal cancer is usually given in daily fractions (doses), five days per week, for about seven weeks. Other schedules for radiation doses are under study in clinical trials. Hyperfractionation refers to dividing the radiation over a larger number of doses (two treatments per day instead of one, for example). Accelerated fractionation indicates that the radiation treatment is completed more quickly (5 weeks instead of 7 weeks, for instance). Some studies have found that hyperfractionation and accelerated fractionation schedules reduce the risk of local recurrence of local recurrence of laryngeal and hypopharyngeal cancer. But, these schedules also increase the severity of side effects, and they have not been proven to improve survival rates.

Internal radiation therapy, also known as brachytherapy, uses radioactive material placed directly into or near the cancer. Brachytherapy may be used alone or in combination with external beam radiation therapy. It is rarely used in treating laryngeal and hypopharyngeal cancer.

Radiation therapy is often used as the primary (main) treatment of laryngeal and hypopharyngeal cancer, especially for patients whose cancer is small enough to be destroyed by radiation without surgery. Radiation therapy is an alternative to partial laryngectomy for treating small cancers. It is also used to treat patients whose general health is too poor to undergo surgery.

After surgery, radiation therapy can be used as an adjuvant (additional) treatment to kill very small deposits of cancer that cannot be seen and removed during surgery. Radiation therapy can also be used to palliate (ease) symptoms of laryngeal and hypopharyngeal cancer such as pain, bleeding, difficulty swallowing, and problems caused by metastases to bones.

Side effects of radiation therapy may include mild skin problems, dry mouth, sore throat, initial worsening of hoarseness, difficulty swallowing, decreased taste, possible breathing difficulty fro swelling of the larynx, and tiredness. Often these go away after a short while. Chemotherapy may make the side effects radiation worse. Talk with your doctor about these since there are ways to help.

Chemotherapy

Systemic chemotherapy uses anticancer drugs that are given into a vein or by mouth. These drugs enter the bloodstream and reach all areas of the body. Therefore, this therapy is useful in treating cancer that has metastasized (spread) to organs beyond the head and neck. Several recent studies have been undertaken to determine whether
various chemotherapy combinations with radiation therapy can control advanced disease confined to the head and neck regions and avoid large operations. Some studies have been able to reach local control rates close to surgery plus radiation but to date no study has shown any survival benefit of chemotherapy. Chemotherapy has also been used for palliation in unresectable (too large to be completely removed) cancers of the head and neck that radiation treatment has not been able to control. Chemotherapy has also been used for patients unable to withstand surgery. 

Chemotherapy drugs kill cancer cells but also damage some normal cells. Therefore, careful attention must be given to preventing or minimizing side effects, which depend on the type of drugs, the amount taken, and the length of treatment. Temporary side effects might include nausea and vomiting, loss of appetite, loss of hair, diarrhea, and mouth sores. Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can result in an increased chance of infection (due to a low white blood cells), bleeding or bruising after minor cuts or injuries (due to a low blood platelets), and fatigue and shortness of breath (due to low red blood cell counts). Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends, although it may look different. It is important to discuss any side effects of chemotherapy with your doctor and/or nurse. There are remedies for many of the temporary side effects of chemotherapy. For example, antiemetic drugs to prevent or reduce nausea and vomiting can be given.

The two drugs used most often for cancers of the larynx and hypopharynx are cisplatin and 5-fluorouracil (5-FU). Additional drugs that may be used include methotrexate, bleomycin, and carboplatin. Several other drugs are being studied but are only used on rare cases. These drugs may be used as single agents or in combination. The combination of cisplatin and 5-FU is more effective than either drug alone in temporarily shrinking cancers of the larynx and hypopharynx. However, no improvement in overall survival has been shown.

Chemoradiotherapy (chemotherapy given at the same time as radiation) has been shown in a few studies to help some patients with head and neck cancers to live longer. However, the survival improvement has been small and side effects may be unacceptable for some patients.