Surgery With Follow-Up Radiation Best for Tongue Cancer: Study

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Patients who started with chemotherapy had worse response, researchers sayTHURSDAY, Dec. 26, 2013 (HealthDay News) -- People with tongue cancer who undergo surgery before receiving radiation treatment fare better than those who start treatment with chemotherapy, according to a small new study.

Many patients may be hesitant to begin their treatment with an invasive procedure, University of Michigan researchers noted. But advanced surgical techniques can improve patients' chances for survival, the authors noted in a university news release.

The study was published online Dec. 26 in JAMA Otolaryngology Head and Neck Surgery.

Nearly 14,000 Americans will be diagnosed with tongue cancer this year and 2,070 will die from the disease, according to the American Cancer Society.

"To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction," study author Dr. Douglas Chepeha, a professor of otolaryngology-head and neck surgery at the University of Michigan Medical School, said in the news release.

"But patients with oral cavity cancer can't tolerate induction chemotherapy as well as they can handle surgery with follow-up radiation," Chepeha said. "Our techniques of reconstruction are advanced and offer patients better survival and functional outcomes."

The study involved 19 people with advanced oral cavity [mouth] cancer. All of the participants were given an initial dose of chemotherapy (called "induction" chemotherapy). Patients whose cancer was reduced in size by 50 percent received more chemotherapy as well as radiation therapy.

Those who did not respond well to the first dose of chemotherapy underwent surgery. After surgery these patients also received radiation.

The researchers reported that their study was stopped early because the results were so dismal. Ten of the patients responded to chemotherapy. Of these people, only three were cancer-free five years later.

Only two of the remaining nine patients who underwent surgery after the initial dose of chemotherapy were alive and cancer-free after five years, the researchers found.

After examining a similar group of patients who had surgery and advanced reconstruction followed by radiation therapy, the researchers found dramatic improvements in survival rates and other outcomes, according to the news release.

However, the new findings contradict the typical course of treatment for people with larynx (voice box) cancer, the news release noted. These patients are given an initial dose of chemotherapy to determine whether or not they should proceed with surgery. This approach has led to improved outcomes and survival rates for these patients.

"The mouth is a very sensitive area. We know the immune system is critical in oral cavity cancer, and chemotherapy suppresses the immune system. If a person is already debilitated, they don't do well with chemotherapy," Chepeha said. "Despite the proven success of this strategy in laryngeal cancer, induction chemotherapy should not be an option for oral cavity cancer, and in fact it results in worse treatment-related complications compared to surgery."

Although the study found an association between receiving surgery before radiation therapy and improved outcomes for patients with tongue cancer, it did not prove a cause-and-effect relationship.

More information

The U.S. Centers for Disease Control and Prevention provides more information on oral cancer.

SOURCE: University of Michigan, news release, Dec, 26, 2013

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4 Comments

Fri Dec 27, 2013 04:40 AM

This study is not good news for the US drug industry. I can see the Spin Doctors going to work soon to discredit this study.

However, the study is very good news for those with tongue cancer as who needs toxic chemo. All it seems to do is feed the coffers of the giant pharmas.

Fri Dec 27, 2013 02:42 PM

Every single person with cancer SHOULD be using complementary therapies to offset the terrible toxicities.  This review does NOT mention how many survive in the treated group, NOR does it discuss the short and long-term adverse effects.

I founded Annie Appleseed Project as a Patient Advocate to inform folks about the natural approaches that many studies - MANY studies - show can help reduce toxicities and sometimes enhance the outcomes.

I had cancer, I used many natural approaches and I think everyone should seriously consider this even though the oncology medical community seems (continues) to be the LAST to know.

Fri Dec 27, 2013 11:34 PM

As of now, I'm glad I opted for radiation. I'll know in four more years

Tue Dec 31, 2013 02:56 PM

i had surgery for tounge cancer  followed by radiotherapy in 2008 still here t tell the story

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