Using their own findings as stepping stones, medical researchers have made one more stride toward alleviating the deadly effects of head and neck cancers.
A new therapy-tested by Medical Center researchers and reported in the June 18 issue of the New England Journal of Medicine-determined that a combination of therapies effectively eradicates advanced head and neck cancers in more than half of patients. In addition to the usual twice-daily intensive doses of radiation, the researchers used chemotherapy during the first and sixth weeks of treatment.
Half of the 116 patients in the study underwent this combination therapy and, three years later, 61 percent of them were cancer-free, while patients who received only the radiation therapy achieved a 41 percent success rate. Researchers found no increase in the long-term side effects of the combined treatment, said Dr. David Brizel, associate professor of radiation oncology and one of the study's authors.
Based on these results, this treatment has become standard for patients with advanced head and neck cancers at the Medical Center, he added.
About 50,000 people annually are diagnosed with head and neck cancers, which are usually caused by the use of tobacco products or excessive alcohol. The traditional therapy-surgery and daily radiation over seven weeks-eliminates disease in only 25 to 30 percent of patients three years later.
Even before being applied to head and neck cancers, the double treatment had been used against cancer in other parts of the body, including the liver, pancreas and lungs.
"We as oncologists have seen that on other cancers, radiation and chemotherapy together was better," Brizel said.
Dr. D.J. Lee, an associate professor of radiation oncology at Johns Hopkins University, said he believed this study represents the first time the double treatment of radiation and chemotherapy has been used against head and neck cancers. "[This research is] a very important piece of work that fits into our understanding of radiation with chemotherapy," he said.
Chemotherapy alone will kill some cancer cells, Brizel explained. However, the toxicity of chemotherapy treatments makes killing the disease and keeping the patient stable nearly impossible.
Radiation therapy will also kill some, but not all, of the cancer cells, he added.
With the combined treatment, chemotherapy allows radiation to eradicate the cancer, Brizel said, although the biochemistry of this process is unclear.
Implementing the findings of a successful clinical trial directly into standard practice is not unprecedented, Lee said. He cautioned, however, that one study alone does not always establish the correct protocol.
"The data does not show that the twice-a-day treatment [of radiation] is superior to the once-a-day treatment," he said, referring to other studies citing the success of once-daily radiation therapy with chemotherapy as a treatment for other cancers.
Brizel explained that he and his colleagues wanted to test the effectiveness of the combined treatment. As a result, they needed to keep the radiation dosage constant for both trial groups.
He emphasized, however, that the current protocol would benefit from further research.
To this end, he and his colleagues have begun a new trial. With only 35 patients, this study uses the new protocol to determine what dosage is still effective without causing complications. Brizel said he anticipates that the current study will end in approximately one year.
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