Leading-edge research is one of the cornerstones of the care provided by our experts in head, neck and skull base cancers. Today’s clinical trials and research studies give us new, proven treatment approaches offering patients more treatment options and hope.
One example of an experimental approach that has become standard is a study sponsored by the Radiation Therapy Oncology Group in the 1990s. It looked at ways to treat laryngeal cancer without removing the patient’s voice box. In short, that study examined three options — giving chemotherapy before radiation therapy, giving chemotherapy during radiation therapy and giving radiation therapy alone. The study found that radiation therapy alone wasn’t enough, but that radiation therapy combined with chemotherapy, either before or during radiation, could successfully treat laryngeal cancer without surgery. Today, these non-surgical approaches to laryngeal cancer have become standard for some patients, and that means they can survive with their voice boxes intact.
Clinical research also builds on itself. Another study we participated in looked at different combinations and frequencies of doses in delivering radiation therapy. The study’s results showed that adding a “boost” – that is delivering two doses of radiation therapy per day instead of one — in the last few weeks of treatment made a positive difference. Today, a “boost” of radiation towards the end of a patient’s treatment has become a standard approach in some cases.
That same study also included a correlative tissue trial, where tissue from each patient’s tumor was collected during a biopsy. Through that tissue trial, researchers learned more about the epidermal growth factor receptor or EGFR, a protein found on the surface of the tumor that can be a strong predictor of the aggressiveness of the tumor. Those findings then lead to a study of an anti-EGFR drug called cetuximab. This is just one example of how each study adds to the knowledge gained before it.
Currently, Stuart J. Wong, MD, Medical College of Wisconsin medical oncologist, is one of the authors of a study challenging the idea that radiation therapy can be given only once in a patient’s lifetime. The study is looking at whether radiation therapy can be effective in patients who are experiencing a recurrence of their cancer. Research like this helps answer questions about whether a new treatment approach will prolong life without reducing quality of life.
We’re also involved in ongoing research that examines different dose combinations and sequences of medicines and treatments to determine the most effective approaches. Combination therapies have become the standard, and as medicine advances, we hope to be able to predict how a specific tumor is will respond to a specific drug. The future continues to open up new treatment possibilities for head, neck and skull base cancer patients.
Quality of Life ResearchMore and more people are surviving head, neck and skull base cancers each year, and research is just beginning to probe the issues that are important to them. More survivors means more people are living with the effects of the cancer and its treatment.
Most head and neck cancer patients are worried about survival when their treatment begins, not potential side effects. Still those side effects can have a lasting impact, and we have conducted research with cancer survivors to help us understand how their lives have been affected.
Long-term or “late effects” are those which develop or continue after treatment. Examples are tightening of scars, persistent loss of movement or sensation, thinning of muscle and lining tissues, persistent mouth dryness and others.
In our own research with head and neck cancer survivors, we learned a great deal about how some late effects impacted their quality of life. We found that even with the most challenging side effects there is hope, and intervention may help. Continuing evaluation by a speech and swallowing therapist can help identify swallowing problems and offer advice for techniques to improve swallowing efficiency. Dental rehabilitation can have a significant impact on quality of life for some patients. And physical therapy and exercise can help address problems with shoulder function.
In the meantime, medical advancements have brought modifications and new treatments, which can lessen some of the long-term problems. At Froedtert & The Medical College of Wisconsin, we are focused on reducing the long-term side effects for head and neck cancer patients. Our surgeons are working harder to preserve tissues and restore contours during cancer treatment. Radiation oncologists have developed newer techniques which spare parotid tissue and diminish long-term dryness problems. And, medical oncologists are testing newer drugs and treatments which may have fewer long-term side effects.
Over the past few years, quality of life research has become an important part of every major cancer treatment. It shows us how to help patients living with side effects now, and where to look for improved treatments in the future. It helps us better understand how to provide the best possible cure and healing to all of our patients.
Author: Joan Cotter Pike
Date: Nov. 15, 2007
|Medical Reviewer: ||Stuart Wong, MD|
|Betty Oleson, RN|
Last Review Date: May 21, 2008
Online Editor(s): Rich Petre