Radiotherapy boosts survival in cancer patients
Are better outcomes possible?
While radiotherapy is commonly prescribed following surgery for patients with node-positive head and neck cancers, until now there has been little evidence that it actually improves survival. However, according to a new study in the International Journal of Radiation Oncology *Biology* Physics, adding radiotherapy to surgery can improve survival by as much as 25% for all nodal stages of cancer when compared to surgery alone.1
The study, which was conducted by investigators at the Mount Sinai School of Medicine in New York City, is based on more than 5,000 patients who were diagnosed with node-positive head and neck squamous cell carcinoma between 1988 and 2001. Researchers identified the patients in the in the SEER (Surveillance, Epidemiology, and End Results) database. The patients received follow-up, on average, 4.4 years after treatment.
"More than 80% of these patients with positive lymph nodes received radiation after surgery; therefore most patients with positive nodes already received radiation," says Johnny Kao, an assistant professor of radiation oncology at the Mount Sinai School of Medicine and the lead author of the study. "A possible exception is the node 1 (N1) group, which is considered to have a more favorable outlook than the N2 and N3 groups. "However, we showed increased survival for these patients also," Kao says.
Consequently, although this goes beyond the scope of his study, Kao says he believes that radiation should be considered for most patients with even one positive lymph node and virtually all patients with two or more positive lymph nodes.
More progress is possible
Although radiation can be difficult to tolerate for head and neck cancer patients, Kao stresses that the side effects usually are predictable and resolve within a few weeks of therapy.
"For the types of doses given after surgery, few patients develop any life-threatening or life-altering complications," says Kao, noting that dry mouth, which used to be a major problem, is much less of an issue now that IMRT [intensity modulated radiation therapy] is widely used. With IMRT, powerful doses of radiation can be delivered to more precisely targeted areas. "Therefore, if survival is significantly increased, we conclude that the benefits of radiation far outweigh the risks for most patients with positive lymph nodes."
Believing that more progress is possible, Kao says that investigators at Mount Sinai have initiated additional studies designed to improve five-year survival beyond 46% for patients with positive lymph nodes. "We currently have clinical trials combining radiation, chemotherapy, and targeted therapy for these patients," he says. "We believe that we can get five-year survival rates above 60% for these patients with currently available technology."
Reference
- Kao J, Lavaf A, Temg M, et al. Adjuvant radiotherapy and survival for patients with node-positive health and neck cancer: an analysis by primary site and nodal stage. Inter J Rad Onc Biol Physics 2008; 71:362-370.
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