Frequent Radiation Better For Head, Neck Cancer

Experts find rapid advances in treating these tumors

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HealthDay Reporter

THURSDAY, Sept. 18, 2003 (HealthDayNews) -- A Danish report of better results in treating head and neck cancer with accelerated doses of radiation isn't the breakthrough that many people might suppose -- and that is cheerful news.

The reason: Treatment of this kind of cancer has advanced so rapidly since the Danes began the study that the results are already outmoded, experts say. Centers across the United States already are using combined therapy that gives much better results than those reported in the study.

"This would have been big news in 1992," says Dr. Nancy Lee, an assistant attending physician in radiation oncology at Memorial Sloan-Kettering Cancer Center in New York City. "Radiation technology has changed dramatically over the last five years."

The newer technology, not used in the Danish trial, allows precise targeting of radiation against a cancer, Lee says. And it now is combined with chemotherapy, which improves the results even more. The Danish trial did not use the combination treatment

The Danish study, published in the Sept. 20 issue of The Lancet, found that giving a fixed dose of radiation faster, with six treatments a week rather than five, improved results considerably, with tumor control -- meaning the cancer was no longer evident -- achieved in 70 percent of patients, rather than the 60 percent control rate of the five-dose-a-week regimen.

"It is an interesting observation, but let's not get excited," says Dr. Jatin P. Shah, chief of the Memorial Sloan-Kettering head and neck service. "The science has moved on much more than was done in this trial."

Tumor control rates of 80 percent to 90 percent how are being achieved routinely, even in more advanced cases of head and neck cancer, Lee says. The Danish study included a large number of less advanced tumors, which are easier to control.

There will be 55,000 new cases of head and neck cancer causing 13,000 deaths in the United States this year, the National Cancer Institute estimates. The leading cause is smoking.

There are good things to say about the Danish study, says Dr. Eric M. Horwitz, a radiation oncologist at Fox Chase Cancer Center in Philadelphia. It is the kind of carefully controlled trial that is regarded as the gold standard in clinical research, he says, and the finding that giving radiation treatment faster is being applied to patients with less advanced stages of the disease.

Head and neck cancers are classified in four stages, each number indicating a more advanced stage of the condition. Less advanced cases generally are treated with radiation alone.

"If you can shorten the time in stage 1 and 2 patients, it does make a difference," Horwitz says. "But for stages 3 and 4, you don't use radiation alone. In all the big clinical trials stages 3 and 4 are treated with combined radiation and chemotherapy."

Results of the Danish trial are also being presented at a meeting in Copenhagen this week.

More information

An overview of head and neck cancer causes, symptoms and treatments can be found at the National Library of Medicine. Also, the American Cancer Society discusses side effects of radiation treatment.

SOURCES: Jatin P. Shah, M.D, chief, head and neck cancer service, and Nancy Lee, M.D., assistant attending radiation oncologist, Memorial Sloan-Kettering Cancer Center, New York City; Eric M. Horwitz, radiation oncologist, Fox Chase Cancer Center, Philadelphia; Sept. 20, 2003, The Lancet

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