Outcomes

The overall survival rates (reflecting death due to all causes, not just from cancer of the head and neck) of our head and neck cancer patients compare favorably with the national statistics both by stage and overall.

This study is a review of 48 patients with squamous-cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx diagnosed at Sentara Martha Jefferson Hospital from 2003 to 2005.

While cancers of the head and neck comprise just 3 percent of malignancies in the United States, the stakes are high for patients, as these cancers can interfere with the ability to eat, swallow and talk. In addition to cure, treatment goals include preservation of the patient’s functional status whenever possible. Much of the innovation in overall cancer treatment, in fact, has been based on optimization of the very challenging treatment of patients with head and neck cancer. When we make real advances in treating patients with hard-to-treat cancers, we can apply those improvements to the management of many other types of cancer.

According to the National Cancer Institute, at least 75 percent of head and neck cancers are caused by tobacco and alcohol use. In the U.S. we are seeing an increasing incidence of cancers of the oropharynx in younger patients related to human papilloma virus infection. Common symptoms/signs of head and neck cancer are persistent hoarseness, difficulty or pain with swallowing, and/or a lump in the neck.

Patients in our study ranged in age from 41 to 82 years, with a male predominance, in keeping with national demographic. The distribution by stage is: Stage 0: 4; Stage I: 13; Stage II: 10; Stage III: 8; Stage IVA: 10; and Stage IVB with distant metastases: 3. Stage IVA comprises a very interesting group of patients who have locally advanced cancers, often with bulky neck nodes, but no evidence of metastatic disease.

Treatment for our head and neck cancer patients was highly individualized based on the location of the cancer and the stage. A few patients with very early-stage cancers were treated with limited surgery.

Seventeen percent of patients — primarily those with Stage 0-I laryngeal cancers — were treated with radiotherapy alone. Most patients received combined modality therapy with radiotherapy and chemotherapy, sometimes followed by surgery. Of the three patients with Stage IVB disease, two received palliative chemotherapy and one received palliative radiotherapy, dying four to 28 months after diagnosis.
Treatment provided a local control rate of 100 percent for the Stage 0 patients. Patients with laryngeal cancer had 100 percent local control, with all patients maintaining a functional larynx.

For the 35 patients who received radiotherapy as primary treatment or part of their combined modality treatment, local control rate in the primary site was 94 percent, and regional control in the neck was also 94 percent. For the seven patients with bulky IVA disease who completed treatment, the loco-regional control rate was remarkable at 86 percent. Two of the patients with IVA disease died shortly after their diagnosis (one from a separate lung cancer) and did not receive treatment for their head and neck cancer.

As reported above, second primary cancers were a cause of death for some members of our group, with patients dying of primary lung cancer, other head and neck cancers (not an uncommon occurrence in the setting of tobacco abuse), bladder cancer, ovarian cancer and lymphoma.

Sentara in the Community