How is Throat Cancer Treated?
The treatment options (modalities) available for throat cancer patients are systemic chemotherapy, definitive radiation therapy In cases where chemotherapy or radiation are used to shrink the size of the tumours before a surgical intervention, they are referred to as neoadjuvant therapies (neoadjuvant chemotherapy or neoadjuvant radiation). These are pre-operative therapies.
In cases where surgery (to remove a primary tumour and/or affected lymph nodes) is followed by either chemotherapy, radiotherapy or a combination of the two, it is called an adjuvant therapy.
Treatment of throat cancer depends on the stage of the disease and patient general condition to tolerate the treatment.
What are the treatment objectives in throat cancer therapies?
The main goal in the treatment of throat cancer is to control the growth of tumours while simultaneously preserving organ functions such as respiration, speech and swallowing.
What are the preferred treatment modalities and general treatment guidelines for throat cancer patients?
Treatment of early-stage throat cancer
The main treatment options in early stage throat cancer are Radical Radiotherapy (Organ preservation) and Surgery. Radiation treatments are preferred for early stage throat cancers. Radiation treatments are preferred for early-stage throat cancers. Radiation is administered at a minimum dose of 70 Gy at a dose of 2 Gy per fraction. Chemotherapy can be given to the patients along with radiation (concurrent chemotherapy) depending on the stage of the disease, risk factors, patient general condition etc.
In some cases of early hypopharyngeal cancer, conservative surgical approaches are advised. Such approaches include transoral laser microsurgery and transoral robotic surgery.
Treatment of locally advanced throat cancer
Stage 3 and stage 4 are considered as a locally advanced disease.
Patients suffering from the locally advanced disease usually require multi-modality treatment which includes Surgery, Chemotherapy and Radiation. The selection of the treatment plan basically depends on the stage of the disease, patient medical comorbidities, age, general condition etc.
Functional organ preservation approach in the form of chemoradiotherapy or larynx preservation surgery or induction chemotherapy followed by radiotherapy is the standard treatment for throat cancer patients. The advantage of this approach is a preservation of the function of the organ like speech, swallowing, respiration etc. This approach has replaced the earlier practice of complete laryngectomy (removal of the entire larynx) and postoperative radiotherapy. These options are exclusively limited to patients who have been diagnosed to be ineligible for conservative approaches.
The systemic therapy approach in early and locally advanced forms of throat cancer
Concurrent chemotherapy generally is given along with the radiation as it is shown to increase the absolute survival rate. It is the standard approach, especially in locally advanced disease. However, concurrent chemotherapy is generally not given to the patients who are > 70 years of age. The side effects of chemotherapy can further deteriorate the condition of these patients. Additionally, chemotherapy cycles can delay the overall radiation schedule, which is more effective in treating throat cancer.
Treatment of recurrent or metastatic throat cancer
Patients with no history of receiving systemic treatments in the past with a good health condition are generally offered chemotherapy on a platinum combination regimen to treat advanced stages of throat cancer (stage 4, metastatic or recurrent throat cancer).
Advanced stage throat cancer patients with no history of systemic treatments, but with poor health conditions and vital stats, are generally advised against combination chemotherapy. Such patients are treated with single-drug chemotherapy regimens at late stages.
Further immunotherapy or advanced (targeted) chemotherapy based options and relevant clinical trials can also prove beneficial for throat cancer patients who have finished neo-adjuvant systemic treatments, surgery and/or adjuvant therapy without tangible benefits.