The study and previous research suggest that chemotherapy given during radiation – called radiochemotherapy – should now be considered a new standard of care for advanced throat cancer.

"This study confirms other studies showing radiochemotherapy is better than radiation alone for these patients," said Arlene A. Forastiere, MD, lead author of the editorial and Professor of Oncology at Johns Hopkins University School of Medicine in Baltimore, Md.

The study divided 222 patients with Stage III or IV throat (oropharyngeal) cancer into two groups. Most patients had cancer of either the tonsil or the base of the tongue. Both groups got the same radiation therapy, but one group also took the chemotherapy drugs carboplatin and 5-FU, which were given during the first, fourth, and seventh weeks of their radiation therapy.

At an average follow-up time of about three years, 42 percent of patients who had radiochemotherapy had shown no sign of the cancer returning, compared to 20 percent of the patients who had radiation only. Of the patients who had both radiation and chemotherapy, 51 percent were still alive three years after diagnosis, compared with 31 percent of the patients who had radiation only.

The average length of survival for those treated with radiochemotherapy was 29 months, compared to about 15 months for those who had radiation only.

"The radiochemotherapy regimen is more effective because those chemotherapy drugs sensitize tumor cells to radiation," explained the study’s lead author, Gilles Calais, MD, Professor of Radiation oncology at the Centre Hospital at the University of Tours in Tours, France.

However, Drs. Forastiere and Calais both pointed out the regimen is not the best choice for every patient because side effects, especially damage to the lining of the throat, are more severe than with radiation alone. "The problems are how to select the patients who are good candidates for this type of aggressive treatment, and how to manage the acute side effects," said Dr. Calais. "We use weight loss, age, liver function and such objective criteria to select patients, but we must also ask subjectively: Can this patient support this treatment?"

According to Dr. Forastiere, "A lot of support may be needed to get through radiochemotherapy. After treatment, a feeding tube and medical help with later side effects may be necessary. So, a person who has already lost a lot of weight, who lives alone, and who doesn’t have the resources to go through months of treatment, may not want to choose this therapy," said Dr. Forastiere. "That patient might be better off with surgery and immediate reconstruction."

But for the right patients, radiochemotherapy would be the appropriate regimen, said Dr. Forastiere. "Radiochemotherapy is an excellent choice for head and neck cancer patients with very little chance of being cured by surgery. And even for other patients with advanced localized oropharynx [throat] cancer, it’s an accepted alternative to surgery," she said.

The American Cancer Society estimates that in 2000 there will be 8,200 new cancers of the pharynx diagnosed in the US and 2,100 deaths from this disease.