Thanks to Dr. Patrick Maguire and his colleagues, patients who undergo radiation treatment and chemotherapy for head and neck cancer may no longer have to suffer its most intense side effects. Maguire, a radiation oncologist with New Hanover Regional Medical Center Radiation Oncology, led a study that showed head and neck cancer patients may be cured even when the radiation therapy dosage to areas surrounding their visible cancer is dramatically reduced. With the lower radiation therapy doses, these patients may experience fewer side effects.
“We were curing a lot of people, but I always had a rough time telling patients, ‘We’re going to put you through some really tough side effects to get you cured,’” Maguire said. “I figured if we could maintain high cure rates and decrease the side effects, the patient’s quality of life would be better.”
Maguire is on the forefront of research of this type. Currently, a few national studies are examining the effect of reducing radiation therapy dose to visible cancer. However, no other studies have looked at reducing radiation treatment in the areas surrounding the visible cancer when treating with chemotherapy at the same time, he says.
Head and neck cancer strikes about 60,000 people each year in the U.S. A large proportion of cases are caused by human papillomavirus (HPV), a group of viruses that are usually transmitted through sexual activity. Other common causes of head and neck cancer are chronic, heavy smoking and long-term alcohol use. The three-year survival rate of head and neck cancer is 70-90 percent. Those whose cancer is caused by HPV fall into the higher range.
The current national treatment plan for patients with advanced stage head and neck cancer that has not spread to distant sites in the body calls for seven weeks of intense treatment: once a day, high doses of radiation therapy are delivered to the visible cancer and moderately high doses of radiation to the surrounding areas. Patients also get high doses of cisplatin chemotherapy once every three weeks.It’s a regimen that leaves patients with nausea, fatigue, and sometimes neuropathy from the chemotherapy and severe sore throats, difficulty swallowing, and dry mouth from the radiation therapy. Many patients with head and neck cancer need feeding tubes prior to or during their treatment course.
“The side effects of standard treatment can be brutal,” says Maguire.
At the study’s inception, Maguire and his team hoped to develop a treatment plan that would get the same high cure rates as the standard treatment, while minimizing the risk of the worst side effects, and improving quality of life. The primary study endpoint that they evaluated was the risk of cancer recurrence in the areas receiving the lower dose of radiation therapy. Patients in the study got intensity modulated radiation therapy five days per week for seven weeks. They received the full dose of radiation therapy (70 Gy) only on their visible cancer. On the surrounding head and neck areas, which might harbor microscopic cancer cells, their radiation therapy dosage was nearly halved (36 Gy). They also received a low dose of cisplatin chemotherapy one day a week for six weeks.
The four-year study included 54 patients, ages 56-66, with advanced stage, localized head and neck cancer.
Maguire’s treatment worked. Cancer didn’t return in the low-dose areas of any of the patients in the study; and, as in standard head and neck cancer treatment, more than 90 percent of the patients were cured. Furthermore, their quality of life appeared to be improved, , according to patient surveys. “Within three to six months after treatment, patients were back to their baseline quality of life,” Maguire said.
In fact, several patients have told Maguire how grateful they were to have participated in a clinical trial that resulted in fewer side effects and still cured them of an aggressive cancer.
“That’s very gratifying,” Maguire said. “It makes you feel great, because it’s a tough treatment.”
The results of the study were published in the June 2017 issue of the International Journal of Radiation Oncology, co-authored by Drs. Charles Neal, Stuart Hardy and Andrew Schreiber. NHRMC has made the new protocol its standard treatment for patients with locally advanced head and neck cancer.
Maguire and his colleagues are pleased that he can help NHRMC patients through research. Not only has his work mitigated the suffering of head and neck cancer patients, through clinical trials such as his, they get excellent care without traveling to a major academic center.
While Maguire has no plans to follow up on this specific study, he will continue to conduct research.
“My partners and I are very motivated to continue clinical research in oncology and keep trying to improve the standard of care,” he said. “We are grateful to the patients who participated in the trial, without whom these improvements in cancer care would not be possible.”