Getting tough with head and neck cancers
Aggressive new therapies bring rewards
By Richard Saltus
Chris Serino makes a point to his squad, which he has led since 1998 - even while undergoing cancer treatment.
A hockey coach who couldn't bellow instructions on the ice or cheer his players on? It might have come to that for Chris Serino, coach of the Merrimack College Warriors, if he had been diagnosed with throat cancer a decade or so ago, instead of in 2001.
Even today, the outcome might have been different if Serino hadn't been treated at a center like Dana-Farber, with its teams of specialists possessing the clinical and research experience to carry out successful "organ preservation" therapies.
A voice for a life: that was a sacrifice routinely demanded of patients with large tongue or throat cancers in the past, when radical surgery was the only means to halt the life-threatening spread of tumors. Individuals often lost their tongue or larynx (voicebox), robbing them of speech or the ability to swallow; in other cases, major reconstruction of the palate, jaw, or other tissues was needed. Today, extensive and potentially disabling surgery for these advanced cancers can be avoided without jeopardizing survival.
"Our program is now based on preserving the voice box and oral cavity structures," says Robert Haddad, MD, clinical director of the Dana-Farber/Brigham and Women's Cancer Center Head and Neck Oncology Program and Serino's oncologist. "We are technically advanced in the way we give radiation and chemotherapy, and there is more awareness among ear, nose, and throat surgeons in the community about organ preservation."
Given his healthy and robust physique, Serino was deemed an ideal candidate for the organ-sparing approach. "They told me, 'It's a harsh treatment, but we'll get you through it,'" he recalls. Avoiding surgery was clearly appealing "because I coach for a living, and I need to talk." But even more than that, he wanted to see his five sons grow up.
The new, finely tuned therapy blends intense, precisely aimed radiation therapy and potent chemotherapy; the latter attacks the tumor and also makes the cancer cells more vulnerable to radiation.
Today, still coaching Merrimack more than two years after treatment, Serino is a winner on both counts. "The cancer is gone, and I have nothing wrong with my voice," he says. "I do everything I did before, except I need a bottle of water all the time to drink with food."
According to program Director Marshall Posner, MD, "Up to 90 percent of our patients with advanced tumors (and lacking other serious medical conditions) are alive two years later with very little drastic surgery needed." And, he adds, "we're testing ways to curb the toxicity of the chemoradiotherapy (combining radiation and drugs) with smaller doses, as well as giving additional drugs that protect against some of the side effects."
The new, finely tuned therapy blends intense, precisely aimed radiation therapy and potent chemotherapy: the latter attacks the tumor and also makes the cancer cells more vulnerable to radiation. The core of the treatment, high-dose radiation, is a two-edged sword: it is what gives patients their best chance for a cure, but has grueling side effects that require the care of multiple specialists. In addition to physicians and surgeons, these include nurses experienced in head and neck treatment, swallowing and speech therapists, social workers, and psychologists.
Roy Tishler, MD, PhD, director of head and neck radiation oncology at Dana-Farber, says, "We have many support services to help people prepare for the treatment and get through it."
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