Breakthrough Treatment Saves Vocal Cords and Lives

Armed with a special laser he uses on opera singers and rock stars, Dr. Steven Zeitels, director of the Center for Laryngeal Surgery and Voice Rehabilitation at Massachusetts General Hospital, is taking aim at vocal cord cancer, to see if he can save not only lives, but also save voices in danger of being destroyed by conventional surgery or radiation.

Armed with a passion for preserving the health of vocal cords, Zeitels has saved some of the most famous voices in the world, like Aerosmith frontman Steven Tyler, Cher and Julie Andrews.

"I had the opportunity over time to manage very elite voices, which taught me a lot of physiology, be they singers or lecturers. And I tried to interweave what I learned about their physiology into the design of cancer operations," Zeitels said.

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He has developed a breakthrough in treating vocal cord cancer. And his research is already paying off for Sefi Rivlin — one of Israel's most beloved comic actors. In 2006, Rivlin was diagnosed with vocal cord cancer and offered traditional treatments, surgery or radiation, both of which would work, leaving his voice permanently damaged.

"One is to do radiation, and the other option is to cut all my larynx with my vocal cords. It means not to talk forever. For me, in my profession, it's like a death penalty. It's like my life is over," Rivlin said.

Rivlin first arrived in the U.S. in October 2006 with cancer that filled his entire larynx. It's the largest vocal cord tumor that Zeitels has attempted to treat with this radical new approach.

Rivlin agreed to undergo Zeitels' radical new approach, using a special laser — called an angiolytic laser — that targets the tumor's blood supply, kills the cancer cells, and leaves normal tissue alone, without cutting away tissue.

Zeitels explained, "You're directing the light but you're only directing it under a microscope to the cancerous tissue, and you don't affect the normal tissue."

In the 10 treatments Rivlin has undergone so far, the transformation is stunning.

"I see no evidence of cancer. The dysplasia is mostly resolved," Zeitels said.

Most of the procedures are done without general anesthesia, in the office, and take about 20 minutes. A major advantage of the laser: It can be repeated as needed for years to come if new lesions are found, with surgery and radiation preserved as options if needed.

In the United States, 90 percent of patients with early vocal cord cancer receive radiation. But radiation often makes normal vocal cord tissue rigid and unable to vibrate, which impairs the voice.

"For vocal cords to vibrate, they need to be soft and pliable, very similar to a child's skin or an infant's skin. This laser is absorbed by hemoglobin and blood and only heats the tumor, which is why the pliability is basically preserved," Zeitels said.

Tomorrow, at the annual meeting of the American Broncho-Esophagological Association, Zeitels will report on his five-year pilot study of early vocal cord cancer treated with the angiolytic laser.

The results are dramatic: all 23 patients are cancer-free and all have excellent vocal function. Larger studies need to confirm these findings, but Zeitels has, no doubt, ushered in a new era of treatment for vocal cord cancer, where losing one's voice isn't the trade-off for saving one's life.

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