Following treatment for cancer, the patient’s voice has returned stronger than before.

At the TGH Onco Life Cancer Centre in Talegaon Dabhade, Pune, a man of 63 years of age is undergoing treatment for cancer.

As the voice started to become less audible

A man who was 63 years old noticed that his voice was becoming hoarser over the course of three months with no apparent cause. Consuming food was a little bit challenging. A swelling that was not painful and was located on the right side of his neck caused him concern. He had a history of using tobacco, and when the hoarseness began to affect his confidence and his ability to carry on daily conversations, he finally decided to seek assistance.

How the scans revealed the information (and why it was significant)

On October 7, 2024, a PET-CT examination unearthed the obvious offender:

There is a lesion in the right pyriform sinus that is FDG-avid and measures 16 × 16 mm with an SUVmax of 6.02.

With extension into the vocal cords, involvement of the right aryepiglottic fold is evident.

Neither the postcricoid region nor the larynx were affected by the spread of the disease.

FDG-positive lymph nodes on the right level II (up to 10 mm, SUV 6.42), as well as lymph nodes on the right level III (26 × 32 mm, SUV 8.27″).

As per the American Joint Committee on Cancer 8e, the clinical stage of cT3N2aM0 is equivalent to Stage IVA, which is characterised by localised progression but has the potential to be cured, particularly when an organ-preserving plan is implemented.

The plan is to treat the cancer while maintaining the voice.

According to the recommendations of a multidisciplinary tumour board consisting of radiation, surgical, and medical oncology, radical chemoradiation should be performed with the objectives of organ preservation.

In order to achieve laryngeal preservation, locoregional control, and functional voice recovery, the treatment that was selected was helical tomotherapy in conjunction with concurrent administering of cisplatin.

To put it another way, TomoTherapy provides a high level of precision in the process of wrapping radiation around the target. It treats the tumour and the nodes that are involved while protecting voice-critical structures to the greatest extent possible. This treatment is combined with chemotherapy.

The moment of decisiveness

Gradually, the treatment progressed from week to week. With the assistance of a group that prioritised precision and ease of movement, he continued on his path.

The outcome that brought about any and all changes

Following the completion of treatment sixteen weeks later:

In addition to being “back to normal,” his voice quality improved to the point where it was better than it had been before the cancer.

There was a complete regression of the neck nodes.

He returned to his social life with self-assurance and embarked on a mission to encourage others to take advantage of early screening.

A post-treatment PET-CT revealed that the disease had completely resolved, and there was no evidence of any active cancer that had remained.

It seemed as though I would never be able to speak clearly again… I can now sing to my grandchildren, which is a huge relief!

The rationale behind this (the story logic)

Precisely mapping the disease (primary and specific nodal levels) provided a treatable target, which was indicated by the correct diagnosis and stage.

Chemoradiation was administered with the intention of preserving organs, and control and voice were given priority.

It was possible to deliver a conformal dose to the tumour or nodes using Helical Tomotherapy, which spared healthy tissue.

Approach taken by the team: objectives were aligned from the very beginning thanks to a tumour board plan and careful execution.