Cancer patient finds voice again thanks to groundbreaking transplant

Cancer patient finds voice again thanks to groundbreaking transplant

Rare vocal cord transplant helps American man speak, part of groundbreaking study

A Massachusetts man has regained his voice after surgeons removed his cancerous larynx and replaced it with a donated one in a groundbreaking move.

Transplants of the so-called voice box are extremely rare and are not usually an option for people with active cancer. Marty Kedian is only the third person in the U.S. to ever have a total larynx transplant—the others were years ago, due to injury—and one of only a handful reported worldwide.

Surgeons at the Mayo Clinic in Arizona offered Kedian the transplant as part of a new clinical trial aimed at making this potentially life-changing surgery available to more patients, including those with cancer, the most common way to lose a voice box.

“People need to keep their voices,” Kedian, 59, told The Associated Press four months after his transplant — still hoarse but able to carry on a conversation for an hour. “I want people to know that this is possible.”

He became emotional as he recalled the first time he called his 82-year-old mother after the surgery, “and she could hear me. … That was important to me, to talk to my mother.”

The study is small, with just nine people expected to participate. But it could teach scientists best practices for these complex transplants so they can one day be offered to more people who can’t breathe, swallow or talk on their own because of a damaged or surgically removed larynx.

“Patients become very withdrawn and very disconnected from the rest of the world,” said Dr. David Lott, Mayo’s head and neck surgeon in Phoenix. He started the study because “my patients say to me, ‘Yes, I may be alive, but I’m not really alive.'”

Lott’s team published the initial results of the surgery on Tuesday in the journal Mayo Clinic Proceedings.

The larynx may be best known as the voice box, but it’s also vital for breathing and swallowing. Flaps of muscular tissue called vocal cords open to let air into the lungs, close to keep food or drink from going the wrong way—and vibrate as air is pushed past them to produce speech.

The first two recipients of a larynx transplant in the US – in 1998 at the Cleveland Clinic and in 2010 at the University of California at Davis – had lost their voices due to injuries, one in a motorcycle accident and the other on a ventilator in hospital.

But cancer is the biggest reason. The American Cancer Society estimates that more than 12,600 people will be diagnosed with laryngeal cancer this year. While many today receive voice-preserving treatment, thousands have had their larynxes completely removed, breathe through a tracheotomy tube in their neck, and have difficulty communicating.

Although early U.S. recipients achieved near-normal speech, doctors have not embraced the transplants. That’s partly because people can survive without a larynx, while anti-rejection drugs that suppress the immune system can cause new or recurring tumors.

“We want to push those boundaries, but do it as safely and ethically as possible,” Lott said.

Head and neck cancer specialists say the Mayo study is crucial to making larynx transplants a viable option.

“It’s not a one-time event,” but an opportunity to finally learn from one patient before operating on the next, said Dr. Marshall Strome, who led the 1998 transplant in Cleveland.

This first attempt in a cancer patient “is the next important step,” he said.

Other options are being studied, noted Dr. Peter Belafsky of UC Davis, who helped with the transplant in 2010. His patients at high risk for larynx loss are recording their voices in anticipation of next-generation speech devices that sound like them.

But Belafsky said there is “still a chance” that larynx transplants will become more common, while cautioning that it will likely take years of research. One hurdle is achieving enough nerve regeneration to allow breathing without a tracheostomy tube.

Kedian was diagnosed with a rare cancer of the laryngeal cartilage about a decade ago. The Haverhill, Massachusetts, man underwent more than a dozen surgeries and eventually needed a tracheostomy tube to breathe and swallow — and struggled to produce even a hoarse whisper. He was forced to retire on disability.

Yet the once gregarious Kedian, known for his long conversations with strangers, did not want doctors to remove his entire larynx to cure the cancer. He was eager to read bedtime stories to his granddaughter, using his own voice instead of what he called robotic speech devices.

Then Kedian’s wife, Gina, tracked down the Mayo study. Lott decided he was a good candidate because his cancer wasn’t growing fast and — importantly — Kedian was already taking anti-rejection drugs for a previous kidney transplant.

It took 10 months to find a deceased donor with a healthy larynx that was exactly the right size.

Then, on February 29, six surgeons operated for 21 hours. After removing Kedian’s cancerous larynx, they transplanted the donated larynx plus the necessary surrounding tissues—thyroid and parathyroid glands, pharynx and upper trachea—and small blood vessels to supply them. Finally, using novel microsurgical techniques, they connected nerves that are crucial for Kedian’s ability to sense when to swallow and move his vocal cords.

About three weeks later, Kedian said “hello.” He quickly learned to swallow again, going from applesauce to macaroni and cheese to hamburgers. He was able to say hi to granddaughter Charlotte via video, part of his homework to keep talking.

“Every day it’s getting better,” said Kedian, who will soon be moving back to Massachusetts. His tracheostomy will remain in place for at least a few more months, but “I’m pushing myself to make it go faster because I want these tubes out of me so I can live a normal life again.”

And as Lott had assured him, Kedian retained his beloved Boston accent.

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