Larynx preservation with combined chemotherapy and radiation therapy in advanced but resectable head and neck cancer.

Abstract

Forty patients with advanced, resectable squamous cell carcinoma of the larynx, oropharynx, or hypopharynx whose surgery would have required total laryngectomy (TL), were treated with one to three cycles of cisplatin-based chemotherapy before local therapy with the goal of larynx preservation. Clinical complete responses (CRs) or partial responses (PRs) to chemotherapy were seen in 26 of 40 patients (65%). Three patients with primary-site disease unresponsive to chemotherapy underwent resection of the primary lesion and neck dissection followed by radiation therapy (RT). Thirty-seven patients were referred after chemotherapy for RT +/- neck dissection. Thirty-one of 40 patient (78%) were rendered disease-free (no evidence of disease [NED]). With a median follow-up of 49 months (range, 31 to 76), the overall actuarial survival rate for the group was 58% at 2 years and 33% at 5 years. The failure-free survival rate was 42% and 33% at 2 and 5 years, respectively. Seven patients refused recommended TL throughout their course. This may have adversely affected survival results. A greater proportion of patients who achieved a CR or PR to chemotherapy remained disease-free compared with those who achieved less than a PR (P less than .001). Sixteen patients relapsed, 10 with locoregional disease. Six patients underwent TL, either for initial induction failure or at relapse, for an actual larynx-preservation rate of 34 of 40 patients (85%). If the seven patients who refused TL are included, the anticipated preservation rate is 27 of 40 patients (68%). Larynx preservation with combined chemotherapy and radiation is feasible and effective in patients with advanced, resectable squamous cell carcinoma of the head and neck (SCHN). This treatment approach requires a motivated patient, careful patient monitoring, and close interdisciplinary cooperation among oncologists.

Treatment of cancer of the head and neck

“…38 Induction chemotherapy with cisplatin and 5-fluorouracil followed by definitive radiotherapy has enabled preservation of the larynx in nearly 70 percent of patients with advanced laryngeal carcinoma, otherwise requiring total laryngectomy. 22,39,40 Patients who require pharyngolaryngectomy for advanced tumors of the larynx or pharynx should have the continuity of their alimentary tract restored immediately to facilitate early resumption of swallowing. Reconstruction of the laryngopharyngeal defect requires the use of a regional myocutaneous flap for partial pharyngeal repair or a microvascular segment of jejunum or gastric transposition for repair of total circumferential pharyngectomy or pharyngoesophagectomy.…”

Different clinical outcomes between locally advanced hypopharyngeal and oropharyngeal cancer treated with definitive concurrent chemoradiotherapy: implication for subgroup selection for induction chemotherapy

“…Although most patients with locally advanced HNSCC can be treated by surgery with curative intent, these sites are good candidates for an organ-preserving treatment approach such as CCRT because of the potential functional or cosmetic benefits after surgery and non-inferior efficacy (6).…”

A Phase II Study of Concomitant Chemoradiotherapy for Laryngeal Carcinoma Using Carboplatin

“…Conventional radiotherapy, which reserves surgery for salvage therapy, can provide sufficient tumor control for early-to intermediate-stage laryngeal carcinoma [1,2,[4][5][6][7][8], but the larynx preservation rate has still to be improved for T 2 or larger tumors. The additional use of chemotherapy has been studied intensively in head and neck carcinomas [2,[9][10][11][12][13][14]. Induction, or neoadjuvant chemotherapy, is reported to enhance local control and is effective in preserving the larynx without lowering the survival rate for patients with laryngeal cancer [15].…”

“…The goal of radiotherapy in laryngeal carcinoma is not only to cure the disease but also to preserve vocal function [1][2][3]. Conventional radiotherapy, which reserves surgery for salvage therapy, can provide sufficient tumor control for early-to intermediate-stage laryngeal carcinoma [1,2,[4][5][6][7][8], but the larynx preservation rate has still to be improved for T 2 or larger tumors.…”