Long-Term Results of RTOG 91-11: A Comparison of Three Nonsurgical Treatment Strategies to Preserve the Larynx in Patients With Locally Advanced Larynx Cancer

Abstract

A B S T R A C T PurposeTo report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation. Patients and MethodsPatients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point. ResultsFive hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P ϭ .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P ϭ .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P ϭ .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P ϭ .0050) and over RT alone (P Ͻ .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P ϭ .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone). ConclusionThese 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed.

Treatment results, side effects and prognostic factors affecting survival in patients with larynx cancer

“…The incidence rates of 10-year cumulative grade 3-4 side effects were also determined for patients receiving CT+RT (31%), concomitant CRT (33%), and RT (38%) protocols. [41] In this study, the incidence of side effects including mucositis, nausea-vomiting, weight loss, neutropenia, and anemia was higher in patients who received CRT rather than RT. The incidence of xerostomia was similar in patients who received RT or CRT.…”

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…Chemo-radiotherapy (CRT) has increased the curability of locally advanced head and neck cancer patients (HNCPs) [1] and has allowed organ and function preservation in laryngeal and hypo-pharyngeal cancer patients [2]. However, competing causes of mortality (e.g.…”

A genetic view of laryngeal cancer heterogeneity

“…It is, therefore, more similar to what we currently understand as larynx preservation. 85 A subsequent meta-analysis for locally advanced larynx cancer found that adding CT concomitant ÃÃ T1 and high-volume T4 were excluded: invasion >1 cm into de base of tongue or penetration through caRTilage.…”