Tumor response, toxicity, and survival after neoadjuvant organ-preserving chemotherapy for advanced laryngeal carcinoma. The Department of Veterans Affairs Cooperative Laryngeal Cancer Study Group.

Abstract

Neoadjuvant chemotherapy was well tolerated and did not negatively affect the definitive treatment that followed. The survival of nonresponding patients who underwent prompt salvage surgery was also not impaired. The role of organ preservation should be explored in other head and neck sites.

A Phase I/II trial of concurrent docetaxel and radiation after induction chemotherapy in patients with poor prognosis squamous cell carcinoma of the head and neck

“…Historic controls for this group were not readily available; however, for the group of pathologically positive patients in the Veterans Administration Larynx Trial, the disease free survival rate at 24 months was 40%. 5 The sequential integration of surgery after radiation therapy for patients with residual lymph node disease proved effective in two of five patients with positive pathologies. Our sequential regimen appears to be effective and offers a more aggressive local-regional treatment approach for selected patients who respond poorly to induction chemotherapy.…”

“…Induction chemotherapy has an established role of organ preservation in the treatment of patients with laryngeal and hypopharyngeal primary tumors and has been studied as a route to achieve organ preservation in other head and neck sites. [1][2][3][4][5][6] The most frequently used radiation schedule after induction therapy has been daily treatment at a dose of 1.8 -2.0 Gy per day up to a total dose of 65-70 Gy, although other schedules have been used. This approach has yielded acceptable results overall in terms of functional preservation, although the outcome for patients who do not respond well to induction treatment has not been good.…”

“…For example, in the Veterans Administration larynx study, there was an Ϸ 70% (pathologically negative) versus Ϸ 35% (pathologically positive) difference in 3-year disease free survival based on preirradiation biopsies. 5 In managing the care of patients who are treated on induction chemotherapy regimens, it is important to ask is whether a more aggressive, local-regional therapy combination may improve the outcome for patients with high risk, poor prognosis disease who have not responded adequately to induction chemotherapy.…”

“…[1][2][3][4][5][6] Phase III studies have demonstrated the efficacy of combined chemotherapy and radiation for maintaining a functional larynx for patients with either a laryngeal or hypopharyngeal primary tumor without altering survival and for improving survival in patients with unresectable disease. 1,[3][4][5][6] Patients who do not have a significant response to the first two cycles of chemotherapy frequently go directly to surgery or radiation therapy. A common finding in these trials is that patients who achieve a primary site clinical and/or pathologic complete response (CR) to three cycles of induction chemotherapy fare well in terms of local disease control.…”

Phase II study of induction chemotherapy with paclitaxel, ifosfamide, and carboplatin (TIC) for patients with locally advanced squamous cell carcinoma of the head and neck

“…This might be of more prognostic value and was documented in a Veterans Affairs study. 5 Also, while of minor importance, the reported survival of 83% does not include the two patients who died after being entered on the study and treated. With an intent to treat analysis these treatment related deaths should be included in the overall survival figure, which decreases to 79%.…”