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Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion
Author(s) -
Worden Francis P.,
Moyer Jeffrey,
Lee Julia S.,
Taylor Jeremy M. G.,
Urba Susan G.,
Eisbruch Avraham,
Teknos Theodoros N.,
Chepeha Douglas B.,
Prince Mark E.,
Hogikyan Norman,
Lassig Amy Anne D.,
Emerick Kevin,
Mukherji Suresh,
Hadjiski Lubomir,
Tsien Christina I.,
Miller Tamara H.,
Wallace Nancy E.,
Mason Heidi L.,
Bradford Carol R.,
Wolf Gregory T.
Publication year - 2009
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20294
Subject(s) - medicine , carboplatin , laryngectomy , larynx , cisplatin , radiation therapy , chemotherapy , carcinoma , urology , surgery , chemoradiotherapy
Objectives/Hypothesis: High rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies. Study Design: Retrospective. Methods: Records from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m 2 ) [or carboplatin (AUC 6)] and 5‐fluorouracil (1,000 mg/m 2 /d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin‐100 mg/m 2 [carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation. Results: Twenty‐nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3‐year OS was 78%, and the disease‐specific survival was 80% (median follow‐up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g‐tube dependent and 6/36 (17%) were tracheostomy dependent. Conclusions: Our results suggest that chemo‐selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion. Laryngoscope, 2009