Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion

✍ Scribed by Francis P. Worden; Jeffrey Moyer; Julia S. Lee; Jeremy M. G. Taylor; Susan G. Urba; Avraham Eisbruch; Theodoros N. Teknos; Douglas B. Chepeha; Mark E. Prince; Norman Hogikyan; Amy Anne D. Lassig; Kevin Emerick; Suresh Mukherji; Lubomir Hadjiski; Christina I. Tsien; Tamara H. Miller; Nancy E. Wallace; Heidi L. Mason; Carol R. Bradford; Gregory T. Wolf

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 559 KB
• Volume: 119
• Category: Article
• ISSN: 0023-852X
• DOI: 10.1002/lary.20294

✦ Synopsis

Abstract

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