Chemoselection as a Strategy for Organ Preservation in Patients With T4 Laryngeal Squamous Cell Carcinoma With Cartilage Invasion

Laryngoscope. 2009 Aug;119(8):1510-7. doi: 10.1002/lary.20294.

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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Carboplatin / administration & dosage
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / drug therapy*
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / pathology
  • Cartilage / drug effects
  • Cartilage / pathology
  • Cisplatin / administration & dosage
  • Clinical Trials, Phase II as Topic
  • Disease-Free Survival
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Kaplan-Meier Estimate
  • Laryngeal Neoplasms / diagnostic imaging
  • Laryngeal Neoplasms / drug therapy*
  • Laryngeal Neoplasms / mortality*
  • Laryngeal Neoplasms / pathology
  • Male
  • Neoadjuvant Therapy
  • Neoplasm Invasiveness / pathology*
  • Neoplasm Staging
  • Organ Preservation
  • Probability
  • Prognosis
  • Quality of Life
  • Radiography
  • Radiotherapy, Adjuvant
  • Remission Induction
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Survival Analysis
  • Tumor Burden

Substances

  • Carboplatin
  • Cisplatin
  • Fluorouracil