title: Larynx preservation using induction chemotherapy plus radiation therapy as an alternative to laryngectomy in advanced head and neck cancer. A long-term follow-up report.
abstract: Since 1977, we have used induction chemotherapy (CT) plus radiation therapy (RT) with curative intent in 35 advanced head and neck cancer (Ca) patients who otherwise would have required total laryngectomy. Fourteen patients had advanced Ca of the larynx or supraglottic larynx (SGL); 21 patients had Ca of the hypopharynx. In six patients the Ca was Stage III; in 26 patients it was Stage IV. Three patients had Stage II disease--2 with cancer of the pyriform sinus and one patient with Stage II SGL Ca who refused surgery. Chemotherapy consisted of platinum (P) + bleomycin in 18 patients until 1982, then P + fluorouracil in the next 17 patients. Total response rate was 77%--complete (CR) in 26% and partial (PR) in 51%. There were two toxic deaths. Surgery was limited to tracheostomy in 4 patients prior to CT and to radical neck dissection after CT in 4 others. Two patients required salvage laryngectomy at 11 and 31 months, respectively. One patient underwent partial laryngectomy with voice preservation. Thirty-two patients were evaluable for overall response after RT. Final disease-free status was achieved in 20/34. One long-term survivor was lost to follow-up (44 months) and 8 patients remained alive at 13+ to 109+ months. Median failure-free survival for all patients was no less than 24 months. Not counting 4 early deaths free of disease, 2-year local control using only chemotherapy plus radiation was 52% (16:31). Overall, 33 of 35 patients retained their voices. Sixteen patients (46%) have survived 2 years or longer. Survival of patients who achieved CR after induction chemotherapy was 48 months versus 14 months for those with less than a CR (p = 0.001). Patients with a hypopharyngeal primary had only a 33% 2-year local control rate with chemotherapy and radiation and a median survival of only 12 months versus 77% control and a minimum 39-month survival for those whose tumor arose in the larynx (p = 0.009). Induction chemotherapy plus radiation therapy is an effective strategy which can produce a high rate of larynx preservation, local control, and long-term survival in patients with advanced cancer of the larynx. Patients with hypopharyngeal primaries have a lesser rate of long-term survival and local control, despite similar overall response rates.
authors.affiliation: Department of Surgical Services, V.A. Medical Center, Boston, Massachusetts.
authors.forename: D D
authors.initials: DD
authors.lastname: Karp
authors.forename: C W
authors.initials: CW
authors.lastname: Vaughan
authors.forename: R
authors.initials: R
authors.lastname: Carter
authors.forename: B
authors.initials: B
authors.lastname: Willett
authors.forename: T
authors.initials: T
authors.lastname: Heeren
authors.forename: P
authors.initials: P
authors.lastname: Calarese
authors.forename: S
authors.initials: S
authors.lastname: Zeitels
authors.forename: M S
authors.initials: MS
authors.lastname: Strong
authors.forename: W K
authors.initials: WK
authors.lastname: Hong
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002423:Cause of Death; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy / Q000592:standards; D008875:Middle Aged; D037981:Neck Dissection / Q000592:standards; D009367:Neoplasm Staging; D010865:Pilot Projects; D011878:Radiotherapy / Q000592:standards*; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate
chemical_list: D001761:Bleomycin; D002945:Cisplatin; D005472:Fluorouracil