title: Chemotherapy followed by accelerated fractionated radiation for larynx preservation in patients with advanced laryngeal cancer.
abstract: OBJECTIVE
  Larynx preservation in advanced, resectable laryngeal cancer may be achieved using induction chemotherapy (CT) followed in responding patients by definitive radiation (RT). To address potential accelerated repopulation of clonogenic tumor cells during the prolonged total treatment time, we studied the feasibility of accelerated fractionated RT after CT.
  
  
  METHODS
  Patients with advanced laryngeal cancer received two cycles of cisplatin 100 mg/m2 and fluorouracil (5-Fu) 1,000 mg/m2/d for 5 days. Responding patients received a third cycle after which those who had complete response or tumor down-staging to T1 proceeded with accelerated RT: 70.4 Gy delivered over 5.5 weeks. Patients who achieved a lesser response to CT underwent total laryngectomy and postoperative RT.
  
  
  RESULTS
  Thirty-three patients were accrued. Three died during the course of CT and two declined definitive treatment after CT. Twenty-one patients had a major response to CT, 20 of whom received accelerated RT. Median weight loss during RT was 11%. Late severe morbidity was observed in five patients (25%). All four patients who underwent salvage laryngectomy after accelerated RT experienced major postoperative complications. The locoregional failure rate was 25%. The larynx was preserved in 48% of the total study population and in 80% of the patients irradiated according to the study protocol.
  
  
  CONCLUSIONS
  Accelerated RT after CT as delivered in this study may increase both acute and long-term morbidity rates compared with studies using standard RT after CT. It did not seem to improve local/regional tumor control or survival despite stringent patient selection criteria.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor 48109, USA. eisbruch@umich.edu
authors.forename: A
authors.initials: A
authors.lastname: Eisbruch
authors.forename: A F
authors.initials: AF
authors.lastname: Thornton
authors.forename: S
authors.initials: S
authors.lastname: Urba
authors.forename: R M
authors.initials: RM
authors.lastname: Esclamado
authors.forename: W R
authors.initials: WR
authors.lastname: Carroll
authors.forename: C R
authors.initials: CR
authors.lastname: Bradford
authors.forename: M B
authors.initials: MB
authors.lastname: Hazuka
authors.forename: F J
authors.initials: FJ
authors.lastname: Littles
authors.forename: M
authors.initials: M
authors.lastname: Strawderman
authors.forename: G T
authors.initials: GT
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil