"FAR" chemoradiotherapy improves laryngeal preservation rates in patients with T2N0 glottic carcinoma.
BACKGROUND
The appropriate treatment approach for patients with T2N0 laryngeal cancer remains highly controversial. Because radiotherapy alone is associated with a high risk of local recurrence, we have developed a triple combination treatment approach consisting of 5-fluorouracil (250 mg/day, i.v.), vitamin A (50,000 unit/day, i.m.) and external radiation (2.0 Gy/day), which we have termed "FAR therapy."


METHODS
Patients with T2N0 glottic carcinoma were initially treated with 15 days of FAR therapy, which included a cumulative radiation dose of 30Gy (i.e., "30 Gy of FAR therapy"). Those patients who demonstrated a complete response either clinically or pathologically continued to receive further FAR therapy, with up to 60-70 Gy. All other patients received laryngectomy without any additional treatment.


RESULTS
Ninety-five patients were treated according to this program, and most of the patients (98%) were able to complete this treatment course. Eighty-eight patients (93%) were treated with FAR therapy alone. The local control and ultimate local control rates were 91% (85 of 93), and 99% (92 of 93), respectively. The cumulative 5-year voice preservation and complete laryngeal preservation rates were 91% and 87%, respectively. The cumulative 5-year disease-specific survival rate was 97%.


CONCLUSIONS
Because a high rate of laryngeal preservation was achieved without compromising disease-specific survival, our treatment approach based on FAR therapy may be promising for the treatment of patients with T2N0 glottic carcinoma.
Kumamoto
Yoshihiko
Y
Department of Otolaryngology, Faculty of Medicine, Kyushu University, Fukuoka 812-8582, Japan.
Masuda
Muneyuki
M
Kuratomi
Yuichiro
Y
Toh
Satoshi
S
Shinokuma
Atsushi
A
Chujo
Kyoko
K
Yamamoto
Tomoya
T
Komiyama
Sohtaro
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D014801:Vitamin A / Q000627:therapeutic use*
D000964:Antimetabolites, Antineoplastic; D014801:Vitamin A; D005472:Fluorouracil