title: Treatment of advanced cancer of the larynx and hypopharynx with chemoradiation.
abstract: OBJECTIVE
  To analyze the outcome of patients diagnosed with advanced cancer of the larynx and hypopharynx treated with combined chemotherapy and radiotherapy at Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia.
  
  
  METHODS
  Analysis of prospectively gathered data concerning patients treated between 1994 and 2000 in a multidisciplinary, tertiary referral head and neck service. Outcome measures were: treatment toxicity, locoregional tumour control, and disease specific survival.
  
  
  RESULTS
  Among 54 eligible patients, cancer involved the larynx in 31 patients and hypopharynx in 23 and, of these, 38 (70%) completed all the scheduled treatment. Chemotherapy and radiotherapy were given sequentially in 39 patients and concurrently in 15. The median age of patients was 63 years (range 35-79 years) and all but three had clinical stage III or IV disease. There were two treatment related deaths. Disease persisted in five patients and 14 others relapsed. Overall, 11 (24%) patients have had a laryngectomy; five for persistent disease, three for local recurrence and three for treatment related complications in the absence of disease. There were 15 cancer-related deaths. Cumulative disease specific survival at 2 years was 77% for the larynx cancer group and 72% for hypopharynx. The larynx was preserved in 26 of 30 patients alive at follow up.
  
  
  CONCLUSIONS
  Patients diagnosed with advanced cancer of the larynx and hypopharynx may be considered for organ preservation treatment with chemoradiation, reserving surgery for persistent or recurrent disease. Careful patient selection is recommended because of the potential for significant treatment related toxicity.
authors.affiliation: Sydney Head and Neck Cancer Institute and Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Featherstone
authors.forename: Stephen
authors.initials: S
authors.lastname: Clarke
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jackson
authors.forename: Kerwin F
authors.initials: KF
authors.lastname: Shannon
authors.forename: Edward B
authors.initials: EB
authors.lastname: McNeil
authors.forename: Mo M
authors.initials: MM
authors.lastname: Tin
authors.forename: Anthony
authors.initials: A
authors.lastname: Clifford
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D007822:Laryngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies