Concurrent intra-arterial chemotherapy and radiotherapy for advanced laryngeal cancer.
OBJECTIVE
An intra-arterial chemoradiotherapy regimen (RADPLAT) provides remarkable local control for head and neck cancer. This study evaluates the efficacy of a reduced RADPLAT protocol in patients who are candidates for total laryngectomy.


METHODS
Forty-three patients with advanced laryngeal cancer were treated with 2 courses of intra-arterial cisplatin infusion (100 mg per body) during 40-Gy irradiation. The patients who showed a greatly diminished tumor received sequential irradiation. The patients with obvious residual disease received chemotherapy during the sequential irradiation. Poor responders, with less than 50% tumor reduction, underwent total laryngectomy.


RESULTS
Forty-two patients completed the protocol. All surviving patients were followed for at least 3 years. Thirty-four patients were alive (80% of the supraglottic cases and 87.5% of the glottic cases). Local control was achieved in 27 patients (67.5% of the 11 glottic cases and 64.0% of the supraglottic cases). The glottic cohort showed better progression-free survival rates than did the supraglottic cohort (68.8% and 45.0%, respectively; p = 0.019). There were 2 cases of grade 3 neutropenia and 3 cases of grade 3 mucositis. No patients required tube feeding. One patient required tracheostomy 3 months after the completion of the treatment protocol.


CONCLUSIONS
Concurrent chemoradiotherapy with a reduced dose of intra-arterial cisplatin is feasible for patients with advanced glottic cancer.
Division of Otolaryngology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Tomokazu
T
Yoshizaki
Satoru
S
Kondo
Naohiro
N
Wakisaka
Shigeyuki
S
Murono
Noriko
N
Kitagawa
Akira
A
Tsuji
Masashi
M
Nakashima
Jun-ichiro
J
Sanada
Osamu
O
Matsui
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage*; D015331:Cohort Studies; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002945:Cisplatin