Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion.
OBJECTIVE
High rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies.


METHODS
Retrospective.


METHODS
Records from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m(2)) [or carboplatin (AUC 6)] and 5-fluorouracil (1,000 mg/m(2)/d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin-100 mg/m(2) [carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation.


RESULTS
Twenty-nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3-year OS was 78%, and the disease-specific survival was 80% (median follow-up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g-tube dependent and 6/36 (17%) were tracheostomy dependent.


CONCLUSIONS
Our results suggest that chemo-selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion.
Worden
Francis P
FP
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA. fworden@umich.edu
Moyer
Jeffrey
J
Lee
Julia S
JS
Taylor
Jeremy M G
JM
Urba
Susan G
SG
Eisbruch
Avraham
A
Teknos
Theodoros N
TN
Chepeha
Douglas B
DB
Prince
Mark E
ME
Hogikyan
Norman
N
Lassig
Amy Anne D
AA
Emerick
Kevin
K
Mukherji
Suresh
S
Hadjiski
Lubomir
L
Tsien
Christina I
CI
Miller
Tamara H
TH
Wallace
Nancy E
NE
Mason
Heidi L
HL
Bradford
Carol R
CR
Wolf
Gregory T
GT
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D002356:Cartilage / Q000187:drug effects / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D017322:Clinical Trials, Phase II as Topic; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D008297:Male; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D009926:Organ Preservation; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D047368:Tumor Burden
D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil