title: Results of chemoselection with short induction chemotherapy followed by chemoradiation or surgery in the treatment of functionally inoperable carcinomas of the pharynx and larynx.
abstract: OBJECTIVE
  Chemoradiation is the treatment of choice for carcinomas of the pharynx and larynx with imminent loss of organ or function. However, the prognosis after CRT decreases when salvage surgery becomes necessary. Single-cycle induction chemotherapy is therefore performed to identify patients who would benefit more from S than from CRT. The present study aims to evaluate the feasibility and effectiveness of this approach.
  
  
  METHODS
  Forty-seven patients received Induction Chemotherapy (IC) with docetaxel plus cisplatin or carboplatin and were subsequently assessed for tumor response. Responders achieving a ≥30% decrease in endoscopic tumor size and a ≥20% decrease in 18F-fluorodeoxyglucose uptake proceeded to primary Chemoradiation (CRT) and non-responders received surgery (S). Six weeks after CRT patients with residual tumors underwent secondary surgery (S).
  
  
  RESULTS
  Thirty eight patients were elected for CRT and 9 received S. A local control rate of 86.1% and disease-free survival of 80.4% was achieved at 2 years. Overall treatment time in CRT-patients >80 days was associated with inferior disease-free survival (p = 0.05), cause-specific survival (p = 0.02), overall survival (p = 0.01) and a trend to inferior local control (p = 0.07) at 2 years.
  
  
  CONCLUSIONS
  The strategy of selecting patients for CRT vs. S based on the response to IC achieves encouraging rates of disease control by surgery and CRT.
authors: Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitaetsstraße 27, 91054 Erlangen, Germany. sabine.semrau@uk-erlangen.de
authors: Sabine
authors: S
authors: Semrau
authors: Daniela
authors: D
authors: Schmidt
authors: Michael
authors: M
authors: Lell
authors: Frank
authors: F
authors: Waldfahrer
authors: Sebstian
authors: S
authors: Lettmaier
authors: Torsten
authors: T
authors: Kuwert
authors: Heinrich
authors: H
authors: Iro
authors: Rainer
authors: R
authors: Fietkau
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D004724:Endoscopy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D010610:Pharyngeal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D049268:Positron-Emission Tomography; D012074:Remission Induction; D016879:Salvage Therapy; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D016190:Carboplatin; D002945:Cisplatin