title: Induction chemotherapy-based larynx preservation program for locally advanced hypopharyngeal cancer: oncologic and functional outcomes and prognostic factors.
abstract: To evaluate oncologic and functional outcomes and prognostic factors in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program in daily clinical practice. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngo-laryngectomy, treated by docetaxel (75 mg/m(2), day 1), cisplatin (75 mg/m(2), day 1) and 5-fluorouracil (750 mg/m(2)/day, day 1-5) (TPF)-ICT (2-3 cycles) for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Prognostic factors of oncologic (overall, cause-specific and recurrence-free survival: OS, SS and RFS) and functional (dysphagia outcome and severity scale, permanent enteral nutrition, larynx preservation) outcomes were assessed in univariate and multivariate analyses. A total of 53 patients (42 men and 11 women, mean age 58.6 ± 8.2 years) were included in this study. Grade 3-4 toxicities were experienced by 17 (32 %) patients during ICT. The rate of poor response (response <50 % without larynx remobilization) to ICT was 10 %. At 5 years, OS, SS and RFS rates were 56, 60 and 54 %, respectively. Four patients required definitive enteral nutrition (permanent enteral tube feeding). The rate of patients alive, disease-free and with a functional larynx at 2 years was 58 %. T4 tumor stage (p = 0.005) and response to ICT <50 % (p = 0.02) were independent prognostic factors of OS. Response to ICT was significantly associated with the risk of permanent enteral nutrition (p = 0.04) and larynx preservation (p = 0.01). In daily clinical practice, a TPF-ICT-based larynx preservation protocol can be used in patients with locally advanced hypopharyngeal cancer with satisfactory results in terms of tolerance, efficacy and oncologic and functional outcomes.
authors: Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103, Nice, France. alexandre.bozec@nice.unicancer.fr.
authors: Alexandre
authors: A
authors: Bozec
authors: Department of Radiotherapy, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Karen
authors: K
authors: Benezery
authors: Department of Statistics, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Marc
authors: M
authors: Ettaiche
authors: Department of Statistics, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Emmanuel
authors: E
authors: Chamorey
authors: Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103, Nice, France.
authors: Clair
authors: C
authors: Vandersteen
authors: Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103, Nice, France.
authors: Olivier
authors: O
authors: Dassonville
authors: Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103, Nice, France.
authors: Gilles
authors: G
authors: Poissonnet
authors: Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103, Nice, France.
authors: Jean-Christophe
authors: JC
authors: Riss
authors: Department of Radiotherapy, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Jean-Michel
authors: JM
authors: Hannoun-Lévi
authors: Department of Radiotherapy, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Marie-Eve
authors: ME
authors: Chand
authors: Department of Radiotherapy, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Axel
authors: A
authors: Leysalle
authors: Department of Medical Oncology, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Esma
authors: E
authors: Saada
authors: Department of Medical Oncology, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Joël
authors: J
authors: Guigay
authors: Department of Pathology, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Anne
authors: A
authors: Sudaka
authors: Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103, Nice, France.
authors: François
authors: F
authors: Demard
authors: Institut Universitaire de la Face et du Cou, 31 avenue de Valombrose, 06103, Nice, France.
authors: José
authors: J
authors: Santini
authors: Department of Medical Oncology, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06103, Nice, France.
authors: Frédéric
authors: F
authors: Peyrade
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005602:France; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D007825:Laryngectomy / Q000379:methods*; D007830:Larynx / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D002945:Cisplatin; D005472:Fluorouracil
keywords: Cancer; Functional outcome; Hypopharynx; Induction chemotherapy; Larynx preservation; Prognosis