title: Treatment results of alternating chemoradiotherapy with early assessment for advanced laryngeal cancer: A multi-institutional phase II study.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of alternating chemoradiotherapy (ACRT) with early assessment of advanced laryngeal cancer.
  
  
  METHODS
  Patients with stage III or IV glottic or supraglottic squamous cell carcinoma were enrolled. ACRT consisted of two cycles of chemotherapy involving 5-fluorouracil and cisplatin (weeks 1 and 6) and radiotherapy (RT; weeks 2 and 7) administered alternately. An early assessment was performed after one cycle of chemotherapy and RT. Patients with a partial response (PR) or a complete response at early assessment continued ACRT. Patients with stable disease (SD) or progressive disease at early assessment discontinued ACRT and underwent salvage surgery. After completion of ACRT, patients who had residual primary tumor and lymph metastasis underwent salvage surgery.
  
  
  RESULTS
  Twenty-eight patients were enrolled in this trial. Median follow-up was 60.0 months. After each cycle of chemotherapy and RT, 24 of the 28 patients (85.7%) were assessed as having a PR at early assessment and continued ACRT, and 4 of 28 patients (14.3%) who were assessed as having SD at early assessment discontinued ACRT and underwent salvage surgery. The estimated 5-year local control and 5-year survival rates were 49.0% and 77.4%, respectively. Larynx preservation was achieved in 17 patients. The estimated 5-year laryngeal preservation rate was 59.4%. Major toxicity included nausea, stomatitis, dermatitis, dysphagia and hemoglobin toxicity. Grade 3 or 4 stomatitis occurred in three patients (10.7%).
  
  
  CONCLUSIONS
  The clinical results of ACRT with early assessment of advanced laryngeal cancer patients showed sufficient efficacy and safety.
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan; Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nakata
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Science, Nagoya 467-8601, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ijichi
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hanai
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nishikawa
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirakawa
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.affiliation: Department of Otolaryngology, Nagoya University Graduate School of Medicine, Nagoya 466-0065, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-0025, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Kurashiki Central Hospital, Kurashiki, Okayama 710-0052, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan. Electronic address: hasegawa@aichi-cc.jp.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003680:Deglutition Disorders / Q000453:epidemiology; D003872:Dermatitis / Q000453:epidemiology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D007828:Laryngoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000453:epidemiology; D011878:Radiotherapy / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013280:Stomatitis / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: Alternating chemoradiotherapy; Laryngeal cancer; Laryngeal preservation; Local control