Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer.
Use of chemoradiotherapy for advanced laryngeal cancer led to a major shift in treatment as an alternative to laryngectomy. Despite widespread adoption of chemoradiotherapy, survival rates have not improved and the original premise of matching neoadjuvant chemotherapy tumor response to determine subsequent treatment has not been followed.



To determine whether improved survival could be achieved by incorporating a single cycle of neoadjuvant chemotherapy to select patients with advanced disease for either laryngectomy or concurrent chemoradiotherapy.



An unselected cohort of 247 patients with laryngeal cancer in an academic institution between 2002 and 2012 was evaluated. Patients with limited disease (stages I and II) underwent endoscopic resection, radiotherapy, or chemoradiotherapy for deeply invasive T2 lesions. For patients with advanced disease (stages III and IV), neoadjuvant chemotherapy, concurrent chemoradiotherapy, or primary surgery was recommended. Overall survival (OS) and disease-specific survival (DSS) were analyzed. Median follow-up was 48 months. The study was conducted from January 1, 2002, to December 31, 2012; data analysis was completed December 1, 2015.



Endoscopic resection, radiotherapy, chemoradiotherapy, neoadjuvant chemotherapy, concurrent chemoradiotherapy, and primary surgery.



Overall survival and DSS.



Of the 247 patients, 191 (77.3%) were male; mean (SD) age was 59.6 (10.4) years. Of 94 patients with limited disease, 33 (35.1%) underwent endoscopic resection; 50 (53.2%), radiotherapy alone; and 11 (11.7%), chemoradiotherapy for deeply invasive T2 lesions. Of 153 patients with advanced disease, 71 (46.4%) received neoadjuvant chemotherapy; 50 (32.7%), concurrent chemoradiotherapy; and 32 (20.9%), surgery. Five-year OS and DSS was 75% (95% CI, 68%-81%) and 83% (95% CI, 77%-88%), respectively, for the entire cohort. The DSS was 92% (95% CI, 83%-97%) for patients with stage I or II and 78% (95% CI, 69%-84%) for patients with stage III or IV disease. For patients with advanced disease, 5-year OS and DSS ranged from 78% (95% CI, 55%-90%) and 91% (95% CI, 67%-98%), respectively, for surgery; to 76% (95% CI, 63%-85%) and 79% (95% CI, 67%-88%), respectively, for neoadjuvant bioselection; and to 61% (95% CI, 44%-75%) and 66% (95% CI, 48%-79%), respectively, for primary chemoradiotherapy. Propensity-adjusted, multivariable controlling for known prognostic factors DSS was significantly improved in the neoadjuvant group compared with the chemoradiotherapy group (hazard ratio [HR], 0.48; 95% CI, 0.29-0.80).



Superior survival rates were achieved with a bioselective treatment approach using a single cycle of neoadjuvant chemotherapy. Good survival rates were also achieved in patients selected for primary surgery, and both neoadjuvant chemotherapy and primary surgery were better than survival rates with concurrent chemoradiotherapy, suggesting that the optimal individualized treatment approach for patients with advanced laryngeal cancer has not yet been defined.
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
Gregory T
GT
Wolf
Department of Biostatistics, University of Michigan Health System, Ann Arbor.
Emily
E
Bellile
Department of Radiation Oncology, University of Michigan Health System, Ann Arbor.
Avraham
A
Eisbruch
Department of Internal Medicine, University of Michigan Health System, Ann Arbor.
Susan
S
Urba
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
Carol R
CR
Bradford
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
Lisa
L
Peterson
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
Mark E
ME
Prince
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus.
Theodoros N
TN
Teknos
Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada.
Douglas B
DB
Chepeha
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
Norman D
ND
Hogikyan
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
Scott A
SA
McLean
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor.
Jeffery
J
Moyer
Department of Biostatistics, University of Michigan Health System, Ann Arbor.
Jeremy M G
JMG
Taylor
Department of Internal Medicine, University of Michigan Health System, Ann Arbor.
Francis P
FP
Worden
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate
D000970:Antineoplastic Agents