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Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion.
- Source :
- Laryngoscope; 2009, Vol. 119 Issue 8, p1510-1517, 8p
- Publication Year :
- 2009
-
Abstract
- Objectives/Hypothesis: 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. Study Design: 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<superscript>2</superscript>) [or carboplatin (AUC 6)] and 5-fluorouracil (1,000 mg/m<superscript>2</superscript>/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<superscript>2</superscript> [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. Laryngoscope, 2009 [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 0023852X
- Volume :
- 119
- Issue :
- 8
- Database :
- Complementary Index
- Journal :
- Laryngoscope
- Publication Type :
- Academic Journal
- Accession number :
- 90733121
- Full Text :
- https://doi.org/10.1002/lary.20294