- The intergroup Radiation Therapy Oncology Group (RTOG 91–11) trial for advanced larynx cancer established:
- Concurrent bolus cisplatin with radiation as a standard of care
- I mentioned that the study was open to patients with squamous cell carcinoma of the glottic or supraglottic larynx:
- Patients with T1 disease or large-volume T4 disease were excluded
- Patients were randomly assigned to one of three larynx preservation strategies:
- Induction cisplatin plus 5-FU followed by radiotherapy
- Radiotherapy with concurrent cisplatin
- Radiotherapy alone
- I mentioned that the dose of radiotherapy to the primary tumor and clinically positive nodes was:
- 70 Gy in all treatment groups
- Severe or life-threatening mucositis in the radiation field was:
- Almost twice as common in the concurrent treatment group compared with either the radiotherapy alone group or the sequential treatment group
- The primary endpoint of the study was:
- Preservation of the larynx
- The rate of laryngeal preservation was:
- 84% for patients receiving radiotherapy with concurrent cisplatin versus 72% or patients receiving induction chemotherapy followed by radiation and 67% for patients receiving radiation therapy alone:
- At a median follow-up of 3.8 years
- 84% for patients receiving radiotherapy with concurrent cisplatin versus 72% or patients receiving induction chemotherapy followed by radiation and 67% for patients receiving radiation therapy alone:
- Distant metastases were reduced:
- In patients who received either concurrent chemoradiotherapy or induction chemotherapy followed by radiotherapy compared with patients who received radiotherapy alone
- Overall survival:
- Was not significantly different among the three treatment groups
- The lack of an overall survival difference between the three groups:
- May be due to the contribution of salvage laryngectomy in all groups, as well as a 2% increase in the incidence of death that may have been related to treatment in the concurrent chemoradiotherapy group compared with the other two treatment groups:
- It is important to recognize that the primary endpoint of the study was larynx preservation:
- Not overall survival
- It is important to recognize that the primary endpoint of the study was larynx preservation:
- May be due to the contribution of salvage laryngectomy in all groups, as well as a 2% increase in the incidence of death that may have been related to treatment in the concurrent chemoradiotherapy group compared with the other two treatment groups:
- The current standard of care for larynx preservation remains:
- Concurrent high-dose cisplatin and radiation for patients who fit the eligibility criteria that were used in RTOG 91–11
chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–2098.)
Rodrigo Arrangoiz MS, MD, FACS, FSSO 