Management of Locally Advanced Laryngeal Carcinoma

  • 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
  • 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
  • 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
Design and results of Radiation Therapy Oncology Group trial 91–11. (Adapted from Forastiere AA, Goepfert H, Maor M, et al. Concurrent
chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–2098.)

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