Nonsurgical Functional Organ Preservation versus Surgery in Laryngeal Squamous Cell Carcinoma

  • The feasibility of nonsurgical functional organ preservation using induction chemotherapy prior to definitive RT was established by the Department of Veterans Affairs (VA) Laryngeal Cancer Study Group larynx trial:
    • Similar results were seen in a European Cooperative Group trial (EORTC 24891) of patients with cancers of the hypopharynx mostly (piriform sinus and some with hypopharyngeal aspect of the aryepiglottic fold)
  • In the VA trial:
    • 332 patients with stage III or IV laryngeal cancer were randomly assigned to three cycles of induction chemotherapy with cisplatin plus fluorouracil:
      • Followed by definitive RT or primary surgery (typically total laryngectomy), followed by postoperative RT:
        • Patients without at least a partial response and those with any evidence of disease progression during or after induction chemotherapy:
          • Were treated with surgery and postoperative RT
    • At a median follow-up of 33 months:
      • The two-year survival rate was equal in both treatment groups:
        • 68%
      • The larynx was successfully preserved in:
        • 64% of patients treated with induction chemotherapy
  • A subsequent publication reported that the three-year survival rates were:
    • 53% for chemotherapy plus RT
    • 56% for surgery plus RT
  • In the European trial:
    • 194 patients with stage II through IV squamous cell carcinoma of the pyriform sinus or aryepiglottic fold were randomly assigned to receive induction chemotherapy with cisplatin plus fluorouracil, followed by definitive RT or surgery (total laryngectomy with partial pharyngectomy), followed by postoperative RT:
      • Patients who failed to achieve a complete response to induction chemotherapy underwent salvage surgery and postoperative RT
    • At a median follow-up of 10.5 years:
      • There were no significant differences in survival or patterns-of-failure outcomes
      • The 10-year progression-free survival probabilities for the chemotherapy plus definitive RT and for the surgery arms were:
        • 11% and 9%, respectively
      • Overall survival probabilities at 10 years were:
        • 13% and 14%, respectively
      • The 5- and 10-year probabilities of being alive with a functional larynx were 21.9% and 8.7%, respectively, on the larynx preservation arm:
        • However, for those patients alive at 5 and 10 years, 59.5% (22/37) and 62.5% (5/8) maintained a normal larynx, respectively.
  • Following the demonstration of benefit with induction chemotherapy followed by RT:
    • Various subsequent trials evaluated the concurrent administration of chemotherapy with RT (concurrent chemoradiation), induction chemotherapy, and induction chemotherapy followed by concurrent chemoradiation (sequential chemoradiation)
#Arrangoiz #CancerSurgeon #HeadandNeckSurgeon #SurgicalOncologist #MSMC #MountSinaiMedicalCenter #Miami #Mexico #LarynxCancer

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