Neo adjuvant chemotherapy and radiotherapy for locally advanced carcinoma of larynx: a method for laryngeal preservation

الملخص EN

Objective : we performed this prospective study in patients with previously untreated locally advanced (stage III and IV) laryngeal cancer to study the results of induction chemotherapy followed by definitive radiotherapy.

Patients and methods : Thirty-six patients with locally advanced cancer larynx were treated with induction chemotherapy [cisplatin (100 mg / m2) given by IV infusion over 6 hours on day 1, followed by infusion of fluorouracil (1000 mg / m2 per day) on days 1-5].

Evaluation of response to chemotherapy was performed before each cycle of chemotherapy.

After two cycles, only partial or complete responders received a third cycle.

Patients with partial or complete response were treated thereafter by definitive irradiation 5000-7000 cGy ; non-responding patients underwent conventional surgery with postoperative radiation (50-64 Gy).

Salvage surgery was also performed when patients relapsed after chemotherapy and irradiation.

Results : complete clinical regression of the primary tumor was seen in 27.8 % of patients after 2 cycles of chemotherapy.

A partial response was seen in 50 %.

Twenty-eight patients achieved complete or partial responses and received radiotherapy.

Following radiotherapy, complete response rate was observed in 75 % of patients (21 / 28).

Surgical salvage was performed in 8 patients (22.2 %) who did not respond to chemotherapy and in 7 patients with persistent disease (5 PR and 2 SD) after chemotherapy and radiation therapy.

The median failure-free survival is 20 months, with a long-term plateau at 47.6 %.

There is a highly significant survival advantage for patients achieving either complete or partial response to induction chemotherapy (p = 0.002).

Survival was not statistically correlated with patient's age or stage of the disease.

At the end of the study, from the twenty-one patients who achieved CR after chemotherapy-radiotherapy, one died from other cause without evidence of disease, eight had loco-regional recurrence of disease, one had distant metastasis and one had both local and distant relapse, leaving 10 patients (10 / 21, 47.6 %) living with laryngeal preservation.

Toxicities consisted of mild to moderate myelosuppression and mu-cositis.

The toxicity was acceptable.

Conclusion : these preliminary results suggest a new role for chemotherapy in patients with advanced laryngeal cancer and showed that a treatment strategy involving induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a certain percentage of patients, without compromising overall survival.