984P - Utility of algorithm-based chemoradioselection for advanced laryngeal and hypopharyngeal carcinoma

Abstract

At our institute, a “chemoradioselection” strategy has been used to select patients with head and neck cancer for organ preservation. In brief, tumor responses are evaluated at 40 Gy of concurrent chemoradiotherapy (CRT). Responders (i.e., chemoradioselected, CRS) receive further CRT up to 70 Gy, while non-responders (N-CRS) are recommended to undergo radical surgery (N-CRS-ope). To those who refuse surgery (N-CRS-refu), continuous CRT is administered. In this study, the results of advanced laryngeal and hypopharyngeal carcinomas were examined. From 2000 to 2012, 123 patients with stage III (44), IV (79) laryngeal (64) and hypopharyngeal carcinoma (59) excluding T4 cases were enrolled to this algorithm-based treatment. Split (15mg/m2 x 5 days, 2000-20008) or bolus (80mg/m2, 2009-present) CDDP was administered at the onset of initial 40 Gy and additional 30Gy of CRT, respectively. Based on the algorithm, 64 patients were CRS. The remaining 59 N-CRS patients proceeded to either N-CRS-ope (34) or N-CRS-refu (25) arm. The 5-yr OS and DSS were 67% and 77%, respectively. The 5-yr OS of N-CRS-refu (47%) was significantly (p = 0.0193) lower than that of CRS (73%) or N-CRS-ope (70%). Intriguingly, multivariate analyses including 4 candidate prognostic factors: T (T1, 2 vs T3), N (N1 vs N2, 3), primary site (larynx vs hypopharynx), and planned treatment or not (CRS + N-CRS-ope vs N-CRS-refu) demonstrated that unplanned treatment alone was significantly correlated with poor OS (HR: 2.584, 95% CI: 1.313–4.354, p = 0.007). This result indicates that chemoradioselection, probably reflecting the biological aggressiveness of each tumor, can segregate patients for organ preservation from those who are better treated with surgery. The overall 5-yr laryngo-esophageal dysfunction-free survival (LEDFS) was 41%. The CRS group demonstrated significantly (P < 0.0001) better 5-yr LEDFS (69%) compared to the N-CRS-refu (20%), albeit identical treatment regimen. Algorithm-based chemoradioselection might provide a novel platform for the treatment of advanced head and neck cancer, taking full advantages of CRT and radical surgery, and thereby achieving optimization of the treatment intensity.