Assessment of Rate of Laryngeal Preservation in Patients undergoing Radiotherapy with Concurrent Chemotherapy for Advanced Squamous Cell Carcinoma of Larynx: A Prospective Interventional Study

Abstract

Introduction: Advanced laryngeal cancer carries significant morbidity with deterioration sinquality of life. The Radiation Therapy Oncology Group (RTOG) 91-11 study found that in the management of advanced laryngeal cancers, Concurrent Chemotherapy and Radiation (CCRT) produced significant organ preservation compared with other treatment modalities without compromising locoregional control and survival outcomes. These studies lead to the employment of CCRT for advanced laryngeal cancer with the aim of organ preservation. Aim: To assess the rate of laryngeal preservation in patients undergoing CCRT in a tertiary care centre. Materials and Methods: The present prospective, interventional study was conducted in the Department of Radiotherapy, Government Medical college, Thrissur, Kerala, India comprising the newly diagnosed patients with locally advanced laryngeal cancers from July 2019 to August 2020. Conventional radiotherapy with a dose of 66 Gray in 33 fractions over 6.5 weeks was given concurrently with injection cisplatin 100 mg/m2 intravenously every three weeks and periodically followed-up for one year. Results: Out of 50 study participants, 40% of the target population were between 51-60 years of age and 90% of the cases were males. The rates of laryngeal preservation were found to be 88% according to this study. The study proved that laryngeal preservation was significantly lower in cases with age 61-70 years, with those with Eastern Cooperative Oncology Group (ECOG) performance score of 2, nodal stage N3 and stage IV disease and in those with fewer chemo cycles. There was no relationship between laryngeal preservation sex, tumour stage, composite stage. Conclusion: These results show that the rates of laryngeal preservation were found to be higher in advanced laryngeal cancers undergoing radiotherapy with concurrent chemotherapy. Locoregional control was higher without causing severe toxicities. This study shows that higher rates of laryngeal preservation could be achieved with good locoregional control thereby leading to organ preservation and avoidance of severe morbid surgical procedures.