Chemotherapy-enhanced accelerated radiotherapy for intermediate-volume hypopharyngeal cancer.

Abstract

5576 Background: To evaluate the safety and efficacy of accelerated radiotherapy (RT) with delayed concomitant, low dose chemotherapy as a radiosensitizer in patients with squamous cell carcinoma of the hypopharynx that was judged as amenable to margin-free resection with curative surgery necessitating total laryngectomy. Methods: Patients aged 20-75 years with previously untreated, histologically proven T2 – 4 disease were eligible for the study. Those who have unresectable and/or bilateral lymph node metastasis or distant organ metastasis were ineligible. A total dose of 40 Gy/4 weeks using 2 Gy once daily fractionation to the entire neck followed by boost RT administering 30 Gy/2 weeks (1.5 Gy twice daily fractionation) to the primary tumor was administered. Cisplatin 80 mg/m2 bolus followed by 4-day continuous infusion of 5-fluorouracil (FU) 400 mg/m2/day was administered concomitantly during boost RT. Primary endpoint was completeness of the protocol within overall treatment time of less than 49 days. Results: Thirty-five patients were enrolled between October 2002 and March 2008. Volume of the primary tumor was estimated as 5–49 mL (median 15 mL) and 29 patients (83%) had that of 10-40 mL. Acute adverse events were acceptable, and grade >=3 acute reactions were observed in 13 (37%) of patients. All patients could complete this protocol as planned within 49 days (39–48 days, median 44 days). After median follow-up period for surviving patients of 54 months (22–86 months), overall and local recurrence-free survival rate at 3 years were 91% (95% confidence interval, 81%-100%), and 86% (74%-97%), respectively. All of the patients who were alive and free from local failure retained their normal understandable speech, and all surviving patients maintained their normalcy of diet without feeding tube dependency at the time of last follow-up. Conclusions: This regimen was feasible with encouraging oncological and functional outcomes in selected patients with intermediate-volume hypopharyngeal cancer. Further study is warranted to scrutinize adequate patient selection and outcomes to maximize therapeutic ratio using this strategy. No significant financial relationships to disclose.