In spite of enhancing the complete response (CR) rate with more cycles of neoadjuvant chemotherapy (NACT) only an early complete response (ECR) correlates with a better disease free survival (DFS) for larynx preservation (LP)

Abstract

5544 Background: Survival (SV) and LP rates were better for pts with operable stage III and IV larynx cancer (LC) who achieved a CR after NACT (PF) followed by hyperfractionated radiotherapy (RT) (Proc. ASCO:895,1996). The aim of this study was to enhance the CR rate with more cycles of NACT and therefore enhance SV and LP. Methods: From 11/95 to 07/01 70 pts with LC entered this study and 68 were evaluable for response to NACT (2 were non-evaluable). Median age: 58 y, sex: F/M: 3/65, site: glottic: 29 (42.6%), supraglottic: 39 (57.4%). Pts were evaluated after the second cycle and non-responding pts (NR) did not continue on NACT(12/68 pts –17.6%). Pts were treated with RT after CR, either after 3, 4 or 5 cycles of NACT. PR pts received a maximum of five cycles. Results: Best response after 3 cycles of NACT: CR: 25/68 (36.7%), PR: 31/68 (45.6%) . Sixteen additional pts achieved CR with more NACT : 4 cycles (14 pts), 5 cycles (2 pts).This difference was significant (p=0.007514). The final CR rate was 60.3% (41/68). Sixty two pts were evaluable after NACT+RT : (51 responding pts and 11 NR pts, 6 pts lost to follow up). CR after NACT+RT was 96% (46/51). With a median follow up of 36 months (r 2–94+) 33/51 responding pts are alive (64.7%) (26/38 with CR and 6/13 with PR (p:NS) and 24 pts (72.7%) have LP (19 CR and 5 PR).The LP rate for the whole group was 25/62 (40.3%)because 1 nonresponding pt refused surgery and received RT. Responding and nonresponding pts had similar DFS and SV. ECR (3 cycles) had a statistical significant better DFS than late complete responders (LCR) (4/5 cycles), p=0.02858. The difference in SV was not significant There was no difference between ECR and LCR. Conclusions: 1) There was a significant increment in the CR rate with 4/5 cycles of NACT over 3 cycles but this did not result in a better SV and LP rate. 2) Only ECR had a significant better DFS. No significant financial relationships to disclose.