Intensity modulated radiotherapy with concurrent chemotherapy for larynx preservation of advanced resectable hypopharyngeal cancer

Wen-Yen Huang,Chun-Shu Lin,Yaoh-Shiang Lin,Chang-Ming Chen,Kuen-Tze Lin,Ying-Nan Chang,Yu-Fu Su,Hsing-Lung Chao,Li-Ping Chang,Yee-Min Jen

doi:10.1186/1748-717x-5-37

Abstract

BackgroundTo analyze the rate of larynx preservation in patients of locally advanced hypopharyngeal cancer treated with intensity modulated radiotherapy (IMRT) plus concurrent chemotherapy, and compare the results with patients treated with primary surgery.MethodsBetween January 2003 and November 2007, 14 patients were treated with primary surgery and 33 patients were treated with concurrent chemoradiotherapy (CCRT) using IMRT technique. Survival rate, larynx preservation rate were calculated with the Kaplan-Meier method. Multivariate analysis was conducted for significant prognostic factors with Cox-regression method.ResultsThe median follow-up was 19.4 months for all patients, and 25.8 months for those alive. The 5-year overall survival rate was 33% and 44% for primary surgery and definitive CCRT, respectively (p = 0.788). The 5-year functional larynx-preservation survival after IMRT was 40%. Acute toxicities were common, but usually tolerable. The rates of treatment-related mucositis (≥ grade 2) and pharyngitis (≥ grade 3) were higher in the CCRT group. For multivariate analysis, treatment response and cricoid cartilage invasion strongly correlated with survival.ConclusionsIMRT plus concurrent chemotherapy may preserve the larynx without compromising survival. Further studies on new effective therapeutic agents are essential.

Highlights

To analyze the rate of larynx preservation in patients of locally advanced hypopharyngeal cancer treated with intensity modulated radiotherapy (IMRT) plus concurrent chemotherapy, and compare the results with patients treated with primary surgery
It concludes that induction chemotherapy plus definitive RT offered 35% of 5-year larynx preservation rate and does not compromise survival compared with surgery
We analyze the rate of larynx preservation in patients of advanced resectable hypopharyngeal cancer after IMRT plus concurrent chemotherapy and compare the result with primary surgery

Summary

Introduction

To analyze the rate of larynx preservation in patients of locally advanced hypopharyngeal cancer treated with intensity modulated radiotherapy (IMRT) plus concurrent chemotherapy, and compare the results with patients treated with primary surgery. Larynx preservation modality for hypopharyngeal cancer has been tested in a trial conducted by the European Organization for Research and Treatment of Cancer (EORTC) Head and Neck Cancer Cooperative group [1] It concludes that induction chemotherapy plus definitive RT offered 35% of 5-year larynx preservation rate and does not compromise survival compared with surgery. It is able to achieve a very high rate of locoregional control with less morbidity under optimal target delineation, appropriate physical quality control and accurate patient setup [7] It has provided promising results in patients with other subsites of head-and-neck cancer [7,8,9,10,11,12,13], publications of using IMRT on hypopharyngeal cancer are rare. We analyze the rate of larynx preservation in patients of advanced resectable hypopharyngeal cancer after IMRT plus concurrent chemotherapy and compare the result with primary surgery

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Conclusion