Laryngeal preservation in advanced piriform sinus squamous cell carcinomas using superselective intra-arterial chemoradiation therapy with three agents

Abstract

Conclusion: Superselective intra-arterial chemotherapy, which enables local control and laryngeal preservation, is a safe and useful therapy for preservation of nutrition, speech, and swallowing functions. Objective: To improve the laryngeal preservation rate in patients with hypopharyngeal piriform sinus squamous cell carcinoma by superselective intra-arterial chemotherapy. Methods: Fifty-seven patients received anterograde intra-arterial administration of docetaxel and cisplatin, and two courses of intravenous continuous infusion of 5-fluorouracil as a neoadjuvant chemotherapy over 120 h starting on day 2. Concurrent chemoradiotherapy was administered from the third course to control the primary cancer. Remaining neck lymph node metastases were treated in principle by neck dissection. Results: The 5- and 10-year survival rates were 68.5% and 58.9%, respectively. The 5-year rates by the T classification were 96.0% (10-year rate, 88.6%) in T3, 48.1% in T4a, and 16.7% in T4b. The 5- and 10-year laryngeal preservation rates were 65.2% and 62.4%, respectively. The 5-year rates by the T classification were 92.4% (10-year rate, 87.6%) in T3, 36.2% in T4a, and 16.7% in T4b. No irreversible side effects, complications, or sequelae were reported. Superselective intra-arterial chemotherapy showed superior laryngeal preservation as well as high survival rates, particularly in T3, and was considered a useful therapy.