Organ preservation by weekly paclitaxel and carboplatin concurrent with radiation therapy in locally advanced laryngeal/hypopharyngeal carcinoma

Abstract

5564 Background: The goal of preserving laryngeal function and structure has dominated the development of newer treatment approaches. Radiotherapy with concurrent administration of cisplatin is superior to induction chemotherapy followed by radiotherapy or radiotherapy alone for organ preservation and locoregional control. This prospective phase II trial was conducted to evaluate the toxicity and organ preservation of weekly Paclitaxel (P), Carboplatin (C) and standard radiation therapy (RT) in previously untreated locally advanced laryngeal/hypopharynx (LA/HP) cancer. Material: Newly diagnosed patients (pt) with stage III-IV LA/HP carcinoma received weekly P (40/mg/m2 over 1 hour) and C (AUC:2) for 6 cycles starting on day 1 of RT which was given once daily for a total of 66.00Gy in 33 fractions. Re-evaluation with endoscopy, CT and PET scans was performed 6–8 weeks post RT. Salvage surgery was planned for residual, or recurrent, respectable disease. Result: 36 patients were included male: 23, median age 51, site: LA 20, HP: 16, Stage III/IV: 11/25. Tracheostomy tube was inserted for airway obstruction in 19 patients and 9 had tube feeding prophylactically. 75% of patients completed the planned therapy. Grade III-IV mucositis occurred in 48% of patients, while 2 patients developed grade IV skin necrosis around the tracheostomy tube. Hematologic toxicity was mild with febrile neutropenia in 4 patients. Weight loss was common and severe in 26% of patients despite admission for nutritional support of 9 patients. Local control for whole group was achieved in 22/36 (61%). With a median follow-up of 35 months, 16 patients (11 with LA and 5 with HP) are alive with no evidence of disease, two third of them with a functional larynx. Late complication in the form of laryngeal edema occurred in 1 patient. Conclusion: This combination proved feasible, with manageable toxicity, resulted in laryngeal preservation, and offered a high rate of disease control and survival in this population of locally advanced high risk LA/HP carcinoma. No significant financial relationships to disclose.