Organ preservation for patients treated with induction chemotherapy (IC) followed by radiation therapy (RT) or chemoradiation (CRT) for advanced stage squamous cell carcinoma of the larynx (SCCL)

Abstract

5600 Background: We reviewed the charts of patients with laryngeal cancer treated with IC and definitive RT or CRT to determine the rates of overall organ preservation and function. Methods: Between September 1995 and December 2001, 29 patients with stage III (45%) and IV (55%) SCCL, were treated with IC and definitive RT or CRT on one of seven consecutive trials. The median age at diagnosis was 54 years (range 38–74). 55% had clinically node-positive disease. 55% and 45% had T3 and T4 tumors, respectively. All received 3 cycles of IC with a platinum-based regimen. QD RT was given to 48%, BID RT to 45%, and concomitant boost (CB) RT to 7%. CRT was given with carboplatin (28%) or docetaxel (28%). Those treated with BID RT did not receive CRT. Results: Median follow-up is 52 months (range 17–85). Overall survival is 66%. Relapse occurred in12 (41%) patients, and 6 underwent salvage laryngectomy (5 Stage III, 1 Stage IV). Of the entire cohort, 59% (17/29) are alive at last follow-up with an anatomically intact larynx, and 48% (14/29) are alive with a functional larynx. Detailed information on g-tube placement/removal was available for 23 patients. Median time with G-tube was 12 months (range, 1–50 months), and 15/23 (65%) had g-tube for 6 months or longer. 23 of all 29 patients (79%) retained an anatomically intact larynx, but 30% (7/23) did not resume their pre-treatment swallowing mechanics and airway protection. Overall rate of functional organ preservation, regardless of survival was, 55% (16/29). The 7/29 patients (26%) who retained a non-functional larynx required permanent g-tube or were unable to return to pretreatment oral intake capability. Nine of 13 with T4 SCCL (69%) compared to 7 of 16 (44%) T3 SCCL retained a functional larynx. Conclusions: The rate of larynx preservation is high, but toxicity remains significant with combined modality therapy. Advanced stage was not an indicator of poor outcome. Half of all patients were alive, able to retain their larynx, and return to pretreatment function. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Aventis