Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion

Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA.
The Laryngoscope (Impact Factor: 2.14). 08/2009; 119(8):1510-7. DOI: 10.1002/lary.20294
Source: PubMed


High rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies.
Records from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m(2)) [or carboplatin (AUC 6)] and 5-fluorouracil (1,000 mg/m(2)/d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin-100 mg/m(2) [carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation.
Twenty-nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3-year OS was 78%, and the disease-specific survival was 80% (median follow-up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g-tube dependent and 6/36 (17%) were tracheostomy dependent.
Our results suggest that chemo-selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion.

Download full-text


Available from: Carol R Bradford,
  • Source
    • "At approximately one month after completing radiotherapy, we took a biopsy sample of his left hypopharynx under direct laryngoscopy to evaluate response to therapy, as biopsy is done after initial treatment in the UMCC (University of Michigan Comprehensive Cancer Center) protocol 9520 [5]. Pathologic examination showed no obvious presence of remaining tumor, and CT showed no obvious neoplastic lesions (Figure 1c). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Radionecrosis (post-radiotherapy laryngeal submucosal inflammation and necrosis) is a complication of (chemo) radiotherapy for hypopharyngeal cancer that is difficult to differentiate from tumor recurrence. A 67-year-old Japanese man presented with a condition extremely difficult to diagnose differentially as radionecrosis or tumor recurrence after radiotherapy for hypopharyngeal cancer. Although tumor recurrence was suspected from clinical conditions and computed tomography findings, pathologic analysis revealed no evidence of tumor recurrence, and successful therapy with steroids and antibiotics reduced the mucosal edema. Our findings emphasize the wide spectrum of radiographic presentation of radionecrosis after chemoradiation of stage IV hypopharyngeal cancer.
    Journal of Medical Case Reports 01/2011; 5(1):25. DOI:10.1186/1752-1947-5-25
  • Source
    • "Of the 20 studies, 11 mentioned explicitly the period (range of years) of patient accrual [11–15, 17, 21, 23, 26–28]. For nine articles, there was no or insufficient information on the range of the patient accrual phase [16, 18–20, 22, 24, 25, 29, 30]. Fifteen of the 20 articles were prospective studies [11, 12, 14–16, 18, 20, 22, 24–30], 5 were retrospective [13, 17, 19, 21, 23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of this review is to systematically assess the effects on voice and speech of advanced head and neck cancer and its treatment by means of chemoradiotherapy (CRT). The databases Medline, Embase and Cochrane were searched (1991-2009) for terms head and neck cancer, chemoradiation, voice and speech rehabilitation. Twenty articles met the inclusion criteria, whereof 14 reported on voice outcomes and 10 on speech. Within the selected 20 studies, 18 different tools were used for speech or voice evaluation. Most studies assessed their data by means of patient questionnaires. Four studies presented outcome measures in more than one dimension. Most studies summarised the outcomes of posttreatment data that were assessed at various points in time after treatment. Except for four studies, pre-treatment measurements were lacking. This and the fact that most studies combined the outcomes of patients with radiated laryngeal cancers with outcome data of non-laryngeal cancer patients impedes an interpretation in terms of the effects of radiation versus the effects of the disease itself on voice or speech. Overall, the studies indicated that voice and speech degenerated during CRT, improved again 1-2 months after treatment and exceeded pre-treatment levels after 1 year or longer. However, voice and speech measures do not show normal values before or after treatment. Given the large-ranged posttreatment data, missing baseline assessment and the lacking separation of tumour/radiation sites, there is an urgent need for structured standardised multi-dimensional speech and voice assessment protocols in patients with advanced head and neck cancer treated with CRT.
    Archives of Oto-Rhino-Laryngology 10/2010; 267(10):1495-505. DOI:10.1007/s00405-010-1316-x · 1.55 Impact Factor

  • Head & Neck 01/2009; 32(1):7-14. DOI:10.1002/hed.21296 · 2.64 Impact Factor
Show more