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Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx – results of a pilot study

Published online by Cambridge University Press:  29 June 2007

A. Thakar ,
S. Bahadur ,
D. A. Tandon ,
A. Ranganathan  and
G. K. Rath
A. Thakar*
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi – 110 029, India.
S. Bahadur
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi – 110 029, India.
D. A. Tandon
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi – 110 029, India.
A. Ranganathan
Affiliation:
Medical OncologyAll India Institute of Medical Sciences, New Delhi – 110 029, India.
G. K. Rath
Affiliation:
Radiation Oncology, All India Institute of Medical Sciences, New Delhi – 110 029, India.
*
Address for correspondence: Dr A. Thakar, Assistant Professor, Department of Otolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi – 110 029, India. Fax: 91-11-6862663
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Abstract

Total laryngectomy for advanced carcinoma of the larynx is effective but functionally disabling. In an effort at laryngeal preservation, 33 patients of stage III/IV carcinoma larynx were treated between 1987 and 1991 with induction chemotherapy followed by definitive radiation. Two chemotherapy protocols were administered. Group I patients received one to three cycles of cisplatin 100 mg/m2 (day 1), bleomycin 15 U/m2 (day 1), and 5-fluorouracil 1000 mg/m2/day (day 2 to 5) at three weekly intervals. This was then followed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m2 with or without leucocovorin rescue followed by radiotherapy. Any recurrence was salvaged by surgery.

Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 per cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88.8 per cent. The Kaplan-Meier probability of two years and five years disease-free survival was 81.9 per cent and 61.4 per cent respectively. For disease-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent.

The control group of 51 patients treated with radical surgery followed by radiotherapy yielded survival figures at two years and five years of 64.3 per cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (p value = 0.280). These initial results indicate that for stage III and for surgically resectable stage IV laryngeal carcinomas, a protocol of induction combination chemotherapy consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiotherapy and combined with surgical salvage whenever required, can lead to comparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.

Keywords

Laryngeal neoplasmsChemotherapy, adjuvant
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 113 , Issue 5 , May 1999 , pp. 433 - 438
Copyright
Copyright © JLO (1984) Limited 1999

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Footnotes

Presented at the Asia-Pacific Congress of Head and Neck Oncology, Mumbai, 1997.

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