LARYNGEAL PRESERVATION BY INDUCTION CHEMOTHERAPY PLUS RADIOTHERAPY INLOCALLY ADVANCED HEAD AND NECK-CANCER - THE M-D-ANDERSON-CANCER-CENTER EXPERIENCE

Standard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we conducted tw o consecutive phase II studies. From March 1986 to February 1991, 64 p atients with advanced untreated but resectable head and neck cancer wh o would require total laryngectomy were enrolled on one of two cisplat in-based induction regimens: cisplatin-bleomycin-5-fluorouracil (PBF) in 31 patients and cisplatin-5-fluorouracil (PF) in 33; all received d efinitive radiotherapy. Surgery was reserved for patients who achieved less than a partial response to chemotherapy and patients with residu al or recurrent disease after sequential chemotherapy plus radiotherap y. Overall complete plus partial response rates to both cisplatin-base d regimens were comparable. The combined PF and PBF overall response r ates were 75% for laryngeal cancer, 78% for hypopharyngeal cancer, and 75% for oropharyngeal cancer. Complete response rates after radiother apy were 88%, 83%, and 50%, respectively. Neutropenia (<1,000 cells/mm (3)) was the most common hematologic toxic effect: if occurred in 44% of patients who received PF and 16% of those who received PBF. Grade g reater than or equal to 3 mucositis occurred in 50% of patients who re ceived PF and 4% who received PBF. The data suggest that laryngeal pre servation was feasible in all three primary-site subgroups. With follo w-up of 15+ to 54+ months, 44% of patients with laryngeal cancer, 28% with hypopharyngeal cancer, and 22% with oropharyngeal cancer are aliv e with laryngeal preservation. The overall 2-year survival rates for p atients with cancer of the larynx, hypopharynx, and oropharynx were 71 %, 46%, and 38%, respectively. (C) 1994 John Wiley & Sons, Inc.