CHEMOTHERAPY FOLLOWED BY ACCELERATED FRACTIONATED RADIATION FOR LARYNX PRESERVATION IN PATIENTS WITH ADVANCED LARYNGEAL-CANCER

Purpose: Larynx preservation in advanced, resectable laryngeal cancer may be achieved using induction chemotherapy (CT) followed in respondi ng patients by definitive radiation (RT). To address potential acceler ated repopulation of clonogenic tumor cells during the prolonged total treatment time, we studied the feasibility of accelerated fractionate d RT after CT. Methods: patients with advanced laryngeal cancer receiv ed two cycles of cisplatin 100 mg/m(2) and fluorouracil (5-Fu) 1,000 m g/m(2)/d for 5 days. Responding patients received a third cycle after which those who had complete response or tumor down-staging to T1 proc eeded with accelerated RT: 70.4 Gy delivered over 5.5 weeks. patients who achieved a lesser response to CT underwent total laryngectomy and postoperative RT. Results: Thirty-three patients were accrued. Three d ied during the course of CT and two declined definitive treatment afte r CT. Twenty-one patients held a major response to CT, 20 of whom rece ived accelerated RT. Median weight loss during RT was 11%. Late severe morbidity was observed in five patients (25%). All four patients who underwent salvage laryngectomy after accelerated RT experienced major postoperative complications, The locoregional failure rate was 25%. Th e larynx was preserved in 48% of the total study population and in 80% of the patients irradiated according to the study protocol. Conclusio n: Accelerated RT after CT as delivered in this study may increase bot h acute and long-term morbidity rates compared with studies using stan dard RT after CT, it did nor seem to improve local/regionol tumor cont rol or survival despite stringent patient selection criteria. (C) 1996 by American Society of Clinical Oncology.