CISPLATIN-FLUOROURACIL EXCLUSIVE CHEMOTHERAPY FOR T1-T3N0 GLOTTIC SQUAMOUS-CELL CARCINOMA COMPLETE CLINICAL RESPONDERS - 5-YEAR RESULTS

Purpose: To evaluate cisplatin-fluorouracil exclusive chemotherapy (EC ) for T1-T3NO glottic squamous cell carcinoma complete clinical respon ders (CCR) after cisplatin-fluorouracil induction chemotherapy (IC). P atients and Methods: A retrospective analysis was performed with T1-T3 NO glottic squamous cell carcinoma CCR after IC consecutively managed at our department between 1985 and 1992. Twenty-one CCR were managed w ith EC. Thirty-seven CCR were managed with IC and a conventional laryn geal-preservation modality. Analyses of survival, local control, nodal recurrence, distant metastasis, and metachronous second primary tumor were performed using the Kaplan-Meier actuarial lifetable method. In CCR managed with EC, the independent factors of age, tumor classificat ion, exact tumor location, true vocal cord motion, arytenoid cartilage motion, total dosage of drugs delivered, and number of courses receiv ed were tested for potential correlation with survival, local recurren ce, nodal recurence, and distant metastasis. Results: The 5-year survi val, local control, nodal recurrence, distant metastasis, and metachro nous second primary tumor rates in CCR managed with EC were 95.2%, 70. 7%, 0%, 0%, and 14.3%, respectively. The 5-year rates of survival, loc al control, nodal recurrence, distant metastasis sis, and metachronous second primary tumor in CCR managed with IC and a conventional laryng eal-preservation modality were 86.1%, 97%, 2.7%, 6%, and 14.5%, respec tively. Local recurrence wets statistically more likely in CCR managed with EC (P=.002). Local recurrence in CCR managed with EC was always salvaged with partial laryngectomy or radiation therapy, which resulte d in an overall 100% local control and laryngeal-preservation rate wit hin this group. In CCR managed with EC, none of the variables analyzed was statistically related to survival, local recurrence, nodal recurr ence, or distant metastasis. Conclusion: The present retrospective stu dies demonstrated that within T1-T3NO glottic squamous cell carcinoma CCR, there is clearly a significant subset of patients with chemocurab le tumors who achieved both perfect preservation of structure-supporti ng voice and long-term survival after EC. Careful monthly follow-up ev aluation allowed for timely successful salvage of local recurrence aft er EC without the need for total laryngectomy. Such management did not appear to increase the risk for subsequent nodal failure, subsequent distant metastasis, or reduced survival. (C) 1996 by American Society of Clinical Oncology.