ADVANCED-CARCINOMA OF THE LARYNX - RESULTS OF SURGERY AND RADIOTHERAPY WITHOUT INDUCTION CHEMOTHERAPY (1980-1985) - A MULTIVARIATE-ANALYSIS

Purpose: Induction chemotherapy has been proposed in the case of advan ced laryngeal cancer in order to preserve laryngeal function in those patients who are complete responders. To clarify the treatment policie s, a retrospective multicentric analysis of 116 patients with advanced carcinoma of the larynx treated by radical surgery and postoperative radiotherapy was carried out in order to evaluate prognostic factors f or local control and survival. Methods and Materials: Between 1980 and 1985, 116 patients with Stage III squamous cell carcinoma of the lary nx underwent radical surgery and postoperative radiotherapy with a cur ative intent. Treatments were very homogenous, and doses delivered wer e in the range of 50-65 Gy according to nodal involvement and surgical margins status. Results: The local recurrence rate and the local dise ase-free survival rate at 5 years were 22.5% and 76.3%, respectively. Actuarial survival at 5 years was 68.3% with 44 patients still alive w ith no evidence of disease (NED) with more than 5 years follow-up. For both overall survival and relapse-free survival, cervical node involv ement with capsular rupture was found to be the only significant adver se pronostic factor in univariate and multivariate analysis. No other parameter was predictive either for local recurrence or for survival. Conclusions: Local prognosis and survival depend largely on nodal invo lvement and capsular rupture while increasing doses of radiation strat egy is likely to reduce the risk of local and nodal recurrence. Preser vation of functional larynx is certainly an important goal to achieve when treating advanced carcinoma of the larynx, provided that local fa ilure rate and survival be similar. In the unique randomized study pre viously published in the literature comparing radical surgery and post operative radiotherapy to induction chemotherapy and radiotherapy, the local-regional failure rate was drastically increased in the chemothe rapy arm. Other results from well-designed controlled studies are awai ted before recommending systematic induction chemotherapy and larynx p reservation in complete responders. On the other hand, testing synchro nous or alternated chemotherapy vs. induction chemotherapy may address the pending questions about the optimal treatment of advanced larynge al carcinoma. Copyright (C) 1996 Elsevier Science Inc.