LARYNGEAL PRESERVATION FOR ADVANCED LARYNGEAL AND HYPOPHARYNGEAL CANCERS

Objective: To compare a single institutional experience with combinati on chemotherapy and radiation for laryngeal preservation with historic al age-, sex-, stage-, and site-matched controls who underwent larynge ctomy for cancer of the larynx or hypopharynx. Design: Fifty-five pati ents with stage III or IV laryngeal and hypopharyngeal squamous carcin oma were prospectively entered into a protocol to receive three cycles of cisplatin (+/-bleomycin sulfate) and fluorouracil and radiation th erapy from 1986 to 1991 (group 1). Following two cycles of chemotherap y, the clinical tumor response was assessed and responders received a third cycle of chemotherapy followed by definitive radiation therapy. Nonresponders underwent surgical salvage. Two patients in the surgical control group were matched to each protocol patient (n=110, group 2) regarding site, stage, sex, and age (+/-7 years) without knowledge of patient outcome. Setting: A tertiary cancer referral center, The Unive rsity of Texas M. D. Anderson Cancer Center, Houston. Results: Followi ng chemotherapy, the tumor response rate for group 1 was complete in 3 8% and partial in 31%. With a median follow-up of 24 months (group 1) and 37 months (group 2), the Kaplan-Meier 2-year disease-specific surv ival for group 1 and 2 was 63% and 74%, respectively (P=.251). Among g roup 1 patients, 67% retained their larynges. Local recurrences were m ore frequent among the laryngeal preservation group (P=.001), whereas distant metastasis was more frequent among controls (P=.35). Thirty-th ree percent (18/55) of group 1 pa tients required total laryngectomy. Examining these subsets of patients showed that of the 67% (n=37) of p atients who retained their larynges, their 2-year survival was 56%, no t significantly different from their respective controls (n=74), 71%. Additionally, 2-year survival among the 18 group 1 patients who requir ed salvage laryngectomy was 75% as compared with 80% for their matched controls (n=36). Conclusions: These results document the results of c hemotherapy and radiation therapy in the treatment of patients with ad vanced laryngeal and hypopharyngeal cancers in preserving the larynx. Although local control is significantly compromised among these patien ts, there is no compromise in overall survival when combined with prom pt surgical salvage.