ORGAN-FUNCTION PRESERVATION IN ADVANCED OROPHARYNX CANCER - RESULTS WITH INDUCTION CHEMOTHERAPY AND RADIATION

Purpose: To evaluate the feasibility and efficacy of a strategy using induction chemotherapy followed by radiation therapy (RT) as a means o f organ-function preservation in patients with advanced oropharynx can cer. Patients and Methods: From January 1983 to December 1990, 33 pati ents with advanced squamous cell oropharynx cancer whose appropriate s urgical management would have required a tongue procedure and potentia l total laryngectomy were treated with one to three cycles of cisplati n (CDDP)-based induction chemotherapy. Patients with a complete respon se (CR) or partial response (PR) at the primary site then received def initive external beam RT with or without interstitial implant with or without neck dissection with surgery to the primary tumor site reserve d for disease persistence or relapse; patients with less than a PR aft er chemotherapy herd appropriate surgery and postoperative RT recommen ded. Results: With a median follow-up period of 6.2 years, actuarial o verall and failure free survival rates at 5 years are 41% and 42%, res pectively. Chemotherapy toxicity contributed to the death of two patie nts and was possibly a factor in two others. Local control was achieve d in 14 patients (42%) without any surgery to the larynx or tongue. Am ong 13 patients currently alive, all had a preserved larynx and only o ne required tongue surgery; 12 of 13 have speech subjectively describe d as always understandable; and nine of 13 have no significant restric tions in their diet. Conclusion: This treatment program is feasible an d effective in patients with advanced oropharynx cancer and produces a n excellent functional outcome in most long-term survivors. Modificati ons to optimize patient selection, minimize toxicity, and improve loca l control are indicated. The relative toxicity, efficacy, and function al outcome provided by this and other chemotherapy and RT programs ver sus either standard surgery and/or RT options can only be addressed in a randomized comparison of these therapies. (C) 1995 by American Soci ety of Clinical Oncology.