A CLINICAL-TRIAL OF CONTINUOUS CISPLATIN-FLUOROURACIL INDUCTION CHEMOTHERAPY AND SUPRACRICOID PARTIAL LARYNGECTOMY FOR GLOTTIC CARCINOMA CLASSIFIED AS T2

Background. Vertical partial laryngectomy (VPL) and radiation therapy (RT) are the recommended conventional conservative options for glottic carcinoma classified as T2. In series presenting more than 100 patien ts with a minimum 3-year follow-up, however, local recurrence rates we re reported as 22-43.5%. The authors' experience with a new strategy b ased on continuous cisplatin-fluorouracil induction chemotherapy (IC) and supracricoid partial laryngectomy with cricohyoepiglottopexy (CHEF ) is presented. Methods. A retrospective analysis of 67 patients who p resented with untreated moderately to well differentiated invasive glo ttic carcinoma classified as T2, managed from 1983 to 1991 with IC and CHEF, was conducted. Statistical analysis of survival, local control, nodal control, distant metastasis, and metachronous second primary tu mor incidence was based on the Kaplan-Meier actuarial method. Univaria te analysis was performed to analyze the relationships between various factors and survival, local recurrence, and nodal recurrence. Clinica l response, histologic response, IC toxicity and postoperative course were reported. Results. The Kaplan-Meier 5-year survival, local recurr ence, nodal recurrence, distant metastasis, and metachronous second pr imary tumor estimate were 92.3%, 5.6%, 1.5%, 1.8%, and 5.6%, respectiv ely. Overall laryngeal preservation was achieved in 65 patients (97%). Ultimate local control was achieved in all patients but one. Nodal re currence was statistically more likely in patients presenting with a l ocal recurrence. Analysis of the specimens demonstrated complete histo logic response to IC in 25 (37.3%) patients. A strong statistical rela tion (P < 0.0001) was noted between complete clinical response after I C and complete histologic response. Conclusions. The change from the p revailing treatment modalities of RT and VPL to a new multimodal state gy (IC + CHEF) did not decrease survival and allowed for an increase i n laryngeal preservation rate. The high rate (37.3%) of complete histo logic response suggests that IC deserves further consideration in the management of patients with glottic carcinoma classified as T2. The fa vorable results achieved in this series, when compared with historic c ontrols, should stimulate prospective clinical trials comparing the tw o surgical procedures (CHEF vs. VFL with or without IC) for resection of Stage II glottic carcinoma.