LARYNX PRESENTATION WITH COMBINED CHEMOTHERAPY AND RADIATION-THERAPY IN ADVANCED HYPOPHARYNX-CANCER

Twenty-five untreated patients with advanced, resectable squamous cell carcinoma of the hypopharynx, for whom standard treatment would have required total laryngectomy, were treated with one to three cycles of cisplatin-based chemotherapy with larynx preservation as the goal. Pat ients with a major (complete or partial) response to chemotherapy at t he primary site were treated with definitive radiation therapy, with t otal laryngectomy reserved for salvage; patients with less than a part ial response to chemotherapy had total laryngectomy and postoperative radiation therapy recommended. Four patients had a poor response to ch emotherapy and thus were not candidates for laryngectomy. Total largyn ectomy was required for initial induction chemotherapy failure in five patients and for local recurrence in five others. Three additional pa tients had unresectable recurrence. Successful larynx preservation was achieved in 32% (8 of 25). With a median follow-up period of 41 month s, the actuarial overall and failure-free 2-year survival rates were 4 4% and 32%, respectively. These preliminary data suggest larynx preser vation is feasible in patients with advanced lesions of the hypopharyn x. Improved local and regional control must be incorporated into the l arynx preservation approach for hypopharyngeal lesions. A prospective, randomized study is necessary for a more valid comparison with conven tional therapy including comparative assessments of survival, morbidit y, cost and functional results.