A multimodal strategy for the treatment of patients with T2 invasive squamous cell carcinoma of the glottis

BACKGROUND. The current conservative standard of care for T2 squamous cell carcinoma of the glottis is either partial laryngectomy or radiation therap y. METHODS, Based on an inception cohort of 100 patients with T2 squamous cell carcinoma of the glottis and a minimum of 3 years of follow-up, the presen t study documented the results achieved with a multimodal strategy using pl atinum-based induction chemotherapy and partial laryngeal surgery. Statisti cal analysis of survival and local control was based an the Kaplan-Meier ac tuarial life table method. Univariate analysis was performed to determine w hether there was a correlation among various factors and toxicity, clinical response, histologic regression, local control, and survival. RESULTS. A complete clinical response and a partial response after inductio n chemotherapy was achieved in 24% and 58% of patients, respectively. Compl ete histologic regression was noted in 31%. A significant statistical relat ion (P < 0.0001) was noted between a complete clinical response after induc tion chemotherapy and a complete histologic regression. The 5-year actuaria l survival estimate was 85.8%. The 5-year actuarial local control estimate was 95.7% (97.7% if the vocal cord was mobile and 93.8% if the motion of th e vocal cord was impaired). Salvage treatment resulted in an overall 99% ra te of local control and a 95% rate of laryngeal preservation. CONCLUSIONS. Because this represents a nonrandomized retrospective study, n o definitive conclusions can be derived. However, when compared with the da ta reported in a large series using radiation therapy or partial laryngecto my alone, this 10-year experience suggests that, in patients with "early" i nvasive squamous cell: carcinoma of the glottis, the use of platinum-based induction chemotherapy prior to a conventional conservative treatment modal ity should be investigated further. Cancer 1999;85:40-6. (C) 1999 American Cancer Society.