Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx - results of a pilot study

Total laryngectomy for advanced carcinoma of the larynx is effective but fu nctionally disabling. In an effort at laryngeal preservation, 33 patients o f stage III/IV carcinoma larynx were treated between 1987 and 1991 with ind uction chemotherapy followed by definitive radiation. Two chemotherapy prot ocols were administered. Group I patients received one to three cycles of c isplatin 100 mg/m(2) (day 1), bleomycin 15 U/m(2) (day 1), and 5-fluorourac il 1000 mg/m(2)/day (day 2 to 5) at three weekly intervals. This was then f ollowed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m(2) with or without leucocovorin rescue fo llowed by radiotherapy. Any recurrence was salvaged by surgery. Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 p er cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88. 8 per cent. The Kaplan-Meier probability of two years and five years diseas e-free survival was 81.9 per cent and 61.4 per cent respectively. For disea se-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent. The control group of 51 patients treated with radical surgery followed by r adiotherapy yielded survival figures at two years and five years of 64.3 pe r cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (p value = 0.280). These i nitial results indicate that for stage III and for surgically resectable st age IV laryngeal carcinomas, a protocol of induction combination chemothera py consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiot herapy and combined with surgical salvage whenever required, can lead to co mparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.