Concomitant radiation therapy and targeted cisplatin chemotherapy for the treatment of advanced pyriform sinus carcinoma: Disease control and preservation of organ function

Background. Squamous cell carcinomaofthepyriform sinus is an unfavorable di sease which frequently presents in advanced stages. Despite aggressive "sta ndard treatment" involving debilitating surgery and postoperative radiation therapy treatments, the survival and functional outcome for pyriform sinus carcinoma remains poor. Hence, we reviewed our experience in the managemen t of advanced pyriform sinus carcinoma using "organ preservation" chemoradi ation therapy. Methods. Twenty-five patients diagnosed with stage III/IV pyriform sinus sq uamous cell carcinoma treated with supradose, intra-arterial targeted cispl atin, and concomitant radiotherapy were analyzed for response rates, surviv al, pattern of failure, and function of the preserved organs. Our protocol consisted of weekly intra-arterial infusions of cisplatin at 150 mg/m(2) x 4 and concurrent radiation therapy at 1.8 Gy or 2.0 Gy/fraction to a planne d total of 68-74 Gy to the primary site/overt nodal disease. Results. Nineteen (76%) of the 25 patients were diagnosed with stage IV dis ease, 17 of whom were first seen with bulky lymphadenopathy (ie, N2-N3 dise ase) while 10 had T4 lesions. Twenty-four of 25 patients were evaluable for response assessment. Complete response rates of 92% and 76% were achieved at the primary site and in lymph nodes, respectively. Hence, the overall co mplete response rate in the neck was 76% (16/21). At a median follow up int erval of 42 months (range = 30-58 months), the projected 5-year overall and disease-specific survival using the Kaptan-Meier method are 23% and 50% re spectively. No patient has developed recurrence at the primary site and onl y one patient relapsed regionally, which was surgically salvaged for an "ab ove clavicle" disease control rate of 88% and an organ preservation rate of 88%. Almost 90% of the patients have achieved a satisfactory voice and 70% are able to swallow at 12 months postcompletion of therapy. Conclusion. Our chemoradiation protocol is as effective as other treatment modalities for patients with advanced pyriform sinus carcinoma while mainta ining organ preservation and function in the majority of the patients. (C) 1999 John Wiley & Sons, Inc.