Sequential induction chemotherapy and concomitant chemoradiotherapy in themanagement of locoregionally advanced laryngeal cancer

Purpose: To determine overall survival, progression-free survival, rate of voice preservation, and patterns of failure in locoregionally advanced lary ngeal cancer treated with induction chemotherapy with or without surgery fo llowed by concomitant chemoradiation. Background: Locoregionally advanced laryngeal cancer has been conventionall y treated with either surgery and adjuvant radiotherapy or radiotherapy alo ne, and clinical and functional outcomes have been poor. Chemoradiotherapy has been demonstrated to improve functional outcome and disease control ove r conventional treatment in recent randomized head and neck trials. Patients and methods: Advanced head and neck cancer patients were enrolled onto two consecutive phase II studies. Induction treatment consisted of thr ee cycles of cisplatin, 5-fluorouracil (5-FU), leucovorin, and interferon-a lpha 2b (PFL-IFN) followed by surgery for residual disease. Surgical intent was to spare the larynx when possible. All patients then proceeded to conc omitant chemoradiation consisting of seven or eight cycles of 5-FU, hydroxy urea, and a planned total radiotherapy dose of 7000 cGy (FHX). Results: A subset of thirty-two laryngeal cancer patients with predominantl y stage IV disease comprises the study group for this report. Clinical CR w as observed in 59% of patients following induction therapy. The median foll ow-up was 63.0 months for surviving patients and 44.5 months for all patien ts. At five years, overall survival is 47%, progression-free survival is 78 %, and locoregional control is 78%. No distant failures were observed. Voic e preservation with disease control was 75% at five years. Only two total l aryngectomies were performed during the course of treatment and follow-up. Treatment-related toxicity accounted for two deaths. Conclusions: The addition of concomitant chemoradiotherapy to induction che motherapy for locoregionally advanced laryngeal cancer appears to increase locoregional control and survival rates. PFL-IFN-FHX resulted in high rates of disease cure and voice preservation in a group of patients that has tra ditionally fared poorly in both clinical and functional outcome.