Chemotherapy alone with curative intent in patients with invasive squamouscell carcinoma of the pharyngolarynx classified as T1-T4N0M0 complete clinical responders

BACKGROUND. The current studies documented the results achieved with chemot herapy alone with curative intent in a series of 67 patients with invasive squamous cell carcinoma of the pharyngolarynx classified as TI-T4N0M0 compl ete clinical responders after a platin-based induction chemotherapy regimen . METHODS. Group I consisted of 36 patients with tumors originating from the glottis. Group H consisted of 31 patients with tumors originating from site s within the pharyngolarynx other than the glottis. A minimum of 3 years of follow-up was achieved. Statistical analyses of survival, local control, l ymph node control, distant metastasis, and second primary tumor rates were based on the Kaplan-Meier life-table method. Laryngeal preservation rates a nd local control rates are presented. RESULTS. The 5-year actuarial survival estimate was 85.1% in Group I patien ts and 54.8% in Group Il patients. Survival was statistically more likely t o be reduced in Group II patients compared with Group I patients (P = 0.01) . The 5-year actuarial local control estimate was 65.7% in Group I patients and 37,5% in Group II patients. Local failure was statistically more likel y to occur in Group Il patients compared with Group I patients (P = 0.02). Local control rates after salvage treatment were 100% in Group I patients a nd 83% in Group II patients. Laryngeal preservation rates after salvage tre atment were 100% in Group I patients and 64% in Group Il patients. The 5-ye ar actuarial lymph node control estimate was 90% in Group I patients and 73 .7% in Group II patients. Lymph node failure was statistically more likely to occur in Group II patients compared with Group I patients (P = 0.04). Th e 5-year actuarial estimate for patients without distant metastasis was 100 % in Group I patients and 90% in Group Il patients. Distant metastasis was statistically more likely to occur in Group Il patients compared with Group I patients (P = 0.03). The 10-year actuarial estimate for patients without metachronous second primary tumors was 56.4% in Group I and 46.1% in Group IL CONCLUSIONS. The current report 1) contradicts the old dogma of nonchemocur ability for invasive squamous cell carcinoma of the upper aerodigestive tra ct and 2) suggests that the use of a platin-based chemotherapy- alone regim en with curative intent in patients with invasive squamous cell carcinoma o f the pharyngolarynx who are classified as T1-T4N0M0 complete clinical resp onders after receiving an induction chemotherapy regimen is best indicated when the tumor originates from the glottis. (C) 2001 American Cancer Societ y.