FUNCTION PRESERVATION IN STAGE-III SQUAMOUS LARYNGEAL CARCINOMA - RESULTS WITH AN INDUCTION CHEMOTHERAPY PROTOCOL

Until recently, standard treatment for stage III laryngeal carcinoma (LC) was total laryngectomy and radiotherapy, Recent data suggest that induction chemotherapy (ICH) plays a role in preserving function in advanced head and neck cancer. No reports to date prospectively evaluate ICH exclusively in stage III LC. The authors designed a sequential phase II trial to assess if ICH allowed a conservative treatment in this disease. The objective of the first part of the study was to rule out a complete response rate with ICH below 30% with P<.05. ICH protocol consisted of three courses of cisplatin 100 mg/M(2) on day 1 and 5-fluorouracil 5000 mg/M(2) continuous infusion over 120 hours. Radiotherapy was administered to patients who attained a complete response (CR). Functional surgery (FS) was planned for patients with partial response. A total laryngectomy followed by radiotherapy was performed when FS was not feasible. Fifty-two previously untreated patients (all males) with squamous stage III LC were diagnosed in our institution, and 46 were entered in the ICH trial. After 9 patients were included, data showed 7 ((78%) CR, ruling out a CR rate of less than 30%. After ICH, a CR was achieved in 29 (63%) of 46 patients. At the end of treatment, 35 patients (76%) had a functioning larynx. With a median follow-up of 3 years, larynx function was preserved in 26 (57%) of 46 patients and in 64% of survivors. Four-year actuarial larynx function preservation, overall survival, and disease-free survival were 55%, 77%, and 67%, respectively. Karnofsky performance score over 80% was the only significant prognostic factor in overall survival (94% at 4 years) and disease-free survival (78% at 4 years). In conclusion, the authors believe that ICH followed by response-related second treatment is safe and effective in preserving laryngeal function in stage III LC. There is no evidence of worsening survival.