Document Detail


Organ preservation and treatment toxicity with induction chemotherapy followed by radiation therapy or chemoradiation for advanced laryngeal cancer.
MedLine Citation:
PMID:  16062079     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The authors reviewed records of patients with advanced laryngeal cancer treated with induction chemotherapy (IC) and hyperfractionated radiation therapy (RT) or chemoradiation (CRT) to determine the rates of organ preservation and function.
METHODS: A total of 29 patients with stage III (45%) and stage IV (55%) squamous cell carcinoma of the larynx (SCCL), were treated with IC and RT or CRT in 1 of 7 consecutive trials. Fifty-five percent had clinically node-positive disease. Fifty-five percent and 45% had T3 or T4 tumors, respectively. All received 3 cycles of platinum-based IC. Daily RT was given to 48%, twice-daily RT to 45%, and concomitant boost RT to 7%. CRT was carboplatin (28%) or docetaxel (28%). Those treated with twice-daily RT did not receive CRT.
RESULTS: The median follow-up is 52 months. Overall survival is 66%. Relapse occurred in 12 patients (41%), and 6 underwent salvage laryngectomy (5 stage III, 1 stage IV). Fifty-nine percent of patients (17 of 29) are alive at last follow-up with an anatomically intact larynx, and 48% (14 of 29) are alive with a functional larynx. Of the 23 patients for whom detailed information on gastrostomy tube (g-tube) placement/removal was available, median time with g-tube was 12 months, and 15 of 23 patients (65%) had a g-tube for 6 months or more. Twenty-three of all 29 patients (79%) retained an anatomically intact larynx, but 7 of 23 (30%) never resumed their pretreatment organ function. The overall rate of functional organ preservation, regardless of survival, was 55% (16/29). The 7 of 29 patients (26%) who retained a nonfunctional larynx required permanent g-tube or were unable to return to pretreatment oral intake capability. Nine of 13 with T4 SCCL (69%) compared with 7 of 16 (44%) T3 SCCL retained a functional larynx.
CONCLUSION: The rate of larynx preservation is high, but toxicity remains significant with IC followed by hyperfractionated RT or CRT in advanced laryngeal cancer. Half of all patients were alive, able to retain their larynx, and return to pretreatment function. Advanced stage was not an indicator of poor outcome.
Authors:
Beverly A Guadagnolo; Robert I Haddad; Marshall R Posner; Linda Weeks; Lori J Wirth; Charles M Norris; Christopher A Sullivan; Laura Goguen; Paul M Busse; Roy Tishler
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  American journal of clinical oncology     Volume:  28     ISSN:  1537-453X     ISO Abbreviation:  Am. J. Clin. Oncol.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-02     Completed Date:  2005-11-21     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  8207754     Medline TA:  Am J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  371-8     Citation Subset:  IM    
Affiliation:
Joint Center for Radiation Therapy, Boston, MA, USA. aguadagnolo@lroc.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / adverse effects,  therapeutic use*
Carboplatin / administration & dosage
Carcinoma, Squamous Cell / complications,  mortality,  pathology,  secondary,  therapy*
Cisplatin / administration & dosage
Dose Fractionation
Esophageal Stenosis / etiology,  prevention & control*
Female
Fluorouracil / administration & dosage
Follow-Up Studies
Humans
Laryngeal Neoplasms / complications,  mortality,  pathology,  therapy*
Laryngectomy
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Radiotherapy, Adjuvant / adverse effects
Salvage Therapy
Survival Rate
Taxoids / administration & dosage
Chemical
Reg. No./Substance:
0/Taxoids; 15663-27-1/Cisplatin; 15H5577CQD/docetaxel; 41575-94-4/Carboplatin; 51-21-8/Fluorouracil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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