| One cycle of neoadjuvant chemotherapy can help select patients with locally advanced laryngeal cancer who would best be treated with organ-preserving therapy
Most patients with laryngeal
cancer desire a larynx-preserving treatment in order to retain the ability
to talk. The standard treatment for locally advanced laryngeal cancer is
chemoradiation. However, some
patients have tumors that are relatively insensitive to chemotherapy and
radiation, and may be better served by surgery. We designed a protocol
utilizing one cycle of induction chemotherapy to determine which patients
should be treated with definitive chemoradiation, and which patients
should go immediately to surgery. Ninety-seven patients were treated
with one cycle of cisplatin 100 mg/m2 and fluorouracil 1000
mg/m2/day x 5 days. Those who achieved a partial or complete
response to treatment (75% of patients) were considered to be very
chemosensitive, and it therefore made sense to administer definitive
radiation with concurrent cisplatin 100 mg /m2 x 3 cycles, and
then 2 more cycles of adjuvant chemotherapy. Patients
who had minimal response, no response, or disease progression during the
one cycle of induction chemotherapy (25% of patients) had chemoresistant
disease, and they underwent immediate salvage surgery.
The overall survival rate at 3 years is 85%. Most importantly,
although this was not a randomized trial, we observed that the survival
rate of patients who had salvage laryngectomy was similar to the survival
rate for patients with successful organ preservation. The overall survival
rate appears promising compared to historical controls. We believe that one cycle of neoadjuvant chemotherapy can help select patients who would best be treated with organ-preserving therapy, or surgery. In conjunction with this clinical trial, we are also analyzing molecular markers that may be useful in determining patient treatment selection. This information will be available in the near future.
Bibliographical reference:
Susan
Urba
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