Laryngeal Preservation Strategies in Locally Advanced Laryngeal and Hypopharyngeal Cancers

For long, the treatment of locoregionally laryngeal and hypopharyngeal squamous cell cancer consisted of either total laryngectomy (TL) or radical radiotherapy (RT). The appearance of induction cisplatin/5fluorouracil (PF) and the correlation between chemo and radiosensitivity in previously untreated patients opened a new era of treatment aiming at larynx preservation (LP). The concept was to select patients to either TL or RT according to the tumour response to induction PF. The first two trials (VALGSG for larynx SCC and EORTC 24891 for hypopharynx SCC) concluded that such an approach could preserve nearly 60 % of larynx without deleterious impact on survival. The EORTC 24954 trial compared 4 cycles of induction PF followed by RT in good responders vs alternating PF-RT in larynx and hypopharynx SCC. There was not significant difference in 5-year overall survival with a functional larynx between both arms (31% vs 35 %). The GORTEC 2000-01 trial compared induction PF to induction PF plus docetaxel (TPF) both followed by RT in good responders in larynx and hypopharynx SCC. The 5-year LP was significantly higher in the TPF arm (60% vs 39 %) but without any difference in survival. The RTOG 91-11 trial compared induction PF followed by RT in good responders vs concurrent chemoradiotherapy (chemo-RT) versus RT alone in larynx SCC. There was no significant difference in 5-year laryngectomy-free survival between the patients treated with induction chemotherapy (44%) versus t...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research