Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion

Authors

  • Francis P. Worden MD,

    Corresponding author
    1. Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
    2. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
    • 1500 E. Medical Center Drive, C361 MIB 0848, Ann Arbor, MI 48109-0848
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    • F.P.W. and J.M. are co–first authors.

  • Jeffrey Moyer MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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    • Presented at the 43rd Annual ASCO Meeting, Chicago, Illinois, U.S.A., June 2, 2007 and the 7th International Conference on Head and Neck Cancer, San Francisco, California, U.S.A., June 20, 2008.

  • Julia S. Lee MS,

    1. Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Jeremy M. G. Taylor PhD,

    1. Department of Biostatistics, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Susan G. Urba MD,

    1. Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
    2. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Avraham Eisbruch MD,

    1. Department of Radiation Oncology; University of Michigan Dental School, Ann Arbor, Michigan, U.S.A.
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  • Theodoros N. Teknos MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Douglas B. Chepeha MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Mark E. Prince MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Norman Hogikyan MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Amy Anne D. Lassig MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Kevin Emerick MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Suresh Mukherji MD,

    1. Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Lubomir Hadjiski PhD,

    1. Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Christina I. Tsien MD,

    1. Department of Radiation Oncology; University of Michigan Dental School, Ann Arbor, Michigan, U.S.A.
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  • Tamara H. Miller BSN,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Nancy E. Wallace BSN,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Heidi L. Mason NP,

    1. Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Carol R. Bradford MD,

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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  • Gregory T. Wolf MD

    1. Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A.
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Abstract

Objectives/Hypothesis:

High rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies.

Study Design:

Retrospective.

Methods:

Records from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m2) [or carboplatin (AUC 6)] and 5-fluorouracil (1,000 mg/m2/d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin-100 mg/m2 [carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation.

Results:

Twenty-nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3-year OS was 78%, and the disease-specific survival was 80% (median follow-up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g-tube dependent and 6/36 (17%) were tracheostomy dependent.

Conclusions:

Our results suggest that chemo-selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion. Laryngoscope, 2009

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