Patients with advanced laryngeal cancer that responds to a single test cycle of chemotherapy may be able to undergo treatment with chemotherapy and radiation therapy without the need for surgical removal of the larynx. The results of this phase II clinical trial published in the Journal of Clinical Oncology.
Cancer of the larynx is considered to be a subgroup of head and neck cancer. The larynx is the area of the throat that contains the vocal cords. It aids in talking, swallowing, and breathing and is sometimes referred to as the voice box.
Most patients with stage III laryngeal cancer and some patients with stage IV laryngeal cancer have cancer that can be surgically removed. Removal of the larynx, however, is associated with a significant decrease in quality of life since patients are left without a voice. Researchers therefore continue to explore the use of nonsurgical treatments for advanced laryngeal cancer.
To evaluate whether response to an initial cycle of chemotherapy appropriately identifies candidates for nonsurgical treatment, researchers conducted a phase II clinical trial among 97 patients with stage III or stage IV laryngeal cancer.
The initial cycle of chemotherapy involved cisplatin or carboplatin along with flouorouracil. The response of the tumor to treatment was evaluated three weeks after chemotherapy. If treatment resulted in at least a 50% reduction in detectable cancer, patients were treated with additional chemotherapy and concurrent radiation therapy rather than surgery. Patients who did not respond to the initial course of chemotherapy underwent surgery followed by radiation therapy.
- 73 of the 97 patients (75%) responded to the initial cycle of chemotherapy and were then treated with additional chemotherapy and radiation therapy.
- A total of 29 patients (30%) underwent surgical removal of the larynx. The reasons for surgery were: nonresponse to the initial cycle of chemotherapy (19 patients); residual cancer after treatment with chemotherapy and radiation therapy (3 patients); cancer recurrence (6 patients); and persistent difficulty swallowing (1 patient).
- Overall survival at three years was 85%.
- Survival did not vary by initial treatment (surgery followed by radiation therapy vs. chemotherapy plus radiation therapy).
The researchers conclude that response to an initial cycle of chemotherapy may help guide subsequent treatment decisions for patients with advanced laryngeal cancer. Providing chemotherapy and concurrent radiation therapy to patients who responded to the initial cycle of chemotherapy appeared to produce good survival results while allowing many patients to avoid surgical removal of the larynx.
Reference: Urba S, Wolf G, Eisbruch et al. Single-Cycle Induction Chemotherapy Selects Patients with Advanced Laryngeal Cancer for Combined Chemoradiation: A New Treatment Paradigm. Journal of Clinical Oncology. 2006;24:593-598.