Function preservation in stage III squamous laryngeal carcinoma: Results with an induction chemotherapy protocol

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Abstract
Until recently, standard treatment for stage III laryngeal carcinoma (LC) was total laryngectomy and radiotherapy. Recent data suggest that induction chemotherapy (ICH) plays a role in preserving function in advanced head and neck cancer. No reports to date prospectively evaluate ICH exclusively in stage III LC. The authors designed a sequential phase II trial to assess if ICH allowed a conservative treatment in this disease. The objective of the first part of the study was to rule out a complete response rate with ICH below 30% with P≤.05. ICH protocol consisted of three courses of cisplatin 100 mg/M2 on day 1 and 5‐fluorouracil 5000 mg/M2 continuous infusion over 120 hours. Radiotherapy was administered to patients who attained a complete response (CR). Functional surgery (FS) was planned for patients with partial response. A total laryngectomy followed by radiotherapy was performed when FS was not feasible. Fifty‐two previously untreated patients (all males) with squamous stage III LC were diagnosed in our institution, and 46 were entered in the ICH trial. After 9 patients were included, data showed 7 (78%) CR, ruling out a CR rate of less than 30%. After ICH, a CR was achieved in 29 (63%) of 46 patients. At the end of treatment, 35 patients (76%) had a functioning larynx. With a median follow‐up of 3 years, larynx function was preserved in 26 (57%) of 46 patients and in 64% of survivors. Four‐year actuarial larynx function preservation, overall survival, and disease‐free survival were 55%, 77%, and 67%, respectively. Karnofsky performance score over 80% was the only significant prognostic factor in overall survival (94% at 4 years) and disease‐free survival (78% at 4 years). In conclusion, the authors believe that ICH followed by response‐related second treatment is safe and effective in preserving laryngeal function in stage in LC. There is no evidence of worsening survival.

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