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Pyriform sinus squamous cell carcinoma: oncological outcomes in good responders of induction chemotherapy-based larynx preservation protocols

  • Head and Neck
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Abstract

Induction chemotherapy-based larynx preservation protocols use chemotherapy to select exclusively patients with ‘chemosensitive’ tumors for a nonsurgical treatment with radiation therapy. This study on pyriform sinus squamous cell carcinoma (SCC) is interested in the oncological outcome of treatment based on radiation therapy when offered to patients with tumors responding to induction chemotherapy. This was a retrospective cohort study. The cohort included good responders to induction chemotherapy, subsequently treated with definite radiation therapy (with or without concomitant chemotherapy) for pyriform sinus SCC, in a tertiary referral cancer center. The primary endpoints were overall, laryngectomy-free and disease-free survival and the secondary endpoints were analysis of treatment failures and possibilities of salvage treatment. Forty-two patients fulfilled the inclusion criteria and were retained for analysis; 7 % were stage II (3/42), 48 % stage III (20/42) and 45 % stage IV (19/42). At 1, 3 and 5 years, the overall survival was 95 % (40/42), 74 % (31/42), and 60 % (SE ≈ 0.08), respectively. For the same intervals, the laryngectomy-free survival was 90 % (38/42), 69 % (29/42) and 50 % (SE ≈ 0.08), respectively. The estimated 5-year disease-free survival was also 50 %. Disease-free survival was significantly better for N0 patients. There was a 28 % recurrence rate, mainly in the primary tumor site (9/11), with or without simultaneous nodal recurrence. Interestingly, more than one-third of all oncologic failures occurred beyond the first 3 years of follow-up. Salvage treatment was not possible or definitely inefficient in at least 2/3 of all recurrences. In candidates for larynx preservation for a pyriform sinus SCC, good response to induction chemotherapy followed by definite radiation therapy seems to be associated with a more favorable prognosis. Nevertheless, in case of locoregional recurrence the possibilities for efficient salvage treatment are limited.

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Abbreviations

SCC:

Squamous cell carcinoma

ICT:

Induction (neoadjuvant) chemotherapy

RT:

Radiation therapy

CRT:

Radiation therapy with concomitant chemotherapy

IGR:

Institut Gustave Roussy

PF:

Platinum salt and 5-fluorouracil

TPF:

Taxane and PF

OS:

Overall survival

DFS:

Disease-free survival

LFS:

Laryngectomy-free survival

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Authors and Affiliations

  1. Department of Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France

    Zacharias Vourexakis, Anne-Marie Le Ridant & François Janot

  2. Department of Otolaryngology-Head and Neck Surgery, University Hospital of Geneva and University of Geneva School of Medicine, Geneva, Switzerland

    Zacharias Vourexakis & Pavel Dulguerov

Authors
  1. Zacharias Vourexakis
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  2. Anne-Marie Le Ridant
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  3. Pavel Dulguerov
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  4. François Janot
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Correspondence to Zacharias Vourexakis.

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Vourexakis, Z., Le Ridant, AM., Dulguerov, P. et al. Pyriform sinus squamous cell carcinoma: oncological outcomes in good responders of induction chemotherapy-based larynx preservation protocols. Eur Arch Otorhinolaryngol 272, 1725–1731 (2015). https://doi.org/10.1007/s00405-014-3081-8

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  • DOI: https://doi.org/10.1007/s00405-014-3081-8

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