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Organ preservation in locally advanced head and neck cancer of the larynx using induction chemotherapy followed by improved radiation schemes

  • Head and Neck
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Abstract

The present prospective study seeks to evaluate overall and disease free survival, response and organ preservation rate, and toxicity of an intensive chemotherapy regimen (CT) followed by unconventional radiotherapy (RT) in patients with locally advanced operable head and neck cancer. Between January 1998 and December 2006 (June 2005), 115 patients with locally advanced, operable head and neck cancer were evaluated. A total of 333 cycles of neoadjuvant CT (cisplatin–5FU, days 1, 14, 28) followed by hyperfractionated/accelerated radiotherapy were given to 108 patients. A total of 108 patients were evaluable and received the planned CT–RT treatment. Two months after the end of RT, 97.2% of patients had a clinical complete remission of the primary and 67.5% of the neck node site. The overall survival was 55% and cause-specific survival was 73% at 5 years. Of the 33 relapsed patients, 12 recurred only at the primary site and 10 patients had distant metastases. The overall organ preservation rate was 73.5%. The chemotherapy regimen reported an overall cardiotoxicity from 5FU in 14% of patients, with severe toxicity in 3%. The radiotherapy schedule developed 84% of Grade 3–4 mucositis in the observed patients. The accelerated CT–RT regimen is able to achieve a high rate of larynx preservation, a good tolerability, and a satisfactory cause-specific overall survival.

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References

  1. No authors listed (1991) Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer: the Department of Veteran Affairs Laryngeal Cancer Study Group. N Engl J Med 324(24):1685–1690

    Google Scholar 

  2. Lefebvre JL, Chevalier D, Luboinski B et al (1996) Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial: EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst 88:890–899. doi:10.1093/jnci/88.13.890

    Article  PubMed  CAS  Google Scholar 

  3. Franchin G, Vaccher E, Gobitti C et al (2005) Neoadjuvant accelerated chemotherapy followed by hyperfractionated radiation therapy in patients with operable, locally advanced head and neck carcinoma. Oral Oncol 41:526–533. doi:10.1016/j.oraloncology.2004.12.013

    Article  PubMed  CAS  Google Scholar 

  4. Fu KK, Pajak TF, Trotti A et al (2000) A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas; first report of RTOG 9003. Int J Radiat Oncol Biol Phys 48(1):7–16. doi:10.1016/S0360-3016(00)00663-5

    Article  PubMed  CAS  Google Scholar 

  5. Kaplan EL, Meier P (1958) Non-parametric estimation from incomplete observations. J Am Stat Assoc 53:457–481. doi:10.2307/2281868

    Article  Google Scholar 

  6. International Histological Classification of Tumors (1967–1981). vol 1–25. World Health Organization. Geneva

  7. Cohen EE, Lingen MW, Vokes EE (2004) The expanding role of systemic therapy in head and neck cancer. J Clin Oncol 22:1743–1752. doi:10.1200/JCO.2004.06.147

    Article  PubMed  Google Scholar 

  8. Paccagnella A, Orlando A, Marchiori C et al (1994) Phase III trial of initial chemotherapy in stage III or IV head and neck cancers: a study by the Gruppo di Studio sui Tumori della Testa e del Collo. J Natl Cancer Inst 86:265–272. doi:10.1093/jnci/86.4.265

    Article  PubMed  CAS  Google Scholar 

  9. Pignon JP, Bourhis J, Domenge C, Designe L, MACH-NC Collaborative Group (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. Lancet 355:949–955

    PubMed  CAS  Google Scholar 

  10. Merlano M, Benasso M, Corvo R et al (1996) Five-year update of a randomized trial of alternating radiotherapy and chemotherapy ccompared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88(9):583–589. doi:10.1093/jnci/88.9.583

    Article  PubMed  CAS  Google Scholar 

  11. Forastiere AA, Maor M, Weber RS, et al (2006) ASCO Annual Meeting Proceedings Part 1. J Clin Oncol 24 (18S):5517

    Google Scholar 

  12. Laramore GE, Scott CB, Al-Sarraf M et al (1992) Adjuvant chemotherapy for resectable squamous cell carcinomas of the head and neck: report on Intergroup Study 0034. Int J Radiat Oncol Biol Phys 23:705–713

    PubMed  CAS  Google Scholar 

  13. Sculler DE, Metch B, Mattox D et al (1988) Preoperative chemotherapy in advanced respectable head and neck cancer: final report of the Southwest Oncology Group. Laryngoscope 98:1205–1211

    Google Scholar 

  14. Jensen AR, Nellemann H, Overgaard J (2006) Growth of H/N carcinoma during waiting time for radical treatment (051); oral presentation. 3rd World Congress of the International Federation of Head/Neck Oncologic Societies. Prague, Czech Republic. June 27–July 1 2006

  15. Jensen AR, Nellemann HM, Overgaard J (2007) Tumor progression in waiting time for radiotherapy in head and neck cancer. Radiother Oncol 84(1):5–10. doi:10.1016/j.radonc.2007.04.001

    Article  PubMed  Google Scholar 

  16. Waaijer A, Terhaard CH, Dehnad H et al (2003) Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma. Radiother Oncol 66(3):271–276. doi:10.1016/S0167-8140(03)00036-7

    Article  PubMed  Google Scholar 

  17. Forastiere AA, Goepfert H, Maor M et al (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098. doi:10.1056/NEJMoa031317

    Article  PubMed  CAS  Google Scholar 

  18. Adelstein DJ, Sharan VM, Earle AS et al (1990) Simultaneous versus sequential combined technique therapy for squamous cell head and neck cancer. Cancer 65:1685–1691. doi:10.1002/1097-0142(19900415)65:8<1685::AID-CNCR2820650804>3.0.CO;2-S

    Article  PubMed  CAS  Google Scholar 

  19. Calais G, Alfonsi M, Bardet E et al (1999) Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 91:2081–2086. doi:10.1093/jnci/91.24.2081

    Article  PubMed  CAS  Google Scholar 

  20. Adelstein DJ, Saxton JP, Lavertu P et al (2002) Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer with hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol 20(5):1405–1410. doi:10.1200/JCO.20.5.1405

    Article  PubMed  Google Scholar 

  21. Adelstein DJ, Saxton JP, Rybicki LA et al (2006) Multi-agent concurrent chemoradiotherapy for locoregionally advanced squamous cell head and neck cancer: mature results from a single institution. J Clin Oncol 24:1064–1071. doi:10.1200/JCO.2005.01.5867

    Article  PubMed  CAS  Google Scholar 

  22. Brizel DM, Albers ME, Fisher SR et al (1998) Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced Head and Neck cancer. N Engl J Med 338(25):1798–1804. doi:10.1056/NEJM199806183382503

    Article  PubMed  CAS  Google Scholar 

  23. Denis F, Garaud P, Bardet E et al (2004) Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced stage oropharynx carcinoma. J Clin Oncol 22:69–76. doi:10.1200/JCO.2004.08.021

    Article  PubMed  Google Scholar 

  24. Jeremic B, Milicic B, Dagovic A et al (2004) Radiation therapy with or without concurrent low-dose daily chemotherapy in locally advanced, non-metastatic squamous cell carcinoma of the head and neck. J Clin Oncol 22(17):3540–3548. doi:10.1200/JCO.2004.10.076

    Article  PubMed  Google Scholar 

  25. Machtay M, Rosenthal DI, Hershock D et al (2002) Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a Univ. of Pennsylvania Phase II trial. J Clin Oncol 19(20):3964–3971. doi:10.1200/JCO.2002.11.026

    Article  Google Scholar 

  26. Hainsworth JD, Meluch AA, McClurkan S et al (2002) Induction paclitaxel, carboplatin, and infusional 5 FU followed by concurrent radiation therapy and weekly paclitaxel/carboplatin in the treatment of locally advanced head and neck cancer: a phase II trial of the Minnie Pearl Cancer Research Network. Cancer J 8(4):311–321. doi:10.1097/00130404-200207000-00007

    Article  PubMed  Google Scholar 

  27. Vokes EE, Stenson K, Rosen FR et al (2003) Weekly carboplatin and paclitaxel followed by concomitant paclitaxel, fluorouracil, and hyroxyurea chemoradiotherapy: curative and organ-preserving therapy for advanced head and neck cancer. J Clin Oncol 21:320–326. doi:10.1200/JCO.2003.06.006

    Article  PubMed  Google Scholar 

  28. Psyrri A, Kwong M, DiStasio S et al (2004) Cisplatin, fluorouracil, and leucovorin induction chemotherapy followed by concurrent cisplatin chemoradiotherapy for organ preservation and cure in patients with advanced head and neck cancer: long term follow-up. J Clin Oncol 22:3061–3069. doi:10.1200/JCO.2004.01.108

    Article  PubMed  CAS  Google Scholar 

  29. Guadagnolo B, Haddad R, Posner M et al (2005) Organ preservation and treatment toxicity with induction chemotherapy followed by radiation therapy or chemoradiation for advanced laryngeal cancer. Am J Clin Oncol 28(4):371–378. doi:10.1097/01.coc.0000162423.13431.8d

    Article  PubMed  Google Scholar 

  30. Posner M, Hershock D, Blajman C, TAX 324 Study Group et al (2007) Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357(17):1705–1715. doi:10.1056/NEJMoa070956

    Article  PubMed  CAS  Google Scholar 

  31. Ang KK, Harris J, Garden AS et al (2005) Concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: radiation therapy oncology group phase II trial 99-14. J Clin Oncol 23(13):3008–3015. doi:10.1200/JCO.2005.12.060

    Article  PubMed  CAS  Google Scholar 

  32. Urba S, Wolf G, Eisbruch A et al (2006) Single-cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: a new treatment paradigm. J Clin Oncol 24(4):593–598. doi:10.1200/JCO.2005.01.2047

    Article  PubMed  CAS  Google Scholar 

  33. Bonner JA, Harari PM, Giralt J et al (2006) Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 354(6):567–578. doi:10.1056/NEJMoa053422

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors wish to thank Ms. Elena Byther and Ms. Daniela Michilin for their advice and collaboration in the revision of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Therapy, Centro di Riferimento Oncologico, National Cancer Institute, Via Franco Gallini 2, 33081, Aviano, Italy

    Giovanni Franchin, Emilio Minatel, Carlo Gobitti & Mauro G. Trovò

  2. Department of Medical Oncology A, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy

    Emanuela Vaccher & Simon Spazzapan

  3. Head and Neck Department, Santa Maria degli Angeli General Hospital, Pordenone, Italy

    Doriano Politi, Maria Gabriella Savignano & Luigi Barzan

  4. Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy

    Renato Talamini

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  1. Giovanni Franchin
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  2. Emanuela Vaccher
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  3. Doriano Politi
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  4. Emilio Minatel
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  5. Carlo Gobitti
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  9. Mauro G. Trovò
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  10. Luigi Barzan
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Correspondence to Giovanni Franchin.

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Franchin, G., Vaccher, E., Politi, D. et al. Organ preservation in locally advanced head and neck cancer of the larynx using induction chemotherapy followed by improved radiation schemes. Eur Arch Otorhinolaryngol 266, 719–726 (2009). https://doi.org/10.1007/s00405-008-0798-2

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  • DOI: https://doi.org/10.1007/s00405-008-0798-2

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