Radiotherapy plus cisplatin preserves organ in advanced laryngeal cancer

For patients with advanced laryngeal cancer, radiotherapy plus concurrent cisplatin is superior to induction cisplatin followed by radiotherapy or radiotherapy alone for the preservation of the larynx, according to the results of new research published November 27th in The New England Journal of Medicine.

“Induction chemotherapy with cisplatin plus fluorouracil followed by radiotherapy is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer,” Dr. Arlene A. Forastiere of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore and multicenter colleagues write. But the “value of adding chemotherapy to radiotherapy and the optimal timing of chemotherapy are unknown,” they note.To investigate, they compared treatment with induction cisplatin plus fluorouracil followed by radiotherapy, the control regimen, with two other regimens: radiotherapy with concurrent cisplatin or radiotherapy alone, in 547 patients with stage III and IV laryngeal cancer. Patients were followed for a median of 3.8 years.At 2 years, the overall survival rate was “excellent” (75%) and did not differ markedly between treatment groups, the team reports. However, significantly more patients given radiotherapy with concurrent cisplatin had a functioning larynx, the primary endpoint, than patients given induction chemotherapy followed by radiotherapy or radiotherapy alone — 88%, 75%, and 70%, respectively.”With concurrent therapy, there was an absolute reduction in the rate of laryngectomy of 43%,” the team reports.Locoregional control was also “significantly better” with radiotherapy and concurrent chemotherapy (78%) compared with induction chemotherapy followed by radiotherapy (61%) or radiotherapy alone (56%).”Both of the chemotherapy-based regimens suppressed distant metastases and resulted in better disease-free survival than radiotherapy alone,” according to the team.While the incidence of acute toxic effects was higher in both chemotherapy arms, the rate of late toxic effects such as swallowing difficulties was similar in all three groups.”Radiotherapy with concurrent cisplatin should be considered standard of care for patients desiring laryngeal preservation whose cancer is within the categories of disease studied in this trial, and laryngectomy should be performed only as salvage therapy,” the investigators conclude.In an editorial, Dr. Everett E. Vokes and Dr. Kerstin M. Stenson from the University of Chicago say these data “confirm that initial treatment aimed at laryngeal preservation is a realistic and feasible option for most patients with intermediate- or late-stage laryngeal cancer.”(Source: N Engl J Med 2003;349:2087-2088,2091-2098: Reuters Health: November 26, 2003: Oncolink)