Chemotherapy/RT Regimens Preserve Larynx Better than RT Alone

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(ChemotherapyAdvisor) – Ten-year results of the Intergroup Radiation Therapy Oncology Group 91-11 trial have shown locoregional control and larynx preservation significantly improved with use of concomitant cisplatin/radiation therapy (RT) vs induction cisplatin/fluorouracil followed by RT or RT alone, investigators reported in the Journal of Clinical Oncology online November 26.

For the composite end point of laryngectomy-free survival (LFS), induction and concomitant treatments had similar efficacy, reported Arlene A. Forastiere, MD, Sydney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, and colleagues.

They analyzed data from 520 patients with stage III or IV glottic or supraglottic squamous cell cancer randomly assigned to induction cisplatin/fluorouracil followed by RT (control arm), concomitant cisplatin/RT, or RT alone. Median follow-up for those surviving was 10.8 years.

Both chemotherapy regimens significantly improved LFS vs RT alone: induction chemotherapy vs RT alone HR 0.75; P=0.02 and concomitant chemotherapy vs RT alone HR 0.78; P=0.03.

“Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR 1.25; 95% CI 0.98–1.61; P=0.08),” they wrote.

Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction cisplatin/fluorouracil followed by RT (HR 0.58; P=0.005) and over RT alone (P<0.001), whereas induction cisplatin/fluorouracil followed by RT was not better than treatment with RT alone (HR 1.26; P=0.35).

Of patients who received concomitant chemotherapy, 30.8% died, compared with 20.8% with induction chemotherapy and 16.9% with RT alone.

“New strategies that improve organ preservation and function with less morbidity are needed,” Dr. Forastiere concluded.

Abstract

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