Randomized phase III trial comparing induction chemotherapy followed by radiotherapy to concomitant chemoradiotherapy for laryngeal preservation in T3M0 pyriform sinus carcinoma

• Published in: Acta oto-laryngologica 2010, Vol.130 (1), p.150-155
• Main Authors: Prades, Jean-Michel, Lallemant, Benjamin, Garrel, Renaud, Reyt, Emile, Righini, Christian, Schmitt, Thierry, Remini, Nagib, Saban-Roche, Lea, Timoshenko, Andrei P., Trombert, Beatrice, Guerrier, Bernard
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Cause of Death; Cisplatin - administration & dosage; Combined Modality Therapy; Disease-Free Survival; Fluorouracil - administration & dosage; Head and neck cancer; Humans; Hypopharyngeal Neoplasms - drug therapy; Hypopharyngeal Neoplasms - mortality; Hypopharyngeal Neoplasms - pathology; Hypopharyngeal Neoplasms - radiotherapy; hypopharynx; Laryngectomy; Neoadjuvant Therapy; Neoplasm Staging; organ preservation strategy; Prognosis; Prospective Studies; Pyriform Sinus
• ISSN: 0001-6489; 1651-2251
• DOI: 10.3109/00016480902914080

Conclusions. Conventional radiotherapy with concurrent cisplatin is significantly superior to induction cisplatin fluorouracil chemotherapy followed by radiotherapy in terms of laryngeal preservation in patients with T3 hypopharyngeal carcinoma. Despite a high rate of laryngeal preservation no survival benefit was recorded in this selected population. Objectives. To compare conventional radiotherapy with concurrent cisplatin to induction chemotherapy with cisplatin fluorouracil followed by conventional radiotherapy. The primary end point was the preservation of the larynx. The secondary end points included toxicity, causes of death, and survival rates. Patients and methods. Seventy-one adult patients with previously untreated resectable T3 pyriform sinus squamous cell carcinoma were enrolled in the multicenter prospective randomized phase III trial. They were evaluated for organ preservation, survival rates, and toxic reactions. Results. The rates of laryngeal preservation at 2 years were 68% for the induction chemotherapy (IC) group and 92% for the chemoradiotherapy (CR) group (p = 0.016). At 2 years, the event-free survival rates were 36% and 41% for the IC group and CR group, respectively.