Sequential four-drug chemotherapy and intensity-modulated radiotherapy for larynx preservation in resectable advanced larynx and hypopharynx cancer: A pilot study

Am J Otolaryngol. 2017 Jan-Feb;38(1):52-56. doi: 10.1016/j.amjoto.2016.09.015. Epub 2016 Sep 28.

Abstract

Objective: The value of additional use of cetuximab with the classical cisplatin, docetaxel and 5-fluorouracil regimen in larynx preservation remains unknown. This study was designed to resolve this issue and appraise its toxicity.

Materials and methods: Thirteen untreated patients with stage III-IV larynx or hypopharynx squamous cell carcinoma were recruited and received two cycles of C+TPF regimen (cetuximab plus docetaxel, cisplatinand and 5-fluorouracil), followed by one more cycle of C+TPF and intensity-modulated radiotherapy (70Gy). Primary endpoint was larynx preservation (LP) rate at 3months. Secondary endpoints were larynx function preservation (LFP) and overall survival (OS) at 12, 36 and 60months.

Results: With a two-cycle induction treatment of C+TPF protocol, four (31%) and nine (69%) patients achieved complete and partial response, respectively. The top three toxicities were dermatitis (9 cases), nausea/vomiting (6 cases), and anemia (4 cases). After the full-course treatment, 12 out of 13 patients (92.3%) obtained LP at 3months. This strategy demonstrated relatively high LFP rates of 92.3%, 69.2% and 54.5% and satisfactory OS rates of 100%, 84.6% and 54.5% at 12, 36 and 60months, respectively.

Conclusions: These preliminary results suggest induction treatment with C+TPF regimens, followed by intensity-modulated radiotherapy is well-tolerated, which warrants further evaluation.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • China
  • Cisplatin / administration & dosage
  • Cisplatin / adverse effects
  • Cohort Studies
  • Combined Modality Therapy
  • Disease-Free Survival
  • Female
  • Fluorouracil / administration & dosage
  • Fluorouracil / adverse effects
  • Humans
  • Hypopharyngeal Neoplasms / mortality
  • Hypopharyngeal Neoplasms / pathology
  • Hypopharyngeal Neoplasms / therapy
  • Laryngeal Neoplasms / mortality
  • Laryngeal Neoplasms / pathology
  • Laryngeal Neoplasms / therapy*
  • Male
  • Middle Aged
  • Organ Sparing Treatments*
  • Pilot Projects
  • Prognosis
  • Prospective Studies
  • Radiotherapy, Intensity-Modulated / methods*
  • Remission Induction
  • Risk Assessment
  • Survival Analysis
  • Taxoids / administration & dosage
  • Taxoids / adverse effects

Substances

  • Taxoids
  • Cisplatin
  • Fluorouracil

Supplementary concepts

  • TPF protocol