[Concurrent chemoradiotherapy for head and neck squamous cell carcinoma with indication of total laryngectomy]

Subjects were 15 patients--13 men and 2 women--with squamous cell carcinoma of the head and neck, indicating total laryngectomy. Their median age was 62 years, ranging from 50 to 71 years. Three had stage III disease and 12 stage IV disease. These patients were treated with concurrent chemoradiotherapy and had been followed up for more than 2 years from the start of treatment. Primary sites were hypopharynx in 7, larynx in 6, or oropharynx in 2. Treatment consisted of 5-Fluorouracil (5-FU) on cis-platinum (CDDP). 5-FU was given at 1000 mg/m2 per day as continuous infusions during 4 days, and 60 mg/m2 of CDDP was given on day 4 beginning on day 1 and 35 of a concurrent chemoradiotherapy course. Radiation was given in single daily fractions of 2 Gy and 5 fractions per week to a total dose of 60 to 70 Gy. Radiation break was scheduled from day 26 to 35. The median total delivered dose of radiation was 66 Gy. Toxicities included mucositis (grade 3, 33.3%, grade 4, 13.3%), vomiting (grade 3, 33.3%), leukopenia (grade 3, 20%). Twelve PT (80%) received scheduled treatment. Seven (46.7%) had clinical complete response and 8 (53.3%) partial response. Median overall survival was 27.2 months (5.6-33.9 m) and progression-free survival was 26.5 months (5.6-33.9 m). The larynx was preserved and free of disease in 60% of patients overall. Two-year overall survival (OS) was 71.8% and progression free survival (PFS) rates was 60%. Failure patterns showed 5 with locoregional recurrence and 1 with distant metastasis. Concurrent chemoradiotherapy improved two-year OS and PFS compared to radiotherapy alone with a significant difference. Concurrent chemoradiotherapy is thus effective in preserving the larynx in a high percentage of patients and improving two-year OS and PFS rates without compromising QOL.