Role of concurrent chemoradiation in laryngeal preservation for supraglottic cancer

The efficacy and toxicity of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy or radiotherapy only and their impact on laryngeal preservation and survival were studied in patients with supraglottic cancer.

Forty-four patients with newly diagnosed supraglottic squamous cell carcinoma (stage II, III, IV) were treated with either two to three cycles of neoadjuvant chemotherapy with cisplatin 100 mg/m2 on day 1 and fluorouracil 800 to 1000 mg/m2 on days 1 to 5, followed by radiotherapy (NC + RT group, from March 1995 to December 1999; median 68.7 Gy, 1.8 to 2 Gy per fraction) or concurrent chemoradiotherapy (NC + CCRT group, from January 2000 to February 2003; radiotherapy concurrently with cisplatin 60 to 80 mg/m2 on day 1 and fluorouracil 600 to 800 mg/m2 on days 1 to 5). The median follow-up was 60.6 months.

The overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) at 5 years were 52%, 66%, and 44%, respectively. Age, nodal stage, and tumour response after neoadjuvant chemotherapy were significant prognostic factors for OS and DSS (p < .05). The 5-year disease-specific survival rates with larynx preservation were 42% in the NC + RT group and 73% in the NC + CCRT group (p = .028). The complete response rate was 81.8% in the NC + RT group and 86.4% in the NC + CCRT group. There was no difference in OS and DFS between the two groups (p > .05).

Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy with cisplatin and fluorouracil was effective as primary therapy for supraglottic cancer with laryngeal preservation.