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Learning Modern Laryngeal Surgery in a Dissection Laboratory
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Published on: March 18, 2020

TPF: a rational choice for larynx preservation?

Gilles Calais1

  • 1Oncologie Radiothérapie, Centre Hospitalier Universitaire, Tours, France. calais@med.univ-tours.fr

The Oncologist
|November 2, 2010
PubMed
Summary

Induction chemotherapy, particularly the TPF regimen, offers larynx preservation for head and neck cancer patients, improving quality of life compared to traditional surgery. This organ-preserving strategy shows promising survival rates.

Area of Science:

  • Oncology
  • Head and Neck Surgery
  • Medical Oncology

Background:

  • The standard treatment for resectable head and neck squamous cell carcinoma (HNSCC) involved surgery and radiotherapy, often leading to significant morbidity and reduced quality of life, especially with total laryngectomy.
  • Chemotherapy response correlated with radiotherapy outcomes, paving the way for organ-preserving strategies in HNSCC management.
  • Induction chemotherapy followed by radiotherapy emerged as an alternative to upfront surgery, aiming to preserve laryngeal function.

Purpose of the Study:

  • To evaluate the efficacy of induction chemotherapy regimens in preserving the larynx for patients with resectable head and neck squamous cell carcinoma.
  • To compare the outcomes of different induction chemotherapy regimens, including cisplatin-5-fluorouracil (PF) doublet and docetaxel, cisplatin, and 5-fluorouracil (TPF) triplet, against standard surgical approaches.

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  • To assess the impact of induction chemotherapy on larynx preservation rates, laryngectomy-free survival, and overall survival in HNSCC patients.

    • Main Methods:

    • Randomized clinical trials were conducted to compare induction chemotherapy regimens followed by radiotherapy with traditional surgery plus radiotherapy.
    • The study evaluated the cisplatin-5-fluorouracil (PF) doublet regimen and the TPF (docetaxel, cisplatin, 5-fluorouracil) triplet regimen as induction chemotherapy.
    • Larynx preservation rates, laryngectomy-free survival, and overall survival were the primary endpoints assessed.

    Main Results:

    • Induction chemotherapy with the PF doublet demonstrated larynx preservation in a significant proportion of patients compared to surgery plus radiotherapy, without compromising survival.
    • The TPF triplet regimen resulted in significantly higher larynx preservation and laryngectomy-free survival rates compared to the PF doublet.
    • While the sequential approach (induction chemotherapy then radiotherapy) was better tolerated than concurrent chemoradiotherapy, its benefit for larynx preservation was less clear.

    Conclusions:

    • Induction chemotherapy, particularly the TPF regimen, is an effective strategy for larynx preservation in resectable head and neck squamous cell carcinoma, offering an alternative to radical surgery.
    • The TPF regimen has become the accepted standard for induction chemotherapy in clinical trials for resectable HNSCC.
    • Further research is ongoing to optimize post-induction treatment strategies to further improve outcomes for HNSCC patients.