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Larynx preservation trials: a critical appraisal
1Division of Medical Oncology, Johns Hopkins Oncology Center, Baltimore, MD 21287, USA.
Seminars in Radiation Oncology
|January 5, 1999
Summary
Induction chemotherapy with cisplatin and 5-fluorouracil offers laryngeal preservation for advanced larynx/hypopharynx cancer. While not improving survival, this approach delays distant metastases and preserves larynx function in over 50% of patients.
Area of Science:
- Oncology
- Head and Neck Surgery
- Medical Research
Background:
- Laryngeal preservation is a key goal for advanced larynx and hypopharynx cancers.
- Induction chemotherapy followed by radiotherapy has been explored as an alternative to surgery.
Purpose of the Study:
- To review controlled trials evaluating laryngeal preservation strategies.
- To assess the efficacy and outcomes of induction chemotherapy regimens.
Main Methods:
- Analysis of three completed randomized controlled trials comparing induction chemotherapy plus radiotherapy with surgery plus radiotherapy.
- Inclusion of a meta-analysis of these trials.
Main Results:
- Induction chemotherapy is feasible, delaying distant metastases but not improving local/regional control or overall survival.
- Functional larynx preservation achieved in 67% at 3 years and 58% at 5 years.
- Insufficient data to determine subsite-specific outcomes.
Conclusions:
- Induction chemotherapy is a viable option for laryngeal preservation in advanced cancers.
- Further trials are needed to define chemotherapy's role and optimize treatment for improved local control and survival.
- Ongoing research addresses chemotherapy's contribution, the role of neck dissection, and combined treatment modalities.