Sequential and concurrent chemoradiotherapy produce similar survival rates for locally advanced laryngeal cancer, but the concurrent approach more often allows the larynx to be preserved, according to a 10-year study published in the Journal of Clinical Oncology (November 26, 2012).
Between 1992 and 2000, a team of U.S. researchers at multiple facilities randomly assigned 547 patients to three treatment groups: induction chemotherapy followed by radiation, concurrent chemoradiotherapy, and radiotherapy alone. All the patients had stage III or IV squamous cell cancer of the supraglottic or glottic larynx that was considered curable with laryngectomy and radiotherapy.
The induction group received up to three cycles of cisplatin 100 mg/m² on day one and fluorouracil 1,000 mg/m² per day for five days, every three weeks. Responders then received up to 70 Gy of radiotherapy in 35 treatments of 2 Gy fractions. Those in the concurrent chemoradiotherapy group received cisplatin 100mg/m² on days 1, 22, and 43 of radiation treatments. Those in the radiotherapy-only group received only 70 Gy of radiation.
Overall survival at both five and 10 years was not significantly different between any of the groups, ranging from 54% to 58% and 28% to 39%, respectively. The researchers also found no significant difference in the cumulative incidence of grade 3 to 5 toxicities among the groups. At 10 years, the rates were 30.6%, 33.3%, and 38% for induction chemotherapy followed by radiation, concurrent chemoradiotherapy, and radiotherapy alone, respectively.
However, in terms of larynx preservation, the researchers found a significant advantage for concurrent cisplatin and radiotherapy, with a 54% relative risk reduction for laryngectomy compared with radiotherapy alone (p < 0.001) and a 42% reduction compared with induction chemotherapy plus radiotherapy (p = 0.005).
