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August 1996

A Novel Organ Preservation Protocol for Advanced Carcinoma of the Larynx and Pharynx

Author Affiliations

From the Department of Otolaryngology—Head and Neck Surgery (Drs Robbins, Wong, and Murry), Department of Radiology (Drs Fontanesi, Kumar, Flick, Palmer, and Ferguson), and Division of Hematology-Oncology (Drs Thomas and Weir), University of Tennessee School of Medicine, Memphis; and Division of Otolaryngology—Head and Neck Surgery, Department of Surgery (Drs Weisman, Pellitteri, Los, and Orloff), Division of Hematology and Oncology, Department of Medicine (Drs Vicario and Howell), and Division of Radiation Oncology, Department of Radiology (Drs Seagren and Kerber), School of Medicine and the Cancer Center, University of California, San Diego.

Arch Otolaryngol Head Neck Surg. 1996;122(8):853-857. doi:10.1001/archotol.1996.01890200043010

Objective:  To pilot a targeted chemoradiation protocol for patients with advanced carcinoma of the larynx and pharynx that would circumvent upper aerodigestive tract dysfunction related to major oncologic surgery.

Design:  Weekly intra-arterial infusions of supradose cisplatin (150 mg/m2 per week ×4) rapidly delivered to the tumor bulk, simultaneous intravenous sodium thiosulfate for systemic drug neutralization, and conventional external-beam irradiation (1.80-2.00 Gy per fraction ×35) were used. Between February 1991 and April 1994, 42 patients were treated who would otherwise have required a major resection of the tongue base, pharyngeal wall, or larynx.

Main Outcome Measures:  Tumor response, toxic effects, disease control above the clavicle, preservation of the larynx, maintenance of oral nutrition, and overall and disease-related 2-year survival.

Results:  Three complications were related to the weekly transfemoral superselective intra-arterial procedures performed 160 times. Grade 3 to 4 chemotoxic effects were infrequent, occurring in 9 (5.5%) of 160 cycles, and only 1 patient required a radiotherapy break because of severe mucositis. A complete response in the primary site was obtained in 36 (86%) of 42 patients, 2 of whom had residual disease in the neck. Median follow-up was 13 months (range, 3-46 months). To date, there have been 5 recurrences: 2 regional and 3 distant. The 2-year overall and disease-related survival was 64% and 76%, respectively. The rate of disease control above the clavicle at 2 years was 86%.

Conclusions:  We believe this chemoradiation protocol represents an effective management scheme for patients with advanced head and neck cancer while minimizing dysfunction and possibly improving survival.Arch Otolaryngol Head Neck Surg. 1996;122:853-857

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