Platin-based exclusive chemotherapy for selected patients with squamous cell carcinoma of the larynx and pharynx
Holsinger FC et al. - In a study to determine the long-term outcomes of pts with squamous cell carcinoma of the larynx and pharynx who were treated with platin-based exclusive chemotherapy (EC) after they achieved a complete clinical response (CCR) to induction chemotherapy, it was reported that for selected pts, EC may provide long-term, durable disease control. For pts who developed recurrent disease after EC, this approach did not diminish survival and maintained function in the majority of pts. Methods- 142 who achieved a CCR after platin-based induction chemotherapy were treated exclusively with additional chemotherapy, and 98.6% were followed for a minimum of 3 yrs or until death.
- 35 pts had >10 yrs of follow-up.
Results- Survival rates at 1 yr and 5 yrs were 95.8% and 61.2%, respectively.
- The main causes of death were metachronous second primary tumors (n=27) and intercurrent disease (n=21).
- Death related to EC was not encountered, and only 2 pts (1.4%) had grade 4 toxicity.
- In multivariate analysis, primary tumor arising outside the glottic larynx and a Charlson comorbidity index >1 were associated with a statistically significant reduction in survival.
- 1-yr and 5-yr Kaplan-Meier local control estimates were 76.1% and 50.7%, respectively.
- Salvage treatment resulted in an observed final local control rate of 93% that varied from 97.2% in pts who had glottic cancer to 88.7% in pts who had tumor originating from other sites.
- Combined chemotherapy with cisplatin and 5-fluorouracil (PF) allowed for successful modulation of local therapy in 54.9% of pts.
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