Utility of bioselection with neoadjuvant chemotherapy for organ preservation in patients with T4 laryngeal cancer.

Induction selection Laryngeal squamous cell carcinoma Organ preservation Total laryngectomy

Journal

Oral oncology
ISSN: 1879-0593
Titre abrégé: Oral Oncol
Pays: England
ID NLM: 9709118

Informations de publication

Date de publication:
28 Jun 2024
Historique:
received: 30 10 2023
revised: 29 05 2024
accepted: 20 06 2024
medline: 1 7 2024
pubmed: 1 7 2024
entrez: 30 6 2024
Statut: aheadofprint

Résumé

Neoadjuvant chemotherapy for induction selection of definitive treatment (IS) protocols have shown excellent outcomes for organ preservation and survival in patients with T3 laryngeal squamous cell carcinoma (LSCC). We seek to evaluate survival and organ preservation outcomes in T4 LSCC patients treated with IS protocols. Retrospective cohort of advanced T3 and T4 LSCC patients who underwent IS protocols based upon potential for preserving a functional larynx. Patients received one neoadjuvant cycle of platinum-based chemotherapy with either 5-fluorouracil or docetaxel or with two cycles of platinum-based chemotherapy with docetaxel and a Bcl-2 inhibitor. Patients who achieved ≥ 50 % response as determined by radiographic review and/or endoscopic evaluation received definitive chemoradiation. Patients who had < 50 % response after IS underwent total laryngectomy (TL) followed by post-operative radiation +/- chemotherapy. Amongst T4 patients, 114 met inclusion criteria including 89 who underwent IS protocols and 25 who received an upfront TL. In total, 76.0 % of T3 patients and 71.9 % of T4 patients responded to IS and underwent definitive chemoradiation. There was no significant difference in hazard of death between T4 IS and T4 TL patients (HR: 0.9, p = 0.86). Among responders, there was no significant difference in 5-year laryngectomy-free survival (T3 - 59.6 %, T4 44.3 %, p = 0.15) or laryngeal preservation by T stage (T3 - 72.8 %, T4 - 73.0 %, p = 0.84). Select T4 patients may benefit from organ preservation using IS protocols with similar response rates to patients with T3 tumors, without compromising survival when compared to upfront TL.

Sections du résumé

BACKGROUND BACKGROUND
Neoadjuvant chemotherapy for induction selection of definitive treatment (IS) protocols have shown excellent outcomes for organ preservation and survival in patients with T3 laryngeal squamous cell carcinoma (LSCC). We seek to evaluate survival and organ preservation outcomes in T4 LSCC patients treated with IS protocols.
METHODS METHODS
Retrospective cohort of advanced T3 and T4 LSCC patients who underwent IS protocols based upon potential for preserving a functional larynx. Patients received one neoadjuvant cycle of platinum-based chemotherapy with either 5-fluorouracil or docetaxel or with two cycles of platinum-based chemotherapy with docetaxel and a Bcl-2 inhibitor. Patients who achieved ≥ 50 % response as determined by radiographic review and/or endoscopic evaluation received definitive chemoradiation. Patients who had < 50 % response after IS underwent total laryngectomy (TL) followed by post-operative radiation +/- chemotherapy.
RESULTS RESULTS
Amongst T4 patients, 114 met inclusion criteria including 89 who underwent IS protocols and 25 who received an upfront TL. In total, 76.0 % of T3 patients and 71.9 % of T4 patients responded to IS and underwent definitive chemoradiation. There was no significant difference in hazard of death between T4 IS and T4 TL patients (HR: 0.9, p = 0.86). Among responders, there was no significant difference in 5-year laryngectomy-free survival (T3 - 59.6 %, T4 44.3 %, p = 0.15) or laryngeal preservation by T stage (T3 - 72.8 %, T4 - 73.0 %, p = 0.84).
CONCLUSIONS CONCLUSIONS
Select T4 patients may benefit from organ preservation using IS protocols with similar response rates to patients with T3 tumors, without compromising survival when compared to upfront TL.

Identifiants

DOI: 10.1016/j.oraloncology.2024.106917 PMID: 38945011
pubmed: 38945011
pii: S1368-8375(24)00235-5
doi: 10.1016/j.oraloncology.2024.106917
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

106917

Informations de copyright

Copyright © 2024 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Auteurs

William J Benjamin (WJ)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.

Allen L Feng (AL)

Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.

Molly Heft Neal (M)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Emily Bellile (E)

Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.

Keith A Casper (KA)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Kelly M Malloy (KM)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Andrew J Rosko (AJ)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Chaz L Stucken (CL)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Mark E Prince (ME)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Michelle L Mierzwa (ML)

Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA; The Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.

Jeremy M G Taylor (JMG)

Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA; The Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.

Avraham Eisbruch (A)

Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.

Matthew E Spector (ME)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Gregory T Wolf (GT)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

Paul L Swiecicki (PL)

Department of Internal Medicine, Medical Oncology, University of Michigan, Ann Arbor, MI, USA; The Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.

Francis P Worden (FP)

Department of Internal Medicine, Medical Oncology, University of Michigan, Ann Arbor, MI, USA; The Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.

Steven B Chinn (SB)

Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA; The Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA. Electronic address: schinn@med.umich.edu.

Classifications MeSH