Role of concurrent chemoradiation in laryngeal preservation for supraglottic cancer.

Objective: The efficacy and toxicity of neoadjuvant chemotherapy followed by concurrent chemoradiotherapy or radiotherapy only and their impact on laryngeal preservation and survival were studied in patients with supraglottic cancer.

Methods: Forty-four patients with newly diagnosed supraglottic squamous cell carcinoma (stage II, III, IV) were treated with either two to three cycles of neoadjuvant chemotherapy with cisplatin 100 mg/m2 on day 1 and fluorouracil 800 to 1000 mg/m2 on days 1 to 5, followed by radiotherapy (NC + RT group, from March 1995 to December 1999; median 68.7 Gy, 1.8 to 2 Gy per fraction) or concurrent chemoradiotherapy (NC + CCRT group, from January 2000 to February 2003; radiotherapy concurrently with cisplatin 60 to 80 mg/m2 on day 1 and fluorouracil 600 to 800 mg/m2 on days 1 to 5). The median follow-up was 60.6 months.

Results: The overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) at 5 years were 52%, 66%, and 44%, respectively. Age, nodal stage, and tumour response after neoadjuvant chemotherapy were significant prognostic factors for OS and DSS (p < .05). The 5-year disease-specific survival rates with larynx preservation were 42% in the NC + RT group and 73% in the NC + CCRT group (p = .028). The complete response rate was 81.8% in the NC + RT group and 86.4% in the NC + CCRT group. There was no difference in OS and DFS between the two groups (p > .05).

Conclusions: Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy with cisplatin and fluorouracil was effective as primary therapy for supraglottic cancer with laryngeal preservation.