A novel organ preservation protocol for advanced carcinoma of the larynx and pharynx

K. Thomas Robbins*, James Fontanesi, Frank S.H. Wong, Daniel Vicario, Stephen Seagren, Parvesh Kumar, Robert Weisman, Phillip Pellitteri, J. Randal Thomas, Pamela Flick, Robert Palmer, Alva Weir, Charles Kerber, Thomas Murry, Robert Ferguson, Gerritt Los, Lisa Orloff, Stephen B. Howell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

78 Scopus citations

Abstract

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 x4) 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 x35) 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 I 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.

Original languageEnglish (US)
Pages (from-to)853-857
Number of pages5
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume122
Issue number8
DOIs
StatePublished - Aug 1996

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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