Abstract
Objectives: Total laryngectomy is still the standard treatment for locally advanced laryngeal cancer, particularly T4, although chemoradiotherapy has been developed for advanced head and neck cancers for organ preservation. At the Comprehensive Cancer Center of Kyoto University, both a head and neck surgeon and a radiation oncologist discuss the possibility of larynx preservation treatment even for locally advanced laryngeal cancers. The current preliminary study reports on the potential of larynx preservation treatment using induction chemotherapy for locally advanced laryngeal cancer.
Materials and Methods: The Comprehensive Cancer Center of Kyoto University was established in 2008, and 52 new cases with laryngeal cancer including seven cases with T3 or T4 cancer have been treated between 2008 and 2011. A retrospective chart review was performed to examine the efficacy of larynx preservation treatment in the T3/4 cases.
Results: Six cases were treated by larynx preservation regimen, while a supraglottic T4 case was treated by total laryngectomy because of comorbidity. Of the six cases, a glottis T3 case was treated with hyperfractionated radiotherapy, and the five other cases were treated by induction chemotherapy of TPF. Induction chemotherapy led to CR in one case and PR in three cases. Grade 5 toxicity occurred in one case. Chemoradiotherapy following induction chemotherapy was applied in two cases, while larynx preservation surgery was performed in two cases. All cases that completed larynx preservation treatment have demonstrated preservation of the larynx without recurrence during the follow-up period of 1 to 3 years (mean 2 years).
Conclusion: Although the number of patients and follow-up period are not sufficient, the current preliminary data suggest the possibility of larynx preservation treatment for locally advanced laryngeal cancers using induction chemotherapy followed by concurrent chemoradiotherapy (IMRT) or laryngeal preservation surgery.
