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Laryngoscope. 2019 Jan 9. doi: 10.1002/lary.27771. [Epub ahead of print]

Optimal sequencing of chemoradiotherapy for locally advanced laryngeal cancer.

Author information

1
Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A.
2
Harvard Radiation Oncology Program, Boston, Massachusetts, U.S.A.
3
Division of Hematology Oncology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A.
4
Department of Otolaryngology, Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A.

Abstract

OBJECTIVE:

To determine the optimal sequencing of chemoradiotherapy for locally advanced laryngeal cancer. The hypothesis was that concurrent chemoradiotherapy (CCRT) would be associated with improved overall survival (OS) compared to induction chemotherapy followed by radiotherapy (RT)/surgery (IC).

METHODS:

The National Cancer Database identified 8,154 patients with American Joint Commission on Cancer stage III/IV (excluding T1) laryngeal cancer between 2004 and 2013 treated with one of the established organ preservation techniques: CCRT or IC. The association between OS and total radiation dose (< 66 gray [Gy] or ≥ 66 Gy) was analyzed using the Kaplan-Meier method, as was the association between OS and timing of IC (21-42, 43-100, or 101-120 days before RT). Hazard ratios (HR) adjusted for patient and clinical characteristics were computed using Cox regression modeling.

RESULTS:

The median follow-up was 32.7 months. The estimated 5-year OS for CCRT and IC was 49.9% and 50.6%, respectively (P = 0.653). On multivariate analysis, no difference was observed between the two regimens (IC, adjusted HR 0.96, 95% confidence interval [CI] 0.88-1.04, P = 0.268). Radiation dose ≥66 Gy had improved OS overall in CCRT group but not in IC patients. When comparing CCRT and IC in patients receiving ≥66 Gy, there was no difference in OS (adjusted HR 0.97, 95% CI 0.89-1.06, P = 0.552). Patients starting chemotherapy 21 to 42 or 101 to 120 days prior to RT had inferior OS compared to patients starting between 43 to 100 days.

CONCLUSION:

For locally advanced laryngeal cancer, there is no difference in OS between CCRT and IC. Factors associated with survival included radiation dose and timing of induction chemotherapy before RT.

LEVEL OF EVIDENCE:

3b Laryngoscope, 2019.

KEYWORDS:

Laryngeal cancer; locally advanced laryngeal cancer; organ preservation

PMID:
30628077
DOI:
10.1002/lary.27771

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