Induction chemotherapy-based larynx preservation program for locally advanced hypopharyngeal cancer: oncologic and functional outcomes and prognostic factors

Abstract

To evaluate oncologic and functional outcomes and prognostic factors in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program in daily clinical practice. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngo-laryngectomy, treated by docetaxel (75 mg/m(2), day 1), cisplatin (75 mg/m(2), day 1) and 5-fluorouracil (750 mg/m(2)/day, day 1-5) (TPF)-ICT (2-3 cycles) for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Prognostic factors of oncologic (overall, cause-specific and recurrence-free survival: OS, SS and RFS) and functional (dysphagia outcome and severity scale, permanent enteral nutrition, larynx preservation) outcomes were assessed in univariate and multivariate analyses. A total of 53 patients (42 men and 11 women, mean age 58.6 ± 8.2 years) were included in this study. Grade 3-4 toxicities were experienced by 17 (32 %) patients during ICT. The rate of poor response (response <50 % without larynx remobilization) to ICT was 10 %. At 5 years, OS, SS and RFS rates were 56, 60 and 54 %, respectively. Four patients required definitive enteral nutrition (permanent enteral tube feeding). The rate of patients alive, disease-free and with a functional larynx at 2 years was 58 %. T4 tumor stage (p = 0.005) and response to ICT <50 % (p = 0.02) were independent prognostic factors of OS. Response to ICT was significantly associated with the risk of permanent enteral nutrition (p = 0.04) and larynx preservation (p = 0.01). In daily clinical practice, a TPF-ICT-based larynx preservation protocol can be used in patients with locally advanced hypopharyngeal cancer with satisfactory results in terms of tolerance, efficacy and oncologic and functional outcomes.

Surgery is not the only determinant of an outcome in patients with hypopharyngeal carcinoma

“…However, a concern is raised whether this approach leaves the patient with a functioning larynx . Bozec noted that those patients who responded to induction chemotherapy were more likely to require permanent enteral nutrition . Lim recorded a 3‐year progression‐free survival of 42% with concurrent CRT, worse than, with comparable treatment, at other head and neck sites .…”

“…However, it was “performance status” only that was predictive of improved overall survival . Bozec recorded a similar circumstance of better larynx preservation with induction chemotherapy of docetaxel, cisplatin, and 5‐fluorouracil . However, a concern is raised whether this approach leaves the patient with a functioning larynx .…”

“…28 Bozec noted that those patients who responded to induction chemotherapy were more likely to require permanent enteral nutrition. 32 Lim recorded a 3-year progression-free survival of 42% with concurrent CRT, worse than, with comparable treatment, at other head and neck sites. 33 This series had worse outcomes for those treated with chemotherapy; however, this was for a group who had many adverse features at presentation.…”

“…31 Bozec recorded a similar circumstance of better larynx preservation with induction chemotherapy of docetaxel, cisplatin, and 5-fluorouracil. 32 However, a concern is raised whether this approach leaves the patient with a functioning larynx. 28 Bozec noted that those patients who responded to induction chemotherapy were more likely to require permanent enteral nutrition.…”

Prognostic factors for survival and nonfunctional larynx in patients with squamous cell carcinoma of the larynx

“…Feeding tube dependence has a major impact on quality of life in head and neck patients, much more than tracheostomy dependence, according to the work of Terrell et al Reported rates of feeding tube dependence after head and neck radiotherapy vary between 3% and 53% . Wopken et al reported a 13% dependence at 6 months.…”