Larynx preservation after initial non-cisplatin containing combination chemotherapy plus radiotherapy, as opposed to surgical intervention with or without radiotherapy in previously untreated advanced head and neck cancer: final analysis after 12 years follow-up

Price, L A; Shaw, H. J.; Hill, Bridget T.

doi:10.1017/s0022215100122662

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…This study and another randomized study (397) both suggest that neoadjuvant chemotherapy can reduce the need for mutilating surgery. Similar results (and improved survival) were observed in several phase I1 studies (398)(399)(400)(401). A subgroup analysis of the VA study found that patients with N2-3 who went into complete remission on induction chemotherapy had better survival (402).…”

Section: Chemotherapysupporting

confidence: 74%

Head and Neck Cancer

Möller

1996

Acta Oncologica

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This synthesis of the literature on radiotherapy for head and neck cancer is based on 424 scientific articles, including 3 meta-analyses, 38 randomized studies, 45 prospective studies, and 246 retrospective studies. These studies involve 79174 patients. The literature review shows that radiotherapy, either alone or in combination with surgery, plays an essential role in treating head and neck cancers. When tumors are localized, many tumor patients can be cured by radiotherapy alone and thereby maintain full organ function (1, 2). Current technical advancements in radiotherapy offer the potential for better local tumor control with lower morbidity (3). This, however, will require more sophisticated dose planning resources. To further improve treatment results for advanced tumors, other fractionation schedules, mainly hyperfractionation, should be introduced (5). This mainly increases the demands on staff resources for radiotherapy. The combination of radiotherapy and chemotherapy should be subjected to further controlled studies involving a sufficiently large number of patients (4, 5). Interstitial treatment (in the hands of experienced radiotherapists) yields good results for selected cancers. The method should be more generally accessible in Sweden. Intraoperative radiotherapy should be targeted for further study and development.

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Section: Chemotherapysupporting

confidence: 74%

Head and Neck Cancer

Möller

1996

Acta Oncologica

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“…Options to explore for this subgroup include non-platin chemotherapy (e.g. taxanes or fluorouracil) either as induction therapy prior to radiation (48) or concurrent with radiation (49). Most interesting for this subset would be biologic therapies, such as anti–epidermal growth factor receptor monoclonal antibodies or small-molecule Bcl-2 inhibitors, with radiation.…”

Section: Discussionmentioning

confidence: 99%

Bcl-2 Blocks Cisplatin-Induced Apoptosis and Predicts Poor Outcome Following Chemoradiation Treatment in Advanced Oropharyngeal Squamous Cell Carcinoma

Michaud

Nichols

Mroz

et al. 2009

Clinical Cancer Research

109

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Purpose:This study aimed to test the hypothesis that elevated expression of antiapoptotic Bcl-2 family proteins predicts a poor therapeutic response of oropharyngeal squamous cell carcinoma (OPSCC) to concurrent platinum-based chemoradiation therapy. Experimental Design: Levels of Bcl-2, Bcl-X L , and Bcl-w were determined and correlated with resistance to cisplatin in a large panel of cell lines derived from squamous cell carcinoma of the head and neck (HNSCC). Univariate and multivariate analyses were used to evaluate the relationship between Bcl-2 and Bcl-X L expression and disease-free survival following chemoradiation therapy in a uniformly treated cohort of patients with OPSCC. Results: In HNSCC cell lines, high endogenous Bcl-2 expression was associated with increased cisplatin resistance, and experimental overexpression of Bcl-2 promoted cisplatin resistance. In patients, tumors positive for Bcl-2 before treatment had greater risk of treatment failure (hazard ratio, 5.99; 95% confidence interval, 1.73^20.8; P = 0.0014). In contrast, endogenous Bcl-X L showed no correlation either with cisplatin sensitivity in the cell line panel in vitro, or with risk of recurrence in vivo (hazard ratio, 1.28; 95 % confidence interval, 0.39^4.19; P = 0.68). Associations between Bcl-2 expression and other clinical characteristics did not account for the predictive value of Bcl-2. Conclusions: Immunohistochemical assessment of Bcl-2 in pretreatment biopsy specimens can predict response of advanced OPSCC to concurrent platinum-based chemoradiation. As treatments targeting Bcl-2 and its family members become available, this immunohistochemical assessment could help personalize therapy by identifying a subpopulation of patients with a poor prognosis who might benefit from such treatments.

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“…Nonrandomized Studies. Many series [1][2][3][4][5][6][7][8][9][10] have assessed in a nonrandomized fashion the reliability of induction chemotherapybased protocols. Most often they were small series that sometimes mixed laryngeal, hypopharyngeal, and oropharyngeal tumors or tumors amenable to partial or radical surgery.…”

Section: Induction Chemotherapy-based Strategiesmentioning

confidence: 99%

Preservation of Form and Function during Management of Cancer of the Larynx and Hypopharynx

Lefèbvre

Lartigau

2003

World j. surg.

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The treatment of laryngeal and hypopharyngeal cancer has seen notable changes during the twentieth century. Intensive surgical research has allowed laryngologists to deal with almost any local extension and to propose an appropriate surgical procedure for each case. This surgery is able to control the disease in most patients locally but is limited in its indications (resectable diseases and operable patients). On the other hand, radiotherapy has been impressively improved (dosimetry, definition of target volume) and has become an indisputable alternative to surgery. The two approaches are comparable in terms of local control and functional results when dealing with early disease. For advanced disease, however, the debate is open between surgery, which is more efficient but mutilating, and radiotherapy, which can preserve the larynx in many instances even though it requires sometimes mutilating surgery for salvage. The appearance of platinum-based chemotherapy has updated this discussion. To date, most of the randomized comparisons of mutilating/nonmutilating approaches have been with induction chemotherapy followed by irradiation if there has been a good clinical response to the chemotherapy. There are other options as well that deserve evaluation (e.g., radiotherapy with altered fractionation or with concurrent chemotherapy), although surgery still seems to be indicated in certain cases. Finally, efforts should be made to select patients properly (based on tumor characteristics, clinical aspects, imaging, and biology) for the various strategies with the primary goal of curing the patient and secondarily to preserve laryngeal form and function when possible.

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Larynx preservation after initial non-cisplatin containing combination chemotherapy plus radiotherapy, as opposed to surgical intervention with or without radiotherapy in previously untreated advanced head and neck cancer: final analysis after 12 years follow-up

Cited by 13 publications

References 12 publications

Head and Neck Cancer

Head and Neck Cancer

Bcl-2 Blocks Cisplatin-Induced Apoptosis and Predicts Poor Outcome Following Chemoradiation Treatment in Advanced Oropharyngeal Squamous Cell Carcinoma

Preservation of Form and Function during Management of Cancer of the Larynx and Hypopharynx

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