Long-Term Results of a Multicenter Randomized Phase III Trial of Induction Chemotherapy With Cisplatin, 5-fluorouracil, ± Docetaxel for Larynx Preservation

Abstract

Long-term follow-up confirms that induction chemotherapy with TPF increased larynx preservation and larynx dysfunction-free survival. In this larynx preservation approach using induction chemotherapy, TPF should be recommended, followed by radiation therapy.

A comparison of overall survival for patients with T4 larynx cancer treated with surgical versus organ‐preservation approaches: A National Cancer Data Base analysis

“…Moreover, IC regimens have evolved since the period between 1965 and 2000 covered by studies incorporated into the meta-analysis and by landmark laryngeal cancer trials. [21][22][23][24] Although not uniformly yielding an improvement in OS in their overall populations, these trials raise the possibility that the improved response rates from intensified IC may translate into an OS benefit in certain subgroups, including patients with T4 laryngeal SCC. NC received IC consisting of either singlet or doublet chemotherapy and various platinum-based regimens, 20 whereas the Radiation Therapy Oncology Group (RTOG) 91-11 trial used a platinum-based doublet regimen of IC.…”

“…As such, we were unable to determine from the NCDB whether patients in our ICRT cohort received chemotherapy both upfront in the induction setting and concurrently with RT (as in recent trials of multiple head and neck subsites including the larynx 10,11 ) or in the upfront setting alone followed by RT without concurrent chemotherapy (as in trials specific to laryngeal cancer 2,16,21 ). In addition, outcome measurements in the NCDB are limited to OS, because data regarding locoregional control, distant metastases, salvage therapy, cause of death, toxicity, and quality of life are unavailable.…”

“…16 In contrast, recent trials have demonstrated that the addition of docetaxel to platinum plus 5fluorouracil improved outcomes over the doublet regimens. [21][22][23][24] Although not uniformly yielding an improvement in OS in their overall populations, these trials raise the possibility that the improved response rates from intensified IC may translate into an OS benefit in certain subgroups, including patients with T4 laryngeal SCC. Although RTOG 91-11 excluded patients with large-volume T4 disease, thereby enrolling only patients with small-volume T4 disease who ultimately comprised 10% of the final population, this trial also offers some context in which the results of the current study may be interpreted.…”

Current Role of Total Laryngectomy in the Era of Organ Preservation

“…Responders to three cycles of induction CT (partial response + recovery of larynx mobility) received RT alone and non-responders underwent TL. The initial results presented in 2009 were updated in 2015 after a median follow-up of 8.75 years and showed a significantly higher response rate in the TPF arm compared to the PF arm (80% vs. 59%) [18,19]. The 5-and 10-year LP rates were 74.0% vs. 58.1% and 70.3% vs. 46.5% (p = 0.01) in the TPF vs. PF arm, respectively.…”

Downregulation of miRNA-26b inhibits cancer proliferation of laryngeal carcinoma through autophagy by targeting ULK2 and inactivation of the PTEN/AKT pathway

“…MicroRNA (miRNA), a type of non-coding RNA that consists of 22 nucleotides and was discovered in recent years, has an extensive gene expression regulation effect in vivo (4). miRNAs are closely correlated with the genesis and development of tumors, and they are attracting more and more attention in regards to the early diagnosis, metastasis monitoring, targeted therapy and prognosis of tumors (5).…”