EORTC 24891: larynx preservation with induction chemotherapy in pyriform sinus (hypopharyngeal) cancer
In hypopharyngeal cancer that would otherwise require removal of the voice box, induction chemotherapy followed by radiotherapy in responders gave survival equal to immediate laryngectomy and let about half of survivors keep a functioning larynx.
Overview
Phase 3 trial of 202 patients with resectable pyriform sinus or aryepiglottic fold cancer randomised to immediate total laryngectomy with partial pharyngectomy and postoperative radiotherapy, or induction cisplatin-fluorouracil followed by radiotherapy in complete responders and surgery in the rest.
Median survival was 44 months with induction chemotherapy against 25 months with surgery (not significantly different, meeting the non-inferiority aim), and at three years 42 percent of surviving patients in the chemotherapy arm had a functional larynx; ten-year follow-up confirmed equivalence.
- Median overall survival 44 vs 25 months (not significant).
- Functional larynx preserved in 42 percent of survivors at three years.
Organ preservation is an accepted alternative to laryngectomy for hypopharyngeal cancer; concurrent chemoradiation has largely replaced sequential induction chemotherapy and radiotherapy.
- Small trial; survival in hypopharyngeal cancer remains poor with either approach.
- Sequential rather than concurrent chemoradiation.
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