Department of Veterans Affairs Laryngeal Cancer Study: induction chemotherapy plus radiation versus surgery plus radiation
This landmark trial showed that advanced laryngeal cancer could be treated with chemotherapy followed by radiotherapy instead of total laryngectomy, with the same survival and preservation of the larynx in about two thirds of survivors.
Overview
Phase 3 trial of 332 patients with stage III to IV laryngeal squamous cell carcinoma randomised to induction cisplatin-fluorouracil followed by radiotherapy in responders (with surgery for non-responders or relapse) or total laryngectomy with postoperative radiotherapy.
Two-year survival was 68 percent in both arms and the larynx was preserved in 64 percent of surviving patients in the chemotherapy arm, with fewer distant metastases but more local recurrences.
- Two-year overall survival 68 percent in both arms.
- Larynx preserved in 64 percent of surviving patients treated with chemotherapy and radiotherapy.
Organ preservation became a legitimate goal in laryngeal cancer; RTOG 91-11 later refined the approach to concurrent chemoradiation.
- Predates concurrent chemoradiation and modern imaging.
- Salvage laryngectomy after radiotherapy carries higher complication rates.