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Concurrent Chemo/RT More Likely to Save Larynx

Concurrent Chemo/RT More Likely to Save Larynx

NEW ORLEANS—In stage III and low-volume stage IV laryngeal cancer,
concurrent chemotherapy and radiotherapy was superior to two other approaches
in controlling tumor and preserving the larynx, according to a three-arm
Intergroup trial presented at the 44th Annual Meeting of the American Society
for Therapeutic Radiology and Oncology (abstract plenary 4). Moshe H. Maor,
MD, of the Radiation Oncology Department, M.D. Anderson Cancer Center,
presented the results.

"Our findings demonstrate that concurrent chemotherapy and radiation
treatment is superior to chemotherapy followed by radiation and radiation
alone when attempting to preserve a patient’s larynx," Dr. Maor said. "We can
now offer patients an excellent therapy that can spare them from the lifelong
effects of a total laryngectomy."

The study, RTOG 91-11, included 547 patients (517 analyzed) with a new
diagnosis of a potentially resectable stage III or IV squamous carcinoma of
the glottic or supraglottic region; those with a T1 or a high-volume T4 tumor
were excluded from the study. Patients were randomly assigned to three
treatment arms:

n Arm 1 (control): Three cycles of induction cisplatin (Platinol) 100
mg/m2 once and fluorouracil 1,000 mg/m2/d for 5 days every 3 weeks.
Responding patients then received 70 Gy of radiation in 35 fractions for 49
days.

n Arm 2: Concurrent cisplatin 100mg/m2 on days 1, 22, and 43 of
radiotherapy with 70 Gy in 35 fractions for 49 days.

n Arm 3: Radiation only with 70 Gy in 35 fractions for 49 days.

Patients with a neck node 3 cm or greater or with multiple neck nodes
underwent a neck dissection 8 weeks after completion of therapy.

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