KHWAJA ASIF AHMED, MD
K. THOMAS ROBBINS, MD; FRANK S. WONG, MD
P. KUMAR, MD; C. HANTCHETT

MEMPHIS, TENNESSEE

While surgery followed by postoperative irradiation remains the standard of care in advanced laryngeal cancer, chemoradiation is emerging as an attractive alternative. The response rates, survival outcome, organ preservation, and patterns of failure were analyzed for 49 consecutive patients who presented with advanced T3 or T4 laryngeal carcinoma between June 1993 and June 1996. The majority (30/49 or 61%) of the patients were treated on an organ preservation chemoradiation therapy protocol (acronym RADPLAT), while the remainder (19/49) underwent surgery and postoperative radiotherapy. Among the 30 patients undergoing RADPLAT therapy, there was a complete response in 27 of 30 (90%) patients and a partial response in 3 of 30(10%) patients at the primary site. In the chemoradiation group, there were 9 recurrences (2 local and 7 distant), whereas 2 patients recurred locally and 2 at distant sites among patients who underwent surgery. The larynx was preserved in 28 of 30(93%) chemoradiation patients and 3 of 19(16%) surgery patients. With a median follow-up interval of 3.1 years for RADPLAT patients, the 3-year Kaplan-Meier overall survival rate and disease-specific survival rate are 75% and 87%, respectively. In comparison, patients with surgery and postoperative radiotherapy had amedian follow-up of 0.9 years with an overall survival rate of 69% and a disease-specific survival rate of 78%. We conclude from this nonrandomized analysis that the use of chemoradiation therapy compares favorably to standard treatment.