 |
|
Concomitant Chemoradiotherapy in Pyriform Sinus Carcinoma
Jean-Michel Prades, MD, PhD;
Thierry M. Schmitt, MD;
Andrei P. Timoshenko, MD;
Pierre-Gilles Simon, MD;
Joanne de Cornulier, MD;
Marc Durand, MD;
Aline Guillot, MD;
Christian Martin, MD
Arch Otolaryngol Head Neck Surg. 2002;128:384-388.
Objectives To test the effectiveness of concurrent chemoradiotherapy in patients
with pyriform sinus carcinoma and to demonstrate the feasibility of an organ
preservation approach.
Design Clinical trial phase 2.
Setting University Hospital Center, St-Etienne, France.
Patients The study population comprised 46 male patients with resectable stage
III and IV pyriform sinus carcinoma.
Methods Two successive chemoradiation regimens were investigated. In protocol
1 (24 patients), carboplatin was given on days 1 through 5 and 28 through
33, with an area under the curve dose of 5 mg/mL for 1 minute per day and
bifractionated radiotherapy (160 rad [1.6 Gy]/fraction) delivered on days
1 through 16 and 28 through 38. A treatment break was planned on days 16 through
27. In protocol 2 (22 patients), chemotherapy was given with the same dose
of carboplatin on days 1 and 21, and fluorouracil (750 mg/m2 per
day) on days 1 through 7 and 21 through 28. Radiotherapy with a single fraction
of 180 rad (1.8 Gy)/d was delivered during the first 2 weeks and then 150
rad (1.5 Gy) twice a day during the next 3 weeks.
Main Outcome Measures Patients were evaluated for tumor response, toxic reactions, and organ
preservation and survival rates. Statistical analysis of disease-free survival
and overall survival was performed using the Kaplan-Meier method.
Results A complete response was noted in 21 (88%) of the 24 patients following
protocol 1 and 16 (73%) of the 22 patients following protocol 2. After 2 years
of follow up, 16 patients (67%) (protocol 1) and 12 patients (55%) (protocol
2) retained their larynx without evidence of disease. During therapy, 15 patients
(63%) (protocol 1) and 19 patients (86%) (protocol 2) required unplanned hospitalization
for toxic effects. The overall survival and disease-free survival rates at
2 years were 58% (protocol 1) vs 53% (protocol 2) and 39% (protocol 1) vs
41% (protocol 2) (P = .80), respectively.
Conclusion Concomitant chemotherapy and bifractionated radiotherapy, although toxic,
leads to good locoregional control and therefore to a significant level of
laryngeal preservation.
From the Departments of Otolaryngology–Head and Neck Surgery
(Drs Prades, Timoshenko, Simon, Durand, and Martin), Radiation Oncology (Drs
Schmitt and de Cornulier), and Medical Oncology (Dr Guillot), Saint-Etienne
University Hospital Center, Bellevue Hospital, St-Etienne, France.
RELATED ARTICLE
Archives of Otolaryngology–Head & Neck Surgery Reader's Choice: Continuing Medical Education
Arch Otolaryngol Head Neck Surg. 2002;128(4):465-466.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Surgical Wound Complications After Intensive Chemoradiotherapy for Advanced Squamous Cell Carcinoma of the Head and Neck
Morgan et al.
Arch Otolaryngol Head Neck Surg 2007;133:10-14.
ABSTRACT
| FULL TEXT
Correct Carboplatin Dose?
Loughner
Arch Otolaryngol Head Neck Surg 2003;129:1351-1351.
FULL TEXT
|
